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.�o Gv - 1 ,,, { e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d_ Parcel Application# y g Health Division �Q� Conservation Division ��- lb �OJ�`- O Permit# -/ Z(0 J 0 Tax Collector Date Issued 2013 0C U We Treasurer ® C �O Application Fee Planning Dept.t. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address J~ UW - Village Owner &�,t Address �`7 Telephone -7 y- E,23 �°- q02 qo Permit Request ckyy4 e- 1 V Square feet: 1st floor:existing_ proposed 2nd floor:existing proposed i Total new honing District Flood Plain Groundwater Overlay CD /- -�-0 r- °Aro� ect Valuation _ .� Construction Type Lot Size Chu I 7:2x0)Grandfathered: ❑Yes UAo If yes, attach supportingadocumentation. �.` Dwelling Type: Single Family l/ Two Family ❑ Multi-Family(#units) Age of Existing Structure / / ZZ / Historic House: ❑Yes W/No On Old King's H ghway: [d Yes U No Basement Type: ❑ Full ❑Crawl ®Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) 7 O-0 Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing 5 new Total Room Count(not including baths):existing 6 new First Floor Room Count 3 Heat Type and Fuel: ❑Gas WOil ❑Electric ❑Other Central Air: dYes , ❑No Fireplaces: Existing 2 New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new . size ��ched 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 ow BUILDER INFORMATION .Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE v2" !-06 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME .c a INSULATION ��`� 0'� FIREPL•A`CEZ �� 13�Fr�� '3,��2C�f0 �— Pi i EL AL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL I FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO.' ASSESSORS REF.: ZONE: FLOOD ZONE: Map 036, Parcel 051 RF Zone C Setbacks: Community Panel No. 0 VERL A Y DISTRICT. Fron t 30' #250001 0021 D Side 15' July 2, 1992 WP — Wellhead Protection District Rear 15' 0 WNER: Thomas S Cohen & Doreen E Cohen PO Box 594 Cotuit MA 02635 Deed Book 1826413 N/F Elizabeth Lawrence Peirson Deed Book 6577/250 r N88°36'40"E 240.02' i \�\\ 44,011±SF Q o� am N/F / m Cotuit Fire District / 76.1' �e Deed Book 1384/73 / , o �o / \\\ 0 / \\\ 01 y v me 96.1' �� / 2 Sty w/f GO -je\ � �\ 97.7'�� Dwelling 00 -- west C) (Variable Width) 00 O O ti"t (Private Way) G4 3 Street `�� � N; �O /500 Rid / ZE 0 old 0Y / 60.9' ►, 239.54' — N88'36'34"E NIF o Cotult Fire District Deed Book 4724/217 c 3 y o � m x�3 m 0n Z 00 Oa O N m2� HOF' c I certify that the structure RPORD tN shown hereon conforms to the A. setback requirements of the LHEUREUX y Zoning Bylaws of the town PLOT PLAN 034312 � IN 9 P of Barnstable. pFE. S% q" 07 6Gr o BARIVSTABLE `Professional Land Surveyor D to (Cotuit) NOTES: MASS. - 1. The structures shown were located on the round DATE: 071OCT104 SCALE: 1"=40' g 0 10 20 30 40 60 80 FEET by conventional survey methods on (or between) 131SEP104 and 29/SEP/04. PREPARED FOR: 2.) The property information shown hereon was Trade Grover compiled from available record information and PO Box 991 does not represent an actual on the ground survey. Cotuit MA 02635 3.) This plan is not for recording and is not PREPARED BY:to be used for construction layout or deed CapeSury description purposes.. 7 Parker Road Osterville MA 02655 DWG #: C632gl FIELD BY: RRL/WHK (508) 420-3994 / 420-3995fox r.-V ✓V..-•.-V•-•.vwA.- V. J.awYuwv.-wuv��Y . . ' � - DepartmentofbidastrialAccidents ' Office of Investigations, f•A ' 600 Washington Street Boston,MA 02111' www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plu nbers Applicant Information Please Print Legibly Name (Business/Oripnization(individual): Qwx_ ' Oroye Address: City/State/Zip: -C4t4 0 3 Phone#:-- -7 7'Y � 9� y0 Are you an employer? Check the•appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ' employees (fill'and/or part time).* have hired the sub-contractors 6• El Now construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. • g• ❑ Building addition [No workers' comp,insurance 5. ❑ We arc a corporation and its 10.❑ Electrical repairs or.additions required] officers have Exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself•[No workers' comp, a 152, §1(4), and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers'' A / ' comp.insurance required.] 13. Other. C / 1ti►h,e y *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomration t Homeowners who submittbis affidavit indicating they are doing all work and then hire outside contractors must submit a now off davit indicating such. ;Contractors that check this.box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site information. - Insurance.Coaupany Name: Policy#or Self-ins..Lie.#: 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 cani 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 flue form of a STOP'WORK ORDER and a fine of up to$250.00 a day against the violator. $e advised that a copy of this statement maybe forwarded to the Office of Investigations of the DI.A for insurance coverage verification. I do hereby certify nder the pains and penalties of perjury that the information provided above is true and correct: - Si ature: °7'`c�` Date:-. 02_ Phone#: 7 7 c2 3 7- Official use only. Do not write in this area,to be completed by city.or town official. City or Town: Permit/Lacense# Issuing Authority(circle,one)t 1.Board of Health L.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• ' Information and Instructions ensation for their employees. ' Massachusetts General Laws chapter 152 requires all employers m the service cT ' under any contract of hire, Pursuant to this statute, an employee is defined as"...every p ; express or implied, oral of written." ' « ' association,Fa�rporation or other legal entity,or any two: or more An employer is defined aS;:Ru indivi�i •Pafinersl�ip' A the foregoing engages ni a Joint enterprise, and incluc`ling the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership association or other legal entity,employing employees. How�er;the- otivner 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,constriction or repair woixba such dwelling house appurtenant thereto shall notbecause of such employmentbe deeniedto be an em "ployer. or on the grounds orbul7dmg MC 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•commoawealthfnr any lwal who has not produced acceptable evidence-of compliance with the insurance coverage required." ano • ter 152 25C(')states"Neither the commonwealth nor any of its-political subdivisions shall Additionally,MGL chap § enter into any contract for the performance of public work until acceptable.'evidence of compliance with the insurance iequirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out .the