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0042 OAK HILL ROAD
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'�Y,�.w. �--e,.a. aK w.:•r-ice. � '�'- :'�v...r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `t Parcel Application © /a33 B Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee -� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 0GLc Irt� Village , Owner Address 5�,,� Telephone qt�- <'w-- 737o Permit Request �A)e_,+L c�ZJ,. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �SZ"' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0� 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 anon ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Mike McCarthyConstruction Address PO Box 52 License # West DennYs, MA 0267W— Cell (508) 280-6964 Home Improvement Contractor# SL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable ° Regulatory Services MAML� Richard V.Scali,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 Property Owner Must Complete and Sign This Section If UsingA Builder as Owner of the subject pmtxn-y lierehy authara7x _ S i t6 act on my behalf, in all matters relative to work authorized by this building permit application for: L/2 Qc,K k11,1 A,J �,j - . ---_. y... (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilired before fence is installed and all final inspe .ons are pe ormed and accepted. e-lilgna of Owner Signature of Applicant �n Prtnt dame Print 1Vamc baiV Q:FORMS'Ow''3FRPF-RMISSIONPWLS Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCAR '- PO BOX 52 W DENNIS MA 6267 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massach-u setts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual F Expiration: 6/16/2017 Tr# 264961 a MICHAEL MCCARTHY MICHAEL MCCARTHY } P.O. BOX 52 ,- WEST DENNIS, MA 02670 - 1 Update Address and return card.Mark reason for change. 20M-05/11 Address Renewal L Employment ❑ Lost Card f '\ The Commonwealth ofMnssnchnsetts Department ofIn(h/s'trialAcchlents l Congress Street,Suite 100 Boston,A1A 02114-2017 www.mass.govA1ia !Porkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Phimbers. TO BE TILED WITH THE PER114ITT1NG AUTHORITY. Applicant Information Please Print Le ibl Iva>t e Name (Business/Organization/individual): P— 0 Box 52 Address: West Dennis, MA 02670 City/State/Zip:. CSL-586 ne VIC-169393 Are yoi an employer?Check Iheapropriate box: Type of project(required): I.7m a employer with employees(full and/or part-time).* 7. EINew construction 2.❑I am a sole proprietor or partnership and have no employees working forme in $. Remodeling any capacity.[No workers'comp.insurance required.] Irl 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t �• ❑Demolition 10 O Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.igsumnce.l 13.❑Roof repairs 6.O we are a corporation and its officers have exercised[heir right of exemption per MGL c. 14.ZOlher 152.§1(4),and we have no employees.[No workers'comp:insurance required.] •Any applicant that checks box pl 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 hn 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!lint is provl(ling)porkers'compensation ins►rrance for my employees. Below Is the policy and Job she Information. Insurance Company Name: Policy#or Self-ins.Lie.#: y�l+/L�b�-6�f CGS(,—.aaiy Expiration Date: ).;I Ili Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the polic number and expiration date); Y P ) Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER•and a fine of up to$250.00 a day against the violator.A copy of this statement may forwarded to the Office of investigations of the DIA for insurance coverage verification. I rlo Itereby certify tin !l al s anr! allies rjury that the'information provider!above is true and correct. Signature: Date: Phone#: 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA17MPAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 800 876.2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:**-***3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces riot shown above: See Location, 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA' B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000,each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information.required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated- No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV I GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements,is hereby countersigned by `'O 12/15/2014 Authorized Signature Date Service Office: Bryden &Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 / , ` 1 WC 00 00 01 A (7-11) �� Includes copyrighted material of the National Council on Compensation Insurance, \�� used with its permission. V Town of Ba rnstable *Permit# `1 Expires 6 months from issue date • j gulatory Services Fee 35• MASS. �X SEp 29 1U,4 Thomas F.Geiler,Director ArE OF BARNS Building Division Building CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 (� VProperty.Address %Residential Value of Work !3S '� Minimum fee of$35.00 for work under$6000.00 VO-wner's Name&Address A,&nfgnj 4.0%. o P kC.. 1-Ls" Contractor's Name Atyr. LLB Telephone Number '��~ir` Sa 410 UniversityJ Home Improvement Contractor License#(if Wjj1®d MA 020�0vr t Construction Supervisor's License#(if applicable) 144 fhb//y X,Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance ' Insurance Company Name AbAv 1$P6- C•Y�a►.� 1• �SwO�A►JC.� Co Workman's Comp.Policy# t^-751" J c,c�5gg -1 o lid Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections 'required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Co actors License&Construction Supervisors License is J required. SIGNATURE: L E - Q:\WPFILES\FORMS\building permit formAEXPRESS c Revised 053012 I — � � oFTt+e ram, . "�: ,�� Town of Barnstable AIFD��a Regulatory Services Thomas F. GOler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 " www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section as Owner of the subject property hereby authorize A Ol to act on my behalf, in all matters relative to work authorized by this building pertrut application for: -�] V— O ' (Address of Job) V/Xfr/,l Signature of Owner 1A ate Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on,the reverse side. P. QAWPFILESTORWbuiiding permit forms\EXPRESS.dpc Revised 070110 P�oF1HKE Teti Town of Barnstable ' °, Regulatory Services BMtNSTABM Thomas F. Geiler, Director MASS. F1639- 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 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 orle ,= 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 15,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1..1 -Licensing of construction Supervisors)-,provided that if the homeowner•engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. ' To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. 