Loading...
HomeMy WebLinkAbout0049 WILLIMANTIC DRIVE �� .� .a ,. ,, �� °� � � ,. a � o - p i e �, �� - � .. i, �. � ,. ,. �a �� � � � ., ,� � .. .. � ��� o ,. -- a- � q�r „ .. ��,��� �. �, ° a � ,... „ ��, o � � '� '� „ � �� .. ,n a n � o �� �. �� ' � 4. 0 i a ,. - � � �. � � � o n ,. .,� ... n _ _ _ _ - � � _�_ ,� � � _ � _ �._ >._ ._ .1� TOVJR 0C r'A",N^;A'!r17 Insulate 8: ?b i W e a t h e r i z a t i o n & Insulation 4io Grove St.Fall River,Ma 02723 Insulate2savemet DI rs I May 28, 2014 Town Of Barnstable Thomas Perry,CBO Building Division 200 Main Street Hyannis, MA 02601 RE: 49 Willimantic Drive r Dear Mr.Perry, This Affidavit is to certify that all work completed for insulation work at 49 Willimantic Drive has been inspected by a certified Building Performance Institute(BPI)Inspector. All work performed Meets or exceeds Federal and State Requirements. Sincerely, Roland Langevin Insulate 2 Save,Inc President CSL 103861 HIC 166311 i tV--1 i i i �P.a.S� ,�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #rd I 67.3 L Health Division Date Issued Conservation Division Application F e Planning Dept. Permit Fee S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address L4Q (101 MCa0:6 C— I A Village 1Mcy s- ny) M` I Owner ffilC he t<)on Address UP Wi 0 l i maIr -kc- Telephone 9 Permit Request �� t(��,1 �, -i `� V t l j IrLSt�_�(.l�ic��1 blown Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family F=K Two Family ❑ Multi-Family (# units) .z o Age of Existing Structure Historic House: ❑Yes ❑ No On Old g's Highwy: Comes ❑ No o Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ?a Number of Baths: Full: existing new Half: existing izoew Number of Bedrooms: existing _new co Total Room Count (not including baths): existing new First Floor Room Count ` Heat Type and Fuel: ❑ Gas : ❑ Oil ❑ Electric ❑Other r 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 ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Named) _cLff Q v n Telephone Number )M.��l- Address 1410 b lR—e QA License # I b,71)%u. i Home Improvement Contractor# Email Worker's Compensation # 14 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 U CCU / G�\1 `v:.eIYA SIGNATURE DATE JAN 2 8 2014 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' Y 3 MAP/PARCEL NO. r �!� ADDRESS VILLAGE ' 1 OWNER r DATE OF INSPECTION: J' FOUNDATION i FRAME r • INSULATION E t FIREPLACE ti ELECTRICAL: ROUGH FINAL f I; PLUMBING: ROUGH FINAL C. GAS: ROUGH FINAL FINAL BUILDING DATE;CLOSED OUT ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts Department of Industrial Accidents u Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Insulate 2 Save, Inc. Address:410 Grove St City/State/Zip: Fall River, MA 02720 Phone #: 508-567-6706 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with 18 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 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 I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation/weatherization employees. [No workers' 13.9 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Guard Insurance Group Policy#or Self-ins. Lic. #: INWC311431 Expiration Date: 12/10/2014 Job Site Addressliol iL�t l h Ima "C, City/State/Zip: I� n,C5, _\ t I is 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 cer. .`under the ains and penalties of perjury that the information provided above Ais�rtrue and correct. Si ature: Date: AN 2.. 8 2014 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#: Acc ram® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDY YY) `-� 12/11/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: _ Anthony F. Cordeiro Insurance PHONE FAX (508) 677-0409 171 Pleasant Street E1EXt) (508 677-0407 a No: ADDRESS: lbri zido@ cordei ro insurance.com Fall River, MA 02721 ' INSURE S AFFORDING COVERAGE NAIC4 INSUR€R A:Atlantic Casualty Ins. Co. INSURED INSURER B:Torus Specialty Ins. Co. Insulate 2 -Save, Inc. INSURERC:Great American Ins. Fall l River, MA 02720 Grove St. INSURER D:Guard Insurance Group Fal INSURER E: INSURER F• — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - (ADDL�Sl18R .... ..