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0217 GOSNOLD STREET
� , �; `: k ` L Town of Barnstable BuildingF' s." a S .Sa^s rF* «_ ". �x,,i� ur� ,s � "�3 .:, "'"` .L .w.�•Sg '' .z .„ �.$ "S Po Th st is Gard SoThat,it is\/�s�ble From"the StreetA, ,roved Plans Must beRetamed on Joband;tfiis Card,Mustbe.Ke",# : MRNtT[AC{LB.. • , a�` . M^ d iJntil P oste Final Inspection Has Been Made �� ea od'°. Where a Certificate of Occupancy;�s Required such Bu�ldmg shall Not be Occupied unt�i a Fina�lns"pection has been made Permit Permit NO. B-18-2211 Applicant Name: Mike McMahon Approvals Date Issued: 08/06/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/06/2019 Foundation: Location: 217 GOSNOLD STREET, HYANNIS Map/Lot: 306 169 Zoning District: RB Sheathing: Owner on Record: BREITBORDE,SANDRA LEE ; 79- Conttactor:Name� ' „MICHAEL T MCMAHON Framing: 1 P 4 Address: 1037 WILLIAMSON STREET,#303 Contractochicense �� CS=068111 2 MADISON,WI 53703 ," Est. Protect Cost: $7,200.00 Chimney: - n Description: Weatherization,air sealing,weather stripping and blown cellulose Permit Fee: $86.72 Insulation: Project Review Req: �'; t Fee Paitl ' $86.72 z; y Date 8/6/2018 Final: Plumbing/Gas Rough Plumbing: -. Building Official s' Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed byths permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for whicWthis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ,. Electrical The Certificate of Occupancy will not be issued until all applicable signatures , BdFireOicals areprovided ontin permit. Service: Minimum of Five Call Inspections Required for All Construction Work:,, " 1.Foundation or Footing Rough: 2.Sheathing Inspection 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: "Perso contrac ' g with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable *Permit# res 6 months from issue date Building Departmet Tee BAatvseABLE. : Brian Florence,CBO o MASS.1639. 0� Building Commissioner Al Bp 200 Main Street,Hyannis,MA 02601 www.town.barnstabl.e. `ok M%j 0 Office: 508-862-4038 �(/� ®,� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL X Not Valid without Red X-Press Imprint Map/parcel Number 30 t: --%6ft Property Address Q1-T (Yas"v0- s"�• T t+t .r��s N Residential Value of Work$ 2-sob Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S'a,a.-, 14aS �rz��I►a �lZ. A Iwo; �g tt. t401 r Contractor's Name &�L 0"., Telephone Number 5-e9-3 ST-7619 Home Improvement Contractor License#(if applicable) /64 611 i3 Email: eizte-cyr-ccn ®C ey^t�Cstsr,nt'f Construction Supervisor's License#(if applicable) O Y4j-77 XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name Pfe_4j A- -_r"SU Workman's Comp.Policy# Fl1ARR P v V R� 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Q Replacement Windows/doors/sliders. U-Value . 3 a (maximum.32)#of windows #of doors: 0 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsofr\Windows\INetCache\Content.Outlook\9NNOKXY W\RESIDENTILONLYEXPRESS.doc 09/26/17 The Comnoounwalth of Massachusetts Deparbnent oflndustrial Accidents ' �-- Office of Investigations Y 600 Washington Street Boston,MA 02111 Y ?' irms inass.gmldia Workers' Compensation Insurance Affidavit:Builders/ContractorsMectricians/Plumbers Applicant Information Please Print Legibb- Name(BusinesslOrganizatiowiu&zdual): Oyy f'►<\ s`RZ,iit�ctr` e: Address:_tS Otbek—; 1A2 City/$tate/Zip: ,�,s A 0--XG,3 b Phone Sd - 3 SS-- °7&e?9 Are you an employer?Check the appropriate box: Tye of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑Near construction 2.[.I am a sole proprietor or partner- listed on the attached sheet- 7- J Remodeling These sub-contractors have ship and have no employees 8. ❑Demolition employees and have workers working for me to any capacity. ' [No workers'comp.insurance comp-insurance. 9. ❑Building addition = required-] 5- ❑ ATe are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per 1MGL 12.❑Roof repairs insurance required.]1 c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp-insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 4 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mow submit a new affrdwit indicating such. :Contractors that check this boa must attached an additional sheet showing the came 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. lam an employer that is praiii ng w=orkers'compensation insurance for my employe-es. Below is the polio,-and job site information Insurance Company Name: Policy»or Self-ins-Lie.»: m A A Q-P 3 614'6 l Expiration Date: $ y 118 Job Site Address: a%1 City/State/Zip: (-��.r��S,i((1A OabO :attach a copy of the workers'compensation policy declaration page(showing the Airy number and expiration date). Failuree to secure coveragee as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the,form of a STOP RTORK ORDER and a fine of up to$250.00 a day against the violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb?c ,under the pains and penahies of perjnry that the information provided above is true and correct Si tore: Date: 1 112,A) Phone#: Official lose only: Do not+Trite in this area,to be completed by cih'or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 _ n�/r�`t�carrraxa�aree<rtl�a��Gi�liss<rc/rruely3 Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: h Registration 104698 Type: Office of Consumer Affairs and Business Regulation ,- Expiration:; 7/15f2E118 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 ERIC A.OMAN - Eric Oman 28 Oxbow Way Dennis,MA 02638 Undersecretary Not valid without signature Cmmonealth of Massachusetts Division of Professional Licensure IF Board of Building.Regulations and Standards Constr, �§dbervisor GS-044977 E�pires 02/04/2020 F r ERIC A OMAII{ 28 WAY OXBOW3 DENNIS .NNIS MA 0�68 .x Commissioner CL — �"WE anaxsTABLE, , Town of Barnstable RFD MA'I A Building Department Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �'� w- iZeat 6�•-d�- , as Owner of the subject property hereby authorize d-60L:- U ^ 'r• to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 12-1 i /1-7 Signature of Owner Date Sox�+�c.• IScL���Do�c� Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\W indows\1NetCache\Content.Outlook\9NNOKXY W\RESIDENTILONLYEXPRES S.doc 09/26/17 ��— _.. « .. � �' t_�, ` ��� � �� {'; � i � 'f � r t 11 ` g ` e j � j" r i t '� �� i � - 4 r. i as+�.... '� - - � a.. -- A- :_ .... r�. r �, ��ws� � 4 ._. .