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0071 ANGELA WAY
a ®�J NO. 152 1/3 ORA ESSELTE 10% v 0 i Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2/7/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. suit Hyannis,MA 02601 IV G®�p-r FED 47 2017 RE: Insulation Permit 17-45 TOwNOFeAR/VST ' AetE Dear Mr. Perry f FA This affidavit is to certify that all work completed for 71 Angela Way,West Barnstable has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 3 Parcel Application #B V ��Map pp 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 o Village W �S'}' 9rti� iL�l lei Owner L4,Arr n J OS CI Address Telephone R 3 b a Permit Request A 12 ' colt al0 e � - l � 1 w LU Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new- . � e Zoning District Flood Plain Groundwater Overlay Project Valuation no Construction Type c_ u_ O Lot Size Grandfathered: ❑Yes ' ❑ No If yes, attach supporting--documentation. c O Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 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 `t Ndqkelf "ta Telephone Number ��2 Address e� License# c = � f*w* AHome Improvement Contractor# Email Worker's Compensation #WG Da SS ct 0 7-06 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6 FOR OFFICIAL USE ONLY APPLICATION # t. DATE ISSUED r_ - MAP/`PARCEL NO. - ter- .. _. • 'r4 ADDRESS VILLAGE -' OWNER DATE OF INSPECTION: FOUNDATION e FRAME - INSULATION g. FIREPLACE - ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT y. ASSOCIATION PLAN NO. I' The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Buildeis/Contractors/Electiricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Auolicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): LE]I am a employer with 15 employees(full and/or part-time).* 7. []New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8. Q Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.a I am a homeowner doing all work myself.[No workers'comp.insurance requited.]+ 10 Building addition - 4.❑I am a homeowner and will be hiring contactors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contactors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ Other Insulation 152,§1(4),and we have no employees.(No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. + t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. *Contractors that check this box trust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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: Star Insurance Co. Policy#or Self-ins.Lie.#: WC085540700 Expiration Date: 4/9/2017 Job Site Address: 71 Angela Way City/State/Zip:West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance + coverage verification. I do hereby certify under th pains andpenaldes of perjury that the information provided above is true and correct Si ature: Date: 12/30/16 Phone#:508-398-0398 Offlcial use only. Do not write in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other c Contact Person: Phone#: ACOROe `DATE jAMIDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 10/24/2016 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(les)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 Ileu of such endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company NCO E : (781)986-4400 FAC No: (781)963-4420 15 Pacella Park Drive E-MADSSS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICs Randolph MA 02368 iNsuRr-RA:Liberty Mutual Insurance Co INSURED INSURERS Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERc:Ohio Casualty/Peerless Insurance 24074 7 D Huntington Ave INSURERD:Star Insurance Co INSURER E: South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER:CL16101422377 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. �TRR TYPE OF INSURANCE POLICY NUMBER MMIDD EFF MMIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RFNTI:U- A CLAIMS-MADE x]OCCUR PREMISES Ea occurrence $ 100,000 BLO1757246490 10/16/2016 10/16/2017 MEDEXP(Anyoneperson) $ 15,000 PERSONAL&ADV INJJRY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a TCOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED Unurffru= Ee accident $ 1 B ANY AUTO BODILY INJURY(Per person) $ ALL X AUTSCHOSUL� A6TrA46796600 11/6/2016 11/6/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED D $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAS CLAIMS-MADE �- AGGREGATE $ 2,000,000 DED X RETENTION 10,000 US057246490 10/16/2016 10/16/2017 $ WORKERS COMPENSATION Officers included for ' X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE Y 1 N Coverage E.L.EACH ACCIDENT $ 500,000 D OFFICERIMEMBER EXCLUDED? n a NIA (Mandatory in NH) •� 8C0855407 4/9/2016 4/9/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 Ityes,descrtbe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Evidence of Insurance / Insulation Specialists I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact 460 Main street AUTHORIZED REPRESENTATIVE Hyannis, MA 02061 Michael Christian/CLC � O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) wa 0, a a e -:0901b ow • .