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HomeMy WebLinkAbout0599 OLD STAGE ROAD r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' ABLE Map 1� Parcel T � N OF � � Application`# 2b� � Health Division Date Issued` Conservation Division Application'Fe U ' ` Planning Dept. Permit.Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis , Project Street Address f6 V11 k D) : � Village OwnerMK OOA. 0 AIL Address59q � " sto ol UI Telephone Permit Request L tip "� 3 �k �re s e vke -t=` �-e v 1� C 01- C. -I t l-v L �eww­- A y i c. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District (9��• Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size t 15 OLE S Grandfathered: ❑Yes 6a o If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure ffia Historic House: ❑Yes UNo On Old King's Highway: ❑Yes UA,01*� Basement Type: ❑ Full ❑ Crawl walkout ❑Other Basement Finished Areas .ft. d Basement Unfinished Areas .ft Number of Baths: Full: existingnew Half: existing 9 new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 'S Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes o 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1, `�&k `,Z--,Z Telephone Number Address 71C� c License # Home Improvement Contractor# Email Z 1 1_ CD Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE✓ DATE I �J i FOR OFFICIAL USE ONLY Y APPLICATION # i DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME S "t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. 4 t a , Ile CommToffirealrli of-Vassadiusetts il3epararreiit cr, 1ndrrshzal Acdderfts 4 - Office of inmtigations 600 Waslrvigion Street y Boston,M4 02111 fi'FViv.masmgovIdia '[corkers' Compensation Insurance Affidavit:BuildersdContractarsJElectr;cians/Plumbers Applicant InfarmafEan Please Print 1,mlhIy Flame(Bus®essrganizationlIndi�*idual}_ Address: �� �� S' �R C�� �Qy`�e r1)\11e-) 02 32 CitylStatelig.� 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 6. Nev construction employees(full andtor part-time)* liave hired.the sub-contracton 2.ElI am a sole proprietor orpartner- listed ou the attached sheet ?_ 1 remodeling i slop and have no employees These sob-contractors have 8.-E]Dem,alafiou wodcing for me in any capacity_ _ employees and have wodcers' [No workers'comp.insurance )asap-imsurancel 9. ❑Building addition zTequired] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3-43- 1 am a homeoramer doing all work officers have exercised their l l_Fj Plumbing repairs or additions mys elf- worm ' sight of exemption per MGL �o ers - ( h 12.❑Roofrepairs .. insurance required.]a c.152, §1 4 and we have no employees. o wot 13.❑Other comp-insurance required-] , *Any sppliczatthatchedubos if1 Fmost also fill out the sectionbelmshowiug thekwadera'compeasationpoliieyinfoemstion� 1 l o,. in a,am who submit This of idwk indicating they are doing.all wal sad t6m hire outside contractors mast submit a new affidavit indicating sacb- fC=acton that check this box must attached sa additional sheet shoRiag the mane of the sub-caamwA xs and state whether or not those entities lime employees. Ifthesub-contactaes have employees,they mint pmvidetheir worken'romp.policy number- I am au employer diat is prm ding workers conpensaf en insurance for airy earplayees Below it ilia paltry and f obi ante inforaiat&n. Insurance Company Name: Policy 4 or Self-ins.I.ic. 99 (�� Expiration,late: � A �/J Job Site Address:59 I S t l�( z �d City/Staw p: (� I� l=l�f a Attach a copy of the workers'compensation policy decliration page(showing the policy number and expiration date). Failure to serum-coverage as required.under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to SUM 00 andlor one-year imprisonme d as we11 as civil peualties.in the form of a STOP WORK ORDER and a hoe of up to 0-00 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 ins anc overage wrification I do hereby cert, 'r er tl and allies o!f ', thatthe infornzationprmideda is s aard correct 01 Signature: �( / Date: Phone g- S�75 �P ^ 5A 0 Official use only. Do not write in this area,to be campLeted by city or town officiat. City or Town.: Permit/I,icense if Issuing A.nthor€ty(taidle one): L Board of Iffealth 1.Budding Department 3.CitytTown Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massaehusetis Geteral Laws chapter 152 requires all employers D provide wo1kers'compensation far their employees. pm-sTa„tin this statute,an eaplayee is defined as."_.evmay person in the service of another under any contract of hire, express or implied,oral or writtcrL" An anpkyer is defined as"an mdividoal,parnnership,association,corporation or other legal earthy,or any two or more of the foregoing=gaged is a joint enfmpnse,aad including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the:occupant of the - dweMng house of another who employs persons to do mafiik nce,construction or repair work on such dwelling house or on the grounds or building appurtenant thcmto shall not becanse of such employment be deemed to be an employer." MGL chapter 152, §25C(e7 also states that"every state or local licensing agency shalt withhold the issuance or renewal of a Hcen e,or permit to operate a business or to construct burldiags in the commonwealth for nay applicant Who has not produced acceptable evidence of compliance with the insurance-coverage required" Additionally,MGL chapter 152, §25CM states'Neither the commonwealth nor nay of its political subdivisions shall enter iaD any contract for the performance ofpublic work uufil acceptablff evidenco of compliance with the in etrran ce._ requiremerrts of this chapters have been presented to the conirarting aLthodty_" Applicants Please fill out the workers'compensation affidavit completely,by checking ffie boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their certificate(s)of ;as=ance. Limited Liability Companies(LLC) or Lhaited Liability Partaerships(LLP)with no employees other than the members or partners,are not requi ed to cant'workers' compensation ins[mamce. If an LLC or LLP does have employees,a policy is regnired. Be advised that this affidavit may be submitted to the Depaj-finent of Industrial Accidents for confnmation ofiamrance coverage. Als.a be sure to sign and date-the affidavit The affidavit should beret=ed to the city or town that the application for the permit or license is being requested,not the DePart aeut of n , Accide +ads. Should you have any questions regarding the law or if you are reqmired to obtain a workers' compensation policy,please caR the Department at the nmmbes listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials f _ Please be sine that the affidavit is complete and prfirted.legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemoitllicense number which will be used as a reference nimmber. In addition, an applicant that must submit multiple peimitllicense applications in any given year,need only submit one affidavit indicating cmTeat " Add.mss"the licaot shoT�Id write"all locations in (cry ar policy in�-�rnation if necessary)and under"Job Site ape - " C he, or town may be,provided to the awn)_ A copy of the�affidavit that has been officially stamped or marked by the,city y p a d affidavit is on file for fuimre e�i.its or licenses. A new affidavit must be filled out each applicant as 'roofthat valid p _ aPP P year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or peumit to bran leaves etc.)said person is NOT rtgndred to complete this affidavit The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Department's address,telephone and fax number. Tha COMM W-1atth-of Masmchl=tt-, Department of lndial Aockdtnts Office of f vmt� attiwa,!, �QQ�ashi�an�`t�t Bostc un MA U2111 T(-,1.4 617'27-4900=t 4,06 or 1-9 MASSAFE Fax 9 617-727;7M Revised 4-24-07 M goof dia �VE Town of Barnstable Regulatory Services MRNnMRX KAM Richard V.Scali,Director 1639.iO�En ' 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 ,, A Complete and Sign This Section If Using A Builder , as Owner of the subject l property hereby authorize �J�'� to act on my behalf, in all matters relative to work authorized by this building permit application for: (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 ins ec ' ° e perfo ed and accepted. Signature of Owner Signature of Applicant " Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services dFtH Richard V.Scali,Director Building Division ' sAttr STAMA ' Tom Perry,Building Commissioner KAM 0.19. .0� 200 Main Street, Hyannis,MA 02601 i°rEc A www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print JOB LOCATION: [ / CO X\> C_ ,`y Ce-V,- rU A e- number street village "HOMEOWNER cif�.v� 1JeaFN Z� �,� 7-76, gkIf. Sa k--7 Zr 'Lt kcf O name �^ home phone# work phone# CURRENT MAILING ADDRESS: S [ S-tr- �. p 2&3 Z 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 su ervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_ ep rmit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"home n fies e understands the Town of Barnstable Building Department minimum inspection procedur d re . e sand 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 to amend and adopt such a form/certification for use in your community. Q:\WPFU-ES\FORMS\building permit forms\DTRESS.doc Revised 040215 t ` �►:� _ ���,��- r�8.: vie .�- _ _. . i bel V15 LJk '?k m, OF. R RNST BLE ' Otwl le "'^"'-" -w++ -' - .tini. q•1>�^^ , 9. � 47p 1035 L'u r wt 1 - - MI\I V 1 I�.'7_' ` A w `•F'`, _q 'F"'."�..'-•.""•�-_-._...�.•+EF.-�' L f. :v '. f A 1 I p - ._.'- . .+,--»gyp' _.. •... r •—/ - ..-_- . ._.��.... --_,--- -...,-...,.__..--�_ :1-_ ..y..-_ {_ •. _ .. _. _ 1 .. � t - �� � �.� .�•........--.....,*..-.._.,t_._. 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Orr «e r.. ....,._.� .. .....1 L I w � � a ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map AI Parcel o O� Application �V15V�V-1� Health Division Date Issued /I S- Conservation Division Application Fee S ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address SNq Village- Owner A a. Address 40 Lai 44.4 Telephone 7 7 Y 39j Permit Request o � f v Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain �lug Groundwater Overlay Project Valuation 301 y Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family &K Two Family ❑ Multi-Family (# units) Age of Existing Structure lq — 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: f2 existing —new Total Room Count (not including baths): existing * new First Floor Room Count Heat Type and Fuel: 4Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes U(No Fireplaces: Existing 1—New Existing wood/coal stove: M Yes ❑ No Detached garage: 4xisting ❑ 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 Xo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 71!j Address FPCA' License # 0-1 T IN 0 2' a Ia Home Improvement Contractor# Worker's Compensation # k;C0 42�-111- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE &&Fe s tr FOR OFFICIAL USE ONLY APPLICATION# 1 I DATE ISSUED I r MAP/PARCEL NO. ._ I � t I i.` ADDRESS VILLAGE ' OWNER I t 1 I DATE OF INSPECTION: FOUNDATION x FRAME I INSULATION !� FIREPLACE ELECTRICAL: ROUGH FINAL y. � I � I � PLUMBING: ROUGH FINAL l GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT N - I ASSOCIATION PLAN NO. A fi+ r r • ��. .� Deparlmentofl�ndrstrial�cczden�c Office oflnvertiga&M 600 Y'ashingtan Street. Bnstar�HA 02M www.mars gwldr"a Yorkers' Compensation Insm-=ce ATidivi -Boulders/ConbmdOrsMedxidans/Ph mabers Applicant Information Please Print Legit ' Name rz Address:Ie , • City/S e1Zrp: Phone#: c Are you an employer?Check fke appropriate bar ape of prof ect(regr : 1.�I a eaiplvper wi$r 4. I coofradw and I 6. ❑New camslrvat m ' . am �= ❑ am a�°� e�p*C=(frill and/or pot�).