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HomeMy WebLinkAbout0077 CONTENT LANE -7 ow r Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 6/20/19 Brian Florence CBO Town of Barnstable > 'ti' , Building Division �' `PgLE 200 Main St. Hyannis,MA 02601 J� RE: Insulation Permit B-19-1182 Dear Mr. Florence: This affidavit is to certify that all work completed for 77 Content Lane, Cotuit has been inspected by a third party Certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable .. Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept 39. 1 Permit AE& �b Posted Until Final Inspection Has Been Made. R Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1182 Applicant Name: William McCluskey Approvals Date Issued: 04/11/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 10/11/2019 Foundation: Location: 77 CONTENT LANE,COTUIT Map/Lot: 040-041 Zoning District: RF Sheathing: Owner on Record: DIMUZIO,ALAN Contractor Name: WILLIAM J MCCLUSKEY Framing: 1 Address: 77 CONTENT LN Contractor License: CSSL-102776 2 COTUIT, MA 02635 Est. Project Cost: $5,000.00 Chimney: Description: Add R-13 fiberglass,and R-38 cellulose to the attic.Air seal the attic Permit Fee: $85.00 plane with expanding foam.General weatherization. Insulation: Fee Paid: $85.00 Project Review Req: Date: 4/11/2019 Final: � - Plumbing/Gas Rough Plumbing: fr This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after u uan . itia Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and.Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department �'f�� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable *Permit# Expires 6 months from issue dote Regulatory Services Fee � y BARNSTABIX .. MASS. Thomas F.Geiler,Director 039. p�Etl MA't� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY � p Not Valid without Red X-Press Imprint Map/parcel Number Property Address � ��' L esidential Value of Work /a S- Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address =�L��Yt �� x-m yA 1D Contractor's Name C�(.��ic2 G✓ © Telephone Number Home Improvement Contractor License#(if applicable) ��'� Construction Supervisor's License#(if applicable) -tRiQ�c�� p� ❑Workman's Compensation Insurance 11 2�13 Chec e:.. MAR 9?1 am a sole proprietor ❑ I am the Homeowner OwN �� BARS-�A��E El have Worker's Compensation Insurance ,T Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro e _ er must sign Property Owner Letter of Permission. copy o / ome rovement Contractors License&Construction Supervisors.License is .. . ed- SIGNATURE: nawvrrr Rc�Fl1RMRlhn;lAino permit fonns\EJPRESS.doc The Commonwealth o,f Massachusetts : Depwhnent of irndustriarl Accidents Of-we of Invesfigafions 600 Washington Street Boston,Md 02111 . rt1n"_jna-,s.gov/dia Workers' Compensafkm Insurance .davit Builders/Contractors/Electricians/Plumbers Applicant Information �,� • Please Print,Lt�1„Is- Narme tiowlndividaal): Dt Gi Addrm: City/State/Zip: G d &t,/7 Phone# Are you an employer?Check the appropriate box Type of project(required): 1_❑ I am a employer with 4. ❑ I am a general contractor and 1 6- ❑Drew constr=tion euiptoyew(full andvpart-time}.* the sub ntracbvrs � 2.El I am a sole pmprieboi or partner- fisted on the attached sheet, 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition. working fume many capacty. employees and have wcdcers' 9. ❑Building addition (No Workers,cc'`rp.in " ,,tee camp.insurance-1 10.❑Electrical or additions 5. ❑ We area corporation audits �d) ; officers have exercised� 1 I- Plumbing repairs or addition s 3. I am a homes. doing all wosje , right of exemption per NfGL 12. Roof myself [No w� rs camp. ❑ repairs ;ncarrsx„re requt,-ii.]T C. 152, �1{�},and we have no employees-[No workers' 13.0 Other comp.insurance required.} 'Any applicam that cbecis box trl mast also fill mat the section below Showing their wcukes'compensation policy udbnaatian_ I Homeowners who submit this affidavit M&CM*+*+9 they are doing all orasic and then hue outside cantzactoU mast submit a new affidavit indicating such tContmctors that check this box must attached an+ddiftu d sheet showing the'name o#the sub-conhwLuss and state whedw or not'iihose entities have emplayees. Ifthe sub-ccnttwors have employees,thegnmstgmaide their mocker'comp.policy number. I aln an employer that is ptrovidirrg.tvorirers'cotrWensation iu=rance far my empIoyem Below is thepvlicy and job site infortura on. . Insurance Company Name: Poling#or.Self-ins.Lic. Expiration Date: Job Site Address: City/Stat�elZip: Attach a copy of the ww*ers'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 imprison—t,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.QU a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Im-estigations of the DIA for insurance cow-erarge veriffcaticn- I do hereby semi the ' s and pe vfyedwy dw the it for no asn prvvided ahm is bwa and correct Si Bate: 3 // Phone#: Ofcial use only. Do not write in this area,to be computed by city or totes]officiaL . City ar•Town- Perm bUcense# Lmuing Authority(cirdle one): . 