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0033 FIDDLERS CIRCLE
E Ir ,� TOWN OF BARNSTABLE Permit No. Building Inspector Cash ($9 6. ,)01 � rua s __ OCCUPANCY PERMIT Bond � r "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor ' first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Lebco Const 3uctit):1 Addressf T'larstons 'Rills Lot 420 54 Fid0fer's Circlq' Tvannis f Wiring Inspector t r ' ' Inspection date f Plumbing Easpector ,���j / Inspection date Gras Inspector i �r Inspection date Engineering Department f f/ Inspection date/, THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING .INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. _ _..._. _......._ ._, ................. _............... _ _.. _ _ __ Building Inspector K. "St'4R 17 Irti -•r Y a 1. a .j a_a jj w x as ., J t' V i, t r a a .. t• �.p , ;�+.. S'•1 S`+y ����>>>y�� ..,r k-4 `•2°^.F£� +s 2°? e 150 �, .��1.r"' �� � � a - ' - �•./ �- t fa is`.,d�`°; x ���"'. 27— Yt3 Ky ro 7i — f w K E : �xt�4 a Y��' ��,�"'.� � a � t�°/-•� � - � r , .: b ��'�a r<'"^+r biz�'�� �-i ': .. ,4a 41 , �'i:,;� •srx, i 1l/�l .a it A.-a-'♦° �y �, 1 d: � r `:� y %,.Y°4,'S 4t; r„y..; �.• �°'`''< v.-0' F?+� 'fir� i � I .: � r . r k'4 ia^ x e$ a�'yD °z„r,e c Kam ✓- y`'�, }z'x „f.` , '' dXt' --/ /,> / -SI/�'• �� .d `'�{.i ?e * �'-rr, f �;,-�,c�," 3 s +�?why W "� ?'✓/'� }\fit� �`Y.:.f�2�°'��. f !4 r 'vj. P' 7 - _ N t',f°• PGt�'S �•�1 EUNOUS '� .:� q i r Y'E d s i^^a' a r ✓'*x , i, h0.6420 .� ✓,"^+'�'"- rk s � x '' i ... - �` �, � ' � i` <P psi n.. suft 1 rKy P v4 i t, CERTIFIED PLOT t `�^_ ^g,s rae"MrFT'.� �J T-{R � t•� � l 4 R a � �ay. ti} xascy� 'GF.` 'I LOT 20jo VX /D/�LCfZS , $tTRU0710N' ONLY.\ rx 1 Q���„F:ouN osA T,I O N f S FEET . ,W POINT OF 'ADJACENT SCALE I �/D L At T E 7 E ENGINEERING CO._IN CLIENT SHOWN I CERTIFY^THAT THE 4 SHOWN ON THIS ' PLAN , t r3TERED' (R* EOISTEREDI JOB NO �UU 3U ON THE GROUND AS iNO1C:AT1~ LAND, r b �" ( I I CONFORMS TO THE, IC?NINl3 'Nal-NE SURVEYOR DR. ®Y• /1 •f1 . _ - --A OF ARNS E CH. QY IVtA1N_ST 712 MAIN � T �M! :40 "TN, MASS HYAN ISM4; � OF /SHEET. - Df b' . RE.G. L AND S �. Town of Barnstable ti1C11n Lae.t _ .'. M7rS¢8 1R.6:'.'.` W ro�h"tt. �a C CeatrtlrzdFif.iniS.:,"aoa t.T'eha,.t rt!is UtsibleFrornro the S tre---eCt-kA'`.�fsp�ra'oa u ed'na`,`Plaxn.:s. Mvust b;ewRe tatnq ed on Job aat.nd this,sG, ar yPermit Mint9 sPcosere ofOccu anc, wis�Re aired such56u:ldm shall,Not"be.,,Oceu ,ied,until,a.F�nal�--Ins ection has-,been made. . : '. Permit No. B-17-25 Applicant Name: Daryl Josie Approvals Date issued: 02/24/2017 Current Use: Structure Permit Type: Building-Deck Expiration Dater 08/24/2017 Foundation: Location: 33 FIDDLERS CIRCLE, HYANNIS Map/Lot 288 168 002 Zoning District: RB Sheathing: Owner on Record: DINEEN, DOUGLASS X&WALENGA,AMY SU Gontrctor Name Daryl C Josie Framing: 1 Address: 33 FIDDLERS CIRCLE Contractor License •,CS-082304 2 HYANNIS, MA 02601 Est Project Cost: $20,000.00 Chimney: Description: Remove and dispose of existing deck. Build ands pport deck to Permit Fee: $ 110.00 American Wood Council Residential code for decks specifications. Insulation: , FeePaid: $0.00 Project Review Req: Remove and dispose of existing deck. Build and support deck to = 2/24/2017 Final: 11311 Date American Wood Council Residential code for decks specifications. Plumbing/Gas , a F„ Rough Plumbing: 'Building g Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents�for which this permit has been granted. All construction,alterations and changes of use of any building and structures8hall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street goad=rid shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable sign5turi gbythe Build g and Fire,Off c als are,provided on thispermit. Service: INV Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing s Rough: 2.Sheathing Inspection .w.. . . . �. „ ''r 3.All Fireplaces must be inspected at the 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:. 'Per spin contracting with unre Istered contractors:do.nothave access to,the uarant fund" as set forth in MGL c:142A .. g g._ Y Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT £a'1- F �. Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee O/� 6 Richard V.Scali,Director 1. TOWN OF B STABLE Building.Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-190-6230 EXPRESS PERMIT APPLICATION — RESIDENTIAL. ONLY Not Valid without Red X-Press Imprint Map/parcel Number O Property Address FC.�C�\��� �(l`mil F lAc.l�� -l -(�(�� C tesidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �c51.t�.iAC �1�P. 11 f�(Y1�-Y L,x kan Vic. Contractor's Name f m ��[ �ylfl(Jmx/ A Telephone Number Home Improvement Contractor License#(if applicable) ,_I O� _'� Email: Construction Supervisor's License#(if applicable) S r (>®b te--Lt 3 LgWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A 1 t t A4 w-f-LLt'.L Workman's Comp.Policy# A WCr LA ob"1 t>CjaM 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) Re-side Replacement Windows/doors/sliders:U-Value n 2C? i(maximum.32)#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 oft Improvement Contractors License&Construction Supervisors License is eqm - SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Tempo Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 DepMmnt of IndusftW Accidents i Qfflce of Invesdgadons 600 Washington Street Boston,MA 02111 www.massgov/dig Workers' CoMWmadon Insaranee Affidavit: Bu7ders/Contractors/Electricians/Plumbers Please Print Legibly Name(Business/ownhadonwividual): Sprinkle Home Improvement Address: 199 Barnstable Road Ci /State/zi : Hyannis, MA 02601 Phone#: 508 775-1778 Ext.10 Are you an employer?Check the appropriate box: Type of project(required): 1.(�I am a employer with 10-12 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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' 9. ❑ Building addition (No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 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 ram ,]t e. 152,§1(4),and we have no 13.E] Other employees.(No workers' comp.insurance required.] Any applicmt dst checks tax#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indightiag they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :onnarxors that check this box must attached an additional sheaf showing the rtame of the subcontractors and state whether or not those entities have mployeos. if the sub-oonpaetors have amptoyees.they must provide their workers'comp.policy number. am=dJV10YV&W h PF workm'cordon basounce for my employees. Below is the policy and Job site ufonnatton. astuance Company Name: A.I.M Mutual Insurance Co. -olicy#or Self-ins.Lic.#.__a W C y 0 6 rl PA24 3 Expiration Date: 1/01/2014 ob Site Address:-2)3 f li,A'AL-111 C�1-1,Lx- City/State/zip: wacnoc�, , MA f &z\-. awl a copy of the work com ers' pensation policy declaration page(showing the policy number and`expiration date). a llure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ere up to$1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ,vestigiitions of the DIA for mi suraaee coverage verification. do icy and palm"of pedmy tN the lot jorm�atlon provided above is true and correct izoamm: i-lm t\- 2� I� 508 775-1778 Ext. 0 . O,,Heighuse only. Do not write in this mw4 to be complewd by ctty or town official City or Town: Permit/License# Issuing Authority(circle one): L Board of He011t6 7.Bniiding Department 3.City/Town Clerk 4.Electrical Inspector 5.PI mbing Inspector 6.Other Contact Person: Phone#: D A 3 ; Q a a ❑ m m o o� 30 a= ail a co g30 m m a o $ Y 00 1 mo CL o m N M M N M N M M M M N IN N N M N M m 8 02 n z o �o I + ! i Io O ra Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CB.00t {g BRAD KBE t no Immum �„j... Expiration Commissioner MOMS Tom �y . L � PrlVatd .. t t859=1111"Rd MIMI. .iL A OQIj@1 V � r if s N W I "' A Hma:�ve�t sIM 1l�i :t PRI N KLE 199 Barnstable Road Hyannis,MA 02601 (508)775-1778 Fax(508)775-1350 Email—sprink@comcast.net Website address:www.sarinklehome.com Doug & Amy Dineen 33 Fiddlers Circle Hyannis, MA 02601 508-360-4218 Fugan.dineen(a)-Qmail.com August 11 2015 Re: Windows CONTRACT New Construction — • Remove and dispose of four wood double hung windows. • Furnish and install four new construction Anderson 400 Series double hung windows with prefinished white interior. • New windows will have Low E Glass, Argon Gas, and full screens. • Installation will include all necessary flashing, insulation, and caulking. Exterior to have white Azek composite trim with interior to have 2 Y2" colonial to match remainder of home. • Installation will be done by our own trained window mechanics. Note: Does not include any painting. Contract Amount — $3,790.00 Deposit - $1,270.00 Start Payment - $1,270.00 Final Payment - $1,250.00 AGREED CONDITIONS 1. Homeowner agrees that payment will be made in accordance with the terms specified herein. 