4 Q:\WPFILES\FORMS',building permit forms\EXPRESS.doc S ppip Al at1m7 nor §F 7resasu gmTt {j _ ram fq �r Burg-WaZ4JO=n aMh i -.Jg-G 'VI,�It &l t4l cam► �Ffe N 3�a�rT �1 R--s- - _ rdtcoaars�aTI-e 8 °� Qsz pp-27VMRTtp II-yT 50 1 ,t Q�Q fl .emu ' QQ13-j a`r a �- 3 f-t13rj rz-n - - al �t�nyt-tr .Y -- .- r._-�_,�_ �ssrz _•_=::,II n"�r.S:-;i;-?. ?a} .__.-:o_ _$17 G< f:< C I:� sg�5ulltj?lOL�����➢��1.® � 1�; aysn OEMYA • � - - �Hv�rL�i�a 31rem� s bai WIL � - �stactd��hrarr-,QQ oadu •masassas� 1 fz aao`aaa't3 u II_��/��mzlm/� �ve+ mu E TIIL6ff5 , Qpa'004'Z3 tE3 -ems X CDztm/C i Mzjlm/QC _ • - �� �xaYrsxsm scUsje' ypy{pa p - aLrpr}.w X .a ZU a065W4 ays t taroa X -• �,� p�zhnAM EJ°t -M&A i pdU'Oa0`•,75 � aaa`aaa'i� ztr�� 3a':k-z�¢rp N x m 490'09Q'ZS I��.�d�a�rt - 000`0� Ls �,�tat3 a ATfCOZ/C�/QL ID695605� W."m �t °E� Da0'0co,zs 3p SMOLUU%3a a`fdSNOLSfrCA'=- ptdl$�CcsHNBa Nfi1�NMOHS �Led 2,1;5fi43tI Ssar tYH 3o ` i ,INV0tO�tYtcurt,utrlN�LYJt�`Q LL1'-224 sg � 1N�lrty3OHOILL"cr12I0R,-L N[3OS�ftOd3 LJ257O?sfStHl S}I[ C< ,1g fvK a3r5ra 4L C L GY S c L p'sII 1�YppH1'2 CO 1nCrod391 �g54f1MNCIISLA-: 3 _ VSR 8o-:�TFsEE-14 IIa�d Fx>E • ��srsa Sd1t.�ta5`,C;?1ina5 -- • 7TI 1t7d SST r M �J 5 try cry rp Y5R Q36La LN �`?� grm�a�t�Yfsb - -oZ�a:uts pE-A,-ddLy� ?f7(s') -7vL `=,S'gacrrJ...t°Cf AJLh :(SCx ucry . l3a 5PC¢£9E CDCL� }-ay ypp{¢i t75}a I LA[Q-i2Flc,q s. �C errtxrr�Vd ue aM b j)llgm dYcsv t�`�4ad ate 3n suoc rlcII goE��. r �E 4 1 p F a4 I�9 � aM IMOLL106V uE s n°���*r�n 3I SN fS2IO�Yf T _ srtIu ��° � II W ry' six0 MoH3Tw 3 ° ; � t1i�'Cs nSHI�N1Il 1T 2OE3Q��dLLi.J g QC � nr T3Io7 E s pa L �a M 0YSY�mCEW � �CVI NGUVM 53 Oan S2� 9-i, N O- QMM E-A TQNW. 'k—_0F.MA'SSA U SM 1 I-Al. AS.— .,,,.IS-SUES THE, E' 'CT-- CONTRA FLED 5 Y5J`. ..-. '- R-1 TY LL C SBA A D CU S J �7 tu rT 410 UN IViER-5- Y :--j.4iA 02090 23 17"V 0 33986 ......... . ...... Commonwealth of Massachusetts Departme�t!+.of Public-Safety License: SS-J161779 Thomas J Lee 410University M 5 Westwood MN 0209 IF 2I Expiration'. Commissioner o5116/2016 S OKE-DETE TORS REVIEWED --- I BARN STABLE BUILDIN DEPL DATE . FIR E DEPARTMENT DATE _._.. 80TH SIGNATURES ARE REQUIRED F.OR PERMITING UUU 2 -- - -.. r� � 1 I ........ ...... rz e, ........._ _. O ! 9.9 .. .. . .... ... ! ,_ fir- d �. j • __........ !_... ..... : L.. U�' ' I i ._ _. ; : __.. _-. __.. ..._. ...... i i _.. �Z6 ' ..._........ . : I i : _. j _ a Avg L ptfl�- __ - - - . - r�w i _........ . . _.._..... ..... _ . - REVIEWED 9ARNSTABLEBUILDI G OEPT DATE �.. i. I . .. i FIRE DERARTIVIEIUT i ,DATTE..l I BOTN RjIGMME$ARE REQOIRED FOR PERM] r fl r t r ; r r r , �. i I r 1 r , r _ r • r , r _ e , fr , i ' I I I i I I I i r , I , I _ .0D I. � I • I I , I I I I I • I , I j� : , 1 I��_�• I f/��� )`I7'�1�1, I V 6""t' � � i I I I I � � I II : I I_. I I , I I 1 I ' i I : : I i - is I LJ I I I I I � I 1 i I f • I I I i 1. , I I : I : DETE S-REVIEW. ED- -- - BAANSTABLE BUILDING: PT. DATE; i - . . -FIRE DEPARTMENT DAATE !. .. BOTH SIGNATURES ARi REQUIRED FOR FERMI rING ' ; ; f I i i ri i ; 1 _ I i - 1 1 I r CS4-1 ----- - -- ---- ----- -- - i I I I I iI 1 ` ! _ _ !_ _ _ _ ___, _ _ �_ ! NJ ZN tH M, INS i . ..- -- 0 I . ; I ' i a�Nam- I - _ - - -- - - I I (1� � , I 1 I - -- -- - - -- - --I - _. I ' I I I - r _ ..-_ _ _.... ..__ .._ ... _.. • .......... i I � ; -.- r � • i ' rho 1 - I . I r r r � I r I r ir ! i _ I _. r I � _ S E DETE TORS REi�iEED- ;-- - - - . . _ -- ARNSTA6LE BUILDIN6 DEPT. ' DATE FIRE'DEPARTMENT. ; - -DATE. 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CONRA'CTR>; I AW C QBA AD!Vnk" - I 410 UNf� R 1TYA1 02090-�3 <T' 17 ;} COmmDnwealth of Massachusetts Departtmefill.of Public-'safety " ticruril�-Stctcm�-mil.icen�x '� License:SS-0-1779 Thomas J Lee - 410 University ve'• Westwood M 0209 Expiration: _ Commissioner 05/15/2016 4 _ „ Town of Barnstable *.Permit# Expires 6 months from issue date- Regulatory Services FeeBAMSUBM �� Y v� 1MASS, `0$' Thomas F.Geiler,Director m P. RMIT Building Division / Tom Perry,CBO, Building Commissioner SEF 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us TOWN OF BARNSTABLE 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 ^/l 17i41, d fl Z1/J 1it""--'' Residential Value of Work` (ff Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address W t�l+ �l Av1 Contractor's Name !, coc. 'LP'� t�q z1 d Telephone Number p 7 /S c"6) Home Improvement Contractor License#(if applicable) W ZZ_Z'7 Construction Supervisor's License#(if applicable) I �� ❑Workman's Compensation Insurance Check one: 0 I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) � � f•Zv6al r-- ��jjtv J e-roof(hurricane bed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required, . SIGNATURE: C:\Users\decollik\AppData\LocalWlicrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised.072110 a Doug Williams Custom Building Co - P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-7754503 www.cat)ecodhomebader.com Nl 'INSac.hus tts DCIMI-111 cot of PutFlic SafetN Boa it of Bui(ilimT Re„;ul.ttit »and Staundards C.onstr.uction.Supervisor License License;,cS 16981 WE Restricted to::,00- DOUGLAS L`, WILLIAMS SR ` P0.BOX 106:9 C-ENT RVILLE MA,02632 fil �_ . Expiration: 3/712012 -- s CA)mm .1,9320'.. FI' a Consu� , m Office of er A fags&B smess Regulation 0 0 HOME IMPROVEMENT CONTRACTOR, c Registration �102227 Type Y > > I 1 Expiration 7V201r2 DBA o } I L O .fl tQ I J F`-r' ' w w c o°io D ;= LAS L WII�LIANITQM�UILDING x r > � w � o �• : Douglas Williams &" � - c ° d �; 3 ,. 222 PINE ST O �_w,/ -- -- +' L .� CENTERUIL,LE MA 032 y�' tTndeecretary c—NC y .+ I C L V CC O 1' nt1� �ftt i2 nu><r n-WIcfttt rtttie�1tnYt 1g �cic n , t�ht� th to re�fif41;#!