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Home My WebLink About0117 GLENEAGLE DRIVE - Amnesty a 9 F e � k 9 ➢ 1 I .y k 1 3 I Y k , - is .. .. • 3 1 1 v , + r o i V r i,• e. a c , r +a r ` i A. 1 11�0 7 NOT ' TAN TIN lot 4 v - AND M• A 91 All « .a.. e. n C� r y 4 . - r ' . . " t ry u n � q , M: x r.' w' ,v ' - h rn AT ZOO • S tot so;i f�- . Y r , : 4 k N .. q � " n F e. a n _ , a ' e . a 9 1 c' y a f r+ e � ' y n � 5 L%L��%`��/��L/ �� l��J . �� f' r f • ' Town of Barnstable , Expires 6 monthsfrom issue.d e Regulatory Services Fee 42 a BARNStABLE p MASS. Thomas F.Geiler,Director �p t639. `� (r TEo Mat a 41� 69 . BuiIding Division Tom Perry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstable,ma.us Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION -. RESIDENTIAL ONLY Not valid without Red X-Press Imprint Map/parcel Number Property Address_j1 7 C A)'eP" tC ' 6�/ /_ i Ile- A0 . e7 , a desidential. Value of Wort. S 300 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address' f,✓j��fsl � .Om e Contractor's Name TlT LJ E'JU ke, 11; ;AIO Telephone Number So - � 619q 1 iome Improvement Contractor License#(if applicable)� � Q Construction Supervisor's License#(if applicable) ✓��Y Q ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietorX�PRESS PERMIT ❑,( am the Homeowner � s�P 2 3 ZOOy [' 1 have Worker's Compensation Insurance f Insurance Company Name Ole U) 1441y ��,,�r TA6 ._ LL TOWN OF BARNSTABLE Workman's Comp. Policy# -3 C��SJ 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) ❑7R ide Replacement Windows/doors/sliders.U-Value . �,� (maximum .44) f #Where required: Issuance of this permit does not exempt compliance with other town department regulations,i-e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required, SIGNATURE: Q—`.Wll-11-hM ORWbuilding permit forms\EXPRESS.doc Revised 100608 ' The Commonwealth of Massachusetts Department of Industrial Accidents Ofj?ce of Invesdgadons 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOcant Information Please Print Leelbly Name(Business/Organization/individual): i N D Address: 0 V/�f, fah. City/State/Zip: .1/� A 1Y)oeJ U hone#: `jog- 9ca-- 11� _ Are you an employer?Cheek the appropriate box: Type of project(required): L�Famlozyseoelse a employer with 4. ❑ I am a general contractor and I (full and/or part-time).+ have hired the sub-contractors 6. ❑N onstruction 2. proprietor or partner- listed on the attached sheet. 7. cling s and have no employees These sub-contractors have �P � Y 8. ❑Demolition working for me in any capacity. employees and have workers' insurance./ 9. ❑Building addition [No workers'comp. insurance comp. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.[1 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 13 ❑Other employees.(No workers' comp.insurance required.] . i . 'Any applicant that checks box#1 must also fin out the section below showing their workers'compensadon policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit it new affidavit indicating such. tContnwtora that check this box must attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have employees. If the subcontractors have employees,they must provide their worker'comp.policy number. 1 am an employer that is providing workers'compensadon Insurance for nay employees Below is the pollcy and Job site Information. 1 Insurance Company Name: cl v Policy#or Self-ins. Lic.#: ocvo C S Expiration Date: / Job Site Address: !> 2 QgA/C/;a j- 0¢ , City/State/Zip: Ct4wer9/,wo A,0 PC5 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 S 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 verificatio I do hereby certl nder tk p ' s a p aide of perjury that the information provided above is true and correct Simatort Date: � _ Pho #: — o`t Offlcialim only. Do not write in 1his area,to be comp eted y city or town ofJ?cial 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 , . 11 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. d as ...every person in the service of another under any contract of hire, Pursuant to this statute,an employee is define express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,Partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or die occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 151, §25C(6)also states that"every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth not any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the a ro wate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used-as a reference number. In addition,an applicant that must submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. When 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 like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ONice of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia I r'i '1...(:i•!!ii.ir.•::�: 134ard of Building itcculatio S`ns and tandards HOME IMPROVEMENT CONTRACTOR Registration: 153140 Expiation: :0/31/2010 Try 278191 Type: DSA iU-VISION IAISTAUL;;IONS STEPHEt'•1 RESTAINO 32 OVAL DRIVE WEST YARMOUTH, MA 02673 Administrator License or r•egi,tration valid for individul use only before the expiration date. If found return to: Board of Puilding Regulations and Standards One Ashburton Place Rm 1301 Boston, ;�la. 02108 t .. Not valid without signature License:- CS SL . 9956.0 Restricted to-. WQ STEPHEN RESTAINO 32 OVAL DRIVE L WEST YARMOUTH, MA 02673 ' -- .-- xp 'ation: 1 /2212012 Tr", . �vL The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinessiOrganization/Individual): x U? k �l�e s Address: v LerCz 9 City/State/Zip: A7T 4& 2lrt ' 305 3� Phone #: ' " ! �-2- Are you an employer?Check the appropriate bo . Type of project(required): I am a employer with_:"' 4. ETI am a general contractor and 1 6. ❑No construction employees(full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. D4emodeling 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.1 required.) 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work q ] officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.f]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. 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: S .S Policy#or Self-ins.Lie.#: 35 Expiration Date: F/e , Job Site Address: l��2 Clew'ey If rv'S City/State/Zip: �n/�U`, ��' 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 Investijzations of the DIA for insurance covera e verification. I do hereby certify under ins and penalties of perjury that the information provided above is true and correct Signature: Date: �� d/9 _ Phone#: " q(O 2 ! �" 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): I.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspectd 5.Plumbing Inspector 6. Other Contact Person: Phone#: r Beard si 00 aed sm"O s :jq HOIAE O WROVEMM WNTRIICTO Cott, 125893 ' E4ir8dw 6►312010 Type: Supplement Card The Horne UeW At-tion'e Se"�* DARREN DEMERS 3200 COBS GALLERlA PKWY 0" � C� ATLANTA.GA 30339 ptitttinis;rator R for individul use oaiy License or negistrtUion valid , before the expiretioa date. If forted return to: Board of Building Replattans ind Standards one Ashburton Place RED 1301 Boston,Ma.02109 I � I Not valid 7ritlitlet iniq/re ACVRDr. CERTIFICATE 4F LIABILITY INSURANCE a/ao/os D PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest®marsh.cou. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:steadfast Ins Co 26387 THD At-Home Services, Inc. INSURER B:Zurich American Ins Co 16535 2690 Cumberland Parkway INSURER C:NATIONAL UNION FIRE INS CO OF PITTS 19445 Suite 300 Atlanta GA 30339 INSURERD:New Hampshire Ins Co 23841 INSURER E:Illinois Natl Ins Co 123817 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR DD' POLICYEFFECTFJE POLICY EXPIRATION LtMrtS LTRR POLICY NUMBER T A GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACHOCCURRENCE $4,000,000 Y. LIMITS OF POLICY ARE SRC SS AMA O 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea rents $ CLAIMS MADE aOCCUF "OF SIR: $1,000,000 PER CC" MED EXP(Anyone person) $EXCLUDED PERSONAL&ADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 MX *LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $4,000,000 POLICY PRO- LOC B AUTOMOBILE LIABILITY SAP 2938863-06 03/01/09 03/02 10 COMBINED SINGLE LIMIT X (Ea accident) $1,000,000' ANY AUTO ALLOWNEDAUTOS BOOILYINJURY $ SCHEDULED AUTOS (Perperson) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per aoddent) X SELF INSURED AUTO PROPERTY DAMAGE I (Per aeddent) $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLALIABIUTY +IPR 3757 608-02 03/01/09 03/01/10 EACHOCCURRENCE $5,000,000 X OCCUR CLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ $ 03/O1/10 X WC SFATU OTH- C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 IMIER D EMPLOYERS'LIABILITY 3566915(ADS) 03/01/09 03/01/10 E.L.EACH ACCIDENT 51,000,000 ANY PROPRIETORRARTNER/EXECUTIVE E OFFICERIMEMBEREXCLUDED? 3566917 (FL) 03/01/09 03/01/10 E.L.DISEASE-EAEMPLOYEE1$11000,000 tf yes,descibe under E.L.DISEASE-POLICY LIMIT $1.000,000 SPECIAL PROVISIONS below OTHER D Workers Compensation 3566918 (KY, MO, NY, WZ, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT[SPECIAL PROVISIONS RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 'HD AT-HOME SERVICES, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2690 CUMSERLAND PARKWAY SUITE 300 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001/08)ckomraus hd ©ACORD CORPORATION 1988 11172180— I - ) 6-2009 12:33 HOME DEPOT HYANNIS P.001 1v/ �/ tiOME IMPROVEMENT CONTRACT PLEASE READ THIS /'�- sold,Furnished and Installed by: $ranch Name ton Date:�clf THD At-13ome Services,Inc. -:dlbla The Home-mot At-home Services 345A Greenwood Slxeet;Unit-2.Worcester,MA 01607 Brandt Number:31 Toll Free(800)657-5182; Fax(508)756-8823 I'tdg-al 1D#75:2698460;ME I,io'#C 02439:Rl Cont.Lic#1.6427 CC Teo#565522. improvcrnent Contractor Reg.#1268.93 Installation Addresi c r/ q /^ — City. :'State ' p work Phone Home Pho� Cell Phone.• IN Porcbaswr(s): 7 Home Addre (If different from Ina alladon.Address) City-: .:Scare Zip Ft]t3a11�Ad'does&{to i eceive project communications and Home•Dvpot updates): . []I DO.NOT wiAh i r rec iveany m nkefwg emails1from The Home Depot Pioject:Informatjj%:'Undersigned("Customer");the-owtters of the property located at the above installation address,agrees to buy, and THD At-Home:ervim,Jac.("The Rome Depot")agrees to 6inish dehVer and arrange for the installation("Installation")of all materials describe don the below and•ou the:refercnced:'Spec-Sheet(s),-all'of which are,incorporated inn this Contrset by thus refereaet,along wilt any ap tplicable State Supplement and Payment Summary attached hereto and,any htinge Orders(collectively. Job•#: prir,.,uil�reieats).;' 1'rvuducmi: S s # PrOeCtAmotmt Roofing- Siding Windows' Insulation �j y�-�' jGoaasY6wi`cEncryDoory . Doling, Siding Windows' Lisulation ff $_. 6 QGutters/Covers (5- Doors ❑ b Cot Roofing -Siding window^- Insulationi QGutters/Covers:ClEntry Doors.Fl ! Roofing Siding Windows' iesulation [abutter,/'Covers 0l ntry'Doors Minlinm 25%-Deno!itof Contrad.Amomtdue r>jwn C10000a.this contract Total Coatzaet Amount $ M21ne ftlawers®r not deposit more than onedhird'or ttte CantradAmount Customer a rocs,tbai•iutn4ediatcly:upon col>Ipleuon of the work for cacti'Product.•Custorer wi11•:e)Lecute a Completion Certificate (one for eacli'pjoduc;.as-defined by an individual Spec Shect)and pay any.br iacc`duc.-'As applicable,-ei cb Customer under this Contract agrees to_be;:ointly and severally obiigated and liable hereundcr: The Home.Oepot rese tees the right to issue-a Change:Order or.tertrnnate.this Contract or any individual Pcoduct(s)included herein,at its discretion,if The l lome Depot or its,authorized-sefyiee:provider determines that it cannot perform its obligations due to,a structural problem with the hori�,environmental hazards such as mold.asbestos-or lead paint,other.safety concerns,pricing crrors or because 11 .work.teguiied to corn>lete the job was not included n.thejjGontract Papngpt Summary: 'The Payment.Summary#-,„ ""`7 included as part of this.•Conttact,.