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0475 WHISTLEBERRY DRIVE
4'15 Whtstieberr�JT)r . � r Town of Barnstable �Ab " Building _ _. . .. _ g 'n uxxsrsea� ; ;Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept v MAM g° ;Posted'Until Final Inspection Has Been Made. ; Permit 1639. 0 m raa' &here a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-4226 Applicant Name: RetroFit Insulation Approvals Date Issued: 12/23/2019 Current Use: Structure Permit Type: Building- Insulation-Residential Expiration Date: 06/23/2020 Foundation: Location: 475 WHISTLEBERRY DRIVE, MARSTONS MILLS Map/Lot: 061-039 Zoning District: RF Sheathing: Owner on Record: LLOYD, BOARDMAN TR Contractor Name: RETROFIT INSULATION INC. Framing: 1 Address: 210 ALLANDALE ROAD APT 3A Contractor License: 160461 2 CHESTNUT HILL, MA 02467 Est. Project Cost: $5,323.00 Chimney: Description: 10" layer Cellulose Open Attic,Attic Damming, Install Therm-a- Permit Fee: $85.00 dome, Propa Vents, Install insulated hose and roof mounted vent to Insulation: Fee Paid: $85.00 bath fan, Install R-19 unfaced fiberglass to kneewall slope,Air Sealing, Install 2" rigid board to common wall area Date: 12/23/2019 Final: Project Review Req: Ubo�9 Plumbing/Gas Rough Plumbing: <<_Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 Final Gas: work until the completion of the same. ; r Electrical r The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this.permit. Minimum of Five Call Inspections Required for All Construction Work:` ' Service: 1.Foundation or Footing '� 2.Sheathing Inspection J Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 7/17 St-rc vl f f T — i AID 6Pe —r#7-V RED /vo re'f/N1� 0,VU.URf- 5b4c)IAldr � � n AER Tiff i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application 0 ')ZOO _ Health bivision Date Issued 45 I Li1 Conservation Division Application Fee Planning Dept. Permit Feei (. Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Z415 i-r+Sa-E gelwy ' 'DX. Village N4A(Z-S7nNs dviL(�S Owner ht 4 N,_S 3od&z sKAn� I c nY; Address Sn,6 Telephone -7 I� Permit Request Rif:-FuILD 2U-c•• a F 7 T DD Th c--icy Dak 14-bb kPL-A o off. l-?XA-r" A6tk. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 466 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ?I Two Family 0 Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes F No On Old King's Highway: ❑Yes ❑ No Basement Type: ` J Full 0 Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.). 0.� 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 I 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: 0 existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 Commercial 0 Yes ❑ No If yes, site plan review # Current Use Proposed Use I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 7 NOnn C.6EI(5� LC441C-f4ky ONc.c.+A I�Z� aK. Telephone Number CPOyak — ya/oZ Address P-6_ Qoie S-78 License# SL7 I oZ �� • t3RRc� C: , ejda 0 dGCB Home Improvement Contractor# Worker's Compensation # 7 ?7UB b i CoO N 616 l b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO to E2ftKo5-,?&C- — CIL SIGNATURE DATE old/D FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER B DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL N2 PLUMBING: ROUGH FINAL - o f . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN'NO. r Town of Barnstable Regulatory Seryice-S fszAsr� Thomas F. Geiler,Director 16)�91 �,� BuHding Division - Thomas ferry, CBO, Building Coxumissioner 200 Maim Street, Hy�s,MA-02601 , www.town.barrutable.�na.us Fax: 508-790-6230 'Office( 508-862-4038 PLAN REVEEW Ma /pel. d b D� Owner: °P — parc pro"ect Address /1l j1GE �� � Builder: The following items were noted:on reviewing: / f Cm UCc . zAa 02 Ile x R A h? e: y: Revi Date: / /O The Commonwealth ofmilssachusetts Deparfinenl of lndustrid Accidents Office of Itt vesfigation5 600 YYashineon Street 13osfo�x, hIA 02111 www,m ass.gov/dia Workers' Compensation lusarance Aftdavit: Builders/Contractors/FIectrieians/Plunibers Applicant Informatioli Please Print Leffibly Name (Business/orkanization/individual): [�' I}Act5n1fKi i)A/uftl 1Deb Syr.— ' Address: . City/state/Zip: Phone.#: Areou an employer? Check the appropriate box; Type of project(required): _�,— 4• ❑ 1 am a general contractor and 1 6 El co.nslruction I am a crnploycr with . have lured the stlb-contractors employees (full and/or part-time)•* Listed on the attached sheet 7. ❑Remodeling 2.❑ I am a•sole proprietor or partner- These sub-contractors have ship and bavc no employees S. ❑ Demolition employees and bave workers' Building addition working for me in any capacity, # 9• ❑ g • o workers' co insurance comp• insurance. >� 5, �] We are a corporation and its 10.❑•Elcctried!repairs or additions- required.] 3•❑ lam 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 incnrancc required.] c, 152, §1(4), and we have no employees. [No workers' 13NOther J QAcomp• insurance required.] ' *Any applicant that chce)a box#1 rnust also fiD out the section below showing their workers' compcnsa4w policy information. t Homeowncrt who subrvit this affidavit indicating tbry arc doing all work and thcn hire outside contractors must submit a new affidavit indicating such. tContiactors that check this box mustattachcd an additional sheet showing the nano of the sub-contrartnrs and state whether or not those entitirs have cmploycm if the sub-contractors have employcee,they must providb their workers'comp.policy number. ram cui employer that is providing workers'compensalton iresuraxce for my employees BelatV is the policy and jab site ' information. Insurance Company Name: Policy 4 or Self-ins. Lic. #: �,7'U Q (� / IU6 �/<� Expiration Date: / Job Site A-ddress: L/2J" City/Statc/Zip: �JMlus;tii4 Attach a copy of the workers' compensa(ior, policy declaration page (show-Log;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 find rip to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tint of up to S250,00 a day against the violator. Be advised that a copy-of this statzmerit may be forwarded to the Ofcc of fnvesti atious of the bL, for insurance coverage verification_ X do hereby certify under the pains•and penalties bf p erjury that the information provided above is true and col rest Date: Si a.tare: Phone 6 Official use only. Do not write in this area, fb be completed by city or town offtclaL City or.Town: Permit/License 4 Issuing Authority (circle one); 1• Board of Health 2• Building Department 3. City/Town Clerk 4. Electrical Inspector S, Plumbing Inspector 6. Other rue Ions Information and Inst ' thcir.c ation. � Massachusetts Gcneral Laws chapter 152 requucs all emplo ersonotn the�Crvzcc Pro yj workers' ot:b r ndcaay contract of hdir,s: Pursuant to this statutc,.an erripLoyee is dc fin ed as ...every p express or implied, oral or written arhicrshi association, corporation or otbcr legal entity, or any two or�more An employer is dcfimd as "an individual,p P of the foregoing engaged in a joint enterprise, and including the legal representatives of a deeeaslod cCs 1Howcvcr the roceivez or tmsteo of an individual, partnership, association or other legal entity, employing Y 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 rna be a�cc/of such emplotruction or 1-cpair work on such ymeut be deemed to be an emplloyer..dwolling " or on the groumds or building appurte-pant thereto shall no MGL chapter 152, §25C(t7 also states that"every state or local licensing agency shall),dthhold the issuance or renewal of a license or permit to operate a business or to construct nil ngshe lin then emco eraga required." dfor y applicant who has notproduced•acceptable evidence of comp Additionally,MGL ohaptcr B2, §25C(7)states 'Neither the c�omrnonWblctcvidc norncc of complizny of its ee adth.the linsura cc enter.into any contractor,the performance of public work P tracting authority. ' requirements of this chapter have been presented to the con Applicants. Please fill out the workers' compensation affrdavit completely,by chcc�ng the boxes &t;apply to your situation and, if . Of necessary, supply sub-contractors) namc(s), addresses) a d�brli e numb along artnerships(LIP)v�rx their employe ss other