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HomeMy WebLinkAbout0124 WIANNO AVENUE �� n � �, ° a ,'r . �.�...... � r._..._.:,-. ..- �--... ...:�......�.�,�n......__ ......„�_,,..-+.._.. ,..,...i4-.,� .�+.. ,._.,,r�r�.,, � ..-.,,..����'1...,..._. ice. --.�.��....-^�,,,..._. r�.,.......r4.n__+-..� ,,.�^+.........-rr....--... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l Parcel Application dA*—(A_ Health Division Date Issued Conservation Division Application-Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 0' r C n no VC 02O6,T, Village OS fy C,..r i J le- , IMO- Owner Vic_k + Al. BO-f k__}Q Address 12 q W I oAnnn Ave_ Telephonej�1Permit Request la 6,j.r of R-35 milli l as 6_*;EjQ) 6 IP_0 DAC. . .741 _ lcx4e_ Vexti- : kzle S14 CcLffexr '60_yc, R Tti l► 02 iausv ioJed hoes a net cpbk LA=11 rnwn4e8 % ee4s 03SO) (p/n( Iie�4� 10 oblen Qabvrj in �r�t ice. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation"I Construction Type &)10_4 r(9r) Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new BUILDING DEPT. Total Room Count (not including baths): existing new First (or1R_b^i?Ui1�ount Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other TOWN OF BARNSTABLE 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) Name ?a1()LrA Telephone Number .� -547 -676 6 Address q/D bf—ov V_ =S1 License # Ji 0:3 S 6 / Home Improvement Contractor# f Sb 7(1 7 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO j ecp (,�112 Ee V-') ��' T SIGNATURE DATE FOR OFFICIAL USE ONLY , ' APPLICATION # DATE ISSUED MAP/PARCEL NO. , 'l ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL = 'r GAS: ROUGH FINAL , FINAL BUILDING r DATE CLOSED OUT ' ASSOCIATION PLAN NO. .y o�o Mee '�`� Rictla:cd'V.•Ssati,.Dirt�clor,. Maq' 3uzlclRng�DtiSo . •raldpOixy; uu iiYag timinissioftr 20bTGlaiii Suet;;-�yaruiis;' >tY26C9Y" . �vivw.to�n.?iari�t�blc.rna:us• ©ffieo: 5W`862,-4438 Fax: 5018, 90:-b230 14CRpe_Owner VJCu;�t. Co�np�e f fisxng..�;B:u�c���r »r �erc�rthe siib�ocr property" hcreb' Zu Iioai e n U jc S Gt _` ici aot o r aehalf,. in.all m mrs.cola i-ve.to woik at.=thorized:by this buAdip pernit�applicatic n for_ ' 'titil ene s and,alar�s aft,the r spon 'ozl�i*o diefap ilican ;-Pbca3s are not't o be:£i17r d.or tiul zed' rice�fcnct�:i , sis fled°and all�:uial: ms eccoas- re pe-if'o zned a. acc.epted. SigFaattu-e 4'1104ner s ie�;of.-Apph - t �/r ~ ;n ® rini. PrintlVarbe Date QTORTas:o�,WF..R ElU fTSSIOIN1100j I i The Commonwealth of Alassachusetts r Department oflndustrialAceidents I Congress Street,Suite 100 Boston,ilfA 02114-20.17 ww1 .nzass.gov1dla orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/.Organization/individual):Insulate2Save/Roland Langevin Address:410 Grove Street City/State/lip;Fall River MA 02720 Phone#:508-567-6706 Are you an employee?Check the appropriate box: Type of.project(required). t.❑✓ 1 am a employee with 20 employees(full and/or pari-time).* 7. .New construction, 2.O 1 am a sole proprietor or partnership and have no employees working for me in S. F1 Remodeling any capacity.[l Jo workers'comp.insurance required] 3.a I am a homcowtler doing all work myself.[No workers'comp,insurance required.]t 9. ❑Demolition 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensuree that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with'no employees. 1.2.❑Plumbing repairs or additions 5.❑lam a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.E]Roof repairs r 14. y1 e Other insulation 6. are a corporation and its officers have exercised their right of exemption per MGI_c. 152.§1(4),and We have.no employees.[No workers'comp.insurance required.] "Any applicant that chcfks 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 trust submit a new affidavit indicating such. -Contractors that check ibis box must attached an additional sheet showing the name ofthe 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. am an employer fitat is providing workers'compensation insurance for my employees. Below islhe policy and job site information. Insurance Company Name:Liberty Mutual Insurance Policy#or Self-ins; Lie.#:XWS 56418741 Expiration Date:12/10/16 Job Site Address._ love— City/State/Zip-�C�e�� Attach a copy of the workers'compensation policy declaration page(shoring the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,525A is a criminal violation punishable by a fine up to S 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.A copy of this statement may be forwarded to the Office of.Investigations of the DIA for insurance coverage verificatign. l do hereby certify under the pains and Halt' -of erjrrry that the information provided above is true and correct. Si nature: Date: Phone#:508-567-l$706 Official use only,' Do not►vrite in this area,to be completer)by c•inr or torus 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:; 0. Phone#: -= ,: _ Office of Consumer Affairs and Business Regulation ' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 180747 Type: Corporation _ Expiration: 12/29/2016 Tr# 261507 INSULATE 2 SAVE , INC. ROLAND ;LANGEVIN 410 GROVE ST -- FALLRIVER, MA 02720 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card Office of Consume-Affairs S Business Regulation License or registration valid for individul use only HOME IMPROVEOENT CONTRACTOR before the expiration date. If found return to: r� 9'Registration: 180747 Type: Office of Consumer Affairs and Business Regulation '✓.\A l!f Expiration: 12/29/2016 Corporation IO Park Plaza-Suite 5170 <= - � Boston,MA 02116 INSULATE 2 SAVE ,INC, ROLAND LANGEVIN � /J 410 GROVE ST FALLRIVER,MA 02720 Undersecretary Not valid without signature Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS-103861 Construction Supervisor ROLAND LANGEVIN 56 HIGHCREST ROAD FALL RIVER MA 02720'-, <� f Expiration: Commissioner 08/24/2017 I • I ZW - RAW-IE 5 aoF f0MTMQM-YAMWCOM MR 0,6,MGM QM— Al©T COMMUTE A CONTRACT N 7ilE'%StM"�, ii!!Q BCE HOLDER.. NIPM '.- • . ,.. - .- + � a11 @itiF�OTS@F1�?�'•A'S�d�F1Et1�.OR�S C@ �195.�•�QE�'f ��@ P'RCOMM HAUL: Pj t€q r F:. Cosdairo In urraace P • '50S 677-0407 I73:' Piesit Street 3isou2aOrderoia .tom F 1,River, l& 02721. care s. MAIM A: Mutual IA8Z4T3aCQ. " iHwsUREFt 8: } Lmsulate 2 gave, Inc. IMBtlR6tC: 410 Grove:St. iraura: Fa I lover, Ta 02720 tMMM F: CERTF. � 9 MW Tt�POLICES OF�.UStED O&OW R%VE BEEN WMD TO T D NN4{B1 A8E�t7 £�2;`3 C OD j S�off,T04Hut OR CONDITION OF ANY OTId OR H2:DO Wff't!£ EGf T4' i S lid 8E OR WAY P 'F/W.THE ING, LW CE AFFORDED BY THE POli=131MGMED HEREIN L4 StXECT To Ali..TH'HE-TERIdS, a 10-1S 9M0M0TMa0F MJCH:POLMES,t!I M S CM MAY HAVE BEEN fAMElCED BY PAJD C1A6ula Y 1=6; 5641.8741 12/10/15 12/10/14 � : cws:cEiwaerrY OCCiJR eiEc EXP(An�eone 'on S I + tsoaasa a0+t ` s 1. 000 000 I cEiAocREcniE. , s. 2 ':�0: c A*GGFf W7EL �sAaQUESPER � � PRODUCM-CO%V .Actc s 2 Oi#0 .000 l LOC s Y Y BAA 56418741 ; 12/i0/1s 12/20/16 ,' is 1 000 000 AW ° I 80aA Y ALAlRY(P P S R 490MEDULED �{ i 600LY RiAJRY.fPaG S .•.t$RE�A�.Cl5 . .�� � t � � PROPS. ' fl� g siam X oom Y Y USO 56418741 112/10/1s� 12110(16 ,.occ s 2 'OQfl ab CLAMMME i AGGfECATE s 1fl 40.4r A I 12/1.0/151 12/10/iS X�1S 5.6418741 .X vArsrATu OTHi- YIN 1jlA' i EL EACHAC molar s 5fl0 .000 EL. - aaPtoY s Soo. 00.0 9saP6ib► eeloii i El.=S44E•-P0U6YtINlfl s 500 '0.00 bHF I LCOMM IVENOW(At WORD W1,Ad2&MdRomftSeJ*dLtt,tfmonspM SngdfgM Proo of insurance CAI CE.1-A3'lE3!! SHOULD.AW OF THE ABOVE SESOMSED PGM,HCfS BE CMCOAZOSEFM THE EXfMr4N WE TfEMW, 'NOTICE WILL BE DEU MM N ACCORDAiM WM IM POUHCY PROYMM. AMOMEa RE?AESB"ABVE 0"Sea10 ACORD'CORPORAMm AN figltfs fesemd. AOORQ26f ? The ACORD name and logo am regiWsedinaft ofACORD Fes'. E-mail. �,� - .. Federal IQ ft OSo405829 RISE En tneeriid R1'corrtractor Reglspatlan O sloe > g' HUY ContraetiTr itegisfratlon No:t20979= A.d'fvisiob of Thielseb£agiaeenag Oil Reg{siratlon,Wo;b20120 .1 -S:Dupont Aye;:S�outb.Yarmouth;:NIA 02664' /+ £IdGINEERING V Q .'1T 508368-1926 FAX'30 568-1933: ,Page: 1' PROGRAMv `.7tfM'cONTRACT f8 FIJTERED RifrO;BETLYEEN;RIBE: MOCOSES nxiamniearsToru FeaWancav VESMSEG'aMOW akoHi: WOPXCRD£n Vicki ivi:$arlettia (61:7)5339.6462 08/25/2016, '224591 26001 ;SERVICE STREET 124 W-iAiitto Avenue 171;0ilre1,Rood ij•'�'� .BttLIHO tRY:SIATE.aP. Y_�'s ;j. :Ostervtlie;MA.U2655 Chestnttt.Htll,NMAU2467 --- - -- _- --- 2Q �JU$DESCk'IPTION r,r AIR SEAL IIVG Provide labor ar+d materials to seal'aneas of your home;t ga�nst wasteful excess air leakage This.work will:be petfo m IT .concert witli;the use of special tools and'diagnostic tests to assure that your home:will:be'teft with a healthful level of air exchartge and indooi air quabty 7vtatenats:lobe used:to.seal your,home.•can include caullcs,foaros,weattierstrippingend er products Primary mctude,air leaTmge-ao;amcs,.>asements:attached�atages and'other.unheated ateas.