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HomeMy WebLinkAbout3485 MAIN ST./RTE 6A(BARN.) P a o o a a a Town of Barnstable Building [WZ'A ostThis,Card So That rt is Visible:Fromthe�Street-ApprQved:Qlans Mustbe Retamed;onJob and'"this Card;Mustbe Kept:; -+ •AFA`t�'['AttL6. • �„ • 163 sted Untinat inspection Has BeenMad�e 7 p yam ere a Certificate of Occupancy isyRequ�red,such Building shall Not be Oc�cu�`ied unti aF�na!inspect�on has been made - j �j jijl� .� ""...s.-�..-. w$'t.,, Permit No. B-19-1949 Applicant Name: YERVAND GHAZARYAN Approvals Date Issued: 06/28/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/28/2019 Foundation: Location: 3485 MAIN ST./RTE 6A(BARN.), BARNSTABLE Map/Lot: 317-004 001 Zoning District: RF-2 Sheathing: Owner on Record: LEARY, KRISTIN&SILBER JEFFREY x, 'Contractor Name: YERVAND GHAZARYAN Framing: 1 Address: 135 WOODLAND AVENUE _. � Contractor License: CS-108653 2 SUMMIT,NJ 07901 n Est; Project Cost: $16,630.00 Chimney: Description: rebuild outside brick on existing chimney Permit Fee: $134.81 Insulation: Project Review Req: HIC must Match Contracted person at fron#desk s Fee:Paid: $134.81 Date: 6/28/2019 Final: '' L (rnitrc — Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed 6yhthis permit is commenced within six•months;afterissuance. � A All work authorized by this permit shall conform to the approved applicafion and theapproved construction documents for which this permit has been granted. Rough Gas: Y All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public,inspection for the entire duration of the final Gas: work until the completion of the same. i - Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building<andFire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:,, Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: ,"Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:. 4 --- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR T*P�E:LLC Reaistrtiti , Expiration 19 _...... � 06/17/2021 ARM MASONRY KHACHIK HUNAN',A :"" 61 PADLOCK LAN&'; \u�.= CENTERVILLE,MA 02W Undersecretary Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston,MA 021la Not vali w out signature Arm Masonry (508)864-461.8 .Job estimate/contract for property at Arm Masonry hereby proposes to perform the following services in a neat professional like manner in accordance with manufacturer's specifications and local building code Gable end chimney Pull permit 1. Take down and dispose existing brick chimney to its base (will not touch firebox and smoke chamber) 2. install "Ice and Water " waterproofing shield behind chimney against house 3. Replace ail cracked or broken flues with new ones 4, Make necessary adjustments to build chimney with quality red brick S. Install new copper pan flushing on roof and copper flushing against house every third course of brick 6. Seal(waterproof chimney) once complete Clean firebox surrounding with fireplace cleaner check clamper for proper operation Total price of the project- $1663000 Tdta[price includes labor material and disposoLofdebris, We will ask 30%of the amount as deposit, 50%half way and balance at completion Arm Masonry LLC.1 Kris+in Leary - _, � \ 0ateQG/l2/3O%9 � Arm Masonry LLC Phone: (SD8)864'46IO | Arm. Masonry @yahoo.conn www.ArmK4asoncy.com - "\p,- w ��. C»`~ V~ . �� v. u` / � ' � .- . � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washhgton Street Boston,MA 02111 www mass govh a Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organiratimtlndividual)' ! 1 n Address: p•®. ZQK fn3 City/State/Zip: #: Soz "8G4-�6 Are you an employer?Check the appropriate bpx: Type of project(required): 1.❑ I am a employer with- 4. V1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- wed on the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g• 0 Demolition workingfor me in an capacity. employees and have workers' Y aP tY• 9. ❑Building addition [No workers'comp.iromince insurance.: rimed.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp. rat of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I must also fin out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the a"' penalties of perjury that the information provided above is true and correct: Si Date: 19111b Phone#: &63 4 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.EIectrical Inspector 5.Plumbing Inspector 6.Other .Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employ to provide workers' compensation for their employees.. Pursuant to this statute,an employee is defined as"...every hi the service of another under any contract of hire, express or implied,o Jx r written." An employer is defined as an individual,partnership,also ' on,corporation or other legal entity,or any two or more of the foregoing engaged in joint enterprise,and including legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or legal entity,employing employees However the owner of a dwelling house having not more than three apartm and who resides therein,or the occupant of the dwelling house of another who�T loys persons to do ce,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not b use of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also Stes that"every state or I licensing agency shall withhold the issuance or renewal of a license or permit to o6rate a business or to nstract buildings in the commonwealth for any applicant who has not produced acceptable evidence of c mpliance with the insurance coverage required." Additionally,MGL chapter 152,§250(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public worktil acceptable evidence of compliance with the insurance requirements of this chapter have been kresented to the con g authority." Applicants Please fill out the workers'compensation davit comp] ly,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), ss(es)an phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LL or Limited iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry rkers'co pensation insurance. If an LLC or UP does have employees,a policy is required. Be advised that as affi ' may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. o sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application f the ermit or license is being requested,not the Department of Industrial Accidents. Should you have any questions ding the law or if you are required to obtain a workers' compensation policy,please call the Department at the ber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed(legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inv ' ations has to contact you regarding the applicant. Please be sure to fill in the pennittlicense number which will be ed as a reference number. In addition,an applicant that must submit multiple pennittlicense applications ineany given ear,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Ajddress"the licant should write"all locations in (city or town)."A copy of the affidavit that has been officially ed or ed by the city or town may be provided to the applicant as proof that a valid affidavit is on file for a permits or h es. A new affidavit must be tilled out each year.Where a home owner or citizen is obtaining a li e or permit not lated to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said pa son is NOT to complete this affidavit. The Office of Investigations would like to thank you in advance for your coop Lion and should you have any questions, please do not hesitate to give us a can. The Department's address,telephone and fax number: ' The Cotamoaw of Musachusetf s Department of ' . Accidents Office of bvestiga s- 600 Washington Street _ Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7744 wwwxam.gov/dia Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"""' `....