than the insurance, Limited Liability Companies(LLC) or Limit tY mombers orpaxiners, arc notxcquircd to carry workers' compensalion?nsuzancc• If an LLC or LLP does have employees, a policy is required. Bc advised that this affidavit may be submittt d to the theDaffidaYi cnt of e�dac-should Accidents for confirmation of insurance coverage. Also be sure to sign an too returned to the city or town that thc'application for.the permit or license is too magrrequested, requirede to obtain aewor�kocs' of Indus trial Accidents. Should you hay any questions regarding the law or if y compensation polrcy,please call the Department at the number listed below. Self insured comq�anies should enter their self-insuranro license number on the a ropziatc line- City or ToWP Ofticlnls the bottom. Please be sure that the affidavit is'connplctc and printed legibly. The.Department has provided aspic the applicant of tho affidavit for you to fill out in the event the Ofdiec of investigatiordi ns has to contact you g tion, an applicant Plcaso be sure to fill in the permiVbccnsc number whichll been cdars need conly submircncc tonp affidaer. in vit indicating current that must submit multiple permit/4ccnsc apphcauons'n y g� Y policy infbrmation(if Accessary) and under'Job Site Address" the applicant should write"all locations ri vidcd to the or town)."A cbpy of the afldavit that has been officially stamped or maxkcd by the city or town may . P applicant as prooEd at a valid affidavit is on file for future o�zm°t R t related to any business or es. A now affe Ucd out cach idavit-must commercial YcntuTe year.-Whero a home owncr or citizen is obtaining a licensep. ffidavit (i.e. a dog license ox•permit to bum leaves &C.) said person is NOT required to complete this a operation and should you havc any questions, Tho Office of Investigations would hlcc to thank you in advance for your co please do not heSitatO to give us a call Tbc Department's address, telephone-and fax number: Vitt CommonwWth of Massnhusert D,,P rZ fn -nt Of Xndu trial Accidents Office of utvestipfl.ous 600 Washa-n Qn Stz�et Boston, MA 02111 Tel; # 617-727-490.0 ext a06 Qr 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.masS-gov/dia '= N111SU'IILISCUS- DclruKmcnt of Public SafctN Board of Building Regulations and Standards Construction Supervisor License License: CS 57122 Restricted to: 00 THOMAS S COHEN 50 PLUM ST W BARNSTABLE, MA 02668 Expiration: 6/12/2011 ('onuuissiuniy. Tr#: 16787 1 Jo;ejtslulwpd N i-9-EF- V '318t/1SNbVg`M _ aanleu�is;noyll H 6118A IO ... _ �� 1S Wf1-id 09 N3HO0 SVV4OHl 0N1 O311WI1Nf1 QJiN3dbV0 uopejodjoO aje/Aigd _ 'uo;sob �------`---:-a. 801zo-uw 8609LZ #�l OLOZ/0Z/OL uollejIdx3 10£I 1l aae au r to Id uol�ngysd O £9£OLL .uol;ealsl6aa spaepuelS pue suolleln2a�H$ulpling}o pjeo9 :ol ujnlaa puno}}1 alup uolle+idxa ayl aao}aq N0I0 NiNQ3.LN3W3AONdW1 3WOH fluo ass lnpinipui uo}piles uo.18:1Is!2aa ao asuaa±'1 /��4"u � e e L_ MAY-03-2010 11:53AM FROM-HARRIS AND LLOYD INC +617-499-6700 T-657 P.001 F-781 7 yoFjHerq� Town of Barnstable 8rt1ZNSTAB�, Regulatory Services • � y -KAU � Thornes F. GePer, Director e �rF btiv��� BUllding Division Tom Perry', Building Commissioner 200 Main Strcct, Ryannis, VA 02601 wwW.town.6�rns`a ble.mn.�s Offioc: 50.8-862-403 8 Fax: 508-790-62: Property Owner Must CGMPIete 'atid Sign This Section EL Using A. Builder T, r n1 i,�U`/1 , as Owner of the 5114:(;G psope.rt-)► hereby autbobzt j +OMiS to act on ry St in all rnattcrs rektive to work authorized by this building perruit application for. t _ (Address of Job) Signature of Owner Date c fi`rz o�.v4+v L L c,`1 c4. Print Name If Property Owner is applyiug•forpc:mitplcasc complete the Hameow'ncm Liters: Exemption Po.aai on tic reverse side. L•d OES)ESS905 AUG-14-2007 02:40PM FROM-HARRIS AND LLOYD INC +617-469-6700 T-612 P.002 F-951 i I I 04/16/2807 15:44 6084205553 YAWM SJNSY PAGE $3/03 MO h?TG AG.E IN'SPHCT TIO N RLAN APPLICANT: BOARDMAN LLOYD TRUST TOWN: MARSTONS MILLS ' LOT 48 r 259 89' O GOT 50 AMALr f� eRrvrcb ,p °moo o � y Op. FLOOD PANEL: 250001 0015 C FLOOD ZONE:"C" DATE MAP REVISED: 08/19/85 t lemal,Rain t11AT T r.wale,=msmam"".w 0Ia fw&#Am'" OATE: 04/16/07 SCALE: 1' - 50' STEvEN A PIZZU11, ESQUIRE DEED REF 10095-184 PLAN REF: 349-58 w[4ttCA11W Of Ila aALLl71G yepT;coif rOT rAu Mtgr >r< T100I PAAum Ina. �I T+TTo wfncc"4' df o,tuwe.rMr.Yty m ea�wvM m nn�aOK 70M•.ti ITMIp N UReI A6 iliu n,l.011M eM m.0'eAaE vdKcaW Pui"ARc�x,Ka aT TAP[IIMK Af M,1►C a►EYCIMICDOH WIN rcf4•feT•0 n0A ZWTK OND-P AL:OVA=Ita"CE"s OMIT,MO W[tlUgrt rjwv WS mWamuo sw Ioil-1.9awo 12 lug TL =Ii p[►WT farm mRAnuk r.•RMTlrVIT Atm U106I"�Pt.U005 Otwics 40. An w[u�YtNt el 1•s I[OZdAT fm rrim pa!"mi p OF 01 .UC394 MJLONG•4tro nrief"O "VrA nR A[v111T r NL IYO.iI,�ittt Or rAr AW IX[401 ICNIi.V=ffATOr.94 ,[ItMP M1 H,R0119/'�'allT ltM� �[d H.a KA 1AsM9 L.'a 4ti 1-mE II,N0 re r[r.T.COaO.f AMA DRR[f�All.R NOl O0WfN1 nW�A A ftm*Q 91"W bw YIM1C=w3meAOr. ��Me ft0�Am Yit TELEPHONE: .508--4213-0055 YANKEE LAAND. SURYEY COMPANY, INC FAX; -508-420-5553 40 industryRood MOrstons Mills. MA 02648 ponkeesurvey0comccBj.net www.yonlceesvrv0Y.ciDM. 38928• JF_ Q � . -tST►r�1� ZL� �C. G� ST r vL • � -fuJr� �ooe, i o r _0 CU< APOJG . './Ubs 6r-s;niw of r SST 1 I Z ` l �l=tX��1�lc�T ` Ss1M.G G,$(!�a�� 4 CL'DAL �1,A-Tf.rk r^lC r`i r ram! DUk AD D r i 1t�I�J �CZ �L(svc�F `7S �vN iS iZ.�SC�ar12 Y�<L. r, n 4ub -TU 5(AUC J s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application 6F,4S r ( J Health Division Date Issued i l O Conservation Division Application Feetoo .� Planning Dept. Permit Fee 5 ` Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis 7�V Project Street Address ILI WTI 14- Village h1 J�dfs Owner Lio)4 , Address Telephone 101- Sf-I �( Permit Request fiG CG 7, C��ZNMsyS C{q y' F/le j WW& UJ m Square f : 1 st Joor: exi ting proposed 2nd floor: existing proposed Total new a Zoning District - Flood Plain Groundwater Overlay Project Va u tioq� � Construction Type Lot Size �E Grandfathered: ❑Yes 0 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 A; Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑ No Detached garage: 0 existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: 0 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) Name .2EIt QI Telephone Number Sa-fi -S' 6 Address �� `1`1� �SI ��1 �1� �� � License # �'T� Home Improvement Contractor# 1166 Worker's Compensation # LWW7111 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �u SIGNATURE `�C DATE io Z7-<l a� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ,4 ADDRESS VILLAGE OWNER ;4 n DATE OF INSPECTION: , FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL `' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' i' DATE'CLOSED,OUT ' ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I' 600 Washington Street ' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: fhb City/State/Zip: h I h64li e Phone #: Are ou 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. ❑ New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.# 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 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' 13.0 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. tContractors 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. 