�tt# _ e Doug Wliba � fto 8uilding Cam¢ .. - hm Nlfilled ut equvemenis tdxT Wv'uba�aorp�!C � 4a]and has rcc' ed eNflyuon-m eondml d t - buW P= ere`ii�iAu?a•+ePea«�ss�7, ) tm��CFR Pin N589 '- ' - Jn fS ��urts�tctz�an �f: Th ifiaIim4dfwn.Wed. f dezp June 17 2015 - " 864 a 9.2070 =mod' :Leed Heavy Metals, M Inoryanics drench Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-7754503 www-canecodhomebuilder com Hits tiaehusett , De1�urtmcnt of Pubilic S tf t� _ VM ioi-tr d of Bwldinl;Re ul<ttionti anti St tnU<ri`ds Co. strttctbn Supervisor_ L►cense Ltcensei;CS 1!6981 Restricted to oUGLAS VWILLIAMS SR PO'BOX.146:9 - - CEN-ERVILLE MA 02632 y � -- — Ex 'ration: 3./7/2012 (_umnuss'ii fi Tr#: .1:'9320 , �� r Office of Consumer Affairs&$ smess Regulahon HOME IMPROVEMENT CONTRACTOR . Registration1;02227 Type s - 0 Expiratl0n AMV 0�2 DBA D L9S L WIRPT 1 d� BUILDING`. - Dou las 1Niliiarns a1 r CENTERUILLE MA. 6,3 {�� Uud'ersecretary r �= l�ntte� , ttte,� �nutr�rtntrnittl° r`�#��tn�t eat � � . � x � - . D ug wilt a'+ to 6ulldin9 y } ' . •_ ;_ hu NlAlled the rtgmrcmrnis tdrT Ac.58bstaossC lna A)'Se,�m402 iec ed eeeud 6 wcaadatt d . ;buedpamt rt+m,�ptron "$ 444PPP -Pan 745 uo &aPa 89 f � � �n urts�dtI�r>ttAM # .. � '=AIIEPA Administeieil.States Tnties a�TeMrories, -__ -� � - - . Thu efufiam valid fianthe dau f.wan andexp _:x Juna 17 2015 _ . ;�. t - .. - NAT-548641 5 - Cuufieeuootl J 3 2010 y:: � Lead Hea�yM Wa,e d ImNa I Brmwh ' 1 The Conztizonivealth of Massachuseft Depazhnaent of Industrial Accidents - ©, `ace of Investigations 600 Washington Street _ Boston,Ali 02111 ttm i.yzassgov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ixably Nam(Tksiness/orgatiization&&viduzl):,00c� L(y,l(�A"..(5 Address: , r OG C( I L City/StatelZip: Phone ik '1'Z y/5-6 Am you an employer?Check the appropriate box: Type of proJea(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employes(full and/or part-time).* have hired the sub-contractors 2.�am a sole proprietor or partner- listed on.the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity- employees and have walkers 9. ❑Building addition [No worloers'comp-incnnmre comp.insurance.1 mod] 5- ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12-0 Roof repairs insurance required.]i c. 152,§1(4),and we have no employees.[No workers' 131--]Other camp.insurance required.] ;Any applicant that checks bon#1 n also fill out the section below showing their workers'compensation policy information- Ifomeovvaera who submit thus affidavit indicating they are doing all wog&and then hue camde conttactars mast subunit a raw affidavit imdicatmg such aContractors that check this boa must attached=addid mal sheet showir g the name of the sub-caatiactaars and state whether at not those ecakiLLs have employees. Iffthe sub-contractors have Employees,they roast psuvide their warkers'comp.policy number I am art eirtployer that ispro 4&ng workers'coupe satioiu itLvnraece for ary ert;ployeex Below is the policy and job site in foratat✓!on. lusu mace.Company Name: Policy#or Self-ins-Lic.it: 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.OU and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a 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 under the pains acid penalties of ped ury that Ste information provided above is true and correct Signature: �—� Date_ ^c.3 p Phone -7 Offl al use only. Do not write in this area,to be completed by city or town o frc4a[ City or Town: PermitUcense 9 Inning Authority(circle one): " 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: -- 6 �WWI ennxsTa11M 16yq.A,� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barostable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �t��tf`��u ,as Owner of the subject property hereby authorize7:h".11,4,40 to act on my behalf, ` in all matters relative to work authorized by this building permit application for: (Address of Job) W Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 oF1HE lg,,, Town of Barnstable Regulatory Services * saxxsTaa[.E. « „ S& g Thomas F. Geiler, Director ,i639. �m 'den r A Building Division �► g Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 March 24, 2008 Mr. Douglas Williams PO Box 1069 Centerville, MA 02632 Dear Mr. Williams, This letter will confirm our recent discussion about inspections at two of your projects. On December 21, 2007 a final inspection took place at 100 Homeport Dr., Hyannis. It failed because the handrail was at an improper height and the attic pulldown was not insulated; it was also noted that fire, gas, and plumbing had not signed off on their finals. On March 13, 2008 a reinspection took place. The handrail was properly installed and the pulldown had insulation; however, the permit was not on site and apparently misplaced. In order for this project to be closed out, you must obtain a duplicate and obtain the necessary signoffs. On March 10, 2008 a foundation inspection took place at your request at 42 Oak Hill Rd., Hyannis. The.inspection could not take place because the sonotubes were filled with cement and backfilled. Two sonotubes, one from each row, need to be excavated to verify depth before the foundation can be signed off. If you have any questions, please do not hesitate to contact this office. Sincerely, . ll Paul Roma Local Inspector TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 Application# 9 b rn I M Health Division Date Issued I — Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board ,. C111 �" o Historic-OKH Preservation/Hyannis Project Street Address LILn 'Irm Village ✓1CD Owner � c"7�'� I '�✓� Address G I q I (0 7141, rV Telephone Permit Request A eyebdo-yv "`�v�e A`� a,-J-57 C) a VwavLJ Square feet: 1 st floor:existing proposed 2nd floor:existing proposedew Zoning District Flood Plain Groundwater Overlay c Project Valuation ]c��e Construction Type t e�Wd Lot Size Grandfathered: Yes ❑No If yes, attach suppo `l'f. IDwelling Type: Single Family Two Family ❑ Multi-Family(#units)Age of Existing Structure f ��d Historic House: ❑Yes On ing No Basement Type: �LEull ❑Crawl ❑Walkout ❑Other �No ,,, Basement Finished Area(sq.ft.) Basem nfinished Area(sq.ft) Number of Baths: Full:existing new alf: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 ❑ ectric ❑Other Central Air: ❑Yes ❑No Firep ces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑ne size Pool:❑existing 0 new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: 1- Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U� o If yes,, site plan review# Current Use Proposed Use 5 ,✓- BUILDER INFORMATION Name 1C_, �e G�i0� s Telephone Number Address �J 10�2 / License# Home Improve ent Contractor# 71%7-:51 61Z,1?z Worker's Compensation# !