__ —_--�-_.__...-...... .._ .._ A TYPE OF INSURANCE POLICY NUMBER PMMDNYYYYY MM11DDfYYYYYP LIMITS A GENERAL LIABILITY y Y M081000174-1 6/12/13 6/12/14 EACH OCCURRENCE S Jr 000,000 X COMMERCIAL GENERAL LIAB LITY DAMAdETORENTEO ^--� �.REMISJ~S•.(Ea_ox�u[rence)_ $ 100.000 CLAIMS-MADE [Z OCCUR MED OF(Arty one person) _ $ _5,000 ------____ PERSONAL&ADV INJURY $ 1 r 000,OOO GENERAL AGGREGATE s 2000,000 7GENT AGGREGATE LIMIT APPLIES PER PRODUCrS-COMP/OPAGG $ 2,000,000 0 POLICY PRE I7 LOC AUTOMOBILE LIABILITY COMB D SIN L I (Eaaecrdarrr $ ANY AUTO BODILY INJURY(Per person) $ AL O SCHEDULED AUUTOSS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS _NOTOSWNED PROPERTY DAMAGE .._$ er aoctdent Is B X UMBRELLA LIAB X OCCUR 78264D131ALI 6/12/13 6/12/14 EACH OCCURRENCE I$ 2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION S '10.000 $ WORKERS COMPENSATION INWC311431 12/10/13 12/10/14 D I WC .,.0 OTH- AND EMPLOYERS'LIABILITY Y/N X T.O L 1MLTS.__ -ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED? N/A E L.EACH ACCIDENT S 500,000 (Mandatory sc b uad _E_L,.DISEASE=EA EMPLOYE $ 500,000 If yyes describe under DESG�RIPTIONOFOPERATIONSbelow E.L..DISFASE-POLICY LIMIT $ 500 000 C Equipment Floater IMP 375-99-76-01 6/12/13 6/12/14 Shop Storage 75,350 Veh Storage 76,250 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rernarks Schedule,If more space Is regLI red) Proof of Insurance. Residential Insulation Contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis, Ma 02601 AUTHORIZED RE PRE SENTATNE '7 • """��.. ©1988-2010 ACO CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: €- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166311 INSULATE 2 SAVE Type: DBA. ROLAND LANGEVIN Expiration: 5/11/201.4 Tree 536 EASTERN AVE. ?2zs32 FALLRIVER, MA 02723 _ -- •__. —_ DP$Cg1 sOM•0004.G701216 Update Address and return "— Address , card.Mark reason for change. G— Renewal �17 Employment Offce of Consumer /� I 1 Lost Card Affa�uo�eS,/v�caacfi�� _ HOME IMPROVEMENT CONT egulaeun Uicense or registration valid for individul use onl Jistration: 166311 CONTRACTOR before the expiration date. �Piration: 5/•11/2014 TYpe: Office of Consumer If found return to: y IN /`TE 2 SAVE DBA 10 Park Plaza_ Affairs and Business Regulation Boston Suite 5170 ,,MA 02116 ROLAND LANGEWN 536 ASTERN AVE. FALLRIVER, MA 02723 � -•--.._ Undersecretary �C . _._ Not valid without signature ____ -- Massachusetts �V - Board of De?ar--E :c; Puh±;c 3uiidin `afe / 9 Re9u a-io•,s _nd Standa.rds Construction supen•isor -;tense: CS-103861 ROLAND LANGEVIN 536 EASTERN AI zj Fall River MA OTW 08/24/2015 OWNER AUTHORIZATION FORM 1, lob /1) c-� (Owner's Name) owner of the property located at 117 u , (Property Address) (Property Address) hereby authorize LS (Subcontractor an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. igna ure Date Federa RISE ENGINEERING RlCont actor .egis"ti .I RI Contractor Rogistrntion No 8186 NIA Contractor Rogistration No 120979 A division orThieisch Engineerin' CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston RT U2 CONTRACT10' (401)ilS1 37110 FAX(Jtll)7f13 3710 Page 1 RISE PROGR THIS CONTRACT laEI:TEREO INTO BETWEEN RISE (. ;�'-Ih�.� ENGINEERING AND THE CUSTOMER FCR WORK AS DESCRIBED BELO'.V ENGINEERING CUSTOMER PHONE DATE. CII<nu John Michelson (508)428-I07: 12/1012013 154087 SERVICE STREET BILLING STREET 49 Willinlantic Drive P.O. Bos YlI SERVICE CRY.STATE.LP BILLING CITY.STATE.JP Marstons Mills,MA 02648 Mansions Mills,MA 02048 JOB.DESCRIPTION Provide labor and materials to seal area o('your home against wasteful,excess air Icakage. This Work Will be performed in concert with the use of special tools and diagnostic tests ur assure that your home will be loll with a healthful level of air exchange and indoor air qualiq+.0,131erials 10 be used to seal your home can include caulks,forms,weatherstripping and other products. 