workers' compensation affidavit completely,by che�c1��g the�b n e� appltheir y to situation s)at on and,if. necessary,supply sob-contractors)name(s), address(es)and phone h LP with no employees other than the. insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L ) members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have . loyees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial �P tion of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should Accidents for coaf n2 be returned to the sty of town that the application for the permit or license is being requested,not the Departinent of Industrial Accidents. Should you have any questions regarding the law or,if you are required to obtain a workers' compensanPolicy,please call the Department at the number listedbelowy 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 Departmencontacto you regarding the applicant of the affidavit for you to fill out in the event the Office of Investigations has� Y. licant Please be sure'to fill in the pesmitlhcense number which will be used as a reference number. In addition, an app that must submit multiple p ermitllicens a applications in any given year,need only submit one affidavit indicating current policy must submit (if necessary)ssary)and under"Job Site Address" applicant should write"all locations in (city or � )» as been officially stamped or arked by the city or town may be provided to A copy of the•affid the avit that h m applicant as proof that•a vat affidavit is on file for;future permits•or'liaenses.•Anew affidavitmust be filled out year.Where a home owner or citizeA is obtaining d nse Or is NO required to complpirmit,not related to ete thiseaffidavrt'�ercial venture (i.e. a dog license or permit to burn leaves e :tc.) p .ez ' lions would h'ke to thank you in.advance for your cogperation and should you have any questions, The Office ofluvestiga , please do not hesitate t4 give us a call. art3nent's address,telephone and.fax mimben The Commonwealth of Massachusetts pepattment of Ind4strialAccidents . . .. • '. . at ..Office qff Y�avesag e r. 600•Washington Street- . Boston,MA 02111. `Tel.#617-727-4900 ext 406 or•1-877-MASSAFE Fax#617-727f.7749 Revised 5-26-05 www.mass.gov/dlia FINE►� Town of Barnstable Regulatory Services BMWST� ' r'Eg` Thomas F.Geiler,Director �'01EpMplp�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date p`-j�Q 6 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. j Type of Work: I��i�y i C/"�1M►1�LJ Estimated Cost ��54 �) Address of Work: �V ��5 S'-~ 6AI Owner's Name: Date of Application: o� l ' 06 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied [Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner s Name Q:forrm.homeaffidav i Town of Barnstable WP`ntt 'O '�� Regulatory Services : `^ Thomas F.Geller,Director 41 Building Division ��Fo►Nit a Tom Perry,Building Commissioner 200 Maier Street, Hyannis,MA 02601 wvrw.town barnstablema.us Fax: 508-790-6230 dice: 508-862-4038 HOMEOWNER LICENSE EIMWnON Please Print ^O V , �4" J L ocATION• 7 i village numbs street ov�r 7 y_ a 3 �= g�yo "HOMHOV+WNEr .home phone# work phone# name ' ' CJggMiT 1_AILLt`1G ADDRESS: state zip code city/town The current exemption for"homejel 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 c'—�t' TI DRYIN ON OF HOMEOWnA person(s)•who owns.a parcel of land on which he/she resides or intends accessary to r such us b and/or there r is,structures.dA ed a one or two-family dwelling, r penod shall not be considered ato' be, attached or detached structures to person who constructs more than o form accep ble to the Building official,that he/she shall be "homeowner'shall submit to theBuilding Official on r onsible for all such work erformed under the buildin Permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State wilding 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 re ts. Signature of Homeowner . ppprava1 of Building Official Note: Three-fay dwellings containing 35,000 cubic feet or larger will be required to comply With the State Building Code Section 127.0 Construction Control. HOMEO'q nWS E?MWTION tom The Code States that "Amy homeowner p�or�g work for wbo h a building that if the homeowner engages a pert is Tequirtd.shall be empt for file to provisions such of this section(Section 109.1.1•Licensing of construction Supervisors);pr work,thaf such Homeowner shall act as supervisor:' results in Ivlany horacowaers who use this exenv*n are maware 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 serious problerrss,particularly when the homeowner hires uacensed persons. In this case,our Bo��not proceed•against the unlicgnsed person as it would with a licensed Supervisor. The homcoQ+aer acting as Supervisor is ultimately resp . To ensure that the homeowner is fully aware of his/her 1•esponsbilities,many corarnunities require,as part of the permit application, tut hoTO ensur certify that he/she understands the responsibilities of a Supervisor, On the last page of this issue is a form cumntly used by stvcral towns. you mnay care t amend and adopt such a fornVicertification for use in your community. .� _. -A TOWN O�" BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 036 051 GEOBASE ID 2191 ADDRESS 50 WEST STREET PHONE COTUIT ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 82410 DESCRIPTION CERTIFICATE OF OCCUPANCY #78379 PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: De artmenk of ARCHITECTS: P Regulatory Services TOTAL FEES: $25.00 BOND CONSTRUCTION COSTS $.00 , 756 CERTIFICATE OF OCCUPANCY 1 PRIVATEsOTai * BABIVS'1ABI.E, + MASS. z63Q. A1� I BUILDING DIVISI . N j BY DATE ISSUED 02/24/2005 - EXPIRATION DATE d I . . . TOWF 07J BA!y. STABLE BUI-DING PERMIT , '. ID 636 05t GEOIj�'SE ID ., 2191 ASS 50 WEST STREET PHONE COTUIT ZIP i BLOCK LOT SIZE �A 11DEVELOPMENT DISTRICT CT 1 PERMIT 78379 DESCCRIPTION RENOVATE .COMPLETE HOUSE ADD DECK .& PORCH PERMIT -TYPE BREMOD TITLE RESIDENTIAL ALT/CONV CONTRACTORS: Department ARQJITECTS: p tment of Regulatory Services TOTAL FEES: $488.24 1 BOND $.00 OF CONSTRUCT�.OT COSTS $104 a 448.00 434 RESID ADD/ALT/CONY 1 'PRIVATE f�* OPT 1AMSPABLE, 16g9. BUILDING DIVISIONBY .. �� , I•E ISSUED. 08/06/2004 EXPIRATION DATE- ,� , TOWN, OFF BARNSTABLE BUILDING PERMIT 4_1 PARCEL ID 036 051 GEOMSE ID ' 2191 ADDRESS 50 WEST STREET PHONE COTUIT ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 78379 DESCRIPTION RENOVATE COMPLETE HOUSE ADD DECK & PORCH PERMIT TYPE BREMOD TITLE RESIDENTIAL ALT/CONV CONTRACTORS: ARCHITECTS: Department of Regulatory Services TOTAL FEES: $488.24 ' BOND $.00 CONSTRUCTION COSTS $104,448.00 434 RESID ADD/ALT/CONV I PRIVATE 'R BARNffrABLE, MASS. BUILDING DIVISION BY EZ�4ilv DATE ISSUED 08/06/2004 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF;EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE A ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. NICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRIC INSPECTIOVPPROVALS A fpoo� ,1 �/ / 1# 2 2 2 Loor rAe4NN //1 1/.