2. Overdue balances will bear interest at the rate of 1.5%per month(Annual percentage rate). 3. Homeowner will pay lawful collection expenses, including reasonable legal fees incurred by the Contractor as a result of the Homeowner's failure to comply with payment terms. 4. Contractor is not responsible for existing conditions of residence. Contract # �S ZZ 5. Contractor is not responsible for damage to such items as, but not limited to: sidewalks; driveways; patios; lawns; shrubs; sprinklers; and other such appurtenances: However,reasonable care will be taken. 6. For inside remodels(i.e. additions,kitchen&bath, basements, etc.),we will take reasonable care to keep construction related dust and dirt to a minimum,however,homeowner will be responsible for their own house cleaning at end of project. 7. All agreements are contingent upon strikes,.accidents, or delays beyond Contractor's control. Should a contract be terminated or cancelled after the mandatory rescission period,contractor will recover costs including all time related to this job with a reasonable fee (including profit) for all completed work and materials purchased or ordered. 8. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 9. Fencing, carpentry,painting,plumbing, electrical, dry wells, etc., and all other work necessary that is not contained in this contract, shall be the responsibility of the Homeowner. 10. For roofing,the above pricing is based on a single layer strip unless otherwise specified. Should there be an additional layer or layers of roofing they will be removed and disposed of at an additional cost. Re-leading of the chimney is not included in quote unless specified and will be bill additional, if required. 11. For Window installation, contractor is not responsible for removal or reinstallation of window treatments. 12. Contracts not fully executed within thirty days of contract date are subject to pricing adjustment if applicable. RIGHTS TO CANCEL The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office, or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agreement. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in workmanship for a period of two (2)years following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship, or damage caused by the Contractor,his subcontractors, employees or agents, is discovered within two years after completion of any job, including clean-up, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied,repaired, or replaced such damage or such defect in workmanship as long as the owner has paid their agreed contract in full. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for product supplied by the Contractor under this Agreement shall be those given by the manufacturers of such product,which shall be and hereby passed directly to the Owner. Such manufacturer's warranties,the Owner may be required to.register or mail in a warranty card or other evidence of ownership and use of such product in order to activate such warranties. The Owner's failure to send in or register such documentation, which failure voids that manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such product. f v Note: Any changes in the contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job(i.e. permits, applications etc.)if necessary. Homeowner Signature Date Contractor Signature Date Registration number: 103757 , Homeowner Signature Date Contract # i Note: Any changes in the contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if nec 't6 '-9 '2Jl-'6' ;-�Vo owner