-sets forth the total Contract amount'and I eyments'rCquired'for the deposits and final payments.by Product(as applicable).' NOTICE TO CUSTOMER Xou arc'entitled 6 'couuiplctdy fffl rt,in'copy of the Contract at the time you sign.Do,novsign a Completion Ccrtdfleate(note: there is one.Complei ion Certificate for.each listed Product-ac'defiued by individual•Spec Sheets)before work'on that Prod is complete. In the event of tern#nation of this Contract,Customer agrees.to pay The Rome Depot the costs of materials,labor,espemes and services providt d by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in,this Agreement or allowed under applicable law. THEHOME DEPOT 1WAY WITHHOLD AMOUNTS OWED TO TIIE F.OME DEPOT FROM THE DEPOSIT PAYMENT OR.OTHER PAYMENTS MADE, WITHOUT LIMITING THE H(ME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Nut►orization: .Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depor with regard-to the Products and Installation services and supersedess all prior discussions and agreements,either oral.or written,relabn;to said Products and Installation.This.A meutcannot be assigned or amended except by a writingsigned by Customer and The Home Depot.Customer•aeknowledges and agrees that Customer has read,understands,voluntarily accepts the iterms of has-recei,'ed a copy of this Agreement. " ~b ) Submitded.•by: ,� _.., -s�1P 0 _ I .X _. ustomer's$i a e Date Sales consultant's Signature Date X Telephone No. Customers Signature;' Dare Salcs Consultant License No. (as applicable) CANCF.LLA,TION: CUSTOMER MAY CANCEL THIS, AGREEMENT WIT ROUT PENALTY OR OBLIGATION BY DELIVERING I I+IMITTEN NOTICE TO THE HOME . DEPOT BY MWNI GTIT ON THE THIRD BUSINESS I)AY AFTER SIG1 LING.THIS AGREEMENT. THE STATE SUPPLE WENT • ATTACKED F F,RETO CONTAAVS A IORM TO USE IF ONE. IS SPECIF'ICALL•X PRESCRIBED BY LAW, IN CUSTOMER'S STA,rE. NOTICE:ADDt7(ONAL TM'IS AND COM1DI•I'IONS ARE STATED'ON Tf&•REVERSE SIDE AND ARE.PA RT Or'•l•M CONTRACT f - You can do it. We can help., September 21, 2009 Barnstable Building Department Re: Home Depot Installer Jasmany Guillermo Naranjo is an approved installer for The Home Depot. CS License # 93783 Exp: 5/10/2010 HIC # 163124 Exp: 5/11/2011 If you have any further questions please contact Mike Bedard, our permitting coordinator at 508-962-6942 or I at 508-756-4105. Sincerely, Ru§sdl Johnstone New ngland Region -Installation Manager THD At-Home Services, Inc. 345 A Greenwood Street-Worcester, MA 01067 508-756-6686-Fax 508-756-8823-Toll Free 800-657-5182 f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 19 1 Parcel 14), Application # . 0 ("o6 Health Division Date Issued40 d Conservation Division Application Fee Planning Dept. Permit Fee �5 ` Date Definitive Plan Approved by Planning Board 0� Historic - OKH Preservation/ Hyannis V Project Street Address ral en m a l e Drive Village HA Owner H c ur i ce_ a.n^.e S Address h-G C_ Telephone2i{ L4 Permit Request C V^ rV t+ a ['in r ')I&tt-d a I k - ► , � �©��_ eve ara w i L Accrc, � b�drz-®o, o-AA L\ UY/ n j Square feet: 1 st floor: existing�4 proposed 2nd floor: existing proposed, 2-1 � 'Total view 2 I k� Zoning District Flood Plain Groundwater Overlay Project Valuation a-D Construction Type rcm Dcl e- ! ( Lot Size 0. :>_�. Mrre-S Grandfathered: ❑Yes )(No If yes, attach s ipporting documentation. CD Dwelling Type: Single Family ] Two Family ❑ Multi-Family (# units) } Age of Existing Structure `Z 0 V r S Historic House: ❑Yes On Old King'S Highway: ❑Yes YNo Basement Type: 1 Full ❑Crawl ❑Walkout ❑ Other tt Basement Finished Area(sq.ft.) 4 3; Basement Unfinished Area(sq.ft) 4'12 Number of Baths: Full: existing new D Half: existing 0 new Number of Bedrooms: 3 existing 6 new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: Gas Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes\,dNo Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garageA existing ❑ new size _Shed existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ,V1 No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION /� 046cn (BUILDER OR HOMEOWNER) Name l�Ce� Telephone Number 2 `� f Address a License # Cs `bS-Aq Net Sk c e rAA a16 L1 9, Home Improvement Contractor# 1 L I'Z'Z 8 Worker's Compensation # �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO T'S�v�n� IJ v to SIGNATURE DATE (8 `+ 0 6 `F FOR OFFICIAL USE,ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER p DATE OF INSPECTION: FOUNDATION i FRAME 2-/�6F- i6l 9bV's, INSULATION x FIREPLACE .� ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL 'GAS: ROUGH FINAL 's FINAL BUILDING `1IZ3�°s' 9�36�ac <; DATE CLOSED OUT ASSOCIATION PLAN NO. .k f The Commonwealth of Massachusetts Department of IndustrW Accidents Office of Investigations 600 Washington Street Boston, AM 0.2111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/Plumbers A licant Information ( Please Print Le 1 Name (Business/Organizalion/Indi',idual): M Address: t V rw kt a J - City/StateJZip: N��i 3�• �� r t Q' 1Phone.#: -q0l�. '5` Are you an.employer? Check the appropriate box: Type of project(required)- 1 I am a employer with 4. ❑ 1 am a general contractor and I 6_ ❑New construction employees (full and/or part-time).*. bavc hired the 5ub-contractors I❑ I am a"sole proprietor or partner- on the attached sheet 7. Remodeling ship and have no employees These sub-contractors bavc g, ❑Demolition working for e i a any capacity. employees and have workers' m 9 ❑Building addition [No workers' l:on�].iMrrance comp.insurance x 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions . r� officers bave exercised their 11.❑Plumbing repairs or adiitions 3.❑ lam a homeowner doing all work myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs incrrran�requirrd]t jr- 152, §1(4), and we havt no 13.❑ Other employees. [No workers' comp.insurance required.] J. . . *Any applicant that chxla box 91 murt also fill out the section below shDwing thcu workcrc'comp=LML1}Dn pDhcy mformahon_ t Homeowners who subroit this affidavit indicating tbey arc doing all work and then hin:outside contractors must rubrmt a new affidavit indicating such. TCDntractors that check this box must attached an additional sbect showing the name of the sub-cantracbm s and stain wbetha Dr not thost entities have arrploycm. If the sub-contractors have employees,they must pnn idb their work='comp:policy nranber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. lDsurancD 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 scctac coverage as rcquired•tmder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 5nn tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvestigatiOnS of the DIA for insurance coverage verification. I do her certi u r e sand penalties cf perjury that the information provided above is true and correct. Si store: Date: Phone# Official use only. Do not write in this area, to be completed by city or town offi.cfaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all crnployers to provide workers' compensation for their employees: f' 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 dcccascd employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state,or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct Buildings in the commonwealth for any the insurance coverage re wired." o ced�acce table evidence of com fiance with g q applicant who has notpr du p p . � Additionally,MCrL ohapter 152, §25C(7) states Neither the commonwealth nor any of its pol itical subdivisions shall enter into any contract for the performance of public work until acceptable cvidcnec of compliance with the in-surance requircmenfs of this chapter have bccn presented to the contraLting authority. Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to.your situation and, if necessary,supply sub-coniractor(s)name(s), add=s(cs) and phone number(s) along with their certificatr.(s)of Ms rance. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no-employees other titan the members or partners, are not required to carry workers' compensation ins;u ance. If an LLC or LLP does have :mployees, a poliy is required. Be advised that this affidavit may be submitted to the Department of Industrial 4ccidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should )e returned to the city or town that the application for the permit or license is bring requested,not the Department of ndustrisl Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ,ompcnsation policy,please call the Department at the n=ber listed below. Self-insured companies should enter their ;elf-inenranco license number on the appropriate line. �ity or TowA Officials 'Iease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ,f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant -Izasc be sure to fill in the permiVEccnse number which will be used as a reference number. In addition, an applicant eat must submit multiple permitllicense applications in any given year,need only submit onp affidavit indicating current olky information(if necessary) and under"Job Site Address" the applica.at should write"all IOCations in (city or rwn)."A copy of the&$davit that has been officially_stamped or marked.by the city or town may be provided to the Pplicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit,must be 511cd out each ear.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture _e. a dog license or permit to b,i:m leaves etc.) said person is NOT required to complete this affidavit. he Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, lease do not hesitate to give us a call to Department's address, tticphone•and fax number. The C6mmonwealth of Mas arhuset't , Be)artment of kdustdal Accidents Office of Investigations 600 Washin.gtan Street Boston, MA 02111 Tel. # 617-727-490.0 ext 4.06 ar 1-M-MAS.SAFB Fax# 617-727-774g :d 11-22-06 wWw.mass.gov(clia f t ,oFTMEra,, TOWn of Barnstable . 0 Regulatory Services v RMMS ssABEY$ Tbomas F. Geiler, Director. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable_ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder j o. y i te as Owner of the'subject property hereby authorize Ceq ot I c to act on my behalf, in all matters relative to work authorized by this building permit application for: 119- 61Cr\cao� Ivt f CCkzr%j-� )lei "A (Address of Job) Signature of Owne ate Print Name If Properly Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable (HE ray r . tt Regulatory Services • `1 Thomas F. Geiler,Director Z nwxxsrwst.>:. M'. Building' Division PJED 'fib Tom Perry,Building Commissioner 200 Main Street; Hyannis, NIA 02601 www.town.barnst2ble.ma.us face: 508-862-4038 Fax: 568-790-6230 HOW-OWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number Street "HOMEOWNER": work phone# name home phone# CURRENT MAILING ADDRESS: city/town state zip code " tended to include owner-occupied ied dwellings. of six units or less and The current exemption for `homeowners was ex p to allow homeowners to engage an individual for hire who does not possess a license,Provided that the owner acts as supervisor. DEFINITION OF HOMEONVIvER Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs mor e than one home in a fwo ear period shall not be considered a homeowner. Such y "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the'building pemnt. (Section 109.1.1) t The undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department requirements and that he/she will comply with-said procedures and minimum inspection procedures and t , requirements. ' Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the ;torte Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeownrr performing work for which a building permit is required shall be exempt from the provisions f this section (Section 109.1.] -Licensing of construction Supervisors);provided that'if thc homeowner engages a person(s)for hire to do such cork,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption sic unaware that they are assuming the msponsibilitics of a supervisor(sec Appendix Q, .ales&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly ficn the homeowner hires unlieenscd persons. In this case,our Board cannot proceed against the unlicensed person as it would Wiith a licensed upervisor. The homeowner acting as Supervisor is ultimately responsible. communities require,as art of the omit application, To ensure that the homeowner is fully aware of his/her rrsponsibilitics,many- q P P PP at the homeowner certify that hcdshc understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by vcral towns. You may care t amend and adopt such a fom✓ccrtification for use in your community. ' I r �A eomm � of lj( � �-\ Board of Building Regulations and Standards License or registration valid for individul use on! HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 7 Board of Building Regulations and Standards Registration 141228 One Ashburton Place Rm 1301 Ezpi rat ron la22/2010 Tr# 262042 Boston, Ma. 02108 r cTjrpe Individual Gregory Joseph Glanclr< r r Gregory Clancy -" 182 Wheeler rd. Mashpee, MA 02649 '"" Administrator Not valid wit ut signature - �w&wAWI e ;Construction Supervisor License r License CS 85247 .Eb Birthca#e s 3/2/1979 EX tatim-03 2009 Tr# 5367 �Restr��o Ofl GRE -ORY J CLAIVCY� 182-WHEELEIR RD �''. '- .