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0017 KEATING ROAD
-RW A i 4 �'� �� i � �, �RMly Town of Barnstable *Pexmit �tl Expires 6 nd from iuue date Regulatory Services Fee BA10M" 2014 Thomas F.Geiler,Director TOW ARNSTABLE Building Division Tom Perry,CEO, BuDding Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDFNTIA.I,ONLY MaplparceiNvmber Nor Valid without Red X-Press Imprint ._ �b�e.l V � "f j � Property Address I dResidential Value ofWork S Minimum fee of S35.00 for work underS6000.00 Owner's Name&Address—K�vi 1n [7ana. &(�e Contractor's Name f ` (j q ^� r -� Telephone Num �ber� (� �}G Home Improvement ConttactorLicense r(ifapplicable)�1d 53 FTM-11 ', fLe rCQ i(( �� Cry .G _ � n57`l �i '1 OP�� Construction Supervisor's License 7(if applicable) l�W orkman's Compensation Insurance I ' Check one: ❑ I ama sole proprietor a kamthe Homeowner 7I have Worker's mpemation Insurance /Q Insurance CornpanyNarrr i Sfaf'e �vizsU.ra 6e, CC) I Workman s Comp.Policy# W L 0 ) Copy of Insurance Compliance Certificate mast accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(strippingshingles)old All construction debris will.be takento W!l roo£(hurricaue nailed)(not stripping. Going over existing layers ofroof) side Replacement Windows/doors/sliders.U-Zahn + 1 ( .35)#ofwindows ofdoors: ❑ Smoke/Carbon Monoxide detectors 4 floorolans marked with red S and inspections required. Separate Electrical&Fite Permits required. °Where required:Issuance of1hk pmw does zwt exempt compliance Rah odor town depa tmeatreguhtnas,ie.Muork,Conservation etc, ***Note: Property Owner umutsignProperty OwnerLetterofPermission. -A copy of le Home Improvement Contractors License&Construction Supervisors License is required. , SIGNATURE• , C'UsersldecoUk'AppDam,LocaLMicrosofdWiadows\Temporary IntannF'Ies\Coate=Oudook18276BD4A\F—URESS_doc Revised 061313 t � - :y Fraser Constructio I n LLC P.O. Box 1845, Cotuit, MA. 02635 Email: info@fraserconstructioncapecod.com www.fraserconstructioncapecod.com Phone 1-508-428-2292&FAX 1-508-428-0123 DATE: 7/17/14 PHONE: 413-531-5679 NAME: Kevin Burke EMAIL: kevburl2@comcast.net MAIL ADDRESS: N/A JOB ADDRESS: 17 Keating Rd. Hyannis, MA 02601 WINDOW PROPOSAL Remove and replace (6) windows on water side of residence in second floor guest bedroom. New units will be Andersen 400 series, white outside and prefinished white inside with no grills. Exterior of windows will be custom colored pre-finished "Hardi" board cement siding down to roof of farmer's porch. Shutters will be removed and reinstalled. Existing interior trim will be removed and reused if possible. Window units- $2,800 Siding labor and materials- $31,410 Labor for windows- $21,100 Total contract price- $8,310 Initial PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. Payment Schedule is 1/3 deposit with balance due upon completion. Payments accepted are: CASH- CHECK MASTERCARD- VISA -AMERICAH EXPRESS * Any payments not immediately paid upon job completion will be charged 0.005% for every day after the given 5 day grace period upon day of job completion. j 1 Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: '�( T Homeowner Fraser Cons ction, LLC f Fraser Construction, LLC P.O. Box 1845, Cotuit, MA. 02635 Email: info ,fraserconstructioncapecod com www.fraserconstructioncapecod.com Phone 1-508-428-2292 &FAX 1-508-428-0123 DATE: .7/17/14 PHONE: 413-531-5679 NAME: Kevin Burke EMAIL: kevburl2@corncast.netTY4MAIL ADDRESS: N/A � �e�; JOB ADDRESS: 17 Keating.Rd. Hyannis, MA 02601 WINDOW PROPOSAL Remove and replace (6) windows on waterside of residence in second floor guest bedroom. New units will be Andersen 400 series, white outside and prefinished white inside with no grills. Exterior of windows will be custom colored pre-finished "Nardi" board cement siding down to roof of farmer's porch. Shutters will be removed and reinstalled. Existing interior trim will be removed and reused if possible. Window units- $2,800 Siding labor and materials $3,410 Labor for windows- $27100 Total contract price- $8,310 Initial PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. Payment Schedule is 1/3 deposit with balance due upon completion. Payments accepted are: CASH- CHECK-MASTERCARD - VISA -AMERYCAN EXPRESS * Any payments not immediately paid upon job completion will be charged 0.005% for every day after the given 5 day grace period upon day of job completion. i Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FI2ASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: �( 7 4 Homeowner Fraser Cons " ction, LLC { FRASCON-01 PAAS .4►�-'�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI) 9/1912013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 CONTACT Viveiros Insurance Agency,Inc. (SOS)676-0309 NAytE Ash(e Paiva PHONE FAX 375 Airport Road A/C o Eel: 508-676-0309 127 (AIC,No): 508-324-9147 Fall River,MA 02720 ADDRESS:APaiva Vveirosinsurance.com I INSURER($)AFFORDING COVERAGE NAIC S INSURER A:Granite State Insurance CO INSURED INSURER Construction LLC INSURERS: PO Box 1845 INSURER C: COtuit,MA 02635 INSURER D; INSURER E: . I 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. lffS-LTR TYPE OF INSURANCE I R WVD POUCYNUMSER D MILDD EXP LIMITS GENERAL LIABILITY EACHCCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAWiSMADE OCCUR MEDEXP(Ary one person) $ PERSONAL&ADV[N;IP.Y $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLES PER. PRODUCTS-COldPtO?.AGG $ POLICY 1 PRO-ECT 7 LOC $ ALFTOM080.E LIABIL]TY COM BINE D SIN GEEU Ea accicent $ ANY AUTO BODLYNLIURY(Per nerson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODL 'WLRY(per acddent) $ HIRED AUTOS NON-OWNEDPRO AUTOS Foraccidenq $ $ UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLA1yls-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATON WC STATIA OTH. AND EMPLOYERS'LIABILITY TORY ATLs ER A OFFICEPIPMREMBEREKCLUDED'+CLJTIVE Y� NIA WC008930601 9126/2013 9/26/2014 EL.EACHACCIDENr $ 500,000 (yes.describe and E.L.DISEASE-EA EMPLOYEE $ 500.000 II yes,describe under DESCRPTION 0=OPERATIONS below E.L.DISEASE-POLICY UMrr S 500,000 DESCRIPTION OF OPERATIONS I LOCAMONS I VEHICLES(Altaoh ACORD 101,Additional Remarks Schedule,if more space IsrequRed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable BUIlding Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601- AUrMORIZEDREPRESENTAMC O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010l45) The ACORD name and logo are registered marks of ACORD Tine Co?,nmop2wealth 017'Afassachusetts Depa?-Lment of Industrial Acc-ide ' nts �} ",,'f ce of IrvestigattOil.S 600 Washingron Street Boston, A 0211.1 www.mass.gov/dia Worker's compelasation 7ncmrance Affidavit:BailderslContracto:•s/Electrieiawfplumbers A pplicant Infol7mation Please Prilat Legibly Nagle(Business/Organizauon/Individual): L Address: City/State/zip: Vt k Od (_0 35 Are you an employer?Check the appropriate box; Type of project(rujuired): I. ED 1 am a employer with 4.❑ I a a general contractor and I have 6. 0 New corsCtietion " employees(full and/or part-time).` lured the sub-nor:tractors listed on the t e4sheett 7. ❑Remodeling 2. I am a sole proprietor or partnership These*sub-contractors have 8. Demolition and have no employees working for employees and have workers'comp. 9. Building addition mein any capacity.