// I 2110166-- 9FPf 3 IS F7T,74J e_IZ310 1 HEATING INSPECTIO PPROVALS ENGINEERING DEPARTMENT ,,NS� �� 1 f���A� �y� V 2 130ARDAO HEALTH OTHER: SITE PLAN REVIEW APPROVAL ,Alcal�?to It'. WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON-' INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. c� i U Di NG!- IL PEIR,.MIT , . f ' ' •t f � I Y ,a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' .3 M Parcel ® Permit# 7?3 7 Map �r6U,_�,^,� �. Health Division ��30 //� �n e Issued 2�e Conservation Division 7/19/ ®q � � � " ' Pro (: A plication Fee Tax Collector Permit Fee �J Treasurer x` ' � Sf 0� --.WAg W COMPLIANCE tTw MOST BE Planning Dept. 1MTHTRLE6 EN1gRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board -. TM REGULATIONS Historic-OKH Preservation/Hyannis r Project Street Address ( W e S r S �© e Village GLe ` Owner `q Pao Address Telephone ,_O Permit Request ��rn Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family, 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes CrI14o On Old King's Highway: ❑Yes o Basement Type: ®'Full Cl Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing O—Z" new Half:existing new Number of Bedrooms: existing -3 new Total Room Count(not including baths): existi g new First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑Electric 0 Other Central Air: ❑ "No Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes a<07 Detached garage:O existing ❑new size Pool:0 existing 0 new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing O new size Other: Zoning Board of Appeals Aut ization El Appeal# Recorded O ❑Commercial Yes, No If yes,site plan review# �` = - Current Use Proposed Use BUILDER INFORMATION cL iG ?N- 31 Name_ YC 1 Lea �! 1� /��u 2 S t� Telephone Number rQ 999' Z g� Address 130 jC p;20 0 License# C 5 ©g/f(v?0 Home Improvement Contractor# �/3 y�� r'h,&r&6r V14 O 2S G l Worker's Compensation,# ��'S �{6 3 U ALL CONSTRUCTION DEBR RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ccyv,;14/1-V l U SIGNATURE DATE FOR OFFICIAL USE ONLY ' PERMIT NO. 1 DATE ISSUED l - MAP/PARCEL NO. ' ADDRESS' :VILL'AGE ' OWNER DATE OF INSPECTION: FOUNDATION �s'y FRAME. ll✓fl?,4 . Pk RXX �Tr•1jG�e' i INSULATION �'i'atr/ A< 5,W61e11 �!/✓39�j i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUE FINAL .•' rn un FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN I ra co �J q B©A"RD pF License: C, BUDDING R N� S EG 7-RU U r C LAT I � " Num, TION S IONS ker UPERVISOR 048207 RICNgRO o: 13425 r BQX wuR � /`t SgGq,MO 08 �� - 2%o m ' Boai of NOI yF/MP �_ Eacp�rat/o 1g3 R2e9480,L E as�d" SRe 9 1StTON TC r`tara da.rr.d sr ON TRgC47g TOR R/CjygRO S 1`ype .Inl?OpS RICH, NU T ._ d!Vid�al ; 9gp Sq N NURST `IR SA DWICI., dR ; GAMoRE,Mq P2S 6j .... r ce- ��ialstratur .. The Commonwealth of Massachusetts M Department of Industrial Accidents' MC of Ism sU M 600 Washington Street Boston,Mass. 02111. Workers' Com ensation.Insurance Affidavit-General Businesses MHE name: y- address' 'gd� state: Zi :Z hone# O S �19,qO CR work site location(full addressl: 36 ❑ I am.a sole proprietor and havt;no one Business Types EJ Retail❑RestaurantBai/Eating Establishment . wor ' in any capacity. [IOffice❑ Sales(including.Real Estate,Autos etc.)' n em lover with eta to es full& art time): ❑Other %//%%%%%/�i '��/%%/ %/%///////////�//%/%%%////%%%//l%%%/%%%%%%%% 711011//O%// I am an employer providing workers compensation for my employe orking on this job.. �1. ..U`f:f:: SP tit •+ •''• ' coIIi' ari'•name• iiiratice.ca:' ::_!• :'17 2,0 ns lic`'•# .'i:.::J iZ , ' '❑ I am a sole proprietor and hsve hired the independent contractors listed below who have the following workers . . .compensation polices: " COIDASIIV II - --- address:. `•' ',,'"' "'• _ ''�: cites p1i'oae.#5. 44.: a,;ri�'r .$: y�:'• .r.U�lc c#, .•.,r':i+:.�?•1:�•.t••� insursnce'co. - •� ~ ad rtss:. C � IIV ge —.-t >. 4. `suceac=Aso:•,° _ "•`o7icv:#":`�='•r'' - ,';: 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 51,500.00 andlor one years'imprisonment as well as civil penalties in the fdrm of s STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of luvestigations of the DiA for coverage verification. I do hereby certify der the aPns an p ti perjury that the information provided above is true and c rrect Date Signature ,( Print name ,) L A 4/Z� es / ' tit 146� - Phone# official use only do not write in this area to be completed by city or town official city or town: pgrmittlicensel# DBuilding Department . ❑Licensing Board Cl check if immediate response is required ❑Selectmen's Office DEcalth Department contact person• phone#; ❑Other (revised Sept 2003)• y Information and Instructions eral Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. chusetts Gen •. �, . Massa - employees: As quoted from the t`law", an employee is.defined as every person.in,the service of another under any,contract express or implied; oral or written. of hire; xp �` '` � _..<;• r,z,e.. An employer is defined as an`individual,partnership, association, corporation or other legal entity;, ' 'any.'two or,mgre of the foregoing engaged a)omt�enteiprise;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.oceupant:of the dwelling house of another who employs persbbs to do.maintenance, construction or repair work on such dwelling house or on the grounds or b g appurtenant thereto shall not.because of such.enVloyment.be deemed to be an employer. ; MGL chapter 152 section 25 also'states that every state*or,-16 1-licensing,agercy shall,vdthhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.c0inmonwealtt for�any applicant who has not produced acceptable evidence*of.compliance with the insurance coverage required:,Additionally,m6ther the- comrnonwealthnor.any.of its political subdivisions shall enter into any contract„for the performance of public work until acceptable evidence of comphance with the insurance requirements.of this chapter have been presented to the contracting . authority:`" Applicants please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation.:Please supply company nanie, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. A.lso'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:workeW.compensation policy,please call the Departriment at the number listed below. City or Towns . Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to Olin the permitllicense number.which will be used as a reference number. The.affidavits,may.be.returned to the Departmentb�,mail or FAX unless other'ariangements havebeenmade.' The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate•to give us;a call- The Depaztrnnt s address,"1ephoMnean6MfaxnMumber:. . • .• . . The Commonwealth Of Massachusetts. Department of Industrial Accidents no of 18"Sngallens 600 Washington Street Boston,Ma. 02111 fax M (617)727-7749 phone M (617) 727-4900 ext:406 E 10� Town of Barnstable • ' �'' °� Reg-aZatoiry Services asrst # Thomas F.Geiler,Director a639' k~�� BWIffing Division T6b�,Ai • Tom Perry,Building Commissioner• ' 200 Main Street, Hyannis,MA 02601 Office. 508 86 2-4038 Fax; 508-790-6230 • Permit no. _ . Data ' AYMAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERIY=APPLICATION MGL e.142A requires that the"reconstmotion,alterations,renovation,repair,modernization,conversion, •iinF0yeroent,removal,demolition,or construction of an addition.to any pre-existing owner-occupied bviiding coatammg 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 regoinz ents, Type of Vol Estimated Cost 3 Address of Work:, �� !it/�5 l S / Cd ✓u • - , Owner's Date of Application-___T1 I hereby certify that; Registration is not required for the following reason(s); , 11Work excluded bylaw . []Jcb Under S 1,000 ' []Building not owner-occupied ' []Owner pulling owu permit - Notice is hereby given that; • OWnRS PULTMG THEIR OWN PFPMIT OR DEALING WITH UNREGISTERED COnRA•CTORS FOR APPLIC4,d HOME ZUROYEMENT WORK•DO NOT HAVE ACCESS TO TEE AR331TRATION PROGRAM OR GUARANTY YUND UNDER MGL c.142A. ' SIGNED UNDER PENALTIES OF PERMY s Thereby apply foi apermit as the agept of the owner: _ D e Contractor Nana RegisErationhto. OR Owner's Name A I Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.5 Release le Data filename: C:\Program Files\Check\REScheck\#1849.rck PROJECT TITLE: New Custom Addition CITY: Cotuit STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) DATE: 07/16/04 DATE OF PLANS: 7-9-04 PROJECT DESCRIPTION: Tracie Grover 50 West St. Cotuit,Ma. 02635 DESIGNER/CONTRACTOR: Rick Hurst Box 28 Sagamore,Ma. 02561 PROJECT NOTES: Ma. Check done by Cape Cod Insulation COMPLIANCE:Passes Maximum UA= 145 Your Home UA= 141 2.8%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 816 38.0 0.0 24 Wall 1: Wood Frame, 16" o.c. 905 13.0 0.0 60 Window 1: Vinyl Frame:Double Pane with Low-E 173 0.330 57 Boiler 1: Other(Except Gas-Fired Steam),87 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the peimit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheckVersion 3.5 Release le (formerly MECchecl and to comply with the mandatory requirements listed in the REScheckInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in tfie Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CNM 1310 and AA Builder/Designer Date REScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.5 Release le DATE: 07/16/04 PROJECT TITLE: New Custom Addition Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: Above-Grade Walls: [ ] I 1. Wall L Wood Frame, 16" o.c.,R-13.0 cavity insulation Comments: I Windows: [ ] I 1. Window 1: Vinyl Frame:Double Pane with Low-E,U-factor: 0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ •] Yes[ ]No Comments: I Heating and Cooling Equipment: [ ] I 1. Boiler 1: Other(Except Gras-Fired Steam),87 AFUE or higher Make and Model Number Air Leakage: [ ] I Joints,penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled. I Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. I Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values,glazing U-factors,and heating equipment efficiency must be clearly marked on the building plans or specifications. i Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: . [ ] I All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation I instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to I partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ J I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as I specified in Sections 780CMR 1310 and AA I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1.. I Swimming Pools: [ J I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% i of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the I levels in Table 2., Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to i" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts i" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) I z t`a C� oY HE Tp� Town. of Barnstable Regdatoxy Services srAst�, Thomas F.Geller,Director 9�bp s6�9;�p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www,tofn.barnstablama,us , office; 508i862-4038 Fax: 508-790-6230 Property Owner Must - - ..Complete and Sign This Section If Using ABuilder X, ' b-l0-0 V ,as owner of the subject property' hereby authorize to act on my behalf, . in all rnatters relative to work authorized by this building permit application for. ® 'V) CC"� (Address of fob) a Signature of owner Da e Print Name RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 30 3®. ®O Building Permit Amendment $25.00 FEE VALUE WORKSIIEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 00 square feet x$64/sq.foot= x.0041= lus 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= O, (number) m a' Deck__. ... / x$30.00= O (number) Fireplace/Chimney _ x$25.00= (number) Ingrodnd Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 7 �� Projcost Rev:063004 j Frorn:!oe Nadera Oe.8.62_f D,')7 T,:,. Hurst 2004 T.-i r ` BC CALC(e)2003 DESIGN REPORT -U5 idtt nday,August o�.�ooa?o:4a Triple 1 3/4" X 11 7/8" VERSA-LAME 3100 SP . ':Ie Name R--Ii,r5!.6C:,I FBo' doll Name. Description ,: Address: 50'J+lest Street Srrecitier: City,Slate:Lip. Barnstable. Designer; Customer. Rick Hurst Company:. Code reports tCBO!512,NER 629 Misc. Standaid Load 40 psi 110 psi TribUary 12 CO 0t ' I :.i 3360Ibs LL 3360lbs LL 91153 Ibs DL 903 Ibs DL -otat Horzontal Length- 14.06-)0 C3eneral Data Load Summary Version: us imperial ID Description Load Type Ref, Stan End Type Value Trib. Dur. S Standard Load i n`.Area Lett 00'C0-00 °4%C'-00 Li,1e 40 p,' 12-00-00 100°/.. Member Type: Floor Beam bead 10 psi 12-00-00 90% Number of Spans: 1 Left Cantilever: No Controls Summary g RightCanblever: No Control Type Value %Allowable Duration Load Case Span Location Moment 15130 ft-,ts 47..4% 1 W0 6 2 t-Internal ► , Slope: G12 Ndg Moment 0 ti-!us I'a i00°n Tributary: 12-00-00 End Shear 12 Ihs 3C.3% 00°,6 ' i-Left ?otal Load Dell L/4E 1(U:{04; 5"".U%. 