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"i, -, � �t " �,�,;i! � , ­�-, �', ""t",i"6' , , I`t,�- "4j.",�'i,,�;��,-,,,�,�����,,--i, 4 zi ::1 �h NdA I 0;�- , 4 �"":�"I,.� , , _:I.�,4_,v,i .���,;-,,�,_-,,,�,�--.,,,-.,�,-";!,�,,;�!�,�,�,,��ti!"� �1. ...I............ zi � 1.11, .:1 -, ,t,4"",i",������,,,,i�,r,,,,�', " ., _:� , '� ' ' , Is 2"0,,:�i:i','l&`P "!",I,���,�""!"",��,-',��,;',��',i',,'�",t""�,�,,�,,,',,""',.!,4�w,�-,.,,,��i��,,,��'i��v�,��','�r������,��,,,�,�,,�-.,���,'.-,',,:,,-,��,�"""�-""",�"i"A".�,���,,,',,.*,�7���,',',,,,'�',,.*,,'����i�;,��,f"��,,�,�,,4.-,��t',--.',�,'.',��,.-,.���,�,,,����,,�:,,��)�:�� \",�tt,�_,t,�4,,� t: _,�, �_' A; sh W , sh" ;,4� -I ­,��,,,�I, , ", �" � q 13067 Town of Barnstable *Permit# M�� � g 2007 � Expires 6 montl, glissueda te ;(OWN CW BA NSTABLE Regulatory Services Fee Thomas F.Geller,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 C "2 G 4-a Property Address 4'2- tzd . Can ter v \\e , ^cY1.q 02„Co32- H Residential Value of Work .506 o O® Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Co\b y 4 P a-V d ex S O n v 4,-2- s\or_\i r,k vN e.t X�Z d C-P_Y,te.r \ \e , om o-Z Q 'S z Contractor's Name Ca, va\ l NQ"e. T�nn�res�Jehnf Telephone Number C�oB����' 0�� �p5 w?V, L-1-- 'O cOLv e.. Home Improvement Contractor License#(if.applicable) 140 4--1--3> Construction Supervisor's License#(if applicable) O Q 0 G5 4- NWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name The %AQ_Vt-CoY d Workman's Comp.Policy# 6 S Co 0 u 1 3 G3 ci Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value 0.'31Ar (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 pall Board of Building Regulalioas and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. df found return to: Registration: 140473 Board of Building Regulations and Standards Expiration: 10/2012007 ®ne. . hburton dace Rm 1301 Type: Ltd Liability COMoration Bow . ibila.02108 G L QQALITy HOME IMPROVEMENT, JOSEPH LAROCQUE 135 RTE 6A - SANDWICH,MA" Not valid without signature The Comnionvealth ofMassachusetts • Department oflndustriaZAccidents ' Office of Investigations 600 Washington Street ,.- Boston,MA 02I-1' ' . VyOw.mass.gov/dia ' Workers} Comipensation Insurance Affidavit; Builders/Contractors/Eleetridans/Plu abers' Applicant Information Please Print Ltsrihly Name(Business/Organizatim/In&-viduat); Qa Address:_ ►3s—Lkp, r0P1 V.0,. sox -1 -A City/State/zip:s&V)Ck\ch %YM 025 oaf: •Phone.#:�5�a1 ,Are you an employ.er?'Cheek the appropriate box: ;Type of pioject(required)`.. 1, I am a employer with 2 4, I am a general contractor and I . employees(full and/or part trme),*• .have hiredthe sub-contractors 6 ❑New construction . 2.Q I am a'sold proprietor or pmtoer- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have $, Demolition:. *oilang for and in any capacity, employees and have workers' [No workers' comp,insurance comp. insurmce.t' 9, ❑Bufiding addition . required.] 5. ❑ we are•a corporation and its 10,111Electricalrepairs or additions g officers-have exezcised their 11:❑Plumbing repairs or additions -- '3.EI I-am-a homeowner doiu -all=work._ --— _ myself,[No workers'comp, right 6f exemption per MGL, insurance.required]t c.152, §1(4), 12.M Roofrepa and we have no'. irs- employees, [Nb workers' .13.E Other vdihdOVV pomp,insurance required] fie. 1 a_c_e"ehN ' *Any applicant that checks box#1 must also,fill cut the section below showing their workers'compensation policy information. ' t Homeowners,who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidayit indicating such, . tConhaators that check this box must attached an additional•sheet showing the name of the pub-contractors and state whether ornot those entities have employees, If the sub-contractors bane