1..Board.of Health y.Budding Department 3.L ly ownGlerit d.Electrical lnspertor S.Plumbing Inspector 6.atlEer.. : Phone 9; . • MUMSras[.e, 9� MAS& Town of Barnstable Al fD MA't s " Regulatory Services Thomas F. Geiler,Director. Building Divisibn Thomas Perry,CBO Building Commissioner 200 Main.Street,' Hyannis,MA 02601 www.town.barnstable.ma'.us Office: 508-862-4038 Fax: 508-790-6230 Property"Owner Must Complete and Sign This Section If Using A Builder ' I, ; as Owner of the subject property hereby authorize to act on my behalf, in. all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. QAWPFiLESTORMS\building permit fomis\EXPRESS.doC Town of Barnstable P. Regulatory Services r + =ARNSUBLF, ' Thomas F.Geiler, Director mass. 9`},A 1639. ` ;,eBuilding Division rFOMAtp t Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnsta ble.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION a Please Print DATE: JOB LOCATION: number street village HOMEOWNER": name hgo_me phone# work phone# CURRENT MAILING ADDRESS:_ 35 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 "home �cner."certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro es uirements an that he/she will comply with said procedures and requirements. r o eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors),provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing"Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. . N Yc w*� mom 7-4 4 f ,1 5f t- s g�¢ E � � 51 . <2 °« « y. ,7 ZAW;E7 i PERMIT;P.A 'ENT RECEIPT TOWN OF BARNSTABLE. BUILDING DEPARTMENT ) ' I BUILDING MAIN STREET HYANNIS, MA 02601 � _ DATE: 12/01/08-,TIME,:---16:27 ---- ------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: �25.00 AMT APPLIED: 25.00 CHANGE,: t `.00 APPLICATION NUMBER: 200806679 PAYMENT METH: CHECK PAYMENT REF: 1480 Town of Barnstable Permi':7/ 60 (a-7 Regulatory Services ate: Gi4l/00 �OpIF1E r Thomas F. Geiler, Director P � Building Division Fee: " BARNSCABLE, Tom Perry, Building Commissioner MASS. 039. 200 Main Street, Hyannis, MA 02601 plFO A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: a✓( `I✓�i( tti Phone: L/a0 Install at: 77 (f�w kt Village: Map/Parcel: Qbt y 1 I Date: /pZ Stove A. ew/ Used B. Type: Radiant/ trculating C. Manufact yic, `Cca(YeP,- Lab. No. D. Model No.: Chimney A. New OE=xisting)(If existing, please note date of last cleaning) /D -- D 7 B. Flue Size /'a n /.24— C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined nlined ; Hearth i C= c� A. Materials: B.. Sub Floor Construction: Y� � Installer o 7 Name: (, ,'Ytt Address: '7? ewo4 4f-,117 IE- n Phone: -/:k S�_ .r y. Location of Installation: 3A-- rn �, G Lv ry '- H.I.0 Registration # Construction Supervisor# OR check�meowner Installing, no e r re APPLICANTS SIGNATURE APPROVED BY: e- Y 03 Jp Please make checks payable to the Town of Barnstable *This constitutes an of stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 3• www.mass.gov/dia Workers' Compensation_ Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: � r �vly9' � o �S� Phone.#: )—Ot Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner-' listed on the attached sheet. 7.. ❑ Remodeling ship and have no employees These sub-contractors have 8. '❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'-comp.-insurance comp. insurance. 10. re ed.] 5. ❑ We are a corporation and its ❑Electrical repairs or additions 3. am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs = insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all.work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. M Expiration Date Job Site Address: �7 /57t 4111_1_� City/State/Zip: Cd .ci% Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal penalties of.a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the pen ies of perjury that the information provided above is true and correct Signafore: Date: Phone#: S — 2-1-2cc Official use.only. Do not write in this area,to be completed by city or town official .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical.Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees: Pursuant to this statute,an employee is defined as "...every person in.the service 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 chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the 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-contractor(s)name(s),address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(,if necessary)and under"Job Site Address" the applicant should write"all locations in _(city or town).".A copy of the affidavit that has been officially'stamped or marked by the city or town may be provided to the applicant as proof that a valid.affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related 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 Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617427-7749 . . Revised 11-22-06 www.mass.gov/dia Town of Barnstable y�P�OF THE t��� Regulatory Services BAP14STABM Thomas F.Geiler,Director MASS E1 a.0� Building Division Tom Perry,Building Commissioner _— --- -- - —200-Main-Street Hyannis,—M-A-0260-1---- _ -- - -- -= www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: nummbe'r street village "HOMEOWNER": /� —Z— name home phone# work phone# CURRENT MAILING ADDRESS: S 2r-r� 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 s_pervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies that he/she understands.the.Town.of Barnstable•Building Department minimum ins n proce es and requirements and that he/she will comply with said procedures and require — Signatirre,o meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules•&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilides,many communities require,as part of the permit application, that the homeowner certify thkt he/she understands the respansibilides 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 fonn/certifi cation.for use in your community. Q:forms:homcexempt zT � Town of Barnstable Regulatory Services • saxxsr�sr..� • r MAa.& g, Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: .(Address of Job) Signature of Owner Date Print.Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. i Q:FORMS:O WNERPERMISSION 3J23 )0 Town of Barnstable *Permit# 091� Expires 6 issueliaze cl „ Regulatory Services Fee BAIUMM NAM Thomas F.Geiler,Director 'I, Building Division Tom Perry,CBO, Building Commissi ner 200 Main Street,Hyannis,MA 02601 Z178VLSN,�bB j0 www.town.barnstable.ma.us NM41 Office: 508-862-4038 900ZF0x6-5*J?0-6230 EXPRESS PERMIT APPLICATION - RESIDE Not Valid without Red X-Press Imprint d�X Map/parcel Number©!YQ D Property Address 2 Z Residential Value of Work G OOC Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address �l�yt �;,'(/I Gzr� = &a dear�- 4,ot (I f O Z6 3j� Contractor's Name _a Telephone Number 5�$ 4/_2e9 -/a S 2 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑� I am a sole proprietor 'LT 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) QRe-roof(stripping old shingles) All construction debris will be taken to )1 / Ct ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must Property Owner Letter of Permission: e prov ent Contract rs License is required. SIGNATURE: Q:Forms:e.Ypmtrg Revise071405 The Commonwealth of-Massachusetts Department of Industrial Accidents Off of Investigations 600 Washington Street Boston,NIA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print ]Legibly Name (Business/Organization/Individual): (_ Address: -7 City/State/Zip: - Phone #: 2 2- Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I 6 employees(full and/or part-time).* have hired the sub-contractors New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have 8,. ❑ Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Budding addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions qulred•] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL l l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' 13.[D Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under t e pair nd penaltie of perjury that the information provided above is true and correez Si afore: - Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. 1 City or Town: Permit/License# Issuing Authority (circle one): I.Board of Health 2.Building Department I.City/Town Clerk 4.Electricai inspector 5.Plumbing Inspector 6. ®ther Contact Person: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the . 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the 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 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 pernut/license number which will be used as a reference number. In addition,an.applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NSA 02111 Tel. #` 617-727-4900 ext 406 or 1-877-NIASSAFE Fax r 617-727-7749 Revised 5-26-05 www.Mass.2ov/cia ��E r The .Town of Ba rn s tab lev,41A Department of Health, Safety and Environmental Services • , l Binding Division 367 Main Street,Hyannis MA 02601 Office: 308 790-6227 Ralph NLCmssea Fax: SOS 790-6230 Building Commissioner Home Occupation Regist=asion Dates #: 77 G 6 -7 Address: 7 Village: (! p f-6t i Type of Business: 9CJM9 S,0e r VY l� �q el WTENT: It is the intent of this sectiea to allow the residents of the Tows of Barnstable to operate a home occupation within single family dwellrags,subject to the Favisi=of Secd=41A of the Zoning aztiinance,provided that the activity shall not be discernible ftnm outside the dweMz g: then shall be no increase in noose or odor,no visual atteran on,to the premises which would sttggat anything other than a residential rue;no increase in traffic above normal residential valutner,and no increase is air or gtoumdwaterpolludem. After zegistrad=with the Btulding Inspector,a cusu m a y home ooaipadon shall be permitted as of right subject to the following oomditioms: . • The activity is carded an by the permanent resident of a single fannly residential dwelling unit,located within that dwaftumt. • Such use occupies no mom than 400 square feet of space. • There are no arwrml alterations to the dweMagwhic h art+not eautomsary in residential buildings,and there is no outside evidence of such