(amdows;are not-generally-addressed) (2b)wori ing _.,. .. :Hours..A"reduction ut'cubic:fixt per minute(cfrn)ofair infiluatron will occur;but'the'actuifl numtierbf:cfm isnot;guaraiitectl: 5:2 002 0 AIR SEALING Provide tabor aril materials to tnstatl:Q-lorriveatherstnpprng and 0:46orsw6c ta'(b)doors)to resmct aar teal ge ;DAMMNG:;Provide;labor and'.n atenals°to msiall:•a 12 layer of R-38:unfeced fibergless belts to(140);square'feet foe deriimmg;Purposes, 5344:40. i AnICT. Provide labor+and.materi�ls to•in all.a:;YO7 layer af,R35 Class'1:Ceit.1w,+added to;(1384)square.feet.ofopen atticspace; $1 854 S& Provide.lab�i•andma4rnals to insulate the•back:of the:att►c hatch with 2"ng�8 foam_board andseul the edge of the'hatsh'.wdh weatherstrrppmg;. $42.50' t ;ATI IC ACCESS'Provrtle labor and materials to risplatetkc%tiacl.of i1'.)' c hatch with;2"'rigid Ihcrmax board.Weatherstrip the.Aixrmete:. $42a0 ATDC ACCESS Provide labo"and materials to nuke(I) access opening from one attic area to another by ctitting a passage tlrrougii; sheathing Thisaccess will.be:leR open,as R 0s tietwccWtwo common unheated non'fir6walled attic areas; $31'3i1 ' VEN7T[ATIQN Prbyide lafior ami materials to install,(2)insutated exhaust hose with'gatile wali'rnounted Iliipper vent fo'exhaust'exisripg ,tiat}iroom fen(s).. �$215i0.t): 'VEN 1ILAT10N Pivviflelaboaan8 materials to iisstall:ventiletron chutes�d(94)'rafler bays to ma►ntain err flow: COMMON:WALLS:Provide labor and materials to u�stsll 2�FSK faced semi rigid fiberglass{ward insuiaUon to(192}square feet:of common' wit area Homeowner has raxived a copy of the EPA's Renovate Rrgtit Lead-Safe,inforniadon gtride explamirg the potential nsl.of the lead Iiarard.eXposun from;the=weatherizgIbn'wor&to be;perfomied Yoursignature'is your actmowedgement ofrece�pt;and:agreement;tq;proceesi `$635s52` ;BASEIviENT 000t2;:Proviite:labor ariil:mateiials:to insulate the back:of the basement door•;kading:tathe bulkhead w"ith`.2k rigid board`ffiaf meets th sec dons=R=3163-A.and 33b;b'requirements.ofbuilding.code: Seal al edges and seams%ith,O. tape. $72;22, " Federal ID#0ti-040 M ai Conbactoi seg'lWaUOn d,81K- RISE.Engineering r+w.cor:iraetOr aeeWbvitton too 40979� A division of Thieisch Engineering. CT Contractor seglst—dn Wo,62012Q R1 5 Dupont Ave,Sontb Y8rmou h,hid►61664 ENGINEERING CONTRACT SM568.1926 FAX"568-568-1933 Page 2 PROGRAM TitIS cavrrtAcn.�.�trERmrxrD'e£Tweoi�ar� Nib EgGWEEttlNti aELcav ADm THE cusrataER:F0AW0RK As oEsr�En CUSTOMER --- PHONE `--- DATE CLENTS'- vromiox�a Vicki'M Barletta' (61-7)538-5462 08/25/2016 224581 26002 SERVICE STREET ealcao STREET 124 Wiatmt 'Avenue 7 7 Laurel Road 8ERVICr CrrY;STATE;ZIP' BIIiHiO CrrY,BTATE,'Z!P Qsterville;MA 02655 Chestnut:Hill,:MA 02467 JOB DESCRIPTION CRAWL SPADE HEIGHT MnUC11uN:Your home's crawlspa0e height is lower tharroilr standard for Broil:to Qrocexd:..the sob=contractor assignW to.rtsfai)these weatherizarion tt easlucs:rescrves thi>rigtit.of refusal,upon visual'inspection of vour Crawlspai e. CRAWLSPACF;Provide iabouand'materials to install(1390)square fei t of 6 ml-polyethylene over apen.gound;in designated crawlspacelearthembasement antes. . $1;062:60 INCENTIVE:RISE Engmarin will apply atl`applioable,eligible incentives to this contract. You will be billed onty.the Tact emour�t: CuireoUy; for eLgibtc nieasures-National Grid offers 75%incentive,not to.'exceed$2,000 per:calmdar.year,and.gi incentive of 100°Jo for the Air Seating measures. For thesafbty,an&health'.a'fyour home's.indoor'air quality,we_will'be,conducting:a:blower,door diagnostic of the available airflow-in your- hornt"before the w0rHi begun;•and after the weatheri7atioirwork is complete.We will also conducra diagnostic assessment of the eombustibn fumes-in the-exhaust flue of your beating*%d n•and water heater.This has•a value of$90 and is atmo cost'.to:you. The Permit will be secured-by the insulation contractor,.at madditional cost.It is the homeowner's responsibility to ciose.outthis'permit.by ca maing their,municipality at the.completion of this work. Totaf` $7-j$ :67 Pr6gram4ticentive $4;554.00 ; customerTotai:: $3,628.67 it7E AGREE HEREBY To FURNISM:SERVICES-00HIPL M IN ACCORDANCE YVITM ABOVE SPECIFiCATtOMB'EOA`THE.St1MQF '"Two Thousand`Six Hundred Twenty-Eight&67-11007D611ars: $2 528.67 UPON fINl1L tNSPECTION:AND APPROVAL'aY R18E EN6Ri£F.RMO:CUSTOEtER;AOrtE£S TO-R£IIfTASdOUNL DUE tN FULL W TEREST.OF-.1%'WIU..BE CHARGED FIONTlfLY,.ON.AR(Y UlIPAtD'9ALANCE AFTElI.30 DAY&8FF,REVERB£FOR kMP6RTANT DJFOSU1ATfCLi ON�CUAnANTEEB;.WCt}ITS OF RECfStON:BCNFDiA.i1d6.'AMDCONiRACTOR RECitBTRATiDN:' .. —— l�D ttOT SIGN'THIS CON7RACT9F THERE ARE BLANK SPACES' I1UTi{ORP£p'BIGPIIITUR£':RtBE FlgirteeNtO; —_—�. 1...-..—...--.. T ACCEDTARCE� . NOTE:THIS:CONTRACT.tdAY'BE WIi14DRAWTI SYUS ff NOT EXECUTED WITHIN i DATE OF ACCEPTANCE - .r ACCEPTANCE OF CONTRACT=TI4480Ye PRkZ%SPECIFlCATIO!ffi,AND CONpniDRfs'AR[c.. 30 SATISFACTORY Tn us ARID ARE HEREBY ACC£PIMYOU ARE AUTNOtt�TO,DO THE;WM ... DA`&- �AS SPECIFIED,PAYMENT WILL BE MADE AS OUTUNW ABOVE * Town of Barnstable Permit ILI Expires 6 rr nths ron 'sue date Regulatory Services Fee uitxsTAsi.a. v M'S Thomas F.Geiler,Director 1639.CFO MAC A Building Division 1 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /I �O� oo Not Valid without Red X-Press Imprint Map/parcel Number "F (/ �( [ /f Property Address�� Gl/ �9/1�o 4/i �X Q�7G'"VI h 1 L 0-S5 Residential Value of Work r/Sl r'. cxl Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address li IC L i e- 12y ( l Qn/70 Os -✓��� Css Contractor's Name �G(/� - D C a -F'f'+c Telephone Number C ('o� SrZ7- ` Z a Z Home Improvement Contractor License#(if applicable) /O S 2117 -exo;r4�c,, 81i3/20/SV Construction Supervisor's License#(if applicable) ` D Z7 3 «m A C0-1 ❑Workman's Compensation Insurance • RESS PERMIT Check one: ❑ I am a sole proprietor APR 16 2013 ❑ I am the Homeowner V-shave Worker's Compensation Insurance Insurance Company Name T VN OF 13 RNSTABLE Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) _j b G 1 (�Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to fG S7i. w +�4m ?'tans pc,4- ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 1 �ACOREr,, CERTIFICATE OF LIABILITY INSURANCE D ATE(MN11DD/YYY1)02/25/2013 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 GUNIAGI NAME: CIC, V Pres, James Tarpey ac°"vo Ert: 978.774.9040 AIC,No):978.774.3581 491 Maple St (Rt 62)-Suite 304 ADDRESS: PO BOX 183 INSURER(S)AFFORDING COVERAGE NAIC# Danvers, MA 01923-0383 INSURERA: AmTrust International Underwrites Limited INSURED Paul E Dutelle & Co, Inc. INSURERS: Norfolk & Dedham 23965 153 Pearl St. INSURERC: Commerce & Industry Ins Company Newton, MA 02460 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 6/2012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INS yyyp POLICY NUMBER MMIDO MM/DO LIMITS GENERALLIABILITY NES101025 06/12/2012 06/12/2013 EACH OCCURRENCE $ 11000,00 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ S0,000 CLAIMS-MADE Fiq OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00( 7X POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY BA90914066 06/12/2012 06/12/2013 Ea acddent $ 1,000, ANY AUTO BODILY INJURY(Per person) $ B AUTOS AUTOS ALL OWNED X SCHEDULED X BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED $ AUTOS PeracddeM I UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ wORHERS COMPENSATION WC006430391 06/12/2012 06/12/2013 X AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER _ ANY PROPRIETOR/PARTNER/EXECUTI E.L.EACH ACCIDENT $ 100,000 C OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5001 00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE James Tare , CIC, V Pres ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I L_ The Commonwealth of Massachusetts Department of Industrial Accidents Oflw' a of Investigations vi 600 Washington Street Boston,MA 02111 ,vmv.massgov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicaut Information Please Print 1,eidbly Name(Busm lln esstorganizationdividual): C1U1 G �ou ,L 4� Address: lS73 Pod <. eo �N6O City/Sta&Zip: 6,u A--- irlIsS Phone#: �0/7- �2`7— 729 2— Am you an employer?Check the appropriate box: Type of project(required): 1.j].I am a employer with _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)-* have hired the sub-contractors 2.❑ I am a sole proprietor ar parl;ler- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sob-contractors have g_ ❑Demolition working for me in any capacity. employees and have wot icers' 9. ❑Building addition [No workers'camp.insurance comp.insurance-1 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required-1 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers'_comp. right of exemption per MGL 12.tO^Roof repairs insurance mod-]I c.152,§1(4X and we have no employees.[No workers' 13.❑Other comp.insurance required] •Aay applicant that checks boa#1 nmst also fal oat the section below showing tLeu war$ers'eampensation policy inf"Mation- I Homeowners wbo submit this affidavit indicating they are doing all waik and then hire ouWe contractors must submit anew afdsvit indicating such TConnactm that check this WE must attached an additional sheet showing the name of the 4ab-comtacmt5 and state whe*u or not those entities Lave employees. If the subcontractors have employees,they must provide their warke n'comp.policy number. I am an employer that is providing workers'conipensation insurance for my employee& Below is the policy and job site information. �) Insurance Company Name: lJ Policy 4 or Self-ins-Lic.4: U4 CJuCv q 33 Q, Expiration Date:�0 2 Zo,�lA,3 Job Site Address- /a4 UV%csht'la AAle _City/StatelZip: CAi�V�L IdCS3 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 cerfift wider the pair d nalties of perjury that the info rat ation provided above is bate and correct Si tore: Date: y /& Phone# 92X gz9di Official we only. Do not write in this area,to be completed by city or town official. City or Town: PermitfLicense 9 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 th 6 i -- --- - f Telephones: (617)527-7282-3 Reg# 108219 Fax: (617)527-7284 PAUL E. DUTELLE AND CO., INC. Roofers and Metal Craftsmen SLATE,COPPER,TIN,TILE and COMPOSITION ROOFING,SKYLIGHTS CORNICES,GUTTERS,CONDUCTORS,TERMITE CONTROL P. O. Box 96 Newtonville, Mass. 02460 January 4, 2013 SUBJECT: Work proposed as outlined in our letters.dated May 14, 2012 CONTRACT FOR: Property located at 124 Wianno Avenue, Osterville Ma PRICING: $56,682.00 this pricing does include taxes REMARKS: Work to be done as