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0180 STRAWBERRY HILL ROAD
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".ch� G. ��.. .-c,'.f �: _ i (`; -i7Sk-P ti r h; ,a+.^ Vg.`..-'a`•c x�',f�'. „R�a.. .-..a y,` y °*A�..l..;_ 5. :•y '+c.,+'r�t."a 4'� '�,._, �,y9��. r '.:+a� ,..Y:.�'.•.g.,s � :Z�.� :ask, is ,r.� }h,�1r !y 1i.�.� .1e ryR. � ,qM�l � - •�r ^ e{•• 1t <f..,•-�•�p _ A,'N�T we �.e L � .y..m .Js atpi �Y`l i4:,'.�"� n�i'��5 � d�.'•.F'+�y ..: �'k•`. ��' Pi,�E -i a ,,�"" �s -i:in > +a5 i. �1 �-�,y. r,.. k:'�': ��> .fY t��i ; , i t .�} „r S�,?r x'���.' - vl�'`' "-.��,♦�'��y R��•*��t ..i°L Y � .k � x�''>"K''� �..� 3+ 3'. .q t �:++r'�,y'F`k-+iw;e y..} ..?�w 4J:.t., i aJP..k+`�- & r' "�, , - - '�. �:� •�,,"'•` `'.�; � to f..: � .- �.-n K� ..., t '. r .'4..♦ v..L:.,. :;} � ,L `k,Y�4' ,� �#.�! E' �. ��v. a �. .."'`'.y �, s..;,�� r -.:. y4'ikr�'P �a.; _ ., .� . ."iR .:' � .,, `' .Lr�. a�,�.' 1: .}�:.. .f °R`."r � `�,,�,��rR... -- ,.'�' �� .-..b'.'s ♦ ;•r �� � :a'�.,, 1.xr.r. '�`}., ✓.''."" $ ,.T'. - '7. ?..3 .;�7x " ,i . ..♦� .r},.},,o s:. ° xffi: v4:.'#�" . ' {: .. .4. .. �, x �{; '!4 `y:. � x'�' j, �* '•. >- 1 Y •..Y:' R,•�i' .sc ';,� .} li - t �+t ��. ° UPC 12143 ' Now ° TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # _ O Health Division Date Issued /1 —7 Conservation Division Q� Application Fee Planning Dept. QiVA Permit Fee r� Date Definitive Plan Approved by Planning Board O Historic - OKH _ Preservation/ Hy r SAO / Project Street Address hrkrp ka.�y Village C_e.�i,-�,�.✓;\i Owner J,e r-E �r w" w, c Ky Address 1 fT j,.f cart-[',ww�or✓ d� � rr,�, Telephone (P 17 - S 03 RLP 4LI Permit Request (I p0 ,;IS. . A.00�k 54y%k� A4 VIS � L\riA 7 Jr 1NPa /4 ZAG ��nn ;h w A.�t �C►1�r.�r� �a o (i ww,r C Square feet: 1 st floor: existing !'/yproposed O 2nd floor: existing 20 proposed 0 Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation 2® 6eP,60 Construction Type Lot Size Grandfathered: lid Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family kl, Two Family ❑ Multi-Family(# units) Age of Existing Structure Y D a< Historic House: ❑Yes UNo On Old King's Highway: ❑Yes E kNo Basement Type: bFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) © Basement Unfinished Area (sq.ft) Number of Baths: Full: existing y new 62 Half: existing fs new e Number of Bedrooms: existing D new Total Room Count-(not including baths): existing knew 6> First Floor Room Count !Y_ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name T � �� Telephone Number �� Ogg Address 66011718 License# /A " i 116� AA Oa 6Y& Home Improvement Contractor# Email���� g� cA4 o tars? Worker's Compensation # ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ZC)SQ)l�p FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER L DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,3 DATE CLOSED OUT ASSOCIATION PLAN NO. i ,_ The Commamveakh qfMma&usetts Department afludasbidAccidentr . Office vfLr;vs*ad&n9. Baston,MA 02111 �arv��.mu�,gtrnfidra -. . Warlmrs' CumpensaffinIusurame fRdavit B>xUde7JC=fra:cW -stFkctd�1}f err PleasePrfid ad&e= �iig{�I� ' I as��Ph�ae� ^U�3 " .Z� — !?�•,;D Are you an employer?.Checkthe appropriate bor; Type of project(rem-ed)= I.❑ I ant a employer vd& 4. ❑I am a general confoctor and I 6. [:]New ennstractim employees(fall audfor part-timer* Imve hiredthe sub-coubmdars 2.IR I am a sole proprietors orpartmer- fisted oa.the attached sheet; 7_ [�Renro g stz£p and have no employees. These sob-c�rs have 9- ❑Demolition Woridn'gr 5W me in any capacity. payees andhave wor mm— Wo WO&MW co uap iMSUM -l- camp_;nsnranci&# 9. ❑Brzi1fing addifioa re aired_] 5. 0 We are a t:orporatim and ifs ld-❑Electrical repairs ar addsliaas 3.❑ I am.a homeowner doing all words officers have exercised their 11-0 Pluubsagrepairs or additiems + € a ' _ of eseupfrau per M(M ne x emsaquived j i c-M,gl('�nadwelbave no 17 Goal employees.[NoWodoets' 13-Elother cam-iaMMnM ] 'Anyspp&Czat Cut cbe rlEste]safiIla�t esechioabeTaws�evEiagH�eawa¢3ces'maap�•mfi poycgiidvnasaoaL T EEMMWVmES WI D sahm3t dos af5d2=mpg$ey u�daia�slf�eaxlc aad&tenhiie aatside c samst snhmit a nezvat�damt indite snrS, '. fCaa $�src3�ecl�ilasbmemu11stradsedeasddiff Shea 5bMdM9theaam4-Cfftsub-cant=tx3sarlstafewheb!rcanatfmseeaddeslk— • empia3•ees,IftLe�,�*-��+*��,�hace�giaFers,t�'aa�stgmvideth�a Rorl�as'�•galic5 m�bez I am all Setodv is iihaprrlicy mrd jab site iafornra�mn . Iasm-�m e Company Nam:. P4ficy�or Self-sus.Lis_� FaaDate= • Job Re Address` C�y/Skai�t�.Fp: Adach a copy of the workers'Compeasationpolicy declaration page(shouing the policy number and Clpu-ation d date}: Fa to secure coverage as required nudes Section 25A o€MGL c.1552 can lead to the impositi..on of rzi-heal penshies of a fuse up to$L5OO OQ aualfor ane-yew impds=nerd.Rs w&as civil penahi,es is the form of a STOP WORK ORDER and a free of up to$25fl_OO a clay agahut the violator. Be ad-dsed fhaf a copy of this st"aftmennt=ay be forwarded t o th,e Office of lmvestigations of the DIA€ar coverage vedEcafiaa- Ma her*ca*fy under tits pests andpenaloes ojrp&j zu),dwttJis mfo prmded abm f i;)bare and cerrect S;va /�.Iiti1� Date_ 4 o 14 t-/ l4 Phrase CWki d we onry. Dm mat surfs in difs area,to be cm mpfeted by city ortoor n gffi tat City or Taww P`ermitaIcense f Auih-ority*(drde One): L Board of$eahk 3.Buffirmg Dqmtmmrf 3.City Tows(1wk 4L Electrical kzpecOr S.Plmmbing for 6.Other Coact Person: Phone P: — ti . :aura .•i•/. t. ., .- .- .).,�•- r.ISim.-I _■.•]l Itl an- a i1■■1t • .• '■■ •r_nl n i. >, rurlt .■. �•u r .-m�r :+. - - •� •. u i■ - - ■ a■•n� n■.� _ rnw :r • m . '..r • . ■ap.�. : _U O•1 ■■.Y .:■ n�•�■a.. _`4..f Y.t•■ r•1 .• _t.•1. a ■t■ -r i3tt•t • •1 _..• ••• • tt•1 - • ■■" 1.7 "••u• �f._l:•�• n •u una:+ u of _u• t■ a nu_ G■ _ - •i a.ar.■•�. • : ■a 1 �. w■n ■•:� n i■- • :Il 1■■ .It_ •d tt�A■tP _..w•.fY.