►�� 06/17/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marie Raymond OCEANSIDE INSURANCE GROUP PHONE , (508)775-0500 FAX No: E-MAIL G ADDRESS: Made@oceansideinsurance.com 52 WEST MAIN ST INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: ARM MASONRY LLC INSURERC: INSURER D: P O BOX 1336 INSURER E: SOUTH DENNIS MA 02660 INSURERF: COVERAGES CERTIFICATE NUMBER: 415185 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER EXP POLICY NUMBER MMIDDYMW MMIDDYlYYYY LIMITS LT R COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED- CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PPReOPERdTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YINr--1 E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? NIA NIA N/A R2WC009569 05/13/2019 05/13/2020 ' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdtworkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STREET AUTHORIZED REPRESENTATIVE HYANNIS MA 02601 Daniel M.Croy ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a y k 01 / x / WAIL � r f ,, ',�%' i ✓ !fir � ,^ ,,,,*, � �, .� 3 ;,- mg Ngi x t i Y,.F Fi' II I IJ• � Elir�t€ I � d uE YJ / y b 4 � b iF 2' Scanned with CarnScanner as r a e / Wo f / U P� ,k 71 WE i; IIN s e \ ✓/f r 9 E All t , E a / h / a r P € 3 f a r e su, o � t, t�✓ sE 3¢; 1. t tia Yj� Scanned with CarnScanner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): U � !^ �� CC Address: 4� City/State/Zip: vo.3 l OZ660 Phone #: -7-7, 36 Are you an employer?Check the appropriate box: Type of project(required): L❑ employer I am a em to er with 4. ❑ I am a general contractor and I mployees(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 8. ❑Demolition workingfor me capacity. employees and have workers' 'many P h'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' .13.[:1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip:. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance co erage verification. I do hereby certify unde ies of perjury that the information provided above is true and correct. Si ature: Date: 06 Phone#: i Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 deemed as"...every person iri the service of another under any contract of hire, express or implied;\al or written." An employer is define as"an individual,partnership,associatio corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the I gal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or of er legal entity,employing employees. However the owner of a dwelling house�having not more than three apartmen s and who resides therein,or the occupant of the dwelling house of another ho employs persons to do mainten ce,construction or repair work on such dwelling house or on the grounds or buildin appurtenant thereto shall not bec a of such employment be deemed to be an employer." MGL chapter 152, §25C(6)als states that"every state or l0 1 licensing agency shall withhold the issuance or renewal of a license or permit t operate a business or to c nstruct buildings in the commonwealth for any applicant who has not produced ceptable evidence of co pliance with the insurance coverage required." Additionally,MGL chapter 152, §25 7)states"Neither the ommonwealth nor any of its political subdivisions shall enter into any contract for the performa ce of public work tin acceptable evidence of compliance with the insurance requirements of this chapter have been pr sented to the con cting authority." 1 Applicants Please fill out the workers' compensation affid it complet ly,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),ad ss(es)an phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or imited iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry work s' co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this ffida it may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. A o b sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for ermit or license is being requested,not the Department of Industrial Accidents. Should you have any questions reg ding the law or if you are required to obtain a workers' compensation policy,please call the Department at then ber listed below. Self-insured companies should enter their self-insurance license number on the a propriate line:. City or Town Officials Please be sure that the affidavit is complete and printed legibly. a Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investi ions has to contact you regarding the applicant. Please be sure to fill in the permit/license number which 1.11 be use as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given ye ,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addrbss"the ap icant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or mark d by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or lice ses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not re ated to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required o complete this affidavit. The Office of Investigations would like to thank you in advance for your coop ation 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 f Massachusetts Department of Indu '.al Accidents Office of lave tigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#61.7-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents -- Office of Investigations 600 Washington Street Boston,ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Address: Z l !22&2o < �vr City/State/Zip: 02632 Phone#: Are you an employer?Check the appropriate bow Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the and penalties of perjury that the information provided above is true and correct. Si afore: Date: NS 7 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town 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 f another under any contract of hire, express or implied,oral or written." An employer is defined individual,partnership,association,corporatio or other legal entity,or any two or more of the foregoing engaged in a�oint enterprise,and including the legal represe�tatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal en ty,employing employees. However the owner of a dwelling house having not more than three apartments and who esides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,cons ction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of suc employment be deemed to be an employer." MGL chapter 152,§25C(6)also states.that"every state or local licensi agency shall withhold the issuance or renewal of a license or permit to ope�ate a business or to construct ildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance ith the insurance coverage required." Additionally,MGL chapter 152, §25C(7)-states"Neither the common alth nor any of its political subdivisions shall enter into any contract for the performance�of public work until accept ble evidence