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0322 COTUIT BAY DRIVE
�a l r � , � � I r I I 1 1� r L. IF—K [N^iiyrL. WEATH.ERIZAT10k 1 8 y Date . 6 Town of Barnstable Building Division 200 Main St. Hyannis, MA 02601 The insulation work � has been completed Q ._ •n a. ..� '•y�.; ."x:.' _ •fit;,;• - i: e"'a .,a�.�! ,^.�",� •.:.dry�: :.:::-n:��y: .5��:�`.': othy'Caakfs ..,:. President ,! _ CSL 105454 "' O zm RJ M 58 QICKINSON STREET I FALL RIVER,MA 02721 I (508)567-4240 I ALTERNATIvEwEATHERIZATIONDGMAILCOM r't map and lot number .. ..rn... ... ..� .....!-- I " SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE d WITH ARTICLE II STATE Sewage :Permit number .......................................................... SANITARY CODE AND TOWN of?NElG _O TOWN OF BARI�E§T .�fE i`" i B9Bd.STADLE, �MA"6 9. `= BUILDING INSPECTOR °' c APPLICATION FOR PERMIT TO ........5,0. G.. .... sf.J�1A.1......�x' r TYPE OF CONSTRUCTION ...... �BrO........�r�r./1�. .e�................................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ : ....` .... ,I� ............("arma......... (CPj!ill..... Proposed Use ......... .............F,*t.'4 Anx......... 5/..,V!� �.!C'.4?=....................................................... ZoningDistrict .........Ar....................................................Fire District .............................................................................. Name of Owner ..f2'X.cV...... .......................Address ,>.......,A( 42!Y OP ....1!YI . ................................,. Name of Builder .�r,XIT7 ... -Syt,/�'�C:..........Address .Ia/..l.....�'�`�.�7!!!L� ��W�.....�r�£ST..�/..'V Name of Architect .('/..r1.e 'S....aW. .;E.)V4,0~oV.1A14dress ...14F .. ...... /�/....... ....���,��� Number of Rooms ............9"........................................:.........Foundation V�X(� TV................................................. Exterior .... lrJfX�.. Q'1Fr•d�'......................................:...Roofing ......17,D A.1 .4-7..........-!C441. 5............. Floors ,1¢ ................................................................Interior f1Td�Jf...... ✓� /'!�G ........ .. . . .... .... ... .............................. Heating ...........Je ..-rA.(.A`..............................................Plumbing ...Z'1�C!......f l j£.. 'Yf?` ......................... Fireplace ............./..................................................................Approximate Cost ..........` �O�r.!/ ................................. YYE 0&f5 7- Definitive Plan Approved by Planning Board ________________________________19________. Area7y. ............... ZlG i�X>!tLu-�l'� Diagram of Lot and Building with Dimensions Fee ...�''r� fir` SUBJECT TO APPROVAL OF BOARD OF HEALTH f Io Jyz GearE zy 14'7' Ii I hereby agree to conform to all the Rules and Regulations of the To,, oTarnsta5 r',g�aerding the above construction. Noa ....... .uy :'.......................... P.tESIDEI�j Shapiro, Fred 18605 1 1/2 story, ............. Permit for..................................... —7 single. family-,dwelling . ............................. .................................................. Cotuit Bay Dr&ve • Location................................................................. C 0 tu i t ell Fred Shapiro Owner .................................................................. frame Construction ........................................... Typelo X 88 f n t r I r Y•r 1 Plot ............................ Lot ...........# ..................... 'j August 19 76 Permit Granted........... 19 Dat6 of inspection ...... .......................:.rl 9 Date Completed . .`/I/ Z..".... "19. V PERMIT REFUSED /'�...................................................... ...... 19 ............................................................ ................... ......................................................................... ......................:........................................................ 'ol 01 ............................................................................... A 1A 'A APOroved ........................................'A' ..... 19 ...........................................................�t................... 4'j .......................................................................... .y N 7 6 a n 30 co co , ` •:. '► Coast �tr _ JN' 1 Y • " �' Jt �/ per_ 07 o, - CERTIFIED PLOT PLAN NEW CONSTRUCTION ONLY TOP . OF FOUNDATION IS FEET IN ABOVE LOW POINT OF ADJACENT J9AJ3hS-t.ta'!a ASS*ROAD.• " L @017ts04 P%I t�QH �CC - 90 SCALE:/ "- 30 DATE t9 /C�19 EL D ED E ENGINEERING CO.IN { CLIENT I CERTIFY THAT THE ���9®i�9 EGISTEREO rEISTERED SHOWN ON THIS PLAN IS LOCATED ` CIVIL ILAND JOB N0. 760 3 Q THE GROUND AS INDICATED AND, 1 00[ FORMS TO THE ZONING LAWS ENGINEER,$ RVEYOR DR. BY: 1,".�BY. O,F BA-REST BLE , ASS. R 33 NO. F^QI'�! Sr ?12 MAIN ST. , CH a 0. YARM' UTH, MASS. ' HYANNIS, MASS. - SHEET- 1 OF �_. DATE REG. LAND .-SURVEYOR '. i I n0 P.� I` 5 Fields Pond Road Weston, Masse 0219y, April 27, 1977 Building Department Barnstable, Mass. Dear Sir, This is to notify you that I am aware of your concern about the possibility of the fireplace smoking, as constructed on Lot 88 Cotuit Bay Shores. I will not hold the Building Department or the Torn of Barnstable liable should this smoking occur. - erely, Frederick Shapiro Personally appeared before me, Frederick Shapiro, and states that the above is tru and correct. Noy •p is;� ' o b. MERITT HOMES, INC. mm • g'signens and - uddens.of pine Custom Homes BUILDING r REMODELING ADDITIONS 164 BEAVER ROAD WESTON, MASS. 102193 TELEPHONE 235-3226 o . t't Lip ft.-LA,,r-44,o 61 7" - ke. )14 d i +' ►�. 6/Gr� � �:u ��� � ��ffa��F�S�,. Alf P.IT ME5, E LC. r by L. P. RITTENBERG jt PRESIDENT fA i d d I e s e x �• ss SubsCi'ib�tl and s,:o n to before me this i 3+h day of.i -m�1971 Notary Public MY Commission Expires' April 17, 1981 .J n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel W 55 Application # . 2oi3 oEC -5 Health Division Date Issued w Conservation Division Application Fee Planning Dept. DIVISION 2, Permit Fee � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ll d r%vc Village Owner��1r h / 0� Address e4 i /3 r, Telephone 77Y-3a 4' asv j Permit Request l�lr !j njul�f7 i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3��c 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 baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) a} ,. . i Name 1 Y1�� lrc�— -Telephone Number ,\ r Address ,�l�%;n S(1� cSf' s� License # 166Y.jy Tlt- /C.iVP� /Its Oa-7 d,[ Home Improvement Contractor# Worker's Compensation # �Gl�s�9/ �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / . - SIGNATURE DATE FOR OFFICIAL USE ONLY .APPLICATION# DATE ISSUED } MAP/PARCEL NO. ADDRESS VILLAGE OWNER Gr DATE OF INSPECTION: +OUNDATl.O.NSD�TI��i ':5 r FRAME - t INSULATION.,' FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING -DATE CLOSED OUT ASSOCIATION PLAN NO.. r - - z t ti Town of Barnstable Regulatory Services Thomas F.Geiler,Director •`0�- 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, CA 0 5 ,1 ef�--. �c�� y - - , as Owner of the subject property heseby.authotize - C�LL�J��� to act'on my behalf,. in all matters'reladve to work authorized by this building petmit (Address o ob) **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 Ttint Name Print N��a ne ✓ Date �V Town of Barnstable Regulatory Services ' t►r.+as. Thomas F.Geiler,Director ��o;;�•`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER 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"homeokAmers"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 Iast 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. C:\Users\decollilcWppDatalLocal\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doe Revised 053012 s' ` OWNER AUTHORIZATION FORM ( wner's Name) owner of the property located at (Property Address (Property Address) hereby authorize ` rl 'tl .. o OeCAe -2-1<)-l G 4J (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature «j 3 If Date Print Form The Commonwealth of Massachusetts ..... Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 �- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name,(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION,INC. Address:1440 STAFFORD RD City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 8 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 working for me in any capacity. employees and have workers' comp. insurance.x 9. ❑ Building addition [No workers comp. insurance p• required.] 5. ❑ Vile are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I..F] 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 INSULATION employees. [No workers' 13.91 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepo/icy and job site information. Insurance Company Name:ACE AMERICAN INSURANCE CO. Policy#or Self-ins.Lic.#:6S62UB5B918901 Expiration Date:4/5/14 Job Site Address l br-, City/State/Zip:a aju it Attach a copy of the workers' compensa on 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 certl unde t R airs a alti.. e ' that the in ormation provided above is true and correct. Signature: Date Phone#:508-567-4240 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#: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2015 Tr# 241009 ALTERNATIVE WEATHERIZATION, INC. TIMOTHY CABRAL 1440 STAFFORD RD. - FALL RIVER, MA 02721 Update Address and return card.Mark reason for change. Address I_ Renewal J Employment Gl Lost Card SCA 1 0 20M-05111 r��1' Iffc//FY/I/:/I//K'llll�f�:��I P/JJUC�//�h��• Office of Consumer Affairs&Business Regulation License or registration valid for ind'mdul use only _ -0ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration• 175663 Type: Office of Consumer Affairs and Business Regulation Er 10 Park Plaza-Suite 5170 Expiration: 6/29/2015 Corporation �s Boston,MA 02116 ALTERNATIVE WEATHERIZATION.INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER,MA 02721 Undersecretary t N t vali 'hout signature ul nnstruction Supervi'n; . _- sa: C3-105454 TJKOTHY CABRAL 581DICKERINSON sT Fall River MA 0121 - 05/08/2015 ac d CERTIFICATE OF LIABILITY INSURANCE W18-CMMCAr_IS ISSUED AS A UTTER Of INFMWION ONLY AND CONFERS NO RNIHM UPON TR CERnWffE HOWER.THIS CERnRr.Arc DOES NOT AFFUMMMY OR NEGATKLY ANEW EffEKD OR ALTER THE COVERAGE TAFFMED By H M*MSY�A��R TM O CERnRCAll R PROMJCM ANDD THIS C6MCM HM NOT COMMIMOLM IMPMANT: B tits eeMcab ImMor I*=ADMIONAL INSURED.fbs pnQq►lf Q musibe on&= .tFS110=7ION IS WAf M notnot etch Ste s holSarlD of sadt panda mW mqtfn an andotswitaid.As' It Ito is utUlta�a d aacm>c� vivMROS WSAGENCY INC. PRONS IF" 375AIRPM IW FALL RIVER MA027Z0 VOURE"ARUWM s+men NSI�t A:ACGA7LL69C{W Il�SttRANCJ'at�AN1f Dom mamma! ALTERNATIVE WEATHERMkT=IND 04SUPERC2 u4s STAFFORD RD FALL RIVER MAWM tt�tAtFJtO: Qt�tt:: e1SiltSijt C TWS is TO cswnFY THAT THE POLICIES OF KSURANCE LIST®BELOW HAVE BEEN ISSI TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 2401CATED. NOTWMISTANDINO ANY RMUIREMEif.TM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIt11t RESPECT TO WHICH THIS CWMCATE MAY BE 136UM OR MAY PERT'AlK THS INSURANCE AFFORDED BY THE POUCIEB DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSION& AND CONDITIONS OF SUCH POLICIES.WHITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAM& laRi=TYPaOP aANf POLR,7WS88t POLECY POmm Uum GootALLum ly FACN s CaQpAERpAL4H'�UL6U1HlLttr B atft� e C=ot UEDW mo S Pe�ruLeAUvaenaer eea�t.wC6s180wTS O OS AGGRO MIILMrAPPLW PM PROWCB-C UP10PAOo s ' pmm LDC i I I s SCHEDULED �� riomrttsttAa't1Psr s AAU OSAUM 8001LrerA(AYpafsOCA06q S KwwAUTOS foomovimm S Avmsti llMOML ALLO OCCUR