� ALL CONSTRUCTI DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ���' SIGNATURE C L�� DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION leo 0 FRAME 's INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL iy PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING ! c _0 DATE CLOSED OUT a ASSOCIATION PLAN NO. t ,o� lati Town of Barnstable Regulatory Services • snxxsresLe. Ames. g, Thomas F.Geiler,Director 0.19. .A. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bafnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize�p `-23S L_ ,� 6� e .,. �� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date C d I Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:O WNERPERM ISSION ,per The Commonwealth of Massachusetts �\ Department of tndustria[accidents Office of Investigations 600 Washington Street Boston,MA 02111' wl•vw.mass.gov/dia ' Workers'Compensation Wnrance Affidavit: Builders/Contractors/ElePcltricians/Please Print Le erl Applicant Information . Name(Business/Organize#ion/bdividual):�O�i�aS .A.d�ress: U�• O . City/State/zip: Phone.#: 7�✓�'�'r� Are you an employer? Check the appropriate box: :Type of project(required):. with 4• ❑ I am a general contractor and I 6 New construction . 1.❑ I am a employer have hired the sub-contractors employees(full and/or p -timz)* listed on the'attached sheet. 7. ❑Remodeling 2. I am a'sole Proprietor or partner- These sub-contractors have 8. ❑Demolition v-- sNp and have no employees . to ee4 and have workers' for me in any capacity. y 9. ❑Bulding addition vvorldng comp,nnsr nco.# [No workers' comp.insurance 5 ❑ We are a corporation and its loTI Electrical repairs or additions required•] officers have exercised their l l.[]Plumbing repairs or additions 3.❑ I am a homeowner doing a Lwork . myself:[No workers, comp• right bf exemption per MGL 12.[]Roof repairs c. 152, §1(4),and we have no 13.❑ Other insurance.required.]t employees. [Na workers' comp,insurance required.] *Any gpplicant @rat checks box#1 must also fill out the section below showing their workars'compensation pokicy information• t H meovroera.Abo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such. t(' additi'oaal sheet showing the name of�sub-contractors and state wbetber ornat those entities have ontracbors that check thin box must attached an a have caTloyees,1heymust provift their workers'co off number. employcca. If the sub contsacim 14M an employer that is providing workers'compensation insurance for my employees. Below isthepolicy and job site information. Insurance Company Name: , # Expiration Date: Policy#or Self-ins.Lic. Job Site Address: �Z � � 61 Pd. City/Statemp: s2<S' d �� Attach a copy of the workers'compensation policy declaration page'(showing the policy n er and expiration date). Fa>Zure 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$1,50D.00 and/or ono-year imprisonment,as well as civil penalties in the form of a STOP WORIC,ORDBe and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi at of the MA for' e covers o verification I do hereby certify under the pains and penalties of perjury that the information provided above,is true and correct~ Si a�—�,_... ���---�_. Date• /Zr/(y-`-z� Phone 7 D o not writ e area, tb be completed by.city or towrt.offictaL Official use only. , City or Town: ' Yermit(License# Issuing Authority(circle one): :1.Board of Health 2•Building Department 3,City/Town Clerk 4•Electrical Inspector 5,Plumbing Inspector 6. Other Phone#: Contact Person: Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 026322-1069 508-775-1500 866-524-0070 fax 508-775-1503 www.cal)ecodhomebijilder.com e-mail homebuilda(a-comcast net �l� �o�iornu.�rcue��ll�t �/i l�auac�uaeCl� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR a' Number: CS 016981 I •. Expires: 03/07/2008 Tr. no: 16167 Restricted: 00 DOUGLAS L WILLIAMS SR PO BOX 1069 CENTERVILLE, MA 02632 Commissioner ao;sJtslu►wpv Z£9Z0`dW'3llIAZI31N3D 'IS 3NId ZZZ �} swellllM sel6noa I r JNla-iine:WOiS b SW`dIl11M S`dlJf1O .flea ad�Ci uoi;e�;si N} 8909ZI. #J1 800Z/t•/L LZZZOIuoi;e��dx3 HOlDVSINOD 1N3W3AObdW1 3WOH spepue;S Puu suogelnliag gulpling;o pasog b I Board of Building Regulations and Standards `s HOME IMPROVEMENT CONTRACTOR g Registration;_lug 102227 Expiration 7/1/2008 Tr# 128068 .. Type DBH 's DOUGLAS L.WILLIAMS CUSTOM:BUILDING Douglas Williams 222 PINE ST. CENTERVILLE,MA 02632 Administrator. y i P / 1 7K 7�n / I G��QoST- •p,Tr�� --- sca(e— r' e✓" 1�yc,sT��� z � nL� 1 ?Ice:Oove- T \41 J 7 !Trade Sc a G° Sa�51' r3� (G tf ,? , 42, 1 � � -- r _ T PLO PLAN nnAP . 1 17) . LOT 7 _ _ f _- --:_•'_ems. 1 { '�..� J qs!_:VC T PLU i i ILAN ;SCALE. l': -20 mAP t" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ZA, Parcel Application# c✓f - 1 0 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 4a_rv4 r�,ll Village Owner IA/� Address Telephone Permit Request f,.r— do SS Rona �,c�G)Or CIL- �s rS -f-oy— c4e at iaa— Square feet: 1st floor:existing proposed"ve� 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio 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 V.V10— On Old King's Highwayf ❑Yes o Basement Type: 'KEull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1VU Basement Unfinished Area(sq.ft) S N Ma Number of Baths: Full:existing Z - new Half:existing newcn tz, Number of Bedrooms: existing new Total Room Count(not including baths):existing , new_ First Floor Room C unt e a) r— Heat Type and Fuef' Yeas ❑Oil ❑Electric ❑Other Central Air: ❑Yes VNo Fireplaces: Existing r/ New A10 Existing wood/coal stove: ❑Yes -10_o Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:>kexisting ❑new size A10 Shed:❑existing ❑new size /1f6-) Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yeess-`_ I No If yes,site plan review# Current Use i _ Proposed Use BUILDER INFORMATION Name Telephone Number Address &61061 License# ��+ ►'�` l Home Improvement Contractor# Ally~. Worker's Compensation.# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c_ SIGNATURE r� °"� - DATE f FOR OFFICIAL USE ONLY t_ r V PERMIT NO. ' r _ DATE ISSUED _ \ MAP/PARCEL NO. ADDRESS VILLAGE OWNER .f DATE OF INSPECTION: Y FOUNDATION . FRAME INSULATION FIREPLACE " } ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL _ FINAL BUILDING C - . ft, DATE CLOSED OUT " ASSOCIATION PLAN NO. i' Town'of Barnstable Regulatory Services g BNVASLE, Thomas F. Geller,Director . MASS. %639. .0�i Building Division ''TFD M7► � Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-79076230 Office: 508-862-403 8 Property Owner Must Complete and Sign This Section If.Using.A.Builder A r\ ,as Owner of the subject property hereb .authornze��v '� • �"���" S �`• to act on my behalf, p in all matters relative to work authorized b7 this building permit application for: d �(Adess ofjob) 07 Signature of Owner Date . w'I Print Name Q:FORMS:OWI'=':�IZPERMIS SIOr1 ' The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111' www.mass,gov/dia ' Workers - Compensation Insurance Affidavit: Builders/Colitractors/Electricians/Plumbers Applicant Information .Please Print Leeibly Name(Business/Organization/Individual): . w t Address: f3plo /U� City/State/Zip: ( �° Phone.#: Are you an employer?Check the appropriate bog: .Type of project(required):. : 1:❑ I am a employer with 4. I am a general contractor and I employees (full and/or part time),* • have hired the sub-contractors 6. ❑New construction . 2. I am a'sole proprietor or partner- listed on the'attached sheet. 7. emodeling ship and have no employees These sub-contractors have g, []Demolition forking 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.[J Electrical repairs or additions q ] officers have exercised their 11.❑Plumbing repairs or additions ' 3.❑ I am a homeowner doing ill . . myself. [No workers'comp. right bf 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 boa 01 must also fill out the section below showing their workers'compensation policy information. f Homeowners,wbo 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 whetber ornotthose entities have employees, Ifthe 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 Comp any Naive: Policy#or Self-ins.Lic. Expiration Date: Job Sate Address: 2— oxfc— City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy num er and expirat,on date). Failure.to secure coverage as requned 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 cnn2 penalties in the form of a STOP"YORK•ORDER and a Fine of up to$250.00 a day against the violator. Be advised that a copy of thin stateme3it maybe forwarded to the Office of Lvestizetions of the DLA for insir,ance coverage verification. I do hereby certify under the pains•and penalties of perjury thai the information provided above is true and correct. S gnature: Date: S _ F.,on C) ; Of fr_jal use only. Do not write in this area, to,be completed by.city or town off Cial, 1, City or Town: Pernt/License 4i Issuing Authority(circle one): 1•Board ofFealth 2,Building Department 3. City/own Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone r: ` Massachusetts General Lavrs chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to+Es statute, an employee is defined as"...every person in the service of another under any contract of hL 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 fore goL,g engaged in a joint enterprise; and includi the legal representatives of a deceased employer, or the receiver or trustee-of an individual,pa1mrship,association or other legal entity,employing employees. However the owmr of a dweling house having not more than three apartments and who resides therein,or the occupant of dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on Le 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." Addition32y,MGL chapter-152,§25C(7)states`Neither the commonwealf]i nor any of its political subdivisions shall enter into any'contract for.the performance of public•work untii acceptable evidenee-of•conipli: ce vvith�tlie insurance requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contiactor(s)name(s),address(es)and phone number with their along w their certificate(s)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.' compen.satio'n policy,please call the Department at the number listed below, Self-insured companies should enter their self-insurance license number on the appropriate`ine. City or Towti 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 necessity)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 fo any business or commercial venture (i.e.a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please cio not hesitate to give us a call. The Department's address,telephone.and fax number:. ` Cazr (>1aw J. of Ma. huwgs D-,pa fit of Industda.1 A.coldczts OHIO of Investigations B_ostan,,,:MA 02111 . Tell.#61.7-72.7-490 e.eti 4 06 4 1-3-37 MAS E 617-7-17-7749 Revised 11-22-06 ' j { �OpTHE1p� Town of Barnstable P � . y Regulatory Services '+ BWSTAELE Thomas F.Geiler,Director MASS. . E1 39. ]wilding 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 PERNYIIT 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: rA�43°2- j�•' G� Estimated Cost Address of Work: A4k__ l c Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ob Under$1,000 uilding 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 MROVEMENT WORK DO NOT HAVE ACCESS TO TEE 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. OR Date Owner's Name Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-775-1503 www.c4pecodhomebuflder.com e-mail homebuilda@comcast.net BOARD OF BUILDING REGULATIONS 4, License: CONSTRUCTION SUPERVISOR Number: CS. 016981 Expires M7/2008 Tr.no: 16167 Restricted:. 00 DOUGLAS L WILLIAIVISSR 5 ;: PO BOX 1069 G- CENTERVILLE, MA 02632 Commissioner n , h X C � �z a 2 t� L U OD � T M o� is -- �� A E_ I `. � o e Town of Barnstable *Permit# �00 Expires 6 months from issue date n� Regulatory Services Fee X-PRESS-5 PERMIT Thomas F.Geller,Director n MAR 2 6 2007 Building Division TOWN OF BARNSTABLEOM Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNnT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint [ap/parcel Number Z c(c)/o'g i ropertyAddress t-IZ C mc— Residential Value of Work 06>0 �- Minimum fee of$25.00 for work under$6000.00 owner's Name&Address W J41 I&M -CC 0 YI .ontractor's Namee�� la Telephone Number [ome Improvement Contractor License#(if applicable) :�s���p�rvisoY'-s-Lioerrse#-(�-appiieatrle-) C� G I/o ]Workman's Compensation Insurance Check one: EF4 am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance asurance Company Name Vorkman's Comp.Policy# ;opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing.layers of roof] (�Re-side aqq Replacement Windows/doors/sliders. U-Value •3 2� (maximum.44) fY ",, VJhere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property.Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. ;IGNATURE: �Q�- -=- ------- --- 1:Fonns:expmtrg .evise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111, www.mass.gov/dia ' Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Jr� 1�J�c_c A,--rn 7' Address: City/State/Zip: Phone.#: 2Are you an employer? Check the appropriate box: :Type of pioject(required)'- 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6, El New construction . employees(full and/or part-time .*) • have hired the sub-contractors 2. I am a'sole.proprietor or partner- listed on the.attached sheet. 7. Remodeling ship.andhave no employees These sub-contractors have 8. ❑Demolition vyorking for me in any capacity. employees and have workers' mp,insurance comp.insurance.$' 9. ❑Building addition [No workers' co . required.] 5. ❑ We are a corporation and its 10.❑•Electrical repairs or additions 3.❑ I am a homeowner doin ill-work officers have exercised their S 11.❑Flumbing repairs or additions myself.[No workers' comp, right of exemption per MGL insurance.required.]t c. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' 13.❑ Other ' comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providb 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 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 MA for insurance coverage verification I do hereby certify under the pains-and penalties of perjury that fhe information provided above is true an'd correct. Date 3 � Phone#; Official use only. Do not write in this area,to be completed by,city or town official ti 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#: 1 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 hiie, express or implied, oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,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 o ermit to'o erate a business or to construct buildings in the commonwealth for any r P P applicant who has not pro.duced,acceptable evidence of compliance with the insurance coverage required." . Additionally,MGL ehapter..152, §25C(7)states"Neither the commonavealth nor any of its political subdivisions shall enter into any contract for.the performance of public•.work until acceptable evi:denee-of ec'midarsce v�ithtlie in.�urance requirements of this chapter have been presented•to the contracting authority,.'t .Applicants , Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti:actor(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 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 onthe appropriate-End. 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 permitilicense 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 fo any business or commercial venture (i.e. 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 have-any questions, please'do not hesitate to give us a call. The Department's address,telephone-and fax number:: `hp,Commonwedth Of Mmarlh=tts Dopartmont of IndusWal.A.ccidects Of ."of Investkaumm ' . • �4�Q� or�Steeet • BWon,.MA 02111 • Ted.# 617-727-00-0 cxt 4%Or 1' MASSAIFE Pax#617-727-7749 Revised 11-22-06. www.mamg6v/dia oF� �o�ti Town'of Barnstable Regulatory Services taNSTABi e g Thomas F. Geller,Director 16 i+9.+' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section . If Using.A.Builder A r1 ,as Owner of the subject property hereby authorize yoy 4 L• t.J�t..G. - -- to act on my behalf, in all(natters relative to work authorized by this building p ermit application for: oA k, 011s (Address of Job) f 3 Signature of Owner Date W re Ark Print Name 4 Q:FORMS:OWNSRPERMISSION f s f t R �r! p ♦♦�� +. i` ;`IA ,w ' �l e 'C�oor�nzavzusea,� o�✓�acrc�iicael� p. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR, Registrattonf 102227 ,EiratJOR �A 2008 TMr xp 128068 if TYPe DBA I E DOUGLAS L.WILLLAMB CUSTON4rBUILDING i Douglas Williams 99 222 PINE ST. .j t CENTERVILLE, MA 02632 Administrator Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-775-1503 www.cgpecodhomebuilder.com e-mail homebuilda(a,comcast.net 0 ` BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS. 016981 `. Expires.03/07/2008 Tr.no: 16167 Restricted:;-'00 5 DOUGLAS L WILLIAMS'SR rf PO BOX 1069 = -` � ..; . CENTERVILLE, MA 02632 Commissloner r--� � _� _ _ v__...� -1 � � � x � r� � � _ - 1 � ,--- � �4 � --� � � � � � �- w L, _ � � Y. �,_._--._.,._..�-- r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4 c :,Parcel/ Permit# Health Division Date..lssued 2. Conservation Division Application Fee Tax Collector�j 3�Q L Permit Fee 01 a� Treasurer 9//3�d�— SEPTIC SYSTEM DUST BE Planning Dept. �� �Ci � /0 INSTALLED IN COMPLIANCE W11'H TITLE� Date Definitive Plan Approved by Planning Board EWRO . AL CODE ANL Historic-OKH Preservation/Hyannis TOWN REGULAMNS Project Street Address 14— S --- Village qyd► ms Owner W i LL-14M /C,(ZSn1 Address _(D 1!4 69 9-K. k Am xv Telephone 1 VVI �I ��J u � /U 7 113 7 a Permit Request 7?xrm CTF ScdPS — I?E��a� d�'� ,c0►� — g'= SAS Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation !Z�ayD Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. c? Dwelling Type: Single Family Ilk Two Family ❑ Multi-Family(#units) ; Age of Existing Structure .30t Historic House: ❑Yes )�'No On Old King's Highway: ❑Yes q No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other -0 Basement Finished Area(sq.ft.) i Basement Unfinished Area(sq.ft) :72: s �p . p Number of Baths: Full: existing new Half:existing new W 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 T65A-(1W,P. P Proposed Use Afo BUILDER INFORMATION Name «--L,.A7vv5 Telephone Number AddressP� t0lo,�'i & k- V 076,7Z License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t,.f DATE SIGNATURE �6Z FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. vl,4-1 ADDR$SS f,- VILLAGE L'• OWNER` - t DATEbF INSPECTION: - FOUNDATION FRAME INSULATION _ FIREPLACE f �` ELECTRICAL: ROUGH qq ' FINALVM L- 1 PLUMBING: ROUGH j _ a w FINAL llvi GAS: ROUGH t FINAL e ra - - FINAL BUILDING DATE CLOSED OUT { ! - R ASSOCIATION PLAN NO. ZHE Town of Barnstable Regulatory Services '* BARNSTABLE, t Thomas F.Geiler,Director MAS& 9a'pTE1639.D MP'�01 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, f �,�11 Type of Work: ?er Lu �`��- [ Estimated Cost(wv Address of Work: y 2 C*C_ ( ge� lid a nqc S Owner's Name: �l_1.