-. s .... �k n .#I .,. ,.. � � ,- _ wa f +� x J,.-, �- ,�. ,,,�,,;�� '"y,: �F++ ,�'i1k.�- "'fir'"` .� _ �, - � � w-,�.... � I 1r�aJ•�s , c�c��- 6 mean �srTtc�trtc�n �. {J� � 1 WF F ip I r 1 �All, o�1'� �Sr�o ld_ �• // �J M,f C l5 tT1 ,t zU+� eU, �- Town of Barnstable - tiilaa,; r .: stTh�s Card: Thath t�s V.>IsibleFrom.Lhe:St eet-A roved=Plans Must be°Reta�ned:an Job-and this,GartlMust be,Ke t§� Po },. 5 P P 1ARN$CAftLL�. ': �,`°3✓a, ,n ,"_ ,�"r += s '�' ,,a u .a k u.0 F c ,. ., -,s r� • t > Posted:4Untll Fmns action Has,,l3een Made ° P a. x irerm Whe a a>;Cert�ficateaf,Occu anc is=ite u�red such Bulthh ,shall;Not�be Occu ied unt�la,Fnal:lns' ectaon has been made llli i Permit No. B-17-1068 Applicant Name: ERIC A.OMAN Approvals Date Issued: 05/02/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/02/2017 Foundation: Location: 217 GOSNOLD STREET,HYANNIS Map/Lot: 306 169 Zoning District: RB Sheathing: �, ZT Owner on Record: BREITBORDE,SANDRA LEE Contractor Name ERIC A OMAN Framing: 1 Address: 1925 CORNELIA DRIVE Contractor L cerise ;CS -044177 2 GALESBURG, IL 61401 " Est Project Cost: $5,000.00 Chimney: Description: Add Slider 6' in place of 3'exterior door relocate existih basement ` $85.00 g PermWFee: . �3 Insulation: stories,remove floor ceiling and frame tray celling m the Den. �� ' a� Fee Paid; $85.00 Project Review Re Add Slider 6'in lace of 3'exterior door elocate existin j Final J q p g Date 5/2/2017 basement stories,remove floor ceiling and frame tray,dbiIi gin ` the Den. Plumbing/Gas Rough Plumbing: ding Official Final Plumbing: Buil x This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six 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 str,'uctures,shall be in compliance with the local zoning by taws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road atnd shall be maintained open for public inspection for the entire duration of the work until the completion of the same. , Electrical a The Certificate of Occupancy will not be issued until all applicable sign,iavtures bythe Building and Fire Offiaalsarprovided on this permit.. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rou h'g . 2.Sheathing Inspection °� � 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: Persons contracting with unregistered'contractors:do.not.have access to the guaranty fund"(as set forthin MGL c.142A). .. Fire Department Building plans are to be available on site Final' ..All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel : Application # -I E 0 Health Division Date Issued J Z I7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis S E)0`T- Project Street Address all (9-q&r c:lcA SA Village Owner LA,-c i Address i�1 i e0aA1:-6_ Telephone 3oq 33f-/3C.b Permit Request 46-6 6- br�C�.c-.t' � r�� plcccc. uk (� ea�'k*�W' �o� /�' �e lOCnst �k1oTr.� b ve♦e-w,l "4 iGsS 1 -Mv+s� -t-� ce%,\% o-V-\6 - _4\,C. 0— -6-,6,4 Cea�►� ►n � 7! z�. Square feet: 1 st floor: existing l yoo proposed © 2nd floor: existing /"1A proposed o Total new 1400 Zoning District :; R'13 Flood Plain Groundwater Overlay Project Valuation t,Zoo& Construction Type waaA Lot'Size /0,300 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 'f D Historic House: ❑Yes )Q No On Old King's Highway: ❑Yes ; ('No Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) L4A a Basement Unfinished Area (sq.ft) i o►to Number of Baths: Full: existing new - Half: existing - ® - new- 0- Number of Bedrooms: 3 existing x new c Total Room Count (not including baths): existing `"i new -v - First Floor Room Count 7." 2 Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other ' J 10 Central Air: ❑Yes v6 No Fireplaces: Existing New Existing wood/coal stove: ❑Ye ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing L,4— ze_ C" Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ] No If yes, site plan review# Current Use 2w,cx,+j AN Proposed User »-f APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Eiz,c Omjl n d.M- &Nxg &St' acnen Telephone Number wog`- 737-617417, • Address 38 Qy, c,� (mac , License# 644177 Dtic,cvs,M A oac,3 b Home Improvement Contractor# /o W713 Email 02%c.arroa\(Z C0NXC6111r_. Worker's Compensation # WL u Jd,J bdoo i,-1.6 68 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE `tI[li 7 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: a FOUNDATION k FRAME INSULATION i7 Al A FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 64 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ulDepartment of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aumicant Information Please Print Legibly Name (Business/Organization/Individual): OX%NPox\ Q�� Address: a$ lt>�ra City/State/Zip: t v . MQ, 4&63t Phone#: ,Tod-3 8�-I t-4 Are you an employer?Check the appropriate box: Type Of project(required): I.E]I am a employer with employees(full and/or part-time).* 7. New construction 2.®I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[31 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 91 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n _ Insurance Company Name: Arc .l-C�bUrr�ls.cL , Policy#or Self-ins.Lic.#: QC,— Expiration Date: 814 6617 Job Site Address: (a SW City/State/Zip: !1nc% . YlkA-' Attach a copy of the workers'compensation policy declaration page(showing the policy num er and date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb eril under thepains andpenaldes ofperjury that the information provided above is true and correct.Si nature.. ,. Date: a'i!t Phone#: 5'i&6- 3tg- 7 1 Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts Department of Public Safety UBoard of Building Regulations and Standards License: CS-044177 Construction Supervisor , ERIC A OMAN �+ 28 OXBOW WAY >a DENNIS MA 02638 i i Expiration: Commissio er 02/04/2018 r��n`�r`!r..vrrrrurzeucr.