Signature ate Contractor Signatur Date Registration number: 10 757 Homeo ner Signature ate Contract #_AS_ S;ZZ YOU WISH TO OPEN A BUSINESS? i For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. w, rtYV 'M1 DATE: Fill in please: APPLICANT'S YOUR NAME/S: SS �j BUSINESS YOUR HOME ADDR SS: rS G c CJ�IEi� ) ` TELEPHONE # Home Telephone Number R, Y x k 04 NAME OF CORPORATION: NAME OF NEW BUSINESS '1—v 6k o. At ; N e-e Ai' TYPE OF BUSINESS Sale pr-wE77 --y-v��sO am IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 3 7�:, G7 c�c�e �—•�n�s /�lu'zEo�MAP/PARCEL NUMBER `Z� ` 1 d� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S OF E This individu I ha' a infor e a PT m't re quiCements that pertain to this type of busines UST COMPLY WITH HOME OCCUPATION Aut on igQat e** RULES AND REGULATIONS. FAILURE TO OM EN i COMPLY MAY RESULT IN FINES. L 2. BOARD F H ALTH This individual has been informed of the permit requirements that pertain to this,type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Town of Barnstable o�IKE r� Regulatory Services o Richard V.ScaIi,Director • Building Division i Rd RN.CI`ARi.*! t p B ASS Tom Perry,Building Commissioner s63q. �� 'DTEot 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: t Permit#: HOME OCCUPATION REGISTRATION Date.• Name: UC Ia&,s. Phone#: Address: + �C)�415 !c1 P , `/cy►y!r 5 Village: c r t�1 S 1 Name of Business: o 71AJC � ap/Lo �2. Type of Business: f 1W S i C.Icon- S,5 1 e t7�a� M t IN'17ENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is . no outside evidence of such use. No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment There are no commercial vehicles related to the Customary Home Occupation,other than.one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and agree with the above restrictions for my home occupation I am reggiisteringA A-pp h �__ _�' Date: (!�- A �--�. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� g Parcel Application #&/ Health Division Date Issued Conservation Division Application Fee 4— Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �� o c �el'S C.I cct e Village \4 C, a1AA S Owner rr I 01- 90 PlN Address 3-3 VcJcJ us r J e— Telephone �(� �,® y �., Permit Request /b m us`►c Poo r*vn — at e_ h-4.L/YYVVN Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00 Construction Type ri ivV r Cr" o�ell Lot Size ® q Grandfathered: ❑Yes VNo If yes, attach supporting documentation. Dwelling Type: Single Family I" Two Family ❑ Multi-Family(# units) Age of Existing Structure �� Historic House: ❑Yes r�'ICIo On Old King's Highway: ❑Yes Flo Basement Type: ❑ Full ❑ Crawl E(Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) �, o 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: 12/Gas ❑ Oil ❑ Electric ❑Other Central Air: 29 es ❑ No Fireplaces: Existing New Existing wood/coal stove ❑Yes alo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: Op xisting ❑ nevF size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:2 a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes VNo If yes, site plan review# =� Current Use (' Q,e \kco\ Proposed Use re�`f COCA APPLICANT INFORMATION (BUILDER OR4QOMEOWNER Name i Lk-55 mee Ai Telephone Number So % 6,0 LT-).Address 3 �,� �2l5 64-r(_ e License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTI G FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: f , i g FOUNDATION FRAME 4 INSULATION yl o FIREPLACE ELECTRICAL: ROUGH FINAL = .` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I� 600 Washington Street c Boston, MA 02111 /` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiz-ation/Individual): V,V CC/0 Address: City/State/Zip: �"�� �y-°ut�'"' /� �'�-�'O Phone #: 50<b 3 Go q Are you an employer? Check the appropriate b Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Memodeling ship and have no employees These sub-contractors have g, F] Demolition working for me in any capacity. employees and have workers'comp. Building addition [No workers' comp. insurance comp. insurance. 5. [] We are a corporation and its 10.❑ Electrical repairs or addition required.] 