- �; l�t�aat�''SX:Sc�ali;:�€irector • 'l'ota�'erry�$�l :.E;oss�aaer • C.tq�t.�iaq�nsfah��ina�a S. Office; 5Q..0.$.f2=4Q38 Fax: Siff p-owli m umg-.&D.'d, .; n•gyp •S�4e' "C#ACC 17i�i s �• Y d iu a1f noattexs. t�+e o rl:a io ze b�.bias bu o pex <applicaim for.- aye Witt be id::or u ed' are Zc et a s a $jai P Na tme Pn�C Narz(e. Daw Q:�ozu+as;o�� ssr�� �s _ Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 0211.6 Home Improvement Contractor Registration _ _ = Registration: 171380 Type: Corporation 1 ' / Expiration: 3/14/2018 Tr# 419291 CAPE SAVE INC. t WILLIAM McCLUSKEY = ` 7-D HUNTINGTON AVENUE w .; SOUTH-YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. _ ram Address Renewal Employment Lost Card SCA 1 e: 2OM-05/11 Ulre�per.A ca rs.&Business `u Mafia e License or registration valid for individul use only Office ofConsumer Affairs&Business Regulation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return for Registration:,.`�_71380 Type: Office of Consumer Affairs and Business Regulation Expiration::—=3/14/2018 Corporation 10 Park Plaza-Suite 5170 —== Boston,MA 02116 CAPE SAVE INC. =-- WILLIAM McCLUSKEY :"R V 7-1)HUNTINGTON AVENUE `,•" SOUTH YARMOUTH,MA-02664 Undersecretary -Not valid i signature Massachusetts -Department of Public Safety Construction Supervisor Specialty Regulations and Standards Restricted to: Board of Building 9 CSSL-IC-Insulation Contractor - a..___. c__-n.. 1.1111�t1111111111 JII IIC/YI\III JIICl.l71IL�' License: CSSL-102776 W]LLIAM JMC 37 NAUSET ROAJ6 � ¢ West Yarmouth NIA �UIV \1 Failure to possess a current edition of the Massachusetts Expiration State Building Code is cause for revocation of this license. Commissi�one'r` 06/28/2017 DPS Licensing information visit:VVM.MASS.GOV/DPS / Town of Barnstable .*Permit# S~ T I Regulatory Services �e 6monthsfrom issue date • snxtvsraBi.E, • 039. Richard V.Scali,Director Building Division ' ' Tom Perry,CBO,Building Commissioner I 200 Main Street,Hyannis,MA 02601 SEP 012015 www.town.bamstable.ma.us TQ VV Office: 508-862-4038 IV QF BAR��,, o -7 0-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 33 2 2(�— o-7 0 Not Valid without Red X-Press Imprint Property Address 7 k& G '�AJ�,c�C at (\5PA [residential Value of Work$ 1411 GOO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's NameC ys\GM CCC ��� j(`�QS Telephone Number Home Improvement Contractor License#(if applicable) 1 b� 51 Email: \45E c0A.'m cc0. �`CC9 Construction Supervisor's License#(if applicable) C 5— t o 3 Oc Ul� I orr an's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner I have Worker's Compensation Insurance cG &�$orae-Aved �. s5Insurance Company Name �� 1 Workman's Comp.Policy# �I.'CC' 00 S d t 14 5— 0� J Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Rre e-side [ placement Windows/doors/sliders.U-Value (maximum.32)#of windows 0 #of doors: _ ❑ 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. Vdd. me Improvement Contractors License&Construction Supervisors License is SIGNATURE: Q:\WPFILES\FO \building .doc Revised 040215 the Comrrrornveakh of Massachusetts Department o,f Industrial Accidents Office o,f lmwstigations 600 Washington,Street y Boston,CIA 02111 fvYP n=mgovfdia Workers' Campensatian Insurance Affidavit Bnildex-sIContractursJEIectricians/Plumbers Applicant Information Please Print Name(BusftessP0rganiz3 ionllndMdaaJy-J_�, 5M. Address: Io M* G �>o 00, CN[ MO Qq\ M Cit3r/state. Phoned_ so' 8v (oLi cb- L,4 Are you an employer?Check the appropriate box: Type of project(required): I.E I am a employer with 4. ❑I am a general contractor and I employees(full.andlor 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 sob-contractors have 8. ❑Demolition working for me in any capacity_ employees and have workers' [No a-�arieers' comp.insurance comp-rn¢nrarrcr l 9. El Building additionrequired] 5. ❑ We are a corporation and its 14.❑Electrical repairs or additions 3.❑ I am.a homeoumer doing all'work officers have exercised their 11.❑Plumbing repairs or'additions nrysel€[No workers'camp- right of exemption per MGL 12_❑Roofrepairs insurance required.]F c.152, §1(4h and we have no employees.[No workers' 13.0 Other comp.insurance required.) ',4ay applicant drat checks boa:Al=st also fill out the sectio¢below showing their workers'compensation policy information. Homeowners who submit this aftidaidt=&ki ing they are doing all wal and then bare outside contractors mast submit a new affidavit imdreating such.. (Contractors that cbeck this book must attached au additional sheet shougng the name of the mb-camtizcto-s and state whethe[or not those entities bxPe employees.Ifthesub-contractarshave employees,theymustpmuide their nrorkus'camp.paliey number. I ani an eitrplq,er that is providing ivorkers'compensation iusuratzce for try*enrplogees. Mom is the palicy and job site information. 