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Home My WebLink About0044 WIANNO CIRCLE u U I ` �� f C f Coyle, Brenda From: Peter<ken nedy444@comcast.net> Sent: Wednesday, March 25, 2020 11:29 AM To: Coyle, Brenda Subject: Re: Address correction Brenda thank you! Sent from my iPad On Mar 25, 2020, at 9:40 AM, Coyle, Brenda <Brenda.Coyle@town.barnstable.ma.us>wrote: Thank you, From: Kim Kennedy [ma ilto:ken nedy4440comcast.net] Sent: Wednesday, March 25, 2020 9:37 AM To: Coyle, Brenda Subject: Address correction Dear Brenda: An electrical permit was recently pulled for a project but the wrong street name was written in. The permit reads:44 Wianno Circle, Osterville The correct address for the project is 44 Crosby Circle, Osterville. Thank you for help making this correction. Peter Kennedy 508-280-5641 CAUTION:This email originated from.outside of the Town of Barnstable!_Do not click links, open attachments or reply, unless you recognize.the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 qA (3 e -� Town of Barnstable Building t ? Post This Card So That it is Visible From the Street Approved Plans Must be.Retained`on°Job and this Card'Must be Kept BAMSTASM s� 14AM Posted Until Final Inspection Has Been Made. Permit 1bs¢ .� ' nrs' Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-245 Applicant Name: Henry Cassidy Approvals Date Issued: 01/23/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/23/2019 Foundation: Location: 44 WIANNO CIRCLE,OSTERVILLE Map)Lot:_139-024 Zoning District: RC Sheathing: Owner on Record: GOLDSTEIN, RANDALL&STEPHANIE S ' Contractor Name' ,HENRY E CASSIDY Framing: 1 Address: 18 BITTERSWEET LANE. + Contractor License: CS_`0988 2 WESTON, MA 02493 fi - �ry " Est. Project Cost: $558.00 Chimney: i Description: 3 hours air sealing, basement sills to 125' 1 Permit Fee: $85.00 l i F Insulation: Project Review Req: Installers certificate required to close Fee Paid:' $85.00 € Date: 1/23/2019 Final: + Plumbing/Gas Rough Plumbing: 4 Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for.public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:! 1.Foundation or Footing + .�. Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOVI OF BARMSTApLF CAPE COD INSULATION 2017 DEC -7 +I; zD IISIR OIASS 51AMLESS SPAAIM" 3YSISNOl0 SATT3 OYTTSYS INSYlAt10N [lIt1NO3 S+A a.�f ��l e 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 f Date: /%/,Z�� a-- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address, Village {er r1 ��ami0 Os4rili �1� cf Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (X > ( ZS) O (X> Slopes Floors ( ) ( ) ( ) ( ) ( ) Walls 47t$ Sincerely He y E C sidy J , President Cape.Cod nsulation, Inc. col°�3°�t�/.� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Appl� ic' iion# Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 0 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village Owner Address Telephone_ Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay i Project Valuation Construction Type /,CP,�4J/l�4A;01 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doc*metion. ° Dwelling Type: Single Family A' Two Family ❑ Multi-Family(# units) �' Z co c- Age of Existing Structure Historic House: ❑Yes .2,No On Old King's Highway: .®Yes-r,0-No vca Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other an Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)! ca Number of Baths: Full: existing new Half: existing new, rn Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION � (BUILDER OR HOMEOWNER) NarriE) s/��LS1�,C, /�'� Telephone Number Address dA License #_ Home Improvement Contractor# v��✓'` 7 Worker's Compensation- dl——��"�✓��d� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE J 1 �- r ; t. FOR'OFFICIAL USE ONLY ; i APPLICATION#. DATE ISSUED t MAP/PARCEL NO. .1 ` ADDRESS VILLAGE OWNER � s DATE OF INSPECTION: FOUNDATION FRAME INSULATION Z FIREPLACE ELECTRICAL: ROUGH FINAL } i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i > . s DATE CLOSED OUT, ASSOCIATION PLAN NO. ad� e� ,i',ra':.l•� i = F 10 Park Plaza - Sul 5170 Boston, Massachusetts 02116 Home Improvement Conti7actor Registration w , Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 ..Update Address and return card. Mark reason for change. �..I Address _-I Renewal L I Employment I.. I Lost Card .:A; 0 bOM-04104•GIUIPI6 O1'I'ic`� off�sumer.