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HomeMy WebLinkAbout0071 WATERSHED WAY Cn r aa,5 Application numbe Date Issued............. . ... ....... ................ 27 2018 Building Inspectors Initi s... .. . ............... Map/Parcel...D....?................................................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: MAUS - INN UU STREET VILLAGE akAvr.� Phone Number SOS6 Owner's Name:- "-WA Address: S �-O l2 �1®0 ,(Ci Cell Phone Number Project cost$ Check one Residential k1 Commercial` OWNER'S AUTHORIZATION As owner of the above property I hereby authorize DL.14�- to make application for uilding ermit' cordance with 780 CNIR Owner Signature: Date: TYPE OF WORK Siding E-1 Windows(no header change)# © Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review U Roof(not applying more than I layer of shingles) r- Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name � T ' y Home Improvement Contractors Registration(if applicable)# q (attach copy) Construction Supervisor's License# I K7� _ _(attach copy) Email of Contractor6 ea!1Pkonenumber5ASCq q+U7O- ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. T for .,o►r- n nvcnvA1 RFMRF a PERMIT CAN BE ISSUED. , i APPLICATION NUMBER...............................................: *For Tents Only I ' Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X_ X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am•-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: O (J Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the To of a stab . Signature A �� Date Z. mil _ APPLICANT' NATURE Signatu • Date All permit applications are subject to a building official's approval prior to issuance: I f0/ Awaa��� Offmof and Business Regulation 10 Park Plaza- Suite 5170 .Boston, Masgadiusetts 02116 ome tmproverneOW. actor Registration I, t Type Inclividual Registration: 128957 ClAiEFEMEN" 1 Expiration: 06/13/2019 6R .� Update Address and return card. Mark reason for change. El Address n•Pne�►a1 n Eet4la�m►pnt ❑List Card__ - ry ......+,, QCRce1dVans@=wAMAm&8usirx=Reguation {, it*3ZE��SE7VENEFi CONTRACTOR Registration valid for individual use only - wNbick t I before the expiration date. If found return to: ligation Office of Consumer Affairs and Business Regulation $; 7� i>rJ13TZ019 10 Park Plaza-B stdfi;M Suite St 70 02116 8#fi NE f D_ YARMOU 7MPORT_MA Not valid without signature t k Commonwealth of Massachusetts lug Division of Professional Licensure Board of Building Regulations and Standards Constructio_43�'S!Wr Specialty . CSSL-099167 I E�fires:09/2812019 IL rA* OLIVER M KEL•LY �l ` 8 RHINE ROADr YARMOUTH PORT MA`02676 ?- f�7n 0�� C"L Commissioner . _ - - I AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) lllt.� 1 05/18/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER CONTACT NAME: Joanna Bednark DOWLING&O'NEIL INSURANCE AGENCY. ae°No E : (508)775 1620 AIX No): E�aAIL ADDRESS: jbadna*@doins.com 973IYANNOUGH RD INSURERS AFFORDING COVERAGE NAICA HYANNIS MA 02601 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURERE: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 270683 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO Jana ADDL UBR POLICY NUMBER PM/DD/YYYYI (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED— PREMISES a occurrence $ MEO EXP y one person $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JPECT LOC PRODUCTS-COMPIOP AGG $ OTHER: $ � AUTOMOBILE LIABILITY - COMBINEDS INGLE LIMIT $ Ea acddent ANY AUTO BODILY INJURY(Per person) $ ALL UTO OS AUTOSCHS SULED N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I PEATtlrE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? I N/A NIA NIA 6S62UB8H08580918 05/10/2018 05/10/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ilimore space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govflwd/workers-compensationlnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Lakeville ACCORDANCE WITH THE POLICY PROVISIONS. 346 Bedford Street AUTHORIZED REPRESENTATIVE Lakeville MA 02347 �w-E CL� Daniel M.C4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I ® DATE(MMIDDIYYYY) AC40R o CERTIFICATE OF LIABILITY INSURANCE 05/18/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). 