[No 1,vorkers' employee. comp insurance re4 J uirec 'We are a corporation and fill 10.Q Electrical repairs or additions officers have exercised theJr fight of l l plumbing repairs or additions 3.II I am a homeowner doing all work p se Lion er MGL c.152§(p .),and 12.Q Roof repairs myself No workers`comp, em we have no employees.D o workers' insurance required.) 13.❑Other �l J i comp.iystttance regnti-ed.J +/Lny applicant that checks box z1 must aIso Lu out The se:ctioa below snowing their W0:kers'.comperrtionpolicy iioniAor. t Homeowners who submit:his affidavit indicating they are dospg all work and then hire ortsicL contractors must submits new affidavit indicating such, *Co ub-co fast'beck this boy rust attach must provide sheet snowing the n ape of the snsycOU��s and state whether or not those entities have�nployees.;f the sub coaxzctors have employees mey mast provide wear;vodcon,comp.policy number. I ass an employer thw is providing worlcem'compensation insua ante for my employees.Beloit,is the policy and job site fnfor»cation �iD J ,�• brsttSanea company Name: ---------------------- Policy Tor Se1r ins.Lic. - v`t 0 q/ 3otle Q I' �.Expiradon Date: Job Site-Address: ty/ at��p: d Failure t copy of£Ire wne ass r compensation policy declaration gage(showing the policy number and expiration date). Fai_ute to secure coverage as required mrcer Section 25A cf MGL c.152 can lead to the imposition of crminal +" one-year impdsozment,as Weil as civil penalties in the form of a STOP WORK ORDER snd a fine tsf an is w p�Gp a Hof a fine up to$1,500.00 and-or that a copy of this statement may be forwarded to the Office o=Investigations of tho DIA for insurance:covemge v:Mcarictit. n et cxe vrolator.Be advised 16 hereby cerh'fv Jcudr the enaliies of perjury tarot tlxe information vided above is true and correct. Sigrlat= Date: Ph3one#- 02. j OffecW use only.Do not write in this area,to be completed by city or town ofJctcial I City or Town: PermitUcense n Issuing Authority(circle one): ' i e f 1.Board o Health 2.BuRdinR � g p I E Department 3.City/Town Clerk 4.Electrical irupector 5.Plumbin Inspector 6.Other Comtact Person: Phone$: Massnahusm -cepaltment or rt)wiC Safety E' Board of Building Regnlntions and Stanclarcls License: C"97668 YAN C P'RASL+R l EAST 1?ALMOY3��A'v�1�gs#�• i Expiration Commissioner 06/07/2015 C,•• � Graf-�/� z �J Office of Consumer Affairs and]Business ReguIation 10.Park Plaza- Suite 6170 Boston,Massachusetts 02116 Home Tmpravement Contractor Registration Registration: 112536 Type: DBA FRASER CONSTRUCTION CO. sr�sr2o15 Tom' 2370e9 DEAN FRASER P-0. BOX 184.5 COTUIT, MA 02635 Update Address and return eardL Mark reason forchange. ss:A> aorc rr n i ❑Address ❑ Renewal E ❑ m pIo yment ❑ Lost Card Orfiec of ConsuoccrAtra;rs.F g Gaon License or registration valid for individul use only �_7 OMr-IMPROVEMENT CONTRACT40R before the expiration date, If found ret egist urn to: ration: 112536 Type: Office of Consumer Affairs and Business Resulati®n ExpiraSon: 323/2015 DBA IIO]Park I'larq_ Suite 5170 FRASER CONSTRUCTION CO. Boston,5TA 0«116 DEAN FRASER 104 TWINN VIEW LANE E FALMOUTH,MA 02536 Undersecretary^ Alotvaiid wi!I Out signature s E` { { fI f . TOWN OFF RNSTABLE BUILDING PERMIT APPLICATION Map G Parcel 00 1 Application # o,DO ,3 0 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee •� Date Definitive Plan Approved by Planning Board 7 1q —13 Historic - OKH _ Preservation/ Hyannis Project Street Address 46,Ji ll �• Village H vti I V7% S Owner Veo, OJ(Ar Address 17 t<er4'>- PJ• q�rn-,ni 5 AA Telephone q 13 - E 3 I - S 6 >1 /� `' Permit Request Revv&v J�C Atis 4l� �J-1 W o ki^ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay CJ o Project Valuation 3 9 ?Sy Construction Type re✓Iv I/o4 n 4 -= Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentat'on. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) , Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Y,e 0_ l0 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Typo and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - " Proposed Use APPLICANT INFORMATION y (BUILDER OR HOMEOWNER) Name Telephone Number So yZ 9 "Z-Z�1 Z Address 3 v w& -+ ICa License # 017 6 6 9 /A* U2 Home Improvement Contractor# i I Z � 6 Worker's Compensation # WC W9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE '7 ���� FOR OFFICIAL USE ONLY y APPLICATION# �+ ;j s DATE ISSUED .` MAP/PARCEL NO. r ADDRESS VILLAGE OWNER R F DATE OF INSPECTION: FOUNDATION FRAME SPEW ti ti ' INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL R t PLUMBING: ROUGH FINAL GAS: ROUGH $.— FINAL FINAL BUILDING a DATE CLOSED OUT ASSOCIATION PLAN NO. i • r The ConwwnweaM o}'3isrssaclzrisdis D� t gf'IudrtstrW-4ccfdents i ®.ffue Oflnva*aam 600 Washvigton Sbgd Bosft,MA 021I1 I vraas�govldza r if perrsatio g ��aierslCta�ciorsJ�I sll,.b=T 'af�rnaatroa ectrieian zs Name(Rnsi-e Q 'Tease�riui L tonlXaai�ids�. aims-Ert��-�fcs ______----- Are7iouas eatplogat';Check the a r �a �/ PF oprrat�ee ltaa: I. I am e-employerwA V 4 r°-'-(Iam a gcaetal=ft'actergad I Type of l?iOTecc(requi �; ernpIoyees W and✓orpart-tree}* have Imedt a sob prietm.pi !s 0 New cans�ctdon 2.0 I Mn a sole pro P��- listed.osttlta st�ached.sheet 7, Remodeling �ship=dhaveaoemIo3+ers Thmmb-confraamhave working forte arty employees=dhaveworkers' 8 1 Sno3hioa RNO wozicers'comp-bscgmce I=MP immunce t 9. BMId*g addition i 3, I meownerdai We ats a corpon ou and its 10.[]Eleciric2l repairs or additions mg all�r«3c offices have exexeised t. rnYself,jATO wvoilaers'COS. rlgltL Of exemPhonl t)eT M Y�( 1 I Plmubiz�repass or additsors msnrauce regui t c 152,§i(4}sad we have no no P,00f repzixs I �aployees_�Na wcrkere 13.n off= MMP- rance zegnuecy] 3 "�'apP7�att&ate�uksbax��mas:aho�IloattEescpiaabe8wslsawiagtb� +� ����' oa ' ' ?$orceowaeawJrosc6uut$isa�xdavitmdi�tiagt8eq'aredoimgsllwatkaedrh��ueo�IIack�--lhazr�eok'8�6oxAamra2�c}r�dadzdditfoaals@eef$ �desontracto:s:aosts+ebmoiCax�ewafudavi:im ' i o tficamncoft8es ��rsards�whetberoraaitaoseen��� empl Y.xs Ifthesttb-e�uacmrs>�emplsytcsg�ey'�,srpmvide#ce3rwaoccrs'w� a� P cY�trher. .. .�am as earployer�fic prorir�ng x�erkerf'ca � I m�o>m�n �.a&oa baurance�ormy v"spto3'eac••,$��the pelicy a►xd job site •-- t instuance Company Name: os74/ r1i r'r�o '�>TS�Us—ee g2e (rn,,i n f -policy#of Self-ios.Lic,#: —� irat�n Dm:! 