\lrair�f};�liw ne. Kcgulttion Lirclur or registration valid for inlividu!u—se enl HOME I1fAPRbVi�f�`f5`(`�f�fflfp�auutetG+. before the expiration date. if found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 1'ark Plaza-Suite 5170 `Zjt:' Boston,MA 02116 iPR�.�OO INSULATION, INC ENRY CASSIDY 55 YARMOUTH RD. YANNIS,MA 02601 Atafid kithtsi---- —.-- Undersecretary Lure '� la•.,.,rliusctts-:0cpartntenl ul'Pul lic 9Safet% 130:11-d ,rf•Bu•ildin�o Ro ulations an(1 Slandart*ls'- Construction Supervisor License Licenoc: CS 100988 HENRY CASSIDY 8 SHED ROW WEST 1 ARMOUTH, MA 02673 c Expiration: 11/11/2013 ( mm� ..i„„•r Tray: 7620 _ No. 1605 F. Client#:4597 CCINSUL ACORD,,, CERTIFICATE OF UA1BILITY INSURANCE GATE(MM1DD/YYYY) THIS CERTIFICATE IS ISSUED AS q MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL077102 01 S2 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANIENI),EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS HTUTE A CONTRACT BETWEEN THE ISSU)niG IN5URER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,ANO THE CERTIFICATE HOLDER. IMPORTA NTthe cerllf(cate holder is an ADDITIONAL INSURED•the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject Io the terms and conditions of the policy,certain policies may ruyLII,e 1dl endorsement.A statement on this certificate does not confer rights to(1'Ic cerilflcate holder in lieu of such ondorsemen((s). PRODUCER Rogers&Gray his.-So.Dennis NAME: Mar aret Youn -- 434 Route 134 PHONE Alc Na ExI:508-760-4602 FA No: 877-$16.2'156 South Demut;, MA 02660-1601 E-MAIL 16 _ 508 398-7980 INBURRR(S)AFFORDING COVERAUE ___, WSURERA:PeerieSS Insurance wsuRED - NAICd 18333 Cape Cod Insulation Inc INSURERS:Evanston insurance Company 455 Yarmouth Road INSURERC:Atlantic Charter Insurance -- Hyannis, MA 02601 INsuRERD:Commerce Insurance Company 34754 INSURER E: -- COVERAGES _ ..__ INSURERF: CERTIFICATE NUMBER: REVISION NUMBER; PHIS IS TO CERTIFY THAT •rHE (POLICIES OF INSURANCE LISTED 6fLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAI'ED. 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 AeFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, FEXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. g TYPE OF INSURANCE WOOL SUER POLICY EFF POLICY EX A GENERAL LIABILITY POLIcrNVn+BER MMIDDIYYYY MOLICYEYY CBP82630(i3 LIMITS A/01,2012 04/01/201 EACH OCCURRENCE $1 000 000 TE X COMMERCIAL GENERAL LIABILITY — CLAIMS-MADE D-X OCCUR S-MISM E" ° $100 UUU MEO EXP(Any one pamon) g 5 000 _ PERSONAL aADVINJURY $1000000 GEN'LAGGREOATELIMI.T APPLIES PER; CIENERALAGaREGATE $2,000,000 POLICYEl PRO' LOC PRODUCTS.COMPIOPAGG $2 OOU OUO p AUTOMO81LE LIABILITY 12MM3CKVMK $ 4/01/2012 04/p1/201' E=Weral GLELIMIT ANY AUTO 1000000 ALL OWNED SCHEDULED BODILY INJURY(per perch) $ AUTOS X AUTOS X NON•OWNED BODILY INJURY(Per sccirleq S HIRED AUTOS X AUTOS PROPERTY S X UMBRELLA LIAB S _ El(cESy uq6 OCCUR XONJ453512 4/01/2012 04/01/201 EACH OCCURRENCE CLAIMS•MApE $1,000,000 DEC) X RETENTION '10000 AGGREGATE $1 000 000 C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WCA00525902 6/30/2012 06/30/201 X WC OTIWFi g YINbICRj RTd& jECuTIvk (Mandatary in NH) � • --Nj NIA E.L.EACH ACCIDENT 1 000 000 II yea,daicnDe undar E.L DISEASE_fA EMPLOYEE $1 000 000 DESCRIPTION OF OPERATIONS below ^' E.L.DISEASE-POLICY LIMIT $1000000 UEBCHIPTION OF OPERATIONS I LOC4TIONS 1 VEHICLES(AUaah ACORD 1a1,Addloonal Hdnmr{cs S�hatlWa,If PIOIB BpgCa la raqufTacD "Workers Comp information`" , Included Officers or Proprietors Certificate Holder is Included as an additional insured unnur General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulatiorl,Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES aE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR2SENTATIVE AI:ORD 25(2010/05) 1, of 1 The ACORD name and IoOo aru registered marks of ACORD 2010 ACORD CORPORATION,All rights reserved. #$83840/M83848 MEY u � The Comttloltl,, ,,:'r6t oJNlassac{11lsetts . Departrrlera , ,,dustrial Accidents - � O CT -! l,nvestigcltivns wIa 600 H ....;;tllgtonStreet J ' i'i 02111 bo.1'(, .. .1'l N'�-�•..