2 1, . Li4e Load C.ef. L1593(C^_3s') 6C.71,1 1.Max Dell. 0.364' 26.4% 2 i Live L(iad' 40 psi Dead load: 10 psi Notes Partition Load: 0 psf Design meets Code milinium L1240)Total load deflection criteria.,, 21 Duration: 1C0 Design meets Code mini{turn t'L/360)Lave load deflector;criteria. ¢ Des!gr.meets arbitrary;1",'Vaximum icac deflection criteria. Disclosure Minimunl gearing length ur BO is The completeness and accuracy of Minimum bearing Ieng h or B1 is 1-112" the input must be verified by anyone Entere'lDisplayec Horizontal Span LeNtni s?=Clear Span+1! min.end gearing-1!'intarmedate bearing who would rely on the output as evidence of suiWllty for a Connection Diagram ' particuier application. The output Nal!ing schedule appi)eS to rcth sines Of the meinhe above is based upon building code-accepted design properties Member has no side loads. e-a and analysis methods. Installation Cont.is.tors are:16d Sinker Nail; of BOISE engineered wood products must tie in accordance a=2" with the currert Installation Guide b and the appiicable ouiidng codes. C r-ri8" --- -- - T--- To obtain an Installation Guide or if d 12 3 you have ony questions,please call e a 3 (800)232-0788 before beginning product installation. BC CALCO,3C FRAMERQ,.8CIS, BC RIM BOARD'".BC_r•:SB RIM s e BOARD'",BOISE CLULAM T1 - v I VERSA-LAMS,VERSA-RINim.. i VERSA-RIM PLUSS, VERSA-STRANDT" "VERSA-S i LfL� ALLJUIST$1 and ;. AJST"are trademarks of Boise Cascade Co- oration. Nr Page 1 of 1 R ..._.••.--- _ c.�rrll.,;lP• :fl;, j V.yL 71r1 Hage Jota Y BOISE SC M-C(�2003 DESIGN REPORT -US Monday.august 02,2004 10 49 Triple 13/4" x 14" VERSA-LAMS 3100 SP `1�Nanny r,: -furs?W :'FB02` • Job Nzrr:,e L�xript;a; Address: 50`Nest S`reet City.State 2,p:Barnstable. Customer: Rick Hurst Designer: Code re Companv ports. lCEO b512,hdER 62� IY'isr,: I - -I I s 1--1-4-+--#—AL a Standard Load-40 PSI`110 pst Trib iary a 2-00 OCI — ._.-1. BO 1 5700 bs LL 01 2565los DL y 5760 lbs LL 2365lbs DL otal f-crzcnlel Length•i A).00 1.1U ,General Data Load Summary Version: US Imperiai ID Description Load Type Ref. Start End Type Value Trib, Dur. S Standard Loa:'• U s Area Left 00-00-00 -6.00-0 00- 0 Live 40psf 12- 0o 100% Number Type: Floor Seam Dead 10 psi 12-OMO 90% Number of ver n 1 1 u ,Lin. Left 00-00 00 ^u-CC-00 Live ' Left Cantilever: No 0 pp hJa 900/t R`:yhTCantilever: No Cxif.Area Left 00-00_')C r-00-00 De �.�pl ,00-00 100 1�90% . psi 1 1� Slope: LA tread ,0 p;t ` 12-W-00 90% Tributary 12-00 00 Controls Summary Control Type va,ue %Allowable Duration Load Case Spar Location- Moment 3330'f;-ibs 7E 5°<: 100% 2 1- Internal Live Load 40 psf Neg Vome:.f 0 ft-Rs a 10(J�a Dead Load: 1C ps1 End Shear 1 11 Ibs =c 0/ -100% Total Load D�fl L130C(0.639 ; 79.9% ? Partition Load: 1 Left C pet Live Load GI✓f.'` L✓43:1 i0.94?" 8�9?!:. . Duration: 100 1 MaK t)e`t. 0 6:3u., bs 1 'Disclosure Notes The cornpletenese and accuracy of Design rnects Code m:11mum(L/240i Total Ioad d�f!eCJor criteria the input must be verified by anyone, Cesicr meets Code minimum(L/36U;L e load deflector-a iieria, who would rey or,the output-as Design meets arbitrar i 9 V!aximum ioac deflec!ion cJferia:.. evidence of suiI ability for a r✓i;nimt,m bearirg length for BO is 1-7r'811 . particular appi!ration. The output MiniMLM bearing ie':j'h for B1 is 1-7/811. above,s based upon buiiaing E111el8,lQisplayeo Hurizontai$ an Len tY;{5�=Clear'.5 di!*`,2 , code-accepted design properties p 9 p win.end'a army 1/2 i li rt!eulat�bear,itg and analysis methods. Installation Connection Diagram of BOISdixts engineered wood rd Nailing stheduie applies to both sides of the member. protects,dust be In accordance with the cu-rert Installation Guide Member ras no side loads and the app!icable building codes. Connectors are: lyd 5 nker Nails' To obtain an Installation Guide or if you have ery questions,please call (800)232-0783 before beginning { product installation. b=3 ---- _ __ r c BC C.AL01), BC F;RA RG9;BClS,. BC RIM BOARDT" BC CSB RIM e= BOARD TNI,BOISE GLULAMT". VERSA-LAMS,VERSA-RIM®, t r, VERSA-RIM PLU519, VERSA-STRANDT", VERSA-STU L rj Dom:A:. J I T(&and. t----. ----- -- —- -;{-;;i✓'_? AJST"are trademarks of L Boise,Cascade Corporation:, Page 1 of 1 = BO�SE� BC CALC® 2003 DESIGN REPORT - US Tuesday,August 03,2004 14:47 Double 1 3/4" x 9 1/2" VERSA-LAM® 3100 SP File-Name: R Hurst.BCC: FB03 Job Name: Description: MASTER BEDROOM CEILING Address: 50 West Street Specifier: City State,Zip: Barnstable, Designer:- Customer: Rick Hurst Company: Code reports: ICBO 5512, NER 629 Misc: Standard Load-20 psf i 10 psf Tributary.12-00-00 r „ 9. � ✓$.:: � � cif � •,,� a c... ,+, f£� BO B1 1560 Ibs LL 1560 Ibs LL 841 Ibs DL 841 Ibs DL Total Horizontal Length-13-00-00 General Data Load.Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value . Trib. Dur. S Standard Load Unf.Area Left 00-00-00 13-00-00 Live 20 psf 12=00-00 100% Member Type: Floor Beam Dead 10 psf 12-00-00 90% Number of Spans: 1 Left Cantilever: No Controls Summary Right Cantilever: No Control Type. Value '/,Allowable Duration Load Case Span.Location Moment 7803 ft-Ibs 55.9% 100% 2 1 -Internal Slope: 0/12 Neg. Moment 0 ft-Ibs n/a 100% Tributary: 12-00-00 End Shear 2108 Ibs 32.8% 100% 2 1 -Left Total Load Defl. U329(0.475") 73.0% 2 1 Live Load Defl. U506(0.308") 71.2% 2 1 Live Load: 20 psf Max Defl. 0.475' 47:5% 2 1 Dead Load: 10 psf Notes Partition Load: 0 psf Design meets Code minimum(L/240)Total load deflection criteria. Duration: 100 Design meets Code minimum(U360)Live load deflection criteria. Disclosure Design meets arbitrary(1")Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". The completeness and accuracy of Minimum bearing length for B1 is 1-1/2". the input must be verified by anyone Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing who would rely on the output as evidence of suitability for a Connection Diagram particular application. The output Member has no side loads. above is based upon building code-accepted design properties Connectors are: 16d Sinker Nailsand analysis methods. Installation of BOISE engineered wood a=2" products must be in accordance b d with the current Installation Guide b-3 -� and the applicable building codes. c=5-1/2" a To obtain an Installation Guide or if d- 12 you have any questions;please call (800)232-0788 before beginning C product installation. BC CALC®, BC FRAMER®, BCI®, BC RIM BOARD TM, BC OSB RIM j BOARDTm, BOISE GLULAMT"" VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, VERSA-STRANDTM', VERSA-STUD®,ALLJOISTO and AJS'rm are"trademarks of s Boise Cascade Corporation. Page 1 of 1 HEtp The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services 9 MASS. 0 s639• �e prFDMA+a Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection P3 F—T—/� Location Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 01 AtrA ai 4-6 0IA.