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HomeMy WebLinkAbout0080 COTUIT BAY DRIVE '� �t►,E Town of Barnstable *Permit Building Department Services EVL-es6moWeeftedar Florence Brian s�xsr,+us, = �o�f`y� ,CB O MASS. �' q� Building Commissioner �ZOliftet,.Hyannis,MA 02601 C�� 0arnstable.ma us Office: 508-86243�8 y/� 6 20�� Fax: 508-790-6230 EXPRESS PERMITIw oN - RESIDENTIAL ONLY of VaWftout Red X-Press Imprint Map/parcel Number Property Address *esidential Value of Work$ ��� . y Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address cAfoA �k( son '30 CQ' k G Oa(.0 35 Contractor's Name m or\u�\ FQ r 1s-t k n Telephone Number�j()�-�1 y-��to to Home Improvement Contractor License#(if applicable) O _ Email: MrntQ�Kp e COL.(O(T\� Construction Supervisor's License#(if applicable) 4f s - /O g BCrkman's Compensation Insurance Chec one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name —IV�Q_.Tr�l� p PxS Workman's Comp.Policy# au iJ` 1 l 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 Oe-roof(hurricane nailed)(not stripping. Going over existing layers of roof) (a-side Replacement Windows/doors/sliders.U-Value 'J (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. P SIGNATURE: QAWPFI MT0RMSIbuilding permit forns\EXPRESS.doc 08/16/17 f the Commiomveakh Q,jfMawar*uset fs Department of rudustrid Accidents K Offce of rations 600 WashuiVan Skreet Boston,CIA 02M wrvtumassgovIdia Workers' Campensation Insurance Affidavit Builders/ContractursMectdciansfPhm2bers Applicant Infnrmafean Ple1ase Print E.e�bly Name; ry e T�,or(�e�a r1C Ad,drew. 53 CM(A -Lsawa� coy/sta> _ o 1��5 SCs-any" qQ Ufa Are you an employer?Check t1le appropriatrb Type of project(required)- I.ElI am a employer-with 4. m a general contractor and I 6. ❑New employees(full andfor part-time)-* leave hiredthe sub contractors 2.❑ I am a sale pmpdeto>r orpartuer- listed adore attached sheet I ❑Remodeling ship and have no-employees . These sub-cmtractars have 8.•❑Demolition worldng far me in any capacity_ employees andhave wodrers' 9 ❑Building addition [Na W.Orkers'camp. camp-tnsuzaace I - 5. ❑ We are a corporation and its 10.❑Electrical repairs or addikions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions o wailmrs' of exemption per MGL �€[No �- c.l52 1 aadwehtawesPa lry�❑,/Rnofrepairs qq is�e�an,nre required]Y 'e {' 13.(Other k J(fl al 4 employees.[No;vo�ess' q camp-insurance required-] J #AnyapyHcsaGdwtchedcsbax#1must also Moutthesw ionbeIowsbowiugtLeawaxkerecampea fumpeEcpiaiimasEEoa- t Hameawnem Thu sabmd this affidava i g they axe doidfl all Tot and lea hoe outside revnrrsCtM WMSt sa l=&a nem affidaeet iadicabgp sacFL ICaa>Lsct. iff=cheA this boot mast%inched zm addieiamal dwet sbouissg the name of die sob-camusctms sad stele whatha ar oat those effrfses have employees.Ifthe sdb-caatractnts have empIcye?-%they mMMT yXavide•the¢dykes'comp.policy number~ I a»t an etspfoyer tfeatis prmJiding workers'conrpertsrtizan iumiraxce for nzy enzpfo3wes. Setoiv is tfie pvHcy and job site information Insurance Company Name: Policy 9 or Self-iri&lie.g.�] U f3-n 11 y N 1.3=q - I 1 Expiration Datte:: (: Job Site Address City/Stafet p:\0-1 V\I- Ma . oa eo35 Attach a copy of the corkers'compensationpolicy declaration page(showing the policy mnuber and expiration date). Failure to secure coverage as required under Section:25A o€MGL c.15 can lead to the imposition of criminal penalties of a fine up to$1,50Q0D and/or ones-year imprisonment,as well as civil penalties in the fora of a STOP WORK ORDER and a fine of up to$250-00 a clay against the violator_ Be advised that a copy of ibis statement maybe forwarded to the Office of Investigations ofthe DIA for insurance coverage verification I do kemby ceti1y andor the pants andpenahies o f$arjuty that t)te irtformadvaprovidrd abm a is bare mid carrect Si>rrsature %�— Date- (D —Co , I Phone ik 5.8 - y _ 9 9.(�o c,0 Ojf rf d use only. Do not write in this sma,to be cmnpkited by clip artown oficiat City or Town• Permitf kense� Issuing Authority(Circle one): L Board of HwItli 2.Building Department 3.t ity awn Clerk 4.Electrical Inspector S.Phunbing Inspector 6.Other Contact Person Phone#: Laformation and Instructions Mmcachu setts General Laws cbapter 152 recjmres all miploye rs to provide wen3cers'compensation for their employees. Pmsu=-to this sbatui.e,an evVLVw is defined as-¢:suety person in the service of another nndea any contract of hi r% express or implied,oral or wnift>m." An e7nployer is defined as`pan inch dual,partneribT,association,corporation or other legal entry, or airy two or more of the fioregoing engaged is a joint else,and i achhdung the legal reluesenfatives of a decease d e m3ployer,ar the r=eivrr or trustee of an mdivid al,Par[ner.