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0018 PINEWOOD AVENUE
/� me wood ���-• °� C; i i i { I�'ii i �_ �� , Town of Barnstable Post£This;Card So That&it,isUis�blenFro";Itret ,ApprovedPlansMustbe'Retamed on.lob and;thisCard Must be Kept Building 6 P it tiFinallnsp coon HasBeen Made ; A� Permit a Whereia Crt�ficateo#Opancyis Requiredsuch BuildgsallNot be O�ccupiedunthaFina 1 Inspect�onhasbeenmade Permit No. B-18-1 Applicant Name: CROSBY,JOHN &JOHANNA Approvals Date Issued: 01/02/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/02/2018 Foundation: Location: 18 PINEWOOD AVENUE, HYANNIS Map/Lot 289-108 Zoning District: RB Sheathing: Owner on Record: CROSBY,JOHN&JOHANNA Contractor Name: Framing: Address: P O BOX 26 TF ContractorLicense 2 HYANNIS PORT, MA 02647 Est Project Cost: $ 15,000.00 Chimney: t �� Description: CONVERT EXISTING BATH TO HALF BATH W/LAUNDRY AREA. Permit Fee: $126.50 . Insulation: yfZY�tP CONVERT EXISTING LEFT REAR BEDROOM TO HA FULUNDICAPPED F.ee Paid:°' $ 126.50 BATH. INSTALL WHOLE HOUSE GENERATOR EXTERIOR OF BUILDING Date 1/2/2018 Final: -REMOVE/REPLACE 2 EXISTING WINDOWS(JOHN CROSBYJS A DISABLED VET WITH A TERMINAL ILLNESS) FOR ADD'L INFO SEEMA - Y � .;r� r Plumbing/Gas DOCS r f Rough Plumbing: Project Review Req: Building Official y Final Plumbing: �y !i �,�: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicatio n and theapproved construction documents for�whichgthis permit has been granted. All construction,alterations and changes of use of any building and structures"shbll be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access sfreefb.r=road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. a . Electrical pr Service: The Certificate of Occupancy will not be issued until all applicable signatures by the'Buil 'in' and Fire Officials aresprov'ded n this�permit. Minimum of Five Call Inspections Required for All Construction Work: g 1.Foundation or Footing w � K Rou h: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: s "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT OF tHE T "� Application N=ber. ...8....... ..�......................... f � O k awes �► Peoah Fee........ .��.::.��....Other Fee........................ str�¢ R�0 Total Fee Paid TOWN OF BARNSTABLE -...............on.....1.�I g Pc=*ApMvalby.. ........ . ! ...... BUILDING PERMIT APPLICATION Mv.......................................r ............ ................... .. Section 1 —Owners Information and Project Location Project Address 10 P)(Ue-V100� 4 VIF-, Village Y M AIV I.S Owners Name � /fir 1V/// Cl�0 5 !S Owners Legal Address S }_ � City State zip d�- eA Owners Cell# 121a il0 Frmaff d G i 2 r AA:-7- Section 2—Structural Use Single/ wo Family Dwelling El Commercial Structure over 35,000 cubic feet ❑ ommercial Structure under 35,000 cubic feet Section 3—Type of Permit _ ❑ New Construction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish-Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar XRenovation ❑ Pool OEP7 Other—Specify /s 00V Section 4—Detail TOWN OF BAphic, ..,. Cost of Proposed Construction Square Footage of Project �t°SSh d h ��'✓�Q YT Age of Structure Dig Safe Number /r /w #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated:1117RA17 Section 5 -Work Description D1fiV �� iS GIs led V&/ wif- 7-01711V,4-z- la- Al iUgs Section 6—Project Specifics I Wiring [� Oil Tank Storage . ❑ Smoke Detectors gPlumbing ` ❑ Gas ❑ Fire Suppression , i ❑"Heating system ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Pd Public ❑ Private Sewage Disposal ❑ municipal On Site � �P P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway , Debris Disposal Facility: I am using a crane C Yes it No Section 7—Flood Zone Flood Zone Designation J Within or adjacent to a wetland,co4 ank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use , i1L Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of pweIling Units (on site Setbacks Front Yard Required Proposed .` 6 4 � Rear Yard Required Proposed. Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes JA No i 1114 I�f1HI �Do f OqS Wpg tyII�JQ 33N O��F�3 y V F Q J 3 O PAS b HoI tit H 02 a Hai a 7771 X r Tipp ��m�i II I z I m Al — g — I .,.:: I �' r 4' b tlt m 1I I ®® a<:itrt:_ :>:;;:rc:..::....:... D D D A m N r mm r r W IT m I DO if if I 7pj To -4 —� w� it I :<��:::::::::;<;:;::;��:_ :::1 Dm 0 C --�---- p 7a0 m 1 C i I co ,. u'e F �Of n Y 11 z Y + L--- . LJ -�• 1R � 3 Ole yyiD i a r f i lk YY � Ili O S -4 r 4 <_ --T--------- 1 I 1 � I I I ®2016 5GOTr LEW15-DO NOT REPRODUCE VAT"GW WRITTEN PEg915510N FORST G-L 00 R PLAK n �p 5GALE: 1/4"- 1'-0" U o I�DUV V1l O�D l,1 V�I1V V e-OTT LEWI5 365 GROVE 5TREET WU�V a W'A WE5T ROXBURY,MA 02,132 (611)29345311 01-10-2011 15PINE WOOD I-IYANNI5_I.dwg zf-4r I � 'I 6 Q II r a II q II II II � II II � II � -I-rrT-T Ii11 _LL r f q , II r vQ I II f II II _ Qp9 g II II II � II II - II @ 20*SCOTT LEWIS-DO NOT REPRODUCE WITYOUT WRITTEN P£R115510N BASEMENT PLAN SCALE: 1/4"= 1'-0" W�� 16 p0NEW000IaVENUE SGOTT LEWIS lul ln\f�pl�pOCC fi�/l!\ 365 T ROVE STREET n W L=IIVIIV c�J9 IIW4;� WESTROXBURY,MA 02132 (611)29340311 "a 01-10-2011 18PINEWOOD HYANNIS_I.dwg ---------- II , I' I II I I I, r I �I L - I I, I I m r r I I 1 D+ Li i i i J p II I I �I r ' it L i Q I , I I�III I i Ifi---------- I ----------- L----------d Deem.a AD TO J018T8 FIN FLw-TO FIR CLC. i A- 4 O m T-T + FD1 FM Tow TO F91 GICs n L w .._....... 6 7 - - L---------- 0 2016 5WTT LEWIS-CIO NOT REPRODUCE WnWOM WRITTEN PMQMISSION SCALE: 1/4' 1'-0" IC-03 pONEW000 G ME HUE 5Go'fT LEWIS Dnpl�p�Ccn/,1/�l 365 GROPE STREETAH 3-) U� fIVUV 39 MA, WEST ROVE 5TR ET 02132 293-63-1 01-10-201-1 I8PINEWOOD HYANNI5j.dwg s}- 90MBLADWMWO PIN PLR TO FN QA. Fjj RATOFNCL& - I m X 1 I - I 0 m Z O I � I 0 I I w I a: I II I 11 1 II 1 II IEEdHH TM .:.........:. .:......... II E- i LEI it II r I II L I III � II I - II I I I _ li r II {.:::.::.;:;.a"i:::i 'is`'.;;'.':ii':: `::'=`:,':`t:'::' :. ..::. :. . 'A A 2016 5COTT LEWIS-DO NOT REPRODUCE WMcw WRI EN p M VISION - REAM[ELEVAB,703M SCALE: 1/4"-- 1'-0" WL�L�1f o pUNEW000 NVENUE SG07T LEWIS MN[-A\NH09 m n 365 GROVE STREET Ull U L'�IIVIIV 9 UW4;: WEST ROXSURY,MA 02132 (611)293-6311 01-10-2011 18PINEW00D NYANNIS i.dwg - tit o i I V A - l61 fit. F �� 1 d y� £ ¢¢�� von Pit r A �• �• �zs 3a � � m Dz L $ ■ ti yT$3� B D 33•-36• lj A r 1 � 1 � ' j{ ! y 1 3 f 1 i t F )� m34•K4X � j- IQ�SPACE f r 3 I 20165=TT LEW15 DO NOT REPRODUGE.WITWOUT WRITTEN PEIZ'IISSIOV - - SCALE: 1/4"- 1•-0" SW�� As PONEW000 0 F°YIEN 9C .SGOTT LEWIS Lf IIM/n f�n1�n�Cc� J/p� 365 GROVE STREET n lUnllllf4;MM J9 WEST ROX5URY,MA 02132 (611)293-53'11 wJj 01-10-2011 18PINEWOOD HYANNI5_ cIwg m R �g � RR� � r� gIF u WW y A °r 3 m D gX mm 411 d ° y g� °G i! a a 2016 5COTT LEW15-DO NOT REPRODUCE WITWOUT WRITTEN PER1115510N q $GALE: 1/4". I,-0" SW�� Il o FINE VV(DOU AVENUE SGOTT LEWIS - 365 GROVE STREETMn n �9 WEST ROXBURY,MA 02132 A00 293-63�1 01-10-201 I8PINEWOOD HYANNIS I.dwg - IMF m r W-s* 4 t w v q p C-4• ! M J p 3 00,: V V p p , 5 r x I I I DD I I I r I R I Q 1 I I I . n=r Ix.-Im• . 0 2016 5COn LEW15-DONOT FEF4WDIIOE WITWOLn WRITTEN F-EFRM15SION - - FORST FLOOD R PUA K 5GALE: 1/4"= 1'-0" To PINEW- 0Oo D AVENUE Se-OTT LEWIS MM�p 01/U'�1 365GROVE STREET Il\JUVU �j uWu llll Jp 111N WE57 ROXSURY,MA 02132 1' ' ((711)293453-11 u 01-10-201-1 15PINE WOOD j4YANNIS_L dwg �•-gyp EXISTING CONDITIONS C Bedroom 3 pc. bath WD ov Arlb 04%WIT14 61-40 W " T WALV 1H'tl11�WITH � a 4 R •r &Ili AP t °' PROPOSED ' FULL BATH HALF BATH/LAUNDRY . ,y ; , •,: +R1.WN yew 4FW"dF«*A*- a► i P 1 LA'S SFE A-1'f T-1) 9 PD L E MEW-r W112W ��SCR iPl, oN-S��f ` DEPARTMENT OF VETERANS AFFAIRS Cleveland Regional Office 1240 E. 9'" St ' Section 262 Cleveland, OH 44199 December 26,2017 Arthur LaFranchise P.O.Box 218 South Dennis,MA 02660 RE: 18 Pinewood Ave.,Hyannis, MA 02601 Dear Mr. LaFranchise, This letter is to inform you that Mr.John Crosby,of the above mentioned address,has been approved to receive Special Adaptive Housing(SAH)grant funds for renovations to his home,specifically an adapted bathroom and whole house generator.As you are aware,it is imperative that the process be expedited due to his diagnosis. I would appreciate it if you could give me a start date for the construction as soon as possible. Please feel free to contact me if you have any questions or concerns. MR at-te M01W U.S. Dept.of Veterans Affairs Senior Appraiser/SAH Agent 1240 E. Ninth Street,MDP 325/262 Cleveland,OH 44199 Cell:21S-866-7168 Fax:(215)842-4076 