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0476 OLD CRAIGVILLE ROAD
G v 0�9 � oVNO- 952 9/3 SCR O 0 0 0 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a H~ Parcel 0 3 Application #( SUIL®ING �� �. Y Health Division � Date Issued Z-Z-'� � 1�►� Conservation Division 'JAN 30 2017 Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis 11 z Project Street Address o u Village C&44trylilt Owner U 6, + c�4, n n rr ti Address °� ►►1.e Telephone 0 $ 3qj; a I Permit Request PW 015 n.l1d 1 3 ce,%&j& —0 Ar, d*46. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3�o� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes J(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1,��I � r, Name U"�`I�WMcCt4kj e �`� P, �°�����► Telephone Number J�� 398 y 3 9 8 Address �O l%l S��A License# C d J ► 1 arM.olt4A Home Improvement Contractor# l J Email Worker's Compensation # W C D 8 5 510 3-0 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yoa m.o,0�► SIGNATURE DATE ` 3 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED }MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t4jf ... M� � !_ _•_-- '! 1 a,..a t 4t -1 1.�A R:O..�"';`� � +Ji t lax��S1 +F t 's 4- n � '�- y r... r_!E."' , ,� t � , ,�. -�.;_Tlie C'oriimonwealtli of Massachusetts:��,°�r•: ,;`.xx ,;�,,�`w:� { -I' +�'.",'F.^� }, "Department of industrial Accidents ' '+, ;'; �,; ~T'•1 - - ,.+. �,r, ir< + .. 't, i+,.;.y: • e i t r' ''4 �.ir fE•1c t r ,"= t 9{ t ,)r ,' 4 I'Con Tess Street,Suate.-100, , t ;�, -,..,• , �,�`:tii:'; f ";Boston,MA 02114=201.7.i: c .. - , ,y .r�y•r .tH S *• -� �a. -•'tc ,r.Q �,� + 44 {r? .Ftt,t� ,� •' ct y .•i: www massgovldia t o " NNorkers'Compensation Iiiiurance AffidiiAt:'Baderi/Contractor`s/Electricians/Plumbers. ' �-" TO BE.FILED WITH THE PERMITTING AUTHORITY.. � r Applicant Information Please Print Legibly t • Cape.Save Inc ,g TTaT11e;(Business/Organization/Indiyidual). , t .- , .,. f 4 � yJ•::1;„ r .r•`el 1 r _r..-. ,+t 1.(° .+'s' I Address:7-D Huntington Avenue+ City/State/Zip:South Yarmouth, MA<02664"s".1 ; phone#:508-398-0398 � — Are you an employeO Check the appropriate box' 1 , e Of ro'eet re un'ed Y�r + 1.❑✓ I am a employer wyth �15 �=employees(full and/or part-time)a u- 0 3?r+ 1,.S r 2 i 1 ~ 7 New construction _ .... f� > � '� k:a ti � { :El :ram "!.. r,r..`., *T f`: [ ..,E -7• ,• dr:� � 4 i 2.❑I am a sole.proprietoror partnership and bave no employees working for me rn } i � &6 a Remodeling ' 4 w:any capacity.[No workers'comp insurance requited) ' a' F a _; a 'r Lr = ' ti L 1 r a- 3'ir ' x ' r '►F x'�l Y,,,'.' :'9'�❑Demolition a,,. ) s";. V"5.;,.,• y ` t 3.a:I am a homeowner:doing all work myself.[No workers comp.,insurance required:]t d • ri i ry `. , ,10 Q Building addition ._�;>'l 401 am a homeowner and will be hiring contractors to:conduct all work oii my property. I will _ .. or ensure:that all contractors either have workers'coin ensation.insurance.or are sole 11.❑Electrical repairs additions + r .. p '' 12.❑Plumbin repairs or additions t proprieto{s with no employees. 1 5.❑I am a general contractor and I.have hired the sub-contractors listed on the ittached.sheet. 13.❑ROof repairs These sub-contractors have employees:and have workers'comp nc insurae: 1 / 14.E]Other Insulation.. ! 6.E]We are a corporation and its officers have exercised their right of exemption per-MGL;c. , 1 , - 152,§1(4),and we haee no employee§..[No workers'comp.insurance required:] t .*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 sheets showing the name of the sub-contractors and state whether or not those entities have 1 1 employees. If the sub-contractors have employees,ihey rnuit pro'vide.their workers'comp policy'number. --r 1 am an employer that:is providing workers'compensation insurance.for my employees Below is the policy and job.site Y 1 `iilfOrfnatiOn. .I , j yInsurance Company Name: Star Insurance Co Policy.#or Self-ins Lice#: 'We085540700~ M x=°•*� s Expiration Date 4l9/2017 I Job Site Address: 476 Old Craigville Road .y _ City/St4fe/Zipi Centerville Attach a copy of the workers'compensation pohcy�declaration page(showing the policy number and.;expiration date). Failure to secure coverage as required under MGL_c. 152,§25A is a criminal violation punishable by a fine up to$1,5.00.00 s t 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 t -day against the.violator.A co .of this.statemeiit maybe forwarded to the Office of investigations of the DIA for insurance. - 'Y �.• � PY coverage verification. a • yl° ir;. ,:c w�: - .:r- . a .�.. . s,�. „. { I do herebycertify.under th ;pains aadpenaldes of perjury that the information prov ded.above:is true and correct t ' l Signature. Date: 1 0/17 t Phone#: 508-398-0398 i Official use:only-"Do not write in this area,.to be completed by city or town orca t,,t w l� �.... .w.+u- "...,r.r......._- _.r..-n__ w+.w w.r�►..s.w�-_. �-�L�.....-+ .w�..-r,-.,r• .-- �.r. s.,......-e...wws M.r.- ..w r , City or Town,' t ��� > �{: . � � r,k �.t+�rsti Permit/License# t to .•, A. r ;. , Issuing Authority(circle one). 'i 11,-n tit, r '.z' °r•"`r` t } • :tea:'. ,, _ .t i s 1.Board of Health 2.Building Department,3.City/Town Clerk 4..Elect rical,Inspector 5 P..Wmbing Inspector r-, 6.Other tir,* ;; "..'.t 4• 1 at--1 l r. i +ix1 ,tri tis'r,l Contact Persons Phone#: ix:.'_►.°. :kit rr •t:i y r,i +i. , '. 