$ �v\-ice S .rrLJa / t + wa� �tDes heej igsu(C141Un r Please call: 548-862-/403-8 for re-inspection. /Inspected by 1,14 ,z1�rl0 V/J l Date essor',s Office(1st floor) Map 03� Parcel C)s V' Permit# Date Issued // 5 - Fee 6f-O d i engineering Dept. (3rd floor Ouse# (� o ,Grff L�c���U,,,� ,�JS INS •. n Rid" BARNSTABLE. • - - mmng 19 b a c TOWN OF BARNSTABLE Building Permit Application � � r IProje t Stre A ress. 5�0 Gil e5`- -5r Village Owner 6 k y\ MC i C J< ddress -60- LJ(!�5r S I • Lc�`7-y ,XTelephone 56$ - lg 6- Y/Zy Permit Request /�p S�•i�a,/�_ First Floor square feet /00 Second Floor square feet ' Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? • Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type ' Commercial Residential ✓' Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number SDF -7 78--0 l Address License# (7)G 0 Rq�21 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE LZ DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) I FOR OFFICIAL USE ONLY PERMI- N DATE SU 'D a MAP/PFAR L NO. a t ADDR S d VILLAGE OWNE DATE F I SPECTION: FOUN ATION , FRAME f INSULATION _ dd « FIREPLACE t — ELECTRICAL: i ROUGH FINAL y PLUMBING' ROUGH > FINAL a ' GAS: ROUGH FINAL FINAL BUILDING d t 1 T Z>0001 DATE CLOSED OUT ASSOCIATION PLAN NO. ! t ' ' "" , The Commonwealth of. fassachusctts War � t=�:_� Department of Industrial Accidents ti �':�` . , ._..! oxceoflfiYest/9211aos - 600 fl ashinrton Street - .: Boston.Alas. (12111 . `- Workers' Compensation Insurance Afriidavit Please PRNT'le�ibl �'� -ARniicaan nformatiil., ._. _. . dL�. •✓ name• �cxu=� t/ �.1�25Tc7>'1 nfc�tii�T• � / am a h meowner performing all work myself. ,_1, amm as sole proprietor and have no one working in any capacity Lam,'�..�L �'�'t7?.. Y .. -:•:. .. .: . ..: .. .... .,. .-. .......:R' •'^"'�anar I am an employer providing workers' compensation for my employees working on this job. compam•name' ' X. •- ad d ress• - cd: phone#: insurance co policy'# 1 am a sole proprietor contractor r homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: cotx• phone#• ircu�ncc co nelic�•# f .�•'.T: � - Men•:f:�.ti:.:.)\Q•-�"?"!�."T'Rt��fi-'�.�'►C4=�' __ ___ -:�7Vf�?'i! '•!%��•:(:R:'!!ii ��V,�;t�'�-'�,!egy.'�R!iCY�'`_AS ctimliany name: address. city phone#• insuronce co policy# :Attach additional sheet if aecessa ,-_,��.:=..tom ,.�- .:t`�^*rr• ,.:'..:_,s='*;+:, _:`.,f'.^�,�L- __��- _ a•.:•. =; " psi , uilure to secure coverage as required under Section f 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rant of 5100.00 a day against me. 1 understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herebt•cc '• nder tit pa. and penalties of ery'uYy that the information provided above is true and correct. XS natu 7- am/ D 7- '%,�ntname re T '� Phoe#//cam r��c fr- G[/1�.5 o - �®� 7 � of iicial use onh' do not write in this area to be completed by city or town official city or town: permitAicense# nBuilding Department Licensing Bnard check if immediate response is required Oselectmen's Office Health Department contact person• phon�11, nUther r Irmsed 3•195 PJA) µ The Town of Barnstable M Department of Health Safety and Environmental Services t6jig. `° P Building Division 367 Main Street,Hyannis MA 02601 7 4 Ralph Crossen Office: 508 790�22 Offs Cotnmissiane Far- 508 775-3344 Building For office use only 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-casting 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. Cl/ T of Work: ReS�i,i't 1 0 Est Cos(/moo 0.1 Go Type ZAddress of Work: X0v66ner.Name: wkrn !30,/D r C1< ate of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING?HEIR OWN PERMIT OR DEALING WITH tTNItEG1ST�ED ACCESS TO THE FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hcrcby apply for a permit as the agent of the owner: _ p 5 Date Contractor name Registration No. . OR Date Owner's name I ' ._. �-�L..—:'L�(`�'I• .. ._.''1 . ♦ .� " 3-1,1��` 1.. �> \ I `� � '.. '�,-�.Rrii��1•+��f "a. t I eCE SAFETY 90 .; ;Coda/aoawallorrarvo< W OF ONE/15 8 s 8 MASSACHUSETTS. BOSTON,, A�i08 { �� ° ottAla/16Nsa• .'LICENSE =` CAUTION EXPIRATION DATE 08/24/19'36 ~'CONSTR. SUPERVISOR. .. FOR PROTECTION AGAINST FFECTiVE DATE LIC-NO.. THEFT, PUT RIGHT THUMB RESTRICTIONS i PRINT IN APPROPRIATE 00 08/01/1993 060892 BOX ON LICENSE. DAVID H WESTOM BLASTING OPERATORS ''. 23. SOUTH RD MUSYINCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEE: W YARMOUTH MA .02673 1 'r NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICWlY '1 STAMPED-OR-SIGNATURE OF THE COMMISSIONER 5.., HHpEEqIGHT: . C. . .,1 4.SIGN NAME IN FULL ABOVE SIGNATURE LINE THIS DOCUMENT MUST BE SIGNATURE OF UCENSCARRIEDONTHEPERSONOF EE THE HOLDER WHEN EN- GAGEDIN THIS OCCUPATION." ♦`, "' - - OTHERS-RIGHT THUMB PRINT i THE COMMONWEALTH OF MASSACHUSETTS -• Board of Building Regulations and Standards Traasaction No. One Ashburton Place- Room 1301 Boston, Massachusetts 02108 > Registration No. Application for Registration as a Effective Dace Home Improvement Contractor or Subcontractor MGL Chapter 142A, CMR 780-6 Expiration Date FOR 0MCE USE ONLY 1 `, "•W Date //-2 2-95 1. Name 1� C4-U,A H • s "►o Y), Print the name of the individual or business applying for the registration(not both) 2 Mailing Address So L) 1 �1 rd- (oea 77� -00 Area Code&Telephone Number J Ular 3. City L • Yn O U 1 V'l State ,r, zip o,,Q 6 23 4. . Street Address(if different) Print street and Number(P.O.Box not acceptable) (Sty State tip S. Applicant type: Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation (See instructions on back regarding enclosing a city or town registration under the DBA or"fictitious name"law-MGL c 110,ss S&6) 6. (see instructions) 7. Number of Employees & Individual responsible for Home Improvement Contracts /,eJ&5 T'o Yq 17 cu 0 ,,,1 N 9. We of individual responsible for Home Improvement Contracts 61-tJ1,7&-c 10. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? Ve�5 Er'C' If yes,complete the table below. Use additional paper if necessary. Yes Nc Type license or registration Issued By License or Expiration Name of License Holder registration number Date 6 o - N- �'. 11. List all partners, trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below.Us, additional paper if necessary.(See instructions on bark) Check here if you wish to receive an application for additional ID cards for key persons.