employees,they mustprovidt them•workers'comp,poicy number. ; I am an em k workers' ompensaton tnsurp g ance for my employees. Below ts.the policy and job ' information. site , Insurance CornpanyName•_ 1'lne Policy#or Self--ins.Lic, Z ExpirationDate:_ c� i Job Site Address: 41 SK\a y kY y tx P d Oi /State/Zi i3' p; h'Ce`C \M e �yyl_�p2� � Attach a copy of the vt'arkers' compensation policy declaration page'(showing the policy number and expiration date); Pailure,to secure coverage as requiredunder Section25A•ofMGL c. 152 canleadto the imposition of criminalpenalties of a fine tip tb$1,500.00 and/or one-year imprisonment;as well as civil penalties inthe farm of a STOP WORK,ORDER and a fine' ` of up to$250.00 a day against the violator, Be advised that a-copy of ibis statement maybe forwarded to the-Office of Investigations of the bIA for jEEya ce coverage verification. ' I do hereby certify under the pains•and penalfies of perjury that the information provided above is true and correcb Si ature: / ' Date: 3 f S/Or7 Phone 4: Official use only. Do not vrife-tn this area,.to be completed by city or town offi'ciaL' City or Town:' Yermit/Lricense# ----------------- . Issuing Autliority(circle one) .'1.Board of Health 2,Building Department 3., City/Town Clerk 4,Electrical Inspector 5,Plumbing Inspector .6.Other ContactPerson: Phone#: .��1t�.�I:I.��.L1�➢dl �.�U'1�1�I,i �.1�:6.119Jig� ' • . . . Massachusetts General'Laws cbaptir.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 maintenance,construction or repair work on such dwelling house or onthe.grounds or building appurtenant 11ierato shall not because of such employment be deemed to be an employer." « issuance • c a licensing a enc �shall withhold the issuan MGL chapter 152, §25C(�also states that every state or local •g g• y • renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produeed•acceptable evidence of compliance with the insurance coverage required.". Additionally,MCrL chapter-1 52 25C . states `I�ethet flie commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of publimwork until aceeptablp evrdEase afucompl ee t�it}sthe n e e requirements of this chapter have been presented'to the contracting authority,." ' Applicants ' compensation affidavit completely,b checldn the boxes that apply to our situation and,if Please fill out the workers comp mp Y, Y g PP Y Y . necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their certificate(s) Of • the insurance. Limited Liabihty'Cempanies'(LLC)or Limited LiabilityPartnersbips(LLP)with no other tha n m.embers'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. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pernut.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' camp ensati.ou policy,please call the Department at the number listed below. Self-insured companies should enter their . self-insurance license number on'the appropriate•line City or Towli Officials Please be sure that the affidavit is'complete'and printed legibly, The Department has provided a spacq at the bottom c of In esti ations has to contact you regarding the a licmt, 'of the•affidavit for you to fill out in the event the Office v g y g� g PP Y Please be sure to fill in the permit/license number which willl be used as a reference number: In addition,an applicant , -that must submit multiple permit/licanse applications in any given year,need only submit on;affidavit indicating current policy informatior-(if necessary)and under"Job Site Address"the applicant should write"all-locations in_'(citYnr town)."A copy of the affidavit that.has been officially stamped or marred by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for f more permits or licenses, A new affidavit must be filled