1C; DA7E(MMIDWYYYY) Ac V CERTIFICATE OF LIABILITY INSURANCE `� r 10/24/2016 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to theiertns and conditions of the policy',certain poliew may require An endorsement: A"statement on this-certificate does-not confer-rights to the certificate holder In lieu of such endorsements. PRODUCER \ CONTACT NAME: Colleen Crowley Risk Strategies Company �• PHONE E (781)986-4400 WC No: (781)963-4420 MIC,15 Pacella E-MAIL Park Drive - r- - ESS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAIC>R Randolph MA 02368 / INSURER A:Liberty Mutual Insurance Co INSURED %f INSURER A11-merica Financial -Alliance -Ins Co .102-2 Cape Save, Inc INSURERC:Ohio Casualt /Peerless Insurance 24074 7 D Huntington Ave ) l! INSURERD:Star Insuraii0e Co INSURER E: South Yarmouth MA 02664 r 1 INSURER F COVERAGES CERTIFICATE NUMBER:C 6101422377 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED LOW HAVE BEEN ISSUED TO E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR C NDITION OF ANY CONTRACT R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED-OR MAY PERTAIN.,THE IIJSURANCE FFORDED BY THE POLIC DESCRIBED,HEREIN.IS,SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMB$SHOWN YHAVE BEEN REDUCED PAID CLAIMS. INSR TYPE OF INSURANCE / POLICY F POLICY EXP LIMITS LTR r POLICY N BER MMIDD MMIDD X COMMERCIAL GENERAL LIABILITY /t EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $ 100,000 /16/2016 10/16/2017 MED EXP(Any one person) $ 15,000 / PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: e p GENERAL AGGREGATE $ 2,000,000 X POLICY 0 P 0 LOC i PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: , $ COMBIN AUTOMOBILE LIABILITY Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL X SCHEDULED I'AUTOSAWBA46796600 11/6/2016 11/6/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY AM G $ X HIREDAUTOS X AUTOS B Per accident i $ X UMBRELLA LIAR X OCCUR ; EACH OCCURRENCE $ 2,000,000 C EXCESS CLAIMS-MADE s , )+ AGGREGATE $ 2,000,000 DED I X I RETENTION 10,000 9005724 990 10/ 6/2016 10/16/2017 $ WORKERS COMPENSATION, ir) OPPiC a included Poi '1!<(.I j'•X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N II AW PROPRIETORIPARTNER/EXECUTIVE ? Cave age E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? FN NIA D (Mandatory in NH) `,t 1SC4855407 4/9/ 16 `4/9/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 U yes,describe under ? /`` DESCRIPTION OF OPERATIONS below } E.L.DISEASE-POLICY LIMIT $ 500,000 fl � DESCRIPTION OF OPERATIONS I LOCATIONS 14EHICLES(ACORbi 107,Additional Remarks Schedule,maybe attached if m e space Is required) Evidence of.Insurance / Insulation/Specialists i S . ? J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact 460 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02061 Michael Christian/CLC `�' O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) : . Sim Tim SW790 st ?�� /t1•GEC G � II pe J is ears aim, e:�o fc Dam Office of Consumer Affairs and Business Regulatior 10 Park Plaza- Suite"5174 Boston;Massachusetts 02116>, Horne Irnprov ementContractar Reglstratlor Registration. 1.713 T Type: Corporation Expiration: 3/14/2018 Tr# 419291 CAPE SAVE INCpD WILLIAM .McCLUSKEY E 7-D HUNTINGTON AVENUE SOUTH=YARMOUTH, MA 02664 3 Update Address and return card.Mark reason for change. " } Q Address 011 Renewal � Employment ( i Lost Card. SCA 1 0. 20M-05111 [Jlte`a+Gaot,,tttnxtue�tllf a.Cl�la:rauc/%ccsell Office of consumer Affairs.Bc Busi es Regulation license or registrati valid,for individui use only. HOME 1MPROVEMENT'CONTRACTOR before the expi"ration date.;If found returator W, Registratron 1713g0 Types Office of consumer Affairs and Business Regulation Expiratwn 3/14/2018' Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 GAPE E.INC. Y L f WILLIAM MCCLUSKEY 7=0 HUNTINGTON AVENUE SOUTH YARMOUTH,MA'.02&64 Undersecretary Not valid i signature . Massachusetts -Department of`Public Safety Construction Supervisor Specialty !{ Restricted to: Hoard of ftiiding:Regulations and Standards CSSL-IC-Insulation Contractor Tww- r License: CSSL 1f)2776 01-11USZ5 WILLIAM J 1VICU 37 NAUSET ROAD M West Yarmouth MA s Jr 1Q"��� Expiration: Failure to possess a current edition of the Massachusetts _ _ State Building Code is cause for revocation of this license. Commissioner 0612WOU .DIPS Licensing information visit: WWW.MASS.GOV/DPS 4 a { I Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 3/24/17 Town of Barnstable Thomas Perry CBO C Building Commissioner A - ' Ln ,D 200 Main St. Hyannis,MA 02601 -} a, RE: Building Permit B-17-255 - TO: Building Inspector(s), This affidavit is to certify that all work completed for 476 Old Craigville Road in Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey THE T Town of Barnstable Regulatory Se y z saxxsrasze r.�.'4%w ARNSTABLE Mass Richard V. Scali, Director 1639. iOrFn +" Building Division ,°, _ t Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable,,Mg jg, E)WISION Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I, PV':3t V L , Construction Supervisor License # Q y0/Z , hereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit rII # ZO 13 0 7 3 7 7 , issued to (property address) CeYlt2ry� ��� on f b 2- 201 . I also certify that on 13 l , 201 , I notified the property owner, that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. ILr I 11 IZ LICENSE HOL R ATE q/forms/newcontr reference R-5 780 CMR rev:040414 Op THE A Town of Barnstable able Regulatory Services BARNSTABLE. Mass. g Richard V. Scali,Interim Director Fo39.+&�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601' Office: 508-862-4038 Fax: 508-790-6230 November 18, 2014 Patricia McKinney 476 Old Craigville Rd: Centerville, MA. 02632 RE: 476 Old Craigville Rd., Centerville Map: 247 Parcel: 032 Dear Property Owner: This letter shall serve as notice that this office has received notification from the construction supervisor for permit application number 201307377 that he has removed himself from the project. Per 780 CMR the project must cease until anew construction supervisor has assumed responsibility for the work: Please contact this office as soon as possible to submit the necessary documents. Failure to have a construction supervisor will result in a stop work order to be posted on the property. Please do not hesitate to contact this office with any questions. Respectfully, *L. Lauzon Local Inspector. jeffrey.lauzdn@town.bamstdble.ma.us . (508) 862- 4034 0 Town ®f Barnstable ocIME r Regulatory Services o Richard V. Scali,Director „ WSTABLE : Building Division BARNSTABLE M,ss $ 9� 039. 