outlined in our letter dated 5-14-12 Exceptions: The pricing does not reflect permits for the City of Osterville Note: Any changes from work as outlined in our letter will be executed only upon Owners or their representative's authorization. GUARANTEE: Paul E Dutelle & Company shall, subject to receipt of final payment, guarantee all work performed on this project for a period of one (i) year from date of completion. All materials guaranteed to be as specified. All work to be performed by our trained mechanics and according to the best trade practices. We as a company follow and are bound by Mass General Law 142A which is applicable to all Licensed Contractors. PAYMENT SCHEDULE: 1/3 Deposit of$18,894.00 for materials etc. with the remainder to be billed as work progresses with final installment to be billed at completion. All invoices payable upon receipt. Respectfully submitted Accepted b urran Vicki President WORKMANSHIP --- QUALITY --- SERVICE Since 1893 - - - - r Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen isor 1 x 2 Famil License: CSFA-082736 168 LAKE Sr-' WRIVMGTN. MA OY882 Commissioner Expiration 03/13/2014 ' lee �o7rvnza�zuieall/ a�../�avaac%uae(,ta Office of Consumer Affairs&B siness Regulation TC HOME IMPROVEMENT CONTRACTOR Registration: -108219 Type: Expiration: :8%13%2014 Private Corporatior- UTELLE CHARLES CURRAN` * ~� 153'Pearl St/Box 96,, Newtonville,MA Undersecretary `_COMMONW.EALTH OF MASSACHUSETTS ' F. SHEET METAL WORKERS d. CHARLE'S 'T CURRAN. PAUL E DUTELLE CO INC t :153 PEARL ST w .;: . NEWT0NVI L LE MA 02458=1443 <i LICENSE NO. EXkI., 7 I Restricted-One-and two-family dwellings or any accessory building thereto, irrespective of size. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPs S l .- License or registration valid for individul use only before the expiration date. If found'return to: Office of Consumer Affairs and Business Regulation: 10 Park Plaza-Suite 5170 3` Boston,MA 02116 • r. r Not va i without signature r � a U/GG 3 S-7p pFn rqr Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee Sf HAMSTAB MASSO v 1 � Thomas F.Geiler,Director �'�ec atAr' Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address a vV 1 Cl 11 c� v ► y r j/ t ( 2-6 — I- hl 3S �— esidential Value of Work v Minimum fee of V5:.00-for work under$6000.00 //Owner's Name&Address j . 13 Q r If _t+ a Contractor's Name G;:r �r Telephone Number 57/ 1 Home Improvement Contractor License#(if applicable) 10 Construction Supervisor's License#(if applicable) X „a o.a, PERMIT � ESS Workman's Compensation Insurance r Check one: J U L 15 2 o l o I-am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTA.B�E ❑ I have Worker's Compensation Insurance Insurance Company Name (,'' f / /dl U A)6— r_!) Workman's Comp.Policy# �- 3 2 O Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows r� Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property 014 must sign Property Owner Letter of Permission. A copy of t e II a Improvement Contractors License&Construction Supervisors License is requ' ed SIGNATURE: CAUsers\decollikWppData ocal crosoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:. a 00740 Type: Office of Consumer Affairs and Business Regulation Expiration: &2312012 Private Corporation 10 Park Plaza-Suite 5170 - - Boston,MA 02116 WCAIZZIHOME IMRRO-_VEWE_NT!1''�rr'1'C. Thomas 1645 Newton Rd. Cotuit, MA 02635 Undersecretary r rY �Nota�lid �ousgn�atr, Dcl)iirt:ni 0 ot,Public ' a';Jeo Board 4A 6uildin and siandill'il Construction Supervisor License License: CS 74640 Rest icted.to: 00 fir r K�- GARY GUSTAFSONs ,� r� ,fin � • 1 8 SHORT WAY SANDWICH, MA 02563 e C.XpIrijt!{)ii. 11/29/2010 rr-: 7755 j 1 ' The Commonwealth of Massachusetts 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/Plumbers Applicant Information 1 '_ Please Print Legibly Name(Business/Organization/Individual): . ZL,- Mnp M—P,— ry V e—I'L-e P1 fi Address: D GL b� City/State/Zip: 4 mA ' 3J -- - Phone.#: , 7 < �ZO 9 S/ l Are you an employer? Check the appropriate box: Type of project(required):. 1. a employer with t 4. El am a general contractor and I oyees(full and/or * have hired the sub-contractors 6. ❑New construction empl art-time). ��• r--- ❑ I am a sole proprietor or partner- - listed on the'attached sheet. 7; L-Zemodeling L - _—T, 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 required.]t c. 152, §1(4),and we have no 13. ther rep to C�(mph employees. [No workers' ��. comp. insurance required.] 1J U) '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 subcontractors 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. 1 Insurance Company Name: Policy#or Self-ins. Lic.#: N W �5 `T 3 Z - Expiration Date: ? Job Site Address: %/�� �l_�_n t) J,f�_ _ — City/State/Zip �S' e f�! t �� ��'I/�o2(;,s3 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 MGGL 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do-hereby-c-art ify und ai and-penalties of perjury-that-the-infor-mation-pr-avi above-is-tr-ue-and-cor-r-ect. Si ature: Date: v — Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE 70604/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:NTAC Karen A Walther,CISR Rogers$Gray Ins.-So.Dennis PHONE 5087604630 5 A/C,No - - A/C Ext: ,No): 08-258-2230 434 Route 134 ADDRESS: waltherka@rogersgray.com P.O.Box 1601 PRODUCE South Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance Co. Capiui Home Improvement,Inc. ACE Property 8r INSURER B: p •t Casualty Ins.Co Capizzi Enterprises,Inc. 1645 Newtown Road INSURER C: Cotuit, MA 02635 INSURERD: 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 TYPE OF INSURANCE D UBR POLICY EFF POLICY EXP LTR NSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocarnence $500,000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY F PRO LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $500 000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Uninsured $250000/500000 1 Underinsured $250000/500000 A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE g5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE - $ X RETENTION $ 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2009 12/25/201 X WC srATu- oTH- AND EMPLOYERS'LIABILITY Y/N LI ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 NIA OFFICERIMEMBER EXCLUDED? �N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 I 'I T DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpentry CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment 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 Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S52549/M52541 KW Y .t Page 7,of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT K i (3(q r) 'e--+� t OWN THE PROPERTY LOCATED AT t -e- i! —T - I IN Ste. ✓I ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I I GIVE MY PERMISSION TO LESSEE it TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. i' SIGNATURE OF OWNER: ' OWNER'S ADDRESS: 1 G�//cc.,�,r,D /I y akr0l r�2�✓"1 ©°� OWNERS TELEPHONE: �f � LESSEE'S SIGNATURE: LESSEE'S ADDRESS: ` LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 I APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: 6 RESPONSIBLE OFFICER TELEPHONE: ' ! - Town of Barnstable *Permit# bO U,TOZ � Expires 6 months from issue dale Regulatory Services Fee z Thomas F.Geiler,Director, . Building Division 11�19�`t Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tbwn.barnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION = RESIDENTIAL ONLY , Not Valid without Red X-Press Imprint Map/parcel Number ko, ' Property Address Z 4 "Y l AA/A/D, A U,�E C)51 L [,Residential Value of Work ZOCD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name —����� `M���� Telephone Number 3 q 4 1 Home Improvement Contractor License#(if applicable) U `� Construction Supervisor's License#(if applicable) cs a 4 ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor N�V 9 2��� I am the Homeowner . I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name A i M M j i lJ As L Workman's Comp.Policy# wC 7Cyo,�-- 3 -70 Z 00 Copy of Insurance Compliance Certificate must be-on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going.over existing layers of roof) ' ❑ Re-side Replacement Windows/doors/sliders. U-Value'3Z* (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.' A copy of e Home Improvement Contractors License is required. l,SIGNATURE: Q:Forms:expmtrg Revise061306 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' Workers"Compensation Insurance Affiddvit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Legibly Name(Business/OrgmAzation&dividual): w/-�LLS C�/(/ST�cJGT'lo/{/ �" !��/1/(C1�CL l�tl C� l ��C. Address: City/State/Zip: s /�R-JVIair4l Aim.07664Phonet 'nF5 gq L ' Ez,3�— Are you an employer?Check the appropriate box: :Type of project(required):, 1.q.I am a employer with 4. [] I am a general contractor and I �_ 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 g• ❑Demolition employees and have workers' 'avorking for me in any capacity. 9. ❑Building addition comp, insuran0e�' [No workers comp.insurance 10.❑Electrical repairs or additions required-] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself[No workers right of exemption per MGL comp. 12.�Jioof repairs instu once.required.]t c. 152, §1(4),and we have no 4 ] employees.[No workers' 13.