Email:Mariorie.Malone@va.eov - ano urcean uevelopment f f / te,cp:uysua,r r1 Department of Veterans Affairs i Farmers Home Administration 'Public reporting burden for this collection of information is estimated to average 30 minutes per response;including the time for reviewing instructions,searching existing data sources;gathering and maintaining the data needed,and completing and reviewing the collection of information. This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number. q The Natiorial Housing Act(1.2 USC 1703)authorizes insuring financial institutions against default losses on single family morlgages. HUD must evaluate the acceptability and value of properties to be insured. The information collected here will be used to determine if proposed constriction meets regulatory requirements and if the properlyissuitable for mortgage insurance. Response to this information oollection is mandatory. No assurance of confidentiality is provided. XProposed Construction Q Under Construction No. (fo be insened by HUD,VA or FmHA) arty address(Include City and State} �'��s fS �®PR®5� �1 fj50p. ���� P11Y6 mpo'b mg= 0° Fi / g:ZI-4�e'pA/7`�:� -Name and address of Morfgagor or Sponsor Name and address of Contractor4f-80110r A. A114, Instructions 1,.For addiional information on how this form is to.be submitted,number of .3.'Work not specifically described or shown.-will not be oonsidered,unless copies eta, see the:instructions applicable'to the HUD Applicalion.for required,then the minimum acceptable will be assumed.Work exceeding Mortgage Insurance,VA Request for Determination of Reasonable Value, minimum requirements cannot be considered unless speci}icallydescribed. or FMHA Property Information and Appraisal Report,as the rase may be, 4.Include no alternates,"or equal'phrases,or contradiclory,dems.(Consid 2.Describe all materials and equipment to be used,whether or not shown on eration of a request for acceptance of substitute matefials,or equipment is "the drawings,by marling an,X in each.appropriale cheek-box,and,entering not thereby precluded.) the information called for each space. If space is inadequate,enter"See 5.lnclude signatures required at the end of this form. mist."and describe under item 27 or on an attached sheet:The use of 6.The construction shall be completed in compliance with the related drawings paint containing'more than the percentage of lead by weight and specifications,as amended during processing.The specifications include permitted by law is prohibiited. this Description of Materials and the applicable Minimum Property Standards. 1. Excavatio Bea soil,type 2.. Foundations f, Footings concrete mix strength'psi Reinforcing Foundation wag materia Reinforcing Interiorfo=Onal i' -all material Party foundation wall Columns andsizes� Piers material and reinforcing Girder rhateral and sizes Sills material B merit entrance.areaway Window areaways aterproofing Footing drains Termite.protection Basementless space ground cover insulation foundation vents Special foundations Additional information 3. Chimneys/V" Material Prefabricated`(malu=and size) Flue-linin atenal Heater flue size Fireplace flue size. Vents ateriai-and size)gas or oil heater water heater. A rtionab information 4. Fireplaces,v Type( solid" gas-bummg ,circulator(make and,size) Ash dump and dean-out_ Fireplace rig` Irving hearth_ mantel. Add" nal'information ref:HUD Handbook 4145.1 A 4950.1,torn HUD-92005(10/84) Retain this:record for three"years Page 1 of 6 VA Fora 26-1852 and form FmHA 424=2 f u CL Exterior walls ofm��q�y ��G sPieuce WADERS PYE 9` wir)• W A/bO v T • Wood frame wood grade,and species ® Gamer hracb.V Burg paper or felt Sheathing #&k ness width C)solid V woad a c 0 diagonal Siding grade type size exposure fastening Shingles grade type size exposure �stenirrg. Stucco thickness Lath weight UL Masonry veneer Sins Lintels Base flashing Masaroy 0 sand faced 0 stuccoed total wan:thlclgms facing thickness._r facing material Hadarp material thidmess handing Doer sins Yifi►dow silts Lintels Base flashing Interior surfaces darr"nx M coats of furring Addfional information Exterior painting material number of coats Gable wan construction. same as noun wars ofirer construction S. Ftior Framing Joists wood,grade,and species other. bridging anchors Concrete slab basement floor C)first floor 0 ground supported 0cif supporting mac Udetmess reinforcing Insulation membrane Fitt under slab material thhdaress . Additional information 7. Subflooring (Describe underflooring for,speolai floors under Ilene 21) Material grade and species sib type Lae that floor 0 second floor 0 attic sq.M C diagonal 0 right angles Additional infarnation r4-�E MA e 9 AL .Tb j ll l)tl 7'}�G�' •.�INI e� SP�}L�S 1 IV t�C'>�,¢/f wi tit ro w►Q f ist fi}��. x N�a��J SlFowPR �}¢�'ff• X. NO a.E W l�0R A46. 8. Finish Flooring(woad only.Daeaei6e o` �' iria�fi floni3ng undue item 2i)!a/ �( 0i4/! L�iQ �iVL�r Location Ravens tirade Species Thidmew Width &dg Paper Finish First floor Second floor Attic floor sq.tt . Addtianal ietomnat on , S:E 5 PkGG?D A lve-T ow Ph>ae A.` D F T#z- PL/3JVS� iL Partition Framing C6W Sr^1e f/Qv . • N &b� sP�'G �-Y� lh�b• lG !�•C Studs wood,grade,and species size and spacing 'Other Additional information 5 t C N eD b 9L.r IT- 17" I 10: -Calling Framing Joists wood,grade,an species Other &WgIng Additional Wdomnation • j 11. Roof Framing . 1J Rafters wood,grade,and spades Roof:trusses(see detail)grade and species Additional information 12..>Roofing Sheathing wood,grade,and species Osolid Ospced or- .Roofing . 9radesize type Underlay, weight or t velom s size fastening -'EM up roofm9- number of pries surfacing material Flashing material Sage or weight 1 grave.stops �snow guards ;Additional.infmmatioA. ref.HUP Handbook 414S.1 A 49M.1 form HUi q=05(10/94) Retain this record for three Page 2 of 6 VA Form 26-1852 form FmHA 424.2 13. Gutters and Downspouts Clutters material gage or weight size shape Downspouts material gage or weight size, shape number ? Downspouts connected to r)Storm sewer C)sanitary sewer dry-well 0 Splash blocks material and size. i Additional information 14: Lath and Plaster ^� / i Lath walls ® callings mater�l - weight or thickness !.L Plaster coats finish Dry-wall ® walls ® ceilings material ., S� thickness finish -A P1 Joint treatment F.(. 1F f/,avlS lSi aT r.CPS �.Q• ,/ �ey'a //Y A;►�s�?avf��fami 15. .Decorating(Paint,wallpaper,eto.) Rooms Wall Finish Material and Appfication Ceiling Finish Material and Application kitchen Bath O Kof At ASO � All J E Other solfflam o4witaiAI Additional information 16. interior Doors and Trim s Doors type �L N✓f y material 1�6D thickness /a Door trim type material 151VD 6 Base type material _ size Z)C� Finish doors jCp % � l/YIo►S trim Other trim(item,type and location) Additional information /,. 17. Windows SEt Ise 60 f/.e. PA, !tc Windows type make material sash thick tress (Mass rade sash weights balances, head flashing'g /,y��-- off— � �s � � Trim type e material Paini number coats, Weatherstripping type material Storm sash,"number ScreensQ full C)half type number screen cloth material Basement Windows type '_ material` •' screens,number'.. Storm sash,number. ......:.. special windows Additional information 18. Entrances and.Exterior`Detail Main entrance door material i . idth thickness Franie material thickness Other entrance doors material width thickness Frame material thickness Head flashing ' Weatherstripping saddles Screen doors thickness number.. screen cloth material Storm doors thickness number Combination storm and screendoors thickness `number -screen cloth material. - Shutters 0 hinged 0 fixed Railings Attic louvers Exterior millwork grade and species -- - : Paint number coats Additional information y. IS-Cabin®ts and Interior Detail Kitchen cabinets;wall units material lineal feet of shelves shelf width Base units material: "counter top edging. Sack and end splash Finish of cabinets number coats Medicine cabinets make _ model Other cabinets and buill4ri°furniture Additional.information . ref:HUD Handbook 4145.1&4950.1 form HUD-920D5(14184) Retain this record for tie% Page 3 of 6 , VAr Form 26-1852 and form FmHA 424-2 e1. L� 20. Stairs Treads Risers Strings Handrail Balusters Stair Material Thickness Material Thickness Material Size Material Size Material F Size Basement Main Attie Disappearing make and model number Additional information - Paf�s P Oe--5 _ .scQi;o 0 F_ T*e- M►S r A*Aee44i j! ><.,s. eta