* bmvm hnzd fhe sob-•ca�achns 2.ElI am a sole proprietor or pm-lner- listed as 1hm affacbad short •7. ❑l3t D&Hag ship andhavo no employees Thew sob-•conkRdo s bave 8. []Dcmoli iaat Vm3cing forme in'eay capacity m4dq s andbave workers' 9. Building addition [No wm3= 'comp.insurance comp.mscQm=t ��l 5. El We are a corpamdtim sad its 10.0 Eleatricalrepanrs addtions officers b m cmrasod the$ 3.Q I am ahmmmowner doing ell work�.. IL❑Phanbingrepaits or additions. nryself [No worms'carte. ri&of eunpticuPerma, 12.[]Roof rcpafrs ;,,mrance rcqahed-1 t c•152,§1(4),and we hEm no CLPbY=&[No ' w 13.[]Outer cep.msm-an=reqr&'=L] *Amy¢PPTicautt5at rhesl6 box#1 most also fill asn thz section beloSg sEutw*gthcsw eompmsz*policy idoamian. t 13nmeawnca who suhmitliris at5davit iadimtiagtbcy aro doing aII wry®d then h5z o atsido caI tna nmst sahm.$ancw aMd=t indierf;ng sorb "rrlmcfrs*&r j -Ir fbis box rmst ath3ed an addi6mml shcatsbowmgibe nano afthe soh-oantmcb=sad sty vdu:f=or notfM=eUtities hate amployea.Ifthe above c=Plqy;cs.*YmustPunaaffick wmk=e camp paIiqym=bcr. I am an anloyer that u proglvorkeas'coarpeas�ian i�u7u metre far nsp rsnplaJ' elow is fhe poky and job site in ornrafion. Iumn mce Company Name: , ' Policy#ar Self--ins.T c:.f: we,�O Al.2S 7 P = £xpsatiaaDabr:Sr'1a C(� rob sift Addhmss:S'9Q CJ a.�C Af b=h a copy of the workers'COMpe:nsation policy declaration page(showing the policy nrmnber and ezpka-dan daim). I I m-In z to scams coverage as regaQzd under Sectim25A ofMCM a.152 cm l and to tb.o impositirm of dinar penalties of a fmn i3p to$1,500.00 and/or mo-yesr imprisn=ant as wall as civti pmu iics is fie B=of a STOP WORK ORDER and a fine of ap to$250.00 a day as but t$e violator. Be advised fbat a copy of fus statZm may be in warded to ibe Office of Inyestiga ti� of the DIA for ham= e:coye:rago verification. I do hereby certify under the pabcs cord pettaities of pm jrn y that the iafbraualon provided/above i correct s trice and corre ( 5i�xae: � tart Data: G l �O• / I Phmm#: 77Q ff.-3 16 d I D frcial use only: Do not rite in this area,to be eompldr�by city or town offidaL , City or Town: - Pero.i•Jf.icemse# Issaing Authority(circle one:):_ L Board of Health 2.BuilffingDebartmmt 3, own Clerk 4.Electrical Inspector 5.Ph=bing Bspector 6 Oikcr Contact Person: Phone Y. ' 'R r aformation and Instructions . Massa r etFs Gkaaal Laws cbapi r LU rec.F=all employ=to provide work='campmsa±tcn for ff==3pIoyees. . this statue an m playm is deffned as'...cvm-y person.m fm secvi -of anud==der any cam ofhur,, or mipliecl,oraI or w�." An m p ix is defined as'an mdividnaI,p ip,association,coip or ad=legal entity,or any two or mods of the ing engaged is a toted esq and inclndmg the legal rn�fives of a deceased employer,or the receives or of an kffvidnal,pulp;association or other I e fit7;eazgl Virg employees. However&e owner of a Noose havingnotmare than three aparlmeots who resides tber fi;or the oc 4zot of the- dwelling hone Wither who employs persons to do ca astiuc[ion or repair*mk on such dwelling house or an t3�e grounds batilding egopurizast ffiemto shaIl not becans of soclt e¢aployrnent be deemed to be eoiployer." MGL cbapirer I32,§ also stairs that aeverystaff or In Tr'Nc:r,g agencyshall witblioId$e issuance or fenewal of a license or to operate a business or to construct bmIdmgs hi the co—ommalth for any applicantwho has nut aced acceptable evideace of co�tpBmce with the insuranm coverage required." AddifioneIly,MGL chapter I §25C(7)stairs NcMber thm/cannnmwealth nor any of its political subdivisions shall a n:tz r info ray cantract for tho p ofpublic wodcpE acceptable evfdcuce of ca¢npliapace T&h the msan ancd. requi=eoieuts of this chapfrrhave b presented in the ` . ao$oriij:" . Applicants ' Please fill otrt fhe Wa�kets'compensa)' for letrly,by checking the baao s that apply to your shoat m and,if e3',supply - Cs)naes)and phone numbers)along with ffieir certifrcate(s)of issuaance. Limited I*M1y CompaniLiability Paztnecsbips(LIP)with no employees office than the members or partaexs,are not rbgried tensaf[on insormce. If an LLC or LL P does have ec¢ployeea,EL Policy is roganed, Be ad be submi�d to ffie Depgimerd of Indnstrial Accidents fur co T maiion offasnranclso be to sign and date the affidavit The affidavit should be retuned to ffie city or town that the r the permit "cc=is being regneshA not the Deparfineof of IndnstaaIAccidents Shouldyonhave regarding the or If me regmred to obtain a wogs' campensationpoliry,please call the Dep at$ie number listed b . Self-insured companies should eater their self-ftw6nce license number on the line. ' City or Town Officials r Please be sane that the affidavit' camplets and pxhAcd legibly. The Depaittnmt vided a space at the bottom. of the affidavit for yan 1n fitt in the evert the Office of lnyest�va{irmc has ffi aornact re7�d the agpli c Please be sum c to frIl m thefpermit/1ice�se number which w�be used as a rzfezeence umnb`ea. on,as applicant that mast Salbintt Ic pe�iM;rrnce applfi�ifons �y Year,need only snl7lnft onet md1�A t:nrrent policy ir►fr„n,�t;a� ssai3')and under`fob S>te Adciarss"the applicant shwld wrhe"all in (Grt3'm town)."A copy pf the affidavit that has been officially stamped or marked byfae city or town maybe vided to$e applicant as goof that a valid affidavit is on file for f Aore p=a :s or Iiaxnses A new affidavit must be out each year.Where a home owner or citizen is obtaining a license ar petmitnotrr�td to suy business or commerca�'al` c (ic.a dog license orpeamit to bmn leaves etc.)said person is NOTrequired to complete this affidavit: V The Office ofInvesfigrirms wooldhlce to thankyouiaadvance faryour cooperation and sbouldymhave any ga wlicns, please do not hesifsin to give us a call The Depmtmefs address,Wr-phone and faxnzanbeT The C OMMOnwedh of I1 ssachnaetts - . Department afTnbstdzfl Amidenta • • Q�ee of�n��g�tious 644��ingtan Siz�t • Btasbxj,MA D2111 'Te,1,#617;7`7-49R0 cit 4€l6 4r I-&77-MAC A Izevised¢24-07 Fag 617-727 77� ` ORO® DATE(MMIDDNYYY) AC ` 40 CERTIFICATE OF LIABILITY INSURANCE 5/28/2015 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 terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Jane Logan NAME: g Andrew G. Gordon, Inc. PHONE (781)659-2262 FAX No:(781)659-4725 306 Washington Street ADDRESS:iane-@agordon.com INSURE S AFFORDING COVERAGE NAIC# Norwell MA 02061 INSURERA:Libert Mutual'Agency INSURED INSURER B:Pil rim Insurance Company 21750 Lux Renovations, LLC, DBA: Owens Corning*of New INSURERC:Peerless Insurance CO. 24198 60 Shawmut Road INSURERD:Star Insurance Company 18023 INSURER E: Canton MA 02621 INSURER F: COVERAGES CERTIFICATE NUMBER:master JL 2/6/15 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. 1LTR TYPE OF INSURANCE D SUER POLICY NUMBER' MMIDDIYYY MCY EFF M/DD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE a OCCUR 1 DAMAGETO RENTED 100,000 PREMISS a occurrence $ CB28512851 P 9/5/2014 9/5/2015 MED EXP(Any one person). $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 MOTHER: 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $a 2,000,000 POLICY❑jE QLOC -. PRODUCTS-COMPIOP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ccideD Ea _ $ 1,000,000 CO BIN D SING LIMIT ANY AUTO BODILY INJURY(Per person) $ 20,000 B ALL OWNED SCHEDULED - AUTOS X AUTOS PGC16007161409 1/17/2015 1/17/2016 BODILY INJURY(Per accident) $ 40,000 X X NON-OWNED PROPERTYDAMAGE HIRED AUTOS $ AUTOS 4. Uninsured motorist BI split limit $ 250,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB X CLAIMS•MADE Y AGGREGATE $ 1"000 000 DED I X I RETENTION$ 10s000- ` CUSS11953 9/5/2014 9/5/2015 $'' WORKERS COMPENSATION «_ PER OTH- AND EMPLOYERS'LIABILITY TY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE' ' E.L.EACH ACCIDENT $ 1,000,000 ID (Mandatory EXCLUDED? a N I A (Mandatory in NH) " WC0428715 _ -' 5/24/2015 .5/24/2016. E.L DISEASE-EA EMPLOYE $ 1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD im,Additional Remarks Schedule,may be attached If more space Is required)'" Carpentry/Basement finishing/Window Replacement 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insured r s copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Geoffrey"Gordon/LEE ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onl4ntt Department of Public 5ajC1y unrestricted-Buildin — Massachusetts - ulations and Standards contain less g of any use group which 1� ems.. I than 35,000 cubic feet(991m3 of �l Board of Building Reg . enclosed space. Con,tructlon gupclziscn I � • License: CS-075131 r r. u, ' EDwAT�T.AI,L�N` �,.. �',•r�� _ . ." _ _ ' . 30 STORMY Z � _ • Dedham 0206 ' Failure to possess a current edition of the Massachusetts Expiration State Building Code is cause for revocation of this license. I For DPS Licensing information visit: www.Mass.Gov/DpS � - o2r27rzo17 _ - Commissioner Gov/DPS r Office of Consumer Affairs nd Business Regulation O 10 Park Plaza - Suite 5-170 - M v CL Boston, M. sachusetts 021.16 . L) Home Im rove=contractor Registration LL p c a n1 Registration: 137943 +, a ¢ `' - Type: Supplement Card o V Expiration: 1/29/2017 E 5 I, LUX RENOVATIONS, LLC. r EDWARD ALLEN M ' i ° �' a 9' d p � � N 60 SHAWMUT.RD CANTON, MA 02021 P 4 - - •E ' Ei S v. . 4+ s�Q Update Address and return card.Mark reason for change. u o , —i \ I Address Renewal Employment ❑ Lost Card i 3CA 1 Co 20M-05/11 i o vseaomvrrwnweai o�C/Z�aaaac�uieeCCb W M A t OExpira ice or Consumer Affairs&Business Regulation License or registration valid for individul use onlyME IMPROVFQIIE�JT CONTRACTORbefaYe the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistratio ; -;q8� Type: 10 Park Plaza-Suite 5170 '� .-:- _ ,� Supplement Card Boston,MA 02116 LUX RENOVATION OWENS CORNING / 'ISHING SYSTEMS EDWARD ALLEN _ 60 SHAWMUT RD M �" CANTQN,MA 02021 Undersecretary Not valid without signature • .Town of Barnstable o ' Regulatory Services MIUMMAMA • _` Richard v.Scab,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, r-WLe k `J1 Gt Z1 as 0.wner^of the subject property herebyauthorize �o�..,�rA rc� ��n to act on mybebalf, in all matters relative to work authorized bythis building permit application for. 519 6IA Afla4x ALA (Address of Job) 'Pool fences and alarms are the responsibityof the applicant.'Pools .are not to be filled or utMwd before fence is installed and all final Mspe p ormed and accepted 1—De I T Signature of Owner Signature of Applicant . Print Name Print Name r Date t QT0RMS:0wNWERMISSMIe00L5 l o'PPn ot-Barnsta nie Mj Regalatory Services `mow¢r Richard Y.Sca%Director '� � .Building bivision r 319aaIsr93= ` Tom Perry,Building Commissioner ILA= �$ M. 200 Main Shv:4 Hyannis,MA 02601 wW W town.barns[abla us Offic • 508-862-4038 Fax: 508-790-6230 110MEOWNlMUCVWr0N -- �pleasePriat DATE: JOB IACAlI— . n shiet' v�age '�iOMEO�VIQER: • name bone phone# work phone CURRENT MAIIAdGADDRESS: - hown the zip code The current exemption for"homeown "was extended to include caner-o ied dwellingsof six units or less and to allow homeowners to engage an individual for ' who does notposs a license,provided that the owner acts as supervisor_ DEFDMO OFROMMOWNER ! Person(s)who owns a parcel of land on whi he/she reside&o intends to resider on which there is,or is intended to be,a one or two- famUy dwelling,attached or detached slru ssory to use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considere homeoe . Such'homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she a onsible for all such work erfarmed under the ermit. (Section 109.1.1) The umdersigned`.