'PRODUCER NAME:CONTACT Joanna Bednark NAME: DOWLING&O'NEIL INSURANCE AGENCY A c°NN Ext: (508)775-1620 Aa'o No Ea11AIL jbednark@doins.com ADDRESS: 9731YANNOUGH RD INSURE S AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURERS: KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURERE: YARMOUTHPORT MA 02675 INSURER F COVERAGES CERTIFICATE NUMBER: 270684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH.THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MIDDIYYYY M/OD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR PREMISES Ea oocurrance $ MED EXP one person $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 JPERCOT- LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PP�ROPEa DAMAGE $ HIREDAUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION X I siATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y r N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBERExCLUDED? NIA WA NIA 6S62UB8H08580918 05/10/2018 05/10/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,desame under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this Certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensation(nvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Falmouth ACCORDANCE WITH THE POLICY PROVISIONS. 59 Town Hall Square AUTHORIZED REPRESENTATIVE Falmouth MA 02540 �_, Daniel M.Cro ;,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r r� 1:^b�f• ur'°y ram';5�� .;r.<-�•- _3'�'V`- - - - � _ - , t. 3 i t� Ys I Mmher$ irk - Krz-1 Yx '-�.ac 9!YYbe�exi► .. Z�Ziir _$ "' 7 ❑ _ Q I0-0 Ebd&dflraea ns €aR cm - emplopee�l�o ": 13_Q� SO- ��?�Sresw+eoae� » sa�smlSraae ��Y Z rfiLLJili 3 - U,51 Z. 5 - � 20 - =.' i�� _ — _ IfZcactl�aiafi�am �a�igevfa - ai� ��s _= � � :aafime Fs Qnif OCR 2 - - .. ; �ar- IDYcw IsReaem# IL,Caw - I TOWN OF BARNSTABLE 32525 Permit No. ......:......... BUILDING DEPARTMENT I 'uan ! TOWN OFFICE BUILDING Cash •Y• HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Thomas Brackett Address Lot #18, 71 Watershed Wav Marstons Mills, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119:0 OF THE MASSACHUSETTS STATE BUILDING CODE. Februar 24 93 Building Inspector TOWN 'OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING � rua t639. HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE:. —a 93 An Occupancy Permit has been issued for the building authorized by Building Permit #......._�/...`......c�� ... . _.........._.......... ._.._...... »...... � ..._ issued to ............ .. � . 7l„ „/i y _.. ! _ iYi ...... .................................._...... ... d Please release the performance bond. SEFMC 13 31 �,AssAsol's offioe Ost floor): THE Assessor's map and lot number ... L Board of Health Ord floor): T-4LCV Sewage Permit number ......... .I ................ 1 L-* BALSSTAXLE, Engineering Department O :Ord floor) TOWN REGULA-rj OoMs' VASIL -- -�/ -* j i� 1639- House number ............................. . . ................................. 0 MA-4 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 ...........................................................Ccnstruct Dwelling................ ....... TYPE OF CONSTRUCTION .......... Wood Frame ........................................................................................................................... December 22 8,81, ............................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........Lot...#.1.8...Watershed...Way, M.a r s.t o.n.s...M i,.l..1 s............................................................................. Single Family ProposedUse ................................................................................... .......... .............................. Residential Ce ntle rVi 11b-LIO s t e r v i 11 e-M a r s t o n s Mill ........../F........................ s i t -/ Zoning District ................................. Fire Di ...... ............................................... James K. Smith Barnstable Nameof Owner ......................................................................Address .................................................................................... James K. Smith Barnstable Nameof Builder ....................................................................Address ....................................................................I............... Nameof Architect ..................................................................Address .................................................................................... Six Poured Concrete Numberof Rooms ...................................................................Foundation .............................................................................. ;" Exterior ....Cl-a-pboa.r.d...&...W...C.-S....................................Roofing ......As.p h a.l.t'!."S'hl i n g.1 P-s.................................... Floors ................Garpe-t..&...Ha-rdvood..........................Interior .......Dzy.wal.l........................................................... Heating ............Gas....Warm...Air.......................................Plumbing .....2...B.a t.h.s...........;............ ........................ .. .. .... .. . One $150 ,000 Fireplace ..................................................................................Approximate Cost .......................... ........................ Definitive Plan Approved by Planning Board -------- Y--------19 Area 2800. . ....S.q......F.t................ Diagram of Lot and Building with Dimensions Fee ... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH A� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above- construction. Name . .......... Construction Supervisor's License ...... k'No ..32525 Perm r it -fo .......One Story J7 Single Family Dwelling Location 71 Watershed Way ............. .Marstons Mills ....................................................... .................... Owner Jame s...K....Smi th............................. .�, Type of Construction ...F.IZdIlle.......................... ............................................................................... Plot ... ........................ Lot ................................ Permit.Granted De _Date:of Inspection ............./......................:..19- Date Completed :,f�:.�...........19 96r � R { I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�'J LI DATA I� TOWN 0 B.-0 o TABLE, MASSACHUSETTS G DATE ill i.`". ;t.U,. . ?3 1'' �'��TO _ .. , .. 19 PERMIT NO.APPLICANT j,?mc!! K. Smith •T. . 3�2525 .:;,.:: s: ADDRESS J:;a.1 '1�>>'+.:--ablL - . (NO.) (STREET) ICONTR'S UCFNSEj, PERMIT TO U.�1.� .:.'I �.)'rJt_'1_a.C1C( '� ' If STORY I'-I �'•.!::1.: .�': I�bJ(:}l:..11� NUMBER OF (TYPE Of IMPROVEMENT) NO. DWELLING UNIT (PROPOSED USE) S- AT (LOCATION) :r 4v'.i.._ _F�•':i:: .. .-.::t:"• .._-.- .1:7 ZONING (No.) (STREETI DISTRICT_f�!*� BETWEEN . (CROSS STREET) AND—_ (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT, IN HEIGHT AND SHALL CONFORM'IN'.CONS.TRUC7ION. 70 TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: •. (,1 1�. �'; -- �/ (TYPE) - I TAREA E 'Bond ' ' VOLUME ::.(i Ij ) ;< I (CUBIC/50 uaRE FEET) ESTIMATED COST ,L50 f l)fIQ � QU PERMIT "•`' FEE OWNER ADDRESS BUILDING DEPT. BY j -`'�FR`OTfi'}'Iq'E•-o'E'v'a aTTA't:-Nr-VE..NbTi`cYt•74vXrkS:'.. OF ANY APPLICABLE SUBDIVISION RESTRICTIONS Ata'L•e-'ty r"I°nt5-rciti:Fi-r=tiygL',; ��.�.y_.;�;.cY .' . 'ti"•*• •-•�•*.•':.«iG1L' :__- = ;;::5;• �r,"y"�%�':y'`^ NIM A OF THREE CAL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB ANO THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. PLUMBING AND 2. PRIOR (READY COVERING STRUCTURAL QUIREDSUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBETORS TO LATH). , 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET ' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 U i9 / wV C• v/AL G C✓G 1 2 2 M-� ��JlLLC7l•�C� --ti. `— 2 — 3 / HEATING INSPECTION�/APPROVALS, ENGINEERING DEPARTMENT OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT w! TOR HAS APPROVED THE vAR1000S Sra(ES OF WORK IS NOT $ARL BE OTEDME ywITHINULL NSDI;vMONTHS OF OID IF DATETHE TOR HAS PPP - INSPECTIONS INDICATED ON THIS CARD CAN BE PERMIT ;S ISSUED AS NOTED ABOVE ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. 77; � , .... Le- OF r RICHARD ' eAXTER d - NO.24o4s ISTER�,JQ� LAU CEeT/.c/EO G,LOT Ol�4�C/ p C.4 T/O/(/ ZDATE 7'�.�/E� SETBA CSC :000'A T,E'l� lyiTy/�c/ TyE 41 OAT, : BA X T.E,2 ,VYE ,4�f/ .2EG/STE�2E0 L4��p SU.el�c' M.4Ss. U-SEp 741 .4G.�,L/CAIV7- r h, �°P D. i r 1 PT �.8. - 6(,3 exf, Gz,-1 \ 62.G 4pc=.N SFA cz- 1 ' LEI Fy TWAT PovNp„T'loa l.;.. !igoLV14 14i. hI� G ►M Lys wl?W tNt's . ! 1 - •'SI�IrLItJ13. y', SE'T►3AGiL � . . ...� fLt3 v 1 I'Lc3�H.�FJ•1rS'.vF ' . , lr Tv�V�J or-" -•A Jf, , Is :.Na- Ln`�-A r"'rO w 1 14 a P,..a ;N os ;�• a„ r L3 f�- .�slt � �-,F has ` S u . \�? n lug Pv c o: a ! !el 60.E lull� (,O•t, CO IIJv �000 � �l/ S�� 1':!;. ')'•! L; G, L �¢'�AIL 3•S ` ,.t:��a�,, '•"j�J..;�> TALC- .WMr~46D '-�.\'. .'c•ti� :a • e �0 0.• PCl'- OIL PacFLs Prz'oPosGi> a c.V A. no Sc 4 le EL= 50 BAXTE N4 24046 �DE<�l bh1 'D,4Z',� • SIU&U-3 FAAn1 .-Y _ 3 =a,z�,�R FLOT ?LA- 14 01= LnN� Igo: T,)SPOSAL R-Ow- 3 x i i o = 3 3 o 6,PD AuSTcl i•15 . M ILLS - /Vl ASS-, ISO 7 TAurL- VS�. lovo l JAMES 4 , SM!.T-1-4 SPOSAL 'Pry'•- v�� 'I '�' ' . �I I VATS', �s • . : •; SI't��w� ,4R13.A = ► 8g s1' N rs I LlG -13 rrrnW AaaAz -� t3 s r- Rr-��sT b L- sfj.l�) 5urzva-10" D -7(3 G E'D GI�/ (;., ' l=�lo I JJJZ y d.e T-a VI tom,(414= 5 46 �.Pp Maw T10 4 `2ATW 1�I►� 2 X411, .OfL L,--S S �T. r. ... Rer- P'8• 17-4 /as Town of Barnstable *Permit# Expires 6 m' e die Regulatory Services Fee • aARxsrARM • t""m Thomas F.Geiler,Director 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 PERAHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address l Wt4 C�A2 S WD Lj 2LIf U✓1d,2q�YI_ PA, I fVl�} [Residential Value of Work 4000•0-0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address DAv t 1 lh-ME5 A O a-�A g,, Contractor's Name :!?Rlc- L DC ,0,-U l S Telephone Number 7-7 L 23 9 -Z 9 19 Home Improvement Contractor License#(if applicable) i 5 4 3 4 j Construction Supervisor's License#(if applicable) G S 76 3q J ❑Workman's Compensation Insurance Check one: ^� ,,.