0'f 2-b aod� Job SiteA.dd�: ► 7 Ufe�,t� (1� I� n�,� A4 Attach a copy of the�eeoai ts'eoa►peusa oa C�s :1�&t::—S YW o 2 G U J Fat�te to Po�Y aleclazation page(showing�e P°hcy rtasuber and esprration date}. secaaecavemgeaszeQu�edmdezSectionZSAofMOLc 152canIeadtathe fate vpta SI,W-00 and/or one,yexr imprison esweII as oiv>f rtuposition of criezmalpengNes ef'a of up to�250.t)Q a day agaiastII�viokatox. Be advised that pertaiiics ite 8ta form of a STOP WOM ORDER and a f a. EL Irtoestigatiorls ofihe DIA forans ce coverage Y ation.Copy of•ems eEC my be f wm&d to the coce of !dohere(iyterdpenaf�iesaf"perfmyJ tt'theW'0?v�on r . Paovrdedabove is true andcona&. I T ate: 7 iy 3 I ones S6Y y 2 ZI offeial aw o ly. D e nerX ZzIn ft area,fobec° d hY c*orrosrm offij,,Z city or T'oss+u: PeaMi$Veense# l -Ts91dugA.u$►0rsfy(circle one): 3.Board o€Health Z..ErfIdingDepartmeat 3.OdyPPown Cluk 4.Elwhim,In*ecto�r S.RImmbingfn, Ct� S.Otter Coatacf-persma: ) -phhane#: i I I - t i FRASCON-01 MOSU A4. ? CERTIFICATE OF LIABILITY INSURANCE DATE`MYYY' 1 ot512012a1 z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poficy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain Policies may require an endorsement A statement on this certificate does not canter rights to the certificate holder in lieu of such endomement(s). PRODUCER (508)676-0309 NCOANMia� Suzette Mon)Z Vfveiros Insurance Agency,Inc. acN.Exc:50$-676-0309 -324-9947375 Airport Road FA[Ca Fall River,MA 02720 ADDRESS:SMOniz Vveirosinsurance.corn INSURER($)AFFORDWG COVERAGE NAICIZ INSURERA:National Union Fire Insurance Company INSURED Fraser ConstructionLLC - INSURERB: P.O.BOX 1845 INSURER c: Cotuit, MA 02635- INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. LTR TYPEOFINSURANCE IDR WVD POLICYNUMBER MMIDa MMIUDD FJCP LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMEP.CtAL GENERAL UA81L1TY TOT ! PREMISES Ea occurrence ,S CLAIMS-MADE OCCUR MED EXP(Any aria person) 5 PERSONAL&ADV INJURY S GENERALAGGRWATE 5 tAUrOMOBILE EUMITAPPLIESPER: PRODUCTS-COMPJOPAGG S P . BIL rY MBINEDSINGLE LIMITEa.5NEn BODILY JNJURY(Per person)SCHEDULED AUTOS BODILY INJURY(Per accident) S S NON-OWNED AUTOS Pe°aw DAMAGEti s S UMBRELLA UAB OCCUR EACH OCCURRENCE $ I7CCES5lJAB HCLAIMS-MADE AGGREGATE S DEA RETENTION S S WORKERS COMPENSATION X 7 RIM 0 R AND EMPLOYERS'LIABILITY A ANYPERIME BRrPARLUDEDCECUTIVE YIN WC00993060'! 9/2fi/2012 9/26/2013 E.L.EACHACCIDENT 5 500,00( OFFICEloryfn H)OCCLUDED? F NIA (MandaLoryinNH) E_I-DISEASE-EA EMPLOYE 5 500,Oo0 Dtyr describe under DESCRIPTION OF OPERATIONS below E,L OleEAS -POLICY UNIT S 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I V,'EIICLES(AttaetlACORp'101,Atlygonat Remarks Schedule,if more spare is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Fraser Construction LLC THE EXPIRATION DATE THEREOF, NO'nCE WILL BE DELIVERED IN 31 $oWdoin Rd ACCORDANCE WITH THE POLICY PROMSIONS. Mashpee,MA 02649- AUTHORMW REPRESENTATWE ACORD 25 201010 ©1988 2010 ACORD CORPORATION. All rights reserved. ( 57 The ACORD name and logo are registered marks of ACORD I _ &XV ((�f�?�t�YYL�� l C�1 12 G/GCY� cf�irr�� & C / l Offce of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 , Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: ,112536 ` Type: DBA Expiration: 3/23/2015 Tr# 237059 FRASER CONSTRUCTION CO. - DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. sCA 1 Co 2OM-05/11 - Address ❑ Renewal Employment Lost Card .rt-J��.• /('n..iii>ierAieiann�/�:7`�.''!'Ia.1diLIr1/i/9C�/,{ ' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only rHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 112536 Type: Office of Consumer Affairs and Business Reulation xpiration: 323/2015 DBA 10 Park Plaza-Suite 5170 FRASER CONSTRUCTION CO. Boston,MA 02116 DEAN FRASER 104 TWINN VIEW LANE E FALMOUTH,MA 02536 _ Undersecretary Not valid without signature i f ` t } - f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License_: C5-097668 m, DEAN C FRASER= '- 104 TWINN VIEW EAST FALMOUTH MA Q2;536` Expiration Commissioner 06/07/2015 t I r Fraser Construction, LLC P.O. BoxE 1845, Cotuit, MA. 02635 Email: fraser_construction@verizon.net www.fraserroofmg.com Phone 1-508-428-2292 &FAX 1-508-428-0123 DATE: 7/7/13 PHONE: 413-531-5679 NAME: Kevin Burke EMAIL: kevburl2@comcast.net MAIL ADDRESS: N/A JOB ADDRESS: 17 Keating Rd. Hyannis, MA 02601 r Remodeling of master bathroom 1. Plans and permits 1 $750 2. Protection, demolition, and removal of existing bathroom $2,840 3. Electrical.work to be.performed time and material Allowance $2,500 4. Plumbing work to be performed time and material Allowance $1,500 S. Remove existing window in bedroom, patch in sidling on outside $1,040 6. Install copper pan and Durock (cement backer board) in shower area and bathroom floor. (includes copper pan) $2,940 7., Blue-board and.plaster . ., .$1 ,800 8. Closed-cell foam insulation in walls and roof $1750 �I 9. Installation of cabinets and interior trim Allowance for carpentry work of$2,500 based upon design and location of cabinets and window. 10. Supervisory hours $1,950 C' 11. Allowance for tile material and installation $3,980 12. Allowance for cabinets $4,000 13. Allowance for countertops $1,800 14. Allowance for glass enclosure $1,500 15. Allowance for plumbing and electric fixtures $1,500 16. Painting interior and exterior $1,400 17. Materials other than copper pan $11100 18. Estimated project cost -$3—,-35� 4 3LIj SG U Allowances for plumbing and electric will be completed with an estimate to the homeowner upon further inspection of the job. The final bill shall be presented and will have a 20% mark-up applied by the contractor. Final pricing for all tile work will be determined upon selection of tile and design of shower. All carpentry allowances shall be completed time and material at a rate of$65 per man per hour with a 15% mark-up applied to materials by the contractor.' All fixtures, cabinets and tile to be selected prior to job start and approved by homeowner prior to ordering. INITIAL FOR UNDERSTANDING OF ALLOWANCES PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. Payment Schedule is 1/3 deposit with scheduled payments throughout. Payments accepted are: CASH- CHECK-MASTERCARD- VISA -AMERICAN EXPRESS * Any payments not immediately paid upon job completion will be charged 0.005% for every day after the given 5 day grace period upon day of job completion. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: Z' Homeowner Fraser Construction, LLC r hr TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BARNSIT B E Map Parcel Application 2013 JUL 11 11: 51 Health Division Date Issued L Conservation Division Application Fee Planning Dept. DIM'S1CF- Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village I Nin I S Owner�i.��l N 'k.�. Address-Telephone 1 -- Telephone /y Permit Request i� � A��flSt 4-D u+,rA a, hL -1�[ 4S� oil hmw� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing r❑ new size _Shed: ❑ existing ❑ new size = Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# - - - -_ Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MTelephone Number 5bb ^ to_Z.3'83eq Address t ksQ License # 102q_ MAHome Improvement Contractor# fZ� Worker's Compensation # °IS�O53 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (Q 12,d 15 FOR OFFICIAL USE ONLY ,-APPLICATION# _DATE.ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FRAME___ INSULATION, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING " .DATE CLOSED OUT ASSOCIATION PLAN NO. - • The CommonwealthofMassachusetts ( Rnnt F-arm , .Department of Industrial Accidents Office of Investigations 4 '` 1 Con ress g , Street,.Suite 100 Boston, MA 02114-2017 www.mass.govld a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AmAicant Information Please Print Legibly NatTle (Busines !(hgatvzation/tndvidual}: Con-Serve.Energy,Inc dba ConserVision Energy Address.376 Route 130 City/State/Zip:Sandwich, Ma 02563 Phone#: Are you an employer?Check.the appropriate box: Type of project(required): 1.