116mar% areas for sealing include air leakage to allies,bascmenta,auachcd garages and other unheated areas(windetvs arc not generally addressed) (16)working hours. At ale completion of the wcathcriraoon work,and at no addnumal cost n)the humcowner,a final hlow,,.r door and/or combustion safely analysis will be conducted by the sub•contractur to ensure the safiay or the indoor air quality. $I.232.00 Provide labor and materials to install it 1 i"layer of R-i^_Class I Cellulose added to(448)square feet of open attic space. $712.32 KNEEWALL FLOUR:Provide labor and materials to install a 1 i"luyer of R-i2 Class I Cellulose added to(1-14)square feet of open kncewall fluor. S227.i2 Provide labor and materials to install R-13 faced fiberglass to(1 12)square feel of kncewall, Then install 2"rigid hoard Insulation Seal all scams with FSK tape. S4 i•4.7_' Provide labor and materials to install(I) new.finished plywood,with 2"ri id•I hernias board,wratherslrippcd attic space access hatch. Prime coat and/or paint is not included S 120.00 Provide labor and materials to install(1) new,I•mished plywood,kncewall space access hatch The hatch will be insulated with code compliant 2"rigid'ncurmax board.weather-stripped,and held closed by eye hooks. (WDod surf;Ices will be unfinished. Prime coca and/or paint is not included.) )120 OU Provide labor and materals to install(1)insulated exhaust hose wit/roof mounted flapper vent to exhaust existing bathroom fan(s). S4l6.10 Provide labor and materials to install ventilation chutes in(54)rafter bnys to maintain air flow. SI al8.dli Provide tabor and materials to install (240)square feet of R-10 rigid Thermax insulation to the crawlspacc perimeter wall up to the sill and against the band joist. S993 60 Provide labor and materials to install(93)linear feet of R-19 unfaced fiberglass insulation to the perimeter ol'tlle basement toiling " at the house sill. S20_;67 Provide labor and materials to frame and construct(2)pressure-treated crawispacc access door.Access to he insulated with 2"rigid Thcrmax board and scaled at the edge with weatherstripping. Sioo.00 i i Federal ID$t 05-0405629 RISE ENGINEERING RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineers CT Contractor Registration No 620120 1341 Elmwood Avenue,C M111SIO R1 0 ill CONTRACT . (401)7 8 4-3 7110 FAX(40 734-3710 Page 2 RISE PROGRAN4 THIS CONTRACTMENIEREDR:TOBErNEENRISE ENGINEERING AND THE CUSTOMER FOR WORK AS (..1.•�.'ll��} 0ESCR19E0 BELOW ENGINEERING .........................._.._... .. PHONE DATE- Client? CUSTOMER (�03)425-107 12 C1 1201 154087 John Michelson BILLING STREET , SERVICE STREET 49 Willimantic D.rive P.O.BON 01 _ .. . SERVICE CITY,STATE.ZIP BILLING Cn'Y,STA T E.LP Marstons Mills.MA 02649 i`4arS(on5 Mills. N1A 02649 JOB DESCRIPTION Total: $4,868.39 Program Incentive: $4,868.39 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***001 Dollars UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARCEO MONTHLY ON ANY UNPAIO BALANCE AFTEA 90 DAYS.SEE RSE FOR RTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF T HERE ARE ANY BLANK SPACES AUT OR{ZE IONATURE•RISE ENCI ER' OUST ER ACCEPTANCE NOTE:THIS CONTRACT MAYBE WITHDRAWN BY US IF NOT ED L•/ITHIN ATE OF ACCEPTANCE ACC EPTANCEE OF CONTRACT•THE A90VE PRICES.SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US ANO ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORN. ....,.. DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED AGO%. 79.9 r 3 ms' DPu►pos plan do not�ePre- ' �` actual 5 , to PhYsical objects I � � }�7 6', .