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0091 HAWES AVENUE
-- -__ - - -- - � �� J _ _ _ '� i E :��� K �. �� �, I �. �s rZ" 2 _ /S T®wn of Barnstable _ -G Permit': �-� 6 mont E Regulatory at®ry Services cpires hs from issue dole Richard V.Scali,Interim Director. $ATFD AAA't a Building Division NOV 19 2015 Tom Perry,CBO,3uilding CommissionTrOWN OF RA R N STAR LE 200 Main Street Hyannis,MA 0260I ..g INTM Own.barnstable.ma.us Office: 508-862-4038 s_> EXPRESS P RNL1 AP-T TC'ATIn7 Fax- j Sg� �j'��,g, ONLY:508-790-6230 Not Valid without Red X-Press Lnarint Map/parcel Number � 3 — Q o Proper Address Ila - residential Value of Work S — Minimum fee of S35.00 for work under$6000.00 Owner's Name&,Address' i- 0,d Contractor's Name 52U- t e I C LJ•, Telephone Number 22 q kip L�li:l - Home Improvement Contractor License_(if applicable) /7 32 4 S Email: Construction Supervisor's License--."(if applicable) p 7 n-7 EfWorkrhan's Compensation insurance Check one: ❑ I am a sole proprietor ❑ I7am the Homeowner I have Worker's Compensation Insurance Insurance Company Name r �G u'r Ins u rg y1 C2_ (' M�rJe4 n V v � - Workmanls Comp.Policyl Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over _ existing layers ofroof) ❑ e-side L�Replacement Windows/doors/sliders.U tialue 30' (maa-imum 35)_of windows 3 T of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Mee6ical&Fire Permits required. 'Where required. Issuance Of this permit does not exempt compliance with other tmvn department regulations,i.e.Historic,Conservation,etc_ ` '-`Note: Property;Owner must sigh Property Owner Letter of Permission. A copy 6 the Rome Improvement Contractors License&Construction Supervisors License is ' . required. SIGINATURE: QAWPFILESTOMMS1building permit formslEXPRESS.doc Revised 061313 - Nn( wal I e ism/dsialS9 Y, and cr.,�.�rwa�:� ., mRsar 9aNtsr rcrs mla mrCarr�a 26 A16ian Raad .ya�+Wn,ktl lV2W)6 1kil Mm 4 12E.7 • _ :_._�.. ,. .:..,,......:_ > e�c,:�.2t�s:.ate.�ol,�ss.�aa i SbadhsuNerorfaSB�dWuelemre;Pd�Qd'r'&4a 13cmeSarsl lryAed:euaen GMvthpa0�+sw 50.g1035n! ` CUSTOM VMDOWA'NDDOORMEM{ODEUNG 8 INMNIT' � J e6dsri>3t!'arrrt. 4 .. •�. c3a126 t . _�1_i.f Il=�•�SIt ..• yr qTTsw 3 - ' E-ears .0�1'Ea& j'�Jl'J'4 � FYmcfe' NPtCt16C. 51 $jt'' ¢b Ilwte.cawv C fi) rfi 3 ,s'`1 [DTJ d'a'l°4r+ 11.91�. _ F.u e41);hetebV jgff,*,x1d scar 9Y affPM as puachase,the Fmdur,Js a,i> 301%2m Of$ME tfgL, EnOE d'Windows,LLG d,tb%m Renewal =fv Ar'49 ac of South=NW-W Engiand 4`�ilY.YtT"t6�b',ut q=ordsac c�dia Tear-4 and r tijIDpTa d-Mliba lvn tliK fi0flL abd,rlte teaiezaa Of d a tYlelct an Llae, let re �toa c a)I�w e�fie r1}; Tigre eptezgl` D.Flats ❑!t'av + E3 II;iTA;T ToaflebAmourit Estimxaed5areti�rFJamc NI h7dafFsrpftwn� Oe�'sq CrCas3a D7EMItat.:tdVat(33rk1 Paeafrt C,nelsaaea a{{•q lair �+pag�t,otfy—r�dm¢rm�F3 aFt6c. E"aFa=as"�,c 4ta'b{131?ijc t§ttmaec�zomgtatrsn t prrt'ert oodt see�:CardPa}r-x F,*Ey of ra J ream ,lu ada�t.,l dot Oe B ra ss smrt of and to 11danm on Ms=dd — �W� ar se an fubstaraW CmVlEdrji ofjrb eareiat bo ma&b� odit Carnpfedptr aF lay f3� iard osc,oats lit rrs by pawrHl Ih�ils s7i rr ; $aagex(s);agre°s�d aandaratandls#b_altt_8•AVmcAnqns cornsdmims the entilte nnA-Vtand:ing:benrreen&*pwmksp at kA that there are no wrb*t;,mderaM np clt%DvM f any or thm" me of tM9 A$fM—nt. M bag renal this Agmcz ent+®dae^,trgsnds the ier—of dUs Apmeffient,and has srccived -0ampuced,signed,,and ditted�. perof.thashZYcementoindmdingtih*00IM&&ed Notices ofCancehation,on the datr:&ntwr.ttesaftoveatA(2}.uusorally isAwmed of Bayces right to exec*1 thleAgmeihmt.IDO NOT S141;.XTMS CJIDNTRACT tF'1ll f &ARE ANY MANY,BPl1CgL (Rho&fsl"aud.W&s only)Nagoe to Nnym o not sign tg es Agreement if anfof the; ea i:tUnded far thL agpeed''teiam to the esieat,f&en avagwMe Inficia tisn.are kft bia:nk.QZ,fYou„are•entitled to a copy d iIUs eteleuY at""#goy ip Yoa'msg at auty tjliiae pap off tltb tv[C+agpt►id f3alararaeicfAt►deer Alcn.reas,,eAit la ea•dom8•F tie.a®titer to receive a paraWrehate of.the Rmeee awl'insurance chars gm(4),Mae seller has no pight to uz_t wf'ally cetcsr Ftaur ptftnises or comamft asap break of the pea&to rt possess goads porn hhamd,und'er this'Agreem4mr.(S):Yoaz may cancel ktfda Agresnxent :if.it bras uiit bean dguad at the rs-gs oM's or i brands affcc�-of tke,ftlky provided you notlfj the seller at his or her onaau ogee-artaeautclaaf>leeaitua af�atEuaAgreermeuttryrsgistertd;oscertified�1;,wlorlgshRnhepost",QotIgfPrt6aoa�+sdrni�+t� aff the tl4'i�calendar day`afbtr.tive dasy an Which,Ilk buyers signs(he Agreement,ers$Msffug;Sun4zy and:�y hoNd'ap an which .regnio a mandel.V•;.ea aro tmt.inmda.Sw*h9's c@M M9yiMgnod0i of eaacellalhnn form f*t as. cxplamItiao a1 tes rights+.