`homeowner"assumes responsibility mpEance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned`homeowner"certifies that he/she Town ofBamstible Building Department mininrr inspection procedures and requirements and that he/she wM mply with said p cedures and.requirements_ Signature of Homeowner Approval of Building Official Note: Three-family dwelUngs co 35,000 cubic feet or larger will be gaited to comply with the State Building Code Section 127.0 Construction Control . HOMEOWNER'S EXEMPTION The Code states that: "Any omeowner performing work for which a building "t is required shzU be exempt from the provisions of this section on 109.1.1-Licensing of coast metion Supervisors);\provided that if the homeowner engages a person(s)for hire to do s ch work,that such Homeowner shall act as supervisor." lYlaay homeowners who a this exemption are unaware that they are assuming the responsrbiIities of a supervisor (see Appendix i j RnIes&Re tions for Licensing Construction Supervisors,Section 2M) This lack of awareness often results in serious problems,p 'cularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicens personas 1t wouId with a licensed Supervisor- The homeowner acting as Supervisor is Ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. • Q:\wPF'IIESIFORMSIbmldmgpamitfmms�u--3rnuFcc�c Revised 061313 SMOKE''DE ECTO�; REVIEWED IMPORTANT -� UPGRACE REQUIRED STATE liU1LDING CODE REQUIRES THE UPGRADING OF _ {� 07 SMOKE DETECTORS FOR THE,ENTIRE DWEWNG WHEN E fA L BUILDING DEPT. DATE ONE OR MORE SLEEPING AREAS ARE ADDED OR CREA R fF�l. IMTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL FIRE DEPARTMENT DATE PERMIT DOESN SATISFY THIS REQUIREMENT. BOTH SIGNATURES ARE REQUIRED FOR PERliTlNG Gt)/�✓04� 0, 6 1. Install new support header, 3- 12"Ivl's. See engineering specs 2- L-ZKco 2. Install new support header,e2 12"IVAS. See engineering specs o 3. Reframe bathroom walls, existing were 2X3 studs, 24"olc. new 2X4 studs 16olc $ 4&5. Reframe most of second floor, existing 2X3 framing, new to be 2X4, 1601c. 1_2 Smoke detectors=green' a Carbon detectors=blue F CA'?-13o,3 C �,s-r—(6n, e 6 . 1 . 5 I + i At CONTRACT customer Nar DeFn*9,Michael&Amaeda -�n�� �! Customer Signature�o 599 Old Stage,Rd i SKETCH .Contract Da center Centerville,MA 02632 Sales Representative Signature 774-392.483t -.ATTACHMENT _ Customer Ph( - Contract Price., ,r ; , t s . s: 6 7 a. 6 16 -U rY V /N `.S ,6. 17 16 !6 4D Yl fT 36 Ps`..�' 3,: u 9 s+ .35 U 37. s6 S. "o ., 47' Q N 45 46 0 46� 46 'A 61 62 "A N 66 56 .fr. so. W z... . I p 40, ; � r ky ' a! � .��`"'o�, t t,. i 'l 10 20 ri I I ( 1 ! � ' I I I ' I I , j i t , { i I i 23 ( r- F 25 i t` t i y:. n 25 � 20 3, { p € - - fG�-+ 'f9702 �.. fi I I { I 1 , , 1 NOTES: � :, �b I 4-no V LcJ,(t �.trt �t'J1r �O p `G ;Eactr;box'equals one toot unless otherwise noted.This sketch'is a good faith representation of the work to be done;it is understood that.all d{manslons derived from this sketch are approximate,and that all locations at outlets,',light' fixtures,plugs,jacks and/or switches are subject to changed necessary. . Town of Barnstable oF1Me, Regulatory Seryices do Richard V. Scali,Director BAMSTABLE, ; Building Division BARNSTABLE 1639. .0 Thomas Perry, CBO �639-zo�< �FD1A°rA Building Commissioner 200 Main Street, Hyannis, MA-02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 July 16, 2015 Edward Allan 60 Shawmut Rd. Canton, Ma. 02021 RE: 599 Old Stage Rd., Centerville, Map: 191 Parcel: 005 Dear Mr. Allan This letter is in response to application number 201504095 submitted to partially finish the basement at the above referenced address. Unfortunately, the application can not be approved at this time because of the following: 1) The construction documents submitted do not show compliance with 780 CMR. Specifically, the headroom shown is contrary to the requirements of 780 CMR 305.1.1. Please do not hesitate to contact this office with any questions. P Respectfully, AJr L. ?akw Local Inspector j effrey.lauzon@town.barnstable.ma:us (508) 86274034 Y , , ! •� �� • • � ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (90 Application # Q6 `D 3 I Health Division Date Issued 3130 11 s Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner t Address Of5�a q e- Telephone - Permit Request " - ' G " Ila Lifafioln-i vi area Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure �aa Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) ii�CD Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 1 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: XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing New Existing woodl,�oal stove;;❑Yet ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 esting ❑new,_ize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:` a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# F" Current Use Proposed Use { APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ 1 j Name Telephone Number � 'T� (�(D Address t / �G� License # lam✓��ll/ l YCIC (J/1 �;12 Home Improvement Contractor# Worker's Compensation #1JPT Q Ei, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r -J6 m ,,_x4b A 4i4 ci 'v)s ('rowell W noe�) SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. K ADDRESS VILLAGE OWNER k DATE OF INSPECTION: r _.FRAME r: "INSULATION,-. �f FIREPLACE ELECTRICAL: ROUGH FINAL E- k s PLUMBING: ROUGH FINAL Y GAS: ROUGH FINAL FINAL BUILDING_ _ DATE CLOSED OUT ASSOCIATION PLAN N O eeiciM�eiuiic � , , OWNER AUTHORIZATION FORM 1 (O er's Name) ' owner of the property located at: " (Property Address) Cente'CV, (Property Addressy hereby authorize S v d Ai (Subcont c ) an authorized subcontractor for RISE Engineering,to act on my behalf to obt5A a building permit and to perform work on my property. This form is ly va' with a ned contract. wne►'s Signature - Date RISE.Engineering, 5 Dupont Avenue South Yarmouth, MA 02664. • t . ACORO DATE(MwDDtYYYYI CERTIFICATE OF LIABILITY INSURANCE. 12/1r2014 THIS CERTIFICATE IS ISSUED AS A,MATTER;OF INFORMATION ONLY AND CONFERS NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH&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 cortificate holder'is 8n ADDITIONAL INSURED,the Aolicy(ies):must be endo('SO., If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain:poiicies:may require an endorsement. A statement on this;certificate does not confer tights to Elie certificate holder' lieu o€'such endorsement(s). PRODUCER ._... - ... cowTACT.tora. FlifzGerald: NAMQ Southeastern Insurance Agency PHONE FAX (508)997-6061 me No (508)990-2131 439 State Rd. ADDRE :ifiti4southeasternins.com . P.O. $OX 79399 1NSURERS)AFFORDINGC6VERAGE NAIC North i33rttdOLltt1 MA 02747 'INSURERAArbella Protection Insurance. �I136G ..... _. t I INSURED - _ :-�.., .,;:.. - 1 _ INSURESBAssociated Employers ins, Co Tupper Construction Co LLG NsuRERc: 79 Mid Tech rDrive INSURER D'.c.:. _ Unit B INSURER -:---- E West Yarmouth62673. .. .. - MA 6267 3 :INSURER F( .. ... COVERAGES CERTIFICATE NUMBER:2015=i REVISION NUMBER Tt115 IS TO CER"tIFY THAT THE POLtC1ES,OF SN$URANCE LISTED BELOW RAVE BEEN ISSUED TQ:THE INSURED NAIviEO ABOVE FOR THE POLICY PERIrl INDICATED, NOTRTHSTANDING ANY REQUIREI�IENT,TERM OR CONDITION OF ANY CONTRACT OR'OTHER DOCUMENT itllTH RES�EGT TO tlCli T0D CERTIFICATE MAY BE ISSUED.:OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS:StpBJEGT 'O ALt TI?c TERMS-, EXCLUSiONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAy'HAVESEEN REDUCED b r'PAI :CLr jMS iNSR ..ADDL SU R POLICY EFF POLICY EXP { LTR TYPE OF INSURANCE POLICY NUM9ER- 1,,Mn o1 -MULIUY YYY s LIMITS `GENERALUAH1tiTY ... .: Er,16H CCURR Pn;e' j;d 1,y_OOO,D00 .K COMMERCIAL GENERIC LLg81LiTY - ETOR 1 HR ti3iSES scca;reire 15 .lOD,000 A �IAIMS3AADE #^!OCCUR 500008743 12'l j2p14 `1/1/2015 c. MED:EXP..(A.ny tore arc) (S S,OOD # t i rr RS(J,Vf: &ADVIi,tU?Y {J °y'000 r 000 9g t IG.e,3�(t:LaG RFC`�tiTE is. ,,�00fl,0U0: L AGGRE-GAT tJts.iT APPL^'E5 PCR. }`( ,` _ 4 _-- PRO- t: 1 t PROSJUMg•�C09-IJP.AGG[S 2,00 coo iii ax.P61.16Y .:CDC - I:5 AUTOAWBILE LIABILITY, . .. ( MEiNED SIhGLE:LIMIT - _ Er Six 2nt1 s 1:Ofl0 o 0 0. +--3 A ANY A iV y ALL RDDILY��.IURY jPKpersart t fi O:NNEO $ SCHEDULED � 020009389 �c ALTOS AUTpS t` .-- 12/:1/2014 `2/1/2018 000ILY.IN NR (Pe.OdeC� S k J{ NON-CINNED >. I I?3a,E4.:IUTCS i AUTOS ii up Ty.DArtAG_ 'S . S� 1 # E{a�s3ecde3y I UMBRELLA UAB'- •. 3 _ - U ry u rydrnn(O s Qi' h.Xrrra ` 250 0Q0 OLYUR 3 I- EACI',.0.URREteC'E il 5 EXCESS UAB 4 "• - A CLFIFM5-tAAsGE.� - f ..- # FCGREC, jr5 DED- R-iENTIONS 600058368 1/1/2014 11/1/2015 ' $ N(ORKFRSCO/dPENSATION _ TA �TATU .AND EMPLOYERS'LIABILITY �, T , YIN: 7 OTs}_ Efi 3 ANY PROPR,ETORiPAR iT dEMEXECU-JVE y3{ OFtICER/h.CA9 SER EXCLU I7ED7 :N i 1 A i j E EACH ACCIDENT t 5:. —1-000 00.0 (Mandatory'inNH) �.. CC50055930120 4A 10/3/2014 :6/3/26i5 I It �s,dxsca�oar(Id .. ( .1. . .. I E DISEASE EA !AF'OY E S 1-.000,D0❑ QES� C#7PnN OF OAERATfONSb?lcivFSEASE £?t CY J^AT 5 Z OOQ 000 DESCRIPTION OF OPER1YTiOMSf LOCATIDNS:VEI;ICLES::(ALtaeh:ACORD'i01;Adddronaf,Remarks Schedule,i{niore space is tereCulred}: CERTIFICATE HOLDER <�:... CANCEt.LATtOtV ' SHOULD.AIV OF TtiE ABOVE DESCRIBED POLICIES BE,CAN THE EXPIRATION."GATE THEREOF; :NOTICE WILL 8E DELNERED IN; �> INFORMA2'ZOAI PURPOSES`:ONLY ACCOROA(YCE-ViIITM THE'POLICY PROVISIONS..' TUPPER CONSTRUCTION Ca: LT,C 546 A HIGGINS CROWELL -RG1AD AUTHOR(LDREPRESEIVTATIVE -- --" ' WEST. YARMO7T4r 134 O2S73; Lora FitaGerald/LHL ACORD'25{2010/05} Q 1.988;20l0 ACORD CORPORATION. All,_ I!rights.reserved,INSO,'L$t7Rt!7q.5TR7 Tha G/i`.•(lAf1 r+om anit inns ara?nnic4drl ii odro-iif lannph r The COMMon ealth of Massachusetts Depaitment•of Industrial Accidents ' Of ce of investigations 00 Washington Street 'Boston,MA 02.1 1 WMw mass.govld.ia Workers' Compensation Insulrancc. ..avit: Oa>Eflfldetsl tractoes/E ectrieaans/Plfa aiiiberg Applicant In 6M. ation Pita t a Ptcilat Iaegj: ly NaMe(Business!Organization/Individual)<'. Tupper Cons.truct.ion Co t :LLB`.. Address: 546A Higgins Crowell Fed City/State/Zip: West Yarmouth; iv7A. 02673 Phone 508-778.-0111 -: Are you an employer?Check the:appropriate-box:4 Type.of project(required): t.[JX I am a"employer with�_ 4= ❑':l am a general.contractor and i 6 New.construction; employees(full and/or part-tirne)* have hired the sub=contractors. 2.0 l am sole or P ietor'or parfner=: lute ;on the attached shee,`t.$` T 0 Remodeling ship and have no employees These;sub-contractor-s'hae _8. [�;Demolition! ,working for mein any capacity.: workers' COO insurance:' 9. Q;Builditlg.addit on; [No workers:`comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.Q Electncal repair"s or adclit�ons 3.0 1.am a homeowner doing all Work." right of exernpt on'per MOII.[] Plumbing repairs.or,additions myself [No workers'comp. c..152;§1{41;and we have-no I2 Roof repairs insurance required-] t employees. [No vorksrs'` comp.;insurance requ red.] 13_Elotherweatheriz,ation *Any applicant that checks box 0 must also EILnut Fl a section below droning their workers'compensation pcilicy infwmatiorn 7 Homeowners who submit this aff iavit indicating they,are doing all Wvrk and then tiiie outside�eontiaetors must submit u ne�v affidavit iitdicatirig such, I Contractors that check this box must attacbed an additional sheet sholving the naine of the sitb coriiiactors and their wIo kerneo. inp;pol icy`:m on.bima d am ara employer that isProviding workers compensation insurance for:Iny employees. Below is.the policy and�ob;srte inforrrWion.. Insurance Company Name: AEIC, Policy##or Self ins:Lic.##_ ..WCC. 5 0 0 5 5 5 3 fl`12 014A E cpiraLaon Date; 0/3115 Job Site Addles` Id , I I ft - it .1statelZip l Attach a copy of fhe workers=.compeusatio p©!icy declaration page(showing the polgey number and expiration ate):. Failure to secure coverage as required under Section 25A of NT,GI c 1�2:can lead to the'impositipn of criminal penalties of a fine up to$I 50060}and/or o'ne year imprisorianexitt,"as ivellas civil penalties in the form:of a STOP V4rORK QI DER.and a fine of up to$250.00 a day against the violator: Be advised that a copy:of this'staterient.may`be.foraardedto.the Office of Trlvestigations of the:DiA.for insurance coverage verification. I;do herebycertify p p ' f perjury that the iraforrratation provadM aboveA zt ire and correct fy render the dhls,---fang 1 enalties a Sitmature: 4 / t Date 1 Pho ne#: t s o 8) 7 s-.011 a ' Of cio apse only, not write ra i4h area,to be eov ohe 0 by crty'vr towia v�ctdL. k aty,or of+n:: " fear t/L �.Board:of�eadth 2 ;f3iaatdmeparfinent 3;CityfTo�n Clerk 4.Electracal ienspector 5.1 [urrabilag taspector 6.Oth er t Contact'<'erson.. P>hoae#; { e 3J{Tics�i ci�asu777t r £Ca7€5 .iti;7nx�+ltz tit ttct:.: a tcrsc n z� tytt.]iiu»v riic;fi iniii+i7lict`srsz u77t�. �� �` C��i�4��t3t311L€k��ilca��'�E:�d,4tnjflt� 37etc�ci:9ctr;.e.X;tcr�at'� � hat,w af£uuccc#crtui}u� i� fstrat63kt uxeg f�- 0Of c<t�t�,,�saii;ua�7 emir a7z<I�tk 7cee4�:iZF�7t7tasa� c�' Fr7 �+fe1tC kIplratio77. 