� i i A 1 s I , V .4 133 j" J , J ' fl X74.2 3 'l �fENNISx --- - .8 --- �\ X74 x 9 _ 1 62 � � I + I t x .15 COURT ' _ --- 13 ' ( `7 \ 71: j 6.4 } - ----- - _:_------ `:r I 1�6 n f\72.7 f w Assessor's Office(1st floor) Map �' �� Lot d,,erm-it'# Conservation Office(4th floor) I q) ) ;rl ;te Issued `��� / 9'f Board of Health(3rd floor)(8:30-9:30/1:00-2:00) S'D,UU Engineering Dept.(3rd floor) House#1 ��h d� c � �; ST BE P . Bldg.) INST'ALLE ANCE 19 ENl�6HONM DE AND TOWN OF BARNSTABLE��®WN ��� ��®�S l/ Building Permit Application Project treet ddre `Ty kllllm 111 Village wles 7DIJ .Owner ��r A JG�C/,//?FLS0A Address ZLh&& rv771C Telephone -Permit Request d p/;> d N 115;yMi L Y /lev 7PI •t- Cg"� &,E .Total 1 Story Area(include 1'story garages&decks) ld square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ y Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type A/&T D Commercial Residential /\ Dwelling Type: Single Family Two Family Multi-Family :Age of Existing Structure S Basement Type: Finished Historic House Unfinished X Old King's Highway Number of Baths__ 11:Z No.of Bedrooms Total Room Count(not including baths) (Q First Floor Heat Type and Fuel llo i gj i2 Central Air Fireplaces Garage: Detached, Other Detached Structures: Pool Attached Barn None Sheds Other /Builder Information �i #, Name_ f�-jiL/C/L / C- o/6Lc$ON Telephone Number '77,j— 3 09' Address /���' LG IL/6 1//64"a b4 License# (,6AI-60 0//e D a 6,3-�2 Home Improvement Contractor# Worker's Compensation# !�i NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO b olps SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. a i DATE ISSUED 6 ! fI 4 MAP/PARCEL NO. ADDRESS '' VILLAGE OWNER DATE OF INSPECTION: l FOUNDATION FRAME INSULATION b l�� � �/�/ FIREPLACE, ELECTRICAL: ROUGH FINAL PLUMBING: �R�OUGH FINAL GAS: •RbUGJJ ; 'FINAL " FINAL BUILDING DATE CLOSED 0i1Ta AIN ASSOCIATION RLAN;NOP E� tad L ' The Commonwealth of Atassachusctts •psi: _ _._- Department of Industrial Accidents OffIce0/111=1/ya11011s �w 600 N ashinl;ton Street Boston,Mass. (12111 Workers' Compensation Insurance Affidavit ._....� ,.�....._,__..._.....�....---_...... .....,...�-,,.. S--•.....�..wr,�.....•.....;p:.......r,.r.•:C„r..;:sue-..�-_...}.,..:___..._.......;..._ Leant �nfnrmatinn• Please PRINT le�lbl ----' ---- ^-- as name Inrntoone `7 / �J/ 1114 A LI C �3� �vv/ /r�s%��S A, // z�f cit), nhonetl 775-'5Y.368 ❑ I am a homeowner performing all work myself. �I am a sole proprietor and have no one working in an capacity ri ,.. t .. .. �rR'=is7': ,:> -.. �y1S.�i"ri`�T_.,•�.,,.._-,�.-- ,��!T_+.....:,.. .,R.:__a.'?"�_`�•l.ne�..r•:.�•n..+•Snn+w.�� I am an emplover providing workers' compensation for my employees working on this job. company name: address: cit: phone#• insurance co. policy# I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name address - city: phone#: insurance co. policy# `• • —r - +rn x-r a ::awn asr }:-'ri �st-raF�P$3'� TF-+u sRN -f c(impanw• name: address: city: phone#• insurance co policy# ditional`sfiteef .__.�..__..�__...._._.�,..:-:�si1:•• Failure to secure coverage as required under Section 25A of N1GL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or unc years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herehr certijI,«ruler the paints ttitd penalties of rjur}-flrat 1 njorntotion provided above is Tru�e/as d./correct. Sienature G��/L J Date f/�yy Print name,A r Z4A,_ 1 1l e—&W-61,�A/ Phone# 775--S.305 s_ iofrcial use oniv do not write in this area to be completed by city or town official city or town: permit/license g Inlluilding Department Licensing Board check if immediate response is required ❑Selectmen's Office oHeallh Department contact person: phone#; nOthcr (revised 3M5 P1A) The Town of Barnstable �$ Department of Health Safety and Environmental Services Ma Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Cm = Fax 508 775-3344 Building Commission For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;modernisation,conversion, improvement,.removal, demolition, or construction of an addition to any pre-pdsting owner occupied building containing at least one but not more than four dwelling units or to sauctmt s which are adlaaat to such residence or building be done by registered contractors,with certain e=Wdons,along with other requircments- 1 Est Cost �/��y Type of Work: /ADD i i o N Address of Work: y�'/ �/�l .