use. • No traffic wall be gmerated in excess of normal residential volumes• • The use does not involve the producsion.of offensive noose,vt==a,smoke dust or other particular mattes,odors,electrical dLu urbane,heat,glace,huandity or other objectionable effects. • There is no stextage or we of toxic or hamrdous Materials,or flammable or explosive materials,in excess of normal household gazatities. • Any need for parking generated by such use shall be met an the same lot containing the Customary Home Occupation,and not within the reegred Rant gird. • There is no exterior storage or display ofnuderiAs or eelmpmeM • There is no aomn=-d l vehicles related to the C4ntam=any Home Occupation,other than one van or one pick-up truck not to exceed one ton capadty,and am trailer not to emceed 20 feet in length and not to exceed 4 lino,parked an the same lot the Cuswnz zy Home Occupation • No sign shall be displayed indicating the( vM=miry Home Oacnpation. • If the Customary Home Occupation is listed err advertised as a bwiness,the street address shall not be included. • No person shall be emzployed in the Customary Home Oa=aticn who is not a permanent resident of the dwellingutnit. I,the wdersigae:d,have cad with the above restrictions for my home occupation I am registering. Applicant: Date: Hc=coc = Asse'ssor's offioe Ost floor): "THE Assessor's map and lot number ........... ........y�................. Board of Health Ord floor): 'y �\LLE® IN COM-P, Sewage Permit number ....................................................... �/ITIi TITLE 5 t BasasTsntc, Engineering Department (3rd floor): AO `V! RONMENTAL CO®. ' fr 3 House number ................................-�g.......17.•�..... '�l TOWN REGULATIONS APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN :OF ;tB_ ARNSTABLE BUILDING` INSPECTOR //. 9 APPLICATION FOR PERMIT TO ...i�,..C�.tLS. �t z� ..:....`Id'....x.11. ..C�.n.. .. .fl.4Jf ..:..... w Woo ,`, t �- TYPE OF CONSTRUCTION ......�/t/.00..I0............ ../ rtl......:................................................................... I /•{r• .( .{..-....�................19..IR(-e TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .... 1C.P.1.?..T,*,n.7........4-4,........ ..................................................... ProposedUse .... , .i,}.l' .....��.O.Q...F .........................................................:................................................................... Zoning District ........................................Fire District .. .................�.. Name of Owner �Y U. . .... ..B.A-kA/ rrQ.r47.`Address .. ..c.P..1l.,TiC/1. ....4n......Ca 7, lY i Name of Builder �J., C � Address .......� .e Nameof Architect ..................................................................Address ...............................................'........................................ Number of Rooms ......�.�..0.............................................Foundation ...PQ.U. ....... C %�� �...��.�cz�, Exier for ... ,1.....�. ./..�{5.` ..Roofing .... 1�...�. .�`1 ..G1..4:.. ........................................ FloorsC.O.Al..C'..re-T �..................................................Interior .................................................................................... Heating Q�C.P..�'iK...... ��©./-;, /-..PIumbin g ..................��/........................................................ Fireplace ....:.............................................................................Approximate Cost ........ ...................................... Q Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ...........�-3..�.................... Diagram of Lot and Building with Dimensions Fee ................� eo............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH . t � 37Ib o ' 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn able regarding the above construction. Name .... .. . .. ...... + . .................. ... Construction Supervisor's License .. .��... ..�.C/... BARN111COAT, DAVID M. 30143 BUILD FU/N001M No.................. Permit for .................... .... .......... Single Family Dwelling .......................................................................... Location 77 Content Lane................................................................. Cotuit ................................................................................ Owner .........D.a.v.i d..M....B a.r.n i c.o.a.t.................... . . .... .... .... . ...... . . . Type of Construction ........Frame........................ ............................................................................... Plot ............................ Lot ................................. Permit Granted .......November...6, 19 86 .. . ........ . . Date of Inspection 1:7r-Y�......................19 Date Completed ....... .................19 Assessor's offioe-(1st floor): L/ Assessor's map and lot number / ......................... Q�of THE To Board of Health Ord floor): Sewage Permit number b5 _ IG� / . � .I d Engineering Department (3rd floor): moo rb 9, � � � 49 �- 3 Housenumber .................................................:............... ........ DNA d' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO ... .n./!. .T.,.l�..:z� .........�h X.....f�r........:`?...<„�.1!�...K.,r�,c r vl�l........ TYPE OF CONSTRUCTION .......(,.t,JC9 f'.).. ......:...P-�/n�..t�t .��.:................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......:.......2.......C.. .? ✓I. .....Z.—O.......... .TCJ.i. ......�.y..!..�`f' ..................................................... ... ProposedUse ....��.t 1.P�.....F 0.0.. ............................................................................................................................ Zoning District .........................!""...........................................Fire District U U ........................ ...................................................... ^ n: ..... ..... Address .. ..C. ?...Name of Owner .. ....,�r.(J./..� Y..?'t.s..f..�� F�..�.lhC� 7r'/ . ...-...�!1...,........�.�%.r.rr� �� Name of Builder..!..!. ..! ..1/!'1.......� .���..�Y1.1. ��,lAddress ...........7.n,..e?'?... " ........................................................ w Nameof Architect ..................................................................Address ..........n.......................................................................... Number of Rooms ..... .. ..C'..............................................Foundation ...l .n �.......t !�..9'!.r.. .7 �'...5.1.?.VJ. Exterior ...�AJ_i,./!.i..T..r...... ..P...r... ..,r.......5.�1,..!..rt jc./15'�..Roofing ....a...��.��..�'l..w..0 ..�........................................ Floors / .!/1... .. ..L�. '.................................................Interior .................................................................................... Heating ; i�T�..P..� .....,/x/C�. .....6A.Jc�... ?�.r..Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ........ ....n.n. '...................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ...........2:s...................... 0 A Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f 5opiRconj � e IIf0 ` 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 �...Iilit / ....... .........................(. f..J;. JJ _ Construction Supervisor's License ..C....S... ..�.. .... BARNICOAT, DAVID M. ,/A=40-041 No ..1014.3.... Permit for ..,Build...Sun Room Single 'Family Dwelling .......................................................................... Location 77 Content Lane ................................................................ Cotuit ................................................................. ............. Owner David M. Barnicoat .................................................................. Type of Construction ..................Frame........................ ............................................................................... Plot ............................ Lot ................................ Permit Granted .....NpV.em. be.r...6............19 86 .. . ...... . Date of Inspection ....................................1.9 Date Completed ......................................19 A o•TM� TOWN OF BARNSTABLE Permit No. ___28886______________ Building Inspector }sauws Cash ($5fin.'�0)-��— .e3a OCCUPANCY PERMIT Bond Issued to David M. Barnicoat Address t Lot #77. 77 Content Lane.. Cnt-,:i t- ti Wiring Inspector Inspection date Plumbing.Inspector \_ Inspection date Gas Inspector ` Inspection date Engineering Department �� Inspection date Board of HealthInspection date' 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. ....................................................... is 1 .G � l/ Buildi ng Inspector / ! OVA TOWN OF BARNSTABLE'- BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .......... ........ .............r- ?t ..Ca. ^ ' Name of Builder ............Address .................................. ---------------- ' ______ NonneofArc6inec -------..`������.---------Add�ss ./��------ ............................................................ Number of Rooms .........../�.----------------'Foun6otion Exie,io, —/ ' �� Yz:— .��—.�� [ ` /� —�_--'RooGng —� �1.��� �_' --�'-------------.— . -' - - ' _ ` Floors ......... ----------'^.|nte,icv .......... ......................................... � Heating —`x� _5.....I� �� .........................................Plumbing ' —. �'--'.. ......................................... � �/�. �� Fi,ep|oce' --,��.'_"..............................................................Approximate. Cost .....47/4'. ��{?�] -- /_� ' Definitive Plan b} Planning 800n6 lV----' Area � ---�---� ' ! Diagram of Lot and Building with Chmphskins Fee __. __. '+� | SUBJECT TO APPROVAL OF BOARD OF HEALTH ~ ^ ~. \ / \�\ ` v / -` | V, , | ' ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS .| hereby agree to conform to all the Rubs and Regulations ofthe Town of Barnstable regarding the above construction. ' mome . —. .