�ll�ri,'G��lfraJur�<racslli Office of Consumer Affairs&Business Regulation License or registration valid for individual use only n before the expiration date. If found return to: �rh HOME IMPROVEMENT CONTRACTOR �^ Re istration T Office of Consumer Affairs and Business Regulation c_b� t' 9 104698 Ype Y-AExpiration 7/1 5/2018 Individual 10 Park Plaza-Suite 5170 - �' Boston,MA 02116 ERIC A.OWN Eric Oman 28 Oxbow Way Dennis,MA 02638 Undersecretary Not valid without signature SINE n Town of Barnstable Regulatory Services ` Richard V.Scali,Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize EA C-Crn0-J . d&L:0MA n &rn;rc.nUn to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alamas are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name l 7 Date Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services drtKE Richard V.Scali, Director Building Division sARNSTABU, Paul Roma,Building Commissioner � , �m� 200 Main Street, Hyannis,MA 02601 prEo www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATIO . number street village "HOMEOWNER": nam home p ne# work phone# CURRENT MAILING ADD S: city/town state zip code The current exemption for"hom wners"was exten d to include owner-occuuied dwellings of six units or less and to allow homeowners to engage an' dividual for ' e who does not possess a license,provided that the owner acts as sLipervisor. DE ON OF HOMEOWNER Person(s)who owns a parcel of land on 'ch /she resides or intends to reside,on which there is,or is intended to -be,a one or two-family dwelling,attached etached structures accessory to such use and/or farm structures. A person who constructs more than one home' a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building al on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed der th buildin ermit. (Section 109.1.1) The undersigned"homeowner"assum responsibili for compliance with the State Building Code and other applicable codes,bylaws,rules and r ations. . The undersigned"homeowner"ce ' es.that he/she unders ds the Town of Barnstable Building Department minimum inspection procedures d requirements and that h e will comply with said procedures and requirements. Signature of Homeowner Approval of Building Offici Note: Thre -family dwellings containing 35,000 cubic feet or larg 'will be required to comply with the State Building Cod Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Co a states that: "Any homeowner performing work for whic a building permit is required shall be exemp from the provisions of this section(Section 109.1.1-Licensin f construction Supervisors); provided tha�the homeowner engages a person(s)for hire to do such work,t t such Homeowner shall act as supervis any homeowners who use this exemption are unaware that they are assu, ing the responsibilities of a supe or(see Appendix Q,Rules&Regulations for Licensing Construction Supe isors,Section 2.15) This 1 k of awareness often results in serious problems,particularly when the homeo er hires unlicensed perso s. In this case,our Board cannot proceed against the unlicensed-person as it won with a licensed Sup rvisor.. The homeowner acting as'Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns: You may care to amend and adopt such a form/certification for use in your community. r 71Z0'hl GJiK - Town of Barnstable *Permit#���� 5 3 ties 6 months from issue date ' Regulatory Services Fee MAM Richard V.Scali,Director Building Division wo Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 J U L 28 2016 www.town.barnstable.ma.us Office: 508-862-4038 T(�'�rn' (� ��yy �'++�tl0T7906230 SOWN OFBA&MM r00 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY a/ Not Valid without Red X-Press Imprint Map/parcel Number �®�o S� Property Address Z j 5� 6 DcVWIZ �Zt A /i Residential Value of Work$ Q Minimum fee of$'35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number �:019E�,� � f Home Improvement Contractor License#(if applicable) /�/�� Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Pr I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Z�1-9&QG ; Copy of Insurance Compliance Certificate must accompany each permit. Permit Req_ st(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 I ❑ Replacement Windows/doors/sliders.U-Value (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 of the Home Improvement Contractors License&Construction Supervisors License is re ired. . f SIGNATURE: Q:\WPFILES\FORMS\building permit formS\EXPRESS.doe 06/20/16 F , 27ie Commw"Peah*r�,f Marsr diusdts Departweut.r,f curialAcdde7zts Ojfwe o,f atiem. 600 FfraslT fivton&reel Bosun,MA 02112 mom-moss govIdia Workers' CmipensafiwtInsurnceAffidavit S�naderslC�an&acturs/Iednc mnsThunbers A13PHCan#InfOrMnatiDn Please Print Nam(B Address-- s � CityfSlatef ph one:l Are . u an employer?Cheekthe appropriate box: Type of project(required): 11 am a employer With 4 ❑I am a general confrsctar and I 6. ❑New construction employees(full andfor pad-tane)-* have luredthe sub-coratt£a as 2.❑ I am a sole proprietor orpartner- listed oa the attached sheet. 7. ❑RemodeHng slip and have no employees . These Mb-CM3 1ract0rs have S_ ❑Demolition waddng for me in any capacity- emp`lorm and Imre wadons' 9. .❑Rni1cring additio'n LNp TV06MM'camp.ixysn ire camp.mmran ce 1 I ❑ re We a a imrpom i an and its 10:❑Electrical repairs or additions 3.❑ I ama homeowner doing all wodc officers have exercised their 11-❑PluaNagrepairs or additions my-welf[No workers'o=p- right of exemption per MGI. 13.vRoof inence required_]i c.152, §I(4� andwe have no repass nra 13-❑f?ther employees.LN6 woAoe& cam-insmance mqdmed-] *Any WBcsat mtcbedcsbos91—stahnMouttheswdembelawshomdmgthe¢wodeW aLgUi ,.permyi=ffin= mL T Smeownes Who sab=t dvs afddavk ID d ey axe domg MU Vraa$and$ea hie aatsi&cantmct=—st suit anew affifteft indiea7.ing sacs, ICd=cinrs$=chedriidsboxmastattachedas9aa;t+r 111 shad sboxxix[gtbeaameofthesoh-c�smdstatewhetheror nut fhaseeWtieshave employees.lftbemlb-r�hgve empIo as,cfieyaauspmviae their, �' •gaIicy atro�tses: -Taman eeiPler flirt is pro�zdircg iur�rkers'comperesrdin ucsriraacevr m}s earpla}'ees: Setncv is ri�ta pvticp arm jab site inrforrrra am Insumce Company Dame: P+}ficy mSe!f--ins Lim /'/'li 1Z' P i�ativaD�e: Job See Addn= ZZ--,2�C -A5d &id Z5f CitglStawzip: Attach a copy of the workers.compensatienpolicp declaration page(showing the policy,number and expiration date). Fa&m to secure coverage as required.under Section 25A of MGI.c�157 can lead to the imposition of criminal penalties of a fine up to$L50QOa inifor axie-yearimprisonment,as tined asrivil penalties in fe form of a STOP WORX ORDERand a fine of up to O-M a day against the viohdar. Be andsed tuna a copy of this statement snag be forwarded to the OTICe of Investigations ofihe DIA far h==w coverage s'erific oa Ida if ruby cwtJFY flta pains and parr $ediu7 ifiattfie iafar maf mj-pn*iiW ahmw h bw and correct si nafnre- Date- ph=eg- Ofi7cidamwify, Do]cat orate iti f d3 area,ter be completed by c ip artotru o ofclaL Chy or Fawn: PernatfLicense if Issuing Amyl ority(drde ore): L Board of IrwItli 2.Duiffi&ng Department 3.