1 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 certify de�th7dpenalties of perjury that the information provided above is true and correct. Signature: Date: Z7— Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL 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#: a 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 pen-nit 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 burn 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 Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia . iNiwisachusetts- Department of Public Safety 11 Board of Buildim-z Re--mlations and Standards `• Construction Supervisor Specialty License License: CS SL 59847 Restricted to: 1A STEVEN L KADY PO BOX 493 FALMOUTH, MA 02541 _ Expiration: 10/3/2010 ('uouvi>.inncr Tr,-: 4392 I Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 126014 Type: Individual Expiration: 4/8/2010 T 265049 STEVEN KADY STEVEN KADY - PO BOX 493 FALMOUTH, MA 02541 Update Address and return card.lYlark reason for change PS-CAt 0 50M-07/07-PC8490 Address Renewal Ej Employment 'Lost Card 10/ 27/0,9 3 : 52 : 44 PM 4136 ® 03/03 ,aco CERTIFICATE OF LIABILITY INSURANCE °A 10/27/27°/200200 9 PRODUCER (508)540-2400 FAX: (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 550 MacArthur Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Arbella Protection Insurance 41360 Steve Kady Masonry, DBA: Steven Kady & Son INSURER B:Travelers Indemnity Company 25658 P. O. BOX 493 INSURERC: INSURER D: Falmout MA 02541-0493 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW(THSTAN DING 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NS PE 0 INSURANCE DATE MM/DD/YYYY DATE MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1' 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS MADE ❑X OCCUR 8500028586 8/14/2009 8/14/2010 MEDEXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY JE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ , ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION Vvt;STATULIM - OTH- AND EMPLOYERS'LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) 6KUB931X732109 8/29/2009 8/29/2010- E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town o£ Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 Main Street .NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE S Harrington, CIC/SMH a' �O'`r- �lctJZr�Lvlq t ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD 4041 v OCT-27-2009 . 01 :34PM FROM-HARRIS AND LLOYD INC +617-489-6700 T-497 P-001 F-426 o�VEr Tawn of Barnstaple Regulatory Services Thomas F Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Strort,Hyannis,MA 02601 �YWW.town_barnstaDle,rn8,us - Office: 508-962-4038 Pax: SOS-790-6231 Property Owaiet Must Complete and Sign This Section if Using A Builder T, as Owner of the su*cgraperty .. hereby authorize c v Ca to act Oa my bA_if, in all matters relative to work authorized by this building perms application for. 1 � (Address DfJOIJ /vli l�r Signature of Owner Date dq R J) M, Print c If Property Owner is applying for permit please complete the fi1�e re Homeowners License Exemption Form on vet3e ssde. o yJ .� 7) -3o o . a . N O O Ilk o . w a o l r-1 op O o - 0 M o 0 31 t;, 30il /#& t-24 27 ;' ; j'- HWFE {��� CR• ate "': i Ex 41 - a - N R`-5=STE mi, °S B2. S S C3 OR P r D 9 F330 F330 r �1 ti oo 97 • ;' z U128412L or�•ti•-L/ S�•o,rro�r. a • a N M 00 O E �08 a8o - YZL3 ' R { 'Al R 4 0'7 Pt r� t . p l �C��L�%�IV W t-� `� � -t- t.S Us�� s ��a�S AUG-27-2007 05:14PM FROM-HARRIS AND LLOYD INC +617-489-6700 T-627 P.004 F-018 August 28,2007 Town of Barnstable Building Division 200 Main Street, Hyannis, MA 02601 Attn: Tom PeM and Bob McKechnie RE: 475 Whistleberry Drive Dear Messrs. Perry and McKechnie, I am the owner of the house located at 475 Whistleberry Drive in Marstons Mills. I have applied for a permit to finish the space over the garage which is attached to the house. I have employed Tom Cohen,at Carpenrty Unlimited,to do the renovation work. In regards to the kitchen area and its use,this is to confirm that our intended use of the finished space is for family purposes only. Please let me, or Torn Cohen, know if there is anything else that you need. Thank you for your assistance. Sincerely yours, Boardman Lloyd I I AUG-2972O07 04:06PM FROM-HARRIS AND LLOYD INC +617-489-6700 T-628 P.002 F-029 j,OL 'Town of Barnstable ��,� 2�01 �1JG 30 . A� I.. 48 s, Regulatory Services ears. : Thomas F.Geller,Director �e?p' Building Division a _ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 WWW.town.ba rnsta ble.ma.us Office: 508.8624038 lrax: S08-790-6230 FIOMEOWN'elt LICENSE EXEMPTION q please Print DATE: ;-( 9;09 7 19 103 LOCATIorl:4 Y7 S' W k srfle 6et'rN �!�Ri r< , N4et�i nar l ;&, number♦rzdr ` C��,p*� Street village "HOMEOWNER"- o l J _�IZ��-.�3/2 617- ?_Y 73oe name ^ home phone work phone 9 CURRENT MAYLA10 ADDRESS: 2 Sf 'T •wT MA cityltown state zip code The current exemption fpr' eowne "v4s extended to include gvmcr-accerpied dwellings of six units or less and to allow homeowners to ongage an individual for hire who dots not possess a license,provided that owner AMS as suta�sor. DEFCYMON OF FIOMEOwNElt 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 hr/s a shall be responsible fjor all such work oerfnrmed under the building;aamit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. I The undersigned"homeowner"cerdfles That he/she understands the Town of.Barnstable,Building Department minimum inspeorlon procedures and requirements and rhathe/she will comply with said proeedturs and requirements, Signaturte of Homeowner r " Approval of Building Official Note: Three hrrilly dwellings com'ainlag 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. KOM OWNMIS EXEMPTION The Code states dt9G "Any homeowner performing work forwhlch a building permit is required sball be cxanpt fgom the provisions of this suction(Section 109.t.1-Licensing ofconstruotion Supervisors);provided that if the.homaowncrcngaees a pason(s)for bir+e to do such work,that such Homeowner shall got u supervisor." Many homcowncrt who tee rhis aceraptiom 810 unaware that thry are assuming the responsnibtlirics of a supcMser(tee Append-cr iZ Ruleslk Regulations fhr Licensing,Consauetion Supervisors,Sccdon 2.IS) This lack of awareness often nzults in serious problems psttsalufy when the homeowner hires unlicensed ptmunL In this case,our Boatel snot proceed against the ualfamsa person.as it mould%ft a housed Supervisor. The homeowner noting as Supervisor is ultimately responm'ble. To ensure that the homeowner is fhlly awue of his/her responfibilhies,many communidcs require,as pan of the permit application, that rho hanicowncr cemr duet hdshc understands the responsibilities of a Superviaor. On the last page ofthis issue is a term currently used by several towns„ You may cant t amend and adapt such a fbrmkenificarion fhr use in your aommuaiw. Z00 'a 6168iL5LOLl Xdi 90 HIM 3eizdd0lUi U 6�:0 ,aUG-20-407 04:06PM FROM-HARRIS AND LLOYD INC +617-489-6700 T-628 P.001 F-029 COVER FAX 2 Brighton Street Belmont, MA 02.478 PHONE: (617) 489-7300 ,1 FAX- (617) 489-6700 TO:. sod ' oL 1 N Tr V i1/ oti► FAX #: •<pS-o da i FROM: pOw.�'� L• w - DATE: PAGES: INCLUDING COVER SHE ,OODZ c. m 4L SA TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma l!G I Parcel Application# �0 Health Division Date Issued a J C�1 Conservation Division Application Fee , Tax Collector .Permit Fee (ft> l . � Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis Project Street Address q7,T Village Y �s Owner Address Telephone( 1 '10/• 5_41q Permit Request tit!, 2666 ;(�✓& d� .v�i GQ.iciT �S �Z.�C�i�. • Square feet: 1 st floor:existing proposed t 2nd,floor:existing proposed Tota new oOD Zoning District Flood Plain Groundwater Overlay � � Project Valuation �v Construction Type g U, _ cn Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting d�)cument7 lot n. N co DMh ling Type: Single Family Two Family ❑ Multi-Family(#units) F Age of Existing Structure Historic House: ❑Yes 4 No On Old King's Highway: ❑Yes ❑ No Basement Type: XFull ❑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: ❑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 0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDE71ephone TION Name v< Number Address License# MQLS,+Vy's� k22�t VY)-4 Lf Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# : DATE ISSUED ` MAP/PARCEL N0. ADDRESS VILLAGE Elite" OWNER DATE OF INSPECTION: FOUNDATION FRAME jeM SG 9 !o o !fq $,AA t>F _ Su.uaQ-� �lusw►� _ __ INSULATION 9Mr ��R/X�.