EACMOCGUIRAHlCQ B QCmUAS CIAIlLSN%QZ ASKS S JOE01 RffMNTPMS 3 ar 1 IV NIA FyEAClIAt:Qn®!r $100.000 bmus: 04-W=3 04-04014 t�1d�'"'►r"I 589f890S t:iots•Ass-e► �0;000 da or ea.ramsa•Pourartuur 51�,000 pBnemPneN at+ooaRaataRsr wmtta�m t vtaaass pnead�xoofta�of.nemvam amens sa�,.am�n mmn sae.u e�e� HOLDER CANCELLATI SMOC ENERGY SERVICES SHOULD ANY OF THE ABOVE DFSCA MI POLUM MI)HOWARD ST CANCELLED 86MM THE OPERATION DATE THEREOF FRANMGHAM,MA 01M 140MM WILL BE DELNERED IN ACCORDANCE, VVIN IM PO PROVISIONS. AUn""t= rartva I ,mlartUrac+�t+�aan ACORD 25(20'IOM The ACORD tome and logm ate m9isand mays Of ACORD neering Dept.(3rd floor) Map Q S s Parcel 005 '�` g Permit# House# ,32-Z (u 1T BM DF Date IssuedsEar,, Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30) :36a. _Fee I)VSPAC y-STe ,� do C Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 1 d� eivip N,lj'il'.l� Planning Dept.(1st floor/School Admin. Bldg.) 7r*Q�r .,off,�'�, � �'."�.•-, Definitive Plan owed by Planning Board 19 ,. BARNSTABLE. ' TOWN OF BARNSTABLE Building Permit Application Project Street Address 3a coTiA i—f I)A't -DR- 'Y Village PAT(,t,l T ' Owner 'Ki CK� ADO MAR iL`10 U'�N Address 3`JI-4 LARo e.T F�1IREP& `VA. 220, Telephone 04 91 `�3 13 ` � Permit Request 'REMCkle Ar3D ?ZP1ACf- A('(VZ f, 3 Of (k pl}R U P(',j AIZD '1,eV)ova: PhX� � d1n 3 OF I1594NJ S�"Lr iREMmE A7JO 41P► e ©t,3E /fTJr3eV-5W GnS�YY1e f r,�Ti+.sc�w. - i First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District F Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family E- Two Family ❑ Multi-Family(#units) Age of Existing Structure t S 7 E/rZ5 Historic House ❑Yes @�No On Old King's Highway ❑Yes 0�io Basement Type: CJ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None•~ ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes D<10 If yes, site plan review# - Current Use 51l SaL1 Rrm p.`f Proposed Use &Ca R1 11 ' T-rC Builder Information Name mr R,Pry Telephone Number (509) +7-8 0C V Address sw0 Dt- ST• License# Q f 88 59 T.0 . Zox 13 3 Home Improvement Contractor# 100 13 1 nn I?UTIItI-T, MA- 02(035 Worker's Compensation#(oRluufS-S)SK ib-8-Jib I -?t Cc - NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ItrZ SIGNATURE DATE BUILDING PERM DENIED FOR T%F LOWING REASONS) .F v 9 • FOR OFFICIAL USE ONLY PERMIT NO. 2�(O 6.3 T DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE M r OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL GAS;.,, ROUGH FINAL i FINAL BUILDING � �-97 DATE CLOSED OUT y ASSOCIATION PLAN NO. erne r� The Town of Barnstable • asaxsr�sr� • 9 'L �0� Department of Health Safety and Environmental Services fob" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. Type of Work: 3 C--SiOC Est.Cost 41 , rro Address of Work• 322 cyywr f -bm -DR a-TkAX T. NO � Owner's Name F�.i CR ftiza7 hin lnpx-1 ,i Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 01,Wq-1 .Tnv, To. 10013 1 Date Contractor Numic Registration No. OR nnta Owner's Name � � ,._ �.'• •.;, rc• • unrnrurrli�cQrrr�r�..��usrarlrusctrr De parline-Frl Of llyd-tuD ial Accidents j �� �'" �i•=� 61111 if ashirrgtrrrr Street 4: +• Bu,tnrr..lfirsx O311I Workers' Compensation Insurance Affidavit liIic•tnt informatitii -—- P►cnse PRINT'ie�ibly , nnmt•• /11T>JM-T l'<� PAI Cse-a JQ... - I� + ^ C-7f tall sa ►�►� . martin"• P.Q• 77)Dx `)J U 1 ESQ 146 L 6T• city COTUl T N4 2(o3 S "boor+t 050g `f 28-cxavl 1 am a homeowner performing all wort:myself. I am a sole proprietor and have no one working in any capacity �K, am an emplover providing workers' compensation for m}•employees working on this job. enninnnc• name• Pi11 GIC- 1 l &,LnL���7 . -XL adtirccr ?, bOx 133 c ! B 5040UL ST. . city• 627 IT ��� O LU S nhnne tt• Y'a-UOO I incur-inrccn RtEL-JA nniicv# (,Rlo s - 6031 Io U^17 a sole proprietor. ;enersl contractor. or homeowner(cdrede Otte) and have hired the contractors listed below who its the following workers compensation ponces: entnnnn't• nntnc• idd rrcc- cin•• "hone t+• incnrnncr rn "olio•d cmmnnny n-ttnr- :ttitlrrcc• . -in•- "hone f1� n,turance cn Holier•d lttach additional sheet if neceiiary ..