�`� M A,SHPEE,'MA.02649 3`t' Commissioner ll; -. r J,AN, 2. 2000 12,06PN HART IIIISURANN CE N1O, 531 �,P, 20O/YTTY, ,QCOIRD,. CERTIFICATE OF LIABILITY INSURANCE 01/02/2008 THIS C1=RTIFICATE IS ISSUED AS A MAT" F OF tNFoRMA7i0N pDDucElt ONLY AND CONFERS NO RIGHTS UPON THE OF HART INSURANCE AGENCY, INC. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 243 MAIN STREET ALTER " COvEI;AGE AFFORDED BY THE POLICIES BELOW. PO BOX 700 INSURERS AFFORDING COVERAGE ,NAIC 0 BUZZARDS BAY, MA 02532-0700 Grego Clancy dba ConstruCGon Company iNSURi:R a PROVIDENCE MUTUAL FIRE INS G© 15040 INSURED Gregory INSURER B: GRANITE STATE INSURANCE. 23809 182 Wheeler Road INSURR C: Mashpee,MA 02UO INSURER D: INSURER E' COVERAGES THE POLICIES OF INSURANCE E CONDITION DBELO HAAVY CONTRACT OR OTHER DOCUMENT W(rH RESPECT TO WHICH THIS CERTIFNG AD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ICA D MAY BE SSUED TOR ANY REQUIRE, - MAY PERTAIN,THE tiN�ES LIMITS TS SHOWN MANCE Y BY THE FOLICIES NAPE 6EEN REDUC DESCRIBED HEREIN PAID ClJ�1M5,IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS 0)=SUCH POLICIES.AGGREG I POLCY BFFECTNE POLICY EXPIRATION I UNITS N7R PDLICYNUMBER EACH OCCURRENCE s 000000 0 MAL IAHIUTY CPP006628400 11I07/07 11/07108 A 500 00 A MIS E&• COIdMERCIAL GENERAL LIABILITY MED EXF Any Vie IW40(1) c 5 000 CLAIMS MADE 2 OCCUR PERSONAL&ADV INJURY s 1 000 000 GENERAL AGGREGATE s 2 000 000 PRODUCTS-QOMF/OP AGG 5 1 000 000 GE,YL AGGREGATE LIMIT APPLIES PER: PRO LOC (°OUCY fgW,BIN2D SING-E Uh'.IT g AUTOh1O9ILE LtABIUTY (Ea seddon* ANY AUTO BODILY INJURY g ALL OWNED AUTOS (POt person) $CFF_OULED AUTOS } 1 BODILY INJURY HIRED AUTO$ a (Fe�at�tlent} NON-OWNED AUTOS PROPERTY pANf+GE g (Pa;accident) AUTO ONLY•SA ACCIDENT S GARAGE LIABIUTY EA ACC S OTHER THAN --� AI.'Y AUTO I AUTO ONLY: A80 S EACH OCCURRENCE S eXCEsS=MRRELLA L1ABB.ETY AGGREGATE s OXUR Q G.AIMS MADE $ 5 DEDUCTIBLE S RETENTION 8 I WC STATU- OTH-I WORKERs 40MPENSAMON AND WC3797254 11/13/O7 11 i13/08 el,EACH ACCIDENT s 1 0 0 00 PMPLOYFRS'LIABILITY ANY PR0FRIETOFVPFRTNE�jEXEOU1IVE F-L DISEASE-EA EMPLOYEE E 1000.000 OFFICERMEUBER MWD.=D? II yc* descdt�e unaer E.L DISEASE-P(y--ICY UNIT I s )00 000 SPECIAL PROVISIONS Gel w OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I UXCW SIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS OPERATIONS PERFORMED BY NAMED INSURED AS PROVIDED BY TERMS &CONDITIONS IN THE POLICY CANCELLATION CERTIFICATE HOLDER sH0uLl1 ANY OF THE ABOVE DESCRI6ED POLICIES BE CANCELLED BEFORE THE UPIRATION DATE THEREOR TILE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS W11177H PROOF OF INSURANCE NOTICE TO THE CERTIMCATE HOLDER NAMED TO THE LEFT,BDT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR U&BILM OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATNES, AUTHORM P""SP.NTATIVE i ACORD 25(2001/48) WACORD CORPORATION 1988 ILL LE J__L� I-��-- , I cp, jc_ I r-s I I , I I I I . i � I I , -- +- --- -- _ T- - - fi- Iw _ I� I 1 i i- _- I - - - I - ► � I j i I I I I I I I � �_ � _ ' I I I I I � i I ! i ! -- 1I I I I ---1--L I i t � � c - -- - --- - - - A - 1--1 - -' • � I I � � I I i I I I -41--4--1' LE -Ab�--Lj7-p _� Y- 5 7- -SION 1 --7 I + TOWN OF BARNSTABLE.BUILDING PERMIT A P ICATION Map Parcel " 1 _ Application#, 6?®0k Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -7 6CftiJW1f beery Village 6?fA 4�//1t Owner /YI*saliL 'JAMfs Address //*I Telephone (SD1) 457-o-%A�� Permit Request WtO WSa/e- dwttis Aft/Ww �vfte_ �y.soor, 65),SS. , I��e01°Qf� l/�!l�iy tCs/iiG /�jer/S1,Qs�v� Z,X Z1,6,e;41prf 4� 4g ksso r3s /CgWily 44VM• ill 4Wery 4A*0f 0AW / o1opq c AwAgo*c A �<rehlff* Al fj(Tf/1/<.e.4e7FA1X171k6- Square feet: 1st floor:existing 97r proposed 2nd floor:existing 70Z' proposed Total new Zoning District Flood Plain Groundwater Overlay " Project Valuation aG Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Er Two Family ❑ Multi-Family(#units) Age of Existing StructZUII re Historic House: ❑Yes to On Old King's Highway: ❑Yes aWo Basement Type: ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.). -175 Basement Unfinished Area(sq.ft) �7a Number of Baths: Full:existing new Or Half:existing 10 new O Number of Bedrooms: existing J newi_ Total Room Count(not including bathsi:existing �r new First Floor Room Count Heat Type and Fuel: la'Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes LiKo Firep aces: Existing / New_� Existing wood/coal ,ove: ❑"es _-&<Oo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exist ng ❑ side 33- Attached garage:�isting ❑new Size Shed:Zxisting ❑new size Other: -` w > Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ld'No If yes, site plan review# `•° na r Current Use Proposed Use /60%04, "' r' BUILDER INFORMATION Name /f Y , AAiivs ['MA//n9 9,00* Telephone Number 500771-071 Address s�d A&I~r A License# WV76 Home Improvement Contractor# A;7913 Worker's Compensation# 6!/L� O3�/✓r�7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ^04,74ex_ A Ili d7071 SIGNATURE DATE .S%A3�df FOR OFFICIAL USE ONLY .APPLICATION# DATE ISSUED � MAP/-PAR `4 /r ' 1 � i •, CEL NO. i ADDRESS VILLAGE j. . OWNER DATE OF INSPECTION: FOUNDATION FRAME 7 A� /z �r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL II' —PLUMBING: ROUGH FINAL %^ GAS: ROUGH FINAL FINAL BUILDING "IA) DATE CLOSED OUT a: ASSOCIATION PLAN NO. 1 ` CORN NONE E■■� �,��!�i�■i�i��ii��.r3� i�i�i iii ■ i ONE Elul &OWAL a w M IMMEM M 2112 mi VIM- I a M M No mlEvlm2:wb" 0��lumm ::MMENEN � + w��! ■ C �e_rr�� f>zv��:sa��r�r��lliTi�i7l� 1 • � . F'wyti Town of Barnstable Regulatory Services q swaxsr + Thomas F.Geller,Director MA8& Fo.19.1%, Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mg.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, /yl,�M'alif JOWS as Owner e of the subject J property hereby authorize AAqAhk,y 4/ FAO, 4*flU &Wm &1+SfW41'to act on my behalf, ys in all matters relative to work authorized by this building permit application for. (Address of Job) Signaturef�wner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. f CREScheck Software Version 4.1.3 �J( Compliance Certificate Project Title: Finished Basement/Family Room Report Date:05/21/08 Data filename:C:\Program Files\Check\REScheck\James.rck Energy Code: 20001ECC Location: Centerville(Barnstable),Massachusetts Construction Type: Single Family Glazing Area Percentage: 9% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor: 117 Gleneagle Drive Anthony Metrano Owens Coming Basement Systems Centerville,MA 02632 Owens Coming Basement Systems 60 Shawmut Road 60 Shawmut Road Canton,MA 02021 60 Shawmut Road 781 821-0060 Canton,MA 02021 ametrano@ocboston.com 781 771-0078 ametrano@ocboston.com Compliance:2.6%Better Than Code Maximum UA:38 Your UA:37 n� � •� �;, a�� : . �� ,, �.. � � ,,� .:a -_ . � .. Basement Wall 1:Solid Concrete or Masonry 583 30.0 11.0 17 Wall height:7.5' Depth below grade:7.1' Insulation depth:7.1' Window 1:Metal Frame with Thermal Break:Double Pane 2 0.650 1 Window 2:Metal Frame with Thermal Break:Double Pane 2 0.650 1 Door 1:Solid 20 0.460 9 Door 2:Solid 20 0.460 9 Furnace 1:Forced Hot Air78 AFUE Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 4.1.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Ate" o rv' iNiv� CAS Sa3 0� Name-Title Signature Date Project Title: Finished Basement/Family Room Report date:05/21/08 Data filename:C:\Program Files\Check\REScheddJames.rck Page 1 of 1 -- --- Ijeparlment of 1ltaustrtat licciaenls Office of Investigations 600 Washington Street Bosto,4 AL4 02111 ' www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly .l ame (Bu.iness/Orsanization`Individual): � �/V� �,`!1///�[7 �� /�LrNT�GIMi?1 5 Address: W/o s1le UM47- Aaelk City/State/Zip: �W AW Phone#: ( l)P°I/00r°0 Are a an employer?Check the appropriate box: Type of project(required): l.U 4 ❑ I am a general contractor and I I am a employer with 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. Remodeling ship and have employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance:. 9. ❑ Building addition workers' co insurance 5. ❑ We are a corporation and its [No �� officers have exercised their ld.❑ Electrical repairs or additions required.] I LE] Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL c. 152,§1(4),and we have no 12.❑ Roof repairs myself.[No workers"comp. _ t employees. (No workers' ' ed. 13 Other insurance regtur ] ❑ c,)mp.insurance required..] *Any applicant that checks box it I muse also fill out the section below shoeing their workers'compensation policy infommtivn t Homeowners who submit this atTidnvit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. w information. tContractors that check this box must attached an additional sheet showing the name of the sub-oo�rnctoas and then workers'comp.pohcy I am an employer that is providing workers'compensation insurance for my employees° Below is the policy andlob site information. Insurance Company Name: � lg/SS9NeIF Policy#or Self-ins.Lic. #: �C D37� 7 Expiration Date: J_02V--off i7 �l£iv£r�l� tY1, City/Statelzip: n� ��a1 /jl,g D�(o3a- 3ob Site Address: � 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 e. 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 terrify t er hte P nd enalties of perjury that the information provided above is true and correct S i ature: Date: S 3 G 8 Phone# Official use only. Do not write in this area,to be completed by city or town of ieial. ' City or Town: PertniVIAcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityftovrn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r == Ate ` � BoarMouoiftjldegulati'b�ns-�'ancit ndars - , One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 137943 Type: Supplement Card Expiration: 1/29/2009 OWENS CORNING BASEMENT FINISHING r, ` ANTHONY METRANO 60 SHAWMUT PARK CANTON, MA 02021 Update Address and return card.Mark reason for change. DPS-CA1 0 50"7l07-PC&490 ❑ Address ❑ Renewal Employment ❑ Lost Can ✓Jre-E7avn�no7uufacai r ��iiv:uuzu ,lGs Board of Building Regulations and Standards License or registration valid for indh idul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 137943 Board of Building Regulations and Standards Expiration: 11292009 One Ashburton Place Rm 1301 v!ar "' Type: Supplement Card Boston,Ma.02108 OWENS CORNING BASEMENT FI AWMtJfgf VETRANO 60 SHAWMUT PARK ` CANTON,MA 02021 Administrator Not valid thout signature o�ucaa�i a�.