3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.D.Plumbing repairs or addition myself. [No workers' comp. right of exemption per MGL 12.0 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 fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a.copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fit 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 DIA for insurance coverage verification. 1 do hereb tin the pains a ies of perjury that the information provided above is true and correct Si nature: Date: Phone.#: $ 6b Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing.Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 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, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states 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(7) 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-contractor(s)name(s), address(es) and phone number(s) along with their certificates)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 pen-nit 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 at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit, The Office of Investigations would like 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE; AND TWO-FAINTLY DETACHED RESIDENTIAL'CONSTRUCTION (780 CM. 61.00) Applicant Name: v S 2.N Site Address: ,j_S grin! jTown: �— Applicant Phone: S-0% N0 Applicant Signatur Date of Application: I NEW CONSTRUCTI N: choose ONE of the folIowin two—options) `ISO CMR.TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FANTILY BUILDINGS hCAMM UM 'MDgL\4UM Ceiling or Slab QOption 1: Basement Fenestration exposed Wall Floor Perimeter AFUE U-factor floors R Value R V lue R-Value wall R Value HSPF S R-Value a and Depth National Appliancc-Energy .35 R-3 8 R-19 R-19 R-10 R-10� ConscrYA n Act(NAECA 4 ft.• 1987 as amcndcd,minimur calcr as a licable Note: This form is not required if you choose either of the two versions of REScheck as listed below. El Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 RES check—Web which can be accessed at http•//www eincr>rycodes.goV/rescheckl :AD�X`��O1VS:OR A.LT�RATXOI�S,TO EXIS'z'TNG$ITLLDZNGS,.O:S?P;RS�.'EARS.OLD* • *buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b a) ' SF 100 x — _ % of glazing (b) Glazing area equals SF b a If glazing is<:40%.ui;e the chart below. If glazing is > 40 %prQGt6d to "SUNROOM" section 780 CMR'TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMTONENT CRITERIA ADDITIONS TO EXISTING. LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM ' 1417TIIMUM . .Ceiling and � Slab Perime Fenestration Wall Floor Basement Wall R-Value U-factor Exposed floors R-Value R-value R-Value ' R-Value and De fl 3 R-3 7 a R-13 • R-19 R-10 R-10, 4 ft a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e,not compressed over exterior walls, and including any access o rains). SUNROOM—An addition or alteration to an existing building/dwelliag unit where the total EY glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the additioi}. Note: Owner to fill out Consurner Information Form found in Appendix 120.P 4 Town of Barnstable Regulatory Services • aAitxsr ist e Thomas F. Geiler,Director ' Building Division PrED I`i'y k Tom Perry,Building Commissioner 200 Mairi-Street, Hyannis,MA 026.01 www.town.barnstable.ma.us Office: S08-862-4038 Fax: 508-790-6230 HOhfEOWNER LICENSE EXEMPTION Please Print DATE: I ��� 0 --r '3 Ail JOB LOCAT70N: � number r strcectt - llage _ -.'HOMEOWNER": \l 1 V\�J` Vb\ ���N 50% 41`_O 9+ 1 bell- `l�6 240 l� nam home phone# / workpbonc# CURRENT MAILING ADDRESS: \�S t l CA Q avmA to-I a 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. DEFINMON OF BOMEOwNER 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 bomeowner. 