of compliance with the insurance requirements of this chapter have been pres ted to the contracting au ority." Applicants Please fill out the workers' compensation affiNdd ompletely,by c ecking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),a s)and phone umber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLCime d Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry rs'c pensat' n insurance. If an LLC or LLP does have employees,a policy is required. Be advised th affida it may a submitted to the Department of Industrial Accidents for confirmation of insurance coverlso be re o sign and date the affidavit. The affidavit should be returned to the city or town that the applicar the pe t license is being requested,not the Department of Industrial Accidents. Should you have any qu regarding a law or if you are required to obtain a workers' compensation policy,please call the Departmee number I' d below. Self-insured companies should enter their self-insurance license number on the appropri . City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Depa ent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inv tigations has • contact you regarding the applicant. Please be sure to fill in the permit/license number which will b used as a reference number. In addition an applicant P PP that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address' the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stampe or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future perr iits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or r ermit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is OT required to complete this affidavit. The Office of Investigations would like to thank you in advanq 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 110f Massachusetts Department of lnd strial Accidents Office of f stigartions 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE . Revised 4-24-07 Fax#61.7-727-7749 www.mass.gov/dia Application Number. .......1.7.......... ......... Permit Fee...............L ..............Other Fee........................ TotalFee Paid............. ................................................. ...... . — /-17 TOWN OF BARNSTABLE Permit Approval by...24-�..............On... ........ BUILDING PERMIT map...........3.. .............Parcel....... ...... APPLICATION Section 1 — Owner's information and Project Location Project Address 3,y;gf Jz, Village sly Owners Name V7�0.f,-� leo,� Owners Legal Address ZiP QW01 City t State Owners Cell#. 6�11 94 z - R9 L-� E-mail I Section 2 — Use of Structure Use Group— F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,00*0 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate [:] Accessory Structure E] Change ofuse El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall E] Solar 1:1 Renovation El Pool El Insulation rr 2 C— Other—Specify_ e, I r- n±::7 C:) vz) Section 4 - Work Description rn ei LO Last undated: 11/15/2018 1 Application Number.................................................... Section 5—Detail Cost of Proposed Construction i/ 6 30 oo Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway' Debris Disposal Facility: I am using a crane ❑ Yes 02 No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks = Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Application Number........................................... Section 9- Construction Supervisor Name �Gcee2c�A5pao Telephone Number Address 9m o RE 134 2 r-�2_ City State IM Zip 02e ',D License Number C,�—f D 8 69 3 License Type Expiration Date 12�//Z26 2 D Contractors Email Cell I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required b and the Town of Barnstable.Attach a copy of your license. Signature Date !96� Section 10—Home Improvement Contractor Name K4acl Telephone Number Address 61 PnJloct City -{ ,1,Il- State Zip C)2,�32 Registration Number /g $I Expiration Date Vz/17/20z1 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date 06 04 Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date r APPLICANT SIGNATURE Signature Date—a Print Name Telephone Number - �c�6�i E-mail permit to: Last updated: 11/15/2018 Section 12 —Department Sign-Offs I Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) j Signature of Owner date Print Name I i i ii i Last updated: 11/15/2018 Town of Barnstable *Permit (0 ' Regulatory Services Efee 6 hsfromissue e sntwsrnat.E. MAss. Richard V.Scali,Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 7QayO® / Property Address JL Mc,'A S �u�h s �K r l-,yA o 2 G 3D Residential Value of Work$J` U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A I t, C C.a'.t- Jel// Contractor's Name e `/� 4 jLe c�, Telephone Number Home Improvement Contractor License#(if applicable) I E-S 73J6 Email: {r'C L7!V 4 C.4 Construction Supervisor's License#(if applicable) s �© /7d y ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's/Compensation Insurance Insurance Company Name ` ipGY! Ti, l Workman's Comp.Policy# f q / Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 The Cominornpeakh of? crssadruset& Department&frndus&id Accidents ffrwe o,f'rMWEAkWimrs. 600 WaSkingt=Si reet Boston,MA fITTIT • tcrvt�a.mas���dia Workers' Cmipensafian Lmumnce Affidzvft:$uildersiCautractors/Electricians(PhEmhers Applicant Infmmafran Please Fit v Naffie ncin� A��f S lei G /5 All- Are you an employer?t�eckthe appropriate b�=- r of ect r 4. I am a euetal coafractffr and I I� Pam] { ���� I.` am a employes witb.�_ ❑ � 6_ ❑!dew oonsfrnctioix • emglogees(full audforpart-fiimej.* �e 12ired.tfie s�b-coad�ao[�oss 2. am a sole proprietorarparEuer- Tinted i(m a attached sheet ?- �Remodeliag V sl Fp and have no employees These sib-cox&actars have g- ❑Demolitiba wadzing forme in any capacity. employs andhave wodoers' 9. .❑Build sci3itiou [NO 'pomp-finance pomp-Msuranc- ' required-] 5_ ❑ We are a coaporafifla and its lam❑Elecrical repairs or addictions 3.❑ I am a homeowner doing all work offieers have eaemised their 1L❑Plumbingrepaim or adchtiems o worb=' right of you per MGL v mimuranyself[No requ � F- C.M,§'1(4h and we have no, � ❑Roofrepaiss� employees_INGWO&s' 13-❑other comp-insurance requirA] #Any RWffcsatd=t cbedabox isl—st also Moutthe sw iaab9awshowmg flieIrwmRae compeasatinnpeTicgMTv mx5m3- T Mmnewaers w1w subs liars affidava mffr=ng they Rm aa=a-zU woak and da m him aaW&camas—st submit a new affidavit indicating such ICoaasctoistT=chec3rWs box mastauadsedanaddiff—alsheet stowing the nameofthe -sadstyewheahaor not those efitieshave emplayees.I€tlsesvb caataEshsce emPtos,[heYxmutFxvt'idttLrs s�ad�'imp•Pa3icF asez lam an enipsr Eliot is pretuidirng�uor&ets"cocsafiern unsriraace�or my earpFvj�ees; $etnry is fl�eprrtiry artrl jeb sde in�ornrafian. �., Insurance Company-Name= Poscy 4 or Self-iM Lic_ -1 7 E�piratronIJafe�(� J �.L4,ddress: d2��v cyrsrer Job Attach a-mpy of the workers'comapensationpolicy declaration page(showing the policy mrmber and e_Viration date). Failure to secure coverage as required under Section 25A of MGI.,m 157 can lead to the imposition of criminal penaldes of a fine up to$UOD 0D andrar or'e-year impsisonmexk as well as rsgt-1 penalties in the fonts of a STOP WGRX ORDER and a$me of up to$250-00 a day a the violator. Be adsised ilsat a copy of this statement maybe forwarded to the Office a Iavestiga#iom of the DIA for insurance coverage ved5cafion. Ida herby csrfafy' under tits paint and pernahtes efperlku7 that the in,formafronprm.