❑ I_am.a employer with $ 4. ❑ Lam a general contractor and I employees(full andor part-time). hake hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- I ist d on the attached:sheet. 7. ❑ Remodeling ship and have no.employees These sub-contractors.have S, ❑Demolition working for me in any capacity.. employees and have workers' 0 Building addition [No workers'comp.insurance comp. insurance:* required.] 5. ❑ We area corporation and its 1D,❑Electrical repairs or additions q. ] 3.❑ I atn.a homeowner doingall w officers have exercised their i L. Plumbing ork ❑ . repairs or additions myself..[No workers'comp: right of exemption per MGL 12:❑Roof repairs insurance required.]t c. 152,§t(4),and we have no .. employees. [No.workers' 1321 Other Weatherization 2013 comp.insurance required;.] *Any applicant that.checks box'#I must also fill outthe section below showing their workers'compensation policy information. r tiomeowners.who"submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new.affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name oi'.the sub-contractors and state whether or not those entities have: employees.. if the subcontractors have employees,they must provide their work ers':cotnp.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:Selectivelnsurance Co.of the SouthEast Policy#or Self-ins..Lic.#:WC7956539 Expiration Datc 311412014 Job Ste:Aiidress: . T City/State/Zip._. . Attach a copy of the workers'':compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section`25A of M6L c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50.0.00 and/or one-year imprisonment,as well as.civil.penalties in the form of.a.STOP WORK ORDER and.a fine of up to$150.00 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.: if do hereby certi under the pains and penallies ofper'u that the info provided above is true and correct. Si nature: 2013 Date:'.. 3 2 Phone#:508-833-8304 Officiat 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 ContactPcrson: Phone#: OWNER AUTHORIZATIONFORM tQwner's Name} owner of.the property:located.at Q t= go C L` roperty Address) Yli(a n(I j. (Property Address e T hereby authorize ;, ' (Subcontractor) an authorized subcontractorforRtSE Engineering, to act on my behal_fto obtain a building permit and to perform work on My:property. Owner's Sighature Date OWNER AUTHORIZATIONFORM (Owner's Name) l owner of.the,property located.at roperty Address) r, (Property Address hereby authorize. :_ ,, t €,, J f (Subcontractor) an authorized subcontractor for RtSE Engineering, to act on my kiehalf to obtain a building perrnit and.to perform work on rhyproperty. Owner's Signature ' Date I Il CONSENE-01 MVAUGHAN AC C>J?L ' DATE IMMID01 YYr CERTIFICATE OF LIABILITY INSURANCE 312g12013 I THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON:TME CERTIFICATE HOLDER.THIS 4 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 certiilcate holder Is an ADDITIONAL:INSURED,the policy(les)must be endorsed:.if SIJBROGATiON IS WAIVED,subject to - 1 the,terms and conditions of the policy,certaln.polfcles may require an endorsement.A statement on this certificate does not Confer rights to the + eertlffeste holder In ilau of such endorsement(s). I PRODUCER NAAMM'CONTACT. .Strategic Business Unit 13GHONE ray Ins.-DennisDannis Branch 60 .398-788t) : �N, 877 816-2156 I South Dennis,MA 02660 E-MAIL.. AODRFSS: i' INSUR AFFORDIM COVERAGE. [INeIIRER.A. elOCtive m Co.of the:SOUMeast - ;.INSURED . . S I INSURER 8. Con.-Serve Energy,Inc. INSURMO dba CoriaerVision Energy s07 Main St: INSURER O: Hyannis,MA 02401 INSUReRa: INSURER:P: - - COVERAGES ... .. .. CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE'LISTED BELOW HAVE BEEN ISSUED TO THE INSURED.RAtAEDA8OVE FORE POLICYPER100 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 09 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH:RESPECT TO MICH THIS CERTiFICATE MAN,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.. MSK : L TYPE OF Hi9URAt4CE POLICY NUMBER !1 .. - tAh1f4 UNITS .OENERALU OILITY A COL1AERCiLLRALLIABiY 2011299 FACHOCCllSENCE GENI / S. ;1,00O;fl 2014 PREMISES Ewa ordure S 100,0 eIALMsrwoE QOCCUR 10.00 PERSONAL$ADY INJURY. S . 1;Otltl,0 .. _ GENERALA E. S 3�QEID.00 GENLAG(;EGATELIMHAP"S:PER- PROCUCTS-CCMP/OPAGO s. 3;000,Q0 -:X:l POLICY COC s AUi0fr011IMEtrA6lLrrY :.... - OMInD - EUfArr S AULOW'O soolL.YI NJURY(Papenpr) AUTOhftED SCHEDULED AUTOS - AUTOS SODILYiNJURV(Peraccder!i) S HerEDAITLOS NON4V*&O AUTOS PHER ACCIOE G $ UYeREILALU9 .00CUR .-. EACH OCCURRENCIP $ i EICCESS LIA9 CIAd;4S; ACGREGA?E - DIED RI;TEfflMi I S WORn0t4 COJtPEfrSI►imll ..��.. ... - .. ' _ ATL I A ANY PROPR1Er6R/PARTNFNEu[wEYIN C7958ti39 3i141201$ : 3/14I2014 E;icHrccicErlr s 600,000j OFFICER1MEMBER M CLUMM - N/A - (61and�reryhNirlderN) .E:LDISFASE-EA EMPLOYE S.. 5000a j nyy@e�),,0D9Crlbet - OESCR♦PrICNOFOPERATIONSbet1w _ ELUSEASE-POLICYtIMIT: S -500,000 OP.SfRIPTlOM OF OPERAli0M8!LOCA71ffi13r YEHIGi.ES Jllttacl.AC{(giD tel,-A,lQEfo,nl Remarks,Schedrrb;�mae spats la matos� —EXCLUDED OFFICERS UNDER WORKERS COMPENSATION:CONOR&COURTNEY MCWERNEY"NOTE THAT BLANKET ADDITIONAL iNsuRED COVERAGE APPLIES TO THE COMMERCIAL GENERAL LIABILITY(IF A WRITTEN:CObITRACT IS IN PLACE). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AWVE DESCRIBED:POLICIES BE CANCELLED BEFORE Rise Engineering THE (EXPIRATION DATE THEREOF, NOTICE VALL OE DELIVERED IN 1341 Elinwood.Ave. t I: ACCORDANCE VATH THE POLICY PROVISIONS. Cran$Wn,.R102910 Aultlo IzEDREPRESENTAiIVE .. .. 01986.2010 ACORD CORPORATION: All rights reserved. ACORD 25(2010106) The ACORD name and togo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T� �,, e i �•s31 vJ Map Parcel b Applicati Health Division , a _,• <4E ' << -Date Issued 3 Conservation Division Application Fee Planning Dept.` '-"`i Permit Fee v p� � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis r;roj`ecFStreet.Adaress -p Cj�Village 4ypn rA k 4- --� C—Owner - .0 Address T�etephone--,. 1 S �..:h..` Permit Request U U i r1 l"z�iU l� - . i IJ t► /�-(lh/-� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5�� Construction Typ (U_2)0 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: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) CTeleph`one Number AddressC1 11'TT7—L,),j License# °e, 1.0 Co 1 . [Horne;Improvement,Contractor# 4 '--.f C2 � Worker's Compensation # j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT W LL BE TAKEN TO SIGNATUR DATE jj 1 �.- i l FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER I DATE OF INSPECTION: FOUNDATION FRAME INSULATION '.i FIREPLACE ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING F t DATE CLOSED OUT. - ASSOCIATION PLAN NO. 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 rName-(Business/Organization/Individual): .202�. Address:-_..,, j�CYL: City/State/Zip—: l CVU Phone#: Are you an employer?Check the appropriate box: 1.ElI am a employer with 4. EJ I am a general contractor and I Type of project(required); employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2A I am a sole-proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. []Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance comp, insurance.