10 Thomas Perry,CBO 1639.2014 QED �a Building Commissioner 575 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 November 5, 2014 Paul Rufo PO BOX 648 West Hyannisport, MA. 02672 RE: 476 Old Craigville Rd., Centerville, Map: 247 Parcel: 032 Dear Mr, Rufo, This letter is to inquire on the status of building permit application number 201307377 issued to remodel the above referenced property. As you may recall, this office issued a building permit on or about October 31, 2013 and to date there is no record of a final building, plumbing or gas inspections. The last inspection appears to be a final electric . inspection on or about February 20, 2014. Please contact this.office immediately and arrange for inspection or provide an explanation. Thank you for your anticipated cooperation in this matter. Respectfully, WLuzon Local Inspector jeffrey.lauzon@town.barnstable.ma.us ` (508) 862-4034 a . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 -5 2— Application Health Division a Date Issued (b l Conservation Division Application Fee Planning Dept. _ ' Permit FeeCAL t w Date Definitive Plan Approved by Planning Board /p 3►�13 Historic - OKH _ Preservation/ Hyannis Project Street Address 'y 7 U`-A ao Village C.. 6Y)tCA,I/i J le Owner 47✓'►61I4 ML lam()rr n Q_t Address '/14 Old Gl'r9i ✓i//-e a"o Telephone 5 oW— T 7'5 - 2..1 SC® c,�.✓�f�rvi!/ ✓� C�2-�o3Z . a Permit Request N/ZLO 3qD Or AUb-Rion -to TeIJ�CtG-e exl�-h nq c.10 5r AHAeHe0 ®eG o F-Av I I P_f OYYl ( - Square feet: 1 st floor: existing IZ-proposed 350 2nd floor: existing proposed _Total new 310 Zoning District Flood Plain Groundwater Overlay Project Valuation _'31 a O 0 0 Construction Type 1N ZLAJ Lot Size + 1-7 Grandfathered: ❑Yes Ck/No If yes, attach supporting documentation. Dwelling Type: Single Family Y Two Family ❑ Multi-Family (# units) Age of Existing Structure MOO Historic House: ❑Yes U o On Old King's Highway: ❑Yes G(No Basement Type: All ❑ Crawl ❑Walkout ❑ Other N Basement Finished Area (sq.ft.) Basement Unfinished Areaa' 1q.ft) � v4 0 -^ Number of Baths: Full: existing new j— Half: existing 6 Uew Number of Bedrooms: 2. existing new m 01- r � � Total Room Count (not including baths): existing new First Floor Room Cot Heat Type and Fuel: ®'Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes SNo Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes [/No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �� --- Name Telephone Number Address Po eay)( License # G5—Qi9®(goZ 4MAVIl Daft- VVI A 0214,W), Home Improvement Contractor# 15!J Ai n o oome.'V, i 6DpAWorker's Compensation # WC-4 315-5'952w'a13 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G m DATE /0 /o 4, / /-3 FOR OFFICIAL USE ONLY APPLICATION# _ DATE ISSUED MAP PARCEL NO. h ADDRESS VILLAGE OWNER DATE OF INSPECTION: OkF -UNDATION?; - -iiiULO)`M)! I3 ,yes FRAME " 23 „.INSULATION: FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. PROJECT NAME: 1M ` 1M1T1 ADDRESS: PERMIT# � PERMIT DATE: 10 M/P; �� LARGE ROLLED PLANTS ARE M . x BOX 1 Z SLOT Data entered in 1VIAAPS prog am on: Z BY: s , t he Commonwealth of Massachusetts Department of Industrial Accidence . Office oflnvestigations ' +600 Washington Street Boston,MA 02111 wn'n:nrass govIdia Workers' Compensation Insurance Affidavit Builders/Co cturs/.ElectricianMumbers Applicant Information /� Tease Prmt Legibly Name(BusinesslOrgantraiit>at/Individn o: &vi, Paxf otbp' ILA d®-,l SLrt,.4 Address: 4 0", _ +City1State17-jp-W N 0& Z- Phone T7 -7 Z2-- 49�S-z� Are y an employer?Check the appropriate box: Type of project(required): 1. II am a employer with 4. ❑ I am a general contractor and I o 6- ❑New construction employees(full andfarpart-time)_* have hired the sub-contractors . 2_❑ I am a sole proprietor orpartner- listed on the attached sheet` 7. ❑Remodeling ship and hate no employees These sub-contractors have g_ ❑Demolition employees working forme in any capacitY-. and have workers' 9- ❑Bnildiag addition [No workers' comp.iumrrAwe COP. -I I xequired.] 5. ❑ We are a corporation and'its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their .1 I-E Plumbing repairs or additions myself,[No workers'camp- right of exemption per MGL 120 Roof repaus ed.insurance r 1 c-152,§1(4),and we have no] 13_0Other employees.[No`sestets comp-insurance required.], •Any appticaut that checks boot#1 mast also fill out the section below showing then workers'compeosatiou policy infntmation- Homeowners who submit this affidavit iudicstiug they are doing all troy}and then hire outside contactors must submit a new affiidnit indicating such_ tCont mcmrs that checlt this boa mast attached in additiwnal sheet showing the name or the sub-cmdractm and state uhethu ar not those entities blue employees. If the soh-contmaorsbwe employees,they must pmvide their workers'comp.policymnaber. lam an employer that isproviding it orkers'compensation insurance for my employees. Bdoty is the poUcy rind jab s&ff it formation. Insurance Company flame: Policy 4 or,seif-ins.Uc.