4116 zolb LL-ti i.��m�#t�` i.M-i LR, a. to `�'�. j ; \•i. v r%miY,stJ`T i,MR:w'.-ot. 3d�c.arir*. c` ;,rc i'sizr3`��'ct3c�cct si„?9;t�tus'�:� - y� w.nw .,�,+ -sec ,.�a .��;� ...�yc;.� '! +.}II�S�h:Jb@tL^�•�EE a'"Frte~� t- z'uvi7 c.af<_y� c i? e3kTEK53ii G3��T rA' }� 9 .€ 1 yti.3iftf�Y�C •tc,i S4a S ti`��' zan a I i,Tiw fir... `3, dIrNn- t-4 I frl CA rftR"UF�ks�K;��t3F ,c'^. RFw"4 E::'L%iE wt-..-. - II PL.IrAE Heal mg-People Suitd 3 Wer o;rldt 1 - l Lipp6 G,6irstr 3G[ion aul�ng�=_t}?�aiessra.-�aa _ ++ r 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-776-0111 FAX: 508-778-5010 Date 1-7 ED Town of Barnstable Thomas Perry CBO -77 200 Main Street Hyannis, Ma 02601 - (508) 790-6230 fax Re- Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # Issued on has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #_ _�; L Address: Richard'Tupper J License # CS-69058 h� A - a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6U5 -Application# omo766 S Q 7 Health Division ` Conservation Division / f1/Permit,# Tax Collector • Date Issued 11 1f Treasurer '' T pA p iiccatim Fee �• � Planning Dept. Permit Fee _36 V e?0 Date Definitive Plan Approved b ning Board 6F�• j Historic-OKH 6 1 V' servation/Hyannis o Project Street Addre s _�� C7 �(,� ��4 ao,-x, Village Owner 41 L o C Address Telephone eOT -- _ ZS Permit Request CA Square feet: 1st floor:existing_ proposed 2nd floor:existing X—Z proposed �'" Total new d Zoning District Flood Plain Groundwater Overlay Project Valuation= _ �' Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ® "*' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: 6d'I-ull ❑Crawl /❑Walkout ❑Other Basement Finished Area(sq.ft.) A Basement Unfinished Area(sq.ft) Number of Baths: Full:existing f new 2/ Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count rl— Heat Type and Fuel: ❑Gas it ❑Electric ❑Other Central Air: ❑Yes W Kb_ Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Wexisting ❑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 Address ALL ( '�c::� _I� License# nn�g Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO } SIGNATURE DATE FOR OFFICIAL USE ONLY, r i PERMIT NO. �. 1 DATE ISSUED MAP/PARCEL NO. r , i ADDRESS VILLAGE. OWNER DATE OF INSPECTION: FOUNDATION,f uba 3 26 d FRAME oK- i INSULATION (Z) 1 o a7 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL -' FINAL BUILDING t t DATE CLOSED OUT ASSOCIATION PLAN NO. ,w Town of Barnstable Building Department - 200 Main Street t BARNSTABLE. * Hyannis, MA 02601 9 MASS i639. , (508) 862-4038 RFD MA'S A Certificate of Occupancy Application Number: 200700529 CO Number: 20070158 Parcel ID: 191005 CO Issue Date: 07124107 Location: 599 OLD STAGE ROAD Zoning Classification: RESIDENCE C DISTRICT Village: CENTERVILLE Gen Contractor: ALBERT ROY BROWN Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: Y/o Building Department Signature Date Signed T WN OF BARNSTABLEBuilding TNE� O �► Application Red Y �.�: 200700520 BARNSTASLE, Dale 02/20/07 Issue , Permit 9 MASS Q� 039. Applicant k.,`ALBERT ROY BROWN i APermit Number: B_ 20070323 Proposed Use: SINGLE FAMILY HOME xY Expiration Date: 08/20/07 :r Location 599 OLD STAGE ROAD Zoning District RC Permit Type _RESIDENTIAL ADDITION/ALTERATIO Map Parcel 191005 ;' Permit Fee$ 364.90 Contractor• ALBERT ROY BROWN . Village CENTERVILLE ,, `�: ,App Fee$ 50.00 License Num. 065525 b .: Est Construction Cost$ .'89,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REPAIR FIRE DAMAGE,INSULATE,SHEETROCK ECT. BRING TO C DEI'HIS'CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: HINCKLEY, ROBERT W BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: z 599 OLD STAGE RD %t, < , INSPECTION HAS BEEN MADE. CENTERVILLE, MA 02632 Application Entered by: JL Ufa Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREETIALLYOR SIDEWALK OR. ANYPARTTHEg'4tITIWR TEMPORARILY ORPERMANENTLY.'. ENCROACHEMENTS ON PUBLIC PROPERTY,,NOT.SPEC IFICALLY PERMITTED UNDER:TH BUILDING CODE,'MUST BE APPROVED BY THE JURISDICTION. STREET ORALLY GRADES.AS WELL AS DEPTH,AND LOCATIQIL OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF'PUBLIC WORKS..: THE ISSUANCE OF THIS PERMIT DOES NOT:RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION�ONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR?eLli CONTSTRUCTION WORK: l,'_FOUNDATION OR FOOTINGS. l` 2.ALL FIREPLACES MUST BE INSPECTED AT THE'T1IROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED-PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS_.(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY r WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. {, WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND V0164F,CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE PERSONS CONTRACTING WITH UNREGISTERED'CONTRACTOItS DONOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). ` k BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 =r•ar< 5 � �07 1 �J � 1 3 1 .Heating Inspeccttion rovals Engineering Dept fi" /� � (s � s 714 o re Dept 2 Bo rid o Health rA re�ll� 0-1 —O-7 tl 1 � The Commonweatth ofMassachuseas Department'oflndustrial Accidents " 0 ee o Iri . � f� f vestigations• . ' 600 Washington;Street Boston,JVL4 02111' wwtv.massgov/dia ' - WorkersrCompensation Insurance Affidavit; Boulders/Contractors/Eleetrician Applicant Information s/pZu L e eris Please Prnt Name(Business/Orgmiiadom/individual)' ` Address: L- 'o LIP % City/,Statelip: Phone. Are you an e4loyer?•Checkthe appropriate box: 1;❑ I am a employer with 4, [] I am a general coiltractor and I :Type of project(required); P.07ees(full and/or part time),*. •have hiredthe stab-contractors 5, ❑New construction 2. am a'sole.psoprzetor or' listed on the-attached sheet; 7. emod ' ®� ehng ship and have no employees . These sub-contractors have -Working for me in azy capacity, employeeo and have workers'. 8. []Demolition. [No workers' comp.insurance comp, insurance,$' 9. []Building addition requited] 5: [] We are i co'rporation and its 10.(]Blectrical repairs oz"additions `3:[]I a=a homeowner-,doing-all.work .- ----officers-have exercised their • myselfi[No workers'comb, right df exemption per MGL• 11:0 Plumbing repairs or additions insurance•required]t c. 152, §1(4), and have no'. 12.[]Roof repaizs . employees, [No workers' ..13:[]Other ' eorup,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 woik and then hire outside contractors must submit a new affidayitmdicatin eemployees'the $Contractors that check this box must attached an additionalAcet showing the name of the sub-contractors and state whether ornotthose entities have employees, Ifthesub-conkaatorshav they must provid'ethekWOrkers'comp.policy,number. lam an employer•that is providing workers'compensation insurance for my irifarmadon. employees. Below is.the policy and fob site' Insurance ConTany Name Policy#or Self-ins.Lic, Expiration Date: ------------ Job Site Address ' City/State/Zip; Attach a copy of the workers' cgmpensation policy declaration page'(showing the policy number and expiration date),Failure,to-secure coverage as required under Section 25A.ofMGL c. 152 can lead to the imposition of criminal penalties of a fine t $ 50.00,00 and/or one-year imprisonment;as weld 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 maybe e forwarded to Investi ations of MA for insurance covera a verification, ' y tlte'Offtce of I do hereby cerii under the pain nd penalties of perjury that the in prgvided above is true and correct. Si Date: Phone#; _ Official rise only. Do not Write in this area,tb be completed by city or toxftc official City or Town:` Bermit/License# . Issuing Authority(circle one):' .'1.Board of Health 2,Building Department 3., City/Town Clerk 4,Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone# Massachusetts GeneralZaws chapter.152 requires all employers to provide workers' compensationfor then employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any.contract of hire, express or implied, oral or written." An employer is defined as"an iudividual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a•deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,Employing employees, However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do rnainteOnce,construction or repair work on such dwelling house or on the.grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states tbat"every state or local licensing agency shall withhold the issuance or rendwal of a license or permit to'operate a business or to construct buildings%a the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required,". Additionany,MdL ahapter_152,§25C(7.)states`TIeithei the commonwealth nor any of its political subdivisions shall enter into any contract for,the perfm rice of pnblic•.work untii aceeptib}e evi 8M0`•of conlplia=i-e tyithtl�e in e' requirements of this chapter have been presented'to the contracting authority,' Applicants • , Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your sitaation and,if necessary,supply sub-contiactor(s)name($),address(es)and phone number(s)along with their cerdficate(s) of insurance. Limited•Liability,Companies'(LLC) or Limited Liability Partuershipa(LLP)with no'employees other than the nembers'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ' Accidents for confirmation of insurance coverage. Alsb be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents, Should you have any questions regarding the law-or if you are required to obtain a workers' compensation.policy,please call the Department at the number listed.below. Self-insured companies should enter their . self-insurance license number on the appropriate'lino. City or Towvi Officials Please be sure that the affidavit is complete'and printed legibly. The Deparhnerlt has provided a space at the bottom of the•affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a refereiice number,' In.addition,an applicant that must submit multiple permitIcense applications in any given year,need only submit on;affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"a.Vocaiions in the town)."A copy of the affidavit tbat•has been officially stamped or markddby the city or town maybe provided to the applicant as proof-that a valid affidavit is on file for future permits or licenses. A new affidavit must be fill ed out each year.Where a home owner or citizen is obtaining a license or permit not relate.dfo any business or commercial venture (i.e. a dog license or permit to bumleaves•etc.)said persbA is-NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for.your cooperation and shou'id you have-anYquestions, please'do not hesitate to givens a call. TheDepaxt=nt's address,telephone•and fax numben. The commwwth OfMusack t'S WashihgkM StMO on,MA 02111 TO.9 617-727-4kO mt 406 of 1-8 -Af.ASSAIFB Fox#617- 27-7 0 Revised I1-22,05. � .��� . r of , Regulatory Services. L sr iE,$ Thomas F,Geiler,Director 9�bpT fp ,�`�• Building Division Tom.Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.towA,barnstable,ma,us , fice: 508-862-4039 Fax: 508-190-6230 Permit no. Date AFFIDAVIT HOME Ily2ROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requires that the"reconstruction,alterations,renovatiori,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 wbich'are adj acent to \ such residence or building be done by registered contractors,with certain exceptions,along with other requirements- O lt kType of Work: Estimated Cost Address of Work:. Owner's Name: Date of Application I hereby certify that: Registratign is not required for the following reason(s); Work excluded by law FjJob Under$1,000 C]Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: ()VnRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PBRNRY I hereby apply for a permit as the agent of the Date Contrac r Signature Registration.No. OR Date Owner's Signature Q:v�files.fQrms:homeafndzv Rev: 060606 3 of HE Town'of Barnstable Regulatory Services MAASS.. snxMSS Thomas F:Geller,Director 9 E 6.39. a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ffice: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) W Signature of Owner Date �� o loy��- V✓ �; �, ck1 Print Name Q:FORMS:OVNMRPERMISSION Permit# Permit Date 0 REScheck Software Version 3.7.3 Compliance Certificate \1f Project Title: Hinckley Project Report Date:02/01/07 Data filename:Untitled.rck Energy Code: 2000 IECC Location: Barnstable,Massachusetts Construction Type: Single Family Glazing Area Percentage: 8% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor: 599 Old Stage Road Centerville,MA o2632 -13 . .'• rD l Q +>;• �•• Ceiling 1:Flat Ceiling or Scissor Truss: 500 19.0 0.0 26 Wall 1:Wood Frame,16•o.c.: J1760 13.0 0.0 131 Window 1:Vinyl Frame:Double Pane with Low-E: 108 0.340 37 Door 1:Solid: 21 0.360 8 Door 2:Glass: 36 0.340 12 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space: 900 19.0 0.0 42 Compliance Statement:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 3.7.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Builder/Designer Company Name Date Hinckley Project Page 1"of 4 THEri Town of Barnstable Regulatory Services 9s"xr'MASL Thomas F. Geiler,Director 16;9;.,a`� Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 PLAN REVIEW Owner: h c.k f ey Map/Parcel: /41 WE Project Address Sqq 0 IJ S 0d Builder: rOw The following items were noted on reviewing: ~ l 6 dsA-e-c+v.,_ u f-JeA per I Reviewed by: r Date: -9106 7 - 2-)g/67 Q:Forms:Plnrvw BOISE' Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301 BC CALCO 9.3 Design Report-US 1 span I No cantilevers 0/12 slope Monday, February 05,2007 10:43 Build 057 File Name: BC CALC Project Job Name: 599 Old Stage Rd Description: girt carring second floor Address: 599 Old Stage Rd Specifier: Bill Campbell City, State,Zip: Centerville, Ma Designer: Customer: Roy Brown Company: Shepley Wood Products Code reports: ESR-1040 Misc: IF A It T 1 17-00-00 BO,3-1/2" B1,3-1/2" LL 3060 Ibs LL 3060 Ibs DL 1169 Ibs 'DL 1169 Ibs Total Horizontal Product Length=17-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area(psf) Left 00-00-00 17-00-00 30 10 12-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 17017 ft-Ibs 53.3% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 3592 Ibs 30.3% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U347.(0.572") 69.2% 1 1 output as evidence of suitability for Live Load Defl. U480 (0.414") 75.1% 1 1 particular application.Output here based Max Defl. 0.572" 57.2% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 16.7 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 4229 Ibs 47.6% 46.0% Spruce-Pine-Fir ask questions,please call (8 B1 Post 3-1/2"x 3-1/2" 4229 Ibs 47.6% 46.0% Spruce-Pine-Fir 00)232-0788 before installation. BC CALCO, BC FRAMERO,AJS-, Cautions ALLJOIST® BC RIM BOARD- BCIO, BOISE GLULAMT"^ SIMPLE FRAMING Member is not fully supported at post BO. A connector is required at this bearing. SYSTEMO,VERSA-LAMO,VERSA-RIM Column at Bearing BO analyzed for bearing only, column analysis has not been performed. PLUS@,VERSA-RIM@, Member is not fully supported at post B1. A connector is required at this bearing. VERSA-STRAND@,VERSA-STUD@ are Column at Bearing B1 analyzed for bearing only,column analysis has not been performed. trademarks of Boise Wood Products, L.L.C. Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. User Notes Bed room floor load only Connection Diagram b d a • • • c • �• - e o 0 077 ,77 a minimum=2" c=7-7/8" b minimum= 3" d = 12" e minimum= 3" Nailing schedule applies to both sides of the member. Member has no side loads. age gtoorff?re: 16d Common Nails Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam11713O2 BC CALC@ 9.3 Design Report-US 1 span No cantilevers 0/12 slope Monday, February 05,2007 10:43 Build 057 File Name: BC CALC Project Job Name: 599 Old Stage Rd Description: girt carrying second floor Address: 599 Old Stage Rd Specifier: Bill Campbell City, State,Zip: Centerville, Ma Designer: Customer: Roy Brown Company: Shepley Wood Products Code reports: ESR-1040 Misc: _1 wx1» .•.4•lv g. •ixY. -r1�1.• n..d •. .d 13-00-00 BO,3-1/2" B1,3-1/2" LL 2145 Ibs LL 2145 Ibs DL 791 Ibs DL 791 Ibs Total Horizontal Product Lengthy'-_13-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area(psf) Left 00-00-00 13-00-00 30 10 11-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 8881 ft-Ibs 41.7% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 2357 Ibs 29.9% 100% 1 1 - Left be verified by anyone who would rely on Total Load Defl. L/585 (0.257") 41.0% 1 1 output as evidence of suitability for Live Load Defl. L/800 (0.188") 45.0% 1 1 particular application.Output here based 0.257" 25.7% 1 1 on building code-accepted design Max Defl. Span/Depth 0.25 1 properties and analysis methods. p p n Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 2936 Ibs 33.1% 32.0% Spruce-Pine-Fir (8 ask questions,please call B1 Post 3-1/2"x 3-1/2" 2936 Ibs 33.1% 32.0% Spruce-Pine-Fir 00)232-0788 before installation. BC CALC®, BC FRAMER®,AJSTM, Cautions ALLJOIST@, BC RIM BOARDTM BCI@, BOISE GLULAMT"' SIMPLE FRAMING Column at Bearing BO analyzed for bearing only,column analysis has not been performed. SYSTEM@,VERSA-LAM@,VERSA-RIM Column at Bearing B1 analyzed for bearing only,column analysis has not been performed. PLUS@,VERSA-RIM@, VERSA-STRANDS,VERSA-STUD@ are Notes trademarks of Boise Wood Products, Design meets Code minimum(L/240)Total load deflection criteria. L.L.C. Design meets Code minimum(L/360) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. User Notes Bed room load only Connection Diagram b d a c a minimum=2" c=7-7/8" b minimum= 3" d = 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 BOISE- Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301 BC CALCO 9.3 Design Report-US 1 span I No cantilevers 1 0/12 slope Monday, February 05, 2007 10:42 Build 057 File Name: BC CALC Project Job Name: 599 Old Stage Rd Description: girt carring second floor Address: 599 Old Stage Rd Specifier: Bill Campbell City, State,Zip: Centerville, Ma Designer: Customer: Roy Brown Company: Shepley Wood Products Code reports: ESR-1040 Misc: 01 u 17-00-Oo BO,3-1/2" B1,3-1/2" LL 3060 Ibs LL 3060 Ibs DL 1169 Ibs DL 1169 Ibs Total Horizontal Product Length=17-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area(psf) Left 00-00-00 , 17-00-00 30 10 12-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 17017 ft-Ibs 53.3% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 3592 Ibs 30.3% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U347 (0.572") 69.2% 1 1 output as evidence of suitability for Live Load Defl. U480 (0.414") 75.1% 1 1 particular application.Output here based Max Defl. 0.572" 57.2% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 16.7 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 4229 Ibs 47.6% 46.0% Spruce-Pine-Fir ask questions, please call (8 B1 Post 3-1/2"x 3-1/2" 4229 lbs 47.6% 46.0% Spruce-Pine-Fir 00)232-0788 before installation. BC CALCO, BC FRAMER@,AJSTM, Cautions ALLJOISTO, BC RIM BOARDTM,BCI@, BOISE GLULAMT"' SIMPLE FRAMING Member is not fully supported at post BO. A connector is required at this bearing. SYSTEM@,VERSA-LAM@,VERSA-RIM Column at Bearing.BO analyzed for bearing only, column analysis has not been performed. PLUS@,VERSA-RIM@, Member is not fully supported at post B1. A connector is required at this bearing. VERSA-STRANDO,VERSA-STUD@ are Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. trademarks of Boise Wood Products, L.L.C. Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. User Notes Bed room floor load only Connection Diagram b d a • • • c e 0 0 0 a minimum=2" c=7-7/8" b minimum= 3" d= 12" e minimum= 3" Nailing schedule applies to both sides of the member. Member has no side loads. Page Yoorf re: 16d Common Nails r ,per fie t°jomvmoouuea o�✓�aaaac�Zwaz Board of Building Regulations and Standards HOME Ilq..ROVE T CONTRACTOR Wra4iQtt; D21/2008 ALBERT ROY Btu, h1 AIR ALBERT BROWI ,`ti" =F 34 HORATIO LN I CENTERVILLE,MA 02632 Deputy Administrator �. t �`ce �om�noozuiea� o�✓�aaoaclu,�aelk BOARb OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r Numb 065525 Birt-hda- _ 942 ` xp�cg '0 /12730 Tr.no: 16902. RE 5tred ,' ` 1 ALIKE R BMgl 34 HORA LN ' CENT ERVILL2(32 � ! Commissioner I . j IMP®RTANT ® UPGRADE REQUIRE® SMOKE D TECTQR REVIEWED STATE BUILDING CODE REQUIRES THE UPGRADING OF 07 SMOKE DETECTORS FOR THE ENTIRE MNELLING UIfM A UILDING D�E T DATE ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. E R FOR THE - [S REWiRE13 . PERMIT NOTE: A SEPARATE _THE ELECTRICAL . SMO KE KE DETECTORS INSTALLATION OF IN FIRE DEPARTMENTDATE �SATISFY THIS REQUIREMENT. BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 1. Install new support header, 3 12 Ivls. See engineering specs pp " ' .. 2. Install new support header, 212"Ivl's. See engineering specs o 3. Reframe bathroom walls, existing were 2X3 studs, 24°o% new 2X4 studs 160% a 4&5. Reframe most of second floor, existing 2X3 framing, new to be 2X4, 160% Smoke detectors=green Carbon detectors=blue - tCIOsM� w..,� �,-- 1? a 4. a t 4. st I LZY � R .. ` * - �,-tom`•` AS 26.2 ell �,ice' •, ^ PLAT PLi4N_ I,E CERrIAP ] 1�//t/ /.3A�Pl�f 5TA COMUL {{ o., cos D4i�J t1 BY L/.9M CAPE-L L�k'O; ''9 q C3 R G'P:.,' SCALE $a DATE �/i S�83 ..R�L': PSPG +' .. ► . HEREBY CERTIFY THAT THE -ABOVE LWELLING IS -MCATT ON THE ORt3UAD .SHt9KN.THAT •.IT' CONPORUBD .TO-THE TOWN'S ZONING SETBACK- MOVI,A11% - 8 ; ±"AT...' E .T .IT`W S CONSTftCCTTsD AND THAT THIS MORMON INSPECTZW NAS ..4* ; . . ;:- � FgtI Sl4 •ACC. Ddli�CE WITH THE TECHAICAL STANDARDS Fait MQR' AtB AN 1"PECTION9 At ADOPTED. BY THE MASSACHUSE TTS .ASSOGIAT,lQN-0P :-LkND._. -SURVE Yolk �707ITYZNGIN) -S INCORPORATED. `. TN/s ,Uc",Ftt-nje' Is AlorJAI VE 4Z44 13RAW 't C TOP T DATE �A.G CARE LAI+V�7 COWSuMoodUA s . - y i PARCEL 11): „r N 191/009 PARCEL D. 1$1/186 79.23 $ PARCEL ID: 191/008 Act PARCEL� fC��C mot/ J - PARCEL ID: O 191/005 r _ D �DR. GRAB/ n � � • �95 � 9 t � zG) o :1rn PARCEL ID: 191/004 Q D i Cmnwy'MAT 7m iWRi"m DWWM PLAN VMS FM PMED IN ACCORDANCE SM ffi0 OR MCI=GAS OF IM MASPMEEM RULIM a RMULAIM FOR in PRACME OF LAND S W&-VM IM 8MCIM SOW IS WL AFFEM BY A SPBOA.FLOOD NAIARD AREA AND DOES cmwm TO Im LOCAL BY-LAND IN O F=AT IM IM OF C016' MON UM RUN=70 SICK AMMOMM OR 6 EMMi FROM 1N%K1 !}EWORCOEENT ACTION Lqm UWAAaHUSE7 604 RILL lAY6 CNAP18t 4QJ1 S�Ildl 7 RfFt70NCE0 O�S1t8d8.T 70 AND BtAI 710:BENS li Of ALL R8in5� .L�f'WAY. AND OF'RN�O M F ANY 7lOa BF M wwAR AS in sqw Aim Orr LEGAL FORCE AND EFFEf:f. � #W9 OLD STAGE ROAD TOWN: 13MNSTABLE (CENTfiRVILLE) HATE: 10/25/12 : :.._ -•_ ,: .._ APPLICANTS: MICIiAEL & AMANDA DEFAZIO CERTIFY TO: CAPE COD COOPERATIVE BANK SCALE: 1 n=80' 5. x, ��, = was TITLE REF: 3786/Z67 MacDougall Surveyinc r PLAN REF s0O & Associates ED'tj�iA.rRD FLOOD ZONE: C' A. COMMUNM PANEL: P.O. Box 2428- +.�.