ovt each �or commercial venture year.Where a homy owner or citizen is obtaining a license or permit not related fo any business (Le, a dog license or permit to bum leaves-etc.)said person is-NOT required to complete this affidavit. eor our cooperation and should you questions, Eke to thank you in advance£ The Office of Investigations would hk y p Y g Y , please'do not hesitate tc give us a calL The h]epaxt=nt's address,telephone•andfax number:_ •fie C==QgUw of MAMCUSWS Offf"of Ili-VesdPilons Rica,.MA 02111 Ta.0 617•727-4 ext 406 or 1- 7-MASSAFE FOX 4 617-727-7749 Revised 11-22.06. wwwxa s6v/dia bof9C Town'of Barnstable » Regulatory Services 9,&ANBLE,$ Thomas F.Geiler,Director fn ;;� wilding 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 641- Qva\\ty "OYYC- ' zMtX-0�k--MehiS to act on my behalf, in all matters relative to work authorized by this building permit application for: 2 tc�h one C Cg--r�ce.rN e , mA a-Z c.`32 (Address of Job) S' ature bf Owner Date CA Print N Y ' 1 Q:FORMS:OWNERPERMMSI0N NOTICE H NOTICE W TO o TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-7274900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: HARTFORD UNDERWRITERS INSURANCE COMPANY NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD, CT 06183 ADDRESS OF INSURANCE COMPANY (6S60UB-3639B14-2-06) 09-11 -06 TO 09-11 -07 POLICY NUMBER r EFFECTIVE DATES 0 OCEANSIDE INS AGCY INC 52 WEST MAIN ST HYANNI S MA 02601 �= NAME OF INSURANCE AGENT ADDRESS PHONE# m— o- G & L QUALITY HOME 6 WASHINGTON CIRCLE oC IMPROVEMENTS LLC _ SANDWICH MA 02563 o= EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE �_— MEDICAL TREATMENT o_ The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services . co— provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably — connected to the work related injury. In cases requiring hospital attention, employees are hereby notified . that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 008560 W20PIG02 TO BE POSTED BY EMPLOYER TOWN OF BARNSTABLE BUILDING TERMIT APPLICATION qq Map Parcel t✓ Permit# M2Z47� -Health Division �� —�/2� , I r Date Issued 1,�;1?0 11W Conservation Division ' S, l J Application Fee Tax Collector Permit Fee SEPTIC SVSTE,M Treasurer INSTALLED, ,; �• f,.,� ^ovC� Planning Dept. WITH ENVIRONMENTAL CODE AND " Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address -17( S ✓�,kr� ��Jtic� Village Cm ,eQv,il-e­ Owner Co46y 4-4 Pkil AndaSan Address �/ S4cv�k.. i ERoeJ Telephone SGT- 7 75"0&7Y Permit Request 1.ew.r d,eL t ►kc•L o^ Aod ow 4(,0(`L`Y AC.���e Square feet: 1st floor: existing proposed-6 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation A1,10K Construction Type Wc)oA Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family lid Two Family ❑ Multi-Family(#units) of Existing Structure �d yet—.s Historic House: ❑Yes M o On Old King's Highway: ❑Yes Mlgo' Basement Type: 9 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 42, 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: 0"Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Flo Fireplaces: Existing L New Existing wood/coal stove: ❑Yes ❑No Y� Detached garage:O existing ❑new size Pool: ❑existing 0 new size Barn:Cl 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 7 7 f—,7/,-0/G,? cc%I Name Ske,yn D. Col-e Telephone Number 833-t5527 aft-- Address i I Cctisce,& wL( Q AJ License# C S o-s 77/C.2 Home Improvement Contractor# l047 7S/ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO fin ,4,51- �Ig:•s0-ne -o- SIGNATURE DATE 9/r,27 lay FOR OFFICIAL USE ONLY "'PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE j OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL d71 PLUMBING: ROUGH FINAL L C? y GAS: ROUGH -- © FINAL lmi_l cc, 12 m i FINAL BUILDING t ' DATE CLOSED OUT IS 4 ASSOCIATION PLAN NO. � Commonwealth of Massachusetts Department of Industrial Accidents' WCOOMWOMPffm 600 Washington Street Boston,Mass. 02111. i ' Workers', Com ensation.Insurance Affidavit-General Businesses // ,ffffffff lz WARM ��'`' Ri''t ;-e,apo.