❑Other cow,insurance required.] *Any applicant @rat checks box#1 must also fill out the section below showing their wMiMM'compensation poficy mfmmation. t Homeowoera.who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit a new affidavit indicating im c =Contractor's that check this box must attached an additional sheet showing the name of the subcontractors and state whether ornot those entities have employees• if the subcontractors have employees,theymust provide their workers'comp.poHcy number. compensation insurance for my employees. Below is the policy and job site' I am an employer that is providing workers' information. Insurance Company Nat= A I M /V l UTVA I— — Policy#or Self-ins.Lie. 76 1 Expiration Date: d Job Site Address: 1 � 1 '. �/�•� <�'�/i/ o `�� ,f City/Statemp: �S�C� y�af 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 tip 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 maybe forwarded to the-Office of Investigations of the bIA for insurance coverage verification. -- - — I do hereby, ertifv der the pains•a of perjury that the information provided ahoy .Is t e and correct Si afore• Date f' Phone# Official use only. Do not wrlfeTi this area, fb be completed by city or towmofficiat 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#: 11/19/2007 11:33 16177342843 UICKI PAGE 01 Town of Barnstable �•' Regulatory ry Services 76o81aI,F.Geller.Director i Building Division Tom perry,Building CommisiJoner 2C*1 Oin Sleet,HYMAi4,MA 02601 ww w.t ow q,bs rW table.ota.u! Office: 508-862-4038 Fax: 508-790-6230 PrO CoenpletePa d Sign Must . $ has Section Uft Builder as Owner of the subject property hereby audtotiw P !.s to act on my behalf, in alI matters relative to work anthOrized by this building p=zmit application for. /R/ iV l Q.,-1.,p ", M D5 (Address o ,fob � els4mnmeof Omer t 0 D t< Print Name If P o er is appIysng for permit please complete the Homeowners License Exemption Form on the reverse side, 0;F0"S:oWWCP.P£.UrISSION L-d SOLI, t% BOG %11sM (oil NPUM 40 6b ^oN I 91te -Co t-,/&,AA",#-4mle& Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 - an tion Supervisor License Board of Building Regulations and Standards License CS: 44847 Construction Supervisor License ! Restriction: 00 Birthdate: 7/5/1962 License: CS 44847 Birthdate: 7/5/1962 Expiration: 7/5/2009 Tr# 17504 Expiration: 7/5/2009 Tr# 17504 j Restriction: 00 i TROY A WALLS 87 CRANBERRY LN �-�- �J Update Address and return card.Mark reason for change. t S YARMOUTH,MA 02664 Commissioner ❑ Address Renewal Lost Card tiva�510i fui�'c'I'i' eg"ulatio a "r7"s"� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 105179 Board of Building Regulations and Standards Expiration: .7/16/2008 One Ashburton Place Rm 1301 Type: DBA Boston,Ma.02108 WALLS CONSTRUCTION&REMODELING Troy Walls 87CRANBERRY LANE, �� .` 6Not .SOUTH YARMOUTH,MA 02664 Deputy Administrator valid ithout signatui • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company Burlington, Massachusetts (800) 876-2765 NCCI N0 26158 POLICY NO. I AWC 7005397012007 ITEM PRIOR NO. AWC 7005397012006 1. The Insured Troy Walls dba Walls Construction&Remodeling Mailing Address: 87 Cranberry Lane South Yarmouth MA 02664 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 03-0542454 Other workplaces not shown above: 2. The policy period is from10/07/2007 to 10/07/2008 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the slates listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policylimit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated Total Annual of Annual No. Remuneration Remuneration Premium INTRA 260607 SEE EXT NSION OF INFORI IIATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 500.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 500.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $291.00 x 5.5000% $0.00 This policy,including all endorsements,is hereby countersigned by &W 09/11/2007 Authorized Signature Date GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Marshall K Lovelette Ins Agcy MA 15403 2 1704 1 1 P O Box 836 WC 00 00 01 A(11-88) West Yarmouth,MA 02673 Includes copyrighted material of(he National Council on Compensation Insurance. used with its permission. r - , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4 100 �6 01 Pa rc I 0 l C � E� , Permit# ( s / 9 3`-!- ,rli QF�r ST;6 SLr B1f _091 Health Division bate Issued 2—e-? —6 _3 g: Epp— Conservation Division 2003�U_ 3 © � Aid lication Fee Tax Collector d� —N�^ / -� Permit Fee �o Treasurer ✓� b3i;1 °1S GI P I SYSTEM MUST BE Planning Dept. DZISTALLED IN COMI'LIANC WITH TITLE S Date Definitive Plan Approved by Planning Board ENVIRONrAENTAL CODE ANE. Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address o li(J t Can ✓1 Village ��/�v%�/�U/� `At, / Owner �G/�% �_�/ �,('�E�� Ct, Address _/O� �'� (�l�IGLt�4Q Telephone Permit Request iJe ",5 SE tS C\,Q4-,g ck pcc, Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation !J�" �I� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family EK Two Family ❑ Multi-Family(#units) Age of Existing StructurV Historic House: O Yes CaWo On Old King's Highway: O Yes to Basement Type: Q'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 V5011 new First Floor Room Count Heat Type and Fuel:: as ❑Oil O Electric ❑Other Central Air: C1 es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑ee ' ting ❑new size Pool:❑existing O new size Barn:❑existing El new size Attached garage:�existing ❑new size Shed:❑existing ❑new size Other: I Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r DATE 4491d FOR OFFICIAL USE ONLY ..PERWT NO. . . - DATE ISSUED MAP E•PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH, FINAL FINAL BUILDING a ° DATE CLOSED OUT ' t ASSOCIATION PLAN•NO.: v l S The Commonwealth of Massachusetts -- = - Department of Industrial Accidents Office alloyesligat/oos = _ 600 Washington Street t Boston,Mass. 02111 Workers' Compensation Insurance davit ' r name: location: 77 nn U (� hone# �D C� ci � I am a homeowner performing o one�workin in ca aci ❑ Iamas ale rietor and have n ///O%/%%O/I/�%�%%/�//., �/%� %OS%4ng/oa this job.....:. .-; orkers com�ensation for my employ w 4hK4Y?,4,e%• S.eoY#,•r,•>r•Y t.{ v;:kr. + ' YY•�`: �;%.;•} to er d]Ilg r:• }'{.}:t•>:?•r.•:::•;{:;:;L;Yz:::•$::ra}}:::; :.,, :v•rr>:k+:;;':'•}:}.i :'•.;{.;r.. an em :•r:,or•.y!: ;u<}:r}:F?$.....r.....;....v•:..:.. :4K..::.,••s;?.;�\;.:y't.,y,Iam y .a ::•}{:{•h;:} x }:i;v.?•i::}i:•rY?{+ .:2 ::d,.v.h h,\}}•n ..�.. ...:v.,....w,v:NL}. +.tv::•v.: .:::r f.•v:n•}.v.w...:.::. rr.,v:.r i'..,..;xv,?• :.{:. a ..... ..rr .5.. ,..r .i..,. n.... .......n::•:;{:4}i.v{:{?LhF:•i'S:v$:4r';n::}�::�{?}S:$$F:L?+.?:�:Y:}1:v.7:,?'•.v.:• :. :,+ ..r.vn.C. 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P d 'es of p information provided above is true and tarred I do hereby e en Date Signature r/ ar # YZI IZ17_ i pit name official use only do notwrite in this area to be completed by city or town oMdd permdt/license# ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office p check if immediate response is required ❑HealthDepartnent phone#; ❑Other contact person: (cetised 9/95 PfAJ Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 me another who employs persons to do ma ance, 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 section25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situationand supplying company names, address and phone numbers along with a certificate-of insurance as all affidavits maybe 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. City or Towns 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 permrt/hcense number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give u`s a call. The Departrnent's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone#: (617) 727-4900 ext. 406, 409 or 375 pFISE Town of Barnstable Regulatory Services ' e Director - t � Thomas F.Geil r, • Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 • Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMXROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERrYUT 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. Estimated Cost 'too Type.of Work: Address of Work: / 7' V r d Owner's Name: 4, Date of Application: d I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑lob Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS �ARBITRATION PROGRAM OR GPLICABLE HOMI UARANTT WORK DO NOT Y FUND UNDERMGL c 142A. ACCESS T SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name egistrationNa. .7 O 3 n-+e Owner's Name Town of Barnstable ' �pF THE 1p� Regulatory Services AB Thomas F.Geiler,Director BARNSTM Mass, 9q,A 039. �. Building Division RFD MA't s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �7 Please Print DATE: .7 JOB LOCATION:. number street [� 12 village "HOMEOWNER": C�, I t .Gt'�16 15n t name home phone# work phone# CURRENT MAU-ING ADDRESS: j; L&U,_l Pj ('fin "V,w� l4i 11� ct__IA- D� -) 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 Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm.structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum' pection procedures and requirements and that he/she will comply with said procedures and ' require nts. Si tune of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of.this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do,such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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 I I EXISIiuv J - owr u.•uc- n) a : Lod- c v� 34 1 o 7. Sq.FT i Ao- O �'J it . 33 j.7 L A�L to ��•` �;' W 1 A �O +� !Q� � f•,.• CERTIFIED PLOT PLAN cxis7in '6- LOCATION 5 T—C:-2 iLLL- I CERTIFY THAT THE SHOWN HEREON COMPLYS WITH SCALE (,'�:_,�� �; `: DATE - ?c - � THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF : PLAN REFERENCE '.'•)!'..�.•':.7-,a,1?L AND, IS �VoT' LOCATED WITHIN THE FLOOOP AIN. P(/4kj Paco\L 371 pg6-le- DATE : 'Z� �C :. _.� t=..r'4.,• �/ BAXTER'4 NYE INC. THIS PLAN IS NOT BASED ON A REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERV.ILLE-' MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES.- APPLICANT P-U K;e•,1 LEGAL L o�T ( C P1,RP G#T 3 7/ PA&E /3 For efficient processing and ,V, Q FILTER 'HANDRAIL a HEATER ELEV. PT. =Q= LIGHT LADDER ZONE R FiN, SET 13ACKS 30'FRon D%ITarsw*-eT construction procedure, it is important that the • ...--_-------- ---•--=--- ---�---�--}�••--_-----_ -- -------- - ----,-• . --;=-_- --- - --••------•- -- ;-- _ items be discussed with the customer and their locations -. -. - . -- - - - -- - -- --- and/or dim - -- -- - - -- .- -.-T- - -- --- - - - --- - -- -- �- -------- - -- ' - - ensions be indicated , --- - -' -t- - - - - �.; - -i - -- :--- - - - - according to scale on this 1 sketch sheet. N I-L _ %: _ --•-----. ----- 1. -- -- _ - - i _.:c:-. _ �-* -j-;- --- - -• - ---�+-•-- - NOTE:'Check off the followings -' - ij- -- 74 . --- _- - - - - 'O POOL DIMENSIONS.._.z O DECK DIMENSIONS ..._ ... __�L _ f •____—__J_ .—.�_ _- _1�`i—t _. _-- .- -{--__•--_- __ _ - - -'--1 O DIRECTIONAL ARROW ' J - f ---^- -_ ! _? i ; -� 0 FILTER LOCATION W r -- - 0 COPING �. . ? ---..:.�. • -- - - -__ -. - t-- -- --- —_fT=- _-_: STEP LOCATION 0 RETURN LINE LOCATION �---- --- - ; , , � '� - -t-- - - -- � ' �-�- - - � _ ---.-- --• O DIMENSIONS TO P. L Q DIMENSIONS TO HOUSE Wf - - - ----- . Q LADDER LOCATION O TREES qr - - Q ELEVATION i- w E : :..- -- ! - -;- --- '-'-i- ----+- -- --• - -- - ---- - - - -- -- -- O GROUND OBSTRUCTIONS, --- _ _} } IF ANY •. -a - ---- -----=- ' - -=--- - - -- ----- - -.- - O SITE PREPARATIONS, IF ANY - - i O PLOT PLAN OR SURVEY I ---- -• _��... ..._.. e �-_.. _..._... __..__ _ ... - • -- - ------ � --- ------ - ---- ' O ANY EXTRAS •"--: ,.. { - 1- O POWER LINES, ff ANY J- 1,1L - - - - - = - - - - - -"----- -- The following bastion poinH. -__:.:: ' t _ _ _---- -._._ _. S.. _ _ ---•------- '--• -_- - dimensions, and coritructioe - __ . .:. - . .. :..:. AGE -._ f-- GAiR _ . -- -._. . . . ; _ - items have been discussed with t --- _ ' ' ' '. '• --- -- _ -- ---- -..- - _..-�.. --= - -=- - -- - -�- - - - - - -- thorn for plans. I - - ---•---t.-_mot-__._ ____ .._. -- -,-'--._......:j ...._ .. . . ._! . . . . .- ---__-.__ _ Everything we haw discussed is I � f - _ ..._. _._..._. -- is understood - ! � shown and the I or changes -- agreements. h •. . •. ._.... . _ _ that any additions . __ ..._.- E Gal D a will necessitate an exIm charye. POOLS HOT TUBS OWNER j azaAT+'T&fJNIFEa G'Orf PHONE YA0,1334%. Owner L U Z IT`t'I 9bb ,e 182 ADDRESS Hyannis. MA 02601 ??1-4142 Assessor's,c:Elioe (1st floor): G JJ�j_ Assetsor's map,and lot number ... ................... —��/ pTIC SYSTEM MUST EO�?NETO`♦ ....................... Board of Health (3rd floor): INSTt�ALLED IN COMPLIA " o� Sewage Permit number ..............��.:-.L1z.1. WITH TITLE 5 98Sd9f!►DLE, Engineering Department (3rd floor): ((// A0.5% ENVIRONMENTAL CODE 263 � House number ......................................�(. ....................... �p a• �'®VJN REGULATIONS �'�E p 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 .4?.�.� ....1�-.... .L?�'iZ°?� cS,LE?%f-'in�. Pam . � �S... . N'�R...................................... �. TYPE OF CONSTRUCTION ........... .. `'..> .e.................................................................................................. :.y..... .Y..................190.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1?Z..Y...... !/'3.N..!vQ........Oq...VE.....................0..S':X.571eil.LGLE /`Z j ` . ........ ................................................. Proposed Use .. .CAP./.!`-!.f-a..tr.. ..�9V..`...... .... -w. !1e.r.I�P.9A.................................................................................. ZoningDistrict ........... .........................................................Fire District .............................................................................. Robe..r..7^ /'� ....................Address ..../. ...L.....W.t.c-t— N..i�..l�.V.. ........5........1�..�c Name of Owner s�S.e.�N..���...1"I........G�.o, � � Cj T-cv c Name of Builder !�(..Zee,TES..�G.c)�5..t-.4V.%.....�.c�.�t ......Address ..�14J..Y.C...U;. ......�i�Y!4.N•clfS�..�7 ... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ....... ...........................................................Foundation .............................................................................. Exterior .................. ............................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..�......... .2!5r."'�'o...���...........................Plumbing .................................................................................. Fireplace Approximate Cost ....... Definitive Plan Approved by Planning Board ________________________________19________ . Area $UO o cr .f 7 Diagram of Lot and Building with Dimensions Fee -TO d' SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................. .. ...... .. ............... Construction Supervisor's License .4.�.6 . .3 Goff, Robert A. & Jennifer M. M,, Permit for ......swimming gool. .......................................................................... Location. ...............124...Wiann.o...Avenue ...... .......... . .... . .................. Osterville ............................................................................... Owner Robert A. & *Jennifer M. Goff ................................................................. Type of Construction ,...swimming...p.00l........... ............... . ...... ............................................................................... Plot ............................. Lot ................................ Permit Granled ..............Yla y...6...............19 87 Date of Inspection ....................................19 Date Completed ...................... .......19U G rid Assessor's offioe (1st floor):- �!'' 'd'' 1� SEPTIC SYSTEM f'�IIST FTNEtO` Assessor's map,'and lot number .../.. �-...� .......Q...�.... A� � �� ` Board of Health (3rd floor): ��SYE�'N��P o el. �...�. VY1!"N'OTLE 5 Sewage Permit number ........................ . �. ..�.,.. 2 Basa9T&BLE. S Engineering Department (3rd floor): ENVIRb aed House number .........................................................................P.M. TOWN REatJLAT10N5 "'�i6,9 D YPY APPLICATIONS PROCESSED 8:30-9:30 .A.M. and 1:00-2:00 only, TOWN 'OF k BARNS-TABLE BUILDING-- 1SaPECTOR �iU� APPLICATION FOR PERMIT TO sl1 T!`�QOQ/rl°e4JD> 9 TYPEOF, CONSTRUCTION .... ...:.....................................................:................................. ............... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..../Zy Ll/!4n/lO...A!/e.. ......�7.ST�yr ..... / ...................................................................... ProposedUse .. �.0.. !l f!!' /......................................................:........................................................................... Zoning District ..... ......................................................:.Fire District .6�sS�FI'!// <G............:................................. q7 Nameof Owner ... .. Address ... ....... ...... .. ......................................................... Name of Builder 7,._A.Alel,�r?-�!.... .Address ..Q<�...0.�� /�!i ........ Nameof Architect .....................................................Address ..................................................:................................. Number of Rooms .....�R.O.� �P /e.e�CnJ�o!1...........Foundation .4/. ���ic.C.? � 0................... Exterior ..�1/�l�O.....Sf/� ��'`G.......:................................Roofing ...�� fJ-ss�� .......................................................... Floors ... .........................................:.........Interior Heating �,�/./ ... j..�'f'-5.........................................Plumbing .../.:. 'gr............................................................ Fireplace .....1111 /1".................................................................Approximate Cost . 01, ete ....................................................... Definitive Plan Approved by Planning Board ----------------------------_---19-------- . Area Z... .0�................ . o Diagram of Lot and Building with Dimensions Fee ......... .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i r o \ 0 - N S I \ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of rnstable re a the above construction. - Name ....... ... .... ............................... . Construction Supervisor's License v5y.8 GOFF, ROBERT & JENNIFER 32582 r - ' No Permit for Add to S in.cfle..:Fami.lY...Dwe,l l i ........... Location 12 4 Mianno..Ave. .r3L>e................. � : Ostervlle .......... Owner` Robert & Qff r r _ / r s• (` Type of Construction . .............. .... ........................................ Plot ...r.................... lot .......... .......... ... ��� January 2p, 89 / Permit-Gran,ed ........................ 19 . Date of lrispection .... ..... . .. . . � ...s,19 j � � •• Date. Completed ................. `.'1 9 q . Syr' '� n - r/ �a - ✓ �.t. •% 1i7`' ✓ � / ;!/ � , �Y', o, tr 1 c• ` `` Assessor's map and lot number ....1.7...�.�... .......... . SEPTIC SYSTEM MUST ro Sewage Permit" number . ` �I?.�.:. :; INSTALLED IN COMP ..................... WITH TITLE e . LE, i House number '.........�.:�. .�...................................... ENVIRONMENTAL C ��a TnWN RECIILATI i639 •�0 0 M a' TOWN OF BARNSTABLE i BUILDING . INSPECTOR APPLICATION FOR PERMIT TOvi ...TYPE OF CONSTRUCTION . ................ ............ ................... ......... . .:.... ...... .. • � \S��r-c2 Z z .�.1/L7.