�"` c; Ci �ti �Q01�a� 5-C C Ma Mo. 02641 DATED: 08/19/85 KC-2- ' � � CURRENT ZONING "RC' Ph- ( } 508 419-1086 fax. (5M)419-1087 emd: macdougd1survey JOB# 10921 Ommcastnet i� V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '�1 Parcel Application#' Health Division - Conservation Division Permit# Tax Collector Date Issued'- Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village aAkra Owner hDLbM,- Address auzao a—:5 o , Telephone Permit Request �n Square feet: 1st floor:existing_ proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay CD Project Valuation 0 Constructiori Type �$"B Lot Size :: l._"7 [25 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. M V• / Dwelling Type: Sing l 6&7E:tmily 2 Two Family ❑ Multi-Family(#unitZo� On Age�of Existing Structure Historic House: 0 Yes Old King's Highway: ❑Yes o 3 Basementc,Npe: Aull ❑Crawl ❑Walkout ❑Other i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing c,—new Half:existing new Number of Bedrooms: existing 13 new Total Room Count(not including baths):existing new First Floor Room Count .2 Heat Type and Fuel: Yas ❑Oil 0 Electric 0 Other Central Air: ❑Yes Mko Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes W►Vo Detached garage:W"existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:0 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 DU Telephone Number + Address j4 �400cfib kcne License# n f'c,hl� o)!q Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING ® 7 ZY I0'7 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 .�� www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Elect Applicant Information Please Print Le 'bl UJ Name(Business/Organization/Individual): . Address: T l 6 13 City/State/Zip: ( i(�,/L 0 t.(-Le Phone.#: Are you an employer? Check the appropriate bog: �� Type of project(required):. 1.❑ I am to er with 4. I am a general contractor and I n►P Y 1 6. ❑New construction . loyees (full and/or part-time).* have hired the sub-contractors listed on the'attached sheet. 7. ❑Remodeling 2. I am a'sole proprietor or partner- r ship and have no employees These sub-contractors have 8. 0 Demolition workin for me in an capacity. employees and have workers' g Y P tY• �. 9.: Q Building addition [No workers' comp.insurance comp.insurance. 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 fin 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 be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certify under the p d penalties of perjury that the information provided above is true and correct Si afore: Date: t _ Phone#: Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and I Aructions Massachusetts General Laws chapter 152 requires all employers to pr vide workers'compensation for their employees. Pursuant to this, statute,an employee is defined as"...every person' e service of another under any contract of hire, express or imped,oral or written" An employWisr°defined as"an individual,partnership, associatio corporation or other legal entity,or any two_or more of the foregoing.,ngaged in a joint enterprise,and including the gal representatives of a deceased employer,or the receiver or truste of an individual,partnership, association or o er legal entity,employing employees. However the owner of a dwe ` g house having not more than three apartme is and who resides therein,or the occupant of the dwelling house of other who employs persons to do maim ante,construction or repair work on such dwelling house or on the grounds o building appurtenant thereto shall not b cause of such employment be-deemed to bean employer." MGL chapter 152, §2 C(6,1 also states that"every state local licensing agency shall withhold the issuance or renewal of a license o 'ermit to'operate a business o to construct buildings in the commonwealth for any applicant who has not oduced"acceptable evident of compliance with the insurance coverage required." Additionally,MGL chapt �'152, §25C('n states"Nei er the commonwealth nor any of its political subdivisions shall enter into any contract for. `';performance of publi work until acceptable evidence of compliance with the inS�ance requirements of this chapter " e been presented't the contracting authority." Applicants Please fill out the workers'compe ation affida 't completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)ne(s), ad- ess(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companie " LC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to c orkers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised t this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance cove a . Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the applic do or the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any estio egarding the law or if you are required to obtain a workers' compensation policy,please call the Dep ent at the .ber listed below. Self-insured companies should enter their self-insurance license number on the approp 'ate line. City or Town Officials i Please be sure that the affidavit is complet 'and printed legibly. a Department has provided a space at the bottom of the affidavit for you to fill out in the ev nt the Office of Investiga 5 ns has to contact you regarding the applicant. Please be sure.to fill in the permit/licens number which will be used reference number. In addition, an applicant that must submit multiple permit/licens applications in any given year,n `d only submit one affidavit indicating current policy information(if necessary) and der"Job Site Address"the applican ould write"all-locations in___ (city-or town)."A copy of the affidavit that h s been off cially stamped or marked by city or town may be provided to the applicant as proof that a valid affida 't is on file for future permits or licenses. A w affidavit must be filled out each year.where a home owner or citiz is obtaining a license or permit not related to an iness or commercial venture (i.e. a dog license or permit to b• leaves-etc.)said person is NOT required to complete ' affidavit. The Office of Investigations woul like to thank you in advance for your cooperation and sho 'd you have any questions, please do not hesitate to give us a The Department's address,telepho 'and fax number:. Thar Commonwealth of MassaGhusettts. � Department of Industrial Accidents Office of Investigations 600 Washingttcm Street Boston,MA 02111 Tel. 617-727-4900 ext 406 or 1-877 MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.rnass.go-v/dia Town-of Barnstable Regulatory Services t IBI STASM Thomas F.Geiler,Director MASS. g 19. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT' HOME MROVEMENT 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. T e of Work Estimated Cost•- � . yP ,kddress of Work: �Q � �� �� C�� ►7�j2,'J g_ Owner's Name; Date of Application: I hereby certify that: P Registration is not required for the following reason(s) ❑Work excluded by law ❑lob Under$1,000 QBuilding not owner-occupied• ❑Owner.pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWhT PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR AFPLICAI�LE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE AREITRATION 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: 7- i3-o7 Date Contractor Name Registration No. OR Date Owner's Name Q:f=1s:hameafJ"3dav s r 2 6 3 t BOARD OF BUILDING REGULATIONS { License: CONSTRUCTION SUPERVISOR .`' 065525 Number:.CS i gird date,0y12J1942 =j Expires 02112/2008 Tr.no: 16902 Restricted s#�0� �,; ALBE BROWN ` RT R .; � � I' 34 HORAVIILLE E, MA 02632` commissioner # CENTER = yO "°f QuitofllV�gZ`ae2 a E iMp Rrb'uiati " ROE °n an Regist,, MF s d St FXpir tap. 1 41�T CONTRgCTOdnrd, l q�CeFRT ROY TYpe; 6/21/2p08 R BFRT B BR0 SBA CFN ORAr1�N N Nh�MFRFpgiR iLCE Mq 02632 \ Deputy A� _ mrnistratOr -. ' t 1FZ ." Palsy 'cra /,'iPl�fST/98L�" Oak By AF M (::f'AP ; nc C/i 5�83 HEREBY PERTIFY THAT THE -ABOVE. MELDING IS WCATM ON THE (;ROU " .5HMNt THAT :IT- CONFORMED TO-THE TOWN'S ZONING .SETBACK- MWITATIONS ; IM IT. WAS '000TRUCTED AND THAT THIS NCHtGAOR INSPECTI.C9. WAS'' "IN .ACC_ORDANcz WITH THE TECHNICAL STANDARDS FOR 1101t%iOl it ; �..•':... r r/. LOAN ISOPWTION9 At ADOPTED. BY THE MAS SACHUS ETTS .AS S0CIAT1QR OF J1 ,D . S�SRI�EYoA ICI ERGIN •S INCORPORATED. _ .. . 7XlE 41ao13Al1u ' ':� C TOP T DATE 6/i S`IYF TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Nk Map / Parcel V y Application Health Division Conservation Division Permit# Tax Collector Date Issued !6 Treasurer Application Fee S6 Planning Dept. Permit Fee c)?5 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owner Address Telephone Permit Request Square feet: 1 st floor:existing �"y6 proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay P-roj�i�l aatic�&. 666 b® Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )4 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type:gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) number of Baths: Full:existing l new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing /�i new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes -Ji(No Fireplaces: Existing New Existing wood/coal stove: 4-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: v. N' -n M, _ E Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ �41 Commercial ❑Yes ❑No If yes, site plan review# 0 Current Use q*qse R' BUILDER INFORMATION A F[Address nl bTelephone Number . �- a :�VA b COI , T9 C License# OR"'I i&Q4(� _1190( Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE L DATE o? 7— L (o f FOR OFFICIAL USE ONLY 4 1 PERMIT NO. DATE ISSUED MAP/PARCEL NO. k ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL , FINAL BUILDING I DATE CLOSED OUT ASSOCIATION PLAN NO. i b41 T ,O�ti Town of Barnstable Regulatory Services BAHNSTABLL : Thomas F.Geiler,Director MASS. 039. Building Division rED N1A'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION g r� r� Please Print j[HOMEO)vVNEW':",ZLL-r TE: O� / o(p V C�1 '�(4 M,4 O�<� B LOCATION: s7 0�(Q SEA�J� �Q �l�Jo number street �3,� < village �Jo I u*`C�h) —name home phone# work phone# RRENT 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 7;ire,mmeAnts. LA 4 —`Sig ature 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. F Q:forms:homeexempt / E � 1 v TV is v a Jv s•aa J6&1j a w Regulatory Services ss ,�* Thomas F.Geiler,Director Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ww vv.town..b arnstabl e.ma.us fice: 508-862-4038 Fax; 508-790-6230 Permit no. Date AFFIDAVIT HOME IlVIPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142Arequires 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 excep eons,along wfta other requirements. Type kJ +u�� �, 01— ub t�� I�cK timated_Cost Address-of Woik: a�1 ©/� XT4 bate-of°Apt I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 uildingnot owner*occupied . Ov n r pulling o�vn peimit�,, Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERMRY I hereby apply for a permit as the agent of the owner; Date Contractor Signature Registration No. R la a. ate .wner's,zSignate u' Q;wpfiles.farms:home�dxv . Rev: 06060b ' The Commonwealth of Massachusetts Department of Industrial Accidents S a Office of Investigations . 600 Washington Street Boston,MA 02111, wtivw.mass.gov/dia ' Workers}Compensation Insurance Affiddvit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual) lit :A/G Address: City/State/Zip: Ce, ,�6WC � Phone.#:_�j0i' adb �3y� ° )!Are you an employer?Check the appropriate bag: :Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* , have hired the sub-contractors 6. ❑New construction . • • 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship.and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' co insurance$' 9. 0 Builrling addition [No workers' comp,insurance comp. required.] 5. ❑ We area corporation and its 10.❑•Blectrical repairs or additions officers have exercised their " . ''3�I am a homeowner doing ill-work . 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 13.