• "T+a C+'+�•Fy,r;•+'t••,�.•': n .•.; •.ta'... ti•':� : ..:sE"••:fld§3 / 11 t e n Diu ' �JccX Wii�� - state' a//p/ Z1U' C/2,:rY/ Dhone# �v• (3 l Ivb cityOo� +a toe atif !full address! `7� '� �+kk`t:�" GPv� eJOle— work I am.a sole proprietor and have no one Business Type. ❑Retail❑Restaurant/Bar/Bating Establishment Acing in, any capacity, ' []Office E) Sales (mcluding•Real Estate,Autos de.)' I am an em to er with etn to ees(full& art tim ❑ Other ' ;t , � ��i��/l/%% /%/%%/%///%%%%///%/////%/%%///%%%/l%/////////%%%%% I am an eployer providing.Yorkers' compensation for my employees worlQng on this job. :�s :.uatrrl,•S: ':?:' tC+,, .,L:.:%a. •;t` ••!".' i. P <!:1•'l:+r'• •.fyiC .^!•�' ••t'::•ti • k' .t �i t:..*•fie ''��•i ie� .:..i.,..��:,• s.: .3• �;�.' ';t..I•_ ':ii:,:'+:•L',t;. COIII=118III •r� t S'�+i r t tJ'!•..• ''+.+4 + l 1 t, d h, r ti '!. - 'a y i} V :s•; "•S:: •Ai o JD' .i+.�. _ .>:� t... .:.._:1'•. ,,.,:{ soli. s{"-r'JIPi---- - r' 't ..r: :�•:•y'r•.•„• 'i•'.'!7'• ~i• ri �( (� '�Y •�:'1 lit.' ,��it.G s:1'' ;2: ,•st..rk4 On � :° : �rti4;•• {' •h �.#•.��•' KIO •:r•L9 rl`� �YP•••I,w i .. r1'1' p _ •ty •.,� ''mey ;.1�,t!i.'i.: is� t'"3sr:' !. p C'•#'' .• 'W,S'� �•.' :��. ., �.� .. 1 !� 'N'•` ''' '+• 5/' n,, H S::1' i.l si�•Vs%�..:.,. 1.1 � •' Tfsu ❑ I am a sole proprietor and have hired the independent contractors listed below who have ilia following workers' .compensation polices: It :��:. t".t: S:(P,? '�` t 14..1•' j, ',t.'.• t f' '1 -a. .t:•y :j'` t cOn]r8Il IISme. ti^l.,; ' •r.ti:sYr',•'+;'�., 4 .�' '.r �1.. •,!•.y:y. r�• ��,r,�r ,l,�.w '1•,;.• .., rf' :1+�':' .:ti!.;`.'i, y'�,�"T.!'.�'�s .. , •'+i. +'1':,j: `.tr•• �•� 's'V.e:Me•:.i Sy .l is •; :SL•G�!,��C:i ', eddressi ,�• '.4. t: 't .Tw •k•a' ,'A iIr'•f•'•i�tr''i0•'{:' rsa't r '.1��. .i�V ,•l' .�:•.'a•r:'a .ri: '�='• `'.�•.'L. `; , .••flr..F.. ''�- '.li�'i .':r:'; 'hOIle" .•. •.t•:. - •� '!•J' p.i'• Cl •a: ,,, •sn, •rK h.ii •• •r ••t".r•?�!'••P.•,ny lly.i'i s•t.},.� ''�^�t",,:• r'•;p•t .tti:.• •s• ;ts,,. • ilisurance'co. „: %//////7 .;� ;y,tt 'i•:' :I*::' ai• s ':t. 11.n.�'• '* •:tr� t�..'•:,•r r�:�"1^sit{ •Ii•{'' :r_ •t'. ..!!�� •1.• ''L •L.tI•:.:. 9,;:.!`i' }•!,, i,,.,��r,df!'-• 't. '.ji:'J. '!�•• �Y•.Tt. ';C• ''t'; It: 'i't •Y„Y?�' ;.i;: .1?, ..isi• 'j; r .�'•.t'. COTnJBII I19IIfe: .i•••: .. - :" .. .i+ • 101111 .. ,! •. t + 'r' s 'i• - :p�OIlE:#: ! 'i �•.:� 'I•R;.;t :'t: , ...L• tt ,ci ya,. s•+ j, .Ys•X, .:t+,y•:•+��•t •'{. i s •i•• 11;,,••�:r.: •J.y; s•i:ins;;. :+� '.1:;';: •:/.:° t ,t,' ,' _•a'. .f:; .,�. ':!' .,:; .J. t: :Y. yin:, •!•.t t,iSl••a•4.5.�• si• sl .tp •t.• .'r',i 'i 4,:: :9•.s•. •.•i••• 'ij i':!t••' t'.,'� ��;.,; :�••,. .'oZ :' i� .r' .i�% .d.! _:,•t ..i 'i: insurance Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,560.00 and/or one years'imprisonment as well as civil penalties in the ftiim of a STOP WORK ORDER and a fine of$100.00 a day against Me..I underztand that g_ copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. . I do hereby certify under the pains and enalties of perju that the information provided above is true d cart' ct Sipstore at!�� )ate 7 t „re _ jam. _ Print name Phone#� i J official use only do not write in this area to be completed by city or town official city or town: permit/Liceme# [❑Building Department ❑Licensing Board check if Immediate response is required ❑Selectmen's Office El [)Health Department contact person: phone#; ❑Other oav9ed Sept 203) a ,ran rrr�TC;ate• '.