#: WL Z^315-M�42-,0 f 3 Expiration Date: Job siteAw,ress: g71i Old Crr9J4yj//f. /LQ City/StaterZip:C•t?nt&kl& Md b2-G7t- Attacb a copy of the workers'compesrsation 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 aiminal 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 WORg ORDERand a fine of up to$250AO a day against the violator. Be advised that a copy of this statement may be fi warded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyy render the pains andpenal!'ies ofperjury that the it forraaflon pm ded above'is true and correct Signature: nd Date: /t', /G•�/ Phone# 77r�L`Z . 9/5"Z Ol al use ontt Igo not writs in this area,to be completed by city or tmm VOCLAL City or Town PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Buffding Department 3.CityfPown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 2 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ��. 10/9/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER O'BRIEN'S CENTERVILLE INS AGCY INC CONTACT NAME: 259 PINE STREET PHONE c o xt A/C No: CENTERVILLE, MA 02632 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual Fire Insurance 23035 INSURED INSURER B: PAUL RUFO DBA RUFO CONSTRUCTION COMPANY INSURERC: PO BOX 648 INSURER D: WEST HYANNISPORT MA 02672 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 17997302 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 ADDL SUER POLICY NUMBER MM DIDY/YYYY MMI DY EXP LT IYYYY LIMITS LTR _ _ _. GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence) $ CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 7 PROECj 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED 8 SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PeOr accidentDAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC2-31S-385298-013 3/7/2013 3/7/2014 WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR PAUL RUFO Workers compensation insurance coverage applies only to the workers com ensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PATTY MCKINNEY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ,+ 476 OLD CRAIGVILLE ROAD ACCORDANCE WITH THE POLICY PROVISIONS. CENTERVILLE MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD hRis certi9ficate ecancevls°anY1supersedes � t previously issued certificates. i �VE Town of Barnstable Regulatory Services r IX � Thomas F.Geiler,Director ° ; ►,� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 1 ie I&I)q, AG_ l"( flyN ,as Owner of the subject property hereby authorize JL' �� to act on my behalf, in all matters relative to work authorized by this building permit �7� �/o c�r9��vr//P �v Genf-ervilj� (Address of Job) -**Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final 'Inspections are performed and accepted. Signature of Owner Signature of Appli t P—a ��E��4e ����� �� Print Name Print Name v w / • Date Q:FORM&OWNERPERMISSIONPOOLS 62012 Town of Barnstable Regulatory Services Thomas F.Geiler,Director 6; •`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in'a two-year period shall not be considered a homeowner. Such"homeowner shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The 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\decoUUc\AppData\Local\Microsoft\Windows\Temponuy Internet Files\Content Oiidook\QRE6ZUBN\EXPRFSS.doe Revised 053012 Mz;ssachusetts-Department of Public Safet;' Board of Regulations and Standards C e o�trurt:irsn saapen 6or License:CS-094062 - � r PAUL A RUFQ- P O BOX 64&' �F RT MA-0261f2 WESTAYAJNISPO j i 1 Expiration commissioner 12/01/2013 MCC of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type: egistration: '154862 DBA Xpiration '4(1012015 RUFO CONSTRUCTION = PAUL"RUFO o 10 OLD TOWN ROAD HYANNIS 02601 Undersecretary t • -} fit . -„' '. a � •. . .. „ _' r REScheck Software Version 4.4.4 Compliance Certificate Project Title: Family Room Addition Energy Code: 20091ECC Location: Centerville(Barnstable),Massachusetts " Construction Type, Single Family Project Type: Addition Conditioned Floor Area: 0 ft2 Hearing Degree Days: 6137 Climate Zone: 5 Permit Date: Construction Site: Owner/Agent: Designer/Contractor. 476 Old Craigville Rd. Patricia Mddnney Rufo instruction Centerville,MA 02632 476 Old Craigville Rd. P.O.Box 648 Centerville,MA 02632 W.HyannisporL MA 02672 Compliance: 8:2%Better Than Code Maximum UA: 61 Your UA:56 The%Better cr Worse Than Cede Index reflects how dose to wmipliance the house Is Dried on code trade-off rules ' DOES NOT provide an estimate or energy use or cost relative to a minimum xxie hone. . Envelope,Assemblies Gross Cavity Cont. Glazing . or or Door- Perimeter U-Factor Ceiling 1:Flat Ceiling or Scissor Thus 256 38.0 0.0 a Ceiling 2:Cathedral Ceiling 168 30.0 0.0 6 Window 1:Vinyl Frame:Double Pane with Low-E 60 0.290 17 SHGC:0.00 Floor 1:All-Wood Joist(rruss:Over Outside Air 396 30.0 0.0 13 Compliance Statement The proposed building design described here_is consistent wit the building plans specifications,and other calculations submitted with the permit application.The proposed building has been designed t nee-1 the 2009 IECC requirements in REScheck Version 4.4.4 and to comply with the mandatory requirements listed in the REScheck Inspection C is Name-Title gnature Date Project Tille: Family Room Addition Report date: 09/30/13 } .n.%1"___rn..__ .r a• nn.r nn n..a_ —r. - n___ • _s �r y i f y f REScheck Software Version 4.4.4 Inspection Checklist Requirements: 0.0%were addressed directly in the REScheck software Text in the°Comments/Assumptione column is provided by the user in the REScheck Requirements screen.For each requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception is being claimed.Where compliance is itemized in a separate table,a reference to that table is provided. 