■Q. •1 •■■i vlttal a~.a■ . O :+nv •' i• R 4- ••••i! • •• - 1 ..• 1.1 - ■.•t.' ■• tl■1 - ■■.■t 1.1 �" _.r:1 ■■I ia1< :■1■ ••.• wwY a- i■�! ter.■ .1 rr- • rllr�..1 • n- /• -� ■t• ■■to� • :lr■ ■� t■ :it/Ir .• a i+/..Ir Il •.■[.•11■lav■.■■r •t/ t a r■•7a •1 -t.n •'./. .n .I ■ ■• - t..■� ■•.A- • ••Ia ■. 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I J ..•� t♦.ti - ■•n - •••[ • .+n i:±t ..r.n u• ►w n r tim I .• - :■�■ n .n r.YO ww • ..u1.■ R. •i1.■1 ■• r.n - • A,:•.■n 1 la A, In �■ w ■ a:• oil �■n. �. t. rural/ �.r a- n • . •.+`•i••:nat •••■ a .•- a u.n. •• n t•.n►: n •u w•r .n n■ n.• ■a. / •.. ►. .u• 1111 - Bell ;I IRA l :.n :,_w r va■u■ .n r r. anu r� 's f Ii_B ►J 1 Its sit'. ' . ~ ^ A WC Guide&m Wood Construction in High Wind Areas:JY0mph.Wind Zone Massachusetts Ch for Co k� y �3Q���X'1`1 . . Cbmk . 1'1 SCOPE Compliance . � Wind 110 mphWin -d----- --~-' ----------._---'..-'-----'-------'-----'------------� --- | � , �2 . � Number ofStories ' Roof Pitch .................. - ........ ----�--' ' -'--�-- Building Y�d�,VV - --- -Building--~-'��o�u,'--'----------'-----' --'-----'------------'` �"Bu ° --- Building Aspect=" --''------_--(Fig*).................................................____!5 3:1 Nominal Height of Tallest OponIng~ ................. ................(Fig 4V..............................................-. :5 618 ---' 1'3 FRAMING CONNECTIONS ' General compliance with framing connections....................(Table 2>........................................................ ....... 2.1FOU0DATIO0 Foundation Walls meeting requirements of 780CMR 54041 ` ' � '` ^- ' Concrete....... ...................................... __,_..____.____'�__ Conc��M000n�-------__-.'--__�-__--~_~-_--__-_____.-__..................... ---- � - 22 &NCHORAGE TOFOUNDATION1,3 ' 5/8'Anchor Bofts imbedded m5/8"Proprietary Mechanical Anchors as an alternative in concrete only' Bplt Spacing-general .~_.____.__ ______..___- in_ Bolt .......... 9 6'-1 � aouEmueum�t-conon�»-----.---------.. --_-__---__-_----- �.a7~ ---' Bolt Embedment-masonry.........................................UFig .......................................- ;z15" --- Plate Washer...............................................................(Fig5).__-_---_,_--_.-.�:Yx YxV4" --- 3.1 FLOORS ;Floor framing member spans checked Maximum Floor ftu1�or '� mVV��� --- ' . pu8H�8�VVaU Floor Openings ha�� �an0�mEuedo,VVa V� �_ _�_~ _ _-' Q� ' . . . _- ---- Maximum Floor ��opr� S�bockoSupporting Loadbearing Walls � ---' urShoamaU.................(Fig7)................................................... D -5d ~~~`'~^^Cantilevered Floor Joists Supp.or�~___'-'~ '_-- _--rwall_'----' Floor Bracing Endwxd�................................................... Floor Sheathing l}po 780 _--� Floor Shea��gFosu��g_----'--'---''--_-.([ab�2)'__�n��ot � In edge ---� . 4.1 WALLS Wall Height and Table .'__-.--_._' � 5�� walls-_-_.. andTob�5>_--___-- ���7 Wall Stud Spacing -_-._-_� ............. 10 and Table 5)...................__in.u24"mz - -- VVoUStory Offsets ........................................................(Figs 7&8)............................................___ft :5d --- � 4-2 ExrERIOmWALLS» ` � | Wood Studs Loadbeari/ walls......................................................(Table 5)........................... .2x� '___ft___in. Non-Loadbearing walls Gob���VY�/B��nQ` (Table 5) --' --- --'- --- Full . VVSP/��Fk�rLang�-�.-' 1 --- - Gypsum Ceiling Length Cff VVGPnot (Fig 11L. _-' _-ft�O�VV ux 4umonuouoLe�ng n�ms��om�u�'-(�Q11).'_--.'-.�........ ...................... ..... ---- ooubla Top PlateSplice Length --- � ................;.......................................(Fig 13 and Table s).....................................---ft � Splice Connection(no.of 1Ud common nails)..............(Table 6)................... ... ..............................��__ --- � ` . � . ` ~ ' J r AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zane Massachusetts Checklist for Compliance(7so cMR 5301.2.1.1)1 Loadbearing Wail Connections Lateral(no.of endnailed 16d common nails)..............{Table T)........................................................ Non-Loadbearing Wall Connections Lateral(no.of endnaffed 16d common naffs).._.:.........(Table 8)........................................................ Load Bearing Wail Openings(record largest opening but check all openings for compliance to Table 9) Header Spans .......................................................(fable 9)............................... _ft_in.511' SillPlate Spans ._...................................................(Table 9)............................... _ ft_in.511' .. Full Height Studs (no.of studs)...... ...........................(Table 9).............................................. ..... Non-Load Bearing Wag Openings(record largest opening but check all openings for compliance to Table 9) Header Spans..................... .......................(Table 9). ........ ................. ft_in.51Z SillPlate Spans...........................................................(Table 9).........................:........_ft_in.512' Full Height Studs(no.of studs)...................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear Simuftaneousiy, Minimum Building Dimension,W Nominal Height of Tallest Opening2 ................................. ..................:........................._5 67 SheathingType..............................................(note 4)............................................. Edge Nag Spacing.........................................(fable 10 or note 4 if less)........................_in. Field Nag Spacing..........................................(Table 10)..........................................I...... in. Shear Connection(no.,of 16d common nails)(Table 10)...........:.................................I......... Percent Full-Height Sheathing...........:...........