-&daboly is bars and correct - Date- Phtzne y Fj t?jykiai ass only, Da riot wrrla in i#cis area,ter be campfeted by cifp ar own offisfat City or Town: PerwitT icense S Issuing Auflarity(merle one): L Board of$eat y Bnffiring Depastinmt 3.CSiyfrawn aerk 4.Electrical Inspector S.Phwibing Enspecter 6.Other Contact Person: Phone#- - - - 6 Tafotmation and 11astractions as a eft General Laws clV[Er 152 reds all erngIoye� to pravide warbeas'=3VMsaGion for tb$]F employees. employees. this stdabe,an esrP&gM6 is dcfmeff E&, .e=ypersaain the service of another lender auy contcart ofbBr� eXpress or impHedl,oral or veritira." Aa employer is defined as`a:u in�l,pa t=sbip,awocfiltion;corporation or of Iegal erray,or any two or more of the foregoing=gagEd in aJoin±enterPrie,and inchIdmg the legal repres�iveslof a deceased eaplay-F.or far, receiver or t us ice of an individual,partneasbip,amocia±lion or ofb=legal enfiV/' .*oymg employees. However ffie owner of a.dwelling haUse Having not more tban gn-w apartcam s and who ffierein,or the occapant of the - dwelling house of m2oll=Wlio employs persons to do maitE2= e, on or repay work on such dWeIIi ag house or on the�tmds or bnr7dmg appurieuai�$ereto sbaIlnntbecause of Ioymentbe deemed to be an employer" MCrL cbapter 152,§25C(6)also?sues that¢everystafe or local agencyshaIIwrfhh0ld the issuance ar renewal of a license or permit fn o erat�a bursmess or t4 cousirurt uHajmgs in the commonwealth for=y applicant-Who has notproducedaacceptable evidence of cdmpr= with thin hsurance covemgerequired" Addit onaRy,M rGL. chapter 152,§25CM states-Teh erthe nor any ofifs political.subdivisions shall eri�rinto any contract for the pertb a 'ceofpublicworicu3til leevidcamofcoinplianca with ibeinsaranc.e. regiments of this`cllapterbane �presenledin the outy.-" APPlicanI3 . Please fDI Out the worldeas' compeasaiion davit coroplet$ly by cog$i e boxes ffiat apply to your situation and,if necessaY,Supply sub-contractor(s)name{s). a dresses)and a nnmber(s) along with their c ca (s) of in cc Limited Liability Companies(LL or Limited iZ,ity-Pmtoembips(LLP)-c dLno employes ofber than the members or paziners,are not rid to cant' ensafion incQrmm If an LLC or LLP does have employees,a policy is requited. Be advisedfhat ' affi yitmaybe sabmified to the Depal-finent of Indvstial Accidents for d onf in aiion of msuranCe covecrage- Also a sin a to sign and date the a�udayit The affidavit should be retnmmd to the city or town tbaf ffie application pe=it or license is being regret,not the DePaiiment of lndrrctrial Ac dents- Mmuldyon have any questions the law or ifyou are rmpi-ed to obtain a worio rs' compensation policy,please call ffid Department at er]is ed below. Se,Jf-msored companies should enter their s eIf-insm-a ce Iiccnse=amber on the appropdafm line City or Town Of ffirials Please be score that the affidavit is complete and IegmIy. a Department has provided a space at the both= of the affidavit for you to f M out in the event th-, cc oflnv has to 6013factyunregzrtlingthm applicant er. In additio =. hcant e e fit fill.in the en�/licesase numb which will be:us •as a refsrcace rnamb � aPP, Pleas b sure p _ e e Ii in need only sabmit one affidavh i*� , of g enrre�t That must sabmit mu1t�I pe�,tlticpnc app any given Y or all loca�.cns in �-Y . policy inl�rmat.ozl(if nerxssary)and trader `J Site fi_ddress ffie apph should�e - ( >. e m fawn be provided to the fawn)_ A copy of the-affidavitihat has bey cially stamped or th city may pro applicant as proo�t3iat a valid affidavit is on a for fuse permits or H Anew affidavitmtist be f Me d oitt mach year.Where a home ov�iier or citizen is o a license or pe�itnot in any business or commercial ve�re ( ie-a dog license. P�or to bum leaves .)said person is NOT required to comgilete thisffi adavit , The Office ofInVCSfigaiinns wouldI --to youin advance for your coop 'on and sbopld you have any questions, please do not hesiiEL±m to give us a call The DrparimMes a dress,telephone and unmbe� y taOfM . Mt cif 1ud c AGcidenta ( tc of Inve tiou% - r - Rwbxi.MA 0�111 T(I-L#It'f-7W-4900 cxt40f or 1477_l L GAF Revised42"7 Town of Barnstable Regulatory Services 8A MAS& ' ` Thomas F.Geiler,Director 039. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I I . IMP / ,as Owner of the subject property hereby authorize vdr t M A-40(l"�70 to act on my behalf, in all matters relative to work authorized by this building permit application for. yy`\a, 57+ �a�n 4C�IF P OX�30 (Address of Job) l Signature of Owner Dat !Z 2�ZZ Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION 1 o Massachusetts Department of Public S4fety Board of Building Regulations and Standards Construction Supe"Nisor License:'CS 107704 JEREMY pNDERSbN ^ 80 CRANBEkRY R]OD ROw1T s Marstons Mils i,KA 0264h Expiration commissioner 10/13/2017 .i1l AffairsBusiness Regulation±'1 �.e T(n��zm'coaatt. Office of consumoVEMENT CONTRACTOR HOME IMPR__. _. 11 --— Type` Individual Exa_ i n Re.ls 0 810 212 01 8di 'I i 185736, Anderson } j Jeremy Jeremy 80 cranberry ridg�'rd Marstons Mills,MA 0264a Under secretary ' I 1 - Massachusetts Department of Public S4fety Board of Building Regulations and Standards Construction Supervisor License: CS-107704 JEREMY ANDERSbN 80 CRANBERRY.:R1b E RO IiT Marstons Mils AA 026,' Expiration Commissioner )I ` 10/13/2017 4 registration valid for individual toe only !. License or regiration date. Regulation before the exp office of ConsumeiAffairs and Business 70 10 Park Plaza 21ui a 5`1 Boston, 16 Not valid without signature -- ------.__ 4 it 7 OfYj{p7 Town of Barnstable *Permit # ti Expires 6 niontlis from issue date + aARN5rA6LE, ' Regulatory Services Fee 4� ►63q ��$ Thomas F. Geiler, Director �plFo��A Building Division Tom Perry, CBO, Building.Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us ` O Office: 508-8 62-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 9i'7 0v 90 f Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 J Owner's Name& Address t�k4I, ez,&p/ __ Contractor's Name ,Y 2)a T pr_j;7_-7� Telephone Number 10 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) f �® ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: /,MI am a sole proprietor SEP 1 2009 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to / ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) 'Where required: Issuance of this permit d es-not exempt compliant with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Proper.. wrier mu `r.o rty vner Letter of Permission. Ha' ent -nit' ors ca Construct Supervisors License is required. SIGNATURE: Q:\WPFIL:ES\FO S\ExpressTXPRESSPE MIT OC Revisc06O4O9 f The Commonwealth of Massachttsetts Department of Industrial Accidents r Office of Investigations 600 Washington Street �j Boston, MA 02111 ;,:yam ►vww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: Q>C,-,vo City/State/Zip:. 00?AIS v Phone #: 's-4 9 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required:] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: V Policy#or Self-ins. Lic�..