$ 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Q Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a 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 ertify under the pains and penalties of perjury that the information provided above is true and correct. Sa u e �j t1 c7 Data - e' (.LJ Phone#: Of use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Cont#ct Person: Phone#: I ' Board of Building Regulations and Standards U1ze�po�nvn�aoau�ea o� a��ac�cu�eC�ri Office of Consumer Affairs&Business Regulation Construction Supervisor ME IMPROVEMENT CONTRACTOR I . License: CS-106188 Uegistration 172220 TYPe piration 6/1/2014 Individual ROBERT SNOW = ' 29 HEATHER LANE j rA ROBERT M.SNOW 1 Yarmouth Port A 0267 ROBERT SNOW 29 HEATHER LN. ��,�,,, JJ/51 . '.`� Expiration g r�>� 10/24/2015 YARMOUTH, MA 02675 UndersecretaryCommissioner i I , License or registration valid for individul use only before the expiration date. If found return to: C Office of Consumer Affairs and Business Regulation, 10 Park Plaza-Suite 5170 Boston,MA 02116 i i Not valid without Signature r , OFTHE Tqy, Town of Barnstable Regulatory Services t aaxxsrasLE, y rinss. Thomas F.Geiler,Director Eo +A,O 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 -s,-- as Owner.of the subject property hereby authorize � [`� �� to act on my behalf, m all matters relative to work authorized by this building permit. l rl (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 t S gnature of Applicant ro Print Name Print Name Date WORMS:OWNERPERMISSIONPOOLS 6/2012 i �IWE r� Town of Barnstable Regulatory Services BMMSTABLE, : Thomas F.Geiler,Director 9 MASS. 16.39 A,� Building Division rFo � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT 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 constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 4. PATIO uElf 1 PORCH PORCH x l Il 1 �1 1 i WING OOM I , s 1 M BEDROOM ' CL 1 - � - 1 HALL 1 c - j 1 IL. iooves- — Y — -----_ �'�j LAUN M PORCH ElEl .PpgrMWARY qd FIRST FL-OOR PLAN GARAG` MMG E PHASE 2 SCHEME Al l/a=1 IT 1017108 BCL easyPDF _= Printer Driver n r �. Li Ln -° —� i v i `� t Y 1HT, *Permit# oQ Town of Barnstable Expires 6 nrad6sfronr iss _ are PER 17, Regulatory Services Fee �- BARNSCABrl 6 ZQQt Thomas F. Geiler, Director �A 1039• sa BARIVST Building Division �I ABLE Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �( Not Valid without Red X-Press Imprint 1 yo v1ap/parcel Number y`e � Property Address —---1 ! N'v;j J'I [Residential Value of Work l 300 . Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address e V 8 ty U N A _ o ro&9 qq Contractor's Name W b ro,0Jev— ��/ l� PN 2 k/ Telephone Number I lome Improvement Contractor License#(if applicable) O f eN 3 Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor M.,,Iarn the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# w C O 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) ❑ Re-side .�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 the Home Improvement Contractors License is required. Ph l l.kS\FOR MS\building permit forms\EXPRESS.doc Revised 100608 s 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/Eleetricians/Plumbers APPUcant Information Please Print Le 'bl Name(Business/Organizationtlndividual): �a9��-e A r e,#U'y •Address: J e C9 .Su 1 / t k) City/State/zip: 10. /4r H,,;r .�`l q, 011CU Phone.#: 0 Are yyoo an employer?Check the appropriate box: Type of project(required): 1. 'LJ' lam.a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the stab-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_'[j Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'-comp.•insurance comp. insurance� required] 5. ❑ We are a corporation and its "10.❑Electrical repairs or additions officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp. right 6f exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also 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. TContractors that check this box must attached an additional sheet showing the name of the subcontractors 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: .� l h J/�Sd 00114 Policy#or Self-ins.Lic.#: C 3d( y (� Expiration Date: Job Site Address: J Z City/State/Zip: A4V iV A,;,rJ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of erimirial penalties of a fin(;tip 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 insurance coverage verification. I do hereby certify r the pains-and penalties o perju that the information provided above is true and correct. St Date: G _ Phone#- .J �-' 3 4�, q �Y Official use only. Do not write in this area,tb 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#: t t Information and I115tructions 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 foregomg-engag ii atom en rprise` ii o-15-d`�lie l eg 7represen�fa'tiWkzf--Xtleceaaed-empiuye , the receiver or irastee 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 insuraance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),-address(es)andphone number(s) along with their certificates)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be'used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that'a valid affidavit is on file for future permits or licenses..A new affidavit must be filled out each year.Where a home owner or Citizen is obtaining a license or permit not related io any business or Commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you leave any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number: The Commonwealth of MassachuseM Department of Industrial Accidents ofce of Investigations 600 Washington Street Boston.,MBA. 02111 TO. # 617-727-4900 ext-406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia tiiEro,�� Town of Barnstable Regulatory Services vMAR& $ Thomas F.Geiler,Director $�E 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 0,2601 - www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, fi P/Upto 1, V P klz- ,as Owner of the subject property hereby authorize 01"A" N p x�ca� ,/ 1:;Ou y to act on my behalf, in all matters relative to work authorized by this binding permit application for. Address offob) r G Sip Aire of Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 0_F0RMS.D WNERPERMISSION Town of Barnstable THE Regu atory Services - Thomas F. Geller,Director • sautivsrA391.e. MA34 g ' Building Division PrE° F Tom Perry,Building Commissioner . .200-Maid. tmet,—Hyannig,M*026,01 Rvvvv.town.b arnstab le-ma.us Office: 509-862-403 8 Fax: 508-790-6230 HOriEOWNER LICENSE EXEMPTION Please Print DATE_ JOB LOCATION: number street village "HOMP,OWNER": name home phone# work phone# CURRENT MAILING ADDRFSS: cityhovm state zip code The =ent exemption for"homeowners"was extended to include owner-occupied dwellintrs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMROWNER Persons)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 farce 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 pndersigned."homeowner"certifies thathe/she understands the Town of Borpstable,BUildipg Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner r Approval of Building Official Not-,: 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 bomeowner performing WDA for which abuilding p=Tnit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing Of construction Supervisors);provided that if the homeowner argages a persons)for hire to