(Table 10).................................................... % 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).............. Maximum Building Dimension,L Nominal Height of Tallest Opening2........... ........... < SheathingType........................................._.(note 4)...................................................... .... Edge Nall Spacing.................... .................(Table 11 or note 4 if less)........................ in. Field Nag Spacing...............:..........................(Table 11).................................I............... in. Shear Connection(no.of 16d common nails)(fable 11)........................................................ Percent — Full-Height Sheathing.......................(Table 11).........................._........................._% 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts).............. ... Wag Cladding Ratedfor Wind Speed?.............................................................. I.................... ......................................... 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) _ Roof Overhang .................................................. (Figure 19).............._ft 5 smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Wails Proprietary Connectors Uplift...............................................(Table 12)...........................................U: plf Lateral............................................(Table 12).............................................L=—Plf Shear...............................................(Table 12)............................................S= plf Ridge Strap Connections,If collar ties not used page a e 21... P P .. able 13 ............... = plf _ Gable Rake Outiooker.........................................(Figure 20) _ft 5 smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift...............................................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(Table 14)........:....................... .....:L=lb. _ Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59).................. _ RoofSheathing Thickness................................_........................................................_in.z 7/16'WSP Notes: Roof Sheathing Fastening...........................................(Table 2)........._..,............................ ................— 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1.If the checklist is met in its entirety then the fogowing metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 it shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2.in,nominal thickness.pressure treated#2-grade. � - --�-ems - " .. - — • AFF'C Gaide to Wood Corrsfrircdozz zrr JiikTr HfrrrdArertr_11O MPAr P/= 1arze M.,umchusetts Cheek for Compliance cna c:&TRs3DT-i r i)r 4. - - a From Tables i g and 11 and)Dmffi n of w all Wmdhing and guar&Aspect Ra5Q,deterinine Peru FUI-Height _ Sheaffring and Marl Spacirg requirements b. Wood Structural Panels shall be muimnun thicimess of7fi 6'and be insballed as fellows: - - _ h Panels shall be insWed VA strength ar=1 parallel In sfilk. I M honor W jolnts shall ocrx>r over and be naffed to framing -- u'L On single sfofy mnsixuc:Son,panels shall be attached to bmttnm plates and inp.fnember of ft double top slsaff iff- to-Ere top member-af-the tipper double top-- ---- plafe and to band joist at boifnm of panel Upper affcm*t of lower pane!shall be made to band jet and imwer attachment made to lowest plate at fast ftoortarning. V. HWr Mr t d nail spacing at dM ble tap plates, band jurists,and guders shal.be a double rout of ad - staggered at 3 inches on aulw per figures below:Vafad and Hortmntai NarTrng for panel Attachment 5- Glazng profs i, a)hex/house orhor>zonfatadMon-required lfprnjadl'-1 rnrle ordmssar tD shore(gan ally,south of Rtr;ZB ornwth of lam.6) ' b)vetfit-d[addffian-not required tmless there is extensive rencnta�on fn the Last floor c)replaramerrtiMdmws-needs energy conservation campbhce only(chap g3) S.Wood Frame Cmnstrvdion Manual(MChq for 110 MPH,Exposure B maybe obbim- edfrom tine Arnericart Wood CaunrsI (AWb)websife: ' • its-rs R - rt>sefa WAs. - •ATVbLa . tt c ii it tt 11 Y ! _ i ii t;�r-j_ ► - 1 , !r lLF • •Q 1 tl t r t d L/ �t 1 .. i s t it m t .. , r if. xxr . • � is 11 rt - � t , E IIr it - t • — a tl • 11 ar q 1 o it ii it 19 t < rl _ hnitr�rrnr.F 3`ti�, fJhESt'JEC�VG �L I�LFPl1�T�i+t � Pltra_ ' . 1 • . �_ �� r r�I�. � mt na c cla a gx�sPRLZg�t1�11SL . ` See Bata Dn Next Page DeWl -Vetfical and HarimrrW NW ng , tTr=rirn�ai md w rr>�I htatlmg for Panel A arhrttetrt foe Ferrel Attsc hmerit . Town of Barnstable Regulatory Services ox Richard V.Scal4 Director Building Division NAM Paul Roma,Building Commissioner � 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILINGS ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. ; DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code,,and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner•shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Town of Barnstable Regulatory Services MAMRichard V.Scali,Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barustable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder IJarwi as Owner of the subject property hereby authorize ;Fd fiZr to act on my behalf; in all matters relative to work authorized by this building permit application for. (Address of Jo ) **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 1n ec 'ons are performed and accepted. S' a of'Owner Signature of Applicant Print N Print Name 0 A07 91)16 Date Q:F0RMS:0WNERPM0SI0NP0OLS Massachusetts -Department of Public Safety Board of Building Regulations and Standards u License: CSFA-657394 IN ROBERT G WAL* 735 Old Barnstabig R.12111111111 East Falmouth MA `� %ors l` ``�• � - * Expiration Commissioner 06/02/2017 l� G-jl�r,�ac�rr�eft License or registration valid for individul use only �e Trc-i�rr�rn�rale«�f�01 Regulation .. Office of Consumer Affairs&Business Reg before the expiration date. If found return .-HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ` Type: 10 Park Plaza-Suite 5170 �Registration: 141991 DBA Boston,MA 02116 Expiration 3/3/2018 HARBORSIDE REMODELING ROBERT WALSH r. -- 250 CAPTAIN CRdSBY ROAD , >{-v = Not valid without signature , ,CENTERVILLE,MA 02632 Undersecretary , t i Column & Post"" Columns Tapered Round Ta �o > ra& osr ® P . plumb per d column From the celebrated and historic cities of Europe, to charming and welcoming front porches across America, the Tuscan column is one of the most recognizable architectural.elements the world over.The Tuscan column and its timeless elegance have been featured on the work of architects and builders since 4 ancient times. The attractive, deep flutes are sculpted into the column master providing long crisp shadowy lines for added depth and attractiveness. Whether configured in a'coto nnade along a veranda or positioned on the sides of a dining room entry,fluted columns wi11 complement the ambiance of these elegant spaces. , Columns must be painted. .- > Bottom Complete Column Shaft with Cap&Base Complete Column Shaft with Cap&Base Load Bearing . Diameter Split for Split for Bearing x Height Smooth Pilaster Fluted Pilaster 6"x 8'-0" $218.00 $313.00 $263.00 - - - 8,000 . 8"x 5'-0" 212.00 299.00 249.00 - - - M000 8"x 6'-0" 228.00 315.00 265.00 - - 10,000 8"x W-0" 244.00 342.00 292.00 $322.00 $419.00 $369.00 10,000 8"x 9'-0" 267.00 390.00 320.00 336.00 459.00 389.00 10,000 8"x 10'-0". 291.00 421.00 351.00 368.00 499.00 429.00 10,000 10"x 6'-0" 291.00 381.00 330.00 - 14,000 10"x 8'-0" 303.00 404.00 354.00 398.00 499.00 448.00 14,000 10"x 9'-0" 335.00 462.00 392.00 435.00 562.00 492.00 14,000 10"x 10'-0" 365.00 499.00 430.00 476.00 610.00 541.00 14,000 10"x 12'-0" 490.00 641.00 571.00 - - - 14,000 12"x 6'-0" 383.00. 478.00 427.00 - - - 1.8,000 12"x 8'-0" 419.00 524.00' 474.00 498.00 603.00 553.00 18,000 12"x 9'-0" 458.00 589.00, .' :- 519.00 526.00 657.00 587.00 18,000 12"x 10'-0" 498.00 636.00 566.00 575.00 700.00 630.00 18,000 12"x 12'-0" 645.00 800.00' 730.00 732.00 887.00 818.00 18,000 14"x 8'-0" 933.00 . 1,020.00 970.00 -, - - 20,000 14"x 9'-0" 971.00 1,083.00 1,013.00 - - - 20,000 14"x 10'-0" 1,008.00 1,128.00 .1,058.00 - - - 20,000 14"x 12'-0" 1,165.00 1,302.00,, 1,232.00 - 20,000 a ' 14"x 14'-0" 1,474.00 1,630.00 1,561.00 - - 20,000 14"x 16'-0" 1,782.00 1,960.00 1,890.00 - - - 20,000 Items priced in italics are factory order-please allow additional lead time. Split columns ARE NOT LOAD BEARING. I For product specifications visit www.calumnpost.com. AUGUST 2015 Brockway-Smith Company COL-5 ' . Town of Barnstable . . . Building 'Postr,This.Card So.That,it: s Visible From;the S,tceet*.¢An roved Plans.MustFgbe.Retamed on.J_ob and,thisrCard MustrcberKe t Y._: `. WtNST'A$LE. 3 *w a.::;a3a" o. •P�t�' -� gam.K �Ia ryre+a 1tip �. :-4a r my us „k _�v.=;t `� a, .� p _ - M"ss i! Uritl Final lns action 11as Been.Made. r , 7 ` ` , fi' wrj ..` a • Poste * _ �X _ w Where a.Certificate ofOccu`anc isERe aired,such B'uldm shall Not be Occu�iedantil a FinaYlnspection has',beenrnade. w eY p y.n�:.rs�• p�.,.uFt�,i �'sa*gp,.;�r Permit No. B-16-3268 Applicant Name: SANFORD,THOMAS W JR& LOUISE M Approvals Datelssued: 11/07/2016 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under° Expiration Date: 05/07/2017 Foundation: Map/Lot: 24 -071 Zonin District: RB Sheathing: 6 Location: 528 CRAIGVILLE BEACH ROAD,CENTERVILLE _gg g Owner on Record: SANFORD,THOMAS W JR& LOUISE M y Contractor Name: Framing:- 1 Contractor License Address: 139 VANCOUVER AVENUE 2 WARWICK,RI 02886 a Est Project Cost: $0.00' Chimney: yw _ . Y Description: 8x10 Permit Fee: $35.00 Insulation: Fee Paid.' $35.00 Project Review Req: 8x10 = Date 11/7/2016 Final: Plumbing/Gas f Rough Plumbing: �Building Official r� Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is commenced within si months after issuance. =t Rough Gas: All work authorized b this permit shall conform to the approved a lication and theca roved construction documents`for which this permit has been ranted. g Y P. PP Pp PP P g All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laW- and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration ofth' work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officals ark provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: w 1.Foundation or Footing Rough: 2.Sheathing Inspection .W;� 3.All Fireplaces must be inspected atthe throat level before firest flue lining is installed , Final:` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations." Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting-with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Y` Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable a Regulatory Services SUILD/NG DEp7- Richard V. Scali,•Interim Director sI Building Division T N®v® 72016 Tom Perry,Building Commissioner o"OF 200 Main Street, Hyannis,MA 02601 BARNS'NSLc www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMITS FEE: $ SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed( dress) Village ZJ Property owner's name Telephone number En Size of Shed Map/Parcel ff tco Al le Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 Jw 8Z:O1 9IOZ/Z/iI I3o i TON -�' zur& -a�rdho t P"P � ��'�s' 3 1S ,f--.'9�ra xE."+�f ���."uY�f'a��r ya�,��3.�rs�r��xs�v3`•l�Y°���"�jl`>'�'�u'f�?.+4a'�'��b4`N3s 6Nkne>r.�._3`;�'iN.»7r�F 3 1 Sbre y7„7wd��e`:e 3et�"sM"'�tc-',*ph+,v��'.'�.'�� M�' a �e".,:_f.'�.�,c»o.�,r-�.,^3 -�:.3,..�,r•.�e�rh�5-:'`x%��1� ":.�w ii�"'�$+Mv ky.i.�.'" gez)h',ar?,';-}'S''x. �.. � a�ao � �' E"x� � � k'�'`.a �� .