-rI/�N Ti L Ole Ails-S a A s Owner.Name: ii�vn /U'//Cy�eL,so� Date of Permit Application: I hereby ctrtify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING'THEIR OWN PERMIT OR DEALING WITH UNKEGISTERED 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 Date Owner's name THE COMMONWEALTH OF MASSACHUSErM Board of Building Regulations and Standards Taansaction No. One Ashburton Plate-Room 1301 Boston, Msssachnsetts 02108 Registration No. Application for Registration as a Effective Date Home Improvement Contractor or Subcontractor MGL Chapter 142A, CMR 780-6 Eitpiration Dace FOR OFFICE USE ONLY - / Date 1. Name C /v Print the name of the in ' 'd or business applyin for the registration(not both) a Mailing Address 3 a (////e- State zip AreaCode tit Telephone Number ty 4. Street Address(if different) Print street and Number(P.O.Boa not acceptable) City State Tip S. Applicant type: 0, Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation (See instructions on back regarding enclosing a city or town registration under the DBA or"nctitious name"law-MGL c 110,ss S&6) 6. (see instructions) 7. Number of Employees d 8. Individual responsible for Home Improvement Contracts /��C/-{�4eLSox� �i9T2/e/L 9. Title of individual responsible for Home Improvement Contracts e1j.1 /P—,/L- 10. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? ,� ❑ If yes,complete the table below. Use additional paper if necessary. Yes No Type license or registration hued By Ucc=or aspiration Name of license Holder registration number Date url�e5i� c e r,2ucT D S� 2 Ue e,� aAJ Su�c>2�is�>Z Pursuant to Massachusetts General Laws Chapter 62C section 49A,I cart*under the penalties of PC*"that L to my best knowledge and bel14 have Ned all state tax returns and paW all state Wren required tower law. Signature of applicant or applicant's representative Tide held with applicant A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registratiom `+t ✓�ie T�airvnzanusea�t o�,./�aaoar./u�aetla r . Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY I CONSTRUCTION SUPERVISOR LICENSE 00 - None Nalber. Expires: ; 16 - 1 & 2 Emily Holes � .Restricted To: 00 "PATRICK 3 MICHAELSON 169 LONSVIEN OR CENTERVILLE, MA 02632 /9/ZT1-::U/ZID ✓�, f� Lo T 4;3- . M 38�f I certify that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date /oI/ Zd CERTI FI ED PLOT PLAN DV, 5 f LOCATION o• SCALE . . /.i.�.�... DATE No✓ Re aRid2`�'{`� r PLAN REFERENCE I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE IS77.�/L t�h/E441^16 or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUN plan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF supervision. 6,1 z STA-eZC WHEN CONSTRUCTED. DATE L/ND�9 !C, /�jiCf�AEZSo.✓ — P��7T/oN� REGISTERED LAND SURVE OR 1 ME ME�, � MM M--- MMi �11 �1IMMI1EMMMmEmmMEENM mmmm ME ME M M ME ME mmmmmmmmm ME Mom IMMI 0 No 0 M IMMEMEM loom OMNI MEMO mom 0 No SEEM MEN SEEN MEMEMEMM mommomm mmmil M M MEN MEENNEEMM ME Mom I NNNo E M MIM mom M MIN mi 0 MEN MINES mmom �Mmmm M MEME ME 0 MENEM MEMO Mom MMMM1 Mom M mimmm NOMMMMM- �11� �ME mmimmmmm M� u Ili i i - ;,, . - .� :, �- � - -v - � Y� i ,' j .j � � � I ,,- � � — _ � y Y � ,..,; - ,�' `� .� �s � � 6. _ it Y � '� '. ° � . dII '.i �f 1 i} .r1 `� � y f c_ i �Y a �'° i � �r � � � I i i I i 1 r. i -� / — - — - � + � I I! I � � � `� 1 i 1 y i !� A � r' i � I of K i f f �.J i i I �Y t �i 1 MENOMONEE " ■ i!