#/:f� Expiration Date: r� ,`Job Site Address; —�f,�/ /(r O City/State/Zip: A4A/ 00i / 6 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 t fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of r Investigations of the DIA tb,,Onsurance,z�7W76 v ification. I do hereby certi er the p enalt' s o erjury that the information provided above is true and correct. Si natur Date: Z Phone#: & >� Official ttse 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: 7 Information and Instructions M��sachusetts 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 f another under any contract of hire, express for implied, oral or written." � t An employer is defined as"an individual,partnership, association,corporatio or other legal entity, or any two or more of the forego' engaged in a joint enterprise, and including the legal represe atives of a deceased employer,or the receiver or trustee of an individual, partnership, association or other legal en ty, employing employees. However the owner of a dwell g house having not more than three apartments and wh sides therein,or the occupant of the dwelling house of other who employs persons to do maintenance,cons ction or repair work on such dwelling house or on the grounds or uilding appurtenant thereto shall not because of su employment be deemed to be an employer." MGL chapter 152, §25 6)also states that"every state or local licen ng agency shall withhold the issuance or renewal of a license or p mit to operate a business or to co:nstru buildings in the commonwealth for any applicant who has not pro uced acceptable evidence'of complia-y a with the insurance coverage required." Additionally,MGL chapter IX, §25C(7)states"Neither the Comm nwealth nor any of its political subdivisions shall enter into any contract for the p formance of public work until ac eptable evidence of compliance with the insurance requirements of this chapter have en presented to the contiacti' authority." Applicants Please fill out the workers' compensation ffidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s) name(s), ddress(es)and hone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LL or Limited ability Partnerships (LLP)with no employees other than the members or partners, are not required to carry w kers' co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that th affid it may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. o e sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for t permit or license is being requested,not the Department of Industrial Accidents. Should you have any questionsfrfe a ing the law or if you are required to obtain a workers' compensation policy,please call the Department at the um r listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is c/taining te and r' ted legibly. The epartment has provided a space at the bottom of the affidavit for you to fill out invent t e ffice of Investigatio has to contact you regarding the applicant. Please be sure to fill in the permit/l n r which will be used as a\eference number. In addition, an applicant that must submit multiple permit/licenseapp ations in any given year,ne only submit one affidavit indicating current policy information(if necessary)aunder' Site Address"the applicant` ould write"all locations in (city or town)."A copy of the affidavit.thate officially stamped or marked by f , city or town may be provided to the applicant as proof that a valid affid file for future permits or licenses. A�,ew affidavit must be filled out each year. Where a home owner or citiztaining a license or permit not related to a .y business or commercial venture (i.e. a dog license or permit to bums etc.)said person is NOT required to compl&this affidavit. The Office of Investigations wouldo thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a , The Department's address, telephone'and fax number: The Comrponwealth of Massachusetts r Department of Industrial Accidents Of Ice of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.ma8s.gov/dia THE T Town of Barnstable °^ Regulatory Services DAMSTAy M ss$ 'g` Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, e-V r4 9 0*,�4` 196e-Q— , as Owner of the subject property hereby authorize �L• �� �t" �� L-p j5j?'3 to act on my behalf, in all matters relative to work authorized by this building permit application for. &e A 6k10111j1%19 lc,--, (Address of Job) Signature of 6bwner ate Print Nam If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse .side. Q:FORMS:OWNERPERMIS SION r, Town of Barnstable Regulatory Ser ices swxxsTna[ Thomas F.Geiler,D' ector MAss. 1b,� a��� Building Divi ion 1pD Tom Perry,Building C missioner 200 Main Street, Hy ,MA 02601 www.town.barnst ble.ma.us Office: 508-862�4038 __ _ Fax: 508_790-6230 HOMEOWNER LIC NSE EXEMPTION Pleas rint DATE: JOB LOCATION: number s reet village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city wn state zip code The current exemption for"homeowners" as a tended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individua f hire who does not possess a license,provided that the owner acts as supervisor. DE I TION OF HOMEOWNER Person(s)who owns a parcel of land on whic e/ a resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or etach structures accessory to such use and/or farm structures. A person who constructs more than one home i a two-y r period shall not be considered a homeowner. Such "homeowner"shall submit to the Buildingficial on a acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building ermit. (Section 109.1.1) The undersigned"homeowner"assumes r ponsibility for comp 'ance with the State Building Code and other applicable codes,bylaws,rules and regul ions. The undersigned"homeowner"certifies at he/she understands the To of Barnstable Building Department minimum inspection procedures and re irements and that he/she will co ly with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwell'Fngs containing 35,000 cubic feet or larger will be requ ed to comply with the State Building Code Section 127.01Construction Control. i HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exe t from the provisions of this section(Section 109.1.1-Licensinglof construction Supervisors);provided that if the homeowner engages a person(`s),,for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is�,fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC -'� iVlassachusetts Department of Public SafetN' Board of Building Regulations and Standards Construction Supervisor License . 'License: CS 14501, Restricted to: .00 a "r ; STURGIS STPETER ' PO BOX 372 BARNSTABLE, MA 02630 J -- Expiration: 8/23/2011 ('ummissiuncr Tr#: 1823 6Te �o�.vxw�xueal o� a�czaoirelzuaet7a { i Board of Building Regulations and Standai ds ` License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Registration 100390 Board of Building Regulations and Standards Expiration 6/16/2010 Tr# 269584 One Ashburton Place Rm 1301 Boston, r Type Individual Bt ,Ma.02108 i = STURGIS ST.PETERS l Sturg _is'St.Peter 65'Ciridy Lane/P.O Box 372 �" I Barnstable MA 02630 ~-' Administratu� � }J Not ys without stguature ....._. ..,.-. .. 