�l" ^s�' '�"�`r "ti i,� 35,E � 3 '3sc �.� v.► A�. ik���'',�R�� 3 aa t s EV to ^ss• �Yty r d F �"k e�it v� �i- .�i��� ,! t�l� "'' � (�"�+ i s �� ��s. \!`�' �, s r �,��yQ,x-fit ,�t. � �.�+ty� •� 9^ " ���.m��� �° ������� ,j/� � �- ..fit � � � . ,� _ ..� � �•o- � � & �� Ss„� of Ali, *• ; � ;. k� • gd &mot, 3XIn ua utBuz Ireu2=3j/sfj/oRPIS RUI/sas/�uoo al�oo�IiEai//:sd�� Jd -906I JWI kit k Town of Barnstable Final Inspection Affidavit Date: 4 Thomas Perry, CBO Building Division` 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed at: Street: .t 7- g (C Villager has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit application number: Id 13 Issue date: Sincerely, .: Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com th fa 02 d3S t �z1KWE r PERMIT Town of Barnstable *Permit# �/ ssc) Expires b months from issue date . . t 1 2014 Regulatory Services Fee * RAIM esM T 9� MASS. �$ Richard V.Scali,Interim Director 63 ARN STABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 180 S�(L,�6e,'Oy N•� R� Cyr C v ���e OrResidential Value of Work$ 120 Minimum fee of$'35.00 for work under$6000.00 Owner's Name&Address �e�� • 9&-!F h 160 s�� �,r�ti fit•11 Z� , C� v,11e , m� Contractor's Name mk hc� bz� Telephone Number SOg_ 'Y/— 9111 Home Improvement Contractor License#.(if applicable) 13 6 42 Z Email: U1 NQJ r- L I & /404 o-.6 1. c., Construction Supervisor's License#(if applicable) C — O7"7 SSA b ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �I have Worker's Compensation Insurance Insurance Company Name L Workman's Comp.Policy# W GC SQQ SC)-I Ct 9 9 Z y'k-& A Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) . ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [R"Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: . Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE:.. /� /l,✓� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 i Cl2e �Pdnvrreo�c�uea���o� --- f, Office of Consumer Affairs&B I( �GIbJ�Le ( License or registration valid for individul use only �i ME IMPROVEMENT CONTRA essRegulationDiu°eh! before the expiration date. If found return to: +. �( ;registration: 136522 RACTOR Office of Consumer Affairs and Business Regulation xpiration Type; r 10 Park Plaza-Suite 5170 8l1/2014 Boston,MA 02116 MICHAEL B Individual I ENJAMIN GASPARDl MICHAEL GASPARp 225 Gosnold st �� t Hyannis,MA 0260 � Undersecretary !. Not valid without signature c re tary '7 r ------------- Massachusetts -Department of Public Safety Board of BuildingRe gulations and Standards Construction Supervisor License:. CS-077U6 MICHAEL B GAS i. 356 Bay Ln Centerville MA 0�632 y Expiration Commissioner, 03/23/2016 The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organmiton/Individual): m�(A� "e.1 L6C.. Address: 356 Za L-unt_ C&Aerv'%\\e -MA ©z6gZ City/State/Zip: Phone#: 4 09 1/15-! - 9 L f`I B Are ou an employer?Check the appropriate box: Type of project(required): 1.�I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. El New construction employees(full and/or part-time). , 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 workingfor me i capacity. employees and have workers' n any ac inarrrance 9. ❑Building addition [No workers comp• comp.insurance required.] 5. 0 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 5II 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'camp.policy number. f 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.#: W GG Soo 5 b 7 Qq Ot 2013 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 Investigations of the DU for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: s� m Date: Phone#: Official use only. Do not write in this areag to be completed by city or town official City or Town: Permit/License# a Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector S.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 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 dwe_Ming house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry 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 permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space of the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition.,an applicant that must submit multiple permit/licease applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"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 future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would ne to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents, Office of layestigatians 600 Washington St oet. Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MA88AFE Revised 4-24-07 Fax#f 17-727,7749. WKW.mass.govfdia Town of Barnstable Regulatory Services mess -Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner I 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us { Office: 508-862-4038 Fax: 508-790-6230 • 1 i 3 Property Owner Must Complete.and Sign This Section If Using A Builder I,!elcjeitn RVCA0 as Owner of the subject property hereby authorize to act on my behalf, i in all matters relative to work authorized by this building pem2it (Address of Job) **Poohfences.and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. e et Signature of<Pplicant 'exi�anicki Print Name Print Name Date MICHGAS-01 MVAUGHAN ,�►`orrn4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/28/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE 'DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements.' PRODUCER .".- - CONTACT _ NAME:. Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 NNE Ale.No,: 877 816-2156 South Dennis,MA 02660 ADDRIESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NATIONAL GRANGE-MAIN STREET AMERICA INSURED INSURER 8:Associated Employers Insurance Co. 11104 Michael Gaspard LLC INSURER c dba Renovation Specialists INSURER o 366 Bay Lane Centerville,MA 02632=3308 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED.TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 9R ER MIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $A'IE TO 1�OOO,OOO A X COMMERCIALGENERALLIABILITY MPP6672B 05/17/2013 06/17/2014 PREMISES E;TL'snce $ 500,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( . GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG• $ 2,000,00 X1 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea a dtleD SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL III S AUTOS AUUTTOSULED BODILY INJURY(Peraccident) $. HIRED AUTOS NON�OWNED PROPERTY DAMAGE $ AUTOS PER DENTl $ UMBRELLA LIAR, OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- - AND EMPLOYERS'LIABILITY TRY LIER B ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N WC C5005079992013A 03/06/2013 03/06/2014 E.L EACH ACCIDENT $, 500,000 OFFICERIMEMBER.EXCLUDED? � NIA - (Mandatory 1.NH) E.L.DISEASE-EA EMPLOYE $ 500,0 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) E CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE j ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD oFTME Tayti Town of Barnstable Regulatory Services muss Richard V.Scali,Interim Director Eo;A�"tee 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,—Pec4eltn RVCA 10 ,as Owner of the subject property hereby authorize �,��� �rC�gTG ,('� to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled ot.utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Ziplicant Veneer, &ZCA r, Print Name Print Name _3 Date L Town of Barnstable Regulatory Services oFTti Tok� Richard V.Scali,Interim Director Building.Division a RARNSMA13 - Tom Perry,Building Commissioner MASS. 200 Main Street, Hyannis,MA 02601 CEO www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB.LOCATIW: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occ]lpied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S E7CEMYTION 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 n for Licensing Construction Supervisors,Section 2.1 This lack of awareness.often (see Appendix Q,Rules&Regulations g p � � 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. MICHGAS-01 LTADDIA CERTIFICATE OF LIABILITY INSURANCE DATE(mYYYY) 3/3l/20/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE Fax 43 Rte 134 A/c No Ext: A/C No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:NATIONAL GRANGE-MAIN STREET AMERICA INSURED INSURER B:Associated Employers Insurance Co. 11104 Michael Gaspard LLC INSURERC: dba Renovation Specialists 356 Bay Lane INSURER D: Centerville,MA 02632-3308 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTRR TYPE OF INSURANCE D POLICY NUMBER MMIDD/YYri MM/DDT LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY MPP6672B 05117/2012 05/17/2013 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE F OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO- Ll LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ UMBRELLA LIAB OCCUR' EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY T E B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N CC6005079992014A 03/06/2014 03/06/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED9 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 it yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) "Workers Comp Information-Proprietors/Partners/Executive Officers/Members Excluded:Michael Gaspard,Sole Proprietor** Terry Kenyon,37 Jackson Ave.Centerville,MA 02632 CERTIFICATE HOLDER CANCELLATION r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map R41 Parcel 1 7 Application # Health Division Date Issued61 Conservation Division Application Fee Planning Dept. Permit Fee '' O Date Definitive Plan Approved by Planning Board 9 9 3 Historic - OKH _ Preservation/ Hyannis Project Street Address gill �Ge Village Owner G. Address C Telephone r Co ` Permit Request 1-n50 Ck C '3 l Square feet: 1 st floor: existing proposed 2nd floor: existing propo j -Total�§w Zoning District Flood Plain Groundwater Overlay. a Project Valuation 43700.00 Construction Type_ Lot Size m3�SIG Grandfathered: ❑Yes ❑ No If yes, attach s�upporting;docurnentation. Dwelling Type: Single Family TR Two Family ❑ Multi-Family (# units) t Age of Existing Structure i q so Historic House: ❑Yes V No On Old King's Highway: ❑Yes 5 No Basement Type: ,4 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: 0 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 a APPLICANT INFORMATION `gg 1ILDER OR HOMEOWNER) R!:ame �C?,tiYl CAA SN� J�/ OY) Telephone Number 4 a37'®a ( 0 Address - 5oa V�GrL^'I C/t" License # Home Improvement Contractor# 16D SSq Worker's Compensation # I D o- 6 a 1 S 31 S ` @g3A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i3g (` c► y: �nnu R�1 �GnJ 44�0wt��. SIGNATURE DATE sLq/W13 F 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: +hy =ftFOUNDATION > FRAME FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FFNAL BUILDING=. DATE CLOSED OUT ASSOCIATION PLAN NO. r F ,T • / , / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: w�e_CNA (o , Phone#: '17 -7•-.0( 1 Are you an employer?Check the appropriate box: Type of project(required): I I_am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or.part-time). - 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' [No workers'comp. insurance comp. insurance:$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I-n 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 �r.l C1a 1(41� 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 a new affidavit indicating such. xContractots 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. / i Insurance Company Name: f"t Policy#or Self-ins.Lic.