� . .MIN Ml mi a �� i� � � mmmmmm MEMMME ME � E M ME MEE � �i'��11 I ME immim Ell MMIMMM mmmm MM w �1 1 mmmmmm mm M MMEN M � iimmmm M mmmimm im immmm M ME MEE m MEE ME M MMMMMEN M Im immmmmm M ME MENEM M M M mmmmmm MIMMMMMMM ommoommm'�i 0 M ME ME M M . A iiiie�e�� � 'iME MEN I i I I I - I ' I ' 7 _r I i i I 1 _ ' I - I 1 I i I ON MEN mmmmmmmm MEN MEN MIN � IIII�I �.: MEN M MENNEN I MEIN �%7&7 s set �. . .� is �SOME��OEM �IN IEN No ME MEMEMEM �'�EN loomII� N M WIN N IN m No mi � 111 M MENEM lim0 M lim111ON MEN MEN MEMNON 111 0 ME mom MMEMEN ommommomm ON 0 M NNOMMEM m 01 NONE MIMMEMS 0 MEMO MMENEM mom NEENJIM �!1 � i�i ui� .. I Il f I :.• k s� i i +rc: I r 4 IN 1oii„M �:;;' mmllm'E Iliiln��iMMMMMMMMMMMMMEMMMMMMMm MMIMMMMMM ME ME mi IN= MMMM�� MMEMEM MMMMMMMMMMMMIM Mm mmmmmm �l I MMMEMMMM MEMM MMMMMMMMMMM MMMMMEMMM MEN Ell .. ME I ONE mmmmm mmmm 1010 0 0�MM 0 ! 1ME Emmom l ENN �g �u moomm ONE ilmll MEN Imll MENEM MEMMEM M MEN 0 No m m ON mommomommo MEN No OEM NONE NO I MMMENE M I NONE e Ell�m ME El ON INN= ON No!MMM.:•. e,9e �eve�l 10 INE _� it loom 10 pENE r i f. .. __ _ __ _ j. ,: �� �-�- - -- �I� '� ' :��r: � _ - ..F�: �" - i � . (; � , . � � _ � _ � � - . '` !y ' _ � �r f ,� I { �` � ;i i i • i ' .� � t i I ��w.,i i i I � . � � a�,,. j � -:,; �„ _�- �_ � � _��_ N.-�.,� — � +. � �� . � - r � i --- :, . -- --, :� � �-�' i � � � �i Assessor's office (1st floor): /G 3 O iTHEt Assessor's map and lot number Q o o` Board of Health (3rd floor): Sewage Permit number ..D .... .oSd ..(�. .. LL, � Engineering Department Ord floor): . J$ �NST�L"�- � �� COS �o M"°a House number ........................................... ...�............. WI�i TITLE O �639 �0 Definitive Plan Approved by Planning Board --------------------------------19-------- . ENVIRONMENTAL CO APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P,M. only TOWN REGULATIONS TOWN OF . BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..Pd.d..... !��.....F-hP K... OKMe ................................................... TYPEOF CONSTRUCTION ........Wood.......FT.'arne................................................. .................................. .............. .. .....---.........19........ TO THE INSPECTOR OF BUILDINGS The undersigned hereby applies for a permit according to the following information: Location ..kn' .....�.9.............49.....I l.�.�.t.l!!!i.fill ?SIC... Q.....................I..IAas.!. .NS......b!. ....................... Proposed Use ....GX.T.Q.N.Q. Q....... ?.. ...d.ok .X 1ST 1NG.... ....�Erd.p .. .5........ .. ....... J�,TH ..................... Zoning District ........... . .... r ...�........................................Fire District Name of Owner Lw&... i.Cka:dS0^1...................Address .!19....W.d.. .t.MtnN.rJ.Cr..... Dkt........M IM:1!S Name of Builder ... 1.. . .``f.....�....OlaLM.TH.&N..............Address ....I3L-7rH....�A!V.F..............L,.j jP.k)A)j.4..... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ....................�.......................................Foundation . ............. /*** .................................................. Exterior .........Vv.Eocf......S.lroo(... .................................Roofin #4--`-.PA4f4 -T Floors ..............cag.e.wr..................................................Interior ............�.e,I, W........ .................................................... Heating .....RaT....A!..R....................................Plumbing ..............13.eT.H......(640 Fireplace ..................../1!./A.................................................Approximate Cost .............1A.r.Q0.Q....................................... ces �. Pam- ���b Area VI -0.�`'`.."'.... .. . g g h miens_ ipprs Fey Diagram of Lot and Building with Di ]� ���•ot......•.••_...•_.. . ZEP TA 0 1 i I I . I I e I I "Ilk I W; 11in.�r�,'f1C 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. t Name ....14.