� w�,u•�? s 7�u�lt�,y. r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL a GAS: ROUGH FINAL z .,e FINAL BUILDING hy, p K 11 DATE CLOSED OUT' ASSOCIATION PLAN-NO. °FTME,, Town-of Barnstable Regulatory Services 9s ! � Thomas F.Geiler,Director i6 Building Division prED MP'�a b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, •improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: D•1�lz Estimated Cost 3 f�v t / ,Address of Work: +7 HS Owner's Name: ✓ k. Date of Application: Sf I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,Q00 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 MROVEMENT 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: Da a Contractor Name Registration No. Date Owner's Name << Q*nTshcmeLffidav ne Commonwealth ofMassaehusetts Department oflndustrial Adeidents Office of Invatigations _ 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers?Compensation 14surance.Affidavit: Builders/Contractors/Electricians/Plumber s AM311caut Information Please Print Legibly Name (Business/Orgauization/Individual):- r Address: 7 ,(�✓. City/State/Zip: Ma4S fkn s Mi (S' hl lot Phone.#: a CK)I Are you an employer? Check the appropriate b z: -Type of io ect re 1.❑• I am a employer with general contractor and I employees(fall and/orpart,time).* bavahared the sub-coutractozs 6• ❑New construction 2.❑ I am a-sole proprietor or partner- listed on the-trtmched sheet; 7, ❑Remodeling ship sad have no employees These sub-comractors bava 8. Demolition worldng for sae in say capacity. employees and have wozk=, [No workers' camp.;*+S+,*a*ee comp.insurance. t• 9. Building addition required.] 5. [] We are a corporation earl its 10.❑Eleetdcal-repairs or additions -3.❑ I am a homeowner doing all work officers have e=ciseA their 11. Plmnbin r noyself [No workers'cam• right df exemption per MGY, � g ��or additions 12.❑Roof repass insurance required,]t C. 152, §1(4),and we have no P-Mployeea. [No w033=' .•13.❑ Othcr comp.insurance required_] 'Any applic=t drat cheeks box#1 must also fll out the section below showing then workers'cousp=zRdon polity oP_ t Homevwnas who submit this affidavit indirmfing they are doing ay work and then him outside comtrecss tmst subnut a yew affidavit indicating such. rCom=ctnra&rat cheek this box must attached an additional sheet showing the name ofthe subtontraetors and state whether or notthose cmdties have employees. if the subcontractors Rave enpioyas,they mntat providt 8tea work=,comp.pobeynmamber. ram an employer that Is providing workers'compensation insurance for my employees ,Below fsthe polity and fob site informadon- Insurance Company Name: Policy#or Self-ms.Lic.#: Expiration Date: Job Site Address: City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(shov!iag the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL r 152 can lead to the position of c=bmmzl penalties of a fine iip to$1,500.00 and/or one-year imprisonme4 as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against*violator. Be advised that a copy of this stattm eetit maybe forwarded to the Office of Imrestieations of the bLk for insurance coverage verification. I do hereby certify ruder the pains. al of perjury that Ike in.fbrrnaiion provided abovq is true and correct Signature: XDate: 20 VI , a 7 . Phou�#: • Qf,*cial use only, Do not write in this area,tb a comp ed by city or town of wtal City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City own Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: ZOO 'd 6Z68IL5LOLI :XU aflU H,L'IM HAIIVAONNI Yid 50 :60 3liz LOOZ-�Z-znf i V The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): . ' •Address: -P- 6• City/State/Zip: gAeATU LEI,Nt4 ba Phone.4: `� b �- Are you an employer? Check the appropriate bog: Type of project(required):. 1.�Q'� I am a employer with t4 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.,14emodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. #• 9. ❑Building addition 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 myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance aequired.]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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. 0 �+ Insurance Company Name: l.,(t _ In's L(Ag liC',�Q_ lea Vi _e� l� Policy#or Self-ins.Lic.#: !741_t 91"V 7=-7 Expiration Date: �. Z Job Site Address: ' D • City/State/Zip: Attach a copy of the workers' compensation polic 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 certify:ender the pains•and penalties of rjury that the information provided abovg is true and correct Signature: Date: /��77 Phone Official,use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department.3.City/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()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-contiactor(s)name(s),address(es) and phone number(s) along with their certificates)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. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 • www.mass.gov/dia t wJe is LID tecaftneq p-wer3gtivo Fseksgd for floe and?tiro-Fx=W RaldeatlalBaiidlovNested WIA'FM'4'fg°h i 11iLA7Cfhf(11YI � A'JITIIA'lUf�( 4Is�sg Gfazing Ceiling W&H Floor Bisetnrat Stab •SeatlaglCooling Arca'(0/9) U-valucl R-value' ' R-YAIUe' R-Yeld W12111 �Peslraeter Egollrment Et6deac . 1'a�c R-value° R-valuer . 5701 to 6300 H fog Itq M Dmys' 1Z% 140 38 13 19 1D 6 Normal 12% 0.SZ 30 19 19 I0. $ N0� F: S . 12%, 0.30 31 I3 I9 10 I3/e 03 6 31 13 Zs -NIA NIA. 3+iormaf T . p Normal 1J 1P/0 0.4� 31 19 19 10 G. v 13s/6 0.44 aft 13 29 NIA NIA �AFIJfi W 138Ye 0.31 30 19 19 10 U ARTS 0.3Z 31 13 Z5 pT/A NIA Nomsil 11 , 0,4Z 31 19 23 NIA NIA Normal 13% Q,4Z 31. 13 19 I d 90 AFVE AA Io°`e f}30 30 19 19 70 90AIV£ I, ADORES.S OF PROPEF�TY: SQUARE FOOTAGE OF ALL EXTERIOR WALLS: COd� 3, SQUARE FOOTAGE OF ALL GLAZING: 4, GLAZING AREA 03 DIVIDED BY42): S. SELECT PACKAGE(Q m AA-see chart above); ; COTE: OTHER MORE IN-IOLVED IYMTEODS OF DE 1171M IN ENERGY REQLTIRLt MiTS ARE.AVAILABLE. ASK,L1S FOR TMS INFORMATION, • . BMDINC3-IN8PECT0R AMOVAL: YES;. I • 5 g�rsts-pQG303a �FIHE r Town of Barnstable Regulatory Services BARNSTABIZ Thomas F.Geiler, Director sM 9 16 Building Division soy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /�. Please Print J DATE: ( / ----� JOB LOCATION: number street Jvillage "HOMEOWNER" -7 .,itko 1/8 9.79 7/4ky."o are home phone# work phone# CURRENT MAILING ADDRESS:— �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 supervisor. DEFINITION OF HOMEOWNER Persons)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-yearperiod 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 Baristable.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 th is 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 ofawareness 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 form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt XON ]he Gommonwealtis of inassacnuseirs Department of Industrial Accidents " Office of Investigations a 600 Washington Street Boston, MA 02111 " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plul®bers Applicant Information Please Print Legibly Name(u�u ess/Organization/Individual): Y Address.— �C7ity/StatefZip: �,�� ��� L _ hone#: Are you an employer? Check the-appropriate box: Type of project(required): 119 I am a employer with— 3 4. ❑ I am a general contractor and I 6. ❑ New construction employees(frill and/or part-time).* have- fired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7 emodeling ship and have no employees These sub-contractors have 8: Demolition working for mein any capacity. workers' comp,insurance. g, ❑ Building addition '[No workers' Comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions r--i t r ,�nT 1 t t• 3.tJ I am a homeowner doing ail work Tight of excerption per 1V1vL 11.❑ Pluu`iviug rdpaL3 addifious myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs -insurance required.] t , 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 aff davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ZContractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #:_ sD 1& zZdk2,02 Y0 L/gz Bxpiration Date: / o Job Site Address:_ y7S— ���iS>ZG%�c�z� / - City/State/Zip:_ L f-. 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 certify under the pains and enalties ry that the information provided above is true and correct; �--� `Si ature:_--- D'ate:- Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Torun: Permit/License# Issuing Authority(circle one): i.Board of Health 2.Building Department 3.City/Towm Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• i , 1 i.