�aaeoa�iu4elta Board of Banding Regulatiods and Standards Construction SuPen►isor License Licence: CS -98076 E)(Piralion. -2QM12 Trd 98076 Restriction: 00 ANTHONY METRANO 246 MEADOW STREETT' CARVER.MA 02330 Commissioner i DATE(MMIDDIYYYY) A ORD. CERTIFICATE OF LIABILITY INSURANCE 5/15� Dos PRODUCER (781)659-2262 FAX: (781)659-4725 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Andrew G. Gordon, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1680 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 299 Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.Star jn"ranae CO an Say State Basement Systems, LLC INSURER e: 60 Shawmut Road INSURER C! INSURER D: Canton MA 02021 INSURERE: 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 09 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. TE LI Y RED LA INSR POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MIAID DATE GENERAL LUL8ILIlY EACH S DAMA��,,E TO RENTED COMMERCIAL GENERAL LIABILITY ISES-(Ea ocwny=01 f CLAIMS MADE �OCCUR MED EXP S PERSONAL&ADV INJURY S ENERALAGGRE S GEWL AGGREGATE LIMIT APPLIES PER: MPI P AGGd POLICY E LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT d (Ea ecodenk) ANY AUTO ALL OWNED AUTOS BODILY INJURY 3 (per Pam? sCHEOULED AUTOS HIRED AUTOS BODILY INJURY = (Per v xJdenl) NON-OWNED AUTOS PROPERTY DAMAGE _ (Par Welder) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC d AUTO ONLY: A G S EXCESSIUMBRELLA LIABILITY EACH MCURRFNCFf8 OCCUR ❑CLAIMS MADE AGGREGATE f s DEDUCTIBLE d RETENTION TA OTH A WORKERS COMPENSATION AND LIMPLOYM LIABILITY E.I..EACH ACCIDENT S 1,000,000 ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERndEMBEREXCLUDED? WC 0371527 5/24/2008 5/24/2009 E.LDISEASE-EAEMPLOYEES 1,000,000 If yea,deeabe under E.L.DISEASE-POLICY LIMIT 1 1,000,0 0 CIAL PROVISI OTHER DESCRIPTION OF OPERATIONSILOCATIONSNENICLESIIEXXCLUSIONS ADDED BY ENDMEMENTISPECIAL PROVISIONS SAMPLE U8E ONLY i 1 j CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ADM DESCRIBED POUCIES BB CANCELLED BEFORE THE Bay State BasementS1:g1ms, LLC EXPIRATWN DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 60 Shawmut Rd. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Canton, MA 02021 FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION-OR UABII ITY OP ANY KIND UPON THE i INSURER,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE G Gordon/CORWIL ACORD 26(2001/09) ®ACORD CORPORATION 1986 2008-0516 09 02 7816594725 Page 1 I y BAS EM ENT { :. Y al, ' FINISHING SYSTEM �k - ...-7$_:.-.... .'Ev.<,: x�S..nF.Ki.'1 v.» wMek ".Filc'�a'i�' &>l Lm•%£�` '. ' DESCRIPTION The Owens Coming"Basement Finishing ater� y a y rj 4 System is comprised of lightweight Y� !� ei fiber glass panel&PVC lineals(which replace conventional framing) moldingsand foamed PVC trim a , (which replace trim lumber).The trim moldings r^ �Y j� y s snap into the fineals,holding the panels in place ` r �w WRr "° " Moldings and wall panels are easily removed to1021s ka � re&Mcx provide easy access to a home's foundation walls.Because traditional wood and paper- x� r h v a at ` 'r } �rf x's q 4 nt is'i' se. Y 7r - based building materials are replaced with fiber tr t3 a glass and PVC materials,the Basement Finishing ��•�q ��, �.��.�F �: System offers inherent resistance to moisture, mold and mildew"The system is covered b Y a lifetime limited transferable warranty— from Owens Coming. .a USES The Owens Coming Basement Finishing System is an innovative system designed to q � insulate and finish basement walls.It insulates, °Kt' acoustically treats and aesthetically finishes walls in a few simple steps.The system can be installed over both masonry foundation walls PHYSICAL PROPERTIES and interior partition walls built with either wood or metal members. Property Test Metfiod Value For Fiber.Glare 8anrd. AVAILABILITY WaterVapor Sorption ASTM C 1104 <2%by wt.@ 120Nf 94'x 48"x 2-11T Panels 95%RH Lineals Compressive Strength ASTM C 165 @10%deformation 25 psf Trim Moldnnr. @25%deformation 90 psf Cove Molding Thermal Resistance ASTM C 518 R-1i t Vertical Battens Normal Density ASTM C 303 3.2 PCF Base Molding For Finished Planet: Outside Comer Lasing Noise Reduction Coefficient ASTM C 423 Jamb Extender Type A Mount 0.95 Chair Rail ;Surface Burning Characteristics, , ASTM E$4+ Class A Flame Spread 25 -Meets Class A Bum Rating Smoke Developed 450 1 Color Choices: Interior Textile Finish Fire Classification NFPA-286 Meets Acceptance Panels:"Linen Mist"woven fabric Criteria Trim:All trim available in White or Woodgrain. Mold Resistance ASTM C 1338 Pass In addition,vertical trim available in fabric book. ASTM G 21 Pass finish or fabric wrapped to match panels. +The surface-burning charactenulcs of the finished composite panel were determined in accordance v,ith ASTM E&4l:ifs stag- dard measures and describes the propel-ties of materials,prod i is or ass mblw.s in res come to hen and Hare wie tir• CODE COMPLIANCE contro}led laboratory conditions Data from ASTM E 84 testing cannot be used to describe or assess the fire hazard or fin= risk of materials products a•assemblies when considering all of the factors pertinent to an assessment of the fire hazard of 2006 BOCA Evaluation 921-2.4 a particular end use.Values are reported to idle nearest 5 rating. 2004 ICC Report#NER-635 'While the materials and design of the Cnuens Coming"" Basement Firashing System resist mold and mildew,the System can riot prevent,or rnmiate mold if the conditions necessary for mold g ioMh othery se ewst in yo,r baserr*m "See.actual vean army for det v&lirmat'sotx anrt rnrtrirraaysc . TOWN OF BARNSTABLE,BUILDING PERMIT APPLI ION 407706 Map I Parcel' r qZ Application # Health Division = Date Issued d i Conservation:Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation/ Hyannis Project Street Address 11_� 6 Q f Village Owner H ax,ri c e J��.e s 01 Address Telephone Snl 1 Permit Request ke_S4r c u gd- :+L) cz 15-rn� , I c- E?SM c I 1 C5I con cc- b)� re-/N\d J`!1A s 11 k-1h K!, 4- 45 , e- Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ��/ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including ibaths): existing new First Floor Ro m Count N Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo4poal stc e: q Yes ❑ No Detached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: xistingr0 nets size= Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ ❑Appeal # Recorded W a, rn Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� .a C Telephone Number 5D 9- Address I 2- LVk,1 12r� 0-- License# CS 8-1�- 7-cf 9- kAc�x ka T < 0-A 6---a q I` Home Improvement Contractor# _ ems)q 17.2 Worker's Compensation #ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 5rr.r rr,-o- by,^A SIGNATURE DATE ;f t FOR OFFICIAL USE ONLY a PPLICATION# DATE ISSUED L MAP/PARCEL NO. ADDRESS VILLAGE - 'OWNER - DATE OF INSPECTION: '} FOUNDATION ` FRAME € INSULATION r. FIREPLACE r _ ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL . : GAS: ROUGH FINAL s FINAL BUILDING 1 '> DATE CLOSED OUT ASSOCIATION PLAN NO. f � 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/EIectricians/Plumbers A tlu_pplicat Information �+ P Please Print Legibly Name(Business/Orgmtization/Individual): �� l._1 An � ., rA��^ Address: 2 L V tJ r City/State/Zip:4— •M-0^ e e- Qi Phone.#�Sb Are you an employer? Check the appropriate box: Type of project(required): 1.VI am a employer with 4. 0 I am a general contractor and I 6. ❑New construction . employees(full and/or part-tame).* have.hired the stab-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me iu any capacity. employees and have workers' 9 Building addition [No workers' comp.•tnsuranne 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 myself[No workers' comp. right 6f exemption per MGL 12.❑Roof repairs insurance. nsurance required.]t c. I52, §1(4), and we have no • employees. [No workers' 13.0 Other comp.insurance required] 'Any applicant that checks box#1 must aho fill out the section below showing their workers'cornprnsetion policy information. t HDrnwwnan who submit this affidavit indicating they are doing all work and then hire outside euntractots must submit a new affidavit indicating such. (Contractors that ohcck this box must atiachcd an additional shoot showing the name of the sub-=tracton and stale wbether or not those entities have employees. If the sub-contractors have employees,they must pravi db 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. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonmeat, 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 msurancc coverage verification. I do hereby rli pains•and penalties of perjury that the information provided above is true and correct. Date: `� a , Si afore: — 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/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: II� 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 receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, it necessary, supply sub-contractors)name(s),addresses) and phone numbers) along with their certificate(s)of insuran_cz. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of m' surancc coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insuran=license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit on;affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A cbpyof the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit,must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to born leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hke 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,telcphone•and fax number. The Commonwealth of Massachusetts }department of Industrial Accidents Office of IuvestigatIOM 600 WashingtGa Street Boston, MA 02111 Tel. # 617-727-49-0.0 ext 4.06 or 1-M-MASSAFB Fax# S17-727-7749 Revised 11-22-06 www.mass.gQv/dia ti • i_ Construction Supervisor License I� License: CS 85247 Birthdate,3/2/197 9 F (! Expiration 3/2/2009 Tr# 5367 �Restnction QO ,� u r F , t GREGORYJ CLA CY !, � tt r-� E� 182 WHEELER RDA, tlr"f�,.�_ a, MASHPEE,MA 02649=. �% Commissioner p f _ � � �lze �anr�no7u�len,�i a�,,�aaaac/zuaella Board of Building Regulations and Standards License or registration valid for iadividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: j Registrati n'\141228 Board of Building Regulations and Standards t, Ez iration One Ashburton Place Rm 1301 P 1/22/2010 Tr# 262042 #—'— 1. Boston Ma.02108 �= Type. Individual ' Gregory Joseph ClancyA ', I Gregory Clancy raj' 182 Wheeler rd �� Mashpee,MA 02649 Administrator Not valid wit ut signature " JAL. ^. 2008 12: 06PM HART Isrt r ANCLL 1v0. 537 up, 2nDrYYYn CT. CERTIFICATE OF LIABILITY INSURANCE 01=008 THIS CERTIFICATE IS ISSUED AS A MAT7FR OF tNF012MAT10N I JQER ONLY AND CONKERS NO RIGHTS UPON THE CERTIFICATE HART INSURANCE AGENCY, INC. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 243 MAIN STREET ALTER THE COvERAGE AFFORDED BY THE PoL(CtES BELOW PO BOX 700 NAIL 0 BUZZARDS RAY, MA 02532-0700 1NSURERS AFFORDING COVERAGE 13NSURER A PROVIDENCE MUTUAL FIRE INS CO 15040 tev Gregory Clancy dba Construction Company 23809 182 Wheeler Road INSURER a GRANITE STATE INSURANCE ; Mashpee,MA 02649 I lNSL'RER C: INSURER D: INSURER E' NG /ERAGFS ��_ �____ E BEEN ISSU5D TO THE INSURED TF {E POLICIESOET AM INSURANCE GTE DBEL Of�Y CONTRACT OF OTHER DOCUM,EN�T WITH RE5PEC7TT0 WH GH TN S GERTOIFICA D MAY ENOTVIAT ISSUED IOR JY REQUIR 4Y PERTAIN,THE'INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS O�SUCH )LICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, EFFECTry W E POLICY EXPIRATION Lrcs p POLICY NUMBER EACR OG'URP."NCB �,s 1.000000 �I GENERALIJADIUTY CpP006628400 11/Q7/07 11/07/08 EA p'OCCU�;�.sts- 50000 CONMPRCVAL GENERAL LUABILITY VIED EYf Any ova Person) e 5 000 CAMS MADE 2 OCCUR PERSONALS ADV INJURY S 1 000 000 I GENERAL ACGREGAT E 3^?00O0 000 �j RoDUGT5-coMP_.roP Acc �s 1,0001900 GEYl AGGREGATE UIMIT APPLIES PER: �— POLICY PRO- LOC 0QM61N60 SINV:f LIMIT S AUTUMOBILE rLMILM (D tsoddo l ANN AvTO 9 INJURY ALL OVtNEDA'UTOS I (Pot rpef person) S�IYJLED AUTOS HIRED AUTOS (Forst dent)INJU I NON-OWNED AUTOS PROPERTY OAR'AGS S AUTO ONLY.EA ACCIDENT I _ GARAGE LIABILITY EA ACC S OTHER THAN ANY AUT0 AUTO ONLY: AGO S I I :ACH OCCURRENCE 15 EICCffntU RRELLA LIABF rN AGGREGATE S OCCUR Q G.AIMS MADE $ 5 DWUCTISLE I S RETENTION S I I ( WCSTATU-WORKERS,QMPENb5ATION AND WC3797254 11/13/07 11/131Q8 —� PJMPLOYERS'LIASILrTY E:L,EAQH ACCIDENT S O O OO ANY PROPRIETORn'A RTNERIOe—rCU'YIVS EL DISEASE-EA EMPLOYEE I 1000.000 OFFICEWENBER EXCLUDED? 11 Y� Mee=rtoe antler E L>�SEASE PO IcY uN.IT i s 000 000 SPEGAL PROVISIONS heloW OTHER I ;SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCWSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS IPERATIONS PERFORMED BY NAMED INSURED AS PROVIDED BY TERMS &CONDITIONS IN THE POLICY :ERTIFICATE HOLDER CANCELLATION SHOULA ANY OF THE ABOV2 DESCRIBED POLICIES BE CANCEL BEFOG THEID(PIRATIO4 RATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 80 D 1��AYS N PROOF OF INSURANCE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 5NAL! IMPOSE NO OBLIGATION OR UAMLSTY of ANY 1END UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORPAR RPPRPSENTAMVE ;ORO 25(2001/08) G)ACORD CORPORATION 1988 °f Er Town of Barnstable ti Regulatory Services k Assam.r.E$ Thomas F. Geiler,Director. 