[StyYTovm Clerk 4.Flectrical Inspector 5.Plumbing inspector C.ofhHw Coact Person Photo#- 6 laformation and last ructious ' 1 MZ&S�Cft GM:nerat LEM❑ aptea 152 reganes an employ=Ito provide w=h&compe nSation f M_their employees. pa¢s¢aztfD this sty,an errplayee is deemed as.,�..every persdn in tiie service of mother mdcr any corJxac#ofbire, f empress or impIiec�oral or written.." Aa�Tay�is defined as"an indlYidn3l,paxtnemship,asSnaiation;cozPar�ion or oilier Iegal e ty,or aay two or more ofthe finegoiug=ngagoI is a joint mter rise,and inchidmgthe legalscpreseEI±H&es of a deceased employer,or the receiver or trustee of an individnal,partnership,association or ofhe=legal enii ytY,employing employees- However Elie owner of a.dwe ing horse having not more than three apadments and who residestharcin,or fhs occupant ofthe - dwmMag house of anoffim who enplops persons to do mamte ce,caushuct;on or repair word on such dwelling home or on the grounds or bnlldmg appmtm wr t,hmrto shall not because of mxh employment be deemed fro be an employee" MQ,chapter 152,§25C(6)also states that¢every state or local licensing agency shall withhold ffie issuance or renewal of a&cease or permit to operate a business or in construct bufldiags in the commonwealth for any applicant who has not produced acceptable evidence of compliance with ffm insurance coverage requiired." Additionally,MGM chapter 152,§25C(7)states¢Neither the ca=mweaM non gay of its political subdivisions shall forthe a once of ublic wu&untl acceptable evidence of compliancewith the insurance. cuter min any contmct p P regdm emu chapter s of this have Been preser'ed to the cr*ftactiag aoihod*." App4cauls, Please El out the worl='compensation affidavit completely,by checidag the bones that apply to your sitnatio and,if necessarL sPPI7 sob=o r(s)name(s). address(es)andphone— er(s) along with their cetcdcate(s)of insurance- Limited Liability Companies p-q or L=itedUability'PMtD=Sbips(LU)withno employees outer than the members or partners,are not rammed to cany wort e&compensation insurance. If an LLC or LLP does have employees,apolicy isregtm-eci. Be advised that this affrdayitmaybe snIm ftedto the Department of Industrial Accidents for conE niatinn ofinsorance coverage: Also be sure to sign and date the affidavit. The affida'vitshould be retuned to ffie city or town that tine application for the permit or license is being re;qatsbA not the Department of TTAas -ins A zddentr, q ouldyou have ray questions regazdmg the law or if you are req=edto obtain a worlctrs' compensation policy,please call the Department at the number listed below. Selfrfimred c mpanies should enter thoir self-insrnance license number on the approprisfe line. City or Town Off I als Please be sure float the affidavit is complete and prkted legIly. The Department has provided a space at ilae bottom of the affidavit for you to fib out in the event the Office ofInvest moons lass to co�rst you regardmg the applicant Please be sure to f ELI in the permitlicense:nwmber which wdl be used as a referrence number- In-addition,an applicant that must submit m-uh!ple penutIIicense appli-cations in any given year,need only submit One affidavit mdicaimg=rat policy information(if necessary)and under`lob Site Addre&'the applicant should write"all locations in__ (may or. town)-"A copy of the affidavitthat has been officially stamped or marked bythie city or town maybe provided to the applicant as proof flat a valid affidavit is on file for furore permits or licenses Anew affidavit must be filled out each year.Where a homeowner or din is obtaining a license or permit not ielafed to any bnsh=s or commercial veotase (i_e-a dog license orpermit to bum leaves etc.)said person is NOT required to comapIe#e this affidavit: The Office of Iuveshgafioas would Irke to thank you in advance for your coopedion and should you have any gaest ons, please do not hesitate to give us a call. The DePartmemt's a ddress,telephone and fax Cr.rtumb COMMIQUwean of M&,=chnsem . • I?ega>�n�cif Ac�;idents office of Inve9tkatio4.1; M&oil II Ta 617' -4 ext 406 W I-977-M ASS� Fax#617727 7M Revised¢24--07 Town of Barnstable Regulatory Services ` Richard V.Scali,Director ►� Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i I, as Owner of the subject property hereby authorize c�. �/�'n��C� to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name 71117 � a Da Q:FORMS:OWNERPERMISSIONPOOIS Town of Barnstable i Regulatory Services dF � Richard V.Scali,Director Building Division t R&KNMEME, f Paul Roma,Building Commissioner 639. L 200 Main Street, Hyannis,MA,02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: k JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage'an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on.which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures: A person who. ho constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner K. 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 y The Code states that: "Any homeowner`performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner -engages a person(s)for hire to do such work,that such Homeowner shall-act as,supervisor." Many homeowners wbo use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations,for Licensing Construction Supervisors,Section 2.15) This lack of awareness often, results in serious problems,particularly when the homeowner hires unlicensed persons. In'this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of`the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor.-:;On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 CERTIFICATE OF LIABILITY INSURANCE DAtatYJ 060012016 THJS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV"Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, TMtS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifloaW holder is an ADDITIONAL INSURED,the poilcy(ies)must be endorsed. If SU13ROGATION IS WAIVED,subject to the tenets and conditions of the Policy,certain policies may require an endorsement. A stafernont on this certificate does not Confer rights to the eartlficate holder In Iles,of such endorsoment(a. °sow Moo Kathleen Goddle NORTHWOOD ESHBAUGH INSURANCE AGENCY, INC. 771-16$2 Not- kgNdls.nort"4ftnauremam.net 60 MAIN ST. IN ArF Nrio RA C• MYANNi5 MA 026OtjmA: TRAVELERS INDEMNITY CO OF AMERICA 2666e elst�FA I 9 DAVID COX INC 1 PO BOX 401 IIStIM @, $YARMOUTH MA 02664 F: COVERAGES CERTIFICATE NUMBER: ONT7 REVISION NUM SER: THIS IS TO CERTIFY TMAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYJITHSTANDINO ANY RSQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRJSED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOY11N MAY HAVE BEEN REDUCED BY PAID CLAIMS, WRI apt LTR T17'a OF INgURANM P ftley NUMa Uq rs COMIYIf+11M 4CNERAL I"-LITY EACH $ CLAIMJ44AAM 11 OCCUR PABIAL4E8t@seaturrrral14 MED W LAM�am Mpj 0 N/A PERSONAL R ADV INJURY Wn A00RE4A7EppLIU�WT,APP�LIPS PER; GENdRft&q9A9jAT§ POLICY®JECr lf3C e•CO6tPA?P 8 S AUTOMMI ALY1eBJTY E ANY AUTO ' f KOILY WAM tW AMId s A OOB p A �D fll NIA ! 8001LY IP WRY(Pa swiclom) 1 "Ago AU►09 AUTOS I fl a UMBRaLLA LWS =UR EACH OCCURRENCE 2zc=LAG CLAIMS-MADE' N/A !(M [LATE WORKIIIA3 S C011teNSATrON IAO RMIML0YMI LIAa116M ANYPRDPR AIlTNVPAPWUTIVE I E.L.EAOrI AODIDENT i 00,000 A IoFFC EXCLUDED? NIA NIA nvA 6HUS91OX742216 07/16/2016;07116J2017 „' N! ea.JAI EAST•sA OMPLOYES a 1 D0,000 E.L.DI rr s 6W 000 J N!A DaBc"TION OF 0101MY10NS f LOCATION8 I VOICCLES tACORb 101,Adit*W Renwks 9eMdufo,moy be mwArndl Worksm'Compensation benefits will be paid to Massachusetts employees only,Pursuant to Endorsement WC 20 03 06 8,no authorization Is given to pay claims for benefits to employs"in states other than Massachusetts it the insured hlres,of hey hired those employees outside of Massschuaetts. This cote of tnsuranOe shows the policy in force on the date that this certificate was Issued(Unless the expiration date on the above policy precedes the Issue date of this eerttSCste of Insurance), The status of Oft coverage can be monitored dally by sooesstng the Proof of Coverage-Coverage Verification Search tool at www,mess,govllwdNcorkers-compenssUanArwestigatianef. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ADM 068CRIBED MUMS SE CANCELLED SEFORE THE EXPIRATION DATE THRREOF, NOTICE. VWLIL so DRILM..RED IN Town of Barnstable ACCORDANCE WPM THE POLICY PROVISIONS. 230 Main Sireet AUTMowaBORsENTAnve Hyannis MA 02601 1�M.CLOLdaY,CPCU.Vice PreslderA—R"Ouai MarW—WCRISMA 01968-2014 ACORI9 CORPORATION. All rights roomed. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety j Board of Building Regulations and Standards 1 License: CS-063537 Construction Supervisor r DAVID R COX ' PO BOX 401 SOUTH YARMOUTH., - Expiration: Commissioner 10/15/2017 rv��e��ourrxorrrn�r'r�l�c`^�lr.i.irrr�u.ie/`li eZ=. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to. 10pag7 Type: Office of Consumer Affairs and Business Regulation tion: . 3l2512Q18 Private Corporation 10 Park Plaza-Suite 5170 .,k",,-VEXeP9:sratmdon: Boston,MA 02116 DAVID COX, INC. x David Co 19 LAVENDER LN At W.YARMOUTH,MA 02673 Undersecretary valid withoursignaTu sor's Office ;1st floor Ma O 62 1 rJS Permit# ` Conservation Office 4th floor ) Date Issued f 3rd floor ' AG 3 F4, Engineering Dept. (3rd floor) House# Pis Planning Dept. (1st floor/School Admin.Bldg.): s Definitive Plan Approved by Planning Board 19 A lie ns rotes 8:30-9:30 a.m.& 1:00-2:00 .m. TOWN OF BARNSTABLE Building Permit Application P Address _'0ZZ Village l yd w w j r Fire District (hvner 7--I'd 10' Address-, 2 /7 Tele one Permit Re uest: Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded 1 Current Use eel ' °ram, Proposed Use Construction Type 44" Existing Information Dwelling T e: Single Famil Two family Multi-family Age of structure r� ,]�y Basement tvpe Historic House k!!� �. Finished Old King's Highway � Unfinished Number of Baths Z No. of Bedrooms / Total Room Count(not including baths) .6-7 First Floor Heat Type and F el 1-1 6 wd d ,' I Central Air ?l y Fireplaces 'Pop Garage: Detached Other Detached Structures: Pool Attached 0 Barn None Sheds 4-,A 1,77 B�e✓/� yak Other 1Y p - r Builder Information Name S P i^J 'w Vx _1b 2V Y, />f 7 r/ATelephone number 7 — /ZZA' Address /y o ,r�}�f � f� j� License# 60 G c t�/J Y1 / �2 2,- / Home Improvement Contractor# 42 1 ,�_ 7 Worker's Compensation # ivj C-1 - 5\-Z.-y'-i 83"� _ 03 e 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 N�f�d�vf r ProiectCost J S Fee ` SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONZ.Y a Y ADDRESS' VILLAGE OWNER DATE OF INSPECTION: • t d FOUNDATION FRAME INSULATION FIREPLACE L ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL i FINAL BUILDING: DATE CLOSED OUT. , ASSOCIATE PLAN NO. ,• �� ; i - ' Yl •9 G'f C O ' � x n A C a 40 �C •O 1 7 i i N O A m y y f�••• Of 7C � G1 � � A n.a.90 O ty CIS Z �. fA � � C '0 lT Z •� � A _' � !m N 'J ` �,•� v Z oa va � O O 7 .. The Town of Ba rnstable M ,g Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosses Office 508-790-6n7 Building Commissions Fax 508-775-33" For office use only Permit no._ . Date AFFIDAVIT HOME DwROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations'renovation,rtPair,moderni=d011,conversion' improvement,.rentmtial, demolition. or construction of an addition to any pm-das which ed t building containing at least one but not more than four dwelling units or to stiu are to such residence or building be done by registered contractors,with certain Ocoeptions, along with other requirements. Type of Wank: Est 6z) Address of Work: • O%mer.Name• Date of Permit Application: 3 -al I hereby certify that: Registration is not required for the following tmson(s): Work excluded by law "4 _ ob under S1,000 Building not owrm-occupied Owner pulling own permtt Notice is hereby gi<•en that: CONTRACTORS OWNERS PULLING MiEIR OWN PERMIT OR DEALING WrM WORK DO NOT HAGIS VE ACCESS TO THE FOR APPLICABLE 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. 