#: W- ��- Expiration Date: � ����S �A xp 3 Job Site Address: 1150 &�_avJ I I I d City/State/Zip: nn Odb7 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder 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$250.00 a day against the violator.. Be advised that copy of this statement may be forwarded to-the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 61 Phone#: 7 y 10 Official use only. Do not write in this area,to be completed fiy city or town official ' City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ,,, Contact Person: - Phone# MINIMUM CEIMMATE OF LIABiLtfY SLI iCE_ UNIMM WEBS f E IS�t AS A Mof m OF nwoompmm�Y AND t NO i .TtBS "tli6 GCE OF NISURRHMDOPS owCOIJERAMW AFFORDED BY THE l TiiOlE A!� =ice NTH Lp ,�111DIMCOCIRWAIEHOLOM - �� Ifdd9iis�t-1tD�[iI�I1L � �t�e .ff�Oti•IS �. rrxloocm cy lumna �i��dcoeSa�Fffiepo�,e�po�ies�cy � As�aa�a��+o ��a �ie - i�altlee•��a�sueh - - - - _ _ ft _ BMW Saa% "� 331S" tAZE1i _ 1 Tm at Guam==CF&W cmarw CROUM Dmwow m f�l S0 E ILVf]BE OR Im PRom'il$ ar-M PaSYP�d ac+rlion Qacm s . A66 S 1 s _ amp: i S { - rK " /�C61ilO !SCHEDOM maw StKOMMIED " =: S ummm*2 AIMS a ,, s 14 A y WARM 3n4WM- e►aae s hQI3t3,0 . �ejL- rm=tsar OF NOCEUJM �r" � HWER �MY HourE SLY IM IN ialf� J aoG['aY+v _ evil=l MOM z7?*ACORlDUM,3:md"omm limp MassaclFusetts-Department of Public Safety e rCa9npzaa�:raerzl�a. 1`ir�saclur>e!t *' Board of-Building Reclulations and Standards Office-of Consumer Aifaaus&:BessRegniaiian ME IMPROVEMENT CONTRACTOR : Construction Super isor SpecialEs License:CSSL, --- t _ , F iratron 9/8/2014, CLC CI e PRANCES S Aw ,. ;:: FRQPGTIER ENERG`F Sf�L{1f 1 , 5M H"W, RD Brewster 02632 ..." - FRANCIS SHEEHAN y ' HARWJCH RD Commissioner � _, BREW erseereffiry ,STER,MA 02631 Und Eli Expiration Q2hm16 z. t ' s Restricted.fo:CSSWC-InsulationContractor License or registration valid fo'r"individul use only before-the ezpiratiow date. If found return to Office of Consumer Affairs and:Business Regulation 10 Park Plaza-Suite 5170 :Boston,MA 02116 Failure to Possess a current edition of the Massachusetts l State Building Code is cause for revocation of this license_, z � ' For DPS tfc.�ing information viu� vwdw htm.Gov/DP5 slid: ithout signature -::., t Yam, _a f • S OWNER AUTHORIZATION FORM (Owner's Name) owner of the property Located at 1�60 S C-CCk/SQ,r y 4 (Property Address) (Property Address) hereby authorize I 1 C�1 M- Cl; (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. _ r Owner's;t - gn ire Date ' 7AUG r, 2013 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0 Map c7 5 Parcel Permit# �� I Health Division Date Issued Z Conservation Division Fee o2I , 00 Tax Collector '► , "' ° ., ' �/�7/ y, Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis t Project Street Address a Village ° Owner Address / 7a,/� �' .04� _ ;Zz Telephone //7-2 66 4 2� ? P � r01, -Permit Request /.�f c' ,mod r .00 Square feet: 1 st floor: existing q proposed 2nd floor: existing proposed Total new Estimated Project Cost :2 9 /® - Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Cl Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use n BUILDER INFORMATION Name Ax6zd Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# /'�'' //-- —27P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r/ DATE FOR OFFICIAL USE ONLY PERMIT.NO. DATE ISSUED j MAP/PARCEL NO. ADDRESS VILLAGE _ r OWNER~ ` � "' r r; ~•i DATE OF INSPECT[OIfa , FOUNDATION FRAME ! INSULATION ^ 4 FIREPLACE , ELECTRICAL: ROUGH FINAL r I PLUMBING: ROUGH FINAL , r f r GAS: ROUGH FINAL t FINAL BUILDING" � —vriT .r DATE CLOSED OUT ASSOCIATION PLAN NO. ~ f t ~ i The Town of Barnstable ensrsrw� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date f AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.Type of Work: '/0 , h w w Estimated Cost' Oros��lA Address of Work: ZA TY—,o A) Owner's Name: IiAx 'ral'of aC A Date of Application:�, a I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [3Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME McROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. see? /lot Date Contractor Name Registration No. OR Date Owner's Name q:fortns:Affidav �/.�.-2.�i: M;4��csiL�!�7�f.�s. 1«:1 rat 0 . 11 1 . 11 - • �1 •4 • 11 1 • 1 . 11 • . • . . 1 1 1 1 • 1 1 II �1 I Y I 1 1 I 1 i1 I - / 1 . • �• 1 1 • 1 1 . la a r / Adw t L.. i 3 • 7.7 dwl ♦1 _ II I . I _ • • • 1 bl' I � 11 11 • i _ 1 vl wwoo W,v,�.000iaaazoo;:iwM.r.:,.:i»+M:w..<o:.. n ■ 1 " ■ } z ... .. � - ,'`w •� ✓1GY T��II�IZimOnCIJP.ClL[IL 4y t/(�/�dd� f . ' t BOARD OF BUILDIN REGULATIONS License: CONSTRUCTION SUPERVISOR Y.. Number.�CS 074360 Birthdate 06/23/1958 �. Expires:06/23/2002 Tr.no: 74360 d ResUicted To:.00 -- RICHARD VILLANI a 185 PITCHERS WAYS a HYANNIS, MA 02601 Administrator , - - HOME'IMPROVEMENT:CONTRACTOR Registration, 128560 .: Type•,- INDIVIDUAL , .' Expiration 04/21/01 RICHARD`VILLANI + RIC}iARD A,, VILLANI G�ta�r�o�i `` PITCHERS WAY �¢ ADMINISTRATOR HYANNIS MA 02601 a • y- s r ♦ n _ - A 3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel Permit# l Health Division ���jY� � � ®a�� • Date Issued Conservation Division :2^c- Z _ Fee Q Tax Collector SEPTIC SYSTEM MUST BE / Treasurer INSTALLED INCOMPLIANCE WITH TITLE 5 Planning Dept. I @�I ON$ ENITAL CODE DatutVtitive Plan Approved by Planning Board istorH'—is OKH Pfeftn*ion�Hyannis Project Street Address 'Z® b(5Y&r2.4' 11L \ =A �tw GIs a3 Village C,(5-M` V t LC,�_ -t Owner j�C�iZS`Is`1^� t�U Po tG _ Address I3k (A-) C.a-3 Tr Telephone (el`"j Z_`c —p7 Z Z 3 pz�f l Permit Request ' Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost ` Zoning District - Flood Plain • Groundwater Overlay Construction Type Cam' Lot Size `'I 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: O Yes ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other - Basement Finished Area(sq.ft.) Q,�� Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new .J_ 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 la'I<lo Fireplaces: Existing New Existing wood/coal stove: O Yes B ITo Detached garage:Cl existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new, size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number _ •_7 2 (05 C) C^' Address License#c5n(b s� 2-5 ' Home Improvement Contractor# Worker's Compensation# (,l� �'3 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ^4 � SIGNATURE DATE �� FOR OFFICIAL USE ONLY PERMIT-NO. DATE ISSUED' MAP/PARCEE NO: yr. t -, ' __ j ... v j�. _ - •' .. t f, . ., ." ADDRESS VILLAGE � OWNER ,�. _ �, •ri' �'` _ � - �.