1659. "tea 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, as Owner of the subject property r �hereby authorize ' -- - -�_ _ _ _ to act on my behalf, in all matters relative to work authorized by this building permit application for: ca�Q_ pC, v e (Address of Job) 0 ,9 c�Z Si iture of O,wrier� - - "`' Date Print Name If Property YOwner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable mop SHE Tp� ti o� Regulatory Services _ • " Thomas F. Geiler,Director saxtvsrwsr.>•;. W s& 9g, 1639- ,�� Building Division PrEp��a Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 vvww.town.barnstabl e.ma.us Office: S08-862-4038 Fax: 508-790-6230 H011'.CEOWN"ER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with'said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomring work for which a building permit is required shall be exempt from the provisions of this section(Section I o9.1,.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption sic 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 hc/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. i C I =,Xi — � --�— ' --- - -F- a 'cr I _ i _r i ! I I , � � I I i� � I I _ _ ► � �r i I , -Dill 4-J, -_I_ ► 1 � I_ I I __� i �J , -j 1, 4-1 1-1 Barry, Lois From: Dillen, Elizabeth Sent: Wednesday, June 04, 2008 1:03 PM To: Barry, Lois Subject: RE: 117 Gleneagle Drive, Centerville Yes,will add it to the agenda with Connemara Circle ,f--dal.Protects C:oord.iriator ._:rria't r.4oriaaerren.t Depa.rm eat vv K, Of 561.rI LS table 67 iMAiiL Street H jaiq.vtis e! '02.4t'831 F!=.x 508.462..47tit -----Original Message----- From: Barry, Lois Sent: Wednesday,June 04, 2008 12:58 PM To: Dillen, Elizabeth Subject: 117 Gleneagle Drive,Centerville Beth, The new owner of this property has submitted a building permit application to remove the kitchen. Will you rescind the Amnesty apartment? Lois 1 091 - )42- - o�-- �Ada s��+d1f CaA-Y4 MASSACHUSE4T.6 UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING r / City/Town:( 79� A MA. Date:� FPermit# r (� Building Locations ��. - w Owners Name: P44-0 . 1C, Type of Occupancy: --- - yp Com ercial�� I Educational Industrial Institutional ED Residential New: Alteration: Renovation: Replacement: Plans Submitted: Yes 0 No 0 FIXTURES a ti z mO ...... > Y rn -I x lam- w 1 Z a w z ta- z z J da Q Q of ? O WLLO W J zOO n Z v a W W J = O ~ xZu- a. Q _Y W W= O W O > OO O z z vZ v> H H x m m 0 u- O x `1 J J N N Fa- 5 SUB BSr. BASEMENT 1 FLOOR ,.f'... 2 N u FLOOR Vu FLOOR 4 1HFLOOR r: 51HFLOOR 6 FLOOR 7 1HFLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Jots¢ A„ , h/ �—� y» D f Corporation Address:,� m .- ram. City/Town ��'t. State: MA rs Pa ership Business Tel: 7 Y3—3 Ll Fax: _ - = Firm/Company Name of Licensed Plumber:� '`�"'.� 5S e ft' W! INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes' yNo If you have checked Yes,please in of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity IF Bond L—IOWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By` ------------- - - _ , R c Type of License: Titiel ; I gnature of Licensed Plumber Plumber 1— v City/Town Master ?n� j t Journeyman License Number: lr 3 OFFICE U APPROVED SE ONLY �y �I Barry, Lois From: , Dilten, Elizabeth Sent: Wednesday, March 12", 2008 11:54 AM To: Barry; Lois Subject: FW: 117 Gleneagle Drive, Centerville Lois- I will wait to rescind until Linda hears back. It may be a transfer instead. 6etVI.Dilten Speci.ai.Projects coord-iisator Growth,Manacen^. int DepL;vtrnenr o�vn c f Bra.rnsta�te 367 Main Street, Iuannts MA e! 5Ci8.8Ei2.4683 -ntx 508.862.4 782 -----Original Message----- From: Edson, Linda Sent: Wednesday, March 12, 2008 11:51 AM To: Dillen, Elizabeth Subject: RE: 117 Gleneagle Drive,Centerville I spoke to the broker, they live out of the country. I sent them a letter and as of yet no response. Did you get the message on Rick Morse? He should be calling today. Linda -----Original Message----- From: Dillen, Elizabeth Sent: Wednesday, March 12, 2008 11:36 AM To: Barry, Lois Cc: Edson, Linda Subject: RE: 117 Gleneagle Drive,Centerville Hi Linda- I think you spoke with the new owners of this property, but I don't recall whether they were interested in applying to amnesty? Beth Ditl.en SpeciU.t Projects CoorA ncaor Grant't4G Nn.nagement Derartkv,ent Town Qf Barnst(J)[C 367 Main Street. I-;�anv,,is MA Tet 508.862.4.683 Fax 508.862.4-782 -----Original Message----- ,�, From: Barry, Lois Sent: Wednesday, March 12, 2008 11:25 AM To: Dillen, Elizabeth Subject: 117 Gleneagle Drive,Centerville Beth, I see that this property has been sold. Has the Amnesty permit been rescinded? Lois 1 i Bk 22713 Ps198 AWL10660 02-29--2008 & 01 2 08o MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Dates 02-29-2008 8 00cc$Ae10660 QUITCLAIM DEED F 877 . QU Fed: f1r04.40 Cons: f320r000.00 I,Teresa A. Downey, of 117 Gleneagle Drive,Barnstable(Centerville),Barnstable County, Massachusetts 02632 for consideration of Three Hundred Twenty Thousand and 00/100($320,000.00)Dollars paid,grant to Marion N. James and Mary J. James,husband and wife,as tenants by the entirety,both of 136 Shore Road, Warwick, Bermuda BARNSTABLE COUNTY EXCISE TAX -- BARNSTABLE COUNTY REGISTRY OF DEEDS with Quitclaim Covenants, - Dates. 02-29-2008 S 01•08ps Q Ct1A: 877 Dorf: 10660 Fees f729.60 Corps: f320000.00 the land,together with the buildings thereon,situated in Barnstable(Centerville), Barnstable County,Massachusetts,with a property address of 117 Glen Eagle Drive, Centerville,Massachusetts,more particularly bounded and described as follows: Lot 11 as shown on a plan entitled"Subdivision Plan of Land in Centerville Barnstable Mass. for: Charlene L. Johnson to be conveyed to James F.Ruhan Scale: 1"= 100' June 1, 1972,Barnstable Survey Consultants, Inc., West Yarmouth,Mass.,"which plan is recorded with the Barnstable County Registry of Deeds in Plan Book 260, Page 71. Excepting and excluding from the above,the fee in Gleneagle Drive adjacent thereto. The above described premises are conveyed subject to and with the benefit of all rights, rights of way, easements,appurtenances, reservations and restrictions of record, insofar as the same are in force and applicable. For title, see deed recorded with the Barnstable County Registry of Deeds in Book 10924, Page 82. Witness my hand and seal this 291h day of February,2008. Teresa A. Downey f Bk 22713 Pg 199 #10660 COMMONWEALTH OF MASSACHUSETTS Barnstable, ss: On this 29`h day of February, 2008 before me the undersigned no 'Y public personally appeared Teresa A. Downey,personally known to me to be the person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it voluntarily and for its stated purpose. ael Boudreau Philip Notary Public Notary Public 6oudreau My Commission Expires: January 28,2011 Notar MCoo m mawmm of ch 2011 BARNSTABLE REGISSRY OF DEEDS Amnesty Program Helping to Make Affordable Housing Possible .Town ofBarnstable F ........... aim Certificate of Compliance This certificate indicates acceptable minimum habitable requirements per Massachusetts State Building Code and Town of Barnstable zoning ordinances in accordance with the Amnesty Program. Location 117 Gleneagle Drive, Centerville, MA Unit Capacity One bedroom, n, exceed two eo le Inspector s� M/P No. 191/142 6/1/2005 i Town of Barnstable Office of Community and Economic Development 330 South Strout,Hy=ia,1MA 02601 $ Office: 862-4683 Fax: 862.4782 �,ri,eil; tea,eedev��Mwn.bansrtn6le.me.ta TO. 'Rona Perry,Buddkg,Cornrnissioner M Lois Barry,Bvw c*Depar naw: FRrW, Rnha+rt Shaw RE; Inspection at: 0 I&P/Parcel I have conducted a Housing Inspectioz of a dwelling ovmed by►s��R,�,, LJ bW�V_�►t PhOYiO: ,S,®d�77� ��1 address: 1 t`1 4 6,g goo le. s7 a ape R d . it d'. Single ftwily OR IVf t-Pemily Unit Capacity. # Bedrooms Unit Capacity. # Bedrooms Unit Capacity: # Bedrooms Unit Capacirp # Bedrooms This unit vs found to be in connpWce with the State SaaharyCode.Please arrange for the Building Deparmient to do its final inspection of the property in order to grunt it Certificate of Compliance for the unit(s). Srgaed.,_��Le✓ Date 16 413 Robert Shia DATE _•�/may/� S� 'I"IlvIE BY elf 7-/L2 ��Pi�G� AP'PROV2D, REJECTED. The folloaiag iurm need correcting: I ` SIGNATURE: `_ 7/P•.1 JGA'nk1 I61 al,l..1n"�7A7r1.•n^+7il.inn "]'1QLd i cuvuo i.iuc7,c e^rara�•e i ui i Ar TOWN OF BARNSTABLE , CERTIFICATE OF OCCUPANCY PARCEL ID 191 142 GEOBASE ID 11539 ADDRESS 117 GLENEAGLE DRIVE PHONE CENTERVILLE ZIP - LOT 11 BLOCK LOT 4IZE DBA DEVELOPMENT '''-DISTRICT CO PERMIT 84364 DESCRIPTION EXISTING 750 SF APT/#84342� PERMIT TYPE BAMNCO TITLE AMNESTY APT CERT. OF OCC. CONTRACTORS: Department of ARCHITECTS: Regulatory ator Services g Y TOTAL FEES: $25.00 BOND $.00 THE CONSTRUCTION COSTS $.00j. 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE 0_ = BARMSTABLE, 1 Mass. 1659. BUIL;D.IN ISION BY --- L% , DATE ISSUED 05/25/2005 EXPIRATION DATE 64 TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 191 142 GEOBASE ID 11539 ADDRESS 117 GLEMGLE DRIVE PHONE CENTERV LE ZIP LOT 11 BLOCK XDEVELOPMENT LOT SIZE DBA DISTT CO !' t PERMIT 84342 DESCRIPTION EXISTING 750 SF APT G PERMIT TYPE : BAMNSTY . TITLE AMNESTY APARTMENT CONTRACTORS: PROPI&gTY OWNER Department Of i ARCHITECTS: Regulatory Services ` TOTAL FEES: $25.00 F BOND $.001ME CONSTRUCTION COSTS $:00 434 RESID.ADD/ALT/CONV 1 PRIVATE , BU IN ISION B DATE ISSUED 05/24/2005 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PER MITTED UNDER THE BUI LDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OFON OF PUBLIC SEWERS A ANY E APPLICABLE SUBDIVISION INED FROM THE A RTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE FOR ALL CONSTRUCTION WORK: THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (R OR LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4,FINAL INSPECTION BEFORE OCCUPANCY. kimulan:82:19 F BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ,Flw 2 2 2 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 3 2 BOARD OF HEALTH SITE PLAN REVIEW APPROVAL OTHER: WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- NOTED MONTHS OF ATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. Barry, Lois To: Dillen, Elizabeth Subject: RE: 221 Five Corners Rd, Centerville We will need to have the approval notice before we issue the Certificate of Compliance, so I imagine he does need to do his final inspection. (I'm not sure what your process is on your end.) -----Original Message----- From: Dillen, Elizabeth Sent: Thursday,April 28, 2005 11:43 AM To: Barry, Lois Subject: RE: 221 Five Corners Rd,Centerville Bob hasn't been there for the final inspection, that's why I was confused. Shall I tell him to set it up? -----Original Message----- , From: Barry, Lois Sent: Thursday,April 28, 2005 11:42 AM To: Dillen, Elizabeth Subject: RE: 221 Five Corners Rd,Centerville Beth, I see that Jack Fitzgerald recorded the final inspection on 4/25. I've written a note to him to issue the CO. After that's issued and paid for, we can issue the Certificate of Compliance as long as we have the Amnesty approval notice. Has that been sent to us? Lois -----Original Message----- From: Dillen, Elizabeth Sent: Thursday,April 28, 2005 11:27 AM To: Barry, Lois Subject: 221 Five Corners Rd,Centerville Hi Lois - I just received a call from the owner of 221 Five Corners Rd, Centerville - he said the building dept gave him final approval and he'd like to have a tenant move in. 1 wanted to check with you first to see if there is an occupancy permit for the unit. 1 o�T► , Town of Barnstable w BARNSTABM : Regulatory Services Thomas F. Geiler,Director AjFp�,1 a � Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 April 19, 2005 Teresa A. Downey 117 Gleneagle Drive Centerville,MA 02632 Re: Proposed Accessory Affordable Apartment 117 Gleneagle Drive, Centerville