+ may --�`LT�;�E• I Information and Instructions. Massachusetttts Gerteral Laws chapter�152 section 25.requires all employers to provide workers' compensation for'their. . loyees� s quoted from the law', an employee is.defined as every person in the service of another under any contract e ,f hire; express or im li p . c% •oral or written. &n em loy artners , association, corporation or other legal entity, or any two or more of p er is defined as an individual,g hrp . he foregoing engaged in a joint enferprise, and including the legal representatives of a deceased,employer, or the receiver or ariners , association or other legal entity, employing employees. 'However the owner of a iustee of an individual,p . mP Swelling house having'not-inore than three apartments and•who resides therein, or the.occupant of the dwelling house bf another who employspersbvs to do.maintenance, construction or repair work on such dwelling house 6r on the grounds or hereto shall not because of such employment.be deemed to bean employer, big appurtenant t MGL chapter 152 section 25 also'states That'every state*or local licensing agency shall vYithhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the.commonweaIth for any applicant who has not produced acceptable evidence•of corripliance with n��Ito any contract for the performance of publicther the- work until coir>trionwealthnoP.any.of its political subdivisions shallY • • acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants w orkers' compensation affidavit completely,by checking the box that applies to your situation.:Please Please i�"in the supply company nanie, addr.ess and phone numbers along with a certificate of insurance as all affidavits may be submitted _. to the Department of In Accidents-for confirmation of insurance coverage. Also'be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regardin 'the'"Iaw" or if you are required to obtain a;workers.'•cornpensationpglicy,Please call the Department at the number'hsted below. City or Towns . the affidavit is complete and legibly. The Department has,provided a space at the bottom of the Pleasebe sure that . e ffice of Investi ations has to contact you regarding the applicant Please affidavit for you to fill out in the event'the 0 g be sure to fal.in the permitllicens.e nurnber winch will be used as a reference number. The.affidavitsY;may.be.returned to the Departmentbj�•mail or FAX unless other'arrangements have been made: The Office of Investigations would hlce to thank y'on in advance for you cooperation and should you have airy questions, o give us a•cal1. hesitate t gl please do noth _ The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department artment of Industrial Accidents tlt[ice of I>�resti�tiens ' 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 • IE To* wn of Barnstable Regulatory.Services . 1 2 Thomas F.Geller,Director �r D.519. Building Division Tom Perry,Building Commissioner ' 200 Main street, Hyamm 4 MA 02601 , office: 508-862-4038 Pax: 508-790-6230 Permit no. . 1�ate A' MAIVIT ' kTOME MPROVI MENT CONTRACTOR LAW SUPPLEMENT TO PBPJY 'APPLICATION •. MQL a 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, • -improvement,removal,demolition,or construction of an additionto any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adj acent to • such residence or building be done by registered contractors,with certain exceptions,along with other requirements, • Type of Work: i�-e n w'.