�i•�' • rIi ry ' - ' •^ '..» `,'. +.S...a��.�a+� '" �.:..�. '•are•.— �•..rr.:�... 'rilure to secure cttycraee as required under tieetton 3A of AIGL 152 cin lead to the imposition of crtmtnal penalties of a lineup to 51300.00 andiur ne v cars' imprisonment a •'ell:ts civil penalties in the form of a STOP NVORK ORDER and a line of 5100.00 a dayagainst me. I understand that a opt of thin atatetttcttt Ma . c furn'ardcd to the Orrice of Inrestigntions of the DIA for coverage verification. 110 herchr crrrif•tut th • air at pry a 'es c tar the information protdded above is trae and correct ^^aturt: 'rint name U E2 /\ ?iqo c9c Phone# (so��� � _600 africiai time univ do not write in this area to be completed by city or town ofritiai city ar town: pti onit/lfeense# MOuildinn Department ❑Uccmiar.Huard C o check if immediate response is required QSeleetmen's Once 1=llealth Department contact permit": phone tYt nUther_�_ � i Information and Instructions r. MassaClhutiettS General Laws chapter 152 section 's requires all employers to provide workers' compchhsatior employecs. As quoted from the "law-' an emplgree is defined as every person in the scr%,icc;dt another undc: contract of hire. express or implied. oral or written. An cmpinrcr is deftncd as an individual. partnership. association. corporation or other IegaJ cntit}, or any tine the fore::=oin;_ en�sa_ed in a joint enterprise.and including the legal representatives of a deceased employer. or recei%•cr or trustee of an individual . partnership. association or other legal entit}•, employing employees. Ho« owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of dwelling (house of another who employs persons to do maintenance, construction or repair work on such dwci or oil the :_rounds or building appurtenant thereto shall not because of such employment be deemed to be an e: MGL cha{hter 152 section 25 also states that every state or local licensing agency shall withhold the issuani rehte��:h! of a license or permit to operate a business or to construct buildings in the commonwealth for s applicant who has not produced acceptable evidence of compliance with the insurance coverage requiret Additionally. neither tite commonwealth nor any of its political subdivisions shall enter into any contract for tie performance of public work until acceptable evidence of compliance with tile insurance requirements of this ci: been presented to the contracting authority. Applicants Please fill in tine workers' compensation affidavit completely, by checking the box that applies to your situatic supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to si;n and date the affidati•it. T'I affidavit should be returned to the city or town that the application for the permit or license is being reques:ed. not the Department of Industrial Accidents. Should you have any questions regarding the "law-or if you are rt: . . please call the Department at the number listed below. to obtain a workers' compensation polic City or ,towns Ple-,ze be sure that the affida\•it is complete and printed legibly. The Department has provided a space at the bo. tlhe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicar be sure to fill in the perm it/license number which will be used as a reference number. T7he affidavits may be get: the Department by mail or FAX unless other arrangements have been made. The Office of Investi=ations would like to thank you in advance for you cooperation and should you have any qt please do not hesitate to __ive us a c:if. The Department's address. teleplhone and fax number. t •T Tic Commonwealth Of Massachusetts Department of Industrial Accidents _.. office of Investigations 