Dear Ms. Downey: We have received the recorded Regulatory Agreement and Comprehensive Permit for the accessory affordable apartment to be created at the above-referenced address. A building permit is required whether the unit is new or pre-existing. We look forward to receiving your building permit application for the apartment. Please call me if you have any questions regarding the building permit process. Sincerely, Lois Barry Division Assistant J040616a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,3 Map /�/ Parcel `�Z _ Permit# 4 3 4 2 ✓Health Division Conservation Division Fee e� 2!1CS MAY 1 $. At.M �: 143 Tax Collector Sv fz ZZ D.. Application ee Treasurer �r _ SEPTIC SYSTEM MUST BE t PLIANCE Planning Dept. R Check N i4 Date Definitive Plan Approved by Planning Board ApprovEld".0NMENTAL CODE AND TOWN RIEULI Historic-OKH Preservation/Hyannis Project Street Address // 7 � Village �� Owner Address // Telephone Permit Request Square feet: 1st floor: existing 1�36, proposed 2nd floor: existing 7 proposed Total new O Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Ad— Multi-Family(#units) Age of Existing Structure %7 y'eL- Historic House: Cl Yes A ,_No On Old King's Highway: ❑Yes Wo Basement Type: UF,ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) AJO Basement Unfinished Area(sq.ft) �3� Number of Baths: Full: existing ; --- new Half: existing new Number of Bedrooms: existing new _ Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Was ❑Oil ❑ Electric ❑Other Central Air: ❑Yes l No Fireplaces: Existing �_ New Existing wood/coal stove: ❑YesJo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:44.existing ❑new size / 6Afl—Shed: _eexisting ❑new size 0-V 170 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes A%Lo If yes, site plan review# Current Use 4;5-:5•b :► Proposed Use BUILDER INFORMATION Name GtJ h Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 Z o ry FOR OFFICIAL USE ONLY PERMIT NOk, DATE ISSUED MAID/PARCEL NO. ADDRESS.' VILLAGE J - OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL M A r r:} GAS: ROUGH ' FINAL FINAL BUILDING DATE CLOSED OUT - I ASSOCIATION PLAN NO: i-a +3 YiS��'f �{ _ �� ..�j..�-- �� 1G �G�� - �c �� i ____ : .. �� .� �y�.�acc-sue II I ' � , t�J``�� I �„ ✓k�� -�s�r�.� i� r r� ffI d t� O �i- ��✓�--s I Bk 19719 P s 24 =24 103 F G5 r,AF, -31 f' 2: 48 .,, dTMe e•; w:x t- 4 jr a v i 'u 6.,a.,.;"'. '� 2 sul m om - Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2005-22 Downey Chapter 40B Comprehensive Permit Applicant: Teresa A. Downey Property Address: 117 Gleneagle Drive, Centerville MA Assessor's Map/Parcel: Map 191,Parcel 142 Zoning: Residential Commercial Zoning District Applicant: The applicant is Teresa A.Downey,who resides at 117 Gleneagle Drive, Centerville,MA. The applicant is seeking a Comprehensive Permit for the conversion of an existing apartment unit within a single family dwelling to an accessory affordable rental unit in accordance with all conditions of this permit.Teresa A. Downey was granted title to the property by deed recorded in the Barnstable Registry of Deeds on May . 20, 1997 as recorded in Book 10924,Page 082. Relief Requested: The applicant,Teresa A.Downey,has applied for a Comprehensive.Permit under Chapter 40B of the General.Laws of the Commonwealth of Massachusetts,and in accordance with Article H of Chapter Nine of Part I, General Ordinances, of the Code of the town of Barnstable,more commonly termed the "Accessory Affordable Housing Program." The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 3- 1.3 (2)of the Zoning Ordinance—Accessory Uses to permit an accessory affordable apartment unit to a single-family owner-occupied residential dwelling.The issuance of this Comprehensive Permit would allow for an owner-occupied single-family residence with an accessory affordable apartment unit attached to the dwelling. Locus and Background: The property at issue is a 0.37 acre lot that was developed with a Cape Cod style single family dwelling of approximately 1,450 square feet.The accessory apartment is a one-bedroom unit located on the second floor of the main residence. The square footage of the rental area is approximately 700 square feet. The lot is served by public water and on-site septic, and is located in an Aquifer Protection Overlay District.The Town of Barnstable's.Public Health Division reviewed the septic on November 29,2004 and approved a total of three(3)bedrooms at this property. r Procedural Summary: I A site approval letter was issued for.the property by Kevin Shea,Director of Community&Economic Development on January 18, 2005,in accordance with MGL Chapter 40B and 760 CMR. .Elizabeth Dillen,Program Coordinator, sent notice of the site approval letter to the Department of Housing and Community Development in accordance with the requirements of CUR 760. .An application for a Comprehensive Permit was filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals on January 20,2005. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on January 28, 2005 and February 4,2005, and notices were sent to all abutters in accordance with MGL Chapter 40B. On February 16,2005 Hearing Officer Gail Nightingale presided over the public hearing. The applicant, Teresa A.Downey,was present at the hearing. Elizabeth Dillen, Program Coordinator of the Office of Community and Economic Development was also present. Ms.Nightingale reviewed the file with the applicant to assure compliance with all of the program requirements. Findings of Fact on the Comprehensive Permit: At the hearing on February 16,2005,the Hearing Officer made the following findings of fact: 1.The applicant is Teresa A.Downey,who resides at 117 Gleneagle Drive, Centerville,MA. The applicant is seeking a Comprehensive Permit for the conversion of an existing.apartment unit within a single family dwelling into an accessory affordable rental unit,in accordance with all conditions of this permit. The applicant is aware that program requires the single-family unit to be owner-occupied and has committed to that requirement. 2.Teresa A.Downey was granted titlejto the property by deed recorded in the Barnstable Registry of Deeds on May 20, 1997 as recorded in Book 10924,Page 082. 3.Kevin Shea,Director of the Office of Community&Economic Development,issued a site approval letter for the property on January 18,2005: Elizabeth Dillen,Program Coordinator, sent notice of the site approval letter to the Department of Housing and Community Development in accordance with the requirements of CMR 760. 4.The accessory affordable unit is a one-bedroom apartment of approximately 700 square feet. 5.The applicant is aware that the unit must meet all applicable building codes to be occupied and that the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. 6.The lot is served by public water and on-site septic, and is located in an Aquifer Protection Overlay District.The Town of Barnstable's Public Health Division reviewed the septic on November 29,2004 and approved a total of three(3)bedrooms at this property. 2 i 7. On December 15, 2004,Teresa Downey signed an Accessory Affordable Housing Program Agreement Affidavit that commits,upon the receipt of a Comprehensive Permit,to the recording at the Barnstable Registry of Deeds a Regulatory Agreement and Declaration of Restrictive Covenants. That document includes restricting the unit in perpetuity as an affordable rental unit and that the dwelling will be owner-occupied as the year-round residence. i 8.The applicant understands that the affordable unit will be rented to a person or family whose income is 80% or less of the Area Median Income (AMI)of Barnstable-Yarmouth Metropolitan Statistical Area(VISA) and further agrees that rent(including utilities)shall not exceed 30%of that income. 9.According to the Massachusetts Department of Housing and Community Development, as of February 16,2005 6.3%of the town's year round housing stock qualifies as affordable housing units. The town has not reached the statutory minimum of affordable housing under MGL Chapter 40B Section 20-23 or its implementing regulations. The Town of Barnstable's Local Comprehensive Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: i 1 Based.upon the findings,the Hearing Officer ruled that the applicant has standing to apply for an affordable housing Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal.is also deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the Town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings, a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicant,Teresa A.Downey,who resides at 117 Gleneagle Drive,Centerville,MA. It is issued to allow for a one-bedroom apartment as an affordable housing unit in accordance with the. following conditions: 1.Occupancy of the affordable unit shall not exceed two people. 2.The affordable unit shall not be occupied by a family member of the owner. 3.The property owner shall occupy the principal dwelling as her year-round residence. 4.To meet the requirements of affordability,the cost of housing(including utilities)shall not exceed 30%of 80% of the median income for a single individual for the Barnstable-Yarmouth MSA.. 5.All leases shall have a minimum term of one year. 6.All parking for the accessory apartment and the main dwelling shall be on-site. 3 i 7.This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. 8.The applicant must apply for a building permit for the accessory unit and secure an occupancy permit and Certificate of Compliance for the unit from the Building Division. The Building Commissioner must determine that the unit conforms to the approved plans as submitted, and meets state building, fire and sanitary codes. 9.The applicant may select her own tenant(s),provided the tenant(s)meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Office of Community&Economic Development of the Town of Barnstable as a qualified individual. The applicant will be required to work with the Town to provide information necessary to docurnent that the tenant qualifies. The unit shall be rented on an open and fair basis to an income eligible individual or family. Whenever a vacancy occurs,notice must be given to the Office of Community&Economic Development, and the unit must be listed with the town. I 10.No later than a year from the date of issuance of this Comprehensive Permit the applicant shall file with the Office of Community&Economic Development of the Town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicant shall provide the town any additional information it deems necessary to verify the information provided in the affidavit. Upon any report from the town that the terms and conditions of this permit are not being upheld,the Zoning Board of Appeals or its Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 11.Every twelve months the applicant shall verify the income eligibility of the individual occupying the unit. 12.This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred, the Office of Community&Economic Development of the Town of Barnstable shall be notified of the name and address of the new owner within 60 days. 13.The total number of bedrooms permitted on the property shall not exceed.three(3)and no future bedrooms may be added within the unit or on the property. 4 i . i Ordered: Comprehensive Permit 200 =5 22 has been anted�' with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Part II, Section 4.02 and Part III, Section 3.72. If after fourteen(14) days from that transmittal,the Members of the Zoning Board of Appeals take no action to reverse the decision,this decision shall become final and a copy shall be the filed in the office of the Town Clerk. Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17,within twenty(20)days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter Section40B 22. . p , In accordance with Part II, Section 4.02 and Part III, Section 3.72 of the Town of Barnstable Administrative Code, the hearing officer transmitted a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on February 16,2005. Fourteen(14) days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. . . /—A—.