2009 tECC Pre-Inspection/Plan Review Plans Verified Field VerifiedValue Yalue Complies?, Comments/Assumptions 103.2 Construction drawings and QComplies [PR1]' documentation demonstrate energy QDoes Not Comply , code com.Vepliance for the building ❑Not Observable envelope. []Not Applicable 103.2, Construction drawings and []Complies 403.7 documentation demonstrate energy ❑Does Not Comply [13113]' code compliance for lighting and QNot Observable mechanical systems.Systems serving []Not Applicable multiple dwelling units must demonstrate compliance with the commercial code. 403.6 Heating and cooling equipment is Heating: Heating: ❑Complies [pR2]2 sized per ACCA Manual S based on Btu/hr Btu/hr ❑Does Not Comply ; \; loads per ACCA Manual J or other Cooling: Cooling: ❑Not Observable approved methods. Btu/hr Btu/hr []Not Applicable Additional Comments/Assumptions: ` n 1 High Impact(Tier,1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) r Project Tide: Family Room Addition Report date: 09/30/13 —Al �_.`\i+�__ � •� AA�Mn__...y_..a'.\r'11^!+_L.�_IAlLI AAA n..�_ n___..._\. n___ n_� -i t 20091ECC Foundation Inspection Complies? 5. Comments/Assumptions. 3032.1 A protective covering is installed to 11Complies c„ , [FO11f protect exposed exterior insulation ODoes Not Comply: and extends a minimum of 6 in.below:[]Not Observable grade. Not Applicable 403.8 Snow-and ice-melting system f1Complies ' (FO12)z controls installed. (]Does Not Comply, s _ []Not Observable ❑Not Applicable Additional Comments/Assumptions: . - i Y f i a 1 « i ` 1 High Impact(Tier9) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) ., Project Title: Family Room Addition Report date: 09/30/13 n.u __�t ni.__ a• nn�ntn�_.._�_a_nr�_�__»a.tn�nn n..t_ n___s_mot. t r+--- n_a o < is 20091ECC Final inspection Provisions Plans Verified Field Verified ValueValue Complies? Comments/Assumptions 402.1.1, Ceiling insulation R value.Where>R- R R []Complies See the Envetnne nssembnes table for 402.2.1, 30 is required,R-30 can be used if El Wood El Wood ❑Does Not Comply values 4022.2 insulation is not compressed at eaves ; Steel Steel []Not Observable [F1i]1 ;R-30 may be used for 5001N or 20% ❑Not Applicable (whichever is less)where sufficient space is not available. 303.1.1.1. :Ceiling insulation installed per ❑Compfies 303.2 manufacturer's instructions.Blown ❑Does Not Comply [F12]1 insulation marked every 300 itz. ❑Not Observable F i :QNotApplicable 402.2.3 Attic access hatch and door insulation R R- []Complies [FI3]1 R-value of the adjacent assembly. ❑Does Not Comply " []Not Observable ❑Not Applicable 402.4.2. Building envelope tightness verified _ ACH 50= ACH 50= ❑Complies 402.4.2.1 by blower door test result of<7 ACH ❑Does Not Comply [FI17]1 at 50 Pa.This requirement may []Not Observable instead be met via visual inspection, []Not Applicable in which case verification may need to occur during Insulation Inspection. 402A.3 Wood-burning fireplaces have ❑Complies [F18f gasketed doors and outdoor ❑Does Not Comply combustion air. ❑Not Obsavahle []Not Applicable 40322 Post construction dud tightness test elm cfm ❑Complies [FI411 result of 8 elm to outdoors,or 12 cm ❑Does Not Comply across systems.Or,rough-in test []Not Observable result of 6 cfm across system or 4 Not Applicable cirri without air handler.Rough4n test ❑ verification may need to occur during Framing Inspection 403.1.1 Programmable thermostats installed ❑Complies [FI9]2 on forced air furnaces. ❑Does Not Comply []Not Observable z ❑Not Applicable 403.1.2 Heat pump thermostat installed on ❑Complies [FI10]z heat pumps ❑Does Not Comply ❑Not Observable QNot Applicable ° 403A Circulating service hot water systems ❑Complies [FI11)z have automatic or accessible manual ❑Does Not Comply controls. Q Ob Not servable A, . ' ❑Not Applicable 403.9.1 Readily accessible switch on heaters : :❑Complies [FI12]3 for swimming pools. []Does Not Comply }y, []Not Observable QNot AppUcable R 403.9.2 Timer switches on pool heaters and ❑Complies [F119p pumps are present. .:-..[]Does Not Comply QNot Observable []Not Applicable 4039.3 Heated swimming pools have a cover. ❑Complies [F12013 Covers on pools heated over 90 OF []Does Not Comply are insulated to R-12 []Not Observable []Not Applicable 404.1 50%of lamps in permanent fixtures ❑Complies [Fl6p are high efficacy lamps. - : []Does Not Comply []Not Observable Nof Applicable i e NO I:. 1 High impact pact(Ter 1) 2 Medium Impact(Tier 2) 3 Low Impact(tier 3) , x' Project Title: Family Roan Addition Report date: 09/30/13. 1'1�i-GI-�-�-. /+.\//--�\/�L�- • •• .fA•A\f���..�.-..a-117I-1�-L--1.\L•A•.tA A.d-/�-.�-s..-1. �-�-C-�. 7 2009 IECC Insulation 1 Plans Verified Field Verified nspectr°n Value Value Complies? Comments/Assumptions 303.1 All installed insulation is labeled or the Complies [IN13)z installed R-values provided. ❑Does Not Comply []Not Observable ❑Not Applicable 402.1.1, Floor insulation R-value. R R- ❑Complies See the E table for 402.2.5, ❑ Wood ❑ Wood ❑Does Not Comply values 4022.E Sted Stect , ❑Not Observable [IN1j' ❑Not Applicable 3032, Floor insulation installed per ❑Complies 402.2.6 manufacturer's instructions,and in ❑Does Not Comply [IN2]' substantial contact with the underside ❑Not Observable of the subfloor. ❑Not Applicable 402ZI l Sunroom wall insulation has a R- R- ❑Complies ' [IN8]' minimum R-value of R-13.New walls ❑Does Not Comply r . separating the sunroom from ❑Not Observable. conditioned space must meet code ❑Not Applicable requirements. 303.2 Sunroom wall insulation installed per ` ❑Complies [IN9]' manufacturers Instructions. ❑Does Not Comply x: ❑Not Observable []Not Applicable 402.2.11 Sunroom ceiling minimum insulation R R- ❑Complies [IN10]' R-value of R-19 in Climate Zones 1-4. ❑Does Not Comply and R-24 in Climate Zones 5-8 ❑Not Observable []Not Applicable 303.2 Sunroom ceiling insulation is installed .❑Complies [IN11J' per manufacturer's instructions. ❑Does Not Comply []Not Observable r ❑Not Applicable Additional Comments/Assurriptions: - 1 High impact(Tiat'1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) _ 'Project Title: Family Room Additibn r Rape date: 09/30/13 • AA nAlAtn-_..