do such work,that such Homeowner shall act as sups visor" Many homeowners who use this exemption an unawarz that they are asnn-ning the responsibilities of a supervisor(see Appendix Q, Rules&Regulatims•for Licensing Construction Supervism,Section 2.15) This lack of awarcri=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 respon.6 litics,many communities require,as part of the permit application, that the homeowner u rtify that(ndshe tmdastandt the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t amend and adopt sueb a fmn/eertifieatian.for use in your community. Q:fmTns:homccxcmpt r Workers Compensation and Employe Rrs Liability Insurance Policy I N S U R A N C E C O M P A N Y 26255 American Drive A member ofAleadowbrookO Insurance crono Information Page Southfield, Michigan 48034-6112 i Policy Number Renewal Of Policy Period Agency .. WC0113246 WC0113246 [ 01/26/2009 to 01/26/2010 0000750 Item Named Insured and Address t Agent 1. Lawrence K. rKenney Renaissance Insurance Agency, Inc. 100 Sullivan Road 981 Worcester Street West Yarmouth, MA 02673 Wellesley, MA 02482 i FED ID Number: 105-28-7178 NCCI Carrier Code No.: 24562 Risk ID No.: 162432 Other workplaces not shown above: None Entity: Individual 2. Policy Period:01/26/2009 to 01/2612010 12 01 am standard time at the insured's mailing address. 3A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation law and any occupational disease law of each of the states listed here: MA 3B. Employers Liability Insurance: Part Two of the policy applies to Employers Liability Insurance for work in each state listed in Item 3A. The Limits of Liability are: Bodily Injury by Accident $100,000 Each Accident Bodily Injury by Disease $500,000 Policy Limit Bodily injury by Disease $100,000 Each Employee 3C. Other States Insurance: Part Three of the policy applies to the states, if any,listed here: All states except ND, OH, WA, WV, WY and states designated in Item 3A of.the Information Page. 3D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All Information below is subject to verification and change by audit. Adjustment of premium shall be made at: Policy Expiration Classification of Operations: See attached schedule Minimum Premium: $500 Expense Constant: $338 Deposit Premium: $3,513 Total Estimated Annual Premium: $11,706 r Change Reason(s): ) Change Effective Date: 01/26/2009 Change Payroll Exposure l , Countersigned 02/05/2009 By, DATE Authorized Agent This Information Page with the Workers Compensation and Employers Liability Insurance Policy and Endorsements, if any, issued to for part thereof, completes the above number policy. Date of Issue:02/05/2009 InslrrPri ( nnv RENGL1 XAr(• nn nn ni 14)m4\ h Board ofBuilding n�nd,Standards i Construction Supervisor License License CS 5609 ' r - {Expiration 318/2}016- Tr# 17469 h Restrlctlon 01 AV 0 E LAWRENCE K KENNEY , sy � W YARMOUTM MA 02673� �� Commissioner . _ - — ✓die �o��vmaouuea/,Cli ✓�aaaac�ucoetla �`:, $-:' oard of Building Regulations.and Standai{.t 1 =- HOME IMPROVEMENT CONTRACTOR' Registration:;.101413 t Expiration ':_6/25/2010 Tr# 268758 ;c'T bi ,Individual LAWRENCE.K. KENNEY x i .Lawrence Kenney I ' 100 Sullivan Road W.Yarmouth,MA 02673 Administrator FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ( uilding Commissioner or Inspector of Buildings O Board of Health or Board of Selectmen ( ) Fire Department TOWN OF BARNSTABLE TOWN HALL HYANNIS, MA RE: Insured: SALVATORE, Daniel Property Address: 17 Keating Road Hyannis, MA Policy Number: N0416710 Type of Loss: Fire Date of Loss: 12/5/2004 File#: 100864 Claim has been made involving loss, damage or destruction of the above captioned property,which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned. insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. G. D. BRIDGE Adjuster 12/21/2004 -77 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map aCa Parcel ; �' Permit#" �D Date Issued 2- 23 _ 9 Tax Collet y �. /°" 49 Treasury _� R P1ar� rove'bq Pt'a M a d j Hfs�- —PreserraTienAiVannis �.Project Street Address /7 kfi�j�i�.'�� it ' ' '' • Village. P Y l9 A; ,V i S 1 Owner 1) i$,L) i L_L. 1W. S/1 VGc. D -t_. Address / Telephone 6 lle- 77:5 Yl k7 'Permit Request c.i -�_ Gi Square feet: 1st floor:existing • proposed ` 2nd floor:existing `:5-D proposed Total new Estimated Project Cost Zoning District -.Flood Plain Groundwater Overlay Construction Type too C1 Lot Size t j��l ' Grandfathered: •0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family(#units) Age of Existing Structure e-_ Historic House: ❑Yes No On Old King's Highway: ❑Yes CVo I X. / \ Basement Type:, Full ❑Crawl 0 Walkout . 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing .3 - new Half:existing new Number of Bedrooms: existing °Z new Total Room Count(not including baths): existing new First Floor Room.Count ' v F ` Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: 0 Yes )4 No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes \64.No Detached garage:0 existing 0 new .size -Pool:❑existing ❑new size Barn:Q existing ❑new size Attached garage:existing O new size Shed:0 existing ❑new size Other:_ Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial O Yes ❑No If yes,site plan review# Current-Use Proposed Use y BUILDER INFORMATION Name 41 Telephone Number I Address License# Home Improvement Contractor# ` Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ✓� DATE "/Z L 3 a FOR OFFICIAL USE.ONLY PERMIT NO `a � ' i •i' _ '' - , t _ ' DATE ISSUED MAP/PARCEL NO.' ADDRESS t, is VILLAGE OWNER :�-..� ..• r S%` � 1 a� t . f � " F • � ,• ,. `r � i .FZ A,, •? DATE OF INSPECTIOlr11r1 FOUNDATION FRAME INSULATION art- �• r'w. � - a .. .. .� .. .=j' ,, '. - . � r• FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL - ri GAS: {ROUGH S FINAL FINAL BUILDING •+ ��U1�i �UQ �"� } t t DATE CLOSED OUT ASSOCIATION PLAN NO. r f r --_- -_ The Commonwealth of illassachusetts Department of Industrial Accidents -=_ iOffice ofinyestigatioes 600 Washington Street Boston Mass. 02111 'pensation Insurance Affidavit �/////// •�••••;••• /// N/ % / / // � name: location: city "7 hone# — U ❑ I am homeowner performing all work myself. ❑ I am a sole ropnetor and have no one workin in any ca ac-ty ZZ ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name address: city: phone#: insurance cn. P01iCV# ❑ I am a sole proprietor, general contractor, or homeowner'(c' le one)and have hired the contractors listed below who have the folloning workers' compensation polices: company name A'G(Gt - address: city: phone# l insurnnce cn. olicv# comnanv name: .:.....:., address: city- phone#: irunrnnce co. olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 andtor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do hereby certify'under e p and en p jury that the information provided above is tr/u:and correct Sigiatnre p Date Ccontact e Phone# use only do not write in this area to be completed by city or town official own: petmitJlicense# ❑Building Department (]Liceming Board k if immediate response is required ❑Selectmen's OMce ❑Health Department person: phone#, ❑Other (muea 945 PJAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any cons-=—. of hire, express or iimplied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or an two or more o P P f IP g n'� Y the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: c: 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renews of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 kmir nce 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 and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial 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. SO 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 permidlicense number which will be used as a reference number. The affidavits may be rcttuned io 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 OfflCe of IWBsugadons � 600 Washington Street . Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat 406, 409 or 375 M CUR Appel J Table JS2.1b(amtfu ed) Prescriptive Packages for One and Two-Family Residential Boiidingi Hated with Fang Fu9b MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor amemeat Stab Hea*vcooling Area'(%) U-valucl R vaiue� It-value R valu2 Wall Pia F.gtnpmcat Eflicimcy' Package i P vafuo' R value' 5"1 to 6500 Headng Degree DaW Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 1211. 0.50 38 13 19 10 6 85 AFUE T 15% 036 38 13 23 WA WA Normal U 15•/. 0.46 38 19 19 1 10 6 Normal V 15% 0.44 38 13 25 WA WA 115 AFUE W 1V& 0.52 30 19 19 10 6 85 AFUE X 19% 032 38 13 23 WA N/A Normal Y 12% 0.42 38 19 25 WA NIA Normal Z 18•/. 0.42 38 13 19 10 1 6 90 AFUE AA IS•/. 0.30 30 19 19 10 d 90AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J . 0 Footnotes to Table J5.2.Ib: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft2 of decorative glass may be excluded from a building design with 300 ft2 of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or.rhass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing.-Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value 1equirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1 1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling, wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 The Town of Barnstable a►niver�, 9 M �m Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8614038 Ralph Crossen Fax: 508-790=6230' Building'Commissioner Permit no. r 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:' C� Estimated Cost ory Address of Work: 17 e a i- C1 Owner's Name: I .. 4 Date of Application: __gl I hereby certify that: TT Registration is not required for the following reason(s): Work excluded by law Job Under S1,000 Building not owner-occupied wner 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. SIGNETS UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Nam& Registration No. / OR Date Owner's e q:forms:Affidav l °F'ME 1� The Town of Barnstable BAMSTMM 9�A 059. m� Department of Health Safety and Environmental Services rEc " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: -D, SNL\-/NTo Map/Parcel: r Project Address: � 7 14-i - -1 t�G iZk), Builder: The following items were noted on reviewing: Vi Y � N�C, ►N TV Cr) L 1.f',,Q T l L t { e Please call 508 862-4038 for re-inspection.; r Inspected by: Date: - 99 q:building:forms:review ................................................... .. .. :. .. .. .... ... .. .: : D ATE (1n NIID .,...,,•., ..,,,,,........::...•::...,..,.....:.,,,,.:.,..:.,::.::;.:;:::::;::::::;::::t::::;:;::;:::;:•:::<:<;.::.;::i:;•.,:ti:;.k::;:::::':::•:>;S:r:i: ??:`$ii333i:$%$•`++::;:;:;:;::::::>.::<`%'?+.>si::xYi` �i: 10/9/98 PRODUCER 508-790-1030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFQR9/98 MATION MCSHEA INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPQU THE CERTIFICATE 320 WEST MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERE O E G AFFORDED B E POL C E• O HYANNIS, MA 02601 COMPANIES AFFORDING COVERAGE COMPANY A NATIONAL GRANGE MUTUAL INSURED -- COMPANY A.J. STAAB BUILDING AND REMODELING B 55 LAKE ROAD W. YARMOUTH, MA 02673 COMPANY C COMPANY .................:....................................:.....:.....:........::............................... D T w.....,,...:..,,,,......,...,..,,.,,.,....,...,.,..w .,, , ,,,,,,,,.,,,HIS 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 B Y 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. CO LTR TYPE OF INSURANCE EFFECTIVE POLICY F POLICY NUMBER DALTE ICY(MM/DD/YY) DATE(MWDD/YY)N LIMITS A GENERAL LIABILITY GENERAL AGGREGATE $ X COMMERCIAL GENERAL LIABILITY PENDING 10/9/98 10/9/99 000 000 PRODUCTS-COMP/OP AGG $CLAIMS MADE a g00 000 OCCUR PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT 300 000 EACH OCCURRENCE $ 300 000 FIRE DAMAGE (Any one fire) $ 500,000 AUTOMOBILE LIABILITY MED EXP (Anyone person) $ 10,000 ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $� (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE Is OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND WC STATu on+ER I EMPLOYERS'LIABILITY TORY LIMITS EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERSIEXECVnVE EL DISEASE-POLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER I DESCRIPTION OF OPERATIONSILOCATIONSJVEHICLESISPECIAL ITEMS ... ............. ......... ........................ .......>:::.:•s::.:�:;axv;>:�:•:>:,..,•:�>:�::r�.x::..••..�::::»::>:,,:;��::::::..•:.::.:�:::.,..:::...,.::.::..;:.,.:w>woJ,�\��+vvu<~.:\a�tv>.;:•:a>�\\..x����\�u� � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PAUL DROUIN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL OAK BLUFF RD. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, HYANNIS, MA 02601 BUT FAIL e O MAIL SUCH NOTIC9 S LL IMPOSE NO OBLIOATION OR LIABILITY OF ANY IN UPON THE CONIPAN 116 AGENTS OR REPRESENTATIVES, AUTHORIZED PRESENTATIV -, Cn x .0 CD CD . O I- , mf �a 3 �.c... 10 ,_+w � � z 3 a rn 3 m �p C IV --4 N N r N f7 :10 1 IF- J �:.:a ......, is 1 s CIS o Assessors map and lot number .. .Q�P `- � M Sewage Permit number .....r . . F.. g 7 !!ySEPTIC SYSTEM 0 t ; Pa�ST�LLe.11 1,14 MUS AHB9TAnLE. House number ..........................................................:........ Y•► CoI�PLI MABa A 1639. \�0 fP I�Pr WITH TITLE 5 ' c MaY a' TOWN- OF BARNS ` I ,CODE AN .a� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............. ... X..7.Ire' ................................................................................... TYPEOF CONSTRUCTION ............................................................. .................................................................... ...... .. ......19. / b. TO, THE, INSPECTOR_ OFrBU'ILDINGS: ,' The undersigned hereby applies for a permit according to the following information: Location ...... ..........1/ .e . /M.�g........./?R�....................... ........................................................... ProposedUse ..........Z.......!° ..!..!,! ...... .of. ............................................................................................I......................... ZoningDistrict ...................................../..�.................................Fire District ................./............................................................. Name of Owner .c?' ��./.....51�'�.�Lt �� ..Address ..... ..../ ..'E?, .lr ....... .......... Name of Builder .�71 N/ ...........�!.! .P/ .J`.d?'�....Address ..... ......4r.. �l.. .......... .:. 