1 Insurance Company Name_ r C) V OI S'1ExpirationDate: o� Job SiteAddre= ��I ��YA I\ot V_\J e4' CitylStat&Zip: U, ) Kt [jam f f` io-6� Attach a copy of the workers'compensation policy declaration page(sh-cuing the policy cumber 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 andror one-year imprisonment,as well as chit penalties in the form of a STIOP WORK ORDEAand a fine of up to WO-00 a day against the-violator. Be adidsed that a copy of this statement may.be fixwarded to the Office of Irrvestigati,ons of the DIA for insurance coverage verification- or do hereby cet fy radar the 'r and penaNes offerju�y tJte informa€iou proi i&d above is trace and correct sionattn e: Date: -l l l Phone if ` Official use only. Do not write in this area,to be completed by city a tonrn o,f j-rciat City or'Town: PerrdtlLicense# Issuing Authority(circle one): 1.Board of Health 2.Buil ling Department 3.fatylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachuse#is Gaheaal Laws chapter 152 reqaires all employers to provide workers'compensation far rhea employees. pmm=ntto this sty,aa.erpIoyee is defined as."-.every person in the service of another ender any cant-act of hoe, express or implied,oral or write" An employe'is defined as"an mdividnal,partnership,associafi an,corporation or other legal errttly, or any two or more of the foregoing engaged is 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 th=apartments and who resides therein,or the occ¢pant of the - dwelli g house of another who employs persons to do mairnt mance,consftuction 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(b)also st3te-s 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 edmpliance with the incnr'an ce"coverage required." Additionally,MCrL chapter 152, §25C(7)states Neither the commonwealth nor my of its political subdivisions shall enfiPr into any contract for the performance ofpublio work untl acceptable evidence of compliance with the ins rran c0. req t;,-ements of this chaptrr have been presented to the contacting author" Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their certificates)of incrnz+„ce. Limited Liability.Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not mquired to carry worriers' compensation insurance. If an LLC or LLP does have employees,apolicy is required. Be advised thattbis affidavrtmaybe 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 retumed to the city or town that the applicafian for the permit or license is being requested,not the Department of rn rig,cfri ai A ccideats. Should you have any questions regarding the law or if you are required to obtam a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-i surece license number on the appropriate line. City or Town Officials f " Please be sore that the affidavit is complete and pried legibly. The Department has provided a space at the bottom of the affidavit for you do fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sire to fiil in the permit/license number which will be used as a reference number. In addition, an applicant . that must submit multiple pennitllicense.applications in any given year,need only submit one affidavit indicating current policy inf6mation(if necessary)and under"Job Site Address"the applicant should write"aII lacaticns in (cry or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 vie (i-t,. a dog license or permit to buts leaves etc.)said person is NOT requ>red to complete this affidavit ons would like to thank you in.a.dvaace for our cooperation ration and should you have any questions, The Office ofInvestigati Y Y oP please do not hesitate to give us a call. The Department's address,telephone and fax number: I7�ecbmmmwedttr of Massachusetts . Department of l idustdal Aocidenta woe of ltvesfigatio= 600,washi4ou T(,-L A 617 727-4900 cxt 446 or 1477--MAC Fax#617-727-774 Revised 4-24--07 ,alga ddia ♦ r THE a a • )AENbTASM 9� Town of Barnstable AjFD MIS A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I,Z4 ,tiEti ^' y d S��+J , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature f Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. I I QAWPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services F l�yr Richard V. Scali,Director Building Division Tom Perry;Building Commissioner 1�6,5¢ ��� 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: 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 i homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. I 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 several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building permit fomvs\EXPRESS.doc Revised 040215 tr . d-lul e Office of Consumer Affairs and Business Regulation � 10 Park Plaza- Suite 5170 I Boston, Massachusetts 02116 l-lome Improvement Contractor R$gistration _ Registration: 169552 Type: DBA Expiration: 7/dk015 Tr# 255521 CUSTOM CRAFTED HOMES JEFF BARON 64 CHRISTMAS WAY S. YARMOUTH, MA 02664 —________.----•—•---_._.__ ----.�..._..,. Update Address and return card.Mark reason for chnage. soA 1 0 20Mowti Address (�] Renewal ❑ Lmploynient Lost Card „fi�n•/(.�:ury�/�..