ju-if f1oaQ Ti 4S /,V TftWc&1-VTiQE' 21. Special Floors and Wainscot(Describe Carpet as listed in Certified Products Directory) /YGrW 6 A'Ca m:, Threshold Wall Base Underfloor Location Material,Color,Border,Sizes,Gage,Etc Material Material Material m `o IGtchen Ir Bath • 6 p IG Naight m o Location Material,Color,Border,Cap.Sizes,Gage,Etc Heighl Over Tub (From Floor) U Bath OpmmgLy l 7% TO t 1 Etl !1{ is Additional.informationeAs.Tiivro, 8ATµe' 1WNSNO F1000 I-T1 4- F&OO ;t Qft Wbj'V4i / C-Tr 5 ELF fY'D, l u 1'L1 - T t Lf- rE E a 22 Plumbing. S A 7)D D U '�i 4 Q L 43 G• 4-1+rG. R ES Fvlure Number location Make MFR's Fbdure Identification No. Size Collor Sink Lavatory. - �- Water closet Bathtub Shower over tub Stall shower Laundry trays �. Tt6y _ Bathroom accessories Recessed material -!L A ram— number, Attached material number. Additional information 0 Curtain rod w},Door shower pan materiai ✓ I n-y L '(Show and describe individual system In comwete detail in separate drawings and specifications according to requirements.) public Water supply community system " individual(private)system': Sewage;disposal public 'cornmunity system individual(private)system' House drain(aside) cast iron the other House sewer(outside) cast iron tile. d other Water piping E ;,galvanized steel (, copper tubing other- f!1/ J w� Sill cocks,number `Domestic water heater type make and model heating capacity gph.100'rise. Storage:tank material capacity gallons Oas service utility company liq.pet.gas other Gas. . 0. piping cooking house heating Footing drains connected`to(( storm sewer sanitary sewer dry well Sump pump make and model- :.capacitf!.`` .. discharges into Additional information ref.HUD Handbook 4145A&4950.1 form HU042005(10/84t; Retain this record for thre ears Page 4.of 6 VA Form 26r1 52 and form FMHA 424=2 23: Heaany A'DDi.TiDNpL f �6K S/ty 84SF&AA Hot water Steam Vapor One-pipe system Two-pipe system �: Radiators Convectors Baseboard radiation Make and model �:Radiant panel floor wall cceH• Panel coif material ' 0 Circulator [3,Retum pump Make and mode", capacity 913rn• Baler make and model * Output Btuh.net rating Btuh: Additional inforrnatlon Warm air 0 Gravity, 0 Forced. 'Type of system Duct material'suppiy return Insulation thickness .Outs ide air intake Furnace:make and model Input Btuh. output Btuh. Additional information Space heater 0 floor furnace (D wall.heater Input Btuh.output Btuh. number units Make,model Additional information Controls make and types Additional information Fuel; Coat oil gas O fly pet gas eleciriic, other storage capacity Additional information Firing equipment fumished separately 0 Gas burner,conversion type .Stoker hopper:feed bin feed Oilburner pressure atomizing vaporizing Make.and model' Control Additional information Electric heating,system type Input watts .� Volts output Btuh. Additional information Ventilating equipment attic fan,make and-modet • capacity, cfm. idtcher exhaust fan,make and model Other heating,ventilating,or,cooling equipment Additional information 24, Electric Wiring Service . overhead underground Panel fuse box circuit-breaker make -AMP's No.circuits Wiring conduit armored cable nonmetallic:cable knob and tube other $peciat outlets13 range water heater other r Chimes' Doorbell- .� Push-button.tocations ~ Additional information 25.Lighting 6dures 47 ..-�/ 1j 4439 Total number of foitures` Total all owance.for fixtures,"Iypicai installation, $ Nontypical installation` .., Additionat information ref.HUD Handbook 4145.1&49W.1 form HUD-92005(10184) Retain fhis,record for year 5 of 6 VA Form 26-1 2 and form FmHA 424-2 G L� 26. Insulation location Thickness Material,Type,and Method of Installation Vapor Barrier Roof Ceiling Wall . Floor 27. Miscellaneous: (Describe any main dwelling materials,equipment,or construction items not shown elsewhere;or use to provide additional information where the space provided was inadequate.Always reference by item number to correspond to numbering used an this form.) f ' Hardware (make,material,and firrish.) 81eclal Equipment(State material or make;model and quantity.Include only equipment and appliances which are acceptable by local law,custom and applicable FHAstandards.Do not include items which,by established custom,are supplied by occupant and removed when he vacates premises or chatties prohibited by law from becoming realty.) N sfiAL-G New W Wo L E 1+4 e,t S e &031aA7 Porches Terraces I Xzm r �OQ Garages �urtu n�iVG A L c645 . 1 101,I4 A'A'a" Ad 'E1>�', Walks and Driveways Driveway width base:material thickness surfacing material thickness Front walk width material thickness Service walkwidth material thickness Steps material treads risers Cheek walls Other Onsite Improvements (Specify all exterior onsite improvernents not described elsewhere,including items such as unusual grading,drainage structures,retaining walls,fence, railings,and accessory structures.) Landscaping,Planting,and Finish Grading' Topsoil thick F9 front yard [I side yards 'Ej iearyard to feet behind main building Lawns(seeded,sodded,or sprigged). ®,:front yard side yards O',rear yard. Planting 0 as specified and shown on drawings as follows.• Shade trees deciduous caliper . Evergreen trees to. a&B Low flowering trees deciduous to Evergreen shrubs to. 8&B High rowing shrubs.deciduous io Vines,.2-year Medium-growing shrubs.deciduous ao. Other Low-growing shrubs deciduous 30 lddhtification—This exhibit shall be identified by the signature of the builder,or sponsor,and/or the proposed"mortgagor if the latter is known at the time of application. ' ate-mmlddlyyyy) ignature ;v ref.HU Handbook 4945.1&49 :1 form HUD-82005(10/84). Retain this record for Page 6 of 6. VA Form 26- 852 and form FmHA 424=2 The Commonwealth of Massachusetts Department of Industrial Accidents LRV Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): .Tb}�,� �— zl m Az 5A- y yy eexp/U� Address: l Q I VEF wey 1) A k1� City/State/Zip: Phone#:Are you you an employer?Check the appropriate bow Type of project(required): 1.El 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. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions I -myself [No workers' comp. right of exemption per MGL 12,❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Airy 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 vyhether or not those 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 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 f ne 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 ce fy u der the p and of p.4�u that the inf rmation provided above is true and correct Q Si at�re:l� Jlb.: 1 Phone Official 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 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the rece iver or trustee of an individual,partnership,association or other legal entity,employing employees. However the ' % three a arturents md4ho*u sid s therein,or the occupant of the `Ili" .Aonse'havin not,morethan p .,�_ owner.of a dwe lug•. ,g ,t. . ; • ` ` ction or repair work on such dwelling house enance constru to do mamt P persons dwelling house of another who employsp the grounds or building urtenant thereto shall not because of sue�u employment b�deemed to,b. an eiWloyer." or on g aPP. ...x - MCr1l cha, ter 152;§25C(��also statesrthat``ery state or local Iicensiag'aen�cy shall withJuol�l the,�seance or renewal of a license or permit to operate a business or to construct buu7lding4 m the comtnonv�ealth far 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 prmance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have keen presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the fr`, 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. SeIf-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 permWlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense 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 m (city or o ( P cy ' ed to the a be rovid • town);'A copy of the affidavit that has been officially stamped or marked by the city or town may p applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Aeddeuts Office of Investigations 600 Washington Sheet Roston,MA 02111 Tel,4 617-727-4900 ext 406 or 1-977--11E1ASSAM Fax 9 617-727-7749 Revised 4-24-07 wwwmam,pv/dia Section 9—Construction Supervisor Name Telephone Number Address City State Zip License Number License Type zation Date Contractors Rma11 Cell# I understand my responsibilities tinder the roles and reg¢lati ar Licensed Construction