�Jl.,�.... .............. .................. .... .............................................. TO THE INSPECTOR OF BUILDINGS: 0 The undersigned hereby applies for a permit acco ding o the following information: Location . ......... .............................../. ......................................................................................................................................... ProposedUse ........................................................................................................................................ ..................Fire District ...... �D Zoning District f`........... ................................................ .......... ..... �� c ;e;l le Name of Owner �. D.�7?/�,5 ... �/�......Address ...� leJ� /lf�....1 ........... .... ......... ... . Name of Builder T �'�r �J.............�f............. ..Address .................. . .. ...................................................... Nameof Architect ................................................Address ..................:................................................................. `..1 /2'� Number of Rooms .�.........................................................Foundation . ..... . Exierior ..40160io o ! ........Roofing ...,...7 Floors C._.v/j /.7.0.V41!/`OOD.y. ..�, �:........lnterior .................................................................... hieatingJ ��'�i�/ 1...... E :'..�c�.......................Plumbing ... ,/ ............................................................, �7 L Fireplace// ��...............................................................Approximate. Cost ....1....y..............�D.......... .. ... lOrU�?�o/(o Definitive Plan Approved by Planning Board -----------____---------------19_______. Area lAAmz� q?..w........ . Diagram of Lot and Building with Dimensions Fee S�'.`7.�' SUBJECT TO APPROVAL OF JOARD OF HEALTH (126-1..93 263x30 � 2e�3xzr8 q di�/D/1 �A "If, � /rJ 44 C11�19 o eez�/L�ve-17 '�XisT��J a LQr ! 41, 0` �2A/9 Ty) OCCUPANCY PERMITS EQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tow o Barnsta a re arding t above construction. No .. ............................ ............. struction Supervisor's License ......../•• ............ NELSON, THOMAS & DEBBIE No ..28.749.... Permit for ....,ADDITION ............... Single Family Dwelling Location „124 Wianno Avenue ............................................... Osterville ............................................................................... Owner Thomas & Debbie Nelson ....................................................... Type of Construction Frame Plot ............................ Lot ................................ Permit Granted December 10, 19 85 Date of Inspection ..............19 b Date Completed . d?c 19 ' Y Engineering Dept. �3r -floor) Map Parcel . Permit# of House# s+�1� ��.- Date Issue Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee S. Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) IKE Definitive Plan Approved by Planning Board 19 BARNSTABLE. ' TOWN OF BARNSTABLE Building Permit Application Project Street Address I a Y W 1&n n zA U Village ® Owner i I .I 2, Addresses �; �,•�,,,o Telephone o — Permit Request ` o First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 2, O'" Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 3 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) p 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 No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove .❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ 'Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name � : nb �"b .Qr (:p,f,(AA)d y- , Telephone Number Address ��e aD�'1 y� S'�t7 r Z ,L/ (4inl License# ®� � o��b Home Improvement Contractor# 1 �{ Worker's Compensation# G 10 go 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 SIGNATURE SATE EUILDING PERM D NIE R THE FOLLOWING ASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 1 -: R DATE ISSUED MAP/PARCEL NO. �~ , ADDRESS , 1 VILLAGE, OWNER ` DATE OF INSPECTION: FOUNDATION , FRAME ' i INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ' ROUGH FINAL - - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f r s •. w The Cutnazonlifeal111 of atassachusctts •�t j `;-==�.�.� Department of Industrial.4ccidents I• :� it • / � 0>Iiceallnyestlgatlons •.\j=i�� _.;;�+ 6110 lf'asJrinJ;run Street Bustatt. Alas. 02111 Workers' Compensation Insurance Afrdavit clI'Plic nt inforntatitin' _ Plc�se PR(NT•1 Uly name, Inc.-ition• - cite• Phone ❑ I am a homeowner performing all wort: myself. I am a sole proprietor and have no one working in any capacity I am an empiover providing workers' compensation for my employees working on this job. CO ttltlrccc• � � LmynIe Ccitv. t 0 w6 aC Y Gcs• C Oofl ,6 incirraticc co. � lice t! •��•_�• •_ I am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed below who h: the following workers• compensation polices: cmmri•tnv nninc- address: cite:nhnnc+t• Holier it in��irnncc rn .�._._.. cnm am• n me: addreic- city nhnnc it• nnlic�• incunncc co _ Attach additional sheet ifneces_sa__rv__ +_..• �.Ii y,a�C fr. �s!��'.r... ...�..r_ +.�.�ti�i`e:�:�• .wa:.� Failure to secure corcraec as required der Section 3A of 111GL 152 can lead to the imposition of criminal penalties of a line up to S1S00.1)U andiu une vicars* imprisonment:ts wcll:is civil penalties in the form of a STOP WORK ORDER and a Giie of 5100.00 a dad against me. 1 understand that copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. 1 do herebr cerrij die t1r •pains mid petral of pc4ufy that the ormation provided above is true urr cote et. 1% VI q�q Si=nature• Datc j� l Print name O,p Q r \ �T Y� PhoneP. "-� -v .yrr..rrrra official use unly do not write in this area to be completed by city or town oRcial city or town: permit/license if r'►13uiidini;Department C C3ucensing guard f Selectmens Officc check if immediate respunse is required • C]1lcalth Department p it• rnUther contact person: hone incur 111ISiFLUCT YMS Massachusetts General Laws chapter 152 section 25 requires all emplovcrs to provide workers' compensation for their employees. As quoted from the "law... an cmp/itree is dcfincd as every person in the service of another under anv contract of Bite: express or implied. oral or written. An emplt trer is dcfincd as an individual. partnership. association. corporation or other legal entity. or any two or morc . the foreaoin�� cn��agcd in a joint enterprise, and including: the legal representatives of a deceasctl 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 Jwcliittu house of another who empinys persons to do maintenance , construction or repair work on such dwelling, hous :)r on the _,rcunds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL ch:intcr 152 section 25 also states that cvery state or local licensing agency shall witlihuld the issuance or -eHOV.111 of a license or permit to operate a business or to construct buildings in the conimonivealth for any applicant who has not produced acceptable evidence of compliance with tlu insurance coverage required \dditionaliv. neither the commonwealth nor any of its political subdivisions shall enter into any contract for tine ,crformanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha :een presented to the contracting authority. _- ._.... --- ,..... .pplicants :ease fill in the workers' compensation affidavit completely, by checkin the box that applies to your situation and ipplyin`� company names. address and phone numbers as all affidavits may be submitted to the Department of .dustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the aMdavit. The 'tidavit should be returned to tine city or town that the application for the permit or license is being requested. .)t the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required obtain a workers' compensatiol, policy. please call the Department at the number listed below. - :tv or Towns ease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in tine event the Office of Investigations has to contact you regarding the applicant. Pleas sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. Office of Investigations mould like to thank you in advance for you cooperation and should you have any questions. :ase do not hesitate to _give us a call. e Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents _ r i Office of Investigations 600 «'ashinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 37S dFTMe The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissic For office use only Permit no._ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. i Est.Cos Type of Work: a`y t b �b Address of Work: � � I -� U� —7CJ���- A -e � Owner's Name I e ? Date of Permit Application: S I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ----- - Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent oft owner. . Date Contractor Name Registration No. OR 31 iFh� �yya�v m Of'�qyi:. 1 �• IF, Av ai "q f!5 t •r: - Cb =0t4b. o0z•Y•a�zo� :�a x .3�✓'���,�,r, s.•.,p�j i,•J_�;�Y. •�•ukyD"7 .. ezr,�'►eering Dept. (3rd floor) Map Parcel U 66— 0 0 Permi # 12 House# / - Date Issued • _— ,Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee a(.l Conservation Office(4th floor)(8:30-9:30/1:00-2:00) • . Planning Dept.