3. F Town of Barnstable *Permit Q Q . _:, �� �� Expires 6 months from issue date Regulatory Services Fee JUL - 3 2007 Thomas F.Geiler,Director TOWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner ® 1 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address O r 1 Residential Value of Work /s®e aG Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address &',; C �Q 1Ij 31 r1J'lti5 l� � C , Contractor's Name K r fft. e ef `i S Telephone Number Home Improvement Contractor License#(if applicable) t,.s_7 Construction Supervisor's License#(if applicable) % ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �! I have Worker's Compensation Insurance J Insurance Company Name Workman's Comp.Policy# -� t f O 7 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to (.�S'c (t G �✓a J ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does_note xempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. A copy of qrovement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents s Office of Investigations a + d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'blv Name(Business/Organization/Individual): . Address: Q.Q 00k 6 7-0 City/State/Zip: SV Vrc Phone.#: Are_you an employer.? Check the a propriate box: Type of project(required):. 1. I am a employer with 4. ❑ I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. El 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 workingfor me in an capacity. employees and have workers' Y P h'• $. 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no n employees. [No workers' . .13.❑ Other z roe c comp. insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. 1 Insurance Company Name: Policy#or Self-ins,Lic.#: WA C& 7 Expiration Date: i T Job Site Address: — •n S City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above ris true and correct Signature: r �"� % Date: 7.1 I6 7 Phone#: Official use only. Do not write in this area,to be completed by city or town ofjtclal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.`Other Contact Person: Phone#: 0 ' in 0 x Q� J 0 df N Board of Building Regulations and Standards m 0 One Ashburton Place - Room 1301 Z 0.� n '^ Boston. Massachusetts 02108 � Z D o Hone Improvement Contractor Registration Z �+ I D a ' registration: 140657 o D Tve: DBA _� Expiradon: 11/10/2007 > 0 z KETTELL ROOFING z m JUSTIN KETTELL z PO BOX 589 m • SAGAMORE, NSA 02561 z � d r UPdate Address and return card.Mark reawn for change. m ® oPs cA1 maw oaros•acasea ❑ Addren Renewal Employment Lost Card 0 � I w v s A r ua-t4-ub Uy b$am From-AIG +973 331 8599 T-414 P.001/002 F-545 �y11�t}�+G•fr 11 I, �I �i ,, I, � ! � �S4�y r>t Jf� J¢' A '1,,d1�"' �°iFt r+r]�P L{�' }ry � Sj ,f��ry`r(P_:�lt,! ;r d S, r�� r: P '1 � • � fir; �R�I,�I ';+"�i:, �i;1�t�1�1i�Y�f7,Ir.��P,� �rY ;{;,'K�lfi�,Qr�•t,I�f a,l�F;, iy1..Np° r h ��yy1 li , sdl I � .! < r R r: 'S� �r yy yl!,.�, 1y a. �J•� r Lti�• .1%�rhr�i4�'11 Irk;"I r,y�A'�M 1�,0,1, :Ir1o..G�7YAT7•:d��:f�e, .ei .l��rr1 n+.lr�il d,.rp.� .�uu UF+ .i�».,r.r 1 ✓'}I`.Ibirr`�l n.l, i,.Y. 4r'i:�`b9�:I$•r Q'�4(67,t',I',gk h:1...,,�R�!�4 t, J?LiC�riy�'{�7� �.�.:�.. r ti4 � �:{'"r�ti%1 I,!rr PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lovequist-Murray Insurance Agency Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O.BoX 38 ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW West Dennis, MA 02670 _ COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Justin G. Kattel P.O.Box 670 Sagamore Beach,MA 02562 it yygg�� ! '.1 I + I'y� Z� �`� III I`,�Illy, �r��+ 1111 �N,1t• !'I S� l i ty i� P'rSMr MOM ,isl�i.�j. �11 8� 1 1�1 �.t.�Wl PI fa t,�• +.•;�JI'r A.�hAl f d �4,:..1,A,I.;,�.,rht'.I.., b t+.��' l.tSf� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE.FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBE©HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co LTR TYPE OF IN6URANCE POLICY NUMBER POLICY EFFECTIVE PATE POLICY FXPIRATION DATF A ORKERs COMPENSATION AND EMPLOYERS'LIAUIWTY LIMITS 1 HE PROPRIETOR/ ARTIVER&RXFCUTIVE l I I I tll F{KERB ARE: Ih�l t II II��}+r} +f t' it:t,° !r'? SaF r STATUTORY LIMITS `yii)rrta,i 'iil�} I�+r ,f E"}'1�jttl INCL o EXCL Q 4.392107 08/01/2008 08/01/2007 1a11,i� �€� �tJd�.>•1 � ,�t;I'�j,�,et,,-:? (�OTHER Coverage Appllpu to MA Opprallons Only. CI{ACCIDENT $100,aQ DISEASE POLICY LIMIT $500,00 OISEAS_E-EACH EMPLOYEE $1QQ OQO DESCRIPTION OF OPERATIONSNEHICLESISPECIAL ITEMS CERTIFICATE.HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORE THE ALI=XA KELLY EXPIRATION PATE THEREOF,TPIE ISSUING COMPANY WILL FNOEAVOR TO MAIL T 20 PARADISE BLVD. PAYS WRITTEN NOTICE TO THr CERTIFICATE NOLbER NAMED TO THE LFFT.BUT CHATHAM, MA 02-633 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TPIE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Asphalt and Rubber Wood and Vinyl Sidjq . Cedar Shingles — " ��9�- Certainteed Certified UTELL Boa RODFIHS a @HDRHOW WWW.KETTELLINC.COM Customer CYGiG CCcmp cell Phone � FTO Date r&/a Address •3ySS' /MC„n S-i'. M141- I3 �7 7e-r,r�,Ce- ®t'. City/Town Tarp off building and take precautions to protect landscaping. Strip entire roof and examine deck for rotted sheathing.Plywood replacement costAt,L sheet. Lineal decking replacement cost ,60foot. Install approved ice and water shield on eaves,valleys,penetrations,and chimney. Install aluminum drip edge. Color to e Cover remainder of roof with 15 lb.Felt Professionally install shingles according to manufacturer's instructions. Shingle type e r}a i e e-d -t,,J m cLr K Color a i io Ventilation:Install exhaust.Type: R I ej e- Installintake.Type: VeWte-k, drip 10 Install vent pipe flashing Chimney-Lift up existing lead flashing,wrap chimney with ice and water shield,insert step flashing ❑ Chimney-Relead chimney,(required for lifetime shingles unless in like new condition.) ❑ Skylites-Reuse existing flashing and wrap skylite with ice and water shield. ® Clean out gutters. C� Magnetically sweep jobsite of nails. Remove all job related debris to an approved facility. ❑ Provide CertainTeed SureStart Plus extended warranty. 10 year labor warranty on workmanship Special instructions fl4si�^ Work. i� e. C�44faeW ivork S4,4 C gsses.Seg/ q+ 1,9t'. n,y {er cc I , Czr+,,n4fee + fa4-t,Cc O,A lct„ .0 6pe dor sme,� Ste .ji'Vrq sw - Poti s6e-d i S nC ©'ne Cost - Good Better L a,%J oa a r 14, 2 0-- 20 11 w�;,� �,;�rr�,•,� - , a o Best 44, 4nark Ptcsw,,ivt - do mPh IVi-: o0 Please select shin choice Z'9�4VV-k Amount$ l - 71r5' Down Payment $ Payments are as follows:No money is requested until the project is c leted; Special order shingles from our supplier require a 1/3 deposit down with the balance payable upon completion. PleTisl'e checks abl o: Justin Kettell Acceptance of proposal �- Customer signature Date of acceptance P.O. BOX 670 • SAGAMDRE BEACH, MA 02562 • TEL: 506-BBB-3744 LICENSED AND INSURED Town of Barnstable *Permit# 7 SS �oFtHe rOjty Expires 6 months from issue date sexxsrnsTZ, • Regulatory Services Fee (� NAM Thomas F. Geller,Director 9 4 16 9•'prE ►. Building Division Tom Perry, Building Commissioner cs 200 Main Street, Hyannis,MA 02601 . Office: 508-862-4038 Q � • NJ Fax: 508 790-6230 ry co EXPRESS PERMIT APPLICATION RESIDENTIAL O _ Not Valid without Red Z Press Imprint 317 DD 00 1 Map/parcel Number 3/�c� O < </a� / W r / co rn Property Address []Residential Value of Work Owner's Name&Address Contractor's N Telephone Number ame �9 �• Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 0 GGo G ❑Workman's Compensation Insurance �� PERMIT Check one: ❑ I am a sole proprietor 2�'j am the Homeowner MAR `. 