4Data Contractor name 1 Registration No. OR SnaII1e . w A► The CuMJJJ0Hl4TU1111 of Massachmetts Department of Industrial Accidents ;y N_ 011lceal/m�estl9arlons :;% : '•a� 6110 111avit nrton Street Boston.A1asx 0 111 Workers' Compensation Insurance AfTtdavit _ 9 .• " _ -- Please PRIN'i`le tbly 1► n • in r.naiinn- �� • name S' / N ) � zl �iocatinn_ > 41Y cnty /Z,� / • t �'L-/� /0 / phone# 1 am a homeowner performing all work myself o i am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Lemnanxminces (/ Idrs • r c6t e 0 1 n en insur�n iP Y. % •# 2-m M .7 I am a sole proprietor, general contractor,or homeowner(code one)and have hired the contractors listed below who hav the following workers' compensation polices: m nny ni e• address: L nhene#•_ c: tn��rnncc co �.r+�'�'L .r�s _ _ - -�� •. -- Ven ar++,F..-Ta�Terl"."'�•.�""�r"yi�s �r,�e�,'�•�7' - - COMPAnv name, nddress- citv: phone#; SU -At additi0aal Shttt!f nttrJlS .. �� '1 •.,u rai..4a -*<•+ r ^•"+ Bois`:a.si, �'ws:. Failure to secure coverage as required under Section:SA of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500A0 and/or one pears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100A0 a day against me- 1 understand that a [op\•of this statement ma. be forwarded to the Office of lavcstigations of the D1A for coverage verification. I do herchr rem • d penalties ojperjum that the infornmtion prmided above is tote and correct Si_:nazure - Date Phone# 7 7 l 7? Print name �a� /� s �k /l`l �"�� � - r Fcontact nly do not write in this area to be completed by city or toen official town: permi0ccuse# r guiiding Department �Lieeasing Huard mediate response is required OSefeetmen's Office (311ealth Department phone#i t••nOther n• - Information and Instructions Massachuactts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted From the "law", an emplityce is defined as every person in the service ol'another under any contract of hire, express or implied, oral or written. An enrplurer is defined as an individual. partnership, association. corporation or other legal entity, or any two or mor 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 th; owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling ]lot or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to bean employe: 4 MGL chapter 152 section 25 also states that even-'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. Additionallv. neither tite commonwealth nor any of its political subdivisions shall enter into any contract fdr the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 11 been presented to the contracting authority. ..�.. •�• ., �td:j•[i �.._..•"• "y' .7 7 .lY�'r li�i.'^,��a .. '::'•+• �'� .. .. Applicants Please 1111 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of - Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. 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. Plea: be sure to fill in the permit/license number which will be used as a reference number. The at may be returned t. the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to ;,Live 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 fax#: (617) 727-7749 nhone #: (617) 727-4900 cxt. 406, 409 or 375 �� a�-�-- ,� � ::.` +' �.,� I . .,. ..». .- .: _ i w I ��� ���.,i _� _ � , �# '� .. ' �r., ,, . ... ... . ...... _ _ ' �u -'r- I .,v is�.r •.C � 'v e.3ef.. �'`{J3 ra+,�:.;';}C��+�. I ... r. 7 G7� S r�iV�► 5MEOr �` 3�" Picker RAi1 CAP i{ 11 -V1.5 'IT }} i , 5?e • /:,( .. _ "�::.:- _c.. ii�'�'Pai"^*�""�"T �` '�W's�_'`-�''. ?parr ' _ RO FCS�O_�ooR PIS N G�-auf,o �avct =-_-- r PROVEMENT E 1946 PRINKLE 199 Barnstable Rd., Hyannis,MA 02601 (508) 775-1778 FAX 775-1350 CONSTR. LIC.#006643 PEG.# 103757 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect, and binds those who sign it. Notice: All improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Brad K. Sprinkle Registration number: 103757 Salespersons name: Brad Sprinkle This agreement made on March 5, 1996 Between Sprinkle Home Improvements, Inc. (Date) (Contractor) of 199 Barnstable Rd. - Hyannis, MA (508) 775-1778, hereinafter called "Contractor" and Alice Setian , of 217 Gosnold St. - Hyannis, MA (617) 244-5313 (Owner) (A dd ress) (Telephone) hereinafter called "Owner" Detailed Description of Work To Be Performed I. Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: DECK Construct pressure treated deck as Thown in plan. Decking material will be 5/4" x 6" pressure treated decking. Rail system will be option#1 as discussed. However,option#2 is available if desired. Please confirm which option yo vish by checking one of the following. 0ption#1 Option#2 There is one (1).set of 8' steps with the option of a second set to go to the back yard. A 7' bench will be installed to the left of the slider as shown. Pressure treated lattice will be installed between the deck and the ground to eliminate anything from getting under the deck. Deck will project out 20' from house with an overall width of 22'. �►_�_ � ���� 'its ►► 1 �� � ; ; , �� �� �- � ,� 1 i� �-� � a �"i. ,I � fit► 11 E�� �� . P��FTHE 1p,:� Town of Barnstable Regulatory Services + BARNSTABLE, y MASS. �, Thomas F.Geiler,Director �p i679. �0 TFO Mai% Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 April 20, 2007 Mr. George Setian 5 Bencliffe Circle Auburndale, MA 02466 RE: 217 Gosnold Street, Hyannis Dear Mr. Setian, In order for the room to be rebuilt that was struck b an automobile on March 9 2007 Y > the existing foundation must be replaced. This existing foundation consists of concrete block that is presently placed just below the surface of the ground. 780 CMR requires that a foundation must be placed at a minimum of 48"below the grade of the perimeter of the structure. So, in order for this foundation to be repaired, it must be replaced. If I can be of any further assistance, please do not hesitate to contact me. i Sincerely, Thomas Perry, CBO Building Commissioner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map W61 Parcel c) Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board - 4- Historic-OKH Preservation/Hyannis Project Street Address 131� Village 1y $ Owner Address lQu�r,TnvQt,j�Tmv� M LA61, Telephone 6 13 Permit Request ?