Supervisor in accordance with 780 k CMR the Massachusetts State Building Code. I understan a construction inspection procedures,specific inspections and f docameatioa required by 780 CMR and the Town of arnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contr for. Name Telephone er Address City State Zip Registration Number r F.gpiration ate I understand my responsibilities under the rules and sp gulations for Name Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. derstand the construction inspection procedures,specific inspections and documentation required by 780 CMR and own of Barnstable.Attach a copy of you FLI.C... Signature Date f Section 11—Home Owners License Exemption Home Owners Name: b`'_�7�0Avi/V� Telephone Number..APO 7-71 7 G) Cell or Numberlhq I understand my responsibilities ies under the rules and regulations for Licensed�Cznsfimction SSu�eeffvisor in accor' c"e' 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Tows of B Ie. ate �30 - Vf- APPLICANT SIGNATURE Signature*)41_C'1W—'J-� ate " Print Name�/� C' Dig C DS elephone Numb 6 `7,��2 E-mail permit to: Last updated:l in2017 I Section 12-Department Sign-Offs Health Department ❑ Zoning Board(ifrequired) Historic District ❑ Site plan Review Cif required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the f re department for approval, Section 13—Owner's Authorization I, . �{ � o °°•L�-gyp /6ilJA/ C,Q�Sg�, as Owner of the subject property hereby authorize /N r1W, Z* F���lSEE_ to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job -n + Sign a of Owner 0 date Print Name . I i i Last 11M2017 . 1 �FTHE Tom, Town of Barnstable *Permit# A-110 -OD76 P��0 Expires 6 months from issue dote Regulatory Services Fee 3S7 * BARN51'ABLE, + Richard V.Scali,Director AjEp�,�A Building Division o Tom Perry,CBO,Building Commissioner (�v 200 Main Street, Hyannis,MA 02601 �/Q ` www.town.barnstable.ma.us 508-862-4038 ����: 501�9.0-6230,��+. EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -,Vle Not Valid without Red X-Press Imprint Map/parcel Numbera3q Q �Address Prop e 1€��t�s��� �.�� • I--� �� �5 lam- v Residential Value of Work$ 5LI . " Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J Awl C Csw Contractor's Name � [® � � � Telephone Number 5!P-) YiA (S 11 Home Improvement Contractor License#(if applicable) 1114-7 3, Email: y ecSC c�Ll, Ij GV LI�Cl c LAC J/ Construction Supervisor's License#(if applicable) ('s..� ❑Workman's Compensation Insurance Check one: ®'I am a sole proprietor ❑ I am the Homeowner ❑ 1 have Worker's Compensation Insurance Insurance Company Name J\tcA -(6t5� Ccl 4;A!p- Policy# rv-1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ,vReplacement Windows/doors/sliders.U-Value "0•,.3 Cj (maximum .32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re u'red. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windo emporary Internet Files\Content.OLltlook\2PIOlDHR\EXPRESS.doe Revised 040215 neZ c PROPOSAL 663 J o aA MA Lic. #069680 Ion 79 Mayfair Rd j � South Dennis; MA 02660 capecodwindows.com H.I.C. #124793 (508) 398-1511 • Dennis, MA (866) 398-15.11 • Toll Free PHONE DATE. TO: M/M John Crosby 508-771=7562 5/25/2016 P 0 BOX 26 JOB NAME/LOCATION Hyannis Port MA 02647 Harvey double hung replacement windows 18 Pinewood Ave. Hyannis, MA :02601 ' JOB NUMBER JOB PHONE 7562/harvey DH SAME We hereby submit specifications and estimates for: Remove. seven pair or wooden"`dour, rr.hung "wtidow `sash' and —rep-1aced iirstall with-seven`Harvey Industry "Classic" all vinyl replacement style double hung windows in same locations. Locations are, ( three in east upstairs bedroom, three in west upstairs bedroom, and one in upstairs. bathroom ) . * New Harvey double hung windows will have a white vinyl exterior with a white vinyl interior, white hardware, 1/2 screens, low-e argon gas filled insulated glass and are energy star rated. New windows will have the grilles between the glass with a 6/6 pattern and have tiltwash ability. These are replacement style windows and some interior trim will be removed and replaced. The aluminum triple track storm windows will be. removed and not replaced. 2. Insulate the cavities of the new Harvey windows. 3. Take the old windows sash to the town landfill. gig. 4. Make arrangement for delivery of new Harvey windows. ; 5. Supply town of Barnstable building permit. * This proposal does not include any other work not described above. * All Harvey Industry products described above will be prepaid by the home owner. Any changes to this proposal must be done in writing and accepted by both parties. ** If this proposal is satisfactory, please sign the YELLOW copy and return with payment schedule. ** Please make a check payable to Vasco Nunez Carpentry in the amount of $ 1,931.48 for your new Harvey windows described above, and please include this check with your signed proposal. Allow 3 weeks for delivery. We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Three Thousand Four Hundred Sixty One and 48/100 Dollars dollars($ 3461.48 ). Payment to be made as follows: ' Labor: 50% Down payment to start at time of start. . . . $ 765.00 labor: 50% Upon completion at time of completion. . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 765.00 Total labor & materials to complete this job less new Harvey windows. . : . . . . . .$ 1,530.00 All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized JL—i involving extra costs will be executed only upon written orders,and will become an extra Signature , charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within f s.da 30 y Acceptance of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature ''. a, Signature Date of Acceptance: j 'ROODUCT 13128G USE WITH 77/C ENVELOPE Deluxe Corporation 1-800-328-0304 or www.deluxe.com/shop PRINTED IN U.S.A. A ------------------ A Iylassc1C11USetts - De,aI,t;rr-,%I n I Sda/nog•ssl!W mmm 31 1 u I or , l I.�IiC.,�'�:,, n Sd4�o t'..,•! s n o13ewjo/ul aulsu93 d i�CCy 3ru^ii•".d7; asua011 s141 do u0i3e30nau io)asnea sl apo3 Rulplin8 a3e3s :(,'IiiLKe)'tIl'Ti i)C L.irensF; CSFAI'F:A-069680 sUasnyoesselAl 943JO uoll!Pa 3uaiin3 a Mssod of amiie�-�'"'"-`� ' VASCO E NUNYEZ:t ,r 79 MAYF iR ItHD. South Dennis lf/dA-026G0 Ilk azis,�O aAgaadsauc`o1aratP 7uipim ,{ qiossaaor �CUL [OSgU[ 3M i n;�rnissic�c�,r 10/03/2016 It ,P,([?1UP-j-0M1 pUU-0110-PaPlAsaa �%r' Y�i,iirurrvrrivrz%/�r/!'%/rr,Lrrri'�,•rdc//t i ' !I office of Consumer Affait•s&Business Regulation IMPROVEMENT CONTRACTOR i a hju GIs.not RAC a t_ r «OR _ p n o str _.a , pp 1.24793 Type' Individual t vidual Vasco E,Nunez Va sco Nunez 911Z0 VW`uo;soa Ij 79 Mayfair Rd. a In - OL 1 «z« I IS S ! ).1« i d I d 0[ �� S.Dennis, �.G� : I not �n�a nts, MA 0266 .� I $ssautsn II«stt 0 «•`�'"�� fl P .taulnsuo i — i .IJ1� o aal 3 .13 - . f :o u.tn a.t U Undcrsecrelnr 3 3 uno •a Y i P �3 3«)tto «.II t � I !a dXa at a.lp a i (� ! (1 ( luo asn Inpinipui ao t«n not u.t 3 P.1 .1 isi$a.t.to astwai'i The Comntonivealth of Wfassadiusetts - Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA021.1.1 wiv.inass.gov1ilia Workers' Compensafion Insurance Affidavit.: BuildersfContractot's/Elerti-tci ins/Plumbers Applicant Information Please Print Leaibb Name(Business organ zationllndividuai): Address: GI�l�� City/State/Zip:::. ; vlUWI-S A G Phone#: Are.you an employer"Check the appropriate boa; Type of project(required): 1.❑ I am a employer u i#h 4. ❑ 1 am a general contractor and I loyees(full and/or part-time)•* hay*e hired the sale-contractors 6. ❑New cD.nstructron 2. a sole proprietor or partner listed on the attached sheet_ 7. ❑Remodeling ship and have no employees Thee sub-contractors have g_ ❑Demolition working for me in any capacity- employees and have wodters' [No w orkem' comp.insurance comp-insurance.: q- Building addition required.] 5. ❑ We are a corporation.and its 10.❑Electrical repairs or additions 3.❑ I am a hameommer doing ail,%,"k officers have exercised their 11.❑Plumbing repairs or additions sel£ o workers'comp. right of exemption per NNIGL 152, 1(4),and m e.have no 12.❑Roof repairs c. insurance required_]f `� 13.k Other ' r . employees.