= Renewal by,in -en tBa M;Nex.Eag1=d BMW,( BYE ` 5.igoat t�� x-c#111'4k �� Sigmsinase: I � ' Pput[Naa+Q altar Print r Frinq 1Vsrric YSOU, THE 81d vER(Sj, .mAY MCA THtfi TBANSA=.ON-AT ANY Tim.FR10' R TO MIDNIGHT OF THE TMD =&D: ESS,l . AFM°Y�7S I TE Oy CI S TRIIla�1�A+0IT L. 'f ill dF`C,Tt $�iliOdl i ..( GILNUMATFON FORMS" gC}Re,N> pfwtvr►TtpP1O `1'�Ig NOTIC NORCE©FCAtNCEt Arrnu Data,of Trmycd6n_!N. nIota may cancel I Date.of Trdnsactmft Tau, v l thIL Wotdincean�vi"oue my penditp or obltgatkn,wt w'n t tftit tt+ansatdon w[altout°Ky'fJes*afty'or Obligation,Wlttiln three i *tm dap f rn.the above date..tf you,s artcok any, .theen.bu J rMM-t te•abaft dgt"If,You t ip any p�rrooperty rrAded aN soy pairnerM�'made by you under,the r' ' 'tPadlad irN a4 Pa4 ments nra�:by you under the C:ot 61;or Sale►grid Ay'ns�gahahla isagVvm*nt wwcuted, i tamest or.521196 attd'•arty sots.g�tiAlo irrs xart�tint:evre Ce by)vu wm be ieturned witl�rn&n builhem days(alWofni s, 'lay'you,wnl be rtturned vrithfq lCrr bossiness days Wtowfng SMIbyr the Seller bAyrottr cartoel[ an.nti�r�.and any Ieitit:bar dlMc'Setler of your Gancl3an tlat➢ct and altar interne troy *Ut of the section. vrill be M secunitlr rntereet thing Out.of t1� trAnsacti'un, will:be canoeledL ff you carrsel;yyaatr:rwn Mtnafm awe to the Seller ecl,if y'aai sw1C8'k YOU Mmt nUdEo avaBahle to ikh&S-tlftr at.Otir rogdenck�n strbst ally as good c®ndidon as when I at your residonct0h subawtitV as goW tond3tion as whoa recetwed,,arW goode delivered to you render than Captraet or I received,sorry goods dtllvored to YOU under this Contract or _ !y�*-tro4tq'�Itlpgrr�rh.coreigiyrath t imst,no5tns cf 1: Sal4l .tnay.tf yxlu.,asornP wl t#ro iastrucaPaltm a! t1sv 5inllesr reEardi>rog tllv:neEaPn thipn+sni'cal't>a>i a klte. the Seller raegau�li thd'r•atr",shlpntieut of the goads at the Saf es�p so,end rMis if p4la•dfo Ml+aa40 d+®gaatf9'xv lalbl4 9cS¢r!s�cpmtse a ni'iio„ff 7�u gaeak rthe gg"oda a+�ailahPe is the:$el6ecrnatttl.tfw S�IIer does not pick them up wit lrirt to the Seller and the$e11er,doss toot ppcic ttwm,:up_wit{tin twditti,c�a'ef the`daMtic 6f'catltslla�4ne you M*l�l"or t' tartrit�r d'aa�� of the d$� of EIS you rnajr retain or dlI' t the gpe&vlil out mny'Zrther ebiiptim If yeti' l dispose of the Sands without shag further amfg0on.If`p6 w(to make the goads amitabla to the Seller,or ifyrmr ag►m I', fail'.to make the Spade a�ilabt'e to the Seller,or it you agree. to return the,goodi to the Bents,and teal.to tla so thou you � to return the eod's to dtie Seller MCI Ml too,do�then you ranuln.liable for performance of all obi`agartism,under the, t reonatn mule r perfomance 4f all ebiCg;a Ons under the Ca�tniatTa sanaei,this tiarsactnar'�rttnll!er d'el'rves~arsigrMed Cara`tra�et.T6 eaeeel ef;is`.fraeMiae9tlott.`i�ij or dalixe�A�geiedi i ond.eJe+ied srapyr o[ tlob cantelbrotian notice or xtty ati➢et' 1' amdl dated copy of this cancellation notka; or any other writumtMkQ,,er land attale to RaftewallyAdk!nenat r written nodoe,orwxdatWk ,toRenewallbpAzderrenof Southern I�saw'Frra�tnd�at,26Awflplon RA_ fmltl 02065: 1. Smxtl.�rn New England,at 26Aah ,R=d'Uncoln,,flh QiMy NOT LATER THAN Mliat+ll®wT'©F f NOT LATER T"AN MfDNtGil<T.OF (Date) (Datel f M BXCANCELTHISTRANSAC'1'101 IF HUMSY CAINCELTHISTRANSACTION'. eayrry,y Prlere Mme Qrrta ur e,dlvw;;re vwRr dome •— thMtt Rba Ccp'f sty 1Swier may.Yell'cwl BLW C yr.Fink f - Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS4NNM BRIAN D DENNISON 7 LAMBS POND',' s Chneiton MA 01567 Expiration Commissioner 09/0812016 ` �f2� �G�7fi��2�lZdGr�t�I��P. Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: SuppletrreM Card SOUTHERN NEW ENGLAND WINDOWS LLr0" 9/19rz016 DENNISON BRIAN -- 26 ALBION RD —--- LINCOLN,RI 02865 Update Address and return card.Mark reason for change, scA t O 2MAQ.Mi 0 Address C Renewal 0 Employment 0 Lost Card �i{e�vatx�vea■.e�laL 9l� a er Conserver Mbin&Bodoess Regulation License or registration valid far ladividul use only IM PROVENIENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation n: f?44r Type 10 Park Plaa-Suite S170 Expration: 9119l2016 Supplemeru•.;ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LC. RENEWAL BY ANDERSON DENNISON BRIAN 26 AL.BION RD / LINCOLN,RI 02865 Undersecretary —got v slid witkoat aigtratarc The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 ` Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone #:401-228-9800 Are yoq_an employer? Check the appropriate box: Type of project(required): IF 2p+ 4. I am a general contractor and I 1.9 I a&a employer with g 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. ❑Remodeling ship and have no employees These sub-contractors have g_ n Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance 1 required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] T c. 152, §1{4),and we have no employees. [No workers' 13.