� U Date of Application: I hereby certify that: Registration is not required for the following reason(s): 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 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 ply for a permit as the agent of the owner: Da Contractor Name R gis �_'onNo. OR Date Owner's Name r Q:forms:homeaffidav L The Commonwealth of Massachusetts —{ - Department of Industrial Accidents Olfice o/JffY0S igatfans _ t• 600 Washington Street Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit r name: .............location C hone# 7 ❑ I am a hora owner performing all work myself. am a sole r rietor and have no one workin in ca acifiy %%%%//%/%%/%%%/%//%%%%%/%/%/G%/%%//O%/%%////G/%%///%%%%////%��//////%�/%/%/�//////�O%///%%/l kers' co ensation for my m loyees working on this job...........:.....:;::>:.<::: :..::.:.:.:.,.:...:,:,::•,:??,:,.>;.;::;:{;:::}:;; Y:::::::z.<.z>:::>z>:':;:.;;;?:;::z;}:Y>:;:.;:.;::•:};Y:. an e 1 r rovi g mp .•.p..::•r:::-:;{.:• �:�:�::�::::::::::Sri::.;.' :..:...::...... .tarn an ..........:...:::.:..:.........:.:.nt,............:. .........n.......,{..n.. 'z Y. 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As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied,oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, 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'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation 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 policy,please call the Department at the number listed below. are required to obtain a workers' compensation City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottoms 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. The affidavits may be retur to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any.questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of loyestlaatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 TsbLi JRT tb(eass��) goad Faeb . pr�yeriptfre PscksSss for daa"d Twa,F'ssa�7 Redd i Bad1��Hsi wits MAXIMUM E7oor Saaamr»t WALU 31ab �= a� Qlaang Ceiba Walt Ar (Y.) U valuc' R-mud R-valua� R= RWWZW pack.zge ST01 to 6540 Heatfa;Dew 17 ' 6 Normal Q IZK 0.40 3E 13 19 10 . 6 Normal R• 12% OS2 30 19 19 IO 95 AFUE 13 19 10 S 12;'. . 0S0 3E WA N/t Not�a! T 13'/. O]b . 3 E 13 u 6 Norma! 19. 19 10 SS AFUE U .1Sy. 0.46 3E WA N/A 0•44 7E 13 23 i 95 AnM p,► 1SY. C 52 30 19 19 10 NJA Nw sl X IE'/. 032. 31t 13 WA ti/A Normal 0.42 3j 19 2S NJA 90 AFUE Y 1 EY. 6 13 19 10 Z lE•/. . 0:42' 3i 90AFUE 30 19 19 10 6 T.AA ADDRESS OF PROPERTY: AA 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5; SELECT PACKAGE(Q—AA-see chart above): L G NOTE: OTHER MORE INVOLVED METHODS OF DETF.FUAWWG ENERGY REQLTgtEMENTS• ARE AVAILABLE. ASK U RM S FOR THIS INFOA710N• BUILDING INSPECTOR APPROVAL: YES: NO: q.farrm-5 803 03 a Footnote's to Tab1e'J5.2.1b:' Glazing area is the iatio of the area of the glazing assemblies (including sliding-class-doors, sdkelieht s and ll basement windows if located in walls that enclose conditioned space,but exciu ude opaque doors) area. expressed as a percentage. Up to 1% of the total glazing a=may be excluded.from the U-value requirement. For example;3 fi of decorative glass may be excluded from a building design with.300 ftz of glazing area. = After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the Nonal' Fenestration Rating Council (NFRC) test procedure, or taken'from Table 11.5.3a. U-values arc for aCi whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized M= construction, If the insulation achieves the full insulation thickness over the exierior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if,used). For ventilated ceilings,.insulating sheathingmust be placed between the conditioned space and.the ventilated portion of the roof. 'Wall R-values represent the sum of the wall eavity.instilatioa plus insulating sheathing (if used). Do not include exterior siding, structural Sheathing, and interior drywall.For example,an R-19 r'equirelaent could be met EITHER by R-19 cavity insulation*OR R-13'cavity insulation plus R-5 insulating sheathing. Wail requirements apply to wood-frame or mass(concrete,masonry,log)wall.construetidns,but do net apply to metal*frame construction. •'The floor•'requirements apply to floors'overunconditioned spaces (such as unconditioned crawlspaces,basements, or garages),Floors over outside air must meet the ceiling rzqui=c=- ' 'T}:e entire opaque portion of any individual basement wall with as average depth less than 50%below grade must rnc_t the same R-value requirement,as above-grade walls. Windows and sliding glass.doors of conditioned br..,ements must be included with the other glazing. Easement doors must meet the door U-value requirement d-scribed in Note b. The R-value requirements are for unheated slabs,Add an additional R-2 far heated slabs. ' If the building utilizes electric resistance healing use compliance approach 3;4, or S. if you plan to install more than one piece.of heating equipment or.more'-than one pie= 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 J52-1a. NOTES: a) Glazing areas and U-values are maximum acceptable.levels.Insulation R valuex are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. U-values must be tested b) Opaque doors in the building envelope must have a U-value no greater t Dmok°e from the door U Value and documented by the manufacturer in.accordance with the NFRC test procedure in Table J1.5.3b. 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'(Le.,may have a U-value greater than 035), 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 compiles 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 arcs-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0,35 for doors). ,' I RESIDENTIAL BUILDING PER MIT FEE S .' • APPLICATION FEE ew 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= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 100 square feet x$64/sq.foot= (o 0_—x.0031= 6 plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft , >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 ' >150 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 S30.00= (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 $150.00 (plus above if applicable) Permit Fee projcost I '�� �j:_ ✓lze Vi omwma�z..aea/,// o��7i�aooa�lzuae�la.. z BOARD OF BUILDING REGULATIONS License:,yGPNSTRUCTION SUPERVISOR Number'4S 016981 A-40 r�eM810��7/ �004 Tr.no: 19306 - InJ F Restnctdcl`OD I DOUGLAS L WIL61A PO BOX 1069 - CENTERVILLE, MA�02632� Administrator ! q{ r Ens, r) Map A:�I_ Parcel 0$Y Perinit# 3 q House#,» Date Issued ` Board of Health(3rd floor)(8:15'-9:30/1:00- �3 ! ee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) SEPTIC SYST RUST BE Planning Dept. (1st floor/School Admin. Bldg.) INSTALLED IANCE Definitiv Approved by Planning Board 19 W1 . ENVIRONM E AN® TOWN OYBARNSTABLE TOWN 9. N Building Permit Application F Project Street Address + G, Village /yy A if h i St 4 • , / Owner t�Q�. 