-ship,association or other Iegal entity,employing employees- However flee owner of a dweIling house having not more than three apartments and who resides them or the occupant of the - dwzIlmg house of another who employs persons to do mai atx�,construction or repay wolic on such dwelling house or on the grounds or building aj p-> a Therein shall notbeoanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also Stitt that"every sty or local Rcensing agency shaII withhold the issuance or renewal of a licen a or permit to operate a business or to construct buildings not the commonwealth for any applicant who has not produced acceptable evidence of compu=c:e with the insurance covexage required.." AdditionaIIy,MGEL chapter 152,§25C(7)slates"Neither the commmweahh nor sty of its political subdivisions shall enter into any contract for the:pmfonmance ofpublic woik until acceptable evidence of compliance with the i osuaramre.. i rez,;r>' =±S of this chapter have Been presented to the eo�cting anfhonity-" : Applicants Please fill out the wonk=s' compensation affidavit completely;by checking the boxes that apply to your situation and,if necessary,supply s°b-confisc6or(s)name(s), adaress(es)and Prone ni— er(s)along with their certificate(s)of insurance. Li with d Liability Companies(LLC)or hatted Liability Par ammbips(LLP)with no employees other.than the members or partners,are not required to can-y wohicers' compensation insurance- If an LLC or IZP does have empIoyees,a policy is required. Be advised that this affidavit:may be submitb�:d to the Department of Industrial Accidents fur confirmation of ms3t�mce coverage. Also be sure to sign and date the affidavit The affidavit should beret rand.to the city or tnwn that the application for the permit or license is being mques Dd,not the Department of . Train st ial Accidents. Should you have arty questions regarclmg the law or if you are required to obtain a workers' compensation policy,please call the Department at the n=ber listed below. Self-insur$d companies should enter their self-insurance,license number ou the appmpriafe line. City or Town Offitcials Please be sine that the affidavit is completh:and pradnd legibly- The Department has provided a space at the bottom of tine affidavit for you to f M out in the event the Office of Inver Wiens has to contact you reg cdmg the applicant Pleas a be sure to fill in the peumir/licrose member which will be used as a refiereace number. In addition,tin applicant that must submit murttiple penatIlicense applic&ons m any given yew,need only submit one affidavit indicating current policy infounation.(if necessary)and undsr'rJob Sit m Address"the applicant should wnte"a]l locations in (citY or town)."A copy of the affidavit that has been officially stamped or m ke;d by tine city or town may be provided to the applicant as proof that a valid affidavit is on file for faits peus or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pezaitt not related to may business or commercial veutm tie. a dog license orpennit to burn leaves etc-)said person is NOT required to complete this affidavit The Office of Invesfigations would lake to thank you in.advance for your cooperation and should you.have any questions, please do not heskate to give us a caIL The Department's address,telephmie and fax number: Degarxatt of Ted ial Accidents =(� a of jive& �tio.- t�4�asbing�n S#rt B wtm.,MA EMIif Tc,-L#617'27-49W and 406 or 1-97-MA S.SA�F?` Fag#617 727 7M l�visea4-za--o7 Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS-102185 Construction Supervisor KARL T SPAIN ` 48 MAIN STREET :. a SANDWICH MA 026®��" �rur.�—! Expiration: /Commissio tie 12/26I2018 `' C"��r. Tpn�rtiitn•irruarull�r�(./l�/JJCIC�udn./,(t �..} a, Office of Consumer Affairs&Business Regulation License or registration valid for individul use only (up HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,;..`1.777(;7 Type: Office of Consumer Affairs and Business Regulation Explration -._2612018 DBA 10 Park Plaza-Suite 5170 K.T.SPAIN CONSTEtICT..11Q1Nt, : Boston,MA 02116 i' � • . KARL SPAIN t. 46 MAIN ST. 57 I � c r SANDWICH,MA 02563 V Undersecretary — t -- ;;ry i of valid without ignature NOTICE N NOTICE TO a TO EMPLOYEES EMPLOYEES V The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 — http://www.state.ma.us/dia As r uired by Massachusetts General Law,Chapter 152,Sections 21,22&30, this will give you notice that I�we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PUUB-0114N13-4-17) - 02-08-17 TO 02-08-18 POLICY NUMBER EFFECTIVE DATES BRYDEN & SULLIVAN INS PO BOX 1497 SOUTH DENNIS MA 02660 = NAME OF INSURANCE AGENT ADDRESS PHONE# o� M.B. HOME IMPROVEMENTS, INC. 53 CONGRESSIONAL DR o� YARMOUTHPORT MA 02675 EMPLOYER ADDRESS '— EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A. copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS OU589 MOP1G1s TO BE POSTED BY EMPLOYER t Ii Office.of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improveme`r�tContractor Registration Type: Corporation r ��' Registration: 180881 M.B. HOME IMPROVEMENT, INC. Expiration: 01/22/2019 z 53 Congressional Dr M Yarmouthport, MA 02675 - Update Address and return card. Mark reason for change. SCA 1 % 20M-05/11 Address D.Renewal f3 Em rrl Elar ninvent Lost Card �e�paic�czoazcaeall�o�C�/lilcca�ac%uaelh ___.__ __._...---•.___..-.