[Other 1.hI J 0l,J 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. _ Policy#or Self-ins.Lic. 9:WC 928058352394 Expiration Date:8121/2016 Job Site Address: ! -!'I LI bi e S ✓e- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A=.ufMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil.penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for urance coverage verification. I do hereby certi under the " s and penalties of perjury that the information provided above is true and correct c 4 Signature: Date: ' I t Phone#: 4012289800 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#: f SOUTNEW-01 SHETTYSHT ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE 11191201DD/ 819/ 5 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT : Willis Certificate Center Willis of New Jersey,Inc. PHONE FAx c/o 26 Cantu rryy Blvd A/C No E:t:(877)945-7378 AIC No):(888)467-2378 P.O.Box 305191 ADDRIESS:certificates@Mllis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen 26 Albion Road INSURER D Lincoln,R102865 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADOLSUOR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD MMID A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR S 2029459 08/10/2015 08/10/2016 DAMAPREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a ECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY ED acciNED dentSINGLE LIMIT $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS Peracadent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ ° 5,000,000 riDED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STAT Y UTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE � NIA 0000068028 08/21/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/2112015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH ORIZED REPRESENTATIVE Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Mass. Corporations, external master page Page 1 of 2 1.r. Corporations Division Business Entity Summary ID Number: 001158788 Request certificate New search) Summary for: TSIEN EDDY, LLC The exact name of the Domestic Limited Liability Company (LLC): TSIEN EDDY, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001158788 Date of Organization in Massachusetts: 01-23-2015 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 91 HAWES AVENUE City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: MELANIE J. O'KEEFE, ESQ. Address: 8 CARDINAL LANE City or town, State, Zip code, ORLEANS, MA 02653 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER BILLIE TSIEN 222 CENTRAL PARK SOUTH NEW YORK, NY 10019 USA MANAGER DAVID TSIEN 11 MOUNTAINSIDE DRIVE MORRISTOWN, NJ 07960 USA MANAGER FREDERICK R. TSIEN 1190 ESSEX LANE FOSTER CITY, CA 94404 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address http:Hcorp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEI... 11/19/2015 Mass. Corporations, external master page Page 2 of 2 The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY DAVID TSIEN 11 MOUNTAINSIDE DRIVE MORRISTOWN, N] 07960 USA REAL PROPERTY BILLIE TSIEN 222 CENTRAL PARK SOUTH NEW YORK, NY 10019 USA REAL PROPERTY FREDERICK R TSIEN 1190 ESSEX LANE FOSTER CITY, CA 94404 USA ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS `e' Annual Report Annual Report - Professional I `E. Articles of Entity Conversion Certificate of Amendment v View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEI... 11/19/2015 A - Town of Barnstable � Regulatory Service 1'_. 1's 1 Thomas F.Geiler,Director AR MASS.M ' Building Division am 9A 059 'Cps �,,,,_- s� f0 MAr a Tom Perry,Building Commissioner,.,,.,,.,�. .;. 200 Main Street, Hyannis,MA 02661 0 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT FEE: $ SHED REGISTRATION 120 square feet or less al EIAWO Al-EIVE WANN��i Location of shed(address) Village Property owner's name Telephone number 12.0 SQUATZt eEET 3 23 /D I 0 Size of Shed T Map/Parcel# Signature Date- Hyannis Main Street Waterfront Historic District? NO Old King's Highway Historic District Commission jurisdiction? �•10 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 I 1 �FIKETptt, Town of Barnstable *Permit# c�befl 6 13(oq �P� O Expires 6 months from issue date Regulatory Services Fee v MASS. Thomas F. Geiler, Director �pEE p 3 , RESS PERMIT , Building Division APR Q 2 2009 Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 TOWN OF BARNSTABLEwww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address G lr\A W FS AVE , N