[ Last Freest, Middle initial We in Applicant Business %Owner Address 12. Is the applicant claiming czemption from the registration fee? (See the instructions on the bade) C� If yes,include a copy of a current Construction Supervisor license or motor vehicle repair shop license or registration. Yea N( 13. Registration fee enclosed:$ c- Guaranty Fund fee enclosed:S f 00.O n Include two separate certified checks or money orders-one marked"Registration Fee,one marked"Guaranty Fund". ALL APPLICANTS MUS'. INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE.See instructions on back for amount of fees. Make all certified checks or money orders payable to"Commonwealth of Massachusette Pursuant to Massachusetts General Laws Chapter 62C section 49A,I e wt*under the penalties of perjury that 1, to best ow� beliey have Ned all state tag returns and paid all state taxes required under law. D � Signature of applicant or applicant's representative Title held with applicant A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration. 7120/92 APPLICA17ION FOR REGISTRATION AS A HOME IMPROVEMENT CONTRACTOR OR SUBCONTRACTOR - Who Must Register: All persons,individuals,proprietorships,partnerships,corporations who solicit,bid on,or perform home Improvements as a contractor or subcontractor on an existing one to four unit owner-occupied residential building and accessory buildings.Complete rules and regulations on registration and enforcement actions(780CMR-6)are available from the State Bookstore,Room 116,State House,Boston,MA 02133,Tel.(617)727-2834. Exemptions from registration include:workers who work for contractors or subcontractors for a wage; in general,all licensed professionals or tradesmen, when they are working solely within the scope of their license, such as architects, electricians, plumbers (except for Construction Supervisors); the Commonwealth or its subdivisions; schools offering voc-ed courses or training in home construction or improvements; persons building their own home or personalty doing their own renovations;where aggregate sum of payments for any bona-fide single job is under SLOW, part-time contractors or subcontractors whose gross revenue is less than S5,000 in the previous 12 months;persons enrolled as a full-time student for the last and next academic terms,and 2/3 of whose employees are so enrolled,and whose gross revenue is anticipated to be or has hem under S5,000;persons who install air-conditioning systems,central heating,energy conservation devices,provide conservation services on behalf of a public utility,landscaping,interior painting,paper hanging,finished floor covering,tile,fencing,freestanding masonry walls,aboveground swimming pools, .shutters,awnings,patios,driveways. Instructions for Application Fill out front side of application printing with pen or typewriter.Item No.refers to Question No. PLEASE READ CAREFULLY! APPLICATIONS NOT COMPLETE WILL BE RETURNED WITH ATTENDANT DELAY! ITEM 1. Applicant:The applicant name must be the name in which you do or plan to do business. S. Applicant type:If applicant is not a corporation and at least the surname of the principal or one of the partners is not included in the company name(dba name),a copy of the"fictitious name"certificate filed with the city or town cleric must be included with the application. 6. Applicant partnerships and corporations must show a Federal ID number.Applicant individuals should show a Federal M number if they have employees (in addition to the owner). 7. Number of employees:For the purposes of this application and 780CMR-6,the number of employees shall include all construction related employees who worked 20 or more hours on the payroll in the weekly pay period prior to date of application. & Responsible individual: If the applicant in Question 1 is other than an individual.(I.e,a corporation,partnership,etc)the name of the individual person ` responsible for the home improvement contracting work of the applicant entity must be entered here. If the person so named holds a construction supervisor's license and owns 10%or more of the applicant entity,the applicant entity is exempt from the registration fee.Enter license and ownership data in Question 11,and check"Yes"in Question 12 if claiming exemption from the registration fee. 11. Corporations or partnerships may include any official document which lists the required information, such as pertinent sections of the Articles of Incorporation,current Annual Report,registration as a forei corporation as filed with the MA Secretary of State,or a copy of the current partnership rpo Poforeign agreement in lieu of listing the required information on names of partners, trustees,officers, directors,and major owners.Organizations other than corporations must submit copies of any business certificates filed in cities and towns pursuant to MGL Chapter 110,Section S.(Also known as the DBA or"fictitious name"taw). If the applicant desires to have additional identification cards issued to key individuals(partners,officers,etc.)check the box as noted to receive a supplementary application form. 12 If applicant or responsible individual is a licensed construction supervisor under MGL C.143,S.94(i)or a registered motor vehicle repair shop operator and is claiming exemption from the registration or renewal fee,check yes on Question 9,and include a copy of the current licenscitegistration certificate with this application.(See instructions for Question S,above). 13. Enclose a certified check or money order for the registration fee(if the applicant is not exempt),and a separate certified check or money order for the guaranty fund. Please note on the check(s)which is for the Registration Pee and which is for the Guaranty Fund.Make checks and money orders payable to the Commonwealth of Massachusetts. ALL APPLICANTS MUST PAY THE GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE! Mail completed application form,required documentation and certified check(s)or money orders to: Director, Contractor Registration State Board of Building Regulation and Standards One Ashburton Place - Room 1301 Boston, MA 02108 Registration Fee: $100.00 (Renewable every two years) see Note I Note 1: Individual Licensed Construction Supervisors in good standing under Chapter 143,Section 94 who register as an individual or as indicated in the instructions to Question 8,above,and individual motor repair shops registered in accordance with Chapter 100A,Section Z are exempt from the tration fee on To qualify for this exemption,the applicant must check "in Question 12 and submit with this a hcation a co of the � I7• 9 fY P PP "Y� PP• PY current license or registration certificate which shows the expiration date. Guaranty Fund Contribution: Zero to 3 employees $100.00 4 to 10 employees 200.00 11 to 30 employees 300.00 More than 30 employees 500.00 See Note 2 Note 1 The Guaranty Fund Fee is a one-time fee at initial registration unless the fund becomes deleted. In such a case,all registrants can be assessed for an additional contribution in accordance with 780CMR-6 and MGL c.142A. ALL APPLICANTS MUST SUBMIT THE GUARANTY FUND FEE t,....,. II...:. Ii...;� ....u.... II II...... �t,...,. ,,�!