< �?Nighting e, Hearing Officer Date Signed I Linda,Hutchenrider, Clerk of the Town of Barnstable,Barnstable County;Massachusetts,hereby certify that twenty(20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has bee of edin the office of the Town Clerk. Signed and sealed this� day o f pay under the pains and.penalties of Linda Hutchenrider, Town Clerk 1 i i i i 5 f REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this day off/(: ,2005,by and between Teresa A.Downey of 117 Gleneagle Drive, Centerville MA 02632 and its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the"Municipality"),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter. 40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/ Family(hereinafter "Designated Affordable Unit");and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: D n✓� A The terms of this Agreement and Covenant regulate the propertylocated at 117 Gleneagle , Centerville MA 02632 as further described by deed recorded at the Barnstable County Registry of Deeds in Book 10924,Page 082. B. The Project located at 117 Gleneagle Road,Centerville MA 02632 will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the "Designated Affordable Unit" or.the"Unit"). C. The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No. 2005-22 and any plans submitted therewith and all applicable state, federal and municipal laws and regulations.Said permit is recorded herewith as Barnstable County Registry of Deeds Book..OJZ29— and Page D. The Owner agrees to occupy the principal dwelling unit located on the property as their year round residence in accordance with the terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and decent housing to persons earning at or below 80% of the area median income of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80% of the Area Median Income (AMI) of Barnstable-Yarmouth MSA and that rent(including utilities)shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable- Yarmouth MSA In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level. 3. The Designated Affordable Unit will be retained as a permanent,year round rental dwelling unit with at least a one-year lease. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated any provision of law,rule or regulation,or any order of any court or other agency or governmental i body,and will not violate or,as applicable,has not violated any provision of any indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a parry or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no.action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement) or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full- C. LIMITATION ON PROFITS 1. The Owner a rees.to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a g household with a maximum income of 80%or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable-Yarmouth MSA. In the allowance established b the Barnstable Housing Authority event that utilities are separately metered,a utility y g shall be deducted from the rent. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner Monitoring ent as des'designated b the Town Manager,within 30) days of the date that a shall notify the Agent, rg y g �y( tenant has vacated the Designated Affordable Unit. IV. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth MSA and that rent(including utilities)shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable-Yarmouth MSA.In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. V. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court(collectively hereinafter the "Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediatelytransmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or registration number of the Agreement. 2 i i 1 � VI GOVERNING OF AGREEMENT: This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VIII. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when ' delivered by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the f parties hereto at the addresses set forth below,or to such other place as a parry may from time to time designate by written.notice. IX. HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless the Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket expenses and attorneys fees necessitated by such actions. I X. ENTIRE UNDERSTANDING: A. This Agreement shall constitute the entire understanding between the parties and any amendments or i changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants,agreements.and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be,and by these presents are,granted by the Owner to run in perpetuity in favor of and be held by the Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Ch. 184,Section 26 which shall run with the land described in the deed recorded at the Barnstable County Registry of Deeds in Book 10924,Page 082 and shall be binding upon the Owner and all successors in title.This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the.holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in the deed recorded at the Barnstable County Registry of Deeds in Book 10924,Page 082. XI. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall only take effect after. 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2) notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court as the case may be,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit, the prdpertywhich is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. XII. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend,declare,and covenant on behalf of themselves and any successors and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive 3 permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns (i)that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (i� are not merely personal covenants of the Owner,and(in)shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. )III. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The.Owner will pay all costs and expenses,including legal fees,incurred bythe Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have a lien on the Project to secure payment of such costs and expenses. The Monitoring Agent mayperfect such a lien on the Project byrecording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or anyportion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof.. MY. MORTGAGEE CONSENT. The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this edayof /�� ,200_. OWNER BY: S;g-� Printed: Teresa A Downey COMMONWEALTH OF MASSACHUSETTS County of Barns . le ss: On this �dayof 41L 20efore me,the undersigned notarypublic,personally appeared ids 1�I1✓N / ,the Owner(s) ,proved to me through satisfactory evidence of identification,whic were Del fl6x_ to be the person(s)whose name(s) is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarilyfor the stated purposes. J___N6 Public Printed: .!` My Commission Expires: ELIZABETH ANN.DILLEN Notary Public Commonwealth of Massach00 a My Commission Expires October 27,2011 TOWN O STABLE BY: , Signature ,.. Printed: MANAGER COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this/ ay of D2 before me,the undersigned notary public,personally appeared the Town Mua er for the To/wln of Barnstable,proved to me through satisfactory evidence ntification,which were ©A)4i- �/ 10)WA) ,to be the,person whose name is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. I Notary Public Printed': ,(,JA1ZA MyCommssionExpires: LINDA R.WHEELDEN NOTARY PUELIC I;O�AMWEALTH OF NASSACHUSUU My Comm.Expires 02-a209 5 Town of Barnstable *THE T Regulatory Services Thomas F.Geiler,Director + &MMSPABM 9� MAS& �� Building Division AlE1 39. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# �� (� FEE: $ SHED REGISTRATION 120 square feet or less Location of shed(address) Village 77l 0j Property owner's name Telephone number ,5�7 k f o /(7/ -- /�/- )-- Size of Shed Map/Parcel# 14 \ C- Signatua Date Hyannis Main Street Waterfront Historic District? D tin Old King's Highway Historic District Commission jurisdiction? / Conservation Commission(signature is required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 1 - � MAP I I 7LJ # 117 CD --------------------------- MAP I I ! c:\conservation.dgn 4/26/2005 9:40:22 AM f T�t F O The Town of Barnstable saxxsrasie. 16 9. ,.� Office of Community and Economic Development QED MA'S A 230 South Street Hyannis,MA 02601 Kevin Shea Office: 508-8624678 Director Fax: 508-8624782 December 17,2004 Mr.John C4 Klinun, Town Manager Gary R Brown,Town,Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 pw^p O� Re: Peter Lincoln 630 Mariner Circle, Cotuit- a single-family accessory unit Ronald Tosti- 141 Highland Ave, Cotuit- a single-family accessory unit Teresa Downev- 117 Gleneagle Drive, Centerville- a single-family accessory unit Charles Hetzel- 55 Seabrook Road,Hyannis- a single-family accessory unit Gentlemen: This letter is to inform you that the Accessory Affordable Housing (Amnesty) Program has received requests for project eligibility letters under the Community Development Block Grant (CDBG) Fund and under the General Ordinances of the Town of Barnstable,Article LXV- Pre-existing& Unpermitted Dwellings and the Criteria for the Local Chapter 40B Program The Program Coordinator is Pviewing the requests.If the Town has any comments on the projects, please forward them to me so that they can.be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Since r ly, Kevin Shea,Director Community&Economic Development cc: Town Attorney's Office Building Department Public Health Department TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a i 'Map (/ Parcel Permit# ® 9 5- Ilk I I Health Division -(b-7 Date Issued 1 / 0/0`f Conservation Division Application Fee v v Tax Collector Permit Fee . 0� Treasurer EXISTING SEPTIC SYSTEM Planning Dept. LIMITED TO__�_#OF BEDROOMS Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owner JAddress Telephone- Permit Request &kCe_ O ,66J /3 ` vZZY& <.cr- �*x(ego" (64ctr S z Izs3a Square'feet: 1st floor: existinc� proposed 2nd floor: exi ng proposed oT"tal new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size • .3 23 ,, Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 14; 5 • Historic House: ❑Yes y0No On Old King's Highway: ❑Yes NXO Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) G �4 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existin! ❑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 i BUILDER INFORMATION �JG � Name Telephone Number Addre s 3 License# 7 Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 641A':��_ SIGNATURE6===�, DATE -�_� FOR OFFICIAL USE ONLY N PERMIT NO. DATE ISSUED - MAP/PARCEL NO. • ; ,ter ADDRESS VILLAGE OWNER i DATE OF INSPECTION: : t FOUNDATION FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH '? FINAL PLUMBING: ROUGIP FINAL ' GAS: ROUGI� 01 FINAL to FINAL BUILDING tn N r 0 _ N W DATE CLOSED OUT N m n ASSOCIATION PLAN NO. 0 i -. The Commonwealth of Massachusetts IT (Q Department of Industrial Accidents F 600 lVashin;ton Street r Boston,Mass. 02111 Workers, Co ensation Insurance davit-General Businesses name: • address: hie state: w k site location full address I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑Sales(including Real Estate,Autos etc.) I am an em loyer with em to es(full& art time). El Other ry// /// %/%%%%%/O/G�%%%%%////%/////%%///O/%%//////%/ I am an employer providing workers' compensation for my employees working on this job. com any name: sddr"ess:' city phone#olia .. .insurance.co::-.:. .;�.._:�,�.'. ..' :. •:'r' . `._�:::�..:,f. • I am a sole proprietor and have hired the independent contractors listed below who have the following workers' mpensation polices: com any name: [•Ert address: -�y city phone#'' !