----- -- Office of Consumer Affairs✓,Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only s'P TYPE:Corporation before the expiration date. If found return to: --Registration iration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 :, I3U881., 01/22/2019 Boston,MA 02116 M.B.HOME IMPROVE,MENT%INC. Michael Bernstein.:53 congressanal`Dy -- %L '� Yarmouthport,MAy02675-' ` Undersecretary Not valid without signature Town of Barnstable Minding Department Services Brian Florence,CBO qg. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using ABuilder d ,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. 0 .(Address of Jo **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant � �'a � � -sow /�I�cNr�lsL f�i ��s�/t c •� Print Name Print Name ' Da 1 Q:FORM&OWNWERMISSIONPOOL4 Rev:OW16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner : , � 200 Main Street, Hyannis,MA 02601 tom. www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# worts phone# CURRENT MAHING ADDRESS: cityhown 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 Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFHM\FORMS\building permit forms\02RESS.doc 08/16/17 Assessor's map and lot number ....... ................. 8EP M SYMM MUST BE Sewage Permit number ............... 'NUALM w COMPUANCE WRH TITLE 5 N CODE AND TORN OF , BAR1�1�'�' ,r,oNs , DA"STODLE "6 9. B.UILDING,`:;,INSPECTOR a wpY e m t rdr u c- A Siva (e dtiu d APPLICATION FOR PERMIT TO .........1.1..................................`�....... .........`:�... .............�...................................• (lt�mcraanaL TYPE OF CONSTRUCTION ...................... ............................................................................................................. ........ ..... ............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........L o-r 1 o Co COT or D R .. 12tU�C.a.....�oTU�T M th 5S. . ........................................................ ............... ........................................................................................... Proposed Use (L. tb N C E ........... E........................................................................................................................................... Zoning District ........�..I ......................................................Fire District ....... .........�T...................................................... Name of Owner CmTubr 81� i-oQES 0a , 13Z �� �sn-a��.1 ��, l,"ULT r�Z63S .............................Address ............ .. ....... J it ►1 `I �� �� i Name of Builder ... cjru tT 3 i S tFOl2�S ..........Address ................ ..................... .................................................................................... Name of Architect .3P4.K IkRl?.y.,I�l)ll.�S b1zewl V,v ..S� . `JOSTON VV! .... ..............................Address ........................n •(� ........ ........................ Number of Rooms 5 Foundation ..�ev_1ledG..�p �p .................................................... Exterior ..............................................Roofing ........ 5�° .......................................................... Floors y Interior .......� I..�'`� S...' ......Qa..k..................................................................... ' C-10.........�Ca........r.......................... Heating 0.1.�.... .l......................................�� lU fiU2 .......:..................Plumbing ......�e.. G04'� II__ rr 4 Fireplace ....... .... .... .......................... Cost ..............5 DOO ......................................... Definitive Plan Approved by Planning Board --------19__1 3. Area aaa.... .......:s.j�........ Diagram of Lot and Building with Dimensions Fee. ...........................................:. SUBJECT TO APPROVAL OF BOARD OF HEALTH 135 LOT 1 4— $1 iu ! RR.Gz ' Vr ay G�1L Ilol I � �6T-u (r- 13A � Qivr AN(t Ca P uG2T I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ...' ..........Y........ . ............... .......... COTUIT BAY SHORES CO. No 2.2CL33.... Permit for Single...................... ........ .... Family Dwelling . .. ......... ............ ..................................................... Location ...Z o.t:.-,10.6. ...Ciatult...Ray...Or. .....................cotuit........................................... Owner C.QtUit...BAY..SI!Qr.es...C.Q............ Type of Construction ..Dz4mq........................... ................................................................................ Plot ............................ Lot ................................. Permit Granted ....March. 11..................19 80 ..... .. .... .... Date of Inspection ............................ ......19 19 Pate Completed 19ou PERMIT REFUSED ................................................................. 19 M ................................ ...... .. .................................................. . ........................................................ ...... ..... ................................................. Ste) <1 to 0 t Appri C;..f....................................... 19 M M*n—***S�—*—*—*,***—'................................. M ......................................... ...................................... 