� Estimated Cost�h'a/aa Address of Work: P L AJ . Owner'aName; C,��b., uw ercc,. Bata of App1i cation: CI v �� • ' I hereby certify that; Registration is not required for the following reason(s); []Work excluded bylaw ' ❑Jab Under S 1,000 ' []Building not owner-oecupied t []Owner gulling own permit Notice is hereby given that: . OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLIC4.1i HOME ZUROYEMENT'WORK DO NOT 19173 ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A, SIGNED UNDER PENALTIES OF PERJURY I hereby apply foi apermit as the agent of the owr}er: pa Contractor Name Re4istratioallo. • OR , Owner's Name 780 CMR Appendix J Table J&Ub(continued) Prescriptive Packages for doe and Two-Family Residential Buildings Hated with Fossil Fuels MAXIMUM MINIMUM i Glazing Glaring ceiling, Wall Floor Basesneat rab Heating/cooling Area'(%) U.valuer R-values R-vakw' R-value° wall eta Equipment Efficiency' Package R-value` -valttd 5701 to 6500 Hating Degree Days' Q 1 °e 0.40 38 13 19 10 6 Normal R 12° 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 6 85 AFUE T IS% 0.36 38 13 25 A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% .44 38 13 25 N/A N/A SS AFUE W 15% 062 30 19 19 10 6 8S AFUE X 18% 0.32 38 t 13 25 N/A N/A Normal Y IS% 0.42 38 1 19 71f N/A N/A Normal Z 19% 0.42 38 13 Ag 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE.OF ALL E RIO WALLS: 3. SQUARE FOOTAGE OF AL GLAZING: 4. %GLAZING AREA(#3 VIDED BY#2): 5. SELECT PACKAGE( --AA-see chart above): NOTE: OTHER RE INVOLVED METHODS OF DETE ING ENERGY REQUIREMENTS ARE AV ILABLE. ASK US FOR THIS INFORMATIO BUILDING INSPECTOR APPROVAL: YES: NO: q.fortes-f980303 a 780 CMR Appendix J Footnotes to Table J5.2.1b: I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft'of glazing area. =After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U valu es are for whole units:center-of-glass U-values cannot be used. The ceiling.R-values do not assum e a raised or oversized truss construction. If the insulation achieves the full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 5 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes eleetric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested . and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- Value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 f OF�FIE Tcy, Town of Barnstable . Regulatory Services Thomas IT,Geller,Director 9$ 1679• Building Division 'OTFa r+�e TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . -" www.town.barnstablema.us _ Fair 508-790-6230 Office; 508-862-4038 Property Owner Must _ Complete and Sign This Section If Using A Builder as owner of the subject property •'to act on my behalf,' . hereby authorize_ ��• ; - . in an matters relative to work authorized bytli s binding permit application for. c (Address of Job) a� v4 S, Owner Dat Print Name I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041=. STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= - (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Proicost t �oFsrte ro��Y Town of Barnstable � a y Regulatory Services sA�IT3PABLE Thomas F. Geiler,Director MAN9 . 1 9. ��� Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 NEW BUILDING PERMIT FEES EFFECTIVE JULY L 2004 Current Fee New Fee Application Fees Residential New $50.00' $100.00 Residential Addition $50.00 $50.00 Renovations/Alterations/Additions $25.00 $50.00 Commercial New $100.00 $150.00 Commercial Additions/Renovations/ $50.00 $100.00 Alterations Building Permit Fees Residential $3.10 per K $4.10 per K Commercial $6.10 per K $8.10 per K Re-inspection Fees $25.00 $50.00 (For work not ready for inspection,incomplete work or failure of inspector to gain access) New Fees Commercial Demolition $75.00. $8.10 per K. Residential Temporary Certificate N/A : ' $25.00 Of Occupancy ' Residential Certificate of Occupancy N/A- . $25.00 Commercial Temporary Certificate N/A . $75.00 Of Occupancy Commercial Certificate of Occupancy N/A .