�./% Office of Consumer Affairs&oust ess Itegulatiou License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expirntion elate. If found return to: egistration: 169552 Type: Office of Consumer Affairs and Business Regulation xpiration: 7/5/2015 DBA 10 Park Plaza-Suite 5170 CUSTOM CRAFTED:HOMES Boston,MA 02l IG JEFF BARONI 64 CHRISTMAS WAY S.YARMOUTH,'MA 02664 Undersecretary Not valid without signature JEFFBAR-01 MVAUGHAN ACORO' DIYYYY) E(MM/D CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 IA/C.No Ent): A/C No):(877)816-2156 South Dennis,MA 02660 E-MAIL mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. Jeffrey Baroni INSURERC: 64 Christmas Way INSURER D: South Yarmouth,MA 02664 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 BR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F30OCCUR MPT2557Q 10/22/2014 10/22/2015 PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&PDVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JE 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (CEOs Me'BIN.danED tS INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Peracddent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I I RETENTION$ $ WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY STATUTE I I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCC-500-5014345-2015A 02/24/2015 02/24/2016 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? Y❑ 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 S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS,MA 02601 AUTHORIZED-REPPR'ESSEENTATIVE 7 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Y 1 I Massachusetts - Depart ent of Public Safety -- Board of Building Regui ions and Standards 11►11�L1 Ul Lll)13 SUPej- :j CPj License: CS-1 y 3v 9 CBMSTOPHER EASLLE 10 Dolly St , South Dennis MA%02 60' r, r� Expiration Commissioner 03/14/2017 NTH Town of Barnstable Regulatory Services •�. s,+xxsrwe�. MASS. Thomas F.Geiler,Director i63g6 +" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner ust Complete and Si s Section p Sign If Using A B ' der as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authoriz d by ding permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS i A t .� Town of Barnstable Regulatory Services BAENSTABLE, : Thomas F.Geiler,Director 9�A .�� Building Division rFD MA'I� 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: 7/ �^�GC.L�} liv/�J 7 /J9/1M1' ASe C �� number street village "HOMEOWNER": L/rL�rn/C L � _573'," got`Z_ Vs-1 7 7S Z name home phone# / work phone# CURRENT MAILING ADDRESS:. 4 6 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 insp ction procedures and requirements and that he/she will comply with said procedures and requireme (S/ina`ture of Homeowner F � i 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, I 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 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 hue, 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 complla nice with-the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their 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 fo any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigati.Qns 600 Washington Street Boston, IOTA 02111 Tel.#617-727-4000 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass..gov/dia v The Commonwealth of Massachusetts Department of Industrial Accidents 93 Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): l/'r G ti C r !9 J) ON Address: 7/ -Gq 4.41 prs� Ci /State/Zi : ���t. /t''� Phone.#: Are you an employer? Check the appropriate box: Type of project(required):,.- 1.❑ 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 workingfor me in an capacity. employees and have workers' Y P t3'• 9. ❑ Building addition [No workers' comp.insurance comp.insurance.$ -��required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.tl� i am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.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 statemerit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and he pains-and penalties of perjury that the information provided above is true and correct. Signature: 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): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i r r oF�ray Town of Barnstable ' 4 ermit# Expires 6 man from issue Regulatory Services Fee + RARNMABI ! MASS ' Thomas F. Geiler,Director 'FD AAPI Building Division , 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 PERM APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ' �-) 0 Property Address 7/ 4 N GC Lq L :3/72A,r,/{z e Residential Value of Work 50006 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4 4 L C EN e- /1 Contractor's Name ' Telephone Number Sda� �L Z t7ff `y% Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X-PRESS PERMIT ❑Workman's Compensation Insurance FEB ;� 2012 Check one: ❑ I am a sole proprietor [;�'1 am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# 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 ^-0,EY-S,- _�(meximum ,44)#of windows 3c, _ .