�.-�a_1nrQ��4_-IA414^4 ^n:.s_ 44 1. 4 2009 IECC Framing/ hdmin O° s Plans Verified Field Verified: Rou 9 Value Value Complies? Comments/Assumptions 402.1.1. Glazing U- ctor(area-weighted U- U- ❑Compfi�§ see the Envebpe Assemblies table for 402.3.1, 'average). ; []Does Not-Comply values. 402.3.3, " []Not Observable 4025 []Not Applicable [FR2]1 303.1.3 U factors of fenestration products are ❑Complies [FR4]' ;determined in accordance with the []Does Not Comply NFRC test procedure or taken from QNat Observable the default table. []Not Applicable 402.3.5 Suntooms enclosing conditioned Ll- U- ❑Complies [FR81' space have a maximum fenestration ODoes Not Comply u-factor of 0.50 in Climate Zones 4-8. QNot Observable New glazing separating the sunroom from conditioned space must meet ❑Not Applicable code requirements. 402.3.5 Suntooms enclosing conditioned U- ll- []Complies [FR91' space have a maximum skylight U- ❑Does Not Comply factor of 0.75 in Climate Zones 4-8. []Not Observable ❑Not Applicable 402A.4 Fenestration that is not site built is ❑Complies [FR20j' listed and labeled as meeting ` []Does Not Comply AAMAIWDMA/CSA 101A.S.2/A440 or QNot Observable has infiltration rates per NFRC 400 []Not Applicable that do not exceed code limits. 402A.5 IC-rated recessed lighting fixtures ❑Complies { [FR16jz sealed at housingfinterior finish and p., QDoes Not Comply of labeled to indicate 2.0 dm leakage at ❑Not Observable 75 Pa. QNot Applicable 403.2.1 Supply ducts in attics are insulated to R- R- ❑Complies [FR121' R-8.All other duds in unconditioned R- R_ ❑Does Not Comply spaces or outside the building ❑Not Observable envelope are insulated to R-6. []Not Applicable , 403.22 All joints and seams of air duds,air ❑Complies [FR13[' handlers,fiker boxes,and budding .❑Does Not Comply cavities used as return duds are ❑Not Observable sealed. []Not Applicable 4032.3 Budding cavities are not used for ❑Complies [FR15p supply duds. ❑Does Not Comply t , ❑Noi Observable QNot Applicable 403:3 HVAC piping conveying fluids above R R- ❑Complies [FRI* 105 OF or chilled fluids below 55 OF - ❑Does Not Comply are insulated to R-3. - []Not Observable gip• []Not Applicable 403A Circulating service hot water pipes are -R- R ❑Commies [FR1812 insulated to R-2 ❑Does Not Comply _,. []Not Observable ❑Not Applicable 403.5 Automate or gravity dampers are []Complies [FR19jz installed on all outdoor air intakes and ❑Does Not Comply exhausts. []Not Observable []Not Applicable Additional Comments/Assumptions: ' 1 High Impact(Tier 1) - 2 Medium Impact(Fier 2) 13 JLow Impact(Tier 3) , Project Title: Family Room Addition Report date: 09/30/13 n_•_ll��- -. h.0 1__�1/"L�- A A AnAAnln__.._.-.•-lnf"A_6--IALAnA^�n..t_n___s��. n--- A -L Plans Verified Field Verified 20W IECC Final Inspection Provisions Value Value Complies? Commerrts/Assumptions 401.3 Compliance certificate posted. OComplies [F17)2 ❑Does Not Comply []Not Observable -._ONot Applicable 303.3 `Manufacturer manuals for mechanical ❑Complies [F118)3 and water heating equipment have ❑Does Not Comply been provided. ONot Observable []Not Applicable Additional Comments/Assumptions: 's 1 High impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(tier 3) Project Title: Family Room Addition Report date: 09/30/13 n_a_ra..._�_. /a.0 P__L\��.__ -• •1'M�Mn__..��_a_!nr'A�6�_IAil1 A•AA n.s_ n__�a�. P n___v_s - 20091ECC Energy Efficiency certificate z Wall 0.00 ' Floor 30.00 Ceiling/Roof 38.00 Ductwork(unconditioned spaces): Glass &Door Rating r Window 0.29 Door 0.30 Heating Coot quipment Efficiency , Heating System: Coding System Water Heater. Name: Date: Comments: • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Parcel O.j p Permit# ���� ,Health Division Date Issued 'Zl� l/ey Conservation Division Fee Treasurer Planning Dept. • 4 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 'y7� !/�/ +�s'l-/�icr i/i%/-e� Village Owner 7�� 7 /`9 C K-� •%e Address - 7lo Q/z Cri4i v;/,)e R alq-.l Telephone _ �$' 7 .S"a Permit Request _ doj!� - 57 e—t Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost SOD.0 D Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ONo On Old King's Highway: ❑Yes 31 Basement Type: Dull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ilJ o 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: C�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 Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number i Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /,r/ 7—F 14 i9•n/ , SIGNATURE DATE FOR OFFICIAL USE ONLY , PERMIT NO. DATE ISSUED f Y MAP/PARCEL NO. J ADDRESS ' VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL f ` FINAL BUILDING _ st t DATE CLOSED OUT f ASSOCIATION PLAN NO. , 0 l t Ay ,V _ The Commonwealth of Massachusetts Department of Industrial Accidents -_ = 0/I/ceol/aresti�atioos �� - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit r� VA VA M WA Wlllllllllllllll,,:, name: LA4&JC1AJ"eiz d location C rfti U U�J/ �tB/9.t� e— hone# I am a homeowner performing all work myself ❑ I am a sole etor and have no one rkin capacity ❑ I am an employer Providing worloers'compensation for my employees working on this job.::: . :..:::::::::: ; >> ii'iz ?;` ;? 11 ; iit> <'_;>}:: _;;; ;;:;?<:i: �zE�< iii<`:i<:::Ei ?::!?!> comaanir ........... stdress. .... .. ... : : , :.::::.::.:..::.:.....................:::::::.:::.:::::::::.::.::::..::...:..............:.......:.:::::::::.:::.:.::: d :?...................::.............:..:::.:.:...::.:::.: ::::.:........... 