� W41i ri.)'.g01/�LtlCt �Vurkel-'s co il'Veusittiott Insurance Afliii...:;: Bilil(1el-S/COliti-actors/Electricii►us/.t'luu.bt, TS \l;lhliranl lufurn►: tit►n L•'lellse Print Legibly bctruczttti�r[/lr[divi(lu i tau au cutl►lUycr'! ( l►eck (Ile aftvrupriale box; `1'yve of project (requived): lam a rntl,luyer with.... `I' ❑ I am a;,i„ 1.,1 cunn'actor and f have 6. � New cirnstrut:tiuu cu,ldUyc:r:, (full an(I/c.,r l,xrt-firnc).a' hired Iln. „i...,ntraetot•s listed on /• Remodeling the atta,•i,,,I .i,;•ct.[ :,n, a Solt.: piUpl-Ictur or pal-mr-rSillp These.;u,, r:tC[ors have s• Demolition u,d itavc: nu entpli►yeus wut•kinl- for en►ployr. ..,.,I have workers' comp. 9. Building addition ult nl ;uty capacity. [No wurkr_rs' insurant. iuuy)nnurance rr.i uirCil. 1Q. ElElectrical repairs ur udthuulls 1 1 5. � We arc .,..,„nn';t[ion and its officer,i,.,,, ; ,crcised their ri;ttt of 1 1. ❑ Plumbing repairs ur addiliuus �.._.� I.uu a h(nuc ,wucr cluing all work exemp i,n,l.,.I Iv'IGL c. 152§(4),and 12. RoO :.s f repilit uty•,CII I N„ WUrICCI'S' cun'rp. we have n„rt:,l,loyees.[No workers' l _ nuurautcc rr.(utrc(I. 13. other I I r comp. ur••t,i.,,,,',required.) 1G t pelt„uu drat checks box it (Oust also fill out the section below shew,, h tr workers'compensation policy inforrnatiorr. --_-_ -^— Itu,;,C.,mutt %t,hu:,ubillit this uft'ieluvit,ndicuting they arc doing all wJ,ti.:,,.:,6;a hire outside couu'actors must subn'tit a now affidavit indicating such. ••,a,.,,a,,,,that cl,cuk,this box trust attach an additional sheet showing it., :, ni the sub-contractors and state whether•or not those entities have eny,luy,:rs II 'onttar.t,as have ctnploycca, they roust provide thcir workers'mi.j. I..•,,,, uumbar. !,un art employer that i.r pro viclirtg wurkers'compensation i,r.w,,,mce for my employees. Below is tltepolicy and job site -- :,t(unnation. , ALh _ 1;:,,1I,,1rr t.'uulpany N;trni:: I'„ih it,,I .\ell•111.5 1.4(:. tt: W A �_ -.._.. Expiration Date: YY it)!'Sac ;k0dic.ss " City/S[ate/Gip: a u:,,h a ropy ul the wurkers' conl Pei sation policy declaration pag,•i:i,:,,,ing the policy number and exttiration(late). --— (•a,im'.to:.eeuie ruveritoe its re(luirecl under Section 25A of MGL c. I?:,.,1 h,;ad to the imposition of criminal penalties of a Pint:up tU:G1,50U.1)lt.ultb'ut "tr ',c- nuln isunntcnt, as well its civil penalties in the form of a STOP ORDER and a fine of up to$250.00 it day abaiust the viAllor. lit:advised ,I:-,t.,,,,/,•,„f Uu,,tutcntcut uta c 1'orwar'iled to the Office of In'csti::..n,..,,,.,f the DIA fur insurance coverage verifii;ation, !du here c if' «itder the I fits artcl penalties uf;pr,.,1my that the information provided above is true arul correct. Date-if C?(lirurt "'Illy A-1 nut write in this area, to be completed bi-,:iv uriorrn official , Cit} yr fu►vu: 1'a mit/License# IIssuiuh:lutluu'ity (circle..otte):I. hoard of Health 2. Buil(liug Dehartinent 3. C'ity i t„iit C'Ierk 4.Electrical lushector S. Plutrtbiub Iuspectur b. t.)thel. l'uutacll'crwu: . Phone#: OWNER AUTHORIZATION FORM (Owner's Name) owner of the'property located at (Property Address) (Property Address) hereby authorize (Subcontrac r) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to�perform work on my property. O e 's Signature Date 1 ' VKKE Town of Barnstable *Permit# '40 Expires 6 ntonthsfrom issue date Regulatory Services Fee -006, BAMSTABLE,1 . f Thomas F.Geiler,Director I / 9 PEST Building Division OCT 9 2oog Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OFBARNSTAf3�E www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY j Not Valid without Red X-Press Imprint Map/parcel Number Properly Address 4 (6ayi►gyp Ce-�'C�1e_- 0 s+ Residential Value of Wor Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1 ce—Z 1 1�Ll Contractor's Name V11111' Telephone Number Home Improvement Contractor License#(if applicable) ` Q�� Construction Supervisor's License#(if applicable) �� 3363 S ❑WorkH' Cufinpensation Insurance e: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. �� .. A copy of the Home Improvem nt Contractors License&Construction Supervisors License is regti ed. j _ SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 Y C The Commonwealth ofMassachttsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I employer with 4. ❑ I am a general contractor and I pl6 ees (full and/or part-time).