� - ,. k � '. _ .• • • i* ' DATE OF INSPECTION: A. FOUNDATION47 s FRAME INSULATION _ 1 FIREPLACE ELECTRICAL: ROUGH' 'FINAL PLUMBING: ROUGH• "FINAL t: r v GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT p" ASSOCIATION PLAN NO. i • t, - " R" • • - is to ' ` y t , .. The Town of Barnstable • r�►sxsrnar.E. • . 9� 6 � Department of Health Safety and Environmental Services 'OrEo �" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 - Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to _ such residence or building be done by registered contractors,with certain exceptions,-along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: . I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME OVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRA O GUARANTY FUND UNDER MGL c. 142A. SIGNED ER PEN LTIES OF PE I hereby apply for a e t as the agen f the owner. 10 Date Co tractor Name Registration No. OR Date Owner's Name q:fb ms:Affidav - - - The Commonwealth of Massachusetts Department of Industrial Accidents e � ...... _ Office ofln�estigatioes 600 Washington Street �'" Boston,Mass. 02111 Workers' Compensation Insurance davit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I a sole =rietor and have no one tvorkin in amp ca achy I am an employer providing workers' compensation for my employees working on this job. 1i address: i l.O city 15�u t(,C(- phone#: t>U b insurance co. cv-, oiicv# �-Oso5 nce -.. �i ��� //. %///////////////////////.�///.�//i////i///�. ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hires the contractors listed below who have the following workers' compensation polices: comoanv name: address. <: dtv: phone#-. . . :.. ..: «:...... .. insarnnce co. .. . ......:.. piney#.. ............:... ..::..,.;•r�.;..•;>::>;::;.::<;.;;. carnnanv name. .....: address- citf: phone#� : ..: ::....::: ? %% Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erhnind penalties of a fine up to 51.500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a Une of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verineatiorr. I do hereby c ify under the and penalties of perjrsry that the information provided above is tru,and correct Signature --- Date Print name r .r Ll £aU�-U �� Phone 0 (pS MMMIMMMM ofnciai use only do not write to this area to be completed by city or town ofIIcial city or town: permit/ncense q ❑Bandinj Department ❑Licensi❑check if immediate mponse is required ❑Selectm❑Health contact person: phone#; ❑Other (eensea 9,95 P1A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any corzo-- of hire, express or implied, oral or written. Am 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 receive: 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 on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. - -'K+M2.ss•pxt. +woas+t a i .vrMc Nr ",1^S% sv.'+ sK"A'"'y"'�iw',.W»eae:�,, sw.+F_:L.s a'G:w rNi-:-. ...._ ... .._ . MGL chapter 152 section 25 also states that every`state`or`local`licensing agency shall withhold±the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe . commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. , Applicants . Please fill in the workers' compensation affidavircompletely, by checldng'the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial-Aceidddff10 confimration of�n�+,*a-' rn` -- .- ep coverage Also lie sure to.sago an , 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;-piease call the Department ai the number listed belor. K V1, x: r City or Towns Please be sure that the affidavit is romplete and printed legibly. The Departm.=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 applicam. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other ariangemeats have been made. ._ The Office of Investigations would lake to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Invesduadans . 600 Washington street Boston'Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 exL 406, 409 or 375 �'i4e�000amo.uaealde o�./f'.�aaac/uaetla ,`; HOME IMPROVEMENT CONTRACTOR . Registration 126560 g° ° Type - INDIVIDUAL Expiration 06/21/00 ALBERT R. BROWN 34 HORATIO LN �WERVILLE MA 02632 rr' ADMINISTRATOR y' ' �/ee �am>nnaruuea,�l�c a�./�aooae/uureC�s DEPAR ENT OF PUBLIC SAFETY x CONSTRUCTION S-UPERVISOR LICENSE �. ` I Number- Er,oires: Bi thdat?: 1 CS 'r 665525 02/12/2@99 @?�1211S4? R9 bted Toi ` '1i 1i�T"'- RLBERT R BR'OWN l� i 34 HOW10 LN CENTERVILLE, !,A 9?632 �` to JI r P WTA �s t �Li s ' t (25 CT .� fscKt yu Ler�- 5: wl _ EEC, s.iabsT s G - � IT, T tc ci `er— 1. s z C � (O`(S SCT" ©m- '4V , , t.� , r; , S « r FILE # K 1041 CENSUS TRACT # 125 ki PAGE T 480DEED BOOK 754 LA AG LUI CL IENT Kravetz & Lahti Kravetz Wxathlee ibbonsO Jeffre �AS SR APPL CANT & N D MORTGAGE INSPECTION PLAN OF LA LOCATED AT 180 STRAWBERRY HILL ROAD DULY 12, 1994 SCALE : 1"= 40' W. HYANNISPORT, MASSACHUSETTS PINE CRF...ST ROAD NOT eu'LT LdT5 Z3,24 4 25 LOT z2 LOT 2G *180 110, Ip' Uz srr A V c o STRAwb :RRY H t Ll.._ ROAD ND ITS I CERTIFY TO KRAVETZ & LAHTI KRAVETZARESNOCVISiBLEIATED OENCR0A0HMENTSRTGAGE LTD. o AOR EASEMEN TITLE INSURANCE COMPANY, THAT THERE AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPER- EXCEPTVIS10N THE LOCATION'' OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE. LOCAL APPLICABLE ZONING BY-LAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS- FERRE1. LL No. 28- THE DWELLING r SHOWN cHnnRE , DOTnONNA7ARD NZONEFAAS .-��.�n.__ :.