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/sbc understands the Town of Barnstable Building Department minirnum inspection procedures and requirements and that he/sbc will comply with said procedures and rcqijurmcuts. .V�Lf Signatit Homcownerr 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 pmrait is required shall be exempt from the provisions of this section(Section 1 o9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pc sons)for hire to do such work,that such Homeowner shall act as supavisar." Many hc)fncowncrs who use this exemption arc unaware that they an assuming the responsibilitics of n supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supm-visors,Section 2.15) This lack of awareness bficrr results in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Board cannotproceed against the unlicensed person as it would with a licensed Supervisor. The hOineoWnCr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hisAar responsibilitics,many communities require,u part of the permit application, that the homeowner certify that he/she understands the mspotunbilitics of a Supervisor. On the last page of this issue is a.form currently used by several towns. 'You.may cart t amend and adopt such a forrn/certifieation for use in your cornrnunity. Q:forms:homccxcmpt Y r Town of B arnstahle Regulatory Services 4 Thomas F_ Geiler,Director FD X Building bivision Torre Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 )vww.town.barnstable.ma.us Office: 508-862--4038 Fax: 508-790-t Property Owher Must Complete and Sign This Section If Using ABuilder as Owner of the subject.property hereby authorize to act oa nV 6eb df, in all matters relative to work authozized by this building permit application for. (Address of job) Signature of Owner Date Print Name If PropertyOwner is-applying for permit please complete the Homeowners License Exemption Form on the reverse -side. AR WOR Liberty ISSUING OFFICE 181 mutUAL Workers Compensation and a INFORMATION.PAGE Employers Liability Policy ACC 1�19. SUB CCT NO. Liberty Mutual Insia�ance Group/Boston 1-36098 000 LIBERTY iWffiTUAL FIRE INSURANCE CO. 16586 POLICY NO. TD/ SALES OFFICE CODE SALES CODE N/R 1ST 7WC2-31S-360989-019X WESTON 102 REPRESENTATIVE 3000 2 YEAR-- ASSIGNED 2007. 1.Name of MICAS LLC DBA Insured NICKERSON HOME IWROVEMENT FEIN 20-8012339 Address PO BOX 2476 RISK ID 30293 ORLEANS,MA 02653 Status 46- LIlyIlTED BITFY C.O_ Other workplace of shown above:.SEE ITEM 4 Mo.Day Year Mo.Day Year Item 2.Policy Period: om 03-01-2009 to 03-01-2010 12:01 AM standard time at the address of the ins d as stated herein. Item 3.Coverage A. Workers Co pensation Insurance: Part O of a policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 ,, policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4.Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rates LINE110 Per$100- Estimated Code Estimated of RE- Annual Classifications No. Total Annual Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ (MA ) Total Estimated Annual Premium $ Interim adjustment of premium shall be-made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by 1 Anthorized Representative Date 02-16-09 1 Loc.Code Term. Oper. Audit Basis Periodic Payment Rating Basis:., Pol.H.G. Home State Dividend RENEWAL OF: 02-16-09 NR MA WC2-31S-360989-018 GPO 4030 RI Copyright 1987 National Council on Compensation Insurance WC 00 00 01 A Insured Copy l-il w I _ I_ I I � I . I 1111 I I I I 14 I I I I , -- - I j I _... �a , ,I ' i j i I I I I '.I . lov IFT— i!(I '_ I.', �I I�-II i I( �!I II II I j • II�i I►"I I iI,II I I ___,,�I I III 1I - 7�iI I V � 1 . II I I I!i J I. ILI I I I I - �i I _ 1 i a I . I ► � .i i � i ,I L I i` I I I i �� ���---{—�--� . ,� - ;I -; I t, � ,,� - �� -T . i I I 4 � t �...-:s.-.._ �.a.,..-..�.a...�.+was:':ra-.r.i.......a.:�.... yacwi,iilJao.✓sM ...M.wu.._rww.: r.�0�a.tx......wi..a.a..r.- .....wu- .—+w...:...:.�.w..-.-w-.a +.._.ram .r... .�.—...1 i...--.... ,atssor's map and lot number .... ......&.fi�.� a � , *THE � , " �o Tee Sewage Permit number ...... .�.3.�� ............. SEPTIC SYST r' EM MU 1� WALLED IN COMPL Douse number... '.7................r............................................, � o � Lam WITH TITLE 5 �a war a�em K ` TOWN OF BARNSPNW LATIONS BUILDING I H,$P E C T LQIMBJECT TO APPPZ0V,1,L INSTABLE CONSERVAL N FOR PERMIT TO ...S.IPj.L.' ...�f ?11►.�. ...'L�.�:5.COMMISSION v� APPLICATIO ............... .................. TYPEOF CONSTRUCTION ......... D.............................................:............................................................. r • ................................ 