6�0�r � Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms .................0..eV... ...............................Foundation .......c -'!. p?.T°.......................................... Exterior .... e>..<Ie7A.....V�.!.''� �0f...........Roofing �G?<...9!.....�r e-�,v E.l................................. ....... ............. .... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ..................:............................................................... Fireplace ..................................................................................Approximate Cost ........>.16P..!.....ETA............... ...................... 2 Definitive Plan Approved by Planning Board ________________________________19________ . Area ..Z, 5.... ....................... Diagram of Lot and Building with Dimensions Fee, .�?.l..D. SUBJECT TO APPROVAL OF BOARD OF HEALTH Tv %ham T cr � �fiP /i'oa✓e . ;lu�/v �, S',t � �/��' �G a� T`���7`"" ��a.�ev1 �,CO �ti���// � .v �iv®�s✓,�+-� 4 ; ' w i �✓�a w • ��� %fie d, Yo, 4:is 7`0 ^.I x � (/ D I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .' /f« . l� ��?'.?;7.............. 77 Salvatore, Daniel 22940 add to & No .................. Permit for .......................... ......... alter dwelli"Ig fr .................................... ................................... Lcication ...........1.7...Keating ting...Road . . . ...... ........ ............................. 4 Hyannis ............................................................................ % Daniel Salvatore Owner .................................................................. frame. Type of Construction ........................................... ........... ................ ................................ .................. Plot ......................... Lot ................................ Permit'�7rantecl ........March...24................19 81 ........... Date of',Inspection ...............................;....19 Date Completed /E..�...... . .....19�6 PERMIT REFUSED ..........cr-4........ ................................ 19 Z............. ............................................ ^......... .I................................................. 7, ................................. ......... Z') .. ................, ................................... .......... CO _1 .0 -Approved ....M, ....................................... 19 ................................................................................ ................ ............................................................ j2A9 i� u Assessor's map,and lot number ...✓... ..:'...1.. 1. ......... . c y0F THE t0� Sewage Permit number, ........ ... . d`Q ♦� /"�e4a-°Q` EPTIC SYSTEM zE. Housenumber ..................................:..................................... IN IN COM e� WITH TITLE 5a 4 TOWN. OFF BARNSI�=%M, UI°ONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... ��^.........��?�✓... ............... TYPEOF CONSTRUCTION ...........:.............................................................:............................................................ ............19 f&' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..../ �..../.6 �/.l1 ....../�C�./ . .. .......11..�I /!i .-f...............:.. Proposed Use .% P�:.�r/. .......... . �c.a .....:.. �:� . r......................................... .......... . .... .................... ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner ..........Address ...... ....40. f�e . ................ O Name of. Builder d/.q...A-Xe.,?.........Address 0°x;..r...... .T ��... .. ..i Name of Architect .!C..�j?J'1. .�7...7!� �' �.:Address ./. r ...1;!�D.:c� r'.... ol�A....... 1!Z/Vs .. IV OYt/e. Number of Rooms ................. .........................................Foundation .............................................................................. Exterior .... .�i..fi".... .rP�lZ.. `1Z.�1� .!4'.1.................Roofing .........�.�..✓.`.�f?'�1 . .r......................................... Floors :...........,..........Interior ........ .. y.G!l........�,.......p.. JF^................ Heating ......................y./Jt� Plumbing X f r)`/� .... ............................ . .... Fireplace. ..................................................................................Approximate Cost...... 47�..jl.l>�'.:.u4 ............. .............. Definitive Plan Approved.by Planning Board ---------------------------------19________. Area 1... . . .... ............... Diagram of Lot and Building with Dimensions Fee .... SUBJECT TO APPROVAL OF BOARD OF HEALTH , R I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name lz �.. .,�,�1..�.. �. .. .................. 65�r SALVATORE, DANIEL Ir No 22.528.7.'.. Permit for APa!TIQN.............. Second Floor and Rog.f................. .................................... .................... 17 Ke Location ............... It M Mg...RQ.Ad...................... .................H annls............................................ Owner Daniel Sa.l .......................... Va.to.rje.................... Type'-of Construction ...F-rame......:................... ................................................................................ Plot ....;........................ Lot ................................. Permit Granted ..... 19 8 0 Date of Inspection ...........3.......................19 Date Completed .......................Z. /J./w...19 PERMIT REFUSED ......................... ... .......................... . ........ 19 W ............MA ................. 4WW C) ............ M .. . ............. ..!g-v............................................. .. ............. ........................................... Approved ................................... 19 .............................. ............................................................................... I i i 140 -------------- ' I I I f I i i i i I 1 -f-- I. I I I I _ � I I f _ ;- Ir I i I I L.. I 1 1 I r= i I ! I I 1 I I I i i 1 I ! I i i i I 7-1 1 - -- I --- --4-i ' �- --I- ' TI - � ---- - -- - I NOTES: Z 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS U) o _ & DIMENSIONS IN THE FIELD W Q co REMOD. I p0N�o BEDROOT — — 2.) CONTRACTOR TO VERIFY ALL INTERIOR & EXTERIOR MATERIALS, Q�� _ rn CLOS. !,DETAILS, & FINISHES IN THE FIELD WITH OWNER m 2 0" 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS �wNw 26-QJOR (STATE BUILDING CODE, 8TH EDITION AMENDEMENT & IRC2009- ^oo w pw�oC) EXIST. 4.) iVERIFY ALL PLUMBING & ELECTRICAL DETAILS W/ OWNERS ON THE SITE p m U) I I /'xa'TI '' HALL iDURING FRAMING CONSTRUCTION Uv�aw �I 5.) iTIMBER FRAMING TO BE SPRUCE/PINE/FIR NO. 2 GRADE _ N �L0 10 5.) {INSTALL NEW PANASONIC WHISPER QUIET FAN & VENT TO OUTSIDE ® REMOD. 1CLOS BATH l-J - . 5 5 b � (2)1'6"DOO S I m io I 4'-8" 01, I V zjpw 2 warc5 om"LL o ppha -- mo ffi-. m FNo=wao"�oo EXIST. uo�»���� g��m o2w" �o°ww�= R PLAN FLOO NEW L.L TILED O SHOWER LEGEND: `L c� � --4 z 0 EXISTING WALLS „ J C7 ;.,. CIO, L--J " U p CONSTRUCTION TO BE REMOVED) w NEW CONSTRUCTION `�' ! ow O -' O o w p <C w ;! U) W W z �Y r W U) W Q Z EXIST.2 x 8 EXIST.2 x 8 Y w Z FLOOR JOISTS FLOOR JOISTS (Y Y Q uj Z m _ NEW DOUBLE 2 x 8's NEW DOUBLE x 8's SCALE : NEW 2 x 6's @ 12"o.c. 1/4" = 1 -0" W/3/4"PLYWOOD DATE : { 7/5/2013 DWG NO. : "SHOWER SECTION