YA N i-�- ) S MA 03� 60 1 Residential Value of Wor C_001 ()() Minimum fee of$25.00 for work under$6000.00 r Owner's Name& Address / Vo t,-N"ien S Et-j 1`I L�0w SHIP R& S? 5Kt"Cr R\pGe /QT 0 7 9 a0 C.'ontractor's Name 3D+y&T H A tN 'Ty L F JZ Telephone Number Home Improvement Contractor License#(if applicable) o b oZ 1 Construction Supervisor's License 4 (if applicable) C S —7 P, 5�-7S ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ( I have Worker's Compensation Insurance Insurance Company Name VEL J-1- Z 5 Workman's Comp. Policy #_ P C3- 01 O —7 Yh P 16 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) [j? Re-side 2 >=&10UE At' L7 ZEPLACP=- 35C) Sgt EET SI�)twALL ❑ Replacement Windows/doors/sliders. 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. A copy of e o e I provement Contractors License is required. SIGNATUIIE: Q: \4 III-I1.I.S\l:0RWbuil in79r.it forms\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �O N A7 H A V�_3 Y Ll< Address: a LYhJ K Jot_rh CT City/State/Zip: " YA tutu► S vvN A , O 3060, Phone.#: SD g - 7 7 S- -7 7 5 9 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and 1 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. .❑Remodeling ship and have no employees These sub-contractors have g•'❑Demolition workingfor me m an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'-comp.•insurance comp.insurance. required.] 5.XWe are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no ' employees.[No workers' 13.Cg Other S l b t=w M 1 t, comp.insurance required.] :4 E Mo v E ICP4ACE *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 erryloyees. 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. Insurance Company Name: RAL,E Li:2 — Policy#or Self-ins.Lic.#: S U 3-O 1 0-1 w\ a b- y - O'R Expiration Date: S�oZ I d CN ' Job Site Address: N A W 95 Avg City/State/Zip: MA, COa 6O1. 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 fins;up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' ce roveragq verification. I do hereb under th cns d penalties of perjury that the information provided',above is true and correct. Si tore: Date: �! 01 0 0� — Phone#: O g ' 7 5' 7 -7 ,�9 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#: Sf 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 foregoingg-engag in a join-en rpns inElu3-ing-the leg representa�ti�e��f- ilec�ased iuyer,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 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 sub7con6actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than time members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is completeand 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 maybe 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 io any business or commercial venture (Le.a dog license or permit to brim 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 11-22-06 www.mass.gov/dia t►+ETo�ti Town of Barnstable . ° Regulatory Services • s.,x,,,sz►st.� • uAR& �, Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.to w n.b arnstab 1 e.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, 7 V p►y NG 75 as Owner of the subject property hereby authorize pi e. -1 Lr to act on my behalf, in all matters relative to work authorized by this building permit application for. Q 1 AAw95 1vre YYArvN I va o � .(Address of Job) Signature of r Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM S:0 WNERPERMISSION Town of Barnstable zHME Regulatory Services • Thomas F.Geller,Director s.�xxsrA►iLr_ .16 6 Building Division PIED Tom Per ry,Building Commissioner __.. . .......200 Main street;Hyannis;MA 026D 1 __.. ..... .._. . .. _.._. . .. _._........_ www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE- -0 JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: ' city/town state., zip code a 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. c 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,thatthe/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."homeownee'certifies that.helshe understands the Tpwn of Barnstable"Building Department F.'i minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. r+ Signature of Homeowner t Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required`to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is ruluircd 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 ad as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, Rules&Regulations for licensing Construction Supervisors,Section 2.15) This tack 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 wrould with a licensed Supavisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is frilly aware of his/her responxibilities,many