* have hired the sub contractors 6. ❑ New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.) 5. ❑ We are a corporation and its 10.VR rical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. repairs insurance required.) t c. 152, §1(4),and we[have no employees. [No workers' 13.❑ Other comp. insurance required.) *Any applicant that checks box III must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-iris.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Inves gaho of the DIA for insurance coverage verification. I do he Iify and the pa�nn Ities ofperjury that the information provided abov is true nd rrect. Si e. Date: Phone Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: r. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia i �tHEToh Town of Barnstable Regulatory Services 9s"xKAS& �" Thomas F. Geiler,Director �jDTFD nu't A. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Nad4l (A— , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this b ' ding permit application for. (Address of Job) igna e o Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION i - I '. oFz�ram, Town of Barnstable Regulatory Services t;nartST"LE Thomas F. Geiler,Director nsas& 9q,P 0.19. ,0� Building Division rEn��s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: s number street village "HOMEOWNER": . name home phone# work phone# CURRENT 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by j several towns. You may care t amend and adopt such a form/certifrcation for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC C Vla sat husetts - Department of P(1l)Ile SafetN 7. Board of Buildinl- RC!,,LIIjjtiOns and Standart'As Construction Supervisor License License: CS 73395. _ Restricted to: 00 y; PETER J KENNEDY 444 MISTIC DR MARSTONS MILLS, MA 02648 cam _ iy% Expiration:..1;A'/7J2010 4 --- ('immissioncr ' Tr#: 5978 r � Boar eolC HOo£ url ing eg datio `� �a "` ME IMP arrd tand ar•ds . Regstrat ROVEMEIyT C6NTR,gCT - oi_r ORY Li E' 128922 cem or r ptrado before the ex g�stration valid for ' n 6n/?011 Type Board o f Prr'ation date• If f tndividul use onl Peter Ken _Individual. Try 281449 One ` Building Re ound recur Y nedy shburton Pla gulations and St; n to: I'eter..Ken 44q: nedy Bosco ,119a..=02108 ce Rrn 130.1 'In ISTIC : . ORIVC ` n1R5TON MILLSy j :.�Ydmiriisti•;iloi� • � �t _ Not-varid tritho - ut signatu re --- Assessor's office (1st floor): = SEPTIC SYSTEM MUST BE tNEr Assessor's map.and lot number ..��..9.....aa. .y..... �; , INSTALLED IN COMPLIANC WITH TITLE 5 d Board of Health (3rd floor): • Sewage Permit`number d� 1 ' ........................................... 'ENVIRONMENTAL CODE AN, BAWSTAXLE. i Engin ering Department (3rd floor): so a ae House number � TOWN RED KJ TrONS ��039.a`0� j'f" .�... .............. C�pY APPLICATIONS PROCESSED 8:30-9:30 A.M. and, 1:00.2:00 P.M. -only+ a . r TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO /✓� ' ........................................................... TYPEOF CONSTRUCTION ................................................................................................. ............................... 4 `/�� "r•!•••!-.?............19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following ' formation: Location �d.. ./ �....(✓ ........ .....`? �............. . ..... ....... . ... ProposedUse - ............................................................................... .................................. Zoning District .. / ............................Fire District Name of Owner .........................Address alG •9 S./✓ � ,.. .............. Nameof Builder ..... . . .................................................Address .. . .. ........................................................................ Name of Architect ... .........................................Address . . ... .......... ........ .....................................................,.. Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating .............................................:....................................Plumbirig ................... .. .......................................................... Fireplace ..................................................................................Approximate Cost ........,� .40 Definitive Plan Approved by Planning Board ________________________________19-------- . Area / X��........ ........... Diagram of Lot and Building with Dimensions Fee .....� ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH aY .3p 16' �b o r 3rd m I 30TiG �3 'elf 1 1 Ro to M 70 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 .� ' ........ .....0....................0........ Construction Supervisor's License .,004..r....... PEARSON, JOHN 29066 Build Swimming Pool No .................vRermit.for .................................... ...........Sing1e.-Family..D.we Ilixig.................... 129 Wianno Circle Location ................................................................ Osterville ............................................................................... Owner .......John...Pearson ........ ...... . . .... Type of Construction ....................Frame...................... ................................................................................. Plot` ............................ Lot ................................ Permit Granted ......March.„21................19 8,6 Date of Inspection ................ ......... .. .....19 Date Completed ..... ......... ..... ...........19 7 Assessor's map and lot number ..�.3�7.- a'`� ,K:......... SEPTiC SYSTEM NW.. Sewage Permit number i INSIALLED IN CM ,, )) . WITH I A H TITLE e� BAaH9TCD LE, i House number ...�2?4.,Ne fir.. . . ...... ENV' 11a'�8ONMEN�,�� M, a t XX q0 i7 39- TOWN REGU�.P�TMw.��OypYa�e TOWN ;OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........:... .... TYPEOF CONSTRUCTION ................ L, ....................................................................................... ti .................ti.. .:' ... r ......I qli �v. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f Location ...�. ,.(�....(�, .-„�...Leiz(/�. ,. .................................... ................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict .......................� .. .................................Fire District .... ............................................................... Nameof Owner ..... . .. . v....... .. .....................Address .. ..'.. a .:' ....................................................... Name of Builder ..... !2!� ........Address Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior ..................................................................................... Heating ..................................................................................Plumbing .................................................................................. FireplaceApproximate. Cost .................................................................................... .. .. .. .... ............ .......................... Definitive Plan Approved by Planning Board -----------_------_-----------19________ . Area ...................... ................... Diagram of Lot and Building with Dimensions Fee �. .. 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 .. ....... .. .......... ---__--' --'—. B. ' 27390 Install Dozznez ' - No -----v'permittfor .................................... ` ` Location ...l2-9..Wiaimo..Circle-------.. ' ..................+.^t~^~^dl^_------------.. . - ' ~ . Ovvnar —'Ji�oz..B� `r— ---------------. ' ' , ' Frame Type of Construction ----------'---. ^ . - ................... ' ' '~ Plot ----�—.�--' Lod ----------' ^ �` 4 85 Permit Granted ..��'��--`.—.-l0 | Dot* of Inspection ..............................�—.`V 'o ` .....................Date, Completed ~~ ' ' ' ^ � . 4� . ~ ' . . Assessor's office (1st floor): F� Assessor's map and lot num' er .................. Q ` Board of Health (3rd floor): fO R Sewage Permit number L BaSa9TODLE, S .............. . .. . . . Engineering Department (3rd floor): '°o NAB& Housenumber ........................................................................ '°?F�ray a• 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 .......................... ' 1...........t ,« ..... . ... ......l�T.:...'... ................. TYPEOF CONSTRUCTION ............................... ..... ? ::_ .............................................................................. . 19 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 7. Location ... � ..... g... ... f..... . ;A..:{......::.. ..s....�I .....� .. 1LS.�..�,. �. .. 1�15 �') ' .. k.,. , >.r.. I: 'i C V . Proposed Use ................. .: C��i cr>.:':'..!c:..<r n` 1=, nil, r •a..r. , ............................................................................................ l� Zoning District ........................ .:.?. ................. . ... ....................Fire District ... G, ......................................... Name of Owner ... -.,.... .1....... c A j.sC.. .: 1y ..... ...:.C.. . C. .J:'.. .. ... , Name of Builder Nameof Architect � .....................Address.......................:.......:............. .................................................................................... Number of Rooms ................: ...............................................Foundation ... r.!....T..:.:; .......... n . Exlerior ..............: ........................................ .................Roofing .. .`'% ."............................................................ Floors ..................................Interior ...... L.J.:. ................................................ Heating ........................ :.:.::.... ..............................................Plumbing ....... 1�...:::: L..:..... ......�......... > s ' x Fireplace % L« Approximate Cost .... �°y •r! ................................................. 6.5,......................... Definitive Plan Approved by Planning Board _________________________ ...,,,�,� �� ------19-------- . Area �. ....�.................. Diagram of Lot and Building with Dimensions Fee ............. / .. ,..................... rj SUBJECT TO APPROVAL OF BOARD OF HEALTH +Id j P ;f 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 PEARSON, JOHN A=139-024 No ...2.93.0.1.ie. PerrrQ for ....Build...Tool...House . ........ ...... . ...... . Accessory to Dwelling ............................................................................... Location I .....44.............Wiannio...C.i.r.c.1 e............................ .... . Osterville ............................................................................... Owner ..............John Pearson .................................................... Type of Construction .......F.r.ame........................ ................................................................................ Plot ............................ Lot .......................... Permit Granted ........May..&,..:.................19 86 Date of Inspection ....... ............................19 Date Completed ..................... ...............19 1111917 Assessor's office (1st floor): f n /�n Gf /� /� / 7 ( . C.../.......v,/1,' fTHET�� Assessors map and lot number .................. /. Board of Health Ord floor): Sewage Permit number ........................................................... i BAsasTsnte, Engineering Department (3rd floor): 9 r� /— 'oo 03 . 0� House number ...............................� 6f...............°�...'....... ''�o�AYa, APPLICATIONS PROCESSED 8:30-,9:30• A.M. and 1:00-.2:00 P.M. only TOWN OF BARNSTA.BL:E•" . BUILDING INSPECTOR APPLICATION FOR PERMIT TO .�..��!�G;C: ,�. !�:�!� ..................,....................................... J TYPEOF CONSTRUCTION .............................:............................................................................,.p.......................... r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .1.....9110A," .... ;7T2 .. .........C'�....... ........ ProposedUse .. J /a71 'v .. . . ............................................................................. f Zoning District .................... ............................................Fire District .......................4.............................. .................. Name of Owner9 L. -J, /...1-...:r...................:Address .� . .N .!!1L+ .....