+.... ...' . ................. Construction Supervisor's license ...Q.0.q.9..75......... a ,MICHAELSON, LINDA K. z «o ; 32286.„Permit for ....ADD...DORMER Single...Fami.ly... welling_......... . e T location .Lot ..#89, 49 Willimantic Drivel Marstons Mills..... ................ ....... ..... ........... -• sr 1: .. t_ Owner '...Linda K. Michaelson Type of Construction' .'..Frame +.. ......................................................... ........ rt Plot .....`...................... Lot Permit Gran ed September =21 , 1,g 88 4 Date of'lrispection .,:. - .. .e,s . ..19 u � 1 Date Completed .. .. ...�' ..�19 s x Y I t :� r `Y r7s. , NJ 71, ttj It V•�) 2. . J Assetsor's office Ost floor): /0.3 _� l� ^� �o o� Assessor's map and lot number ..._. . . . c� FT NET ` Board of Health (3rd floor):- WQ o Sewage Permit number ...�1J�......�: .at .SJ.2QM Engineering Department Ord floor): !ry ri� moo 16}9' Housenumber .............................................. ........................ Definitive Plan Approved by Planning Board ________________________________19__-_._:_ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..Add..... ................................................ TYPEOF CONSTRUCTION .........W.oe,)d........Fro.>m.e................................................ .................................. .� ff TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the'following information: Location ... !. .T......P�. ..............! ..... .!.1.�.1.►'vi �.)Tic....n�; A2�►0►JS �"�� �lt, .. . ...................... Proposed Use .... X..T. .!�1. E.I�........iF.X.1ST.I.N.G.....` ..... E�'Ik:f?O.►?!1. ............ ...1� (� �ATH Zoning District ...........�.�...'.�....�........................................Fire District ...��—L..../'). ..... ......................... I I Name of Owner J.;.....d.:...........H!.C!1A...I`4.......................Address .!:I:. ....�..!.....!.I.►.'!e`f.N.....(...�....�................... �.5.l.t1Ns �� 11 �. .. .ALl..l71. .!V.............:Address ..... .C.J.H.... AN. ......'........f't�1.P..!�?.1�).1.5.............. Name of Fuilder ....r ..t. . .. ........ f` Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ......................; r........................................Foundation I/�d,nO......`SN..!. G�.�......................... ............ 5 P I-)A LT Exterior ......... . . Roofing ........................................................... Floors .............. 9..-7..................................................Interior D2 . fit)/-lll ...............................\................................. Heating F.QkCCG�......E o..r....A.l.�...................................Plumbing ............. .....-�:.!�......(.. ................::........:...f Fireplace .....................NIA " .ess... . ................. ................Approximate Cost ............. . . .Q.n.O.,.................................. Area mob., �.� Diagram of Lot and Building with Dimlensio,n io Fey . U 15EPTC- -1 TA Q 51 p I ! I � I • �G I s 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. ) A Namea..l��...... /...f �!..�!,, tt_k.�+.t1?��................. :` Construction Supervisor's license ...Q.D...%.�..7..5".......... IMICHAELSON, LINDA K., A=103-062 0'e" � tQo .322.86•• Permit for ..Add... ormer '.•..;•Si•ng•le•••Famly.•Dwell• ng•••••••. Location ....... O1;...#.89.R......4.9••Wil•limantic Drive .....................MAK.stan ..:.................. Owner ........Linda••K.•••Michaelson••...•• Type of Construction ...k'.;~Me.......................... ...............................................: Plot ....:....................... Lot ................................ Permit Graded ... e•ptember•••2.1......19 88 Date of Inspection ....................................19 - i Date Completed ......................................1,9 90 d f ;4AAA PERMIT COMPLETED 1/1/ I