•1 , ICI I - I ' �i It c) 6 _ f•1 � � t�l 1{+ lai Ali I� i i - I`� c Table J3.2-lb(continued) Prescriptive Packages for due and Two-Family Realdentkal Building Heated withFond Fuels MAXIMUM MINIMUM Glaung Glaring Ceiling Wall Floor Basement Slab Headng/Cooling . Area'Ci) U-valuer R-valuer R-value' R-valuer Wall Perimeter Equipment 05ciemcyr Pac'�age R-value° R-value' 5701 to 6500 Heating Degree Days' 12% 0.40 38 13 1 19 10 6 Nonmal R 12% 0.52 30 19 19 10 6 Normal S 12% 1 0.50 38 13 19 10 6 85-ME T 15% 036 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 j 16 6 Normal V 15% 0.44 38 13 23 N/A N/A 85 AFUE W 15% 0.52 30 . 19 19 10 6 85 AFUE X I11% 032 38 13 23 N/A N/A Norma! Y 18% 0.42 38 19 25 1 N/A I N/A Nomnal Z 18% 0.42 38 13 I9 10 6 90 AFUE AA 19% 0.50 30 19 19 1 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: e 6 a 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f9803O3a f RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 a� Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq. foot= x:.0041= Plus frot below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x .0041= Z,6eZ 7374 us frord below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x .0041= ACCESSORY STRUCTURE>120 sq. ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x .0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 i Relocation/Moving 5150.00 (plus above if applicable) Permit Fee Projcost ' I Rev:063004 I p pC,o saclZu°elta I. License or registration valid for individul use only. Board of pililding Regulations and Standards before the expiration date. If found return to: ' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR One Ashburton Place Rm 1301 Registration\110363 Boston,Ma.02108 I Expiration '10120/2008 lug Type_Indlvldual THOMAS S THOMAS COHEN _\ zY 160 HIGHLAND Not valid without signature =-�` pcp;�ty Adniiuistrator COTUIT,MA 0263.. c l 06/12:2007 TUE 1.6:39 FAX .908 564 5531. BOLCHIE INSURANCE Z002/003 ACQ D,M CERTIFICATE OF LIABILITY-INSURANCE � D0611212 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Robert E.Bouchie Jr. Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1352 Rt 28A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 400 —' ---�-- Cataumet,MA 02534-0400 _ INSURERS AFFORDING COVERAGE _ _I NAtC# INSURED Carpentry Unlimited,Inc. lN—SUFeRA PATRONS MUTUAL INS CO OF CT 50 Plurn Street INSURER B: TRAVELERSIST PAUL INSURANCE CO West Barnstable,MA 02668 INSURER C: -------. -`—------ I INSURER D: '�—�'-----'--_-_�— I I INSURER E:--_-- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIVSR!AOD'L--- -----i-------- I POLICY EFFECTIVE POLICY EXPIRATIONT-- +�_-- LTR IIISRQ__ TYPE OF INSURANCE- POUCYNUMBERI_ I LIMITS A GENERALLIABILITY CTR0OO1417�Tf 12/1-4/06 12/14;'07 EACH OCCURRENCE is 1,000,000 COMMERCIAL GENERAL LIABILITY �R-MA S S(Pia occut��M I�s 50.000 CLAIMS MACE OCCUR i MED EXP(Any ans pwsans_-,—_ 6,000 PERSONAL&ADV INJURY --•$ —_1,000 000 GENERAL A_G_GREGATE $ 2.000.00O. GEML AGGREGATE LlIAITAPPLIESPER;I PRODUCTS-COM14PlOPA.GO $ 2.000.000 -- POLICY PRO- r .LACJECT I 'AUTOMOBILE LIABILITY COMBINED e idml)SINGLE LIMIT ANY AUTO ( S ALL OWNED AUTOS BODILY INJURY S - I SCHEDULED AUTOS I (Pei nelson) — — HIRED AUTOS ? j BODILY INJURY I S Par accident) N014-OWNEDAUTOS , L __--, PROPERTY DAMAGE �$ -- (Pw accident) GARAGE LIABILITY — AUTO ONLY-FA ACCIDENT IS I _ANY AUTO i ;OTHER THAN CA I ACC $ AUTO ONLY: AGG S EXCESSAIMBRMAIUA61LITY I EACHOC(.URRENGE_ T$ -- OCCUR CLAIMS MADE AGGREGATE I IS i 'DEDUCTIBLE I $ I _ RETENTION S __ S B WORKERS COMPENSATIONAND 7PJUB400OB40O07 02/21/07 i 02/21/08 WC 111urr ER EMPLOYERS`LIABIUTY i i £.L.EACH ACCIDENT S 1 I ANY PROPRIETOR.T'ARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE $ 100 000 Him describe wrier SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT S 500 O OTHER OESCRIFTION OF OPERATIONS I LOCATIONS,'VEHIC LES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THERECF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL, 10_DAYS WRI'TEN 475 Whistle n of Barnstable I histle Berry Drive NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT,BUT FAILURE TO DO SO SHALL 75 Marstons Mills, MA 02648 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON 7FiE INSURER,ITS AGENTS OR REPRESENTATYVcS. AUTHORIZE PR °NTATIVE 1 • I ACORD 25(2001N) ACOFM CORPORATION 1988 I I • ��� Gil-'-t����:�(��� ��. 1 / -- - -- i Cap s L. ;I �$ti tom-.. t r~its. GWAt J. k(+P'' - r6oA'L Air"c f 7c 4n.�,k�,�i.�►^•��.rr`�-1'^'+r"'"��'�'y`5�:.;5'�p;a°�.aG : ':II':r':2"�"''1`7t'.3"•'L.'•.rs�c$'r�'9::0..�'+t;;C'sy�i'.;.+�§xE•uvj.:vt'c�;n..::-�•�.t...-.....�>�i'�x.�i+"1af<eftiv j'y�{!�t`"'•vr.�' �~v��'�X:,t-�':'^ `FINE Tp Town of'Barnstable 7 �r RARNSTARLE. • Regulatory Services. MASS. p i6s9• a 0 Building Division• AbV TED MAy 200 Main Street, Hyannis,MA,02601 VA� Office: 508-862-4038 Fax: 508-790-62300 qInspection Correction Notice Oi Type of Inspection Location 7 7� Si'G ley n Permit Number JP,.W d t 0 6— Owner Builder 0 One notice to remain on job site, one notice on file in Building Department. The following items need correcting: L /U /C) D N� UA)-77C, M I r7 l�� � iS rf(n�5 Oa) I�JJ Please call: 508-862- or re-inspection. Inspected by Date -7 0 k fD 7 00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ��% Application# (NXV ` y T Health Division 20 0:;� (9L73 Date Issued Conservation Division 1-Y Application Fee T Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board 1� Historic-OKH Preservation/Hyannis dw-7 d:56 S',? Project Street Address 11-75- (su Isj laay Village /,41f5reA5 au it-is Owner &4--1rs Address Telephone Permit Request�� �,o�.� r 6� /i-G-� (J &97 G,` 644e,,1- J6vc r4lS0 1-1 �'i1ti5 u�1 l:4/•1'ZC�7✓ �( 6 PC2 74,W0 4i'�lr�g Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 2!2 Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ❑No Basement Type: /0 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: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 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 Elo Commercial ❑Yes- -0 No If yes, site plan review# I Current Use Proposed Use BUILDER INFORMATION Name ��9A u yo r Telephone Number 0 -, Address`` License# w 44S Home Improvement Contractor# Worker's Compensation# 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 DATE OF INSPECTION: FOUNDATION FRAME INSULATION ,i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. T h i ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): . &AKhA-4A1` LQ 6 Address: . , City/State/Zip: Phone-#: l g D j S Are you an employer? Check the appropriate bog: -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.El am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance coin•insurance.t 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 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' A3,X Other Pik Sk`/uu4 iS 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 anew affidavit indicating such. 1C6ntractors 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-contactors have employees,they must pravidb their workers'comp.policynumber. 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.#: 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. 