*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. ICYNATURE: \WPFILFS\FORMS\building perm' forn,\EXPRESS.doc ;wised 070110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel � ` ,C opp C Ps Health Division Date Issued t C� Conservation Division Application Fee Planning Dept. ' :_ Permit Fee. ��CJ Date Definitive Plan Approved by Planning Board Historic _ OKH Preservation/Hyannis Project Street Address �� ����� Gt� W. Village eQ /7.PX26A_- Owner : Lf�!'i" s7olw- Address Telephone J`�0� ' .3 - /9,1/7 Permit Request;:f e�7 A-70vG4- 6e cl� AIZZ1.1 /OAVA An A;�1 -,q4 S11 war' �T7le-; Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7s Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl Walkout ❑Other 1� Basement Finished Area (sq.ft.) i:,- 6O0 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: "-existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: d Gas ❑ Oil ❑ Electric ❑Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn O,existing i n size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other w Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Ln ❑Yes � Commercial �No If yes, site plan review # w :r- Current Use Proposed Use v' rn APPLICANT INFORMATION p�Jj>'1r'y �.*J? ,,¢e4BUILDER OR HOMEOWNER) Name ����� G� 411;lephone Number Address �� cif" d4 Qh/ �/ License# 9 70o�,9 Home Improvement Contractor# /`-6 y14s� Worker's Compensation # C/V 3 766,E 'alO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 17� /.lp7x lk�r A�N- OAQIII SIGNATURE DATE 011 - /3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL` FINAL BUILDING �� g o �. DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street c Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information D A Please Print Legibly Name (Business/Organization/Individual): jC+//V/'7r h /e/)h�a Address: 0. &X CUP City/State/Zip: O��Ai1' OLto O/ Phone #: tf— 298'2S2 3 Are you an employer?.Check the appropriate box: Type of project(required): 1.❑ 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 _ .. _ _ __ _. d ..._...._. 2.❑ I am a sole proprietor-or partner- listed on the attached sheet. 7. ❑ Remoeling 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.$ 5. We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: W el3I 6.3 7 6 6 S.-69/0 Expiration Date: 40.3 11,712011 Job Site Address: 7/ /0, (l City/State/Zip: Attach a copy of the workers' compensation poli 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 insur a coverage verification. 1 do hereby cer ' sties p and penaltie o perjury that the information provided above is true and correct. Si ature: JJ Date: Phone# 4Z�_� — �98 ZsZr Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitJLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and. 1pstructi®ns 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." i 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 tfustee of an individtial,,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 j 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 sihiation and, if necessary,supply sub-contractors)nanie(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 rel'urned 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' nter their compensation policy,please call the Department at the number listed below. Self-insured companies should e 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 permi0license 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)amd under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leave$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 fak number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-87.7-MASSAFE Fax 4 617-727-7749 Revised 4-24-07 www.inass.gov/dia i ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Basement ❑ Option l: Fenestration exposed Wall Floor Wall Perimeter AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of 35 R-38 R-19 R-19 R-1 O 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ .Option 2: � REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www-energycodes.gov/rescheck/ A.DDITIONS:ORALTERATIONS,TO EXISTING BUILDINGS:OVER.S YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equ4ls Formula: (100 x b_ a) I SF 100 x — _ % of glazing b a .(b) Glazing area equals.-SF If glazing is:< 40% use the chart below. If lazing is > 40.% roceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter Fenestration Wall Floor Basement Wall R-Value Exposed floors R-Value R-value R-Value U-factor R-Value and Depth .39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e. not com ressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120T) BELPORT BUILDING & REMODELING. LLC PO.Box 2981 e HYANNIS,MA 02601 r-- ��0 Tel: (508)298-2523 Fax: (508)534-9244 HIC REG# 164148 LIC#97029 BELPORTBUILDING@LIVE.COM Proposal#107 from 04/09/2010 to: Larry Joseph 71 Angela Way, West Barnstable, MA (508) 362-1947 Home (508) 451-7752 Cell IriosephAcomcast.net Project address: 71 Angela Way, West Barnstable, MA General to the Entire Project: 1)BelPort Building & Remodeling(BBR) to carry both Liability and Worker's Compensation Insurance; 2) The Owner shall maintain their Homeowner's Insurance Policy throughout the duration of the work. 3) BBR to pay the required Town of Barnstable fees