[No workers' comp;insurance required..] *Any applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors Hurst 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an empdower that is prosiding workers'compensation irtsitranee for rriyeisiplo�tees. Bedois�is trite policy artd job sr`re information. Insurance Company Name: T Chi-Nl :Tb 1 , rn Policy##or Self-ins.Lic..,4:__ ZD I I Expiration Date:_ (` i?Ok Job Site Address- City/State/Zip:-4w auvi�& %4 'k"� (°j2LC(-- Attach s copy of the workers"compensation policy declaration page(shou-ing the policy nutdber and expiration date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 andtor one-year imprisonment,as we11 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 Harter thlepains and penalties of perjury that the irtfortilwion provided a bore is tare and correct Si hire: Date: CJ Phones OfflZiad use onIy. .Do not write in this area,to be completed by cit33 or town of ciaL Ci.ty.or To,t,n: Permit/License# Issuing Authority(circle one): L Board.of Health 2.Building Department. 3.Cityll`ouvm Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#; Client#:647900 2NUNEZVA ACORD., CERTIFICATE OF LIABILITY INSURANCE FgATE(MWDDMYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THISE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY TH BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT- Dowling&O'Neil Insurance Ag P ME: 9731yannough Rd,PO Box 1990 A/C No El):508 775-1620 AX-M No A :5087781218 EIL Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC a INSURED INSURER A:National Grange Mutual Insuranc Vasco E.Nunez III D/B/A INSURER B: V.E.Nunez Carpentry INSURER C: 79 Mayfair Road INSURER D: South Dennis,MA 02660 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY EFF 20W INSR WVD POLICY NUMBER MM/DD/YV LIMITS A GENERAL LIABILITY MP05117J 9/12/2015 RENCE $2 OOO OOO X COMMERCIAL GENERAL LIABILITY - ovence $500 000 CLAIMS-MADE a OCCUR one person) S 1O OOOSONAL&ADV INJURY S2 000;000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO- LOC PRODUCTS-COMP/OPAGG $4,000,000 JE AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO Ea accident S ALL OWNED BODILY INJURY(Per person) S AUTOS SCHEDULED. AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE $ Per accident S UMBRELLA LIAB OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE g DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU- OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N . IQRY LIMITS ER OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF,, NOTICE WILL BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S157633/M157632 CBD . CAPECOD INSULATION [j7 Il6''s GUTTI bS Msuu om SOSV4ND[C 6ATT5 WTlEQ3 lNSUtATtON Q1LIN05 1-600-696-6611 _ Town of Yarmouth Regulatory Services Building Division Address— 1146 Rte 28 Address—South Yarmouth, MA 02664 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. The work meets 780 CMR Mass State building codes; or Mass Save, Cape Light Compact specifications. \Propegry Owner 1 Property Address Village w Insulation Installed: Fiberglass Cellulose R-Value Restricted Uric ricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) (X ) t otCy (X) ( ) ca Floors /5A P\q5 Walls ( ( ) ( �3 ) `r se 6�W.e, e Sincerely Henry assidy Jr,"President Cape od Insulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -® l 3<O Map _ Parcel (a?) Application # Health Division Date Issued f 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address � �e�� Village Owner ��d1�� Address_ Telephoned /3 e '771 7,!1'f Z Permit Request a !.j C��v��.f� 12./�G xd a l� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation A Construction Type/ll Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .2/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes P-No On Old King's Highway: LJYes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other :K= ' � U) c v ZE Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) :"? o Number of Baths: Full: existing new Half: existing 1 news a` ? ZZ Number of Bedrooms: existing —new U c:+ sj: Total Room Count (not including baths): existing new First Floor RoomlCount .._ 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) Name T ,j � �� > ,�2/ Telephone Number Joe zx� / 5l : v Address icense # '00 Home Improvement Contractor# Worker's Compensation # 4Z44od J�-9,5EI ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1410oyeF U >° SIGNATURE DATE ,1 f r c FOR OFFICIAL USE ONLY L' r APPLICATION# DATE ISSUED P MAP/PARCEL NO. r ADDRESS VILLAGE „ttt S OWNER DATE OF INSPECTION: FOUNDATION 4 FRAME INSULATION .Y FIREPLACE ELECTRICAL: ROUGH FINAL j PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL ` FINAL BUILDING `t } DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts - Department of Public Safct% Board of Buil'ding Re-ulations and Standards_ Construtction Supervisor License Licen CS 100988 a w HENRY CASSIDY 8 SHED ROW k WE;3iTAARMOUTH, MA 02673 � Expiration: 11/11/2013 ('rrnuui,viuner Tr#: 7620 = Office of Consumer Affairs and Business Regulation -.-. 10 Park Plaza - Suite 5170 � g Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration. 12115/2°bl4 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE ----- - ---- - __...-----__.__---__.. SO. YARMOUTH, MA 02664 = Update Address and return card. Mark reason for change. SCA t % 2QM-O5;t t Address ❑ Renewal F] Employment (_l Lost Card - 1����(. �(04/LI/GC7tfft(:C7lr/�/l�'(�(C7.9dCKC1lCCdC'C� ' L\ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only IQ '= OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation xpiration: 1211'512014 Private Corporation 10 Park Plaza-.Suite 5170 Boston,MA 02116 CAPE COD INSULATION INC HENRY CASSIDY 18 REARDON CIRCLE. SO.YARMOUTH, MA 02664 Undersecretary of val' witho t nat re , No. Cllent1t: 4597 GCINSUL `AG�� ,, CERTIFICATE OF LJAEILITY INSURANCE DAfe(N;hIIDI,JY;YY; TH1'CERTIFICATE IS ISSUE lJ AS A MATTER OF INFORNIKI1Uri ONLY AND CONFERS NO RIGHTS UPON E CERTIh'ICATE HI�L07/02i2OS, CERTIFICATE DOES NOT ArFIRMATIVELY OR NEGATIVELY AIW-NCI,EXTEND OR ALTER ThIE COVLRACI4=AFFORDED BY THE POLICIES ktkL,OW, 1111S CERTIFICATE OF INSURANCE DOES NOT CCW,l Il U I k A CONTRACT BETWEEN 1'HE le UING INSUI�f;lt(S),AU rhIQRILLU REPRE$L:NI`A'I'IVE Qlt PF1Ql"]L10ER AND 111E CERTIFICATE IIULLiEIt. INIPORTgNT:If tl,o cerllflt ate hulLter ie an AbO11"IONpL INtiUKt 0.Ihr pulicy(Ies)must b endt)rsed.II'SUE]RCIGATION 1$WAIVED xutlJu,:1 ro Ulc Icl nix unLl cuncUtluna of{Ilo policy,cn)tale pull Clef;"lay r,,,;,:I,,ell ql"ICIDrI Dfllglll,A hL 1IBlIICIIJ QIl this Ck1IJI1(U(( (14e:! II01(:UIItVf 60I113 IU I11C Cor1111cJ1u 1101L10r ill hIAj 7;ItSUGh tlll(tPl9tlllltlJl(9), ......_.-......._._.__....-----_ �';i,IDIILLit _ NAME Myr 1rCl Y0t111.1 - _ _._.,--___..._._.._._..... ftuS.lcr:; d.Gray IItY. -So. Clarints __..._ PIONE'__—._ ._.—..—.. ,,._...�_.�____-. 4J4RLIUIC0 I Arc,No.Emj1508-760 I6U2 rnX ..•_d l._.. /-tl ah_.._...116•.IJII _. ---._.._--- tti� Stn.Il11 OunnIE:, MA U216UO-1GU'I _ ,.._., INGUI10(4)AFFOfl11NVG COVINnItL _..__.—.._---,------- ............ IJAIC N _ - N,uNENn, eerloas Insurance10333 Crape cad (n5ulatlon inc INSl1NERD:Evall$1011111suranCO CwIlp;tny I:;S Yarn)outfl F;ua({ wsuk Rc:Atlrintic ChzuterinsLI"I"-It llya1163, MA 02601 IN9ukER0 ominerceInewraliceColllpany uvsukeR E: 4LhTIFII'.Afk NUMBED. _ RL:VISION NUIVIL1L=fi; U,I t9 lu Cthll!'1 InAC IIIt' NptILIr: Or wtil,t2ryN(E LISIEL, I„ HAVE BEEN ISSUED TO IHE INSURED NAMED ABOVE FUR I'HL I'OLICl I'E:LIOI! NDI yIL.0 NL)IWIII ISIANDING ANY N(z'0UIRENIENI', J�RNI OF CJiv1111101,1OF ANY CONTRACTOR OTHER DOCUNIENT WITH 1.tI=SPLC1 Tu wl-11C11 llu5 aih<IIHt:rUG: MAY BL, f3SUGD OR MAY PERTAIN. THE INSUFWNt:r ;u rl:n 060 BY THE POI.ICIES DESCRIBED HERE-IN IS SU11.IEG'f"1-0 ALL 'I1jE 1'kKA15, US)ONS ANO CONDf 1_I0NS OF SUCH POLICIES. LIMITS sF10wr1 Irl�.'i rh1VE BEEN REDUCED BY PAID CLAIMS. Fi K __--�._._ __�—___ —_--__._ ._ + ADOLSUDR 1'YNr'OF INyUNANGE POLICYEFF PiILIGYe)f'F' '"""` --••--_._._..,______.._._.......___....__. _ Fo1.hrwl,lunrll th1hI1D0lYYYYL(A1M)OD/YYYY1 LIM1Yb {, tiLNLNAL LIAt11C.11'1" _ UP826306: 4101120'12 U4/011201' EACH OCCURIINC..E x'1,0UU UUU -~ x Ia!h1htLNCIAI GL-NkHAL t.IAaILIIY ------— ��-- ,,,, 00 u90 C LAI M ti-AM1AD t I—.-.-------i.-___._.._.._„_. I __X GCCUr2 A Nil�0 Ell((Any uJIL)p6fdt)n ti UOU --- ---- PkA8o1NAl A ADV INJUI-IY v'l 000 000 OENEI:AI_AOI;jRQ0Afl; _ $2,000,U00 t 11 L Ali4H>;UAI k LIMI T APPLIGkI PER : —' -- -------- .. PRO- PR000GTS-GOMPIUF'AEC; Y Ut1U 111111.. u AUTOMUk11L1;L AE,ILI I V IL CGhll311�f:0SINGLCI'IhIIT_-- 12MMBL'KVIVih 4JU1�2U'12 04JU1/2901; EaaT.c¢Irnil___.__— I UUU UUU.___. BODILY INJURY P., .c,... sCNtz)uLr;u AM ON OS _ AU I-Os BODILY INJURY(Per A-ivanl) S NON-O}NNEL1 - — - - '--- x 1,(F(W AU l05 X I OPERh' _ .__.. Auro;J I•f X' UMd Mkt lA LIAN ------•_--__.._._�_____._.._...