2004 ❑ I have Worker's Compensation Insurance �g _ .e-,. .� �.. Insurance Company Name Worknzan's Comp.Policy.# Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris.will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side.' [] Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. M Owner must sign Property Owner Letter of Permission. ***Note-.Note: Property gn P Home Improvement ontractors Licenrequired. Signature Q:Forms:expmtrg `. TOWN OF BARNSTABLE BUILDING PERMIT•APPLICATION Map 3 Parcel —� P , y a'L,Z Permit# N FE Health Division ^?^��, � CONN Map D IitUE ate Issu' b STRUCI�JOIV ft Conservation Division Tax CollectorP"t Treasurer Planning Dept. ` Date Definitive Plan Approved by Planning Board Historic OKH Preservation/Hyannis Y i Project Street Address S A 85 "MJAI XJ S K+A Village wa r .t Owner S COT(' SAAk v 6 rJ Address 3 S (AA rN %T —RA(k5��� " Telephone 50$ Permit Request S2Ccsnc� �u FA� v- cu✓1 x�S—�c roVy\, CJv� Y' Of 4 Square feet: 1st floor: existing K0 proposed floor: xisting pgLA proposed 5G� Total new ;► d. /, �siY O Prn•p-&-a 11Z. T,4-A f. lI—Z� Estimated Project Cos?6-0 •°a d Zoning District Flood Plain Groundwater Overlay Construction Type W<. Fawn 2 Lot Size S,C r Grandfathered: D Yes D No If yes, attach supporting documentation. y - • Dwelling Type: Single Family Two Family ❑ Multi-Family(#units). 4 Age of Existing Structt�re O 1. Historic House: D Yes ❑.No On Old King's Highway: Z.Yes , ❑No Basement Type: CdFull ❑Crawl ❑Walkout * D Other Basement'Finished Areas � ( q.ft.) Basement Unfinished Area(sq.ft) t©�1 e Number of Baths: Full: existing 3 new 1 Half:existing new. ' Number of Bedrooms: existing ��= new Total Room Count(not including baths):existing �` new — First Floor Room Count -- t � . Heat Type'and Fuel: ❑Gas 4-61. ❑ Electric ❑Other . Central Air: ffYes ❑ No Fireplaces: Existing 3 New — Existing wood/coal stove: D Yes a- 0 Detached garage:[existing D new -size .Pool:O"existing-'D new size Barn:O existing ❑new size •Attached garage:D existing ❑new size Shed:a existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# - Recorded❑ Commercial ❑Yes D No If yes,site plan review#" Current Use Proposed Use } - BUILDER INFORMATION. , Name Telephone Number 5c) 3(o2 - Address S S 'Pow License# O l^l 3 l It Home Improvement Contractor# Worker's Compensation# LI' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO M A ec3 v^^-��' J SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. �` �- r y'' . . � �_ ^� -- r� � •, - i � L f " s DATE ISSUED MAP/PARCEL NO" _ r { ADDRESS _ VILLAGE OWNER ,! ;;, ! , � t ;•r. _t ti DATE OF INSPECTION FOUNDATIONS — F FRAMEt INSULATION"' • f ,�,,. k' - , .•' _- �— �'. •• r � -, �, F -. * �%' . .may l��`� P• s ry r 64 # "`7 a 4 -. az •4 < Y - m ", .. FIREPLACgE` _ ELECTRICAL`. ROUGH FINAL c: PLUMBING:iit " ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING t• _ DATE CLOSED OUT ASSOCIATION PLAN NO. " ' Vol-Ell. . .. -_ TEUr'05CG Nrl-� ��rnC.oNfi fi.0(Jfi Fi I r I - -- - i I �� ARCM AT 11011S1 (-Tt) Lij i I r r ;I I i NarE - 'FINISH�(Ilb-FINISH r'IATERIAL- - ljIiTNCf- TO r'I/ITCIh GRIST• LLI.� CoIGKi 129 rt"McN q(ly{, 'FkormmeG,Y.9CITtUN¢JCL'T�X-r1p1�5 GIGO-iT $la,�Ll.Y OKVN d;� 25-5t5 rAiq 4,rT<L�f• I eoPasE-o TT�nE0. - 3h T I � El int000sro --? _ xe�orntr<14 �_ �7 E SA6►.tif acid f y�� - 3405 h1UN 'I -14 NiR��lSWri !i S�1111 VL CVOA-nO _FKND� _ i LL ToM1I F :i �s pyft)2.ax L e I Afc£aw* e An55' AN351 Cwn5 G �� CWaS L r {--hATCH 9c+cn�lz 'T'fP.-�L�AENo �El`IpVJS.IED �XIS'(Ir�CI�(HtKO fLOv�t �IAN Exl<�?. R.IGG6' . 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LOC*- Vhr.Kuo"p fzO6N,�@ALL ,� ArcEAh of EJ� XL{4. r� �N e 1-Irw 1�7H 'KUOt15 / e ' Ca- OND Q ®r --wfA-E- I/4 - I'-Of '�IZp.r11N ��G'fION C �x�L� •�',_ i—a,-----------...-_._ �orT a S.t>✓I,- oKur�.tz�slv�N4�' A- •tZNs'FLdl.r,1't•4. . .. - .c.u:J16 1�ITEp •..wovEo n: wri sr R7 .. _ �cx KLIn RU11..p4J'JL �iI PLJCNS oMwws TJIeD.�Loo12 �NI�'S�GTIo JOF4 „a 9-3 I -- ._�-- Fl:;e Ir \/EN'f L.I/fIL-TER Rlix"i 6D. i o C.-u/'&,wx 6HTc, -- —...--------- - -- i, Iri I); I; - / LEII.ON Ixy -'/ `�TRP`G Lc 2ao•C. 2x95,e IC O.L. W/Ile GOx 6HTa, Ix'b ir"er-INC,AS OW19."OR 414 .. .. ........ .. .. .. I / I I � � QENhI?Y tN4 UL. €T�ROpIER VIEN! ! i C�x�-"EO SLOPED GgllS. I ( � ti NLw SAT f�rons II N k5 W I B TH R:aJ:�S KNEE Wails p oR NT Alt,SELOCIM II Zn46C IL"O-C NEW S'HNIN. OP(IEO O IN SU L. I' IN LIED OF R-30 XD. fLahMING — CE Ro.i•T[E.5 �fWRpt@y/vcFu 1Fv ALUM.Mp-bxe 4oFFff so u/ A9,1[cgROOF LONT•VCl rj-Ix 'FQIIEZE 6D. _ .._ ?Xs flR. -10IS(T4 C I6"O.C. W/ —........ HEWfi� 9 VZF IJEN 5/W ni 1.6Uw FLK• CKxLYf.fin- y.L-lb—W A►uvE —._ LxL hallo (Cl VT.2OOf -',C:n ECT.@ bx q PONr4 @ ''II W alp L OGaT10N lyf *ION4 fOREIjKO11N0-iCESE�r.'e) I / END. R8-1917 E,a. '-TL e E.4 htot I I 1 N ex.v II i /CwyT. �Urr cxon� —(ExlvT• 2,e4i WALL4 W/WPW4-� ( On) r I Ei lil I �I - r .-'- -- C�j�.IbT• 'FLOEJR fi.55ET'IIaLY� ---- - I' I ' 13fo Nor 'FOUNvA-Tow) —.... fKAm Li6CTIOt J liGO(( d 1�-Al.L'r OKUIJ rSe l k?CNGC 3485 t->aw.ST.- 2r�•GA- �16TT�C�t�,rfd DATE: 10-5-57 ErvacD ... `--J1ACK KLlnn - - OEAWMD MIWYII . T[FIGcL..�jECfl?NS.�. . 'WnS7.1 ST (,�� �.�ST I►�� N f 577 1911 ITS * 18S 1Q10 I I i i t \ UP i i --------------------- -, � 1 i I I I �I I o K;>1C ne.y 4- 1 I / I ' I I I � I I I � I � I � � I 'v 1 -------------------------- \ I I I I 1 1 1 I , V (/Vr c I I -- 1 b i b I _._._._._._._ __.___.—_—__._._._.__._____—._...._.__.___. 1 1 I I I I I 1 I I 1 I I 1 1 I I 1 I I I I I I I I I 1 1---1 ------------------------------------ --� 17'S 18'4 10'B 11'1 577 i 46'9 11'5 21'10 13'6 49 99 T4 66"6 TO 2 jA1 f Ili iN c ec, o ,te � o I� � r1� T HALL T 356 sq ft N a m i Gur� ese�rao,1� 6 2 T3 710 T7 5-10 69 69 LIVING AREA 163 3'7- 13A eq ft 13'5 136 .411.M Ell Z lX/tc�.y�� -/' — "0 469 - I The Town of Barnstable • Bwxxsrasi.E, • Department of Health Safety and Environmental Services FDA Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 1 Type of Work: ZJ1D Sf nr �ar le I— ��1, Estimated Cott (Do r OG O Address of Work: 3 q S /Vl►4�I17 �1 r V� -able (�rA Owner's Name: S�O'tT c5 IA �N p K U" Date of Application: GJS�99 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law 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 agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav TabI*J3=b(eoatbued hwaiptive Packages for One and Two-Familr Residsndal Botldtap Aeascd with Fossil Fuel e i MAXIMUM MINIMUM r' 01gk 8 Gazing Ceiling Rail 11" Baste Slab H9id*Coo&9 At='(%) U-vaiuet &vdnJ &value' &valuer Wail paimetoe Eqw pm= F.itrderrry' Padcaae &Value &Valuer 5"1 to 6500 Headag Dege+ee Darn Q ` . 12% 40L.40 38 13 19 10 6 Now R ma 032 30 19 19 10 6 Normal S 12% 030 38 13 19 10 6 ✓ 25 AFtJE Trisen 15% 0.36 38 13 25 WA WA Normal U159/0 0.46 38 19 19 10 6 Normal V1P A 0.44 38 13 23 WA 'WA 85 AFUE W 032. 