1 ❑ I am a sole proprietor,general contractor,or omeowne (circle one)and have hired the contractors--listed below who have thefollowing vrorkers' compensation polices:.........:......:............:.:......... ......................................:.;................,.:............................................:.,................ ::.::..............................,........:. ::.:.:::::.:...........:::::::}} ..: 00. .......... :.................................. r�:k:�iiiiiii:ii::i:•iiii>::I:ii iiiiiii:{:::ii'�iiiiiiiijj?{<:rviiitj;:ijri{$ii�::}i<iG:S r::i:':•: ..........n.........i...:...... r.... :` .,n......................................:..:.:.. r.................................. ...................r.........r:::::....:: C' ...n......,.......................... ....-........\::.�-::::................................�:.,,v,?......r.,.::::rr:n-:r.�:.�::::-•::.-.w:::::::.�:::._::::.�.�:.�.�:::{::•:N%{:':•:iiti�}?:J}:-}:-:�.:• ... ......... ......r.v:h•.v::::Rx•.., .v.vx.:.....v.......r...r?...:.:.•:v::::v.�::::::!^:•?}:::..w:::v.....v.. ................v...... ...... ......{tv ..v v:w::::............-.i.................................. ...r..{..........:_...... :A••F..:::;n n.:i....•r...........rxvti:•r v�i....... ...:...::w::::.;.... ...wf•n�nvN}i.O.viS4iT::�:ii}}i M. :';;•': :•�:f}:��<t `?'`:�:��r:�:�:::%'r :�:�'r':��%�':� ��:�:>::�'r':=��:��:'3>::WAM ..:...i.:.S: .S:.::}�%%':�':::;:;i ::�::�:y:�:�:� :.'•{:�{:;rr�:;':•'::5::: i:::>:i::::::>:;::::::5:::;:::;:i::::'::::i:::;:;:;;::;:::} r:::::::ii::::?::: y{: ::: :' :{:%:�i:%::+{: :y ::;2::;;.;y:::::::'y: :::: ::` ::%:::::%% r ::_;;:3:2::2::: L"OnID � .w ............r...... 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Oki .�....,.. ,:,.: Fame to seeme coverage sa required order Section 25A of MGL 152 can lead to the impealttam of erhuiod penaWes of a Sue to 51,500.00 and/or one years'imprisa�eat as weII dv8 penalties is the form of a STOP WORK ORDER sad a Sue of 5100.00 a day against me. I understand.that a copy of thb atat®mt mry be forwarded to the Ocoee of Investigations of Sic DIA for coverage vetiScation. , I do hereby certify under the pains and pmaba of perjury dim the information provided above is& :and coned Sigaatare Date Sri 0211�/ Print name C, I Z Phone# &lJ 1,nlo 9 oiacial use only do not write in this area to be completed by city or town oiHcid city or town: permit/licease# QBuihiing Department f QLicensing Board Q ebeck f ire response is required QSekvbnen's Office _ QHealth Department Contact PMM phome q; QOther ------------ OM"d 9/93 PLV I . I a.1 • •11 . 1 ti q•11• • • . • . - • •II11�11 .1■ •II • • - �IUI• . . • �• . •111 11 1 . t/ r . 111�• / - . 1 11 1 - :1 . 1 . 1�I 1 .� 1 •1.1• • t Y• w • 1111• .I • . 1 :11 1 / / . • - •11 �I 1 10 sit us I mt llli / • •M ■ •I/ • •• .1■ • 1 • • 1 �•'Y• :111• • .11 • • II• • 1 • • • 11 • �I I • _�• l o • /1 �111 �i • •11• 11 t 11 • 1 •Y• - • �111 Y.1■ • o i•: �• �111 U • • /1 - • • • 1 11 • II • r1 �1 ell• •M .1. •11 • • 1�1 - r illl■1 :1111• • 1 • i1n1• • • • � 1 - • • 1 a • t • 1 • 1 • 1 11 • 1 • 11 • 11 •e1 1 � I •11�111A ,11 / 1 • :rCl t w, 11�1 11 • 11 11• /1 • • - / • 11� 1 • • I • I'61 1 • .1/1I•)(411J4•..1 Ilt *I. • II I11 al 1 V" •11 • 1 Mt •II •) • • ■. •11 I I o • II • 1 • • •1• II J • II• • • • • 1 I 1 • 4 3 Mr.�-111 �• I• / 1 :1111• • :1 16 ./ • I11 • Y.11:.� 11 .1 [ /' I 1 1 1 1 I7ji too 1 1 1 / oil 1 11 .1 1 v 1 1 :+.. 1 1 1 1 / I r 1 • 1 �: 1 1 1 1 1 1 1 1 1 1 1 1 ' : 1 • 1 1 1 1 1■ •11 • I •11lltl •il "�= 111 1 II .11 •) IA • • 1• ✓ 1 111 r •11 '11 I �+IU-1 111 • .11 •I11■ 1• 11 - •:1 • 11 •11 - • • • • • •. 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I r Y. 11 ' .II.a Y•�IIII�t1.wII •II I • r 1 'y ."� i /1 1 I . 111 �11 .1 11 /lltll I�l 1�. • • ' j�jj�j���jj/j��// all 1 1 1 • ' I 11 11 .1 1•1� It . ` 1 VII1111 �1 .11 • . rJ1111�1 �.'1 Is rl 1 • 11/ III IN 1 LA 1 I Ili to I&I sr. 114 1161 I 0111 • / II • 1 1.1y ` • I "'I • 11 11 •1 �•11 11 II V • 1 `�•. 1 Y1. •II 1 V OW A. II •11 « •• 1 �T.r .17,77111 • • IM:111 • 11 1• ~1 11 11 •�1I 1111 •'�•1 111111 I .i • I 1 I I 1 �1 •ill MI 111111 I�1 1 ■I I IA 11 • I11.1 �• 11 1 • I/1�111 1 • 11 •I 111 • 11 -1 .II •11 • :n1/w•IIA 1 . •��.1 IIY. 1 1 � It Y" • 1 .••. • •Y.1/ •II •• . • II .11 • 11 • ` .11 V • I 1 V•• I�1 .1• •II 1 1 1 • • • 1 .11 • w ■ •/ /j��jj�j��j11,0", . 7A r" • 1 •II •U I Y•►' /1 111 I�/ 11 11 11 1 1 1 � 1 A' ' I , •11 I I 1 1 o 1 ' 1 of 1 1 I 1 1 . 1 �tae r The Town of Barnstable MAM• B�sxsresie. • �m� Department of Health.Safety and Environmental Services �,,ot► 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. Type of Work: -Z-?D n u" Estimated Cost 0/ Address of Work: z/'7'� rAi�! �/i// c� CC�.✓7'-�f'////�P " Owner's Name: PST i il-3- /Ll lr i,-'AJ-e Date of Application: v f) 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 QjOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME BeROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR a ate Owner's Name q:forms:Affidav Building Division E►stvsrAt.a- ' 367 Main Street,Hyannis MA 02601 trsAss 9 059. ,0 Office: 508-862-4038 Ralph Crosser Fax: 508-790-6230 Buildinz Cumm:s. HOMEOWNER LICENSE EXEMPTION Please Print DATE:, a o"Ldcf JOB LOCATION: 10 Old C V// � -1 number street village "HOMEOWNER": T-/�L�/14 /AI r,,_1.1e SJIoF S .21 � SGr 9' �-dy tf_3 S name Ame phone# work phone# CURRENT MAILING ADDRESS: eaty/towa state up 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,2rovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner'certifies that helshe understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION . The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors).provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors.Section 2.15) This lack of awareness often results in serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the , unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. , To ensure that the homeowner is fully aware of his/her responsibilities.many communities require.as pan of the perrtut 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 to amend and adopt such a form/certification for use in your community. Q:FORM S:EXE?11 PTN g , t 1 n7 €J a g Z v 6+ O Z a 7 0 o "vmoon3D I i , 7 �- I O"m x.4 O hon,+b /p1 of a+s=4 LL O N } - ti !. I d 'bi+F + loin fov+nq 6`O } 'f andh I sans GL^GG Galum b .