4r----- 106 2, - L /\ N o h ®- 19, Z w o 4 . 871 1 PANT � 2� cod, i 1/ Z°I 1 Maet Jr L 0 OF 41,4GRETE MsoHANNON ;10 26tEl:i p • ��Q/sS tiK • GNO 5U�ti � l hereby ceHlfy that the PLOT PL A N foondotlon /s located as shown LOB► ,Os and conforms. to the ZoNng By-Lows of the Town of " COTUf r BAY SHORES " Barnstable, IN COMM, BARNS TABLE, MASS Owner: scale /".V 40' Jon. 3/ , /980 comr BAY sHoRrs, lNc. BOHANNON LAND SURVEY CO. West Bridgewater, MASS 02379 TOWN OF BARNSTABLE permit No.�_12 V I Building, Inspector saurc.n Cash 4 i rua � , ryY #F /` OCCUPANCY . PERMIT Bond srv`�1�A No building nor structure shall be erected,and no land, building or structure shall be used for. a new, different, changed,.or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No'building shall be occupied until a certificate of occupancy has been issued. by-the Building Inspector." Issued to Couit Bay Shores Co, Address COtuit Lot 106 80 Cotuit Bay Dr. Cotl4it Wiring Inspector Inspection date ° ) Plumbing.Inspector ^ '�+ Inspection date v � Gas Inspector �, �� Inspection date Engineering Department Inspection date 1 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. .I Building�,"Inspectorw w, f AssesAssessor's map- and lot number .... ......... ............................. Sewage Permit number .................................. ETHE TOWN OF BARNSTABLE ARNSTAI]LE, 163 MABIL 9- fb BUILDING INSPECTOR a M of. APPLICATIONFOR PERMIT TO e rital�..................................... ............;.......................................................... TYPE OF CONSTRUCTION ........ _h*aj.*1,, 4!... ....................... .......................I 9.e; TO THE INSPECTOR OF.BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......... �oTvtr SA,' o-rU,'r M A 55, .......................................................................................................................................................................... Proposed Use ............( 6................. ................................................................................................I......................... .. .. .. . ... .. .. .....................Fire District ........ ....................................................... Zoning District ............ C Con)rr n z ar .......................... .......................... . Name of Owner OT L;Ir T,1� [�tte_ C�d................Address ............................................................................. Name of Builder ....C C.T.U.IT--B.A.1i...S1.1.0.2.(.3....It.-0.............Address ..... ...... ................ .....................k.k.........IA............... .... .. . ... Name of Arc-hitectAi a L..L.a...................Address Nay) 6 Lj V U.... . Be)-CTT)N . ........................ . ......................................... .. Number of Rooms ........................................ ...............................................................Foundation .......19..Y..V...0..... Exierior Af.\�ra&�+ ........Roofing ..............f..................................................................... Ie ,Y� coat [d de i- Floors ....... .....................................................................Interior ..................................... Heating ............ ..........Plumbing C Ac- .......... ................. ng ...... ..................................................................... ........................................................ ................................................................ Fireplace ......................Approximate Cost .... Definitive Plan Approved by Planning Board -------19 Area. ...... ............................ Diagram of Lot and Building with Dim.ensions Fee ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH kCT* C06 1-/00 tj ----------------A I-f " q116 2 Y A, 4^T cc I-V (T 3-A DANK Coucorr I hereby agree to conform to all the Rules and 'Regulations of the Town of Barnstable regarding the above construction. Name ......................*.................................... ...................... COTUIT BAY SHORES CO. A=56-25 No ..22,0.33.. Permit for .....si gle....:........... ..........F.ami ly...Dw:e l u ag............................. Location ,Lot 106 8 0 Cotuit 'Bay Dr. Cotuit ............................................................................... OwnerQatuit..Bay....Shares...Ca.............. Type of Construction ........8 YP rams..................... , ................................................................................ Plot .............................. Lot ................................ i March 11, 80 Permit Granted ..................................19 Date of Inspection .....................................19 Date Completed ......................................19 PERMIT ,REFUSED ...................................... 19 ................................................ f Approved ...............................................................................