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 WA r WA Normal Y ISSA Q42 38 19 25 WA WA Normal Z IBra 042 38 13 19 10 6 90AEVE AA It% 030 30 • 19 19 10 6 90AFUE 1. ADDRESS OF PROPERTY: f 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 210 T -1•- 2 o .4Lk Jun 3. SQUARE FOOTAGE OF ALL GLAZING: ' 31 Z-4 9& e 4. %GLAZING AREA(#3 DIVIDED BY Q): 366 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. r r BUILDING INSPECTOR APPROVAL: ,d YES: -'`~ NO: q-forms-080303a t Footnotes to Table J5.2.1b: ' GI ' g area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights,and basem t windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,exp ed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value r.Ouirement. For examp ,3 ft of decorative glass may be excluded from a building design with 300 fl of glazing =After Jan 1, 1999, glazing U-values must be tested and documented by the manufacturer in rdance with the National nestration Rating Council (NFRC) test procedure, or taken from Table J1.53a. -values are for whole units: cen r-of-glass U-values cannot be used. ' The ceiling R-v ues do not assume a raised or oversized truss construction. If the insu n achieves the full insulation thickn over the exterior walls without compression, R 30 insulation may substituted for R-38 insulation and R-38 ' ulation may be substituted for R-49 insulation. Ceiling R-values ent the sum of cavity insulation plus insul sheathing (if used). For ventilated ceilings, insulating sh g must be placed between the conditioned space an the ventilated portion of the roof. Wall R values represent a sum of the wall cavity insulation plus insulating Bathing (if used). Do not include exterior siding, structural sh ing,and interior drywall. For example,an R- requirement could be met EITHER by R 19 cavity insulation O R-13 cavity insulation plus R-6 insulatin sheathing. Wall requirements apply to wood-frame or mass(concrete, onry,log)wall constructions,but do of apply to metal-flame construction. a The floor requirements apply t floors over unconditioned spaces ch as unconditioned caawlspaces,basements, or garages). Floors over outside must meet the ceiling requ' ts. The entire opaque portion of any dividual basement wall • an average depth less than 50%below grade must meet the same R value requireme as above-grade wal Windows and sliding glass doors of conditioned basements must be included with th other glazing. B ment doors must meet the door U-value requirement described in Note b. The R-value requirements are for unhe d slabs.A an additional R-2 for heated slabs. If the building,utilizes electric resistance eatin a compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or mo one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficienc uired by the selected package. For Heating Degree Day requirements of a osest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are m unum acc table levels. Insulation R values are minimum acceptable levels. R-value requirements are for insul ,on only and d not include structural components. b)Opaque doors in the buildin velope must hav a U-value no greater than 035. Door U-values must be tested and documented by the manu cturer in accordance ith the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door rains glass and an aggre U-value rating for that door is not available, include the glass area of the door wi . your windows and use the ague door U-value to determine compliance of the door. One door may be exclu d from this requirement(i.e.,m have a U-value greater than 0.35). c) If a ceiling,wall, fl r,basement wall,slab-edge,or cra I space wall component includes two or more areas with different insulation 1 els, the component complies if the a-weighted average R value is greater than or equal to the R-value requ' ent for that component. Glazing or do components comply if the area-weighted average U- value of all wind s or doors is less than or equal to the U- ue requirement(0.35 for doors). 43 ��t,t:rgyy The Town of Barnstable Department of Health, Safety and Environmental Services Building Division MAM 9 1659• 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: el Co f q9 Name: s' CARE:i OG2APH�- Phone#: 1505 :5Co2Co 1-7 Address: Z48,15 tilAn tJ 6T Village: �� ( Type of Business: feA1U lA CA-t2e CO W-SLALn fV 6 Map/L t: -3 1 7 0() y"Cy,) I INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering qF Applic it ` Date: !. Homeoc.doc j'� o r's'map and lot number3.�..7..........i`�-........g' 1.wa a Permit number . . . .. . .. '. .. ...... ........ .... ��// Z BAHHSTADLL House number .....`..1..� .'1.. ............................................. o rasa + �p f6}9. e00 • �F�MPY a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................................................................. ......... ........... .s- TYPE OF CONSTRUCTION ......... rr� e .................................................. ............................................ ...... ...:!.`.f.....��.......................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according'to the following information: Location .......................................................�............................................ ................................................................ ProposedUse ..... ! ?n........................:......................................:.................................................................................. Zoning District ......... v ...........................................Fire District �n�;S�`7 �t,�s��............................................ .......... Name of Owner ......................Address ...r ....� r��.. J .... ....... Name of Builder .*f r1.. " +�z- .................... „I�/ �.�.f ......(A�........i.!?!1, Address ....................... Name of Architect ................��-��.'��..................................Address ..... .............................................................. Number of Rooms .....................�..............I............................Foundation �aYL.C%/!f f .............:............................. ................... Exterior �► /. eJ`c�� Roofing!� �1 ..... ................................................ ......... .U.. 3........................................................ Floors .Interior f �C' ..�r{' ................................................. .................................................................................. , . Heating � Y'�� ..........................................................Plumbing ..............�fy uo................................................... Fireplace .................... .Approximate. Cost ,•• Definitive Plan Approved by Planning Board --------------------------------19________. Area a Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 3A 2 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name yc ��_� ......................... Construction Supervisor's License#............. ........ KEIGNELLY, RICHARD 709 ' Build rage .............. Permit for .................................... ccessory to Dwelling ........................................................ ' 3485 Main Street Location ............................................................:... - Barnstable ' a ............... ..........................'.....................,........... Owner ..Richaxd...KeT1Xle.� lY...................... Frame Type of Construction .......................................... Plot!........................... Lot ................................ - - L' Permit-.Granted January 10 83 ;w ` Date of. Inspection J Date Completed .............�? ......'19 _..� - C f' ,- ,A E . ' 7