___ __.._0OU _..._ )(ONJ453512 4/0'1120'1204101/201' CAcr,on,ualace .r1000 1 LLAINIa�MAOk rn7 X ru-lr..rallorl IUGUU _._._-._.__ wwt� l<a r UNIMtNtlAI ION AND MILOYeFUd LIAU11.1 fY WCAOU525:i L1� 6/3012012 0@301`10,1' k wesr�ili: I - __. AW I1itrnlNlL i,} f�,N L i Y/N tY11nu111.J-, lCLi___;_ . �E Y l U { _ u�t It:ElUru1�M ti NIA A C.L,f1,Cr1 Acc.lol;NT ,1 UUU (hlvuWt0ly d,NM) `--N� ._L..1_.,._.,1, 11 yuo,aum:nun,uxlo, 6.L.DISI_ASC-f:A cr,,f�l_ovkC TY'I UUU UUU ._.._-- D sL'HINnoNpr USE' 11oNs,_-_f.lu,. - C.L.DhCnaf •Poucv uhul' y'I ODU UUU ---- --.._.. i "CJI:NII'IION UI'UNL-KAI IONN 1 LOCATIONS f VL•HICLES(All-h ACORD 101,Add l,l.,,,,+,.,,,�,;,,>;4�hpuultl,It IAPPJ BpgGd 1@ fUgtlllow •,Workars Comp InfcJrrnntion +" IIILautluil Utticer'a Of P1'pprIetor5 Certirlt:ate IloidUl i;i 1IIQIUd4'0 tla an additional insurdd urRl 1 6011(JTal LiaUility While raqulrod by written contract or agreement, :EC:TIFICa\TC IIQL.UL=Ft --�_— CANCELLATION Cups God Int;ulatiUn,lnc SHOULD ANY OF THEAaavt Ot:3CRIda)POLIGIE,11ECANI;N11:)0Ic1 GRL• THE EXPIRATION DATE THEREOF, NOTICE WILL BE Ur.LIVkketl IN ACCORDANCE WITH THE POLICY PROVIWON3. AU HLIR12E0REPRf_SENIATIVE Ib Mb-2010 ACO14D CORPORATION.All d9li ,ivsaryucl. ' Acultu z (=U'IU/U5) I of"I (Ile ACORL1 t1y111e and logo:In,roUlafirod marks OACORD 1fSU3ti�lUlMt)384t1 MkY The Commonwealth of Massachusetts Pr1nt Form ., r =M Department of Industrial Accidents Office of.Investigations `l 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f apt Address:_ City/State/Zip: V {MA' Phone #: -�2_0�- Are you an employer? Check We appropriate box: Type of project(required): 1. I am a employer with 90 4. ❑ I am a general contractor and 1 employees (full and/or-part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ 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 3.❑ 1 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof rep a'rs insurance required.] f c. 152, §1(4), and we have no j �e�#11I employees. [No workers' 13.� Other W rK h comp. insurance required.] 'Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. 1-lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t .onUactors 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. I f 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:__A�ck V � C/�tG1V I� (�G1/1G�i 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 tine 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 tine 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 cer 'y nller the pains a, penalties o er'ury that the in ormation provided above is true and correct. Si)nature: / 7 Date: Phone#: -7 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: Phone#: f Housing Ass lstanC�. Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work may be done by the Weat erization Program of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: p 1" The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right.to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) f — . ^. Date: . 44 p(( Agent. (signature) Date: HAC approved Weatherization Company : L- CCOL L� All Cape Ener �Cape Cod Insulation` ape Save Efficient Buildings,LLC Fro.ntirrEtw7gy, oluions,.:• L,oh ,&S,ons , ;.<.:. ti. Resa{ution Energy TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION Map a . Parcel Permit# �� Health Division L �- � Date Issued Conservation Division 61 hoo Application Fee Tax Collector cOd oZ. D to `- ) I I 0 3 Permit Fee Treasurer K I 3 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address q �10'� r Q66 C O -C� Village Owner eLL,) IS.A4 Address \ � Telephone 7) fi Permit Request \ Co �� ,W ( t -.,6 N/A[—/VD C)D b as -ro . c -(, o.�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tog newZ:) O9R/. Zoning District Flood Plain Groundwater Overlay n AD -� -T1 Project Valuati6n`� Q®o Construction Type - N Lot Size tZv 5� �Z,`; t Grandfathered: ❑Yes o If yes, attach supporting ISO mentati . Dwelling Type: Single Family )- Two Family O Multi-Family(#units) rn sv Age of Existing Structure 3CI ti raS_ Historic House: ❑Yes LIN6' On Old King's Highwa 0 Yes 43_f4o Basement Type: ❑Full let;rawl ❑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 O Total Room Count(not including baths):existing (�2 new�_ First Floor Room Count 4 Heat Type and Fuel: as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 4No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes )iallo Detached garage:O existing ❑new size d Pool: 0 existing ❑new size o Barn:O existing ❑new size c7 Attached garage:0 existing O new size d Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ ,Commercial ❑Yes 19 No If yes,site plan review# ,,Current Use Z V%LL Proposed Use S�-M- - 1 BUILDER INFORMATION Name Lc � �r3o� r Tele hone Number Address 8' C Z&L <Q �� _ License# L.S r 71n'2,q Home Improvement Contractor# Worker's Compensation# V-2s® ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO j SIGNATUR -'° DATE c`A-- 03 R. FOR OFFICIAL USE ONLY . ..> ~ PERMIT NO. DATE ISSUED r MAP/PARCEL NO. , a. ADDRESS VILLAGE OWNER — r' DATE OF INSPECTION: e FOUNDATION 3/3�0 , FRAME 6 FR/17 16 3 ,>?- _ 1 INSULATION FIREPLACE T ELECTRICAL: ROUGH FINAL,- PLUMBING: ROUGH FINAL-. GAS: ROUGH FINAL FINAL BUILDING J - / DATE CLOSEDwOUT 4 } ASSOCIATION PLAN NO. ' r' I The Commonwealth of Massachusetts Department of Industrial Accidents Office atlnyestf9atiens < 600 Washington Street Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit e: location: a hone# -""t 4 clitv ❑� ��a homeo //er performing work myself. 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L:n,�.:a {.....,r..r,..::.............{im.:....:•rr:.........:...:•. .......................:;.......... v...;,y, .... ..............;•v5:;:::::w:;•Y;}}n:,t:};:;^iv. r .r<'^.......:..::.Yn•%•}:;{;•:•i{hi>:t•5}s;:n$:�}:::.;}:•}S:;try;;•5:•>:L•}:•:::L•:c.};:;t%+}:.;;r:$$:•}:•>$}}::;•.;.}:{:::..;.:: •..:� gadbue to s ecm a coverage as regtdred raider Section ISA o[MGL 151 eaa lead to the imposition of erhninal penaitin o[a Sae np to Sl,St)D.DO md/or one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Sae of S100.00 a day agslnst ma I mtderstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify the enalties of perjury that the information provided above is true and tarred Date — — Print name official use only do not write in this area to be completed by city or town official perndt/Iicense# ❑BuO.ding Department city or town: QLicensing Board required ❑Selectrnews Office ❑checkif immediate response q ❑Health Department contact person: phone#; der Uni"d 9/95 PJ N n 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 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 and who resides therein, or the occupant of the dwelling house of dwelling house having not more than three apartments 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 as employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold th sspup ce or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an 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 supplyingcompany: ames, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an �i date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the `law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided theme at theb Please affidavit for you to fill out in the event the Offi f the ce of Investigations has to contact you regarding applicant be sure to fill in the pemnitllicense number which will.be used as a reference number. The affidavits may be retariR*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. ///j/%%///%%///%/%///%///%//////////%///%%%//////%�%%////%�i,, �%%%%�///%%/ The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents amce of Invesugatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 I °FIME,° Town of Barnstable ti Regulatory Services ' BAMSPABLE. ' Thomas F.Geiler,Director 9 MA95, g ' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. tt Date \ -6 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: Estimated Cost 6 Address of Work: Owner's Name: Date of Application: "C- d I hereby certify that: Registration is not required for the following reason(s): Work excluded by liw ❑Job 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 apply for a permit as the a ent of the owner: ' Date Contractor Name Registration No. OR Date Owner's Name 1 i 3 I � I i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 0 square feet x$96/sq.foot= �� x.003 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Q Permit projcost � I�� � G-�✓ N S �� � C�� � � ���� i L _ ._ . M CMR Appends J Table J531b(continued) prescriptive