❑ Other employees. [No workers' 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 anew affidavit indicating 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 employees,they must provide their workers'comp,policy number. lam 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 tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the bIA for insurance covera>e verification Ado here—byyccerrtti� un the ains nd pe al 'e of�e u that the information provided above is true and correct. Surer / Date: /0�1 '� _ Phone# Official use only. Do not write in this area, to be completed by,city or town of City or Town: ' Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a-deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenan e,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not becaus of such employment be deemed to be an employer." MGL chapter 152, §1SC(6)also states that"every state or local li� ensing agency shall withhold the issuance or renewal of a license or rmit to'operate a business or to construct buildings in the commonwealth for•any applicant who has not pro. uced,acceptable evidence of compli nce with the insurance coverage required." . AdditionaIly,MGL ehapter..1 §25C(7)states"Neither the co onwealth nor any of its political subdivisions shall enter into any contract for•the pe rmaace of public-work until ac eptable evidence.of•cornpliarice vyithtlie insurance• requirements of this chapter have b n presented•to the contracting authority." Applicants Please fill out the workers' compensation a \11 letely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),a and phon number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLCed Liabili Partnerships(LLP)with no employees other than the members'or partners,are not required to carryomr nsa 'on insurance. If an LLC or LLP does have employees, a policy is required. Be advised thvit ma be submitted to the Department of Industrial Accidents for confirmation of insurance cover sure o sign and date the affidavit. The affidavit should be returned to the city or town that the applicae pe 't. r license is being requested,not the Department of Industrial Accidents. Should you have any questions regardin a law or if you are required to obtain a workers,' compensation policy,please call the Department at the number ed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed Iegibl , The\haent has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of estigati o contact you regarding the applicant. Please be sure to fill in the permit/license number which be usedfs nce number. In addition,an applicant that must submit multiple permit/license applications in an given yed o submit one affidavit indicating current policy information(if necessary)and under"Job Site Ad ss"the at shou write"all locations in city-or town)."A copy of the affidavit that has been officially st ed or my the ci. or town maybe provided to the applicant as proof that a valid affidavit is on file for a permits ores, A ne ffrdavit must be filled out each year.Where a home owner or citizen is obtaining a lic a or permitlated fo any iness or commercial venture (i.e. a dog license or permit to bum leaves•etc.)said p rson is NOT rd to complete affidavit.The Office of Investigations would like to thank yo in advance for operation and sh uld you have-any questions, please'do not hesitate to give us a call. The Depg ment's address,telephone-and fax n er:. The C oiaw ith of .assachusetts D .. ent of ladustdal Accidents ' Off!"of Invest tions ' f�4 R�as� �g Street • B(? ton M 02111 • . T,e,1. 617-727 444.0 ext 406 or 1477-MASSAFE Fax 4 617-727-7`-49 Revised 11-22-06 www,mamgov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION l ilz�/a� Map Parcel r c - }}11(p�, Application# ,L Health Division r Conservation Division bv Z+ f "`` 3 Permit# Tax Collector Date Issued . Treasurer � i'ti ;;l09 Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -T 91 6 ld 514! t'l-& Village t CL� `�i Owner uT !e-11724 Address �'If Q lc� ��— Telephone 9 1i- 'Permit Request < TIACE I J0 60 w+b 40 1AJ 4:11,ill< Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: Cl 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 O 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/,IN-F,O�RMATION Name }'f4L,-i4•-t on, o!6 4 -ram���!/ '1[�'Yelephone Number 1 Address �1 O MC&U License# 6'�Z 11 � _E Wiest ` �'l 1��1 Home Improvement Contractor# -3 'F<-- Worker's Compensation# Q C qq- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO NO rr S /t7 I ,9 SIGNATURE DATE fI� /y� v' FOR OFFICIAL USE ONLY ? PERMIT NO. r DATE ISSUED MAP/PARCEL NO. ' r - • ADDRESS VILLAGE r OWNER i 1 DATE OF INSPECTION: FOUNDATION FRAME INSULATION R FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s k GAS: ROUGH FINAL f. F FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth-ofMassachusetts E ; Department of Industrial Accidents t f Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: r-I City/State/Zip F t✓ ./c!hu� 'l VA4. 411 T1 Phono k- Are you an employer? Check the appropriate bog: Type of project(required): 1,[Tam a employer with_. _. 4, El am a general contractor and I employees(full and/or part-time),*- - have hired the'sub-contractors 6. ❑New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity, workers' comp;insurance, 9. ❑Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.j]Electrical repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11,17 Plumbing repairs or additions myself. [No workers' pomp. - e, 152, §1(4), and we have no 12,❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13,❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp,policy information. am an employer that is providing workers'com nformation. pensation insurance foamy employees. Below is the policy and job site . assurance Company Name: Ti 3L.,,4,,cF 'olicy#or Self-ins,Lic:#:_ 1�/��� �� ��• (� Expiration Date: �j( �f Q 7 ob Site Address: V5 d iJ- S-P41 E V-d— City/State/Zip: 'Ay STD attach a copy of the workers' compensation policy declaration page (showing the-policy number and expiration date). . ailure to.secure coverage as required under Section 25A of MGL e, 152 can lead to the imposition of criminal penalties of a , ine 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office.of nvestigations of the DIA for insurance coverage'verification. 'do hereby ceerrtify,9nder thepains andpenalties ofperjury that the information provided above is true and correct i afore: ��✓/ �- Date: !t`b 'hone#: 7 �— 3 l 0 3 3 Official use only, Do not write in this area,,to be completed by city or town ofjiciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: information and Instructions �. Massachusetts General Laws chapter.152 requires all employers to provide workers'compensation for their employees, pursuant to this statute, an employee is defined as"...every person in the.service of another under any contract of hire, express or implied,oral or written." An emplo r is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the forego g engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trust of an individual;partnership,association or other legal entity,employing employees.'However the owner of a dwellinghcuse having not more than three apartments,,and who resides therein,or the occupant of the dwelling house of anof4er who employs persons to do maiuten ce,construction or repair work on such dwelling house or on the grounds or buiing appurtenant thereto shall not bee se of such employment be deemed to bean employer," . MGL chapter 152-, §25C(6)also tates that"every state or to al licensing agency shall withhold the issuance or renewal of a license or permit to \abusinessess or to c nstruct buildings in the commonwealth for any applicant who has not produced aence of co pliance with the insurance coverage required." Additionally,MGL chapter 152,§2either the mmonwealth nor any pf its political subdivisions shall enter into any contract for the perfohe work un acceptable evidence of compliance with the insurance requirements of this chapter have bethe contrating authority," Applicants Please fill out the workers' compensation affidavit complet ,by cheoking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and ne ri=ber(s) along with their certificates)of insurance, Limited Liability Companies(LLC)or.Limited Li ilu�ty artnerships(LLP)with no employees other than the ' co sa' s ce an L r LL doeshave ed to a workers m tion uran , If LC o P ers are not required p members or partners, qu carry employees,a policy.is required. Be advised that this affidavit ay be su'mitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be re to sign an ate the affidavit. The affidavit should be returned to the city or town that the application for the pe t or license is be requested,not the Department of Industrial Accidents, Should you have any questions regaz g the law or if you are equired to obtain a workers' compensation policy,please call the Department at the n er listed below. Self-insur 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 I ibly, The Department has provided a space at ' bottom of the affidavit for you to fill.out in the event the Office f Investigations has to contact you regarding the app t. Please be sure to fill in the pennit/license number whie will be used as a reference number. In addition,an applican that must submit multiple permitllicense applications ' any given year,need only submit one affidavit indicating current. policy.information(if necessary)and under"Job Site ddress"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fu a permits or licenses. A new affidavit must be filled out each year,There a home owner or citizen is obtaining.a he nse or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said p rson is NOT required to,complete this affidavit. The Office of Investigations would like to thank you' advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address,telephone and fax number; nt3 common alth of IMas achusetts Depa ttmpt o lndwtHal Accidents Qf Ice o 7esti tiara: 600 a Street BB ostGhl:- 02111 Tel, # 617-727-4900 ext 40.6 or 1-8,77-MASSAFE - fax. frl'�-727-7'�49 Revised 5-26-05 Wwwanass 0VIdia i . Town of Barnstable sni:xsr�atE, • MASS,9� Regulatory Services piEa. p Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �d44 , as Owner of the subject property hereby authorize M � /�'!G- � G�°''� S to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name Q:Forms:expmtrg Revise071405 .A 51 Moore Road Weymouth Industrial Park East Weymouth,MA 02189 (78 1) 33 1-0333 1-800-232-9991 American Mobile Homes, Inc. Fax (781)335-0707 The Temporary Housing Specialists Est. 1972 PROPOSAL Date /1/a7 4o<o Name �Q ( {- 1 Est. delivery date Address �9�j'—�(�(ci �-fz�c� Izc� _ ytS� American Mobile Homes,Inc. hereby propose to furnish the mat vials and perform the labor necessary for the completion of installing —j3 leased mobile home containing: Refrigerator,stove,dining set,living room set,curtains,bedding Is ,2nd �]Ird I di'pt_ ,washer and dryer,wirr WTemporary Plumbing installation to mobile home rip' i lying for building permit for mobile home a "l emporary Electric installation to mobile home : emove necessary trees,tree limbs or shrubbery ❑ Temporary LP gas installation to mobile home ❑ Remove any necessary fencing ❑ Other: Any resulting damage to said property as a result of the installation,removal and existence,of mobile borne and its its utility connections shall not be the responsibility of American Mobile Homes,Inc.,specifically driveway;fence, stonewall,septic system,trees,lawn or any other type of landscape items and/or: American Mobile Homes,Inc.,is not responsible for the re-installation of any of these items. Costs: The monthly rental of the mobile home mos. The delivery and pick up charge of — Air conditioning Pet fees other There will be additional charges for utility connections,permits,fees,site preparation. There will be a profit and overhead charge of 10& 10 for all sub contractors and fees paid out. Any applicable sales tax.A 5%carrying cost will be billed and payable on all invoices not paid within 45days of billing. A$1,000.00 security de osit is due on delivery of mobile home. Uwe agree to sign a lease for the mobile home rental at,delivery. Projected job cost: SLID- nGLu L 3 rvJ� �,e11,� ��5� a,F�7ih � �S Payment Method : d1 illed directly to insurance company with a signed assignment of payment. ❑ Other: Any alteration or deviation from above specifications involving extra costs, will become an extra charge over and above the estimate. All agreements Respectfully submitted contingent upon strikes,accidents or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. If insurance company is not willing to honor assignment of payment,I/we understand I/we will be responsible for full payment of all services. NOTICE OF RIGHTS TO CANCELLATION You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office or branch thereof,provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing agreement. \ See attached notice of cancellation form for an explanation of this right. ^� G tt.