(1st floor/School Admin. Bldg.) IKE►p Definitive Plan Approved by Planning Board 19 • RARNSTARLE. MAWk f1 39. TOWN OF BARNSTABLE •L�(./ Building Permit Application . Project Street Address Village t Owner - ddress Telephone 6 /7 — . _-z 3 _-:z -- O a 54 -Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ c;2.00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 2/Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes li< Basement Type: Full &rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing o New No.of Bedrooms: Existing New Total Room Count(not incIP&hg baths): Exist' (� New First Floor Room Count Heat Type and Fu Gas ❑Oil Electric ❑Other Central Air Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes 0 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) 02 ew-L1/ ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) Y FOR OFFICIAL USE ONLY a PERMIT NO. ' DATE ISSUED + MAP/PARCEL NO. r ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING , K DATE CLOSED OUT ASSOCIATION PLAN NO. ` I� - CF THE Tp� .. The Town of Barnstable r • a • I BMWSPABM • 9� � Department of Health Safety and Environmental Services 10rEo n►e't" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date: u 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: - / Est. Cost 0, v U 0 - 6 a (�Address of Work: 4R11— Owner's NameVZZw� , Date of Permit Application: /A — v-7 3 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. B ' ing not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name r _ _ The Commonwealth of.4fassachusetts Deparnizent of Industrial Accidents office 011flyesfiffallms 600 lVa.vNizvon Street Boston, A1u.vs. 02111 Workers' Compensation Insurance Affidavit . i !icon int rnt i n: APKii—ePR 1 - ---•- ' •_ ._ m • locition• city phone# 9 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working; in any capacity .. �� -.w.....t.. �.,....,..—•:�ae..xw..rz:lTc*!�'�'•.^"va.".l�T'?�:,.:!Tt!r....r..uw.�r.�.:.�m.m.....s..aey�w.w�•�....iM�'."....wt�7^'?'+,:^.rM�:'�...rn��..�. _J.... I am an employer providing workers' compensation for my employees working on this job. comtiany n• rne: address: city: phnne#: insurance co policy# r'. . ..:.... ....... „_: ._,........ ..:.r......�+::�...•......wrw�....urw�Jt _ ♦�w.rypw.w+s�aws� .. ........�.... 1 am a sole proprietor, general contractor, or homeowner(circle are) and have hired the contractors listed below who have the following workers' compensation polices: comp•tm• name: address: cih•• phone#• insurance co Policy# .- .. .:.a.�,.:•: .��c^.-:......�....,�'-�..._- -_ _ — rr"•--:;:�.?mot�r:-r+ ��;+;:c-...- �- coniyan • nnmc• address: city! phone#: insurance co police# _ ._._._,._.•_ :_.. ....� -...,,..tee-,, ->. . �.r-�.r77 :Attach additional sheet tf neccssa �.:..' ..� �• -J,:":=�.' ' Z^,. �w"ti" _� Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of line up to 51.500.00 andior one years'imprisonment as Nvell as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. I understand that n cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereb'v certi to rler the p ins and penall s of perju •that tl a information provided above is true and correct.9 Si^-nature Date /� Z- Print name Phone k T wuLLY _ ofTiciaf use only do nut write in this area to be completed by city or town no `-� city or town: permit/liccnsc Ot I"Iliuilding Department oLiccnsing Board O check if immediate response is required C]Sclectmen's Office t 011ealth Department contact person: phone#: MOther s: :_.. _._....._..:.:.._•�.,.-�....r.-_. ,•-- --mot. . _. _ ,,....4�.r,-._�- Uo ned 3:11;PJAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "la��' , an entph vee is defined as every person in the service of another under anv contract of hire, express or implied. oral or written. An em/t/ur•er is defined as an individual, partnership, association, corporation or other legal entity, or anv two or more oi' the foreuoinu cnuaucd in a joint enterprise, and including the lei-al representatives of a dcceasetl 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 dwellina house of another who employs persons to do maintenance , construction or repair work on such d\ ellil-- liouse or oil the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chajpter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renc%val 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. 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. 77 Applicants Please fill in the workers- compensation affidavit completely, by checking the box that applies to your situation and Supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to 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 leave 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. City or Towns Please be sure that the affidavit is complete and printed legibly. Tile Department has provided a space at the bottorn of the affidavit for you to fill out in tiie 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investicat1oils would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to Live us a call. y.r-yv.r.-tom,.._._: ....-. �..y...._ ._•��,.I:t9•.•r-r'.,::���..s►w�:�'^.!�-._i--.+.....T,flrA-w••!i�:>wv+a^_\Tw..TSow!.•...�!r..�-.,IwaY,_..-..:'.!1�,a.'w.�,•1_tfM'SrT:'•-.^,r.� 1�+'1•Miw�e-'.....•.viw The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents yi• Office of Investigations 600 NN'ashington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street address Section of town "HOMEOWNER" V / 02 0 - a •... .. .. Name Home ph ne Work phone - - PRESENT MAILING ADDRESS 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 such homeowners to engage an in- dividual 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 re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes .responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands - the Town of Department Building Deparment minimum inspection procedures and requirements and that he/she will compl w' said procedure an -equirements. HOMEOWNER'S SIGNATUREt/ APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. ' HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if a Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for • licensing Construction* Supervisors, Section 2. 15) .- This lack of awarenes often results in serious problems, particular) when�,-the Home Owner hires unlicensed persons. ' In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner' actin as supervisor is ultimately responsible. , To ensure that the Home Owner is fully aware of his/vier responsibilities,. man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. Assessor's map and lot number 7 B.�(' ✓J `' CF T N E TD ..........�.I....�.., ro�'Q ♦w Sewage Permit number ........::.....�......... - S BAR33TADLE, . ,.^ ... MU86 House number ..........Z....... ............................................... 'oo 039. MAY a• TOWN OF BARNSTABLE BUILDING INSPECTOR ����s APPLICATION FOR PERMIT TO /u �....V ��� i8'��� /gX'y vi ............... ... .... .................... .. .......................... .... �S�Ur'Q Z Z X 29 TYPE OF CONSTRUCTION !0.. / .. ..� ...................................................:.......................................... . . ...................19.5� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acccoo.�ding o the following information: Location . �/ �f'.... ...C✓" �� ........................ I /�... .......... :.................................. .... ...... ..... ........ ... ...... Proposed Use / ` Zoning District ...... 1�................................. Fire District ��� .............................. Name of Owner . />/?7i?5 �`.�Yl%�4J.0 ......Address ...� .. � � ..�..:.`" T •�/� a�� e0_/..Adc1ressName of Builder ..... ......... ..k>........................ .................. ....................................................... Name of Architect ..j4�lJ/�1................ ........Address Numberof Rooms .... ...........................................................Foundation . ...... ..................................................................... Exterior ..l�l?G��:....� !.?. l.lsl.......... Roofing .../...y. ....."'......... .............................................. Floors .�U4.�.T..!..��...�.��v�..........Interior .................................................................. Meating , +-r '..�./G ,...Plumbing. lL!. ../ . �' .: « a . Fireplace .. .. r� Qw / p .... ...........................................................Approximate. Cost Definitive Plan Approved by Planning Board --------------_-------_______19________. Areaitl.l!r.. _v��J.�....... . Diagram of.Lot and Building with Dimensions F���r� a ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ` 6,1+1-,q9e`- Oki�'c�ien �zg . ► �X4ST�/!/P IJ/YIiC i ,\.. of ar_p /oAr�ive Z y 9. 7,1/ .4K, OCCUPANCY PERMITS R!EOUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tow o Barnsta• e re arding'th above construction. ! ! Nam ..' ......................... ......... Clenstruction Supervisor's License ....... v ............ NELSON, THOMAS & DEB IE. A=141-006-OQI ho No ...28749... Permit r ADDITION Single Family dwelling Location 124 Wianno Avenue ............................................................... Osterville Thomas & Debbie Nelson Owner .................................................................. Type of Construction Frame Plot ............................. Lot .................... December 10, 85 Permit Granted ........................................19 Date of Inspection .....................................19 � J Date Completed ........:.......... .......19 Assessor's map and loi,number ... ....... "�� Q Sewage e Permit number .... ..........c' ..........................:; Z BASB9T1►DLE i House number ....I� ..:.......................................................... vo aea p 1639. 9� c � TOWN OF BARNSTA.BLE.- ` BUILDING INSPECTOR D g --- APPLICATION FOR PERMIT TO �....... A' 60. . ... .. ....... .... TYPE OF CONSTRUCTION S I h�' �a ►^ ' �� . TO THE INSPECTOR OF BUILDINGS: The undersigned / hereby /ap)plies for a permit according to the following information: "T Location ......J. ...... `'�. �......... ............... !!� � . .....:...................................... ProposedUse .....SL. ,5 ` ...... w`.!.!