19........ 4 . TO THE' INSPECTOR OF BUILDINGS: " ''` ... x The undersigned hereby applies for a permit according to the following information: Location .......1" !.!..... ..... ........f:.7.0 p . ..... ..................... ProposedUse ...... ...................... : t..l ..... L,<y......1 ,................ . .................................................................................. Zoning. District / Fire District ... Name of Owner ........... _ ... .,,.._...Address ........ .... .. .... . . �. ... s7� .. � ' / �� Name of Builder ... .. .:... �',,,!.....................Address ��1 1L1� ! / �� Nameof Architect ..................../.............................................Address .................................................................................... Number of Rooms ...................... ...........................................Foundation ......... Exterior Gl l �?� t�......�5.k.(..K&h-5.................Roofing !!�! .....Sf'+J.�C1�.L. ..5................. J FloorsC-4&pel t..............................................................Interior .// E' �� c... \. ....................................... Heating :.1. fZ1CL. .. ......................................Plumbing .��'P �..'r. .�.1.�:�(..lp.�,. Fireplace ....... /C.. .....................................................Approximate Cost ... ��J�. .5 �.Q. ....................... Definitive Plan Approved by Planning Board _c�_j1�L—_-----__19__ © Area ! �WE's' Diagram of Lot and Building with Dimensions Fee ..........� ... ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH D r � I� v 1/1 UUUJJ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. Ci..s.. ... ... ................ t LEBCO CONSTRUCTION 22.3a2... Permit for ..0ae...1./..2. .Story •.•...••.Single• Family Dwellinc......_•... LocationLot••#2O Fiddler,'•s,•,Gle . .............HY?.nTxi.s..... .Q.................... ' N , Owner Lebco..Constr.�oiT.�,Qrl.........„••••••„ i Type of Construction ..FXA CIP........................... ............+............................ .............. Plot :........................ . Lot ................................ j July 10 .- Permit Granted 19 8 , Date of Inspection ........ ...19 j Date Completed ..1...9` PERMIT REFUSED r !a ............................................. ......... . .�. .. ............................................... +i .......... ............................................. i f cr ! Approved ,A................................... 19 ! ' .................... ......................................................... 1 Assessor's map and lot number . ,ti.,.......... OF TN E TO ............................................ Sewage Permit number .......:.." Z BABBSTADLE, i House number ...: .......................................................... v NAM � 00,0�039, 90 ;r � QED YPY a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,.....-. ?.I6. .. ....... L4-`::................................................... TYPEOF CONSTRUCTION .........1.a ?';X2D........................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�`. ... "......%.4,�........F (1)J l: .�� �.....r.r�.4 .�.:r` . ;{t/. .��.�'!� �5... vT'? .. .... .. ,. . .�. ... ...................... ProposedUse ..... .t`L t ............. tiVll.1. l..... �t-5......................................................................................................... Zoning District .................L.....................................................Fire District .... .......... _ _� LL..� � 94 Name of Owner ....... Address `? � i.�y� " ... , " .... l / /... Name of Builder44r / JrJvk' / p.l e .................Address / `t �%sj /%/'4%�7c9{ ! /%F�/�' /i/,z Nameof Architect ..................................................................Address .................................................................................... Number of Rooms �...............:...�:............................................Foundation ..... :. �''U ...)P, r /.. A..........:.............:........... Exterior ,.