\e �« ` �''yt i�V"n� �2 ' X \ Zt Square feet: 1 st floor:existing proposed 2 S-U 2nd floor:existing proposed ' Total new Zoning District Flood Plain Groundwater Overlay t Project Valuation QM Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supportin§,dbcumentation. , Dwelling Type: Single Family tr Two Family ❑ Multi-Family(#units) ` Age of Existing Structure ICl S0 Historic House: ❑Yes CAo On Old King's Highway: .O Yes a'�o Basement Type: 2(Full dcrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: C!rGas ❑Oil ❑Electric ❑Other Central Air: LMs ' ❑No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes O'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use = Proposed Use ^^ BUILDER INFORMATION Name 1 1 \t��v�A 67--S R,3� Telephone Number 50 4Y 5_1 Address (_Tt�v ,odd, S V License# 0.)—7 �3 MA Lo l Home Improvement Contractor#_ (� �5_2-Z, Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ham ,r SIGNATURE DATE (4 10"7 FOR OFFICIAL USE ONLY `PERMIT NO. -- ' DATE ISSUED _ MAP/PARCEL NO. ADDRESS �' VILLAGE r OWNER.- v �; N r DATE OF INSPECTION: FOUNDATION 0 K- FRAME -7 `0-T j INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL "- GAS: ROUGH FINAL„ = FINAL BUILDING r d -O DATE CLOSED OUT '` ^ L. ASSOCIATION PLAN NO.� - N 1 17'-3" „ 1 -11 1 -11 2-0 2-0 2-0 7-5„ 2'-0"x 5'-3" 2'-0"x 5-3" 2-0"x 5'-3" � I Anderson casement windows N O I -- Line of addition I N I o Existing addition i o N (to be rebuilt) o I I � I Thermo shield entry door _ I N I Existing8" house 1-117' Z-1" X-I' Setian Residence o 217 Gosnold St Hyannis, MA 4 11"—�' r r Asphalt roof shingles W/ridge vent 12" 12"CDX plywood sheathing 4 R30 ceiling insulation 2"x6'ratters 16"oc soffit&facia 2"x6"ceiling beams 16oc vented Hurrican clips at rafters 12"sheetrock 12 OSB sheathing 44 Cedar shake side wall Setian Residence 217 Gosnold St. Hyannis, MA. 411 2"x4"wall framing 16'oc -44 Tyveck house wrap 411 R13 wall insulation 314"advantack subfloor(glued&nailed) 2'x 10"floor beams 16oc 2"x 10"box 2'x6"PT sill R30 insulation Sill sealer Poured 3000psi concrete foundation wall f 12"x24"footing 4"below grade 3000psi concrete Town of Barnstable .*Permit# Expires 6 months roue date Regulatory Services Fee r � a ggR��pBI.E�r j619. ,� Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 30�j lfjq Property Address n1 ] '� (1({� ( ( A residential Value of Work s Minimum fee of$35.00 for work under$6000.00 Owner's Name & Address G� k l L �j� �'/A N G-0SN6 e- - Contractor's Narne Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance MG 1. 2 2010 Check one: I-OWN OF BARNSTABLE ❑ 1 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 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 #of doors Replacement Windows/doors/sliders. U-Value (maximum .35) #of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\bdi. ing permit forms\EXPRESS.doc Revised 072110 the Commonwealth of iW assachusetts - -- Department of Industrial Accidents r-= Office o,f Investigations { 600 Wi shin fora Street IfostwTa, M4 02111 vwivm rnoss.govJdaa Workers' Compensation Insurance Affidavit: BuilderslContractoi•s/Electric ins/Plumbers Applicant Information Please.Print Legibly Name(BusiDeWJOrgMliZOti(MlU&Vidaai): Gq PR 115 L Rerr II--1 IV Address: GD5AId LA .ST ; City/State/Zip: / Nl 5 Phone#: Are you an employer?Check the appropriate box:: Type of project(required) L[II am a employer with 4. ❑ I am a general contractor and I employees(fu11 and/or part-:time). * have hired the sub-contractors 6 ❑New construction I❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. ❑.Remodeling ship.and have no employees These sub-coutractors have 8. ❑ Demolition. working for me in any capacity. employees and have workers' 9. Building addition comp.,o workers' co insurance comp-insurance.: ❑ g etluired.] 5. ❑ We are.a corporation and its 10.❑Electrical repairs or additions I. :I am a.homeowner doing-all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'camp- right of exemption per MGL 12.❑Roof repairs . insurance required.]' c. 152, §1(4),and use have no employees.[No workers' 13. Other comp.insurance required.] •Any applicant that checks box C nuut.also fill out the section below showing their workers'compensation policy informstiao- i Ho ieowners who submit this.affidavit indicating dtey are doing all'wcA and then hire outside contractors mast submit:a new affidavit indicating such lConiractors that check this bex must attached an additional:sheet show.ing:the time of the sub-contractors and state whether or not those entities have employees. If the sub-contcactors:hav-e employees,they.mnst:provide their workers'comp.polio number. I am arc employer tltat isprojidirig xrorkm'corrrpertsadan irisrararice for t,tty earplo,ees. Beloit-is the police and job site inforNladvit. Insurance Company Name: Policy#or Self-ins.Lic: Expintion Date: Job Site.Address: City/State/4: 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 ciin 'l penalties in the form of a STOP 'ORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be.forwarded to the Office of Investigations of the DIA for insurance coverage verification.. .I do hereby certi rrder thep zin and es of perjury that the informations prat iderl a.bmv is true any'correct /� - 5i lure: 1 �"� , 17ate. Phone#: Official use only. Do not ivrfte in this area,to be completed by cite:or town official City or Town: PermitUcense# IssuingAuthotity(circle-one): 1.Board of Health 2.Building Department 3.City/Town Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A lati Town of Barnstable Regulatory Services Y XLA A BLE'$ Thomas.F. Geiler, Director cb''reMA'ta Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 ,www.town.barnstable.ma.us ' Office: 98-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 'Please Print DATE: JOB LOCATION: -7 G-DSNbL number street village "HOMEOWNER"— L; �Gn-fA V name home phone# r work phone# CURRENT MAILNG ADDRESS: city/town . state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro ures and re=emen' s and that he/she will comply with said procedures and requirements. Sig lure of Homeowner Approval of Building Official Note: Three-family dwellings containing 15,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for. Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed,persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 e OF THE Tp� r • BARNSTABLE. "SS" Town of Barnstable 'OlFn Mn'+" Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.'barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_A06 1 6q - Parcel L6+ 10 Permit# ��"7 I is S Health Division Date IssuedZA Conservation Division ' Application Fee S� Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address (ra��r.A\ �� A Village �� r�ten\ Owner Ere z S e fj e_k-O-V\ Address ,i �i �, -nr.�l� TMA C3246� Telephone 4 4— 9313 5-08m 77, 61,13 Permit Request Y m' eXACA t1-01, Q=Ow eco�' (' �r•�J hc���� �outnl Q o�I AA -r6�7,— (2-_-- Inc-) �TroJ Square feet: 1 st floor: existing 17,5-0 proposed 12S-D 2nd floor: existing proposed Total new Zoning District f 00 Flood Plain Groundwater Overlay Project Valuation 00 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 6k 50 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: YFull YCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) 1 0S 0 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: C'Gas ❑Oil ❑ Electric ❑Other Central Air: L!fYes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes LAo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number S yIB— 415_1 q`_1L1 8 Address ZZ5_ 6-0% License# 077 84 b ��je�vno f � 8 bc�1 Home Improvement Contractor# 1`fib sZ?_ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOc�a�en� SIGNATURE //n A;- DATE Z 12It/0 i FOR OFFICIAL USE ONLY a PERMI.T NO. , DATE ISSUED , MAP/PARCEL NO. ADDRESS I VILLAGE � OWNER ' DATE OF INSPECTION: '• r FOUNDATION FRAME INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT• - ASSOCIATION PLAN NO. The Commonwealth of Massachusetts - Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Co ensation.Insurance Affidavit-General Businesses ".'ir-.' name: ��ssb�A1/[�J�1 1 .1�f -•� V i�cn{r - address: 27. &(� cit V inn 1^'1.$I state: MA- zi-p:0 ZbO 1 -phone# —cl fit Lf S work site location full address): ZI am a sole proprietor and have no one Business Type: 0 Retail❑ Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.), WI am an em to er with em to ees(full& art time.): ❑Other I am an employer providing workers' compensation for my employees working on this job.. company nmet. address:• . citye phone.#::•` .insiirance.co 0 I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: COIDpanV II8m'e: address: `)ioae'# ' . city:. u insurance co..... ...... .:-,..... .. ,.:. :":' '.o7ic .# xxxx cornan.- 'ni�aied" A V - address: - . i :nsurance co: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flne up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that p copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties ofperjury that the information provided above is true and correct Signature T`�'` Date Z 1 J 2•4 /D-7 Print name Phone# •��' / y y official use only do not write In this area to be completed by city or town official j city or town: permittlicense# ❑Building Department []Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: __ __ phone#; ❑Other (revised Sept 2003) r Information and Instructions Massachusetts General Laws the 152 section 25.requires all employers to provide workers'compensation for their.. employees. As quoted from the"law", an employee is.defined as every person in the service of another under any 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 enfeiprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the.occupant of the dwelling house of another who employs persons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to bean employer. MGL chapter 152 section 25 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, 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, 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. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding'the"law"or if you are required to obtain aworkers' compensation policy,please call the Department at the number hsted.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 fill.in the perrnit/licens.e number.which will b'e used as a reference number. The.affidavits may be returned to the Department by.mail or FAX.unless other'arrangements have been made. 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 Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents . 8ttice of lelrostl�atlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 Town of Barnstable . o�TME TOwti • ReguJ,atory Services s�xsr�$ , ; Thomas F.Ge11er,Director 9`b ' �`�� Building Division TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable;ma.us offioe: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property' hereby authorize.' t©act on mybealf, in all matters relative to work authorized by this building permk application for, Address of Job) 6tE'i Z 0-7 S' of Owner Date L Print Na= RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= qp q x.0041= LA O' C 3 plus from below(if applicable) , GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit- square feet x$96/sq.foot= x.0041= STAND ALONE PERINUTS Open Porch x$30.00= (number) Deck x$30.00= (number} Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground SwAmrning Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 I a° ✓fze �amxmnmcuea� o�✓�aaacu,/euaelta Board of Building Regulations and Standards �. HOME IMROVEMENT CONTRACTOR Re s05-1 bii . . 6522 (gyp-=-rr-a_tr©rr_=. ? 008 iXpe�,-:-'d idual 7 '1 MICHAEL BENJM ' MICHAEL GASPl��u r 225 Gosnold st f`: vic Hyannis,MA 02601 Deputy Administrator; BOARD OF BUILDING REGULATIONS License, CONSTRUCTION SUPERVISOR Yvs j 4 077846 u Bi[td�te $3�23/958 j,7 s! Q3123I0,08 Tr.no: 19304 i �tb i Restu6ted; QQ j F�1 MICHAEL B GASPR f 'f f 225 GOSNOLp ST HYANNIS, MA 02601 Commissioner f ASd.°Q. 33 . .:,. .:.-: ... '.: .• ... :,::;: �itt' ,. -:;:^. ...: �.:, :. :.�:':.. -,... �' .. d .. mNmkw�.:.ma..•e+rM*�vwa.xr,. vt ld . ' 4. / ol .i. i4 e— r:..,,...y.....«,,....x:M..««. t 36 1 � . o O Y gg t' . :.:..:gym.--�.-.�-�..M* -,_ �.� ,.. : .:, ..- •.... .... . .... - f a• rx.136 it �w N BY A�Pd�Er� r: SCA LE: ' y � J ; „DATE. ;t'.r REVISED e DRAWING,NUMBER _ . Its`ave ol a - • f am .. . a. _ . a evA � s w V 4a 6-*;,fvv-f !G[OdDdA�"EtCA4& 1:7001, SCALE: N�T�,�, APPROVED BY: DRAWN BY DATE:'ijJ1 N�� REVISED V DRAWING NUMBER