✓�' 1 Signature Date I I —��— Signature iw /-t I #' Lice`nse COIRR,,IJCT O fi ` n4 Numiber� ©8'11149 Birth. : ti965 :. _ 42565; W'ILLIAA fPN'N 'HA iI MA a20 a ;� i Town ,otiv)<1 0f Barnstable• table *Permit -/� �F1HE Toti, Expires 6 months from Issue date do Regulatory Services Fee BARNSfABL& y MASS. Thomas F.Geiler,Director �Arf0MPIA`0 Btfliding Division Torn Perry, Building Conuriissiouer 200 Main Street, Ilyanrus,MA 02601 Office: 508-8G2-4038 ®PRESS :VIM Fax: 508-790-6230 EXPRESS APPLICATION - WLSIDLNTIAL )( 2005 Not Valid without Merl�'-Press Imprint TOWN OF BARNSTABLE Map/parcel Number r Property Address Value of Work VKesidential �! Owner's Name&Address P K , > Telephone Number _ Contractor's Name - Home Improvement Contractor License#(if applicable) U CI Construction Supervisor's License#(if applicable) l . ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I ajA the Homeowner lave Worker's.Compensation Insurance Insurance Company Name Workman's Comp.Policy Permit Request reek box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Gourg over existing layers of roof) wl 7 _ LQOS ❑ Re-side 1-OWN CF GARNST`*'` ❑ Replacement Windows. U-Value (niaximuur.44) ❑ Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,eta f e ' Signature CAPIZZI HOME IMPROVEMENT INC . / SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 ��a(�3 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FORA BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT INC TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: 1 APLLICANT'S SIGNATURE: ol 1,1,' � APPLICANT'S ADDRESS: 1645 NEWTOWN RD- COTUIT, MA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL # I `r Jan-06-06 03:57am Fram-AIG 9T8^818-8903 T-724 P 0021002 F�122 tr H ,4 9 4 7r r:r yr�r•�,.' I��P aQ :.t� .,'" �6'+b r •' �.. s ' ,f7��1 r i,�r:' ;r •�Ic.• _., ,T , f�x j� r r r �r� • 1:,.:.'r r, ' , 1.•� 1 t � , '� 'j,�••• '.i, r , •eet , •..j1' 1 •r,r 1�•.;r�9 n{V� �}y •�� F Jy%%%111��� ■y:�.1,y �'' 17. y �' ,y��j �.A�( ft..•.�Ir V� �1� - -J'i�rr 7'-�T :•Nr pp .c r 7 I M ■�s �"Nse" s 'r.'7']IY: r.1� .,, i r I «• w r ..� 1 r: '1/.1,ilr. F r L r. �.. ? ,tl ''u.l ,,\r11•-T''�I Ir•.� . .r„5•, tr ,i •�-x (�;. • .a 5 rr'"'.r• :''E'••" ,$y�,'•rr ��..�:.. A'�' .: :.•fir'.:i•• r,. '. �t�y � PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 2M"!,, p , ONLY AND CONFERS.NO RIGHTS UPON THE CERTIFICATE : ;` 3 '; #i Employers Ins Group Inc ! HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 201 Main Sheet,Suite 91 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 4".' Fitchburg,MA 01420 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED x 't r r;� Resou=Managaments Inc 281 Main Streak Suite 95 t Fitchburg,MA 01420 I ^.�T}'_ • tr•Tr„Y' .�.r 6!'r r ... r+wr .r .1. •f. RnY.,IA.. tr . .i •an'r TFT THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USM®FLOW HAVE BEEN ISSUED TO THE INSURED NAMECI ABOVE FOR ' THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OP ANY CONTRACT OR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THEE �r;- .` POLICIES DESCRIBED HEREIN 1S SUMCT TO ALL THE TERMS,ExmusiONS AND CONDITIONS OF SUCH POLIGE$.UMff$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO l IJROPLNSr1RANCLI POLICYNUMBER POLICY 9*P-CMC DATA POLICY15MRATIONDATE a s A 0O MP17V8AT10N k} PROpr11ETORf I.M TS ARTNE:R9�F?�QlTtv6 A:A Ate. t�,'1 •.'JQ I,t , / ..,t ' ` • . a,o�r� C GMUp 12252004 1=5l2005 TVTOff UM 0477152 a r APprtn W 11A4 ODa70ans Oldy. �,.. (�� l••i� CH ACCIDENT ;Z 4;100,0 t�,+ ;s XM 690 Emu - I91:R96 POLICY LET' '' '` ,S SOO,G ; ' $ 100.0 *6 E ON OF 0MRATIONSFO- ICL1101 CIAL!1'EAAJ RE:COVERS THE EMPLOYEES OF THE NAMED INSURM LEASED TO:CAPIM HOME IMPROVEMENTS INC,1645 NEWTON ROAM._ .r c` OTUIT MA Pi BSIJ. CERTIFICATE HOLDER CANCELLATION Q ENDUED ANY OF TNHABOVE D!laCRJlIlRi POLIC168 L;gNCTiLLfiO 06PQI�THE CAPM HOME IMPROVEMENTS INC wpArloNDATES.TmRSUMGcompANYWRLBmvoRTOMgn,1Q 1645 NEWTON ROAD i' DAYS wRIrTEN NOTICE V THE cszrrwe HOLDER NAM®TO Tm LEFT,eUT „ COTUIT,MA 02838 I FAILURE TO MAIL SUCH NOTIOQ SMALL mew NO oLLua :rm OR UANKIrY OF ' ANY KIND UPON T}I<:COMPANY,ITS AOFJtT9 OR REPRESRN'i•ATNE'3. AUTHORIZED REPRESENTATIVE s L IP d r.. ;t PA�a LATE OF LIABILITY INSURq C.J. 6 "�ightoa Cape loc NCE OPro o 937 sta��lkY Ius.6cjer,�,.linc. IS CER71FICA S ISS ED AS A �1 o9/os/o4 no.Y eve ONLY AND CO k OF 1 F 1NATl �anoutl,'14A 02664 HOLDER, CONFERS NO RIGHTS UI'ON'"E CgltiFICATE ALTER E"iO��RDED 13Y�op z'hOne:5o a-3s 4_ .DCf END Oit 0946 �'ax:508-760•-1907 _ 1-1GES BF.LO , INSURENS AFFORDING ayslm�A; 1Nationa�, GCAVERAGE NAIG� :�zzi X(gap� gJ6(agB: ouatd ins age ImeA�tua1 , Co C'tuit M 0263 xaVelmeni xue: BusURLMRc: � O�roup COVERAGES aasLmD: THEEPOLICIES LICIES SURANCE USTED BELOIry HA1/E B MAY PaTAINM% D AN DED BY EFL ISSUED f0 TH ACTE INSU POLIgES AGGREGAIt TE UM17S 77iE�LIGES D 071jE DOCU ABOVE TUR THE POLICY PERIOp INDICATED.ND LtB a MAY HAVE BEEN R 8(Y�bIIMS, ECRESPECT THETO �R SD(q�T) MAYBE ISSNjH SIG TYPE Of DANCE Rql,uggam, PDLICY Nub CONDITIONS OF so $ DAiE(M1yppA n DAIS(�aNDD�ALUAenrrY bPS02733 tsars CLAWS MrDE D DC" 04/01/09 09/Ol/ f 3-000000 05 S(E°°°awnoe) i500000 ��'Wgoneppep� #10000 PoLryEGAIE I�V'PLESP gt { Ngl&ADVaaM j"00000 X Auromax tyenm LOC "TDL8 E t 2000900 ANYAuro 11W $20001D00 ALL OWNWAvTos W802733 ODMDVeD X sp �Auros 01/31/pq 01/33./OS sFlarar 4250o00 2 10tWAUros a'''9FDAVios BOMYDUJRY n 9DDa Y"RY t>IABa.I) CARgGE ��ddet�) f y A�1YAUro R AMowy.rAA0Ca7 a ` FA Am ppCllRp� � a,",m m CUS02733 , AM _ O4/o1/0 04/01/05 , 9100Do00 RE'EN"°N 910000 row% 71DN AI 13NY F A - - f E C8WG401093 '«uoEo', 01/01/09 oa/o1/D5 TORY E. AociDeM Wowf.i00000 E1.D .EAe�PIOYEE i100000 E1.DOSEAlppL LOM s 500000 ora DF OPERgnOwl�ca?ro�s rYeap�a�aADD®sY l�CIAL oWSYCos CERTIFICATE ycm O�pR CE11 ATfON W"ULD AN Y0F RW A9DYEDESCW8W POLLS XPIP DALE THER�F �E CANC13lTWE { ND71CgTDT1#CFR W-�SAVDRTDMNL 10 "DAYSIiYNAT 1&ICATE HDLDER Nq► Tp Lam. STD DD BDI.: .. � A �GATIDNDRLIABIUiY0fMlyKt�UPDNTHEpIS(IRg�Ii6ACQITSpp ' A�Ro z�(ZWDnvoe� 1 CORD ORppRgTiON 998E w i S Boar o g Regula ons and Standards One Ashbur(on Place - Room 1301 Boston. Massachusetts 02108 Home Improvemep -oRtractor Registration = - - Registration: 100740 _ Type: Private Corporation Expiration: 6/23/2006 CAPI7ZI HOME IMPROVEMENT,_INC. _ Thomas Capizzi, jr. 1645 Newton Rd. Cotuit, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Board of Building Regulations and Standards F' Registration:, 100740 One Ashburton Place Rm 1301 _ Expiration: 6/23/2006 . Boston,Ma 02108 Type: Private Corporation CAPIZZI HOME IMPROVEMENT,1 %omas Capizzi,jr. 1645 Newton Rd. �-�, ,fr..✓ Cotuit,MA 02635 Administrator Not valid without r s r. i . i J i ' I t U �}ilk+ ✓� OLI 0�� �[aef.(4 !' R`fiiF�.. RI7�1711C!�gl�_ rF �� ,p�?p65 fir.n(D; 711'.0 3 ii9C�Ml�lS x ' 9�9�41t1E'1111TvbY1h�1�O,�'�- r Gb13`; 1VIfi +O�k35 ,..tt�iraTiimisF" _ . I 111 z -:..e...rT.i ,,::,.;•,s 1r,,.,..riA.:E4t":9 t•L Y fi4:-r.kaw� .,:.:..Srwro..cF:'s?"ex19KMtm+.'AN::�tl r The Commonwealth of Massachusetts Department of Industrial Accidents Al - , — Me®/�i�s 600 Washington Street Boston,Mass. 02111 Workers'Co m ensation Insurance Affidavit:Buildin lumbin lectrical Contractors name: 4 address: city state: Zip: phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ' ❑ I am a sole ro ietor and have no one workin in an capacity. ❑ Buildin Addition //%//////%O////% %/////%%%%%%/////%/%//////%%%%%%%%/%////%/%//%/%%%%%%/%%/////%/%��%%%%I%%%�%/i/%%l/%%�%%%/G////i I am an employer providing workers' compensation for my employees working on this job. com aII :name•' �`. addfese:. :* , p. insiii•ence:�eo. � # El I'am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: .:..... .. :. ..::.:..::. ... .....::<.:: omnany n m ` " f: ddress. ' _ c .::. ., ..:. ::...;..;.'.•:„ ;hone#s:';. msurahce'.co. ..:. :: ,_•_., :::. ,: Folic �#`:. /%%O/ : comaahv..neme... .. ..... r address: o6otie`#e : ....:. " he :#::: ,..... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flue up to s1,50o.0o and/or one yearn'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of siomo a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. r I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature Date �rh k CEPrint name lU l�I Phone# /U official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department check if immediate res nse is re uired ❑Licensing Board IMI—w— El Po q ❑Selectmen s Office El Health Department contact person: phone f/; ❑Other (revised Sept.2003) g —, ?.'1' .d ,- ,v:hJ#as� _-. ._.,..�w •`SSn�'^v�- ... 3..r,.,.._. u....... ...,_ r :E3 �. -.. tc.t. ♦ -., f _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel- r,:V�� - Permit# 2) zt-q f4ea+th-Division ' Date Issued S C-anser Fee "cam Treasure - > i Planning Dept. Date Definitive Plan Approved by Planning Board Htsterie--=AKH Pti�ll�a�is - . Project Street Address Jl cl �—L� S 729-65 E RJ ` Village C�iitl �VL Ll� OwnerL1 j {�>hl / ' . Address tSGr � Telephone ,,ac zo Permit Request . �ri9�2 �i�- ��d0 �e. )- V/1 L J•V. 0?-7 /Yx34 3�y,�ad M ,Ar aa// Y ; �l3 5 nlCn 9CP4. a `)-SQ �2� s�i�3zE UAr� Square feet:-1st floor:existing proposed 2nd floor:existing proposed Total new ' Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Q° 6�- / 4 Lot Size T p Grandfathered:; ❑Yes o If yes, attach supporting documentation. Dwelling Type: Single Family .f� .Two Family ❑ Multi-Family(#units) ` Age of Existing Structure Uk)Kke w-kf Historic House: ❑Yes W-fq'o On Old King's Highway: ❑Yes 1-40 ' Basement Type: ❑Full ❑Crawl Cl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) umber of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new jTotal Room Count(not including baths): existing new First Floor Room Count Q -Heat Type and Fuel: ❑Gas' O Oil ❑ Electric ❑Other Central Air: O Yes ❑No 'Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing Cl 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# _ g Current Use 6)A)Lk6r, Proposed Use S�9yriE • BUILD R INFORMATLON Name L Telephone Number `7 d- r— Address - S License#, 0-'_5 D r10`2. 1745' Co ntc T G�3 4 Home Improvement Contractor# /Ov 7qo Worker's Compensation# C (�(o$1 ALL CONSTRUCTION DEBRIS RESULTING:FROM THIS PROJECT WILL BETAKEN TO C,9� SIGNATURE DATE r s } FOR OFFICIAL USE ONLY F. F PERMIT NO. t1 , DATE ISSUED MAP/PARCEL NO. ADDRESS i 1 r.• VILLAGE?•- i i 4. M ► }' . _ ' , ! ~ OWNER�' 7 ♦ - ^ � ',... ,. i. •tom{ ` k - 'y'• tj } � i �-. >t ' ; _. k DATE OF INSPECTION: FOUNDATION { t -4 L u ` t` 1 I-J FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH' FINAL - PLUMBING:+ ROUGH FINAL- GAS: 'J 'ROUGH FINAL FINAL BUILDING, DATE CLOSED OUT ASSOCIATIONtPLAN NO. , �. � •, . .:._....-.��.Vic'.L .___> Ci--._ -__...._.._ ..... i r F.T - f • " , t A9 2-. .2 '} C7 T' T t3 I A nn t Su P�023^ LA I D 1 p CIP f' U. tt i „„„"""TTT ( + _ l r 1 4 , 2 - - y - ----- -- — r ; :4 ��77T,�11 - 1 t P (r�/fit ODL - 577 DRAW. APPROVED BY: N 8Y i "J'L� f SCALE: 4 �. DATE: G.� - -7 IT ' �V� f, Hyd2]Ylis,MA D RA WING. 0 EARAYJONES=HENRY DESIGNER f G F J