�"r ]t # insu ' //%///////% %/ / // / ///// • /////////// com en. name: address cliv't... pho_ne_# frisurence co.:.: o7icv#: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flue up to$1,500'00 and/or. one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify n r the p ins and pen ti s 0 perjury that the information provided above is true and correct Signature Date Print name Phone# s. official tLae only do not write in this area to be completed by city or town oiliclaI permiducense# ❑Building Department city or town: ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑$ealth Department � contactperson: phoneM,, ❑Other e (revised SepL2003) P Y 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 dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if you are required to obtain a workers' compensation policy,please call the Department at the number listedbelow. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrnit/license number which wM b'e used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made.: The Office of Investigations would.Ile to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The D_epartment's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of IMS11gstlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 OFZHE ro Town of Barnstable ti Regulatory Services � R ' BAMMBLE. ' Thomas F.Geiler,Director NAM. g' 1639. n39.E& Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. &4 !!,, Type.of Work: Estimated Costy Address of Work: /1 7 /I Owner's Name: ' Date of Application: I hereby certify that: - Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under S1,000 []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: ,,-.,q_0 At4 Date Contractor Name Registration No. OR Date Owner's Name Q:f6rms:homeaf6dav SIRE Town of Barnstable Regulatory Services ELIPMABM Huss, $ Thomas F.Geller,Director Eo;Ar Building Division Tom Perry, Building Commissioner 200 Main Street, Iiyannis,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, /,(n� ,as Owner of the subject property hereby authorize /�o to act on my behalf, in all matters relative to work authorized by this building permit application for. -7 614W (Address of Job) Signature of Owner Date Print Name Q:-ORMS:OWNERPERMISSION f � • ��e�omvina�ecuea�c � �� BOARD OF BUIL®ING REGUII:ATl'01+S License. C;QNSTRUCTION SUPERVISOR Numbegs� 065525 Bit d €'e` 7fg(� 6 Tr.no: 14425 . Re ALHERT 34 HORATIO LN �, ��e e G• ��i ;a CENTERVILLE, MA 02• Admia'ist�ator �', Bo�d of Bull ing Reg ons and tandards HOME IMPROVEMENT CONTRACTOR Registr f 126560 •E . a 1/2006 ALBERT ROY B'. 0 y y ACg�-RT BROW j _ .- 34 HORATIO LN oa+ . = yen !'G-' CENTERVILLE,MA 0 Administrator :1 c7 W 1J tG `� �'St� t•SC� Daniel E Braman, .E. 189 Harbor Point Rd. . C L LiT�R.V�C.hE �.�-A► Cummaquid MA 02637-0361 . 8 L Nl,ASS �-['A-TE �v � �...pt rim �c�� •=' _ �- 'D►µ.me : FL o©��- 1, .C.. c L,L ? 4-C)pS t act�� • �- �-� " ��!�� 12� ES etA %h tAP. ' DANIEL Rp Oe y ® v STRUCTURAL H a 9d0.98595 IONAL _ RAMSBEAM V2 . 0 - Gravity Beam Design Licensed to: Dan Braman, P.E. Job: Downey Res. Glen Eagle, Cent. Steel Code: AISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W10X15 Fy = 36. 0 ksi Total Beam Length (ft) = 14 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 015 k/ft Line Loads (k/ft) : Dist1 Dist2 DLl DL2 Pre DLl Pre DL2 LL1 LL2 0. 00 14 . 00 0. 180 0. 180 0. 000 0 . 000 0. 480 0. 480 SHEAR: Max V (kips) = 4 . 72 fv (ksi) = 2 . 06 Fv = 14 . 40 MOMENTS: Span Cond Moment @ Lb Cb Tension Flange Comp Flange kip-ft ft ft fb Fb fb Fb Center Max + 16. 5 7 . 0 0. 0 1. 00 14 . 38 24 . 00 14 . 38 24 . 00 Controlling 16. 5 7 . 0 0 . 0 1 . 00 14 . 38 24 . 00 --- --- REACTIONS (kips) : Left Right DL reaction 1 . 37 1 . 37 Max + LL reaction 3. 36 3. 36 Max + total reaction 4 . 72 4 . 72 DEFLECTIONS: Dead load (in) at 7 . 00 ft = -0 . 084 L/D = 1992 Live load (in) at 7 . 00 ft = -0 .208 L/D = 809 Total load (in) at 7 . 00 ft = -0. 292 L/D = 575 ' RAMSBEAM V2 . 0 - Gravity Beam Design Licens,ed to: Dan Braman, P.E. Job: Downey Res. Glen Eagle, Cent. Steel Code: RISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W8X18 Fy = 36. 0 ksi Total Beam Length (ft) = 14 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 018 k/ft Line Loads (k/ft) : Distl Dist2 DL1 DL2 Pre DL1 Pre DL2 LL1 LL2 0. 00 14 . 00 0. 180 0. 180 0 . 000 0. 000 0. 480 0. 480 SHEAR: Max V (kips) = 4 . 75 fv (ksi) = 2 . 53 Fv = 14 . 40 MOMENTS: Span Cond Moment @ Lb Cb Tension Flange Comp Flange kip-ft ft ft fb Fb fb Fb Center Max + 16. 6 7 . 0 0. 0 1 . 00 13. 11 24 . 00 13. 11 24 . 00 Controlling 6 1 . 6 7 . 0 0 . 0 1. 00 13. 11 24 . 00 --- --- REACTIONS (kips) : Left Right DL reaction 1 . 39 1. 39 Max + LL reaction 3. 36 3. 36 Max + total reaction 4 . 75 4 . 75 DEFLECTIONS: Dead load (in) at 7 . 00 ft = -0 . 095 L/D = 1763 Live load (in) at 7 . 00 ft = -0.231 L/D = 727 Total load (in) at 7 . 00 ft = -0. 326 L/D = 515 TME T° Town of Barnstable °* Regulatory Services �B" ' S. Thomas F.Geiler,Director �'Olp1639n. Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 November 9, 2004 Ms. Teresa A. Downey 117 Gleneagle Drive Centerville Ma. 02632 Re: 117 Gleneagle Drive, Centerville MA. 02632 Map 191,Parcel 142 Dear Property Owner: Our records indicate that your house at the above-referenced location is currently being used as a two-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home. • Apply to the Amnesty Program. • Prove that this is a legal two-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely, Linda Edson Amnesty Officer Building Department gf6rms:zoning3 r.yF J1+-�,^;•.. ,. "ay.r wv'•...�y .k _... .,,,.�.r.y�.nfx^.hr..=l• ;'+A 'ems .�sY ( ...+rr-.,...,,,�sa`—'�t e _ - i - r.�•'s.�r-'.z-,.�-^•r`YYL. '`r - Ire o � • ,FINE>, TOWN OF BARNSTABLE Permit No. ....31584..... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to C & B REAL ESTATE Address lot #11 117 Gleneagle Drive, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. June ................ 19..88...... ............ ;.......................... Building Inspector a'fy��•: TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING ' rua HYANNIS, MASS. 02601 i �0 rwY 1. MEMO TO: Town Clerk FROM: Building Department DATE: l J u v e d An Occupancy Permit has been issued for the building authorized by BuildingPermit #.............. 5 ................................................................................................... ....._...... ......._._ ...... issued to ...0 r�.. . L....... siAT�. ..... 1�....#..1 .... t' ..G.�c��_ �'��v�— Please release the performance bond. L THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) i M DATA �t N`OF�4ARNSTABLE"MASSACHUSETTS * P� rr Yn1, efir �sy c z n t,• qq'E q - i A� „ ;DATE T .�a'L 1,zz.l... I 19 ti Z PERMIT PL jly}Q�� b�' A. APICANT L ( I C ry�i—y � Rtil LiL�aY ADDRESS. r=�. A . x INOJ (STREE t f (�-ONTR S LICENSE) a; PERMIT TO A..n: NUMBER OF e } '1 ;6' � ��_( ) STORY _ !e i e � tlidk�l —'ZQ'.�VELLING UNI S OF M RO EME-AT:T ._ NO. - (PROPOSED USE•) •+, •' - ` P g AT (LOCATION) T .a s - �' ZONING- (S7R _.r. —t`r7 ' DISTRICT_ , .1- .) _ EETI / aT.�,`'.1-�'�SiS"i. r rr BETWEEN AND Y �+. 1' ("CROSS STREET) (CROSS STREET), I . § SUBDIVISION " LOT !t LOT BLOCK 512E •» E �'r dr J : BUILD ING,IS TO BE FT r� nn '• WIDE BY FT. LONG BYFT: .IN-HEIGHT AND SHALL CONFORM IN�CONSTR.+ '` ^� \ YS Iq Y 4' TO TYPE F, USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) 1h�•,- REMARKS AREA OR <t1? � •, �1t� VOLUME 12 I S(T �;"[, ESTIMATED COST /J , UOO. U�.T PERMIT (CUBIC/SQUARE FEET) z� OWNER ... .. ... 4AD^h SS ' rir+ . e m BUILDING DE PT. r ' BY t�,�'i��?�,�r r�'�S•�rE/��'�i'`r5'�f ib!a��C h '><!t'S a- S � �J- rr•'"ea aly f .�, t.r;+. OR r."tY1'- '.� ,y� q1 N.`�'� ,� �rrr' 2 :h,... ✓71,F S11, Y'.v .. 75 'ti y;l t +!'. dtt '`. _a.,' AP- w, r ; , t'_G F"1.'ri r�"1'�R1VIl'1""�J't7t� ' .e ., .�-L�.t�v i!}:.�rtti. i,ry_,�,,��y �I N E D 'ry v i"r¢ 7ilVTF-RD10i"I"FFt� T I O N S OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ,INSPECTIONS REQUIRED FOR ALL-CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING,STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBFINAL I S(RE INSPECTION TOB BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET - BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 Or !V_ 3• CL.C., HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT OTHER BOARD OF HEALTH :r WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE, TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIXMONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. 7 ' O Zoi.s9 y�/o f/ L oT 1/0 �g �cQ\! ' !°� "�,. ►1 coo a29874 V MUs 3�•3 34 04 if •. 1 /.E 3 (/—? /. //mil /(/oTE.' T/ES Ta Woo n TR/M CEp rI Fri�• A Lc=T G.oc�TEa /• 2S �� .�` GOT // GGfiS/.��9 GG�' .ate/�E G1-tOJT:A(ALAit/T/S 'T7 1 U Lir`! E�CIS"ri c� F E:;OwDAMCo1W =;-i-M !=LL I5 J` '�" : 1t1� 15 lA'rED I!-i Pt�mor-a To 47 C') �-r>= �/� GQ E,(: 17•�1 �'R. T4E7 1;yj-S-M 1 M�tJv FWTS =*b w%1 aAST SAr._IDv41W, MA .,oLs37 cry e•�: ,1� � ,�,� __�� 5f-I�r I of t Assessor's offioe (1st floor): SEPTIC SYSTEM MIDST BE 0`THETD AssJssor's'Aap and lot number ....�.. .............................. .. $ �` 'y Board of Health (3rd floor):. INSTALLED IN COMPLIANCEe�Q Sewage Permit number . . (a7...�i.4' .......................... WITH TITLES • `'1VIRONMENTAL CODE AK 2 Ba$mAs.L E, Engineering Department (3rd floor): v° rma House number ................................� ........................... 1.4 OWN REGULATIONS °�i63 o Apr Ar APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF BXkRNSTABLE BUILDING INSPECTOR ' r r a C' C f 17- ✓V I'-Lv 14 e w 4= APPLICATION FOR PERMIT TO ............................. TYPE OF CONSTRUCTION ...s/kV6-L OL ............3.�..:...---------------------19....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..Z.0.T.....�.�.....GL svJ1eGL 4 �..l,ti/ tC"/? (!i G L L� !"'i /� rf ........................................... . ..................................... ............................................................... ProposedUse ................... � .......................................................................................................................... Zoning District /:�� ....................................................Fire District .................................... y Name of Owner ?`.Q... Es G... T.�..:�T...`_..................Address f�`..I.!�......��r! L=2 ....L.i.�'....�........G..U6 Name of Builder ¢.J..Q(I.IGO.CAI................................Address /�f'f//.!........P /'6'L�-//L.�.�...�"1. J. 0le/G3 Name of Architect ...Y.{.'#.9.A.S.f..........................................Address ..lr"1.��.1s.!+r'� t . . ....................................................... Number of Rooms ........4/,, .......................................................Foundation .17-Ll z 4....G w C�, P r d .............................................. Exterior �.f/��f4G%ROS C o/z/( .r/�!4 h'eC R P -r/-,//rr�C t.f Roofing ... ......................................................................I......... Floors .Interior ........................................................ Heating /{ 4� n r .........................................Plumbing .... f S Fireplace .........4..w ........................................... p Approximate Cost ..........e.......................I................ ..... .......... Definitive Plan Approved by Planning Board ------19-------- . Area Diagram of Lot and Building with Dimensions Fee ! d� /tea �.... ...... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH A 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 . ...... .... ................................. / G � � G � Construction Supervisor's License .................................... I C & B REAL ESTATE 31584 12 NB� ................. Permit for ....1.......Story......................... Single Family Dwelling .......................................................................... Location .....Lot #11..........1.1.7...Gl.ene.ag.l.e Drive ..... ....... .... .. Centerville .. ............................................................................... Owner C & B Real Estate Type of. Construction ........Fr..ame................................ ............................................................................... Plot ............................ Lot ................................ PeFrmit Granted ...........Fe.b.ru.a.ry. ....2.!..19 88 .... .. .... .. .... '2.. ......... Date of Inspection ........................... ,Date Completed .................. 9 (-0 1511 X 3 tr 10 tit on