600 «Vashington Street Boston,Ma. 02111 f..Y -�i• (m"n ;27_7749 lie 609mmanwealM. c1, _Aaajac/ewea4 Restricted To; 1G DEPARTMENT OF PUBLIC SAFETY 4 1 g 12 — - CONSTRUCTION SUPERVISOR LICENSE 00 - None Number; Expires: 1G - 1 & 2 Family Homes , Restricted To; 1G Failure to possess a current edition of the Hassachusetts State Buiilding Code w ROBERT R PADGETT is cauX for revocation of this li ense. 184 SCHOOL ST POB 133 COTUIT, HA 02635 °TI. HOME;IMPRQVEMEXT:.CONTRACTOR, ;;,Registc.etion :1OD131 ;PRIVAT.. .CORPORATION Expir:etion::" 06/09/:9C..., PAD.GETT-BUILDERS,,,: ADMINISTRATOR .' .'Cotuit"MA`02635 Assessor's map and lot number ....�. ........�.....`~' Sewage Permit number ...... ` .. ................................. 7NET°� TOWN OF BARNSTABLE SS i 339SHSTADLL i MUL 9 BUILDING INSPECTOR 'FO MAY a' APPLICATION FOR PERMIT TO ...eow ,M!1�'.........,�! G,G. .... ,�/�1 :X...... ITYPE OF CONSTRUCTION'; ..5 4:�9"..:....... .I .C.!<'J�........................ .......... ................................... r........ 19.�- ............... . TO THE INSPECTOR OF BUILDINGS:` The undersigned hereby applies for. a permit according to the following.information: Locati on ........467.r....,e.: P, ••!`.. . ........... l�l., : .. .. C�(.? E�a~...Alf .... Proposed Use ......... .t ......... .. I ... ::.�f �.►rrl 6f`� !I?�S^ ................................................ Zoning District ..........OAS..................................................... District ......... ::`...............:..... ..... .......... Name of Owner £ ...... .��R j.0.0.......................Address ....... ...................... .... ..... f{/T / Name of Builder f .... ...T...N"'.....' `- ./ .:......:.Address A:V..../..�. /l� ,r ........ . .... 5. Name of Architect ress ...lel -G�° .... ....... ....^......... Number of Rooms ..<............1 ..........:.............................u;........Foundation da¢G/2v� T ..................:........... y............ Exterior .... .� .. '?`a /�'�s............ ................ .. Roofing .:....A � + g 7"..........�.f / �iLb'.5.............. Floors a. .....Interior �'�iS"dc/� b.' r ...... ...... a Heating . ..Plumbing ... Fireplace .:...........4 ...................................................Approximate—Cost ..........._.,!�Ief ..... Definitive Plan Approved by Planning Board ____ ______ ___________19________ . Area 57v. 5ee_Ax w Diagram of Lot and Building with Dimensions Fee :ar.�e....... SUBJECT TO APPROVAL OF BOARD OF HEALTH 411 { 1 °gxw hereby agree to conform to all the Rules and -Regulations of the.:Town of Barnstable re arding the above construction. ....................... - . by L. P. RITI CNB'E'.V pRFSMENT Shapiro, Fred A=55-5 18605 1 1 2 story, No ................. Permit for .................................... single family dwelling ............................................................................... Location L.Cotuit. . . ...Ba.y...Drive. . ................... ......... . ...... . . .... . .... . .... Cotuit ............................................................................... Owner Fred Shapiro .................................................................. Type of Construction ..........frame ................................ ................................................................................... .�88 V Plot ............................ Lot ... .,. ...... Permit Granted .......... August 19 19 76 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED .................................. ........................... ............................................................................... ........................................................ 1 ............). } r t ` j Approved .................. .......`..... / �.:....... 19 .................... �. ............:...I................... ..................... .. :. {/ ! .l l...........................