16 hereby certify under the pains pea of perjury that the information provided above is true and correct: ff Signature Date: Phone#: i Official use only. Do not write in this area,fb 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 CIerk 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, §25g7)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 inrance 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 permittlicense 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 fo 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:. Tho Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-490.0 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 vtrww.mass.gov/dia i E,q Town-of Barnstable Np °� Regulatory Services it SAMMABM Thomas F.Geiler,Director MASS 16 � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyanais,MA 02601 Office: 509-862-4038 Fax; 50$-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMTT 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 strictures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: p( An) `i' S,L/�/� Estimated Cost Gb — ,Address of Work: �f7s G✓/�iS�f'�C7L� f1� S�7/�� �CGLI Owner's Name: /l-:4/WkS �U a ✓ L(-�'y� -- Date of Application:)1 y I hereby certify that Registration is not required for the following reason(s): E]Work excluded by law []Job Under$1,000 OBuilding not owner-occupied Owner.pulling own permit Notice is hereby given that: OWNERS FULLING THEIR OW14 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: Date Contractor Name Registration No. OR Owner's Name Datee • Qf'o=hamedmMdav AUG-29-2007 04:0812M FROM-HARRIS AND LLOYD INC +617-489-6700 T-629 P.002 F-030 �S Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Tom perry,Builditig Commissioner 200 Main Street, Hyannis,MA 0260) www.town.barnsta ble.ma.us Office: 508-8624039 Fax: 508-790-15230 HOMEOWNER LICENSB EXEMPTION Please print DATE:— Penman D-°l. ---G7 JoltLOCA71ow: W • �r� Rj�a 1 r1/r ��! number(rz, r) GA10 street V11UP "HOMEOWNER": rzw— - �� /Z 6/ - 3Do nIIme hams phone# work phone 0 CURREW MAILINO ADDRESS: +K a S it p •K ci4'/tow4 state tip code The current exemption for IMM— "was extended to include wrier ied dwe in s of six units or lass and to allow homeowners to engage an individud for hire who does not possess a license,apvided that the owner acts� gise��- DEFIIVMON OF HOMEOWNER Person(s)who owns a parcel of land ott 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 one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a fort acceptable to the Building official,that hie shall be resnensible for all such work ierformad under the buildin,,permic (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 3arnstabie.Building Department minimum inspection procedures and requirements md•thst he/she will comply with said procedures and requirements. S 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 ibac "Any hom'xrwncr peftruina work for which a building permit is rtquirW shall be ertp W front the provisions Of this lwtton(Station 109.1.1-Liamsina ofcanBtt C604 Snptxvisorty,provided that if the homamcr angagcs a pasoe(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who rrsa'his eeranption are unaware that they tfe assumieg the rapaulbilitia of a sups vlaar(sw APpcodnt Q. Rules a Regulations for Liaenaing Consmtetion Superviscra,Section 2,1$) 'Phis lank of awareness otter rrsarts In seriaas probleuu when panialLdy tbo bomeownet bins 0lloanscd polTQn& In this msr,ourBoand=not proceed 49AW9 lbe uatieaased paean Asir would vimt t I,.pas Supervisat: The homcowncr wring as Supavisor is Wtimately myonatble. that the homo cnsu that the hwneowaer is fWty sw&m ofhMer rospooslblhfes,macy communities mqufM as parr oft arn he prirapplication, ani$r that hdsho undersmnds rho responsibilities of a Supervisor. On the last page ofthis issue is a aft eu'r+e py used "weal towns, You may care r amend and adopt such a tbrrnkeRiflcation fbf uu in your cam mun jW. by Z00 'd 6Z6B IGScoG 1 .Xyd HI1T� HZ7Y� �AI�V�101iNI I`I`J ex J! L 4 ►u C- U ty C2$ � I Cam; u pox- I Y 1 i AUG==14-200r 02:40PM FROM-HARRIS AND LLOYD INC +617-489-6700 T-612 P.002 F-951 i 84 W2007 15:a4 6884205553 YANCEF SURVEY PAGE 83/93 1v O-RTTG A G.E lNSP-EC T70 N PL-A'V APPLICANT: QOARDMAN LLOYD TRUST TOWN: MARSTONS MILLS i i I LOT 49 a y �I •� I/♦IIII// LOT 5 /.. ./ IIIII III// IIII •I/I I• /L4P/ZtLT 4 //IIII nR�� 71 y o y r FLOOD PANEL: 250001 0015 C FLOOD ZONE:"Ca DATE MAP REVISE: 08/19/85 1 limat rfattrr IM,T tar.uarttCACC Wfaremm rvo ay atDt rTtbNlm rua OATS: 04/19/07 SCALE: 1' - 50' STEVEN A PIZZUTI, ESQUIRE nEEO REF: 10095-184 PLAN REF: 349-58 1Nt tneAnw Pr nt ota>.�str.wm�eats lmtrma r1ty,A.�KnAE nooP AAEIAo tlta. •{�TAno aP+'�•.6+ twc oduwP wr.M9 ro wA.oM To tNt�oOK 7pw4i YTutlt w VR.C/ax a1RYCNtt7 trolr eM tNy ItmlrCAac rMSACc�rw I:Air 4U,-J'rto 4T TArE SOAK Ar M,fl1E Q COti^Vll<n0.v wlti ACcrItT•0 hOrtItDVTK(INrlIi1011K PCMAU aEaW04%ls PUT.MO W9IPYKAI 11r4rR'r w5 PCwbIWn Ittl tPEAPba 3.4w MC AfDpoNAIAI. arl Ii dUWT PRMI MalA1WM rrmpcEll Crrt AL71011 Iala60 W.WII'�µ Uks OflAltw mI AN a{u,.rtHt Olkltt•f htCEY:ANT tat rKL45C PCR'�NA!1w W try4.o+lrP taelT(4( ft10M I.(IGrt PEYG•ry.I0 10MACf"O -1 Tlrlr Tx%4trEnT Or mt NO.it.�¢,t{of■AT IMP crtA0nO1MLMli.1/AM{POT.E101GA MY AGA087►AWlA1T 14M1 -/Mlrte ts.aniaVAhaNs N.9 ntaoa!1 w or atcoea.r Awr it"WaLk eC rm waCfld W4KT COWAMM J1S 04"rot aE 1HIC WAXIl tot ONMt=e RrA4Ota r4W AMY U59 Ai W 9.%ML Mer Cr kvm 1-0-A AMo Crrrct. d 1114 IMA r9A suopm 900 b AA WWWAM 60mer10A. TELEPHONE: .50Q-:a28•-0055 YANKEE LAAND. SURZEY COMPANY, INC FAX: •508-420-5553 40 IndUStry Rood, MOrslons WIS. MA 02548 ynnkeesurvoy*Comcc%.'net www.yank eesUrveY.cbm. 38928• JF y 4 ..�„ L r, -.^.'�+.1''\F' '. ti `'+h'- •;tirt,"7':ceis'•H•ar'�.::,I:-r-^•.: �w.v..�`> �,� _ ^r'^1LY�.�'��,'�-t' F��;!t:,,r.t��t'� •rY^'< .!�•i�y�.r',�"=!./t`..SY Y`. 7� '�f'�• �i'ft �Y+`Y'�S�ki�'�.it'�"tw+�i"4`,�,7.-iy 1'�Y'�-...<r• i `OPINE►o Town of Bams'.table BAR`1SPABLE. • Regulatory Services MASS.. - A,E,�„ye Building Division 200 Main Street, Hyannis, MA 02601 Office: 508-8624038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location Permit Number f Owner Builder 0A,-,- One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 0 Please call; 508-862-46.Oafor re-inspection. Inspected byi� Date C( I (l I� F k, . ra$t'— ?� .Y�tyr^'y'!'!"�`r+"'!y� •is ir�+(k.'t7't_e✓'?•�J' .�.!'':r::' } �e�l:`,5 .".•<.' a'.°rJ ri`i e Y f ��r 1��^•+N7 �,+�'cr7�i�+,1�`+.'Sr`r"'-'�r�.f. Town of Barnstable BABNSTABLE.p Regulatory Services MASS. _—........._.— ta39. Building Division pfFD MAC s. 200 Main Street,Hyannis,'MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection P Location AI 4mio y �6t Permit Number e Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: AC)7- A) So PIC-r r n '( YD age AkZACE TIRE-Af6cClk— 1 S ) �i R�,F1 a c�litJG itl t &40 JC— 150 T-7c/ Ic E / Please call: 508-862- 8 for re-inspection. Inspected by Date % _ Assessor's offioe (1st floor); /, /_.. /�� ofTNETo` Assessor's map and lot number ... `.!..... .. G). BedrooV�n� Board of Health Ord floor): -- � Ei — • ' Sewage Permit number ................................ 1I. . ,,.... � Z 33AB.a9YADLE, Engineering Department (3rd,_.floor): 4 �o`e,raea P' � House number . � � � YP£a� 3a `e APPLICATIONS PROCESSED 8:30-9:30 A.M. -and 1:00-2:00 P.M. only' ..� .� TOWN OF BARNSTABLE Y BUILDING INSPECTOR Thomas Marone Jr. Sterlin Construction Co. APPLICATION FOR PERMIT TO ...............................Y............................ ..........................................................::.... b TYPE- OF CONSTRUCTION ....Bui?d..new..Home.................................................................................................. 1a. 1`a G.........................193.6.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to *the following information: Location ..Whistleberrv.,Development....Lot......#.50..Plan..RPM....S1eQt..h..aF.. ..1.r....................................................... ti 1 Proposed Use Friv to SJ., P 1 ' 4 r' a........ ii. e...I?'"?W,1._...ax! ,. ............................................................................ .......................... Zoning District ...ReS.ident.7.a)....l.....:.................................Fire District ....N/A................................................................... Name of Owner .David. Romeiser Address"hob..Litm..hPr..t..Ma.)..1...,�e�.,..GPt�XPrv.,l.J.P.;.,.Ma...,,,, ........................................... ' Thomas Maroney,...Jr.,...�`r..Q4. 9.7.........Address ..7...patarlee..Rc1....W: Yarm��,rh. ..Maa...(1?...673...... Name of Builder ................ Name of Architect E>^y7nQ..F9... a1..?S�L1 .S.# ..r5.4..7�3............Address .Michigan................................................................. Number of Rooms ..Elght..Ro=..........................................Foundation Exlerior ..................................Roofing .:9.snha.1..r.................................................................... 0,1(e"_ • Floors ..WOO i...C.0."n.et...and..Tile........................................Interior Arl,?Twa.�.................................................................... Heating ..Heat taUm ..Central..az.?r~.............. ................Plumbin tWo R, half Fireplace tW0 ehi.MDe-y S ..........................Approximate Cost .