(:� 1. %.............. j Nameof Builder .........................................Address ..... .. ................................ ...................................... � . '__ n Name of Architect ...��f'�`.........................................Address ..... ................................................................................ : Numberof Rooms ..................................................................Foundation ..................................:........................................... Exlerior ......................`.............................................................Roofing .................................................................................... Floors ........................:.............................................................Interior Heating :..,Plumbirig ......................... ::.....................................:............... Fireplace ..............:...................................................................Approximate Cost 41111-A(.1")�. ........... Definitive Plan Approved by Planning Board _______________________________19-------- . Area �� ........... Diagram of Lot and Building with Dimensions Fee .. , SUBJECT TO APPROVAL OF-BOARD OF HEALTH y a a�► /61 fib o c j E--3 a 3 l SCPT�C �3 4t 4% 00f z ROD M I 7° ' 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. Na4.1.1a. �..?/4 .......... .................................... Construction Supervisor's License .(��.`?.(L��.�?........... PEARSON, JOHN A=139-024 29066, Build Swimming Pool No.......0..........�'Permiii for .................................... Single Family Dwelling .............. V-9 ,� Wianno Circle • Location ............................................................. Osterville ............................ .................................................. Owner John Pearson ................................................................ Type of Construction .....Frame .............................. ..................... ............................. Plot ..................... ....... Lot ............. ................. � Permit Granted ........................March 21 86..I ................19 Date of Inspection ......................................19 Date Completed ....................................19 �v Assessor's map and lot number I I '� 4/ :K:.'....:... ' THE ur✓e � /� �. �. G/. ` �-/ � PAC T4` Sewage Permit number ........................................................ n Z BAHH9TODLE. i Howe number ... o... .X............................ 0639 ems �Eo MAI a� TOWN OF BARNSTABLE BU.LLDING INSPECTOR APPLICATION FOR PERMIT TO .............Q` A�!.... ,rl,. ' ►�a-�.,.....,......... TYPE OF CONSTRUCTION ............... ► /1?: ,!................................................................................................... ...................L:.;..''...�a......I TO THE INSPECTOR OF BUILDINGS: ; The undersigned hereby applies for a Qpermit according �jto the following information: Location ..�. ....0!I a�a- n...�ePi4`,� j,. r./. . .................................................. ...... ProposedUse ............................................................................................................................................................................ ZoningDistract ......................................c:.......................:........Fire District .... ................................................................. e ...... .:.CT'-�4-�ac�.� "* . .:'s Address rr�/ ' v Nameof Owner -•�. . .. ....n�=:............. !3'I� .:...... .......................................... ................................ �_. e" . Name of Builder �..... .k:<,... .... .� ....ul� rYl.... ..........Address ... ...:f!I ...l{ !.2a �................ l Name of Architect Address ''° Number of Rooms Foundation'. Exterior ........................ Roofing .... ................... ......... .............................. Floors ......................................................................................Interior .................................................................................... Heating Plumbing Fireplace ....................................................................:.............Approximate. Cost ...