�,� ....Ii.... II.:.... 1,,..a� Ii...... II T'4,11 tl....Ji 8...,l' Jun.. II...... Issue late: 11/22/95 ------------------------------------------------------------------------------------------------------------------------------------ Produter: I This t e r I i I i c a I* is issued as a matter of ial*raaIion only and confers no rights upon the certificate holler. this tertilicale lees not amend, SOUTHEASTERN INS AGCY �1 extend or alter the coverage afforlel by the polities below. POBOX 2611 1------------------------------------------------------------------------- 641 MAIN ST I COMPANIES AFFOR0I116 COVERAGE HYANNIS MA 82611 1------------------------------------------------------------------------- Cole: $ul-tote: I to Lit A: ARBELLA PROTECTION ------------------ ----------------------------------------------------------------------------------------------------------------- Insured: I Co Lit B: ------------------------------------------------------------------------- DAVID H WESTON I to Lit C: BLDGS REMOLING 1------------------------------------------------------------------------- 23 SOUTH ROAD I to Lit D: W YARMOUTH MA 02673 1------------------------------------------------------------------- ------Co Ltr E: COVERAGES this is to certify that policies of insurance IIstet below have teen issued to the 1asure4 name/ above for the policy period iaIficaIe4, aotwiIhsIaa4ial any reduireseaI Iera or canIitioa 01 any tonIratt or other 4 o c a a e a I with respect to w 6 1 t h this tertilicale may be issuel or a a y pertain, the insurance allorleA I the policies described herefa is subject to all the Ieras, extlusi0a$ an/ t0nIiI140$ of such polities. Limits shown may have been reduteI by pail claims. ------------------------------------------------------------------------------------------------------------------------------------ Co i i 1 Policy Polley i Ltr: Type of insurance 1 Policy number : effective late : expiration late: All limits in thousands ------------------------------------------------------------------------------------------------------------------------------------ A 1GENERAL LIABILITY 1 ORDERED 1 11/21/95 1 11/21/97 ( General aggregate: . Commertial general liability Produtts-romp/ops aggreg: Claims ride I X 1 0ccur i i i iPersonal/alverlising inj: 1( Owner's A contractor'r prof 1 1 I 1Each occurrence: 311 1 1 1 1 ( Fire tamale: 51 iHelical expense: 5 ------------------------------------------------------------------------------------------------------------------------------------ 1ADIOM08ILE LIA8111TY I I I IComb ino4 I I[ Any auto i i i ifingle IialI: I I( All owned autos i i i iBoIfiIy injary I I[ $ChetuIeI autos i i i i (Per person): I N i r e 4 autos 80lily injury Non-ownel autos (Per atci den I I Garage liability 1 1 1 I (Properly tamale: I ------------------------------------------------------------------------------------------------------------------------------------ IEgCESS LIABILITY i i i i i Each 1[ ] 1 1 i i i Occurrence Aggregate 1( I Other than umbrella form ------------------------------------------------------------------------------------------------------------------------------------ IFORKERIS COMPENSATION latutory AND (Each actileal) EMPLOYERS' LIABILITY c— — Disease= olic limi-1 (Disease-each employee) ------------------------------------------------------------------------------------------------------------------------------------ OTHER ------------------------------------------------------------------------------------------------------------------------------------ Description of operations/locations/vehicles/restri<tionr/special items: ANY AND All CARPENTRY WORK ------------------------------------------------------------------------------------------------------------------------------------ CERTIFICATE HOLDER CANCELLATION I Should any of the above described polities be cancelled before the expiration tale thereof, the issuing company will endeavor to BUILDING INSPECTOR �I wail 11 days written notice to the certificate holler named to the TOWN OF BARNSTABLE ' fell, Out failure to mail such notice shall impose no obligation or SOUTH STREET I liability of any find upon the company, its agents or representatives. HYANNISMA 02601 1------------------------------------------------------------------------- Aulhorized representative: 1 SCOTT W LOWE JA ------------------------------------------------------------------------------------------------------------------------------------ 4/89 e-a 74,•a,t Ir-o" cr�!n�w � cEx�nnri «nvinc�� a ��a � � CCC N Z x g a I II I If II I I Z O 4 (s I I --4 > ,V 2,6,E PGGI 1 - _ ,6"°M a Qo y o 1 az p „ i1 � Id ` I g o 4 II ig� II I vo jr - � c exlsnrra 1 mI 1 . I 1 1 I------ Cl) 11 11 11 I, co y .� I —_ -- -----u cn —I m rn v m IT W m y C —I , e,,a, 40'-0'l r" —' o n (AMOK) :0 z S v O m -� > a � u � m mp 177 m NEW ADDITION FOR: DESIGNED/DRAWN BY: a �h COTUIT BAY DESIGN n' l° o TRACIE GROVER 43 BREWSTER ROAD z p MASHPEE ,MA. 02649 �-' 50 WEST STREET COTUIT, MA (508)274-1166 (ld7 nON) (MAW N G o N � `•cl I 4�1 I 1 y1 1I JB 1 II R 11 � awl .. - 13 IT— ZE ✓ II I II „....II II QQ 1V �� II _ 1 1 Q,IrIP Q Q II Ci II II a i. ea 2gat (AMON) (EXtSnNG) N ,'00�� \� CCC 01) izs Ck Z cR - 17 a NEW ADDITION FOR: DESIGNED/DRAWN BY: o N COTU[T BAY DESIGN TRACIE GROVER 43 BREWSTER ROAD o 'p MASHPEE ,MA. 02649 - 50 WEST STREET COTUIT, MA ' (508)274-1166 cnurcr+exKnrraJ L tetnraEWWo � 3 I. tMAnfonrra N � � cMnraexisrnra kL 3 W ' +z Rt 713 R� �— (� 0 ❑ 5t os �- o o ❑ N EEB 25 rzi 0 N J . m a NEW ADDIT ION FOR: F ESIGNED/DRAWN BY. o ' ° ' OTUIT BAY DESIGN z o �= TRACIE 'GROVER IT ROAD 50 WEST STREET COTUI ASHPEE ,MA. 02649 T, MA (508)274 1166 . K _ _ �� __ - .-� I `_ 2 ,L .��."ka^5T •r' Y^' .•��. erg. r.: �' a.,;�..-- - • N EEB EH lid Ml Mt J!� NEW ADDITION FOR: DESIGNED/DRAWN BY 'COTUIT BAY DESIGN A m 0 TRACIE GROVER 43 BREWSTER ROAD o MASHPEE,MA. 02649 50 WEST STREET COTUIT, MA (5os)2.4-1166 " 11 2A'-0 t 12-0 e (extsnnra <rnolncnn <wvinaw m a a 4 Q ar\7 4 a Z a EMT. m O Q N o a Q �x m N • ^-1 . - - 2ro 2a'o"i --- � (EX511tdCJ FF WW V,i.2 10's 16"04. - l • WIN F.T.2 x.12's 9'O 8'.9, q.-y. max,. Ao'-0" y N (PDD�nON) C. aj Q aX. . . V; DESIGNED/DRAW N BY, : NEW ADDITION FOR: COTUIT BAY DESIGN 43.BREWSTERROAD MS16 9AHPEE MA. 0264 (508)274-16 TRACIE GROVER rM IhlPCT CTRFFT COTUIT. MA C&N fij{C►A rwNw., Soar �P /VCw. R(.Ape,c'*.�� All e.i G C �S f�Fi,17 ax s f - . r• ,�r G� / + J r �11�� �C3 FW� e t 9Ga.�dJ' 1 � �e�.DV�s /�..^. DU �PIW6 5�C� N @ IBC f OKCH SCALE: ' ' ...t)"1 APPROVED BY ED�RAWN BY DATE: O DRAWING NUMBER -cx:C CHARRETTE PRO-FORM 940Pf PRINTED ON 920H CHARPRINT VELLUM - -