¢ ,� ll Film aMuxm.H 4+ie.. prone 1 - L )C 2 XB P.T.Jsis s ICo"Ob. i W ! 1 1/2" ' Attach 2x0 I¢dq F('- x 4 I!2" I- -� Thru-boltsa IB- !( Z �i�mpsa o 2•t"(axm LU 2!0® 1!o"o.L. roimpsons NOU 2-si0�2.5 h ai'mpssns Hou 2--Oh 2.°i s LUy2 e-2 1 N d,`` FI brq a 4 0 I Z"p 4`O tUb /�qf (L O .;nd himpssns N p fl y7i OTE All —1 hwrwwr¢+o be-4-1 P for cxter or wxpowra and PT con+ac+ -� �' 2 z 1 O-lsi.•ts = 10 < s Und¢r Add.+ian/Dick W F ®� rolmpsons HOU 2-w V• 2.5 s�impsonm., I 2 B o el-2 I I I .fN. 6-)it Z W L 3.moo -} ns HOU2-siOh 2.5 I r__ _•____:__-- - _-_n I _ _ U Attach 2 x 1 O.Icdq¢r w/1/2"X 4" p I I. e I -75 o ew�iTWG FouN IoN r I o Q p 1 I I p. w m 6,N:,,.I .. I � IL- � L (� ,f h• e;ihTWG F�-AMINI i - i i __ dems;-- �,. IL J o 0 1 L�' "'-�� � -I - I �� Y p 4 GO•sJsna+ub �pfss+m 2 4 � � Q I C�'^y � I � J p U d ra+c FslUmn t t'q w/9-•9 � n' � I 1 zr++cwl rcbar I.5"mm-% ma mbadm¢n+ �_ �•' >E• I I iN I and 66folo cclumin bw'a. CO 'A++ach 2x 1 0I.d6a1 w�1/2 1 ' FO'NI7ATICJN FLAN o 0 A 0 AA PIF, FLOOR-FF-A1'iE u /'�'1 ►"-y NOTe:All expos¢d hwrwNr¢to be rested ` Y _N Q _ e.. Cv for axtcnar¢xps•.Ure rood F.T.can+act I .o m m m mp pOt 1-6 � • OvH.a�mu S a,.a'd D m d i D%.\C`OF AWUSA 2� DAN IEL cy � P. j c0i CRTE C IL o NO.46253 � DRAriI1,[6 TYPE: �wc` FG/$TES \� FOUndA,11On plwn �ssIO N AL��G Firs h Floor Frame SHEET NUMBER: ` A 1 0 0 LL ti- su £ . m � k 0 m °E° Ma+GN& '(.-cof brnG n4 O 4 O _ U f p nalconn G+ 7 N +q ✓u E� o ll rm'mpaon N 2.5 hurr'GNna �` ° -� .mil i l y _ y }I I _ JL f Imi. exist 4f mrn4 wl7 I/2 1/4' -I- IL I vl N � O� y'7, I m won c h aGYora a I v' Ki Q� + m 1 E 1 eXIhTING F�.AMING 1 ¢ yy � I eXi>7TLA WG F�-AMING � q 6 'Y, 1 LI -- it i i� it 2 1 x I C V _ 4 k Woa d + + lb + fl G. 1 I 1 k. _ \ Vila-PH 2 4 4'-4 7:/8" it L NEW FAMILY F-OdMI - - V;conm C'I{2 4�4 2 2(widc.-mulll- �y N m a n 1031 1 (fl—h fr °� e ame d+o Ge Ilny 1 ;. iu / Z i k --_- --------- C+ tn- t -- -o - a' W v LL K $o U In I. i ! I �° --------- ------------- A Flesh r FL©off P�-RAN Addj+ian.A.rech-,k e f I:./W 1" 1.7 2 rh a PI< w d e ad danGa wire 3°E°E z e 0 ' rham+ern + tt= 'd r IG�da 200� � od 0 � �d r�on and+Ie rl „chuwa++a 7 00 GMT-' o U1 u a+ 5I Oo akh > > c FI _ wlndaw - ' +ion df nl,en nqs. f W II Y b rcmavad DRAWING TYPE: u wood First FI¢or Plan I + f9 —v. �GA�-O9 F-oof Frame Plan God.,ko it Id sack No+a: SHEET NUMBER: yr° - } All Maw an+s 1 rJimansion re+o be sitc var f'ad b ra1Gan+rwG+ur i Y' r rm x�c a+r I'' I t 1 W o s�g�£gWmio • W v aIO= nh'�co=u ti 1 d I � F ' I l f � I ( ti l I L O tt w i l 3 a Gen+lnuoua ridge ven} C 0 ! 2 x a Gollar ties I'In"o.c. _ L e i Asphalt shingles+o ma+chcx:arbiq(tyP.) W 1 5.Felt pope .} ! I/2"yrlx plywood sheer+hinq(typ.) O > d Faf+Irs s I 1 2 P G.Isula+io %0 + of H.O.1—ula+io -P%O C` ($ proper vent e I/e"o.G. N l.l. 't V —I water shield(+yp.) 2 xa ".iliq o>+a e 1 lo^o.c. JU III Z oorroimpsan N 2.5 hucnc erne tie%e I!n"o.c. � O '// F� Aluminum qu+rers}a drywzlls � Q . _/'.2 x0 Hea era(+yp.l - i I'x_PVG trim boards � J Gont nuous soff+1en4- i+yPJ �� .q(• White cedar ahingles a Fi"t.w.(typ.} a: Family foam p v+'ra9c v Ty—k houaewrop I YP.}t - mry - I/2"APA (+yp.) f 1 2 x rl want do sud e I "o o.(+yp.) 0 W a m . - 4 �/9"APA rated TIG.roubfloor 9 1 � �R u•� 9 8" nzuln#ion-F-'�O yyy } J w J o -t At Fri+umel H.P.I Impregn.:+edhy�f+board � � #. QJ m Q f v j� 75 :�. 2x10F1a Jaiatse tlo"oc. 1(1 - '�-2.1 O's d Jm o Z cm 3-2 x f O'a.P.T 9--2 x 1 O's.P.T. %-2erYI O s P.T. 1 _ �iimpsonm GGQ`o-lvhrJ�2.ci Golumn cap 0' 'D E U e v 1 - y P.T.toxv II CL- tu. ♦ tL J o- 0 0 I.5'J:I ii..•:i I ! ": , I is I ( 2"m x 4=0"yonorubc5/P-"igfoote 2 6 O poured concrete c lu Noo+m'f n 9w/4-r4 r I' :I l i J I I � vertical rebar I S -�"maxembedmgnt I :I and�i'mpaonm GP�CoIo coWmn bast ++ i l)IL(JING� T10N"A" Y � P I • ' A900 Gale: i /2.r = 1 �_��� � moo�o.3� m m A � ! Oz O c S 6 m6 r a Z n m m _ }1 ~V¢Oi LU N tl 0 DRAWING TYPE: ' 3 � P�uildinq 2eckion"P." f SHEET NUMBER: +� , I A400 1 .9 IT- Cc? �gt�c.E� c00 IIHM =,8. as d m �"ooa�3�Ho� lit L O J W — y 7 -. 3 N 14 I 'I I II 1!it —-------_ —_—._ __ ______ __________ eA eLevaTlbN_ � iL � � of . X ( - � ~ Ov j W7 Q t O V � O m � w � ° mom o0 m. 4— m < I v 'Se S FfFf lii .Iil j .. f t W I:I I:.I 1 Iwl' II I21 1:1 I;'I II H_ r_______________a.___--____---- -______________ ____________ _______�__________� _________ __—____------ ^Ga .R GNT eLEYP TION _� LEFT ELEVATION hcale: 114,o 1,-a" °o : f r 0 f a° _ l u N E s c W d a a o I i I DRAWING TYPE: ' I Elevai'ions SHEET NUMBER: A�JOU � . 0 Moen st Z, �a ok' LOCUS Croi Ville Beach Rd L.00A T/ON MAP NAssessors Map 247 Lot 4A r` • Area — 7;500 S.F Deed: Bk: 12777; Pg.89 Plan: Bk. 103; Pg.75 • o A Y RECORD OWNER m PATRICIA A. McKINNEY 476 OLD CRAIGVILLE ' ROAD CENTERVILLE; MA 02632 ZONING DISTRICT Off' b� 0 - 'L LOT 5A O ' .. o O O � 1'1 5 PROPOSED Addition 0. A SHED LOT 4 PROPOSED 7 500 S.F.- ce Rebuilt � ti . Bldg. Section s" 0:11 Ac:+/ LOT 2A o b�h 1 SH of*3,s LOT 3A OF o� l"I �cyG� s90ti P. STEPHEN G ORC VIL B. MOORS `a No. 46253 No.39398 co SS/ONAL ORAN ENGINEERING , ASSOC . LLC 508-432-2878 941 MAIN STREET RTE 28V HARWICH, MA CERTIFIED PLOT PLAN- lN CENTERVILLE -prepored For: Paul Rufo 476 OLD CRA/GV/LLE ROAD CEN TER V/LLE MA PROJECT: 13=2:31 SCA L E: 1 " 20 ' DA T E: 9 27 13