/L................ .. ................................................................................ Zoning District ...........d.�.�.............................. ..................Fire District ........ ._ Name of Owner-!..:..of ....C4.wh).e.J...........Address .. ................... Name of Builder .......................S tE .......:......Address .... . s..................:.: � v) - Name of Architect ..... w..... & 1. �d. ...........Address , ............. ................. ........... Number of Rooms .............�......................f........................Foundation .....V/D.Qq.Akb.................................. ................... Exterior ........ S i `�C 1 Yti 1 � '................... �........................ ...U.......................................Roofing .......�........................:................�........ Floors ......41'......................................................................Interior .........�i`R�".!.. v'4............................................... } Heating .....4!.c...l............!.... ' . .''......................................Plumbing `.......... ...........././ .i..�l,..................................:. ....... Fireplace ........../......:.............................................................Approximate Cost ..............�1 Lt.. ................................ Definitive Plan Approved .by Planning Board ---1 -% __------_____19.__ 1. Area .......................................... T Diagram of Lot and Building with Dimensions Fee •J SUBJECT TO APPROVAL OF BOARD OF HEALTH r l I ` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS f I hereby agree to conform to all the Rules and Regulations of the To n of-B riistable re g rding the ab3ve construction.' • �. Name ;�. ., .�. .... .. .......................... A==141—CRAWFORD, BARRY J. 6 00 24557 �2 Story No ................. Permit foir . .............. , Single Family Dwelling ...................... ........... Avenue Location ......................r.......................... ........... OstervIlle! ........................... .........i................ ................. Barry J. Crawfdr Owner .................... ............................................. Type of Constructibi .....Fame I ............I...................... ............... ............I........... .... .................. ................. Plot ..'..................... ... Lots. ......................... vembe.r 6 82 Permit Granted .... ............... Date of Inspection ... ..............19 Date- Completed .. ...... .........i.. ..............19 t6O �103 Assessor's offioe (1st floor): % //�j_ O .� _d0 *THE A'Assessor's mop and lot number ............................................. Board of Health (3rd floor): _ Swage Permit' number .............. -�.. ..�12.I.. Z 339Hd9TSDLE, t Engineering Department (3rd floor): r / G.J.S moo Mb o m� House number 7 3 `e ...............................................:....................... o MAY°. 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 .&0 CJC....C ...g.�?!` 1. �.... Pca ( W Li JQ oo t � ...................... TYPE OF CONSTRUCTION ......... ..v..."..t ..e.................................................................................................. f ............ .............1........ 19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit'according to the following information: Location 1 2..y......Wl. 9.NNO......../'�..-va.....................OsTC:RllltGtc I�1 f9 ............... .o. .......................................................... ProposedUse ...... ....w.�.!.r..iov.t.................................................................................. ZoningDistrict ........................................................................Fire District ........................................................................ Robert' f� � Name of Owner etj"Xer M Cra�� ,, ,.......Address � a a E d TtrJe(�e. ..........................�................... � ...l......G�J.t.....F�!./�.... .�!............S................ Name of Builder !...U2�e V....... s.. ...(�4�.....� .4? ......Address .�S`3�../.1�9t1rC.... .s+ ......!�2�.Y!g.N�/i.la..r�' ... Nameof Architect ..............................................r................Address ................................................................................:... Number of Rooms .. ...... ...........................................................Foundation .............................................................................. Exlerior .................. ............................................................Roofing .................................................................................... i Floors .....................................................................::...............Interior .................................................................................... Heating_ .Cr.. 15...........3.��.:.uoo QTv plumbing -.... ;'- . Fireplace ..................................................................................Approximate Cost ..3 O"..cTd't?............................................. Definitive Plan Approved by Planning Board --------------_------------------19-------- . Area ..800 Sce "rr c9................... Diagram of Lot and Building with Dimensions Fee O SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ....... ...... ........ ..... ................ ..GG ............... S;. . Construction Supervisor's license 4 O 3 g ................................... Goff, Robert A. & Jennifer M. A=141-006-001 No Permit for .....swimming..p9q.l.. ..... . .......................................................................... Location .....12.4...Wiann.q..Av.e.nue...................... ...................... ................................... Owner ..........Robert A. & Jennifer M. Goff ........................................................ Type of Construction .......Wi1w.ihg-PP.Q!...... .................................................................. ............ Plot ............................. Lot ................................ Permit Granted ...........M4Y..6....................1987 Date of Inspection ....................................19 Date Completed ......................................19 rib- Assessor's offioe (1st floor): A lessor's map and lot number ...... QQ�i� �d� oFTNEITo B rd of Health (3rd floor): I Swage Permit number ........................ ..................r t 116SII9TSDLE, : Engineering Department (3rd floor): 'oo NABIL 0m� House number .......................................:...................: 1639- ............ ` 0 rpv a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00•P.M. only TOWN OF BARNSTABLE BUILDING ' INSPECTOR {� T�Q00� �4J17/�/0.�.,iv/�� r APPLICATION FOR PERMIT TO ... ................................. ......... ......................,............................... TYPE OF CONSTRUCTION ....�% �V .... !,f ................................................................................................. - Q ............... T.�.. /-....... 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... rli!l....C..... i9................................:................:.................... 1- ProposedUse ....................................................................................................;............................. Zoning District Fire District ..� T���'v//`e............................................................... ...........................:....... ......... ` / tp Nome of Owner 4�G ......... ..................Address ... .`T�.L!///�/!/!O 11�1'4/4 f Name of Builder �/� //P�-S�!�.... U�� ��tO�Address :../.�/Z ��� d� QS/� / il�........ ..f. .. .F.... ............ .... ................................... Nameof Architect ......... .....................................................Address ............................�....................................................... el Number of Rooms .....14..r>.,.o4...xf.'��t�oi! ........Foundation .B�G/G/!�/ie�C ,��e</�...................... Exterior ... ................................ : / Roofing ........ ... ......................................................... Floors .... ,f..OJ .I..`... ...................................................Interior ........ ....................................................................... Heating %/ .'.... ti....` -s ............Plumbing ...%`.:.......T......: Fireplace ...../r�,� ................................................................Approximate Cost ..... .ev ............................................ Definitive Plan Approved by Planning Board --------------------------------19___-____ . Area ........:....... Diagram of Lot and Building with Dimensions Fee ©.. ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH .-%.. o 4 In m � C f K OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS +, I hereby agree to conform to all the Rules and Regulations of the Town ;f-b-irnstable, regg.rd.i.ng the above construction. Name�� ... ..v�........... ....... , ............................... Construction Supervisor's License .................. ............... • r J � GOFF, ROBERT & JENNIFER No ..IZU.2... Permit for ....Add...T.Q................ Single.. ........ Location ...12 4 Ki?IRXIQ..Av.ezxue................ ....................... ............................. Owner .....kMPe-Kt... J.QT1n.ifeX,...G.Qf.f Type of Construction ..........F.rame................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ......�7PAWkKY...2.Q.,... 19 8 9 Date of Inspection ......................................19 Date Completed ....................................."19