6 a k 4 e w Ief a Address y1, ogle 1411 Telephone So$ 7 7 T 6333 ` 'Permit Request Rr_ - J- A&? C Treys I ew0LI-C dtip �Q eL Q�� >^e(��4Ge. �ow►�,eL /G ' boka o�)(7 Ra4-feL,3 . C -e-ePY i8 ' Lo�, a 2 X T f.4,d'yLeLs. Qe"I c-e C'ecliiy S�,i4 e, mk �' ie�� �y+-rneL . Qe(�lectP C���at, -S .a?rs 0L, G'ctd�-e Ch2 'First Floor square feet Second Floor ! square feet ( Construction Type \ Estimated Project Cost $ 30 0 0 6 , b� Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family #units) ) Age of Existing Structure Historic House ❑Yes Biro On Old King's Highway ❑Yes a, o 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use C)b,e i,i e.K �e- ��h 8�ti u�`fio ti Builder Information Name LJ w ca.wJ ®�e Lt Q k JeLP Telephone Number ,;o T Address /&1 a2 a H.+-e L_ �— License# D c of 7.3 Z- �.eh-K i s n L 0411 .9 . C)2 6 J f' Home Improvement Contractor# //3 g 7 Worker's Compensation#. 9 o 1p NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t y� ►� a w�� �u 44 SIGNATURE A,,,_m• ®Imo' L\ DATE 7 7— 9 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �1 c / $� FOR OFFICIAL USE ONLY PERMIT NO. J —2, ; DATE ISSUED MAP/PARCEL NO: ADDRESS _ s r -VILLAGE } r OWNER DATE OF INSPECTION: _ y FOUNDATION t F t FRAME } e 4 r INSULATION FIREPLACE f ELECTRICAL: ROUGH - FINAL" ' PLUMBING: -j ,'=ROUGH FINAL-- CA) ;f r^t GAS: .I�ZOU •GH _ FINAL 4 � . FINAL BUILDING;. DATE CLOSED OUTS r` F • - -- ASSOCIATION PLAN NO- TKE The Town of Bdrnstable • snsrtsreats • 9 ,uRW � Department of Health Safety and Environmental Services 1"9.4% BuiIding Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 308-790-6230 Building Commissic::t For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, moderni=tion. 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: R�"�' Rt'e�'aC�P Est. Cost20 a'tro u Address of Work: 2 �Q l� � R,e� N`1 g h" 's ki Owner's Name 3t2►-I�ri1.4 C�- e ti Date of Permit Application: 7-1- VE I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner- 7 TT ��u.a�� 19- Cab-eu( a,,t�evRegistrationDate Contractor Name Registration No. OR Date Owner's Name r The Commonwealth of Massachusetts {,- =1 Department of Industrial Accidents Office of/n�estigations _ = 600 Washington Street Boston,Mass. 02111 Workers, Compensation Insurance.Affidavit f! kc�wa� c� l� ®�i��� Ch�tJe 193 �e�, Y'-t� S name location yL e 4L k4 a l PQ ` !y 014 k fS tart-i 4' hone bOS"39f'" 0�� city ❑ I a homeowner performing all work myself am a sole pruprictor and have no one working in anv capacity ❑ I atn an employer providing workers* compensation for my employees working on this job. company ndme: address: hone# city: insuranc nlicv# e cn. ❑ I am a sole proprietor, general contractor. or homeowner(circle one)and have hired the contractors Iisted below who have the following workers' compensation polices: tom nnv name: nddresr. hone#. dtv insurance co. com anv name. address: hone#: city- .:......::..._. olicy# insurance co Fafiure to secures coverage as required under Section 25A of MGL 152 tact lead to the imposition of criminal penalties of a One up to S1.500.00 and/or one years'imprisonment as well as civil penalties to the form of a STOP WORK ORDER and a One of 5100.00 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 herebv certify under the pains ands�penalties of perjury that the information provided above is tru,-and corred Date 7 - Sigltature --�^- Print name k w Q c� 69 4 e�� Phone a ofnclai use only do not write in this area to be completed by city or town official permit/license rt ❑Bufiding Department city or town ❑Licensing Board ❑selectmen's Office ❑check if immediate response is required ❑Health DeQatbnent phone#: ❑Other. contact person: � ,�Y,95 PIA) 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 conga 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 o: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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 c 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'renef of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h. not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation 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 ym are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of tht 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 penmit/license number which will be used as a reference number. The affidavits may be returned 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 1 , . Department of Industrial Accidents Office of Imtesdoadbus 600 Washington Street Boston,Ma. 02111 fax#: (617).727-7749 _ phone#: (617) 727-4900 ext. 406, 409 or 375 Tk DEPARTMENT OF PUBLIC SAFETY r CONSTRUVIOM SUPERVISOR LICENSE Nueber r Expires: '— Restrctedjo EDWARD R 08ERLANDER 4 � 183 CENTER'ST ? DENNISPORT, MA 02639 a HOME IMPROVEMENT CONTRACTORS REGISTRATION +h4� Board of, Building ReguI-a-t i o ns: and Standards'" }k • One Ashburton Place Room ..1.301j ° Boston,- Massachusetts. ;a , , Ix •; k}lzz x„ 02108 , _ HOME IMPROVEMENT CONTRACTOR ' r '4�s $ t '� T A x: y Registration. 113387 Expi-ration: 06/09/99 r ------ Type - INDIVIDUAL U '�!40E IMPROVEMENT.CONTRACTOR. Aegistration 113387 OBERLANDER CONSTRUCTION ° Lirpe -'INDIVIDUAL EDWARD A. OBERLANDER- ljxpiration 06/09/99 183 CENTER ST DENNISPORT MA 02639 I .:OBERLANDER CONSTRUCTION {EDWARD A. OBERLANDER CENTER ST I ADMINISTRATOR :DENNISPORT MA 02639 exis ing tis C*) o O 1�. v a O ti Sin 101, r ple 2x 8 header here o ?o w `n w ? ff--2" .�- 6-90" 8, 5" - o°Y614r9U 2'--9" GFI CA Anderson 6-0 x 6-8 Slider Anderson 6-Ox6-8 slider exist- rch m replace m not he space 4 replace m 93'--3" 90=9" - � 3'-O'Y 8'�'91l , �P A �# i--------o existing garage b a x i � q3 h � I 0 V � w 5'-9" 24'-0" Doug Williams Custom Building Co. repairs for 42 {yak Hill Rd Porch area 5-24-07 2 sliders and repair headers over and floor