communities require,as part of the permit application, that the homeowner certify that he/she rmdestands the respambilities 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 forn/certifu ration.for use in your community. Q:forms:homocxempt F VD AC C AW" a TRAVELERSJ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (.7PJUB-01 07M26=4-08), NEW-08 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA NCCI CO CODE: 13579 1. INSURED: PRODUCER: REMODELING ASSOCIATES INC. BRYDEN & SULLIVAN INS AG 2 LYNXHOLM COURT 88 FALMOUTH RD HYANNIS MA 02601 HYANNIS MA 02601 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 05-02-08 to 05-02-09 12:01 .A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each.state listed in item 3.k The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee, C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY. ENDORSEMENT WC 20 03 06A o_ D. This policy includes these endorsements and schedules: r SEE. LISTING OF ENDORSEMENTS -EXTENSION OF INFO PAGE o� 4. The premium for this policy will be determined by our Manuals of.Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 05-28-08 MB ST ASSIGN: 'MA OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: BRYDEN. & SULLIVAN INS AG 232MY ha Boar o i' f m mg egu ah s an , tart ar s Constructi` on Supervisor License - t' Lurerjse: CS 72579 /4/2010 Tr# 14112 r - r;��n�trga--IIFl�u j JON/ T HAN M TYh'F r 2 LYNXHOLM CT `x HYANNIS,MA 02601` Commissioner r License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration 106627 One Ashburton Place Rm 1301 Expiratrorr'.7L24/2010 Tr# 0 t- Boston,Ma.02108 7T pff Individual JONATHAN M TY4I EE Jonathan Tyler Y 1 i 67 Cranberry Lane'Bo8Q , W Hyannisport, MA 021r2 ;> Administrator Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mat h 3 'Parcel O!O Permit# Health Division, 1211610 -temr. Date Issued Conservation Division a,/°�,4�4 Fee Tax Collector ! GO, ZApplication Fe . Treasurer Planning Dept. ChCT Date Definitive Plan Approved by Planning Board Appr#ved By SEWER ACCOUNT Historic-OKH Preservation/Hyannis Project Street Address 0/ 16 a/,-S 15�16 i Village Owner AddressY/G3A�/&�yrA/r� L� Telephone �D�l f al Of/6 Permit Request e� 4f 6e240_��V f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay 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 J' & YAr Historic House: ❑Yes al o On Old King's Highway: ❑Yes d eo Basement Type: Full ❑Crawl ❑Walkout ❑Other C Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) j rn �Aqumber of Baths:—1 Full: existing L new / Half:existing :5 new' M Number of Bedrooms: existing new 77 Total Room Count(not including baths): existing 7 new First Floor Room COL nt S 4? :01 or Un M Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: && ❑No Fireplaces: Existing l New Existing wood/coal stove: ❑Yes ulio QO Detached gar g isting ❑new size Pool:❑existing ❑new size Barn: ❑existing ❑new size Attached garage:910'existing ❑new sizelZ. 2 Shed:❑existing Cl 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 �.�� S Telephone Number zz i is s"O Address-3v /N/✓/+�/Q ���'Od� /r� License# ®ZO K/ 2— .5— YAnon 7/ �,9 U z c ef` Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s SIGNATURE oe DATE FOR OFFICIAL USE ONLY PERMIT NO. ; r i DATE'ISSUED P MAP/PARCEL-NO. Y ADDRESS VILLAGE f OWNER DATE OF INSPECTION: FOUNDATION = FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH 0 FINAL f Y GAS: ROUGH p FINAL ' 1 FINAL BUILDINGTit © -^ � ; —O� �'` ,• DATE CLOSED OUT 0 ASSOCIATION PLAN NO. c _ Town of Barnstable Regulatory Services t , Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office. 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. le Type.of Work: ge � Estimated Cost gOd Address of Work q/ fiIAGUG�S /�i/P_ /�p,vvi S1Q• O Z Owner's Name: Date of Application: CZ i I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑lob Under$1,000 []Building not owner-occupied (]Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WrMUNREGISTERED CONTRACTORS FOR APPLICABLE HOME'IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a ermit as the agent of the wner: Dat Contractor Name Registration No. OR Date Owner's Name Q:forms:homeafdav �tHE r Town of Barnstable Regulatory Services y'" "MASS. Thomas F.Geiler,Director 1639. �p�FDM1pVa�0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L Z* 49 ee, -Tri -�� ,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) •.fir... „ � 1- I b O S� Signature of Owner Date MA; LL"IVAI 1 siev Print Name Q:FORM&O WNERPERMISSION only istration valid for indiv►durn to: p/ //rrLL w� License or reg If found return v�dm�n�ynv• Standards before the expiration date• ulatwns and Regulations and Standards oEBuilding>zeg. TRACTOR