}.. �....:...:<.................Roofing ..;......,:...............................:.,*�.: ...................... Floors <...:. /<' . . .1...............................................................Interior ^::. / C'r.: .......................................... Heating !� �a-r`� F= r.- ..............................................Plumbing r-7". . f.......... r .. Fireplace ..:.....:....... ........................................................Approximate Cost ................................... Definitive Plan Approved by Planning Board _.._a_ _� '�_--------19__ _ Area ........................................... Diagram of Lot and Building with Dimensions Fee a, " SUBJECT TO APPROVAL OF BOARD OF HEALTH � � -�� hr (� r�n r C z. V ` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' Name �r.'l...��.....{.......... .I,.f�..:f r !r! -.................. A=288-168 LEBCO CONSTRUCTIQN No 2.�.3.3.2.... Permit for 1 1/2 Stork in ........... .............. ..... ..... Location i 4.cl 1 e r Ci� cie ............ ........ .................Hyann i s.................................. .... ... Owner .....Le.bc. o....Construction .................. .. .... .... .. .... .. .... .. .... .. Type of Construction Frame ....................................... ................................................................................ Plot ......................... ... Lot ................................ Permit Granted .........JMjy...I.Q.,..........19 80 c. Date of Inspeion .....................................19 Date Completed—1..................................19 PERMIT REFUSED ................................................................ 19 ....................../....... ............ ...... ...... ................ . . . . ......... . ... .... ................... ..... ...................... ................. ............................................................................... Approved ................................................ 19 .......... ................................................. ................ ................ .......................................... ................ pFtH Town of Barnstable *Permit# o)16 6q p* Expires 6 months from issue date ,,,MST„B,s, : Regulatory Services Fee `$a5 6 C) M"M&639. • Thomas F.Geiler,Director ED11A�p Building Division -PRESS Tom Perry, Building Commissioner PERMIT 200 Main Street, Hyannis,MA 02601 MAY 11 2006 Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY AN -Q, Not Valid without Red X-Press Imprint Map/parcel Number A�V - A � Property Address 3 S field leis 0AP' S [`Residential Value of Work l �• Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address t7 • u � fiddle.r3 C�►�1LL.� Contractor's Name \mQS au B Cq Telephone Number -1 9 0 "r M Home Improvement Contractor License#(if applicable) I ` ,S 10 Construction Supervisor's License#(if applicable) ❑W&kman's Compensation Insurance Ch one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Q (� 11��occ— Re-roof . 0Re-roof(stripping old shingles) All construction debris will be taken to r'J D6��� �r`(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. me Improvement Contractors License is required. Signature QTorms:expmtrg Revise063004 ro fie (�omvrr�o�zuseai �✓�aaaac�ucarlla Board of Building Regulations and Standards License or registration valid for individul use only HOME ITIROVEMENT CONTRACTOR before the expiration date. If found return to: Re ism..twai 24310 Board of Building Regulations and Standards UW - /?007 One Ashburton Place Rm 1301 ySGividual Boston,Ma.02108 James Curley ,T M James Curley r r. 287 Fuller Rd. f���w"�'s.e°ems � Centerville,MA 02632 Administrator Not valid without signature r Town of Barnstable DY•�NE TohM . Regulatory Services $ Thomas F.Geller,Director =q, WAS& Building Division ED Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . www,town.b arnstablema.us Fax:- 508-790-6230 CffiCe; 508-862-4038 Property Owner Must - complete and Sign This Section If Using ABuilder C-n16-4u n ,as Owner of the subject property T� 'to act on my behalf, hereby authorize . �J in all matters relative to work authorized by this building permit application for. 3 3 -Fi ddliff br�j (Address of Job) jO a.o Jiab f ' er ate o : a S lvLL t Name