Padmga for One and Two-Famiiy Residential Buildings Hated with Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Hearing/Cooling Arm'(Yo) U-value= R-valued R-value R value' Wall Perimeter Equipment Efficicnc)� Package I R value' R value' 5701 to 6500 Hating Degree Days Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 12% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: ( � n 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): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303 a 780 CMR Appendix J Footnotes to Table A2.1b: 1 GIazing 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 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Y 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 ventilated portion of the roof. the conditioned space and the Wall R-values represent the sum.of the wall cavity insulation.plus insulating sheathing (if used). Do not inc.14de 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 mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. S 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. Tl:e 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 br.:sements must be included with the other glazing. Basement doors must meet the door U-value requirement &=ribed in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipmerior mo re 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 requirements 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 J1.5.3b. 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). l 43 I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 -671 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot=_ 1%, Gl,-V . x.0031= plus from below(if applicable) ALTERA.TIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq, ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable_) at Permit Fee cost i ,Barnstable Assessing Search Results Page 1 of 2 T. "5+.. t 3 / x era, atfc ri y ri i 9 Home: Departments:Assessors Division: Property Assessment Search Results —back to search 18 PINE WOOD A VENUE Owner: CROSBY, JOHN &JOHANNA Property Sketch Legend Map/Parcel/Parcel Extension 289 /108/ Mailing Address ��� r CROSBY,JOHN&JOHANNA 9i,•g J r; ��ir'�,i,A 3 i11��� j h f z, P 0 BOX 26 (3. HYANNISPORT, MA. 02647 s Assessed Values: Appraised Value Assessed Value Building Value: $87,400 $87,400 Extra Features: $2,400 $2,400 Outbuildings: $0 $0 Land Value: $44,600 $44,600 Interactive Property Map: ap requires Plug in: Totals:$ 134,400 $ 134,400 1 have visited the maps before Show Me The Man April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: CROSBY,JOHN &JOHANNA 8/15/1983 3817/184 $67,500 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,263.36 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3% of Town Tax Hyannis FD Tax $388.42 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $37.90 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,689.68 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/11/2003 I Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.34 Year Built 1961 Appraised Value $44,600 Living Area 1487 Assessed Value $44,600 Replacement Cost$107,863 Depreciation 19 Building Value 87,400 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 1/2 Stories Heat Type Hot Water Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,400 $2,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/11/2003 I j � f :. Op AVE t NW 289123 ' #11 ' IN E � # 118 � Amasswq y Md. an joy gjave ��- 65 289104 H � � E 2884.2 IL im aliz # 130 09, www 289 V ow, UK_ k :. K 2 ., 289159j #o 8146 # 2 pf OOD vE A uMwm P'NEw � t 288370 to 9 288 4 ,/W E` k t E ` ' k'+`9 �-V✓r,EE €I� �, b,+ € .�E '.1, za,. # 1`54 woo $ tyu y 2"Sub 2'." € 28 1� rc "„1 8 1Tipilil � Er v: #5, �,, � _� 20 ■ yA i y � W � 9 89102 121 7 `j2891 t3 #s$ ` 288143 x 55 289104 �t" # �1 ? 293 881�44 TO 31 � � n r 289 08 w r . 2$9107 #? am $� y288155 2891`59 #so 288146 � .! #42 f 28J106 �� f s #54 �a -, r'_- _ �� Rs 8 ' ... \'E 4 28 154 DA V Wpp � PINE y y 2147 #ss S i WIRM r �' '' 288073 28807 #2s 1 I 9.4e Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Ma usetts 02108 Home Improve e�_Cantr�ctor Registration 11 .=— Registration: 105530 Type: DBA CA n �--.Expiration: 7/17/2004 MICHAEL A. BINNALL ADDITIO '., Ci ; Michael Binnall _ w 78 CENTER ST APT. 117 = DENNISPORT, MA 02639 Update Address and return card.Mark reason for change. 7! Address rl Renewal 7-11 Employment F 1 Lost Card ~{ � � FV ✓/ie �i 10,2t BOAR© 17 B''ILDIN,, RE%W1LATLicense CONSTRUCTION SUP-ERUISNumber 1CSn`, 0454,08 Nit sjTr.no: 1' Restricted To 1G ' MICHAEL A BINNALL _ {' 78 CENTER ST#1 17 I DENNjSP.®.RT, MA 02638 � Admnlstrafor �coxSiRn�TFO 0 SUr00MS �Y aches =sore` uaIdin Coe Dampen eCH .z 3. The Massachusetts State Building Code (780.CAM) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall,seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.1.23.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size,configuration,orientation,form of construction or percent glazing,but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/mstallation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a"sunroom".It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential. energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/.seal durability and/or weather tightness of the sunroom • Adequate ventilation Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.123.1,..requires that the actual oronerty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. Signature of A Bu• g Owner Date Print Name Address of Permitted Project E Owner Address(if different than project location) Owner's telephone number RIDGE BEAM 'urn026TJ-Beam(TM)6.05Seria 0 0 1 3/4" x 14" 1.9E Microllam@ LVL User:1 1/16/03 1:29:10 PM Pagel Engine Version:1.5.12 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM2 Roof Slope70M2 F_ Film � 16*31/2" All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:6'6" Primary Load Group-Snow(psf):25.0 Live at 115%duration, 15.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Snow(1.15) 195.0 130.0 0 To 16'3 1/2" Replaces ROOF LOAD 30/20 6'6" SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.63" 1588/1114/0/2703 L1: Blocking 1 Ply 1 3/4"1.9E Microllam®LVL 2 Stud wall 3.50" 3.63" 1588/1114/0/2703 L1: Blocking 1 Ply 1 3/4"1.9E Microllam®LVL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s): L1: Blocking -Bearing length requirement exceeds input at support(s) 1,2.Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 2647 -2219 5353 Passed(41%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 10561 10561 13949 Passed(76%) MID Span 1 under Snow loading Live Load Defl(in) 0.405 0.798 Passed(U473) MID Span 1 under Snow loading Total Load Defl(in) 0.689 1.064 Passed(U278) MID Span 1 under Snow loading -Deflection Criteria:STANDARD(LL:U240,TL:U180). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. PROJECT INFORMATION: OPERATOR INFORMATION: MIKE BINNAL Andy Shakliks 13x16 ADD Mid-Cape Home Centers Route 134 PO Box1418 So Dennis, MA 02660 Phone:508-398-6071 ext4987 Fax :508-398-4559 brubel@midcape.net Copyright 9) 2002 by Trus Joist, a Weyerhaeuser Business Microllam^ is a registered trademark of Trus JJoist. C:\Program Files\Trus Joist\TJ-Beam\Job Fi1es\13x16.RIDGE.sms �T� 3 r RIDGE BEAM "^ reuserB,uin� 1 3/4" x 14" 1.9E Microllam@ LVL TJ-Beam(TM)6.05 Serial Num er:7002003607 User:1 1/161031:29:11 PM Page2 Engine Version:1.5.12 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Operator Notes: NO PLAN PROVIDED PROJECT INFORMATION: OPERATOR INFORMATION: MIKE BINNAL Andy Shakliks 13x96 ADD Mid-Cape Home Centers Route 134 PO Box1418 So Dennis, MA 02660 Phone:508-398-6071 ext4987 Fax :508-398-4559 brubel@midcape.net Copyright � 2002 by Trus Joist, a Weyerhaeuser Business Microllam0 is a registered trademark of Trus Joist. C:\Program Files\Tres Joist\TJ-Beam\Job Files\13xl6.RIDGE.sms FILE# MIP 22751 CENSUS TRACT# 125 CLIENT: DUNNING&KIRRANE, L.I,.P.. DEED BOOK 3817 PAGE 181 OWNER: JOHANNA CROSBY38 PAGE 91 LOT ' APPLICANT: . SAME ASSESSORS PLAN 289 PLOT 109 M O R T G A G E I N S P E C T I O N P L A N O F L A N LOCATED AT 18 PINEWOOD ROAD BARNSTABLE, MASSACHUSETTS SCALE: V=40' ,August 23, 2001 f � LOT 40 _ 12r S' l r Z5pr LoT 4B (0`y- kV Sva 14,600 .F A- oto U Se�K LoT 47 WT 4,) �tlr I%z sue. 123 BIT, D DRIVE I R 1 V � t I tr i PINEWOOD ROAD CERTIFY TO DUNNING & KIRRANE, L.L.P., CTX MORTGAGE COMPANY, AND ITS TITLE INSURANC OMPANY,THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS.EXCEPT AS SHOWN A HAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION. THE LOCATION OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE 'ZONING BY-LAWS WITH RESPECT TO HORIZONTAL a.,e DIMENSIONAL REQUIREMENTS. \ KENNETH THE DWELLING SHOWN HERE DOES NOT FALL WITHIN �( 1..1=trig-IRA A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY#250001-0006D DATED 7/2/92 BY THE F.I.A. ��ti—�.: LAB 4,� I THE EXACT LOCATION OF THE BUILDING SHOWN CAN NOT BE DETERMINED WITHOUT AN ACCURATE INSTRUMENT �` c"� � �.o Kenneth R. Ferreira SURVEY.' Engineering, Inc t P.O. Box 1903 ' New Bedford, MA 02741- , 1903 508-992-0020 Fax: 992-3374 GENERAL NOTES:(1)The declarations made above are on the basis of my knowledge,information,and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land surveyors practicing in Massachusetts. (2)Declarations are made to the above named client only as of this date. 3)T1us plan was not made for recording purposes,for use in preparing deed descriptions or for constructions. (4)Verifications of property line dimensions,building offsets, fences,or lot configuration may be accomplished only by an accurate instrument survey. t `pFI14Efp The Town of Barnstable BAR ABLE. Department of Health Safety and Environmental Services T M �b r� . 