Board of Building 1301 Board on place Rm OVEME►'1T CON HOME IM One.Ashttart02108 09884 Boston,lYla. Re istration 2006 r id > r . iture KENNETH WEE - r �, - riot alid without sign KENNETH WEE 30 cp ong Brook �j�ninistrator couch-Yarmouth.MA 02664 BMARDAdF�B iIiLDIiN'G0RE,@%4ikftT1g'O1Nr.S t t�icen"se C'@�NSTRU:CTION SiU'PER��%IS'Q`R � I�ui`a�lber r 020412 Tr.no* 41959.0 KENNE rU C_ 1NIN aS �pi:.ci�ITNIN!I�NG4SR0� �. SY�/arRM®,�JTM, MA 02r6 � ti__ ' C^ommis�omer 5 fi}e v _�..,..._�. FiII• pfju,(d L..QAIC�V - Porch F. h fDU 1 !3fIUIts ALL eXIStIIv� 1� f( Pack,. LANAI i NR - y CGNUr2Te r. � AY.4 q e. 1AX I// 45, t�a J i / Q' _ VA r1h. �. R, ;ta n o _ 47 PO _ /oo.oa it 147- , Z®, W qy o� i o Al 2 o It �1N OF Al o� GFORGE L . � LJANIOES `^ • IFo.22723 0 Ave - !a rs 1$4 �4h0 sua'��' i RrrBr1Z'P 0Ww D BY Q Gars /e % 6{° � No N� Yge FN 141v/ 7SI FA/ owd•8k 1413 P�4,6 _ j Ken '/,/ nowow= AopDse-d �Nork 7516iv &,IeA lldAe- 9//I/oS Y '' MA Shee,t #1 / Awes Ve y/iNrvis 'IYh, 4Av1 g e \s1\as YA v cl Room 13A rti gal �4// existM3 � 3 I y � _ ,, -� 1 •, r r✓ .— � _ t..:.,_-:�du/ � I n`' �, tea- , • ow �uisTih/q douse h.\ .r.r. 10I A N/rL N --_—.— a - cxisrNf - I /ev.9 fiOiU Pro pose/ te �Pa. -7 '-7 ",(ev xy9 ' ��Ieeaw C . -.� Pte- �eeye- e,014r. Idle 3s 13 f ti.�s r a Mud Roo &l �F. 1 v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, ' Parcel 0/40 Permit# E38 9-7 Health Division 41 2- 0,5-, uin Xe 6,P-r Date Issued Conservation Division J Fee 41 •�� Tax Collector Application Fee d Treasurer �d Planning Dept. CheckeONQMD SEWER ACCOUNT Date Definitive Plan Approved by Planning Board Approve 3;,=='-�P Historic-OKH Preservation/Hyannis Project Street Address 7 //17licJP�S Village , /�" N'r/✓S ,p Owner �1 �/�iS e��y`/ /�iu Address F04 3 /tee/�u� eft.,o /'� Telephone c sOff Permit Request , l 0 chA✓ ® Z W Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation �f0, D®� Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docu entationc", : ' M c-) C Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) a Age of Existing Structure 1 �' Historic House: ❑Yes I�NO� On Old King's High ❑Yeses �o Basement Type: L-Full ❑Crawl ❑Walkout ❑Others Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half:existing new Number of Bedrooms: existing S new Total Room Count(not including baths): existing a new First Floor Room Count Heat Type and Fuel: 61as ❑Oil ❑ Electric ❑Offer Central Air. e Yes ❑No Fireplaces: Existing �/ New Existing wood/coal stove: ❑Yes ❑ No Detached garage:gklexiisting Cl 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 4'Cl!/ Name / �.✓� �G P,�S Telephone Number Address "?a �.� f /3kzfo k. PW License# a 7-o / Z_ C U-20 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE /�� l FOR OFFICIAL USE ONLY PERMIT NO. .t DATE ISSUED ( : MAP/PARCEL NO. f ADDRESS VILLfAGE . f i OWNER DATE OF INSPECTION:- ~ " s•• 4' FOUNDATION FRAME eOIC INSULATION ® �� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH B"i FINAL GAS: ROUGH FINAL FINAL BUILDING Q C—_ I L�--7 G DATE CLOSED OUT . ASSOCIATION PLAN NO. 0 _ may( f Town of Barnstable Regulatory Services. . g rY Thomas F.Geiler,Director y MASS. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME Il4PROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,-alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied- building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. - Type of Work: If Estimated Cost /P-04:1 Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): FlWork excluded by law 71ob Under$1,000 E]Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name Q:forms1omeaffidav r— ' SME Town of Barnstable °F �°� ' Regulatory Services r � &MMSTABM Thomas F.Geiler,Director �prec •�aim Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, p ��/ ,as Owner of the subject property hereby authorizetiti��� ����� to act on my behalf, in all matters relative to work authorized by this building permit application for. 9i 1�r treS e, Zil./ (Address of Job) X /k.. �Z<lr� rSignature of Owner Date Au Print Name QTORM&OWNERPERMISSION I f :v -,✓��ie �o�mirizaozuseal!/c o��/�aaaac/ucae�a. � : �: Board of Building Regulations and Standards License or registration valid for individul use only HOME 11V? OVEMENT CONTRACTOR ;. before the expiration date. If found return to: Re atran. 09 Board of Building Regulations and Standards One Ashburton Place Rm 1301 lug 2�2006 Boston,Ma.02108 r Id/ idual _ KENNETH WEE - KENNETH WEE 30 Spinning Brook rs s` GG �."` .i•'. _ �' — ---South Yarmouth,MA 02664 Administrator Not alid without signature. d OLainmxareu�e BbA.RD OF B'U4LDIING R�EG�IJLA7TI,O�IS �.icense C a NSTRUGTIO`.N SUP'0,01—O:R =Wumbe _ 020412 x }I .6 ..ne: 419-%G i KO,,NTHH F55 � S Y�AE2MOO lJ9TaH!, VIA C.ommissio r I f _ 5 v 4 8 CD -T I I 4 ; oil . 