$75.00 I . fie -lVarivntonurea�y p� �ivap,�q , BOARD OF BOIL®IN,G R't<, ilTLONS License CONSTRUCTION SUPERVISOR Number 057712 C d Tr.no: 18779 Restri .eiµ STEVEN D COLE PO BOX 10005 �' � ' r MA=RST®N'MI'LLS, MA 5 6Y A ctihom�s oner 1, Board of Building Regulations and Standards / HOME IMOVEMENT CONTRACTOR Re istra@ 09751 4/2006 I p - ; ership BOURQUE&COm- ES&REM. f JOHN BOURQUEu� 80 CROCKER RDA WEST BARNSTABLE,MA 02668 Administrator I i I } Ii _ LOT 4 � . o - M LOT 5 j dos•=== � i O 3 ¢0 o 5g 38. LOT 6 • i RE- 2o1VE.• "Rc" This MORTGAGE INSPECTION Plan is For FLOOD ZONE. C TOWN: _ .• DEED REF: jgj� _------ nk Use On! REGISTRY OWNER jWW.4.4 �L _ DATE: -4./�2,LQO___^_ -----BUYER: .�01.8Y LEA tVfUN �dc P��� ���`� EBY CERTIFY TO d�T PLAN REF: 2,24 L, 7 �COMPAIVY_____ SAL-�1TY�Q��� = SCALE:1"- 2Q_ _FT. SHOWN ON THIS PLAN IS LOC -- ON THETGROUNDLDING *�" YANKEE SURVEY SHOWN AND THAT ITS POSITION DOES __ '�S To THE ZONING LAW SETBACK REQUIRE�fENTSCpFTHE + CONSULTANTS TOWN OF __ $�Q11Y�T�9� _----______ A. MEAN 40B (SUITEI 1) IT DOES_�1!Ofi AREA SHO LIE THIN THE SPECIAL FLOOD HAZARD INDUSTRY ROAD CON THE H.U.D. MAP DATED.,�/,Q�g� MARSTONS MILLS. MA. 02648 .250 Ol— 015—C TEL. 428-0055 FAX 420-5553 tp-�5 -----_—__ THIS PLAN NOVSURVFX gADE 1�OM.ANN I TRUMENT NC �'8734 LA1, ineering Dept. (3rd floor) Map Parcel 01-f `Permit# House# ° �Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) /-:37LI Fee Conservation Office(4th floor)(8:30-9:30/ 1:00-2:00) Iof % —P1Apa4 g Q&@L, 41 ct flnnr/S,-hnnl Arimin Ricia 1 � C SY beiia-kim RIM 19 U—S e AL L rEI �i y�`Y, MRFISTABLE. �7 �t � Mass .� TOWN OF BARNSTABLE ] 1-2- Building Permit Application Pr 'ect Stre Address Village e Owner X14 IAI Address Telephone 776=.3 S Permit Request 6� U�y-►�'- ,� �j„/ 2�� First Floor by f\Ye-a- ojn ,Q square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ✓f No On Old King's Highway ❑Yes ff Flo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name V/e Telephone Number �12�F� Address License# O,5'�2 43 Z Home Improvement Contractor# /GD 73�,O Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �r'ilibd7��` SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 3: FOR OFFICIAL USE ONLY PERMIT NO. t DATE ISSUED MAP/PARCEL NO. ' E 1 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME S INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f _ 1 1 1 1 1 1 ✓f22 TD I 3 �OME .IMPROVEMENT CONTRACTORS REGISTRATION . !' Board of Building Regulations and Standards f One Ashburton Place - Room 1301 :Boston, Massachusetts 02108 - j I HOME IMPROVEMENT CONTRACTOR "� Res-, stration 100740 Expiration 06/23/98 Type — PRIVATE CORPORATION _ 7 HOME IMPROVEMENT CONTRACTOR i• Registration 100740 CAPIZZI HOME IMPROVEMENT, INC- I Type - PRIVATE CORPORATTON Thomas Capizzi , Sr : Expiration 06/33/98 1645 Newton Rd . 1 Cotuit MA 02635 CAPIZZI HOME IMPROVEMENT, INC Thomas Capizzi Sr. ZY, �' Newton Rd+ ADMINISMAiOR Cotlll't MA 0263S. . ( DEPARTMENT NE AGIiUR DOSTUN, 4kUC,Ti•O.NiSUPERVISOR LICENSE Y•� . .t ExPires: . �- ��;SECURIJ:Ys'�:.•030-5a- 494��.-� •�r'••_�� - .. :- t - The Commonwealth of tlfassachusctls Dcparttncatof lit dustria/Acc•idents Office ollnyestigall ,7S 6(I(1 1f aslrinwtun Street Boston,Alas. 02111 Workers' Compensation Insurance Afftdayit -A lican inf rm tiori� ' PI aee PR l gi�l Pam : z ,� location cin phone t Y12 h'— q:3`:/9 I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity - - 72 7 I am an employer providing workers' compensation for my employees working on this job. comnanv name: address: city': �thone#: • Insurance co -lot-l— r ........ .s.. •M..y, +.�..�i".c„S"^ `.., Y+-es-• .;•ts;r;--•-r-,�!.sa < -►�.�'0�.:.^...