�." :... ..... ........... ............... - Definitive Plan Approved by Planning Board -----------_______-----------19_______ . Area............................................ Diagram of Lot and Building with Dimensions Fee .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Ct4,.V f 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 ....... .,�"•. v. ......................... a�19 �3 Construction Supervisor's License ............ ....................... PEARSON, JOHN B. A= 9-024 No Perm-%� for ... ..... 27390 :.t 1 Dormer ......Extkmd•BreE?zeway/..Sirug]-e.-Famil-Y..JDwel.ling Location.L- ................... ................... Wille.... . ......................... Owner ....JohnA.,..Pear.s.on............................. ...... . .... Type of Construction- Fram............................... ............................................................................... Plot ............................ Lot, ................................. Permit Granted .....!7aquax 85 ....�.y .............19 Date of Inspection ....................................19 Date Completed ................. ....................19 Assessor's office (1st floor): ,{ 4/ v / ( OFTNET�� Assessors map and lot number .... ...../........./..... .............. Q� f Board of Health (3rd floor): Sewage Permit number .... = EARISTADLE. S Engineering Department (3rd floor): 'oo 1639• o� House number e ......................................................................... o�,o gar a� , APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN "OF B ARNSTABLE BUILDING r"IN SOECT0R APPLICATION FOR PERMIT TO .`. �X .........f1p. . �/. .••.... TYPE OF CONSTRUCTION ......................... 1 ............................................................................. + ...... ... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Q Location ..../ ./ .......kilAfflyllp...... ...... 1 ./ .•�.•' •.. �'' ProposedUse �i . ... 0.0 .... ................. . ®. ► 1�. dVK .................................:........................................................... Zoning District ....................Fire District .... err ash Name of Owner .... Q.h. Address .y ...... trC�� Name of Builder ..........� F� ....... .Address . . .. ............ r .. `' �R4'.I +t�� ' . > 9 Name of Architect ..:.................... ......................Address ' .... .................................................................................... a Number of Rooms ................I...............................................Foundation .. .�.R...... , t.D.........4#.-ncrc.7j... p r Exterior ..............1. .l1...............................................................Roofing ..� o . ............................................................... Floors ..............C.0... ..................................Interior .... � � ./ .:................................... Heating ................. ..................................................Plumbirig ......-. �►A1•MT. .. '� ...).f�� Fireplace ..' ......................................Approximate Cost .......4.00 p s4 pp ......................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ......l...yfJ.... .:.................. Diagram of Lot and Building with Dim nsions Fee . ' SUBJECT TO APPROVAL OF BOARD 01 HEALTH O � Y �- ' I LMA-TS..-F OCCUPAN 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 O.A06. f.. PEARSON, JOHN No ... Permit for'...Build Tool House--- ................................. ;Accessory to Dwelling.......................... Location ......44 Wianno Circle .......................................................... O ..............................sterville................................................. Owner ...........John Pearson ....................................................... Type of Construction .........Frame....................... ................................................... Plot ............................ Lot .......................... Permit Granted .........................................May 6, 86 9 Date of Inspection ...... .............. ....1'9 ................19 Date Completed .... 4C