0 A559. �0 "'fo May Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: o FF/i[ rC2-0-4 3 y Map/Parcel: 89 Project Address: / h//V��- Builder: 101 C The following items were noted on reviewing: S/4 CA,r4 e1 ri/ �o-a T/1/4-, �Nd 0 a 73Glify` 4 1/ CL Reviewed by: Date: q:building:forms:review 1 18 Pinewood Ave. Hyannis, MA 02601 o April 2, 2018 -n Attn: Jeff Lauzon Town of Barnstable Building Dept. C' Eo M 367 Main St. Co Hyannis, MA 02601 Dear Mr. Lauzon: I request approval to amend permit B-18-1 that you issued on January 2. Subsequently, my wife and I decided to reduce the scope of our bathroom remodeling project as per the enclosed exhibits that I signed again today and that the VA recently approved: (1) original plan with amendments (2) before/after sketch of floor plan (3) narrative detailing work to be completed The plans show the existing bathroom increased in size and the adjacent bedroom decreased in size. I further understand that since the bathroom expansion has reduced the width of the adjacent bedroom to less than seven feet, that it cannot be designated on;any future plans as a bedroom. If you require any additional information, please so advise. Our telephone and email info are on the original application. Very truly yours, �I y, f f John,Crosby enc. 3 � ,►.� Town of Barnstable Building �. Il IlIlIl onxtrslne Post This;Card SoThat it is Visilale From the Street-Approved Plans Must be Retained*on Job and this Card Must be Kept',Posted "'''M �' Until Final Inspection Has.Been Made. emit +° Where.a Certificate of Occupancy,is Required,such Building:shall Not:be Occupied until a Final.Inspection has been.made,; ,er.mit No. B•18-1: Applicant Name: CROSBY$JOHN&JOHANNA Approvals ,ate Issued: 01/02/2018 Current Use:, Structure. ermit,Type: Building-Addition/Alteration-Reside Exiration Date: 07/02/2018' Foundation:ntlai p � _ - ocation: 18 PINEWOOD.AVENUE,HYANNIS Map/Lot: 289-108 Zoning District: RB Sheathing: )wnee on Record; CROSBY,JOHN:;A JOHANNA Contractor Name:': Framing: `1 1. address: P O BOX 2fi: Contractor License. 2 y. b HYANNIS PORT, MA 02647 1 Est.P roject Cost; $ 15;000,00 Chimney: ,escription: CONVERT EXISTING BATH TO HALF BATH;W/LAUNDRY AREA, Permit Fee: $_126.50 CONVERT EXISTINGIEFT REAR BEDROOM TO FULL•HANDICAPPED .;Fee Paid:: $226.50 Insulation: BATH. INSTALL WHOLE HOUSE GENERATOR EXTERIOR OF'.BUILDING- Date:• 1/2/2018 Ffnal:: REMOVE/REPLACE 2 EXISTING WINDOWS(JOHN Y DISABLED VET WITH A TERMINAL ILLNESS)FOR Plumbing/Gas DOCS Rough Plumbing: ro)ect Review Req: Building Official Final Plumbing: his permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: II work authorized by this permit shall conform to the approved application and the approved construction documents for whlch this permit has been granted.. II construction,alterations and changes of:use of any building and structures shall be incompliance with the local zoning by laws and codes. Final Gas: his permit shall be displayed.in a location clearly visible from access street or road and shall be maintained open IC r,pubJirinspection for the entire duration of ie work.until the completion of the.same, Electrical he Certificate of occupancy will not be issued until all applicable signatures by the Building and-Fire Officials are provided on this permit, Service: Ainimum of Five Call inspections.Required for Ail Construction Work: Rough: Foundation or Footing Sheathing Inspection Final: All Fireplaces must be inspected at the throat.leve.l beforefirestflue lining is installed Wiring&Plumbing Inspections to be completed prior.to Frame Inspection Low Voltage.Rough: Prior to Covering Structural Members(Frame Inspection) Insuiation Low Voltage Final: Final Inspection before Occupancy Health Mere applicable,separate permits are required forflectrical;Plumbing;and Mechanical Installations. Vork shall not proceed until the inspector has approved the various stages of construction. Final: 'Persons contracting with unregistered`contractors do not have access to the guaranty.fund',`(as setforth in MGL c.142A). Fire Department ' Building.plans.are to be available on site: Final: All Permit Cardsaire the property of the APPLICANT-IS&UED RECIPIENT' liininate proposet�new batfiro�m� � � f .in eAsting,beriroom. Decrease sire of,existing bedroom_ Increase size of e�asting'bathroo►n,- install 4'x 5' roll-in shower, laundry - closet, new toilet and new vanity. AIM l' 1. 9 _ 1 NJ ® IYGiN FAMILY '7FS70A9 ato' i I --------^ 1 Ii cast I .,- • � HALL 9 Cm y >avlr� as ti g BE�ODP'i ®• �Y n msm' 9 . ate• .. t.W outswing rh. door 2.4`x 5'custom built tied shower laundry closet for stacked w/d -access door to.stacked w/d and wet wall access panel g SL4+Oit_roO-cosq.4 -E tp91FVI� . Lt--wfs C� 9 MR7 GROVE SMEEr A vr�laxamrr-ear.z 91_10-26r kin vrCt �.:#ayts_t ,d PAGE ONE OF TWO PAGES (reduced scale) - - (see a tided 1/4" scale sketch on page 2) Contractor Veteran Both a� sinnAd nn FPhn 1a d, . I A r *-AA t � !e 2&'bifold access door to iI. 1- w/d&wet wall access panel i - new toilet NI AiI. 0'-O'° ! 15'vanity 416'shouter tl }, k 1 36'rh door tt � tr 1 � 1 0- a`' C:LO= ' DROOM 2 I Remodel of bathroom at 18 Pinewood Av., Hyannis MA 02601 designed for the specific needs of veteran John Crosby Additional detail: Shaded areas= new Reduced depth vanity to allow for 5' turning aide A floor the of .42 DCOF or greater on entire top floor surface. Ordinary wall 0 Contracto VeteranW � both'above signed on F ruary 24, 2018 PAGE TWO OF TWO PAGES �z . C?�i- THE EXPANSION/REMODEL OF EXISTING BATHROOM AT 18 PINEWOOD AVENUE, HYANNIS, MA 02601 is design limited to the needs of disabled veteran JOHN CROSBY, who is afflicted with ALS, and is a two person lift, requiring full assistance from bed to chair, commode, etc. He is unable.to speak intelligibly, stand. erect, use a fork or shaver or toilet paper. A roll in shower in the new, larger bathroom will enable him to be properly showered via transfer using chair or hoyer type power lift. Chronological work description: Demolish existing closet currently servicing bedroom #2 and existing bathroom including all gypsum, wood trim, tile, top sub floor, tub, toilet, sink, 3 doors and wiring, and two wall frames (a.k.a. tub wall and entry door wall ADD 20 sq. ft.+- of-floor space by extending entry wall approx. 2.4 f linear feet. Replace frame both walls, shower and laundry closet. INSTALL: new top sub floor (with minimal pitch of shower floor towards drain at rear); rough plumbing., electric and vent duct; four door jambs;. outside wall insulation; sheet rock of walls and ceiling; tile, fixture$/appliances, new toilet and sink; prime/paint of exposed gypsum, doors, wood trim". Repair and refinish oak flooring in hall and remainder of bedroom. The -whole house automatic generator will ensure the constancy of heat, lights and hot water. * refer to EXISTING sketch '`refer to P R 0 P O S E D sketch r Arthurta Franchise, aontr 02=24-2018 I F M I i I 1.{ IT W .. _mil I 71, i 9 is l I f 1. C s r kAp DZI 77) _ 4J • i 1 � (( ff T� 6 f f 4 ss I IN W _ ............ _ -F NN- _ # _ r 1 I I II r iI i .___. i s f I 4 I I I � I f I F _ r I ! \vf 7- Ti , r SI V- v i y I-` it 1 1 - It --L-J _ _ ^ i y r � . { ' I I UIII f Tr a' 1 , ! 1 j i 1 i f- 1 � { f