+?rt.. +-rw..na.. .;�..r 1 am a sole proprietor,general contractor,or homeowner(circle one) and hav:hired the contractors listed below who have the following workers' compensation polices: company name: • address cit-v: phone#: insurance co Policy# �.._._............ .:�i�-... :�ti�x..'aa�_:1:..� '--^-'s?cr:La1`I.:a:x:<`.:• - '�rs!�..ii�:.: �-r�:a�'i:�'+,_'•'�.:rrsta.ic� •' -•c:...'i:' - .c_.:_ cornannv name- address: city: phone#: insurance co policy# Atiac6 additional slicef iC ticccssa .;���.. rc- '�..•.c r�< `i"T„�iS ir,K�r ��v�;e ��'..--� �<j=���'Y.�.�_�l '�-"'• Failure to secure covera,-c as required under Section 25A of MGL 152 can lead to the imposition(.'criminal penalties ora fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fir:of S100.00 a day against me. I understand tlmi a cope of this statement may be forwarded to the Office or Investigations of the DIA for coverage verification. l do hereby certijr i der pants all d pc lties ojperju{y that the information provided a5ove is true and correct. Si2naturc f Date �G�ts —�9 Print name /'C �� ���� 1=ione R -�- g��� official use only do not write in this area to he completed by city or town official 2 �;. cin'or town: permitAiccnse 9 rlt3uildin-Departmcnt k a L nicensing hoard:. is check irimmediate response is required oSelectmen's Office Ilcalth Department - O �contact person: phone 9. 00111cr �.:�.,..-......�____.......^_�.._ -c'•�-•-�-. .�^-. ..�^a-r,+�+.-t-.yc�s+-yr_-y-=ter.-_-:^.ti -T•,...r-,.,.-_...>�-.._,.-..�..t-�,e•.-,..-�'=.a�_ lrnmcd j;qj PJA) The Town of Barns table -= - .•. • , Department of Health Safety and Environmental Servi Ma Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosses nffi= 508-790-6= Bun Commissionc 509-775-3344 For office use only permit no. Date/G/S AEFIDAVIT _ $OMF SUPPLEMENTT TO PEMAM APPLICATION MGL =quires that the-=nstrmcdon,alterations;renM=iM repair, °�=nToo=", c. 142A itnprevemeui,.r+ctno�'�. dttaolition. or c�nstrtrQion of as addition to-any �� �}� building containing at least one but not rnorz than four dwelling units or to sorcdtues are to such residence or building be done by registercd coatraczcrs,with vataia aao�tions+along with Type of Est. Cost �, ! �Address of Work: O%mcr Name: /3 G� Date of Permit Application: I hereby certify that: Registration is not required for the following rza=(s): i Work ccduded by law Job under S1,000 Building not owaetoccugied Owner puling own P== Notice is hereby gh-en that: OWNERS PULLING THEIR OWN PERMTT OR DEALING DSO N� HAVE TOFF FOR APPLICABLE DOME EWRO�DWORK MGL c 142A ARBITRATION PROGRAM OR GUARANTY UNDER SIGNED UNDER PENALTLES OF PERMY I hereby apply.for a permit as.the agent of the Dauer. Registration No. Date OR 1 �9 II II ___ �Z z � II � llllllllll11111111111W �CCC Of ��G -�i•Zrnll , �1 I Z Z-N{ ry III (TfL-- �" I' � Qyllln III I Q I77 lllLWllllllllllWllll \I� it it Fc II Jill �z --NiW 2•15/4"x 9 I/4'I.VL � ®® At 13 a I I I o S ®® LEE Q S ®® µ z Ewsr C1C _ C 8 o O sit X 0a \N N - S\ �� 'v "v � z � ZO CCC LiZ: c"l N C'R y Z X o ❑❑❑ o �R oo o qX �X z � � ❑❑a❑ �� z 775 0 o n VN DESIGNED/DRAWN BY: o a a NEW ADDITION FOR: o Q,Im u m COTUIT BAY DESIGN OA COLBY & PAUL ANDERSON MABREWSTER H EE MARO 64D 9 b 42 SKUNKNET ROAD CENTERVILLE, MA (508)274-1166 iJ .a X N N a (MAtCNEx6fINC) L m O* 75 77 775 (N Z �tt mom S ' 7z o� ETC N 4 0 z 8Z ZZ l NEW ADDITION FOR: DESIGNED/DRAWN BY: z = r COTUIT BAY DESIGN COLBY & PAUL ANDERSON 43 BREWSTER ROAD z o MASHPEE ,MA. 02649 �' 42 SKUNKNET ROAD CENTERVILLE, MA (508)274-1166 A,-0" a � o 75 it N fla lz � ~ CCt L\ z �N 7. 21-0, C� N es (VERIFY INFIELD) x o z � ICI nM p � I I I a ' I C�CC -75 � LJ z O yN g /75 z-a' 7s Z O ° NEW ADDITION FOR: DESIGNED/DRAWN BY: oz m m ii m COTUIT BAY DESIGN COLBY & PAUL ANDERSON 43 BREwSTER ROAD z o MASHPEE,MA. 02649 I 42 SKUNKNET ROAD CENTERVILLE, MA (508)274--1166