4 s j. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map! Parcel v , Permit# R-1 o 6 Health Division 360P2, 10 Uil `�" Date Issued Conservation Division ® Application Fee Tax Collector ` Permit Fee Treasurer Ou"I Planning Dept. CONNEC gCCpUNT Date Definitive Plan Approved by Planning Board # •..•.....� Historic-OKH Preservation/Hyannis Project Street Address A�9� iQ lye.! ' �IJP Village Y,/�,c/�✓O�S Owner ,/9! e 01-s /�'vt Address IO, e Telephone f o 8' 9-a 3 ^1 9 to Permit Request / �* f/ e la�cr C, �e_ _10 t4C6f CooffiT oNT tVD ADbl o" a F o A ,ls /.��' �'.��> �fl� �%/�'' ✓�/', � _���� ��� �",���n,�n,Y Tra f'C��4k�/f-ice w Square feet: 1st floor: existing 5 yo proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z50 o��y Construction Type djoel Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. { Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: O/Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 961AW Basement Unfinished Area(sq.ft) /°5"�o S Number of Baths: Full: existing' :Z_ new Half:existing new Number of Bedrooms: existing new 5 Et.C, Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: /- Gas ❑Oil ❑Electric ❑Other Central Air: 60'Yes ❑No Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes ❑No hvw Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:ko isting ❑new size �_ Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ w; C�� Commercial ❑Yes ❑No If yes,site plan review# Current Use` -'� ` Proposed Use `''' - c� BUILDER INFORMATION Name /T,.�srs�,l�j �o, Telephone Number P 11 It Address TO �,_>,f"/U)A,JP ����_j k License# oL®%// Home Improvement Contractor# /a Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 5 SIGNATURE - DATE /� D� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME FR 07 O A X 10011 INSULATION d/Al,C y C) /c �( ist �/y��-.�, FIREPLACE ELECTRICAL: ROUGH A FINAL PLUMBING: ROUGH FINAL Fq GAS: ROUGH r1 FINAL FINAL BUILDING Q DATE CLOSED OUT ASSOCIATION PLAN NO. *' 7k Po7na uea/C! °� uaeQa Board of Building Regulations and Standards HOME IM 2OVEMENT CONTRACTOR Re istra-on., 109884 i� 2006 i idual ;i KENNETH WEE r �i KENNETH WEE s, -- Spinning J 30 g Brook South Yarmouth MA 026 - — --------- ._. Administrator U. rT�°�re7xo�z�� � a� _..i�z7ckzr�iccae6 BARD®'F BIJILDDNG REGULATIONS License. CW'NSTRPUCTION SUPE-RUISOR MAW 0204+2 IBM (Z J - ! - 6 Tr.n'o: 4859.0 I KE'NN�sTH F WE � r 30 SP61��'NING RBRB O�� 1� ComIn Ssidner + a r �.pTHErO�'1� Town of Barnstable °-^ Regulatory Services s � 1ARNSTABLE, Thomas F.Geiler,Director MASS. g E 639. 0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �Pe_Z f�Grl?e` Estimated Cost ® Address of Work: Owner's Name:/fib q /.s Date of Application: I hereby certify that: Registration is not required for the following reason(s): FlWork excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY ereb pply for a rmit as the agent of the owner: y �f ®�r11 L 6. �?' wwel Date Contractor Name Registration No. OR Date Owners Name Q:forms:homeaffidav j RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= Qi�� 0 CS x• _ 3 e 00 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot— x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. X >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.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost The Commonwealth of Massachusetts -- Department of Industrial Accidents — Office vllnyastitlatlatrs _ 600 Washington Street ' Boston,Mass. 02111 Workers' Coro ensation Insurance davit i ovation: ti 4P # city 57 %y�.r► ®� ���� phone#���.�� ����' ❑ am a homeowner performing all work myself (�fI am a sole r rietor and have no one worlds in ca aci /// ne////%�%/%les /o/// �/%%/%%/////%%//////%%//////%%//O////%//%%%%% mensatio � M I am an emTlloy pnroviding workers ca wa.4. ❑ P"� ,f:,.. a••,;,+'rv?!fi:S•,•.•'"^.Sstt•'.s: :a};r::;k<•.,•s,?::{�c:`•'•; x....+,c2t•,'),£,.c''j•:,;;,�r,?Y•,,r y:+?3Y3Y+3'• ,yt4. �`:':wY' x3•J:y} t tig.;.;::.+.y„?,..yr, ;�' ri:. .a;,",•S•.jca:.{ ys•.�:pv,{... x rt;fi�ua+4�, a:n;;•.}•:r:,,: •?�?r:•:,...4.;:T+4•'• :•:.<, ',.,t:,.::�'''.^ :.3�Y."•a4`.,,,r;;FJr+�r,.:.;.s,.2:o$•t,.::s."Ts6>r31.�.>. rF� w :t?;}?+:{. ,;.wrra+r:33,^•^:'v::?#'::'T.'EEa:G:tra; ..,E3>.. .::•.c••: +•.is:.•4.:.;., ..•4.,t;t���?c•},rr3,. „•;r,•:f~''• tr , d..�Y:-Srs'Y'v•�T:. ,r,:.j..}�,.:r,...F:•'•?+..,. .C4,...:^2} 4;f;�2'•Y 4�::•:a :i:'y•:. .}:4•?, :;{T�-arr'vfidF3s::{i:: ,F:.J,'txx'•:,. `,x n:�:'`o-': :• +3 s..i,•.;\y, ,.4Y. .;S X, :.a, :. .,}+., r,�`n;., Q } ,.a.}�•,'t{;•,:Fr ??�,.:?., •t}Tr r:�;+...}..; .:fir}t:g;:,,}:.:{'• ,?:¢ . .y4., .4: :t:4• ',+' ;r'•y4ti._'�,'��+ �x,:t,Y^yTtj:�x•.4Y�,w'vy,{+h;...kt•:.