• r=, dam a sole proprietor r. S MIT ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance O C j 11 2011 Insurance Company Name TOWN OF BAIPNSTABLL 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 rho 1'1L�dA1es A #of doors -eplacement Windows/doors/sliders.U-Value o� 3 (maximum.35)#of windows •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. SIGNATURE�vk,,— Lowt�� C:\Users\decollik\AppData\Local\Microsoft\Wmdows\Temporary Internet Files\ContentOudook\DDV87AAZ\MTRESS.doc Revised 072110 ✓.__. -----~--0O - - �lu,,:tchusctts- Dcl►ai�mcnt nl'Public Safe"� Office�l"Ooumer errs u ;n oa 4 Board of Building`Rc��ulationsLind Standar(Is = HOME IMPROVEMENT CONTRACTOR _ Construction Superv;sor Registration• ,..154345 Tom' License: CS 76391 Expiration: ,?J28T?013 Individual ?, { p` - =` DALE C DAVIES =, t : 23 NEWTOWN ROAD DALE DAVIES SANDWICH, MA 02563 'vim T 23 NEWTOWN RDs` ��-�— SANDWICH.MA 02563,' 'I Undersecretary i Expiration: 323/2013 Tr#: 13915 . ('unimi.�iuncr - / License or registration valid for individul use only Failure to possess a current edition of the before the expiration date. If found return to:Regulation Massachusetts State'BuLding Code Office of Consumer Affairs and Business tense for revocation of this license. 10 Park Plaza-Suite 5170 is Boston,MA 02116 Refer to: V WW.Mass.Gov/DPS s. Not valid without signature s T'Ine Commonwealth of Massadiuseffs Deparfitent of Industrial Accidents RiBrce of Iivestigations 600 Washington Street Boston,MA 02111 tvrvn.nnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Plumbers Applicant Information Please Print Legibly Name(Bvsinesvoiganimtion/Individual): I, G .7�l,4-V 1 Address: Z 3 nl ew 7� w ti h-Q Ah a(,JL t G ff City/StateJZip: 14 ,4 o 2S'Z 3 Phone#: 7-77 - Z 3 9 - 2,0 / Are you an employer?Check the appropriate boa: Typeof project' r am a general contractor and I p (required): . L❑ I am a employer with 4. ❑ I l; 6. ❑New construction loyees(full andlor part-time).' have hived the sub-contractors 2. 00"lam a sole proprietor or partner- listed on the attached sheet 7. BRemodeling ship and have no employees These sub-contractor have g- ❑Demolition w for me in capacity. employees and have workers' working any ap h'- 2 9. ❑Building addition [No workers'comp.insurance comp-insurance. required.) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions exemption m}��elf.[No workers right of exemp comp. per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required] •Any apphc=that checks box#1 mast aL=o M out the section balm showing the?workers'compmsationpohcy mforommioa. Homeowners who submit this affidavit mditath<g they are doing all work and rhea hire outab comzacmrs must submit a new aff datit m&catin.-such :Comracmr.that check this boa imv-t attacked an additional sheet dwniae the name of the sub-coaVactors and state whethez or cot those entices have employees. U the sub-comrattors hate employees,they nmst provide their workers'comp policy auaaber. I am an employer titat is prodding tr orkers'eonrpensatioe insurance for u{y employees. Belot,is the policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby certi ,raider thepahes and penalties of perjury that tire information provided abo,e is true and correct Si titreUtG-L G - Date: b l/ / Puree#- 7-7q- Z 3 0 Official rue only. Do not write in this area,to be completed by c io,or town official City or Town: Permit/License# Issuing Authority(circle.one): 1.Board of Health 2.Building Department 3.City/Iown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 ■AIU MA]" 3 9. Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 j Property Owner Must Complete and Sign This Section If Using A Builder I, HE 4CSf} kL._A 4 dD ,as Owner of the subject property hereby authorize A�N GR U I t S to act on my behalf, in all matters relative to work authorized by this building permit application for: i (Address of Job) Signature of Owner ate ��ir SSA d RLANbo Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Miaosoft\Windows\Temporary Intemet Files\Content.CnNook\DDV87AAZ\E3(PRESS.doc Revised 072110