—. , ' � ' Construction Supervisor's License �l���x���';«..v`--. | | BARNICOAT, DAVID M. A=040-041 ' No .... Permit for ... ............. . ...............Single Family Dwelling............................. Location ,.Lot 77, 77 Content Lane .............................................................. Cotuit ............................................................................... Owner .....D.av id....M......B.a r n.i.c.o.a t....................... ...... . .. . ...... . . . .... Type of Construction ...Frame............................. \j .......................................................... ....................... Plot ............................ Lot ................................. vv Permit Granted .........January 27r 86 I 01 .........................le.,......19 r Date of Inspection ....................................19 W Date Completed .......................I......... :1 9 41 1111d,7 Afse's'sor's,ma ' and lot number...... T IN E p e ............................... w. SEPTIC SYSTEM MUST Sewage Permit ,number ................... INSTALLED IN COMPLIA t PAUSTAXLE, T. House number. ....... ............................... WITH TITLE 5 ENVIRONMENTAL CODE 1639- Ali Arl TnwN fiEttrTION TOWN OFBARNSTA BUILDING INSPECTOR APPLICATION FOR PERMIT TO r. O.z.n. R n.C...6.............................................. TYPE• OF CONSTRUCTION ...RC�,.*.C.k. ....... 1. 7......................191's TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ........... o-.n7e.47.......I. ma-ss........................................ Cr)C.. ...... Proposed Use ...... .......1-7, 4.... .......... ....................................................................... Y Zoning District ......................IF ....................................Fire District ............... V ............................. 3;8.Name of Owner T2A.0' .i.D....;.Yn......BARM.64ddress .....)RORAX... � Name of Builder ......0 ie f..........Address .........................4 /....................................................... Name of Architect .......................:,:,77:7:77=...........................Address ................................................................................ Number of Rooms ...........Foundation ..10,0kit"'ed...C-0 Exterior ......". ...........Roofing ..... ............................................. Os�Floors "A4/..................................Interior ..........62F ....................................... -4 Heating .... !-' ......FAA.........................................Plumbing ...../.. ... ................. ................. Fireplace ...... ..............................................................Approximate Cost ,4 .................. Definitive Plan Approved by Planning Board ---------------------------- Area ...................... Diagram of Lot and Building with Dimensions Fee ..... I!rl 10... SUBJECT TO APPROVAL OF BOARD OF HEALTH 140" f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS L 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ..... .. . . .... . . . ......... . .. ........ Construction Supervisors License ..61ro..'XCI....... tARNICOAT-, DAVID M. lvo ..MH.... Permit for ...on, ...S.t.Q.r.y............. ...........$.inglp...Family...Dwalling................... Location ...Lott...7.7.......7.7..(;.ou t e n.t...Larip......... ..................C.Otu:Lt................................................ Owner ....Ravid...M,...Batnjx-aa t...................... Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ......J4n.v.ary...Z7a... ......19 86 Date of Inspection ...........19 Date Completed BUILDING di- TOWN OF BARNSTABLE, MASSACHUSETTSPERMIT JOB VEATHER CARD DATE 19 PERMIT NO. APPLICANT ADDRESS (N0.1 (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) _ DISTRICT IND.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT INALLS OF FOUNDATION ' (TYPE) REMARKS: AREA OR PERMIT VOLUME A ESTIMATED COST $ FEE . � (CUBIC S ARE ) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. 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 MEMBERS(R'EADY TO LATH).3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDIN NSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I 3 V �' HEATING ENSPEC7ING APPROVALS REFRIGERATION I PECTION APPROVALS W - E QIN RI�Q 2 8 tivl a � l9 86 . .. III , j ��rIER z oaro t _ . _ . . _ . = 2 N11�3�f'T �0� � Bma, � NCRK SnAL_ NCT -RO=EED U..N?:L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION ENSFECTIONS INDICATED ON TH!S CARD .NSPECT,F SAS AP=ROVED 7LIE VLA ISUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE =AN BE AROANGED FOR By TELEPHONE STAGES DF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. � a 14 O•Op` .'i •Q U Lo�f �5 ExIsf L14 ° Lb 7(o Fo11t�DAf�orJ S 140 od _ - AN i _..:: —SCALE AlS o -': -- Z PA D.::.-Fo. =._...::. ::.:C3 .P-1J.I COAT.._............. ._ a �\\ M s _ ......-........:.... .. 34' 4 4t1iL1 .tJ,4 _ p't. .GEORCiE_ _._ S�-IDW U.oN 1'4-115.PLA1.t 15 LDCAt�.P .oK1:.1�1-)F __�_:::4rzouNp AS ai-lokl i�1 %ICE .►:c:atiJ•� -f1aAT... ...._ ....._ _:_. Q 4 S Fo P.f✓I--�'o..-fN E.zA_t�i.wl4._ ... . .. . . gY.�� : :.c r . t.f!' 14.4f_6v-F'IASNPEG-Y: OS • ;:��_N. ........ ....................-