%.1,.QQ—n0.Q. 0.0..... Definitive Plan Approved by Planning Board ----JMn_-.9----------------19$5__- . Area Merst_in..NIT.l.1..s:.............. Diagram of Lot and Building with Dimensions Fee ~l .. .............................................. SUBJECT TO APPROVAL OF BOARD OF .HEALTH 1 V - V lt" 1! _ 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. y Name .....: ................................................ `'> Construction Supervisor's License ......�.!..��.'��....�....... ROMEISER, DAVID A=61-39 No 30614 permit for , Two Story ................. Single Family Dwelling .......................................................................... Location ,Lot #50, 475 Whistleberry Drive .............................................. Marstons Mills ............................................................................... Owner David Romeiser .................................................................. Type of Construction ......Frame .................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ......Apx ,I...8.R.............19 87 �I Date of Inspection ....................................19 1 Date Completed ......................................19 g i PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 04/18/07 TIME: 10:03 -----------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 CHANGE PLIED: 25.00 APPLICATION NUMBER: 206! 13 PAYMENT METH: CHE'' PAYMENT REF: 1411 Town of BarnstablePermit: pFtNE rp` Regulatory Services ate: Thomas F.Geiler,Director BARNSPABLE. = Building Division Fee: y MASS. �A .asa �e� Tom Perky., Building Commissioner 200 Main Street, yannis,MA 02601 www.town. arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Phone: `�cU Install at: j Ai 611,07B y(� Village: �1� pZ,T0-4 J- IS M Map/Parcel: Date: 1�p Stove A. New/,ZJsod B. `Type: Radiant/Circulating G. Manufacturer: Vf5&0L11-6ASTL&% Lab.No. D. Model No.: Chimney A. New/.Existing (If existi ,please note date of last cleaning u B. Flue Size . C. Are other appliances attached to Flue? D. Pte-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: ► 1[ `�' B. Sub Floor Construction: �!��L w6iyv'�.. Installer �T,'. QC�i t ( W �Q�c CCn fA(T qjA 1��(en v Name: Address: Phone: Location of Installation:�►�� !�9 H i5T►.��iTt` !t�QS�U.c� 11 i,�i APPROVED BY: Please make checks Wable to the Town of Barnstab e *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 f \ ->. 3 � �n � .� . � ' .i 3 R �, 4, �` -.t y Y �+ r � q i I � e , � i ' j, ' � w:A..� wa. . f[:�1 .�.- ..r:Ys^,.a:,. .�...�..w.�. ., r> e...r,:s:+:.e»,... +.�. ... .� .....-rr.,�. .w.var.+. �* .. � e . ..r.-1 ' '� {. • s � •� t •{< > ' ; \�. �. i To: The Town Of Barnstable Building Department 200 Main St. Hyannis, MA 02601 I Re: 475 Whistleberry Dr Marstons Mills, MA 02648 Dear Sir: It has recently come to our neighborhoods(Whistleberry) attention that Mr. Mrs. Lloyd (owners of 475 Whistleberry Dr.) have built a bedroom/apartment for themselves above the garage. We know the permit was for living space but it is being used as a bedroom/apartment by them because they have leased out the main house to a Dr. and his family. This is zoned as single family and now we have a situation of 2 families using this home. I believe that this is illegal. The Lloyd's are using it on weekends now and during the summer and don't appear to be there much during the winter. We would appreciate it if you would check into this. Many of the neighborhood are concern about this situation. Thanking you in advance, Whistleberry Owner N o c T9. -� N v IV 5 O m w rn M E , • / p u� T Y - r j _ F a aL x' LoID s Op ns r ` w �M1 `.a •V' '� �:E �V r c _ . - x1 � • � -� � (, % 4ssesJoro s offioe (1st'floor): / (� // z SUBJECT TO APPROVAL OF of THE Assessor's map and lot number ... ..1................................' BARNSTAgU C Q.. i Board of Health (3rd floor): dYno M� • �g?`J - ��/An�N fO� � ��� •� COMMISSION Sewage Permit numbe'r ..................:.....'.:.... • BAB39TYDLE, Engineering Department (3rd, floor): r moo 163Q• •� House- number ..... ..... « �0YPYd. APPLICATIONS PROCESSED 8:30-9:30 A.M. and: 1:00-2:00 P.M. only APP .RGVED ` WITH TITLE 5 J:ns4blLe4ons.erv,a�tionrQWN _ O F B,A ft \ � CODE AND ' � ��TIONS edy Date r ILDING INSPECTOR M��s��� . Ms�� 0Qv Thomas Marone Jr. Sterlin Consi �� �t�5�e CC APPLICATION FOR 'PERMIT TO .............e.................Y....................... ...g............ �.. F TYPE OF CONSTRUCTION ....Build..neaa..Ho[ne..........f..................................�����.�.......W��t�P�.C�g®®. � . ................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .Aistleberrv. Develo Pent... Lot..�54..Phan..R��....Sk1E<et...6..a�..�� ,............:...................`....................... Proposed Use Trivate..Single..Dwelling.......................................................................................................................... Zoning District ...Real.deatial.11................. ...................... District ....N/A................................................................... Name of Owner David Rome' ......................................Address 6. ..�dJ[flt Zt..]"I].��.Rd....CieClteJCV7��4.�... a...... Name of Builder `hQTa.$..Marmey..,..Jr,.A..04 0.7........Address ..7...Pawnee..Rd....W....Ya>:mouth.,..Ma,,..02673...... Name of Architect ZrvJ.Dg..E,..Fa1mquilt..#5.478.............Address .Michigan................................................................. Number of Rooms .Eight..Rooms........................................Foundation Full..Basement..P.oured..8'.'...wall..an..12.'.Toot Exterior ..Clad?..bQard..arkd..,9bingle..................................Roofing asphalt................................................................... Floors - ..W0od..carpet..and..Ti1.e.............. I.........................Interior ..drywall................................................................... Heating Heat.. ?um�?S!R2ntr?l...ai] ..................................Plumbing ....two..&..half..ba.ths........................................... l - yFireplace ...tWO..ekl.7-1-!!neyS......................................................Approximate Cost .$100.,.000 00 Definitive Plan Approved by Planning Board -----Jan__2----------------19_85___'. Area Mars.tin..Mllls....... I . Diagram of Lot and Building with Dimensions Fee l� SUBJECT TO APPROVAL OF BOARD OF HEALTH 1d' _ I �40 q9. v� OCCUPANCY PERMITS-REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town o arnsta a egarding the bove construction. Name ................................................... ... ... ` Construction Supervisor's License .......411400 f��...... RQMEIS ER, DAVID M ts -- No Permit.'Tor %. '..Story........... Single Family 16.7elling .......................................... . ........................... Lot #5.0 ,-., 47i5 Whistleberry Drive Location ................... ........... Drive . ..CV.........i.................... Marst(ghdi MiAls ........... .................... . ...................................... o �4 Owner .... iE'er .............................. ............Type of Construction .......................... Frarre ..................................... ......... ............................... Plot ............................ Lot ................................ Permit Granted .....April 8 , ............19 87 ...................... Date of Inspection ....................................19 Date Complete .........19 0 FAA p 9 a,• 0 iz 2 9 p �o � O' CO + T I 0 I -7-JV- Lt SO 0� �S- ro r gip. ON � � At OF.144s r� +� IONS P Lag YL$ w i ere�► I=,OT tt�70 •DoV—�S N t7-C IST �LOO 1?L C 67R r1#4 0i .�� o T . FOR �TgR4.1�i4 CONSTtLV�T�.O C.O . 70- y✓N CF B ARI�IST A@LE L07"". S O P RC1� / Ct�?T/F Y Ti�AT 3✓f,/�T /.S Sf�03�/N ON T,�s//�• f'L AN /S AS /T EX/STS O,A/ T7WE G�f'DUNL�ThN 9Nb COifp,ES TOWl4 /OA/S . /r�fE i rP�G/�'. ,?EG> .C.•4Nl� �l��P Y�'YO/? INC. -5�7 /`�Or2/N ,.9 YE, .Fi4G/`10UT�/, /`'i4•SS. ?Mfr TOWN OF BARNSTABLE Permit No. ....30614..... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 N� I �(/ 679• �cwr� HYANNIS,MASS.02601 Bond X CERTIFICATE OF USE AND OCCUPANCY Issued to DAVID ROMEISER Address lot #50 475 Whistleberry Drive, Marstons Mills USE GROUP FIRE GRADING OCCUPANCY LOAD T`IWS 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. ...... February.5.. ...... 19......88....... .....4 G ............................ Building Inspector lo /;NT RNSTABLE, MASSACHUSETTS B�1I �G.. `PEI�M1�' DATEPERMIT Re-��—k-.•erg ADDRESS (N ,) 1.1 1 L-'l i•R C'L (� IIIOUL.adO NTR'S LICENSE) RMIT TO STORY � ,-, NUMBER OF CJ N6: - - !`I PROP 5 D USE) a f}W ELLIIJG.UNITS AT (LOCATION) 7 ZONING _7 lN.4) `ll 1 tR T) 1-, _L u'. i - - ! DISTRICT_ i BETWEEN %(C �S STREET) AND (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT,WIDE B\W FT, LONG BY 'FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION t TO TYPE. USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: --�EyFJ e3fffy—� (• i i?y v ':'.. Li o AREA OR �'3rJI;Ci VOLUME. 2400 SCj ft ESTIMATED COST ^� MIT C (CUBIC/SOUARE FEET) FEE OWNER _ 1 1:7`71,'� .Rnmc 1 r• ADDRESS BUILDING DEPT. 1\ c u BY FROM THE DEPARTMENT OF-�PUB!LI'G7WdRKS.tHE ISSUANCE OF'THIS PE RMI'F'UUtS NU Ht LtAtE-I n E'H'rr Lll,M:�:•r nvm•, OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ^� �v•�+ MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL IN IRE INSPECTION TO LATH1, FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I - 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT rNSTRUCTION; � BOARD OF HEALTH ED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SI� MONTHS OF DATE THE INSPECTIONS INDICATED EP THIS CARD CAN LIE ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT )S ISSUED AS NOTED ABOVE, NOTIFICATION. DATF • r CONTINUATION OF ROAD BOND BUILDING PERMIT ;l06 The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of Public Works. loam and seejshoulders as soon as weather permits. other (explain) — r LOCATION a S4 L1 IGNED Owner on ra JNGJ�NEERI A. TH IZATIOt i • �OFTNE t0 DEQE He No. SE 3-1533 (To be provided by DEQE) (+� Commonwealth . • DA of Massachusetts X3Ti8LX : City/TowrL Barnstable ao react i639• m� Applicant Sterling Construction � �� i �0�aY �.ompany Order of Conditions MASSACHUSETTS WETLANDS PROTECTION ACT f G.L. c. 131, § 40 TOWN OF BARNSTABLE WETLANDS PROTECTION BY-LAW, Ch. 3, Article XXVII FROM: BARNSTABLE CONSERVATION COMMISSION To Sterling Construction Co. Sarre (Name of Applicant) (Name of property owner) 7 Pawnee Rd. Address West Yarmouth, MA 02673 Address This Order is issued and delivered as follows: ❑ by hand delivery to applicant or representative on (date) by certified mail, return receipt requested on J a n„a r� 9A7 (date) This project is Iodated at Lot #39 maistleberry Drive, Mars Cons Mills Barnstable Assessor'_s Map # 61 Lot 39 The property is recorded at the Registry of Deeds in Barnstable Book 366 Page 58 Certificate (if registered) Notice of Intent dated Nov. 14, 1986 Date of Hearing Dec 9 & 23, 1 986 This Order is issued on Jan. 12, 1987 Findings The Barnstable Conservation Commission has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Barnstable Conservation Com- mission at this time, the Barnstable Conservation Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act (check as appropriate): ARTICLE 27 ONLY Public water supply ❑ Storm damage prevention N Erosion Control ❑ Private water supply XR Prevention of pollution ❑ Wildlife )�] Ground water supply ❑ Land containing shellfish ❑ Recreational Flood control 0 Fisheries •❑ Aesthetic v ,, V • J Therefore, the Barnstable Conservation Committee hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the regulations, to protect those interests checked above. The Barnstable Conservation Committee orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. GENERAL CONDITIONS 1. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years,from the date of issuance and both that date and the special circumstances warranting the extended time period are set.forth in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber,bricks,plaster,wire,lath,paper,cardboard,pipe,tires, ashes,refrigerators, motor vehicles or parts of any of the foregoing. 7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In'the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the Barnstable Conservation Commission on the form at the end of this Order prior to commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bear- ing the words, "Massachusetts Department of Environmental Quality Engineering. File Number SE 3-1533 10. Where the Department of Environmental Quality Engineering is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hear- ings before the Department. 11. Immediately following completion, the project shall be certified to be as per these conditions and plans, in writing, to the Barnstable Conservation Commission by the project engineer who shall be registered in the state of Mass. engineer 12. Upon certification by the project the applicant shall forthwith request, in writing, _that a_ Certificate of Compliance_be issued stating that the work has been satisfactorily completed. 13. Prior to any work being done at the site, all legal advertising bills incurred by the petitioner in relation to the Wetlands Hearing held on this project shall be paid. 14. This Order is issued under Article XXVII of the Town of Barnstable By-Laws as well as under.Mass. G.L. Ch. 131, sec. 40. The Barnstable Conservation Commission or Conservation Officer shall be notified no more than two weeks nor less than two days prior to the commencement of work, and have the authority to issue an Enforcement Order if the terms or intent of this Order are not complied with. 15. It is the applicant's responsibility to provide all contractors with a copy of this Order and to ensure that all workers are informed of the conditions of this Order before they begin work at the site. I O 16. The work shall conform to the following plans and special conditions: PLAINS: Title Dated Signed and Stamped by: On File with: Rev. jan. 9, 1987 Ciiristine Fairneny, San. Commission Site •& Sewage Plan Oct. 24, 1986. John P. Doyle, R.L.S. Barnstable Conservation Special Conditions (Use additional paper if necessary) 1. All areas disturbed during construction shall be .revegetated immediately following completion, of work at the site. No areas shall .be left unvegetated or unmulched for more than 60 days. 2. This approval is contingent upon approval by-the Board of Health of the subsurface sewage disposal system. 3. Dry wells shall be installed to handle roof runoff. - 4. The driveway shall be constructed of pervious material. 5. The work limit on the southern portion .of the parcel will be established at a distance of 20' off the garage. 6. The work limit at the western portion of the parcel will be established as a straight line running north and south at the intersections of the 38' contour linz and the parcel boundaries. 7. Staked hay bales shall be set at the work limit prior to the start of work at the site and maintained throughout construction. 8. There shall be no disturbance of the site, including cutting of vegetation, beyond the work limit. 9. The denuded bank at the southeast portion of the parcel is to be loamed, appropriately stabilized, and planted with.vegetation. This area is to be immediately cordoned off to prevent dirt bike access. 10. Any filling of sand pits' on the parcel is to proceed via access from Whistle- berry Drive, thus falling within the prescribed work limits. 11. An appropriate certified plan shall- be submitted to address landscape .detail, recontouring and the stabilization of denuded banks. .......................................................... (Leave Space Blank) Issued By Barnstable Conservation Commission Signaturelss f This Order must be signed by a majority of the Conservation Commission. On this 12th day of January 19 87 before me personally appeared Bradley Bailey to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/free t and deed. November 28, 1991 i ary Pu lit My commission expires The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work. 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