�C,;,^}>v�:vv.4`:'?}3r:.r•^„a�.v^•,�a�.:.?,•}:.•tit; .r.K.•'w;.,.$.h:.• i'Y,4 ;:...•3 ,, ;.,r,.:�: ;:+::•.,.,a.;' +•.: ',.;.'�.4\;''` :4x.:.• t'ac{$:.X'SL?F�.�:v'T?37Cr•;.:ab};'••f,r,.,;.},}: :�;+•.}#ra.+.;Y .c•:. .r :.t•.. ✓a:t•:rr''. \ , b. •4., x:.x.,•r..:..,rx..r.. . �y.,?.•}::krSa:-1,r: •tir.•;•.,..,'t,?: •'t :•ra?},t:�•,,.•}?:Y�:•t::%a�:t„•:.•G4f�:}'rx.c�4srr•,�. 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(Address of143b) ; /� 12d . siat f over Date Tstoo Print Ns�e ' ;'yi. "�`.>,.rt:�mow..�,3�;�V�'.1:�" • Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code t REScheckSoflware Version 3.6 Release 1 Data filename:C:\Program Files\Check\REScheck\#4535.rck PROJECT TITLE:New Dormer CITY:Hyannis STATE:Massachusetts HDD:6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) WINDOW/WALL RATIO:0.23 DATE: 10/20/04 DATE OF PLANS: 10-01-2004 PROJECT DESCRIPTION: 91 Hawes Ave Hyannis,Ma. 02601 DESIGNER/CONTRACTOR: Ken Weeks 30 Spinning Brook Road South Yarmouth,Ma. 02664 PROJECT NOTES: MaCheck by Cape Cod Insulation INC. #4535 COMPLIANCE:Passes Maximum UA= 137 Your Home UA=135 1.5%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perime er R-Value - alue U-Factor UA Ceiling 1:Cathedral Ceiling(no attic) 760 30.0 3.6 23 Ceiling 2:Flat Ceiling or Scissor Truss 64 30.0 0.0 2 Wall 1:Wood Frame, 16"o.c. 792 15.0 0.0 47 Window 1:Wood Frame:Double Pane with Low-E 186 0.340 63 Boiler 1:Other(Except Gas-Fired Steam),90 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to {`meet the Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECchecl) and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The 14VAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and AA. Builder/Designer Gam/ Date / UEScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 DATE: 10/20/04 PROJECT TITLE:New Dormer Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Cathedral Ceiling(no attic), R-30.0 cavity+R-3.6 continuous insulation Comments: [ ] I 2. Ceiling 2:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1:Wood Frame, 16"o.c.,R-15.0 cavity insulation Comments: Windows: [ ] I 1. Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ }No Comments: I Heating and Cooling Equipment: [ ] ( 1. Boiler 1:Other(Except Gas-Fired Steam),90 AFUE or higher Make and Model Number I Air Leakage: [ ] I Joints;penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 c&n(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. I Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ] ' Insulation R-values,glazing U-factors,and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] ( HVAC piping conveying fluids above 120 T or chilled fluids below 55 OF must be insulated to the levels in Table 2. I .,Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pine Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts TMer ture(F) U t� o 1" Un to 1.25" 1,5114 2.0" Over 2„ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minhnum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System es Ranee(F) 2 Runouts 1 and Less 1.2 2.5 to 411 Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) .v ���js�d /.��/s 10/i/10 v wenvwaw The we�.p S.Ysrrtau►Ft,MA 02564 -:4 �1.�_ , 9 is i 7 7-a: iI- , t , t I L _ I I_.. t t �-��" _ ;. tic � ,•. a 1 � t ! � :: A.: r T— t �Tl t T _ —t ► s:: - :� •r--- �.f�.:. 77 t Sete s horc.A t 5�iec! �j9P �ropo sec//�eclf oun, �i i " I Iro Ac PIClur ' (NJ-0W Urvrt lGlurc G(�Na�cw7 L/roiT P/cTurt G/iNd�w :Uiv� I � t SGAIf- FILT ve UV.-0 CIO W 1 I cf�, Roof C�veY } Liviivq /frJz9m A5ter 8ed'- •1 - - -. i f We V L��Ufe�` C�O.Sef Y 0;NNiNo AYeA Qed .31 iSed 2 13 Ken weeks The Weeks COmpt S.Yarmouth►1A�o2eaa. 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Town of Barnstable I"E Regulatory Services 'iRs TABLE P Thomas F.Geiler,Director 05 OEC _2 B ASS.Mns9. ` Building Division 9: gg y 0p 039. ♦0 Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 ~-'`""`- Office: 508-862-403 8 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date: a De:;- Rec'd by: Complaint Name: Map/Parcel Location Address: Originator Name: Street: Village: State: Zip: Telephone: �� Complaint Description: ter\ 11V41 AIA, I Q-0 TO�,L�4 Lk ),-'I U P L4 Q - S F R OFFICE USE ONLY Inspector's Action/Comments Date: 2-'2- '��� Inspector• ! i Additional Info.Attached Y ` fnVnvu Q:forms:complaint S . 6 -a tins oN sl07 — Fib --7 �p -alai 3 G iV a £t[ZZ 'a� - �, S30INV1 358039 �o . IV 1° �1 o ,t ang a _ r P '.' Q ADZ� Ito Aj .44 OOVI a 4 v r :c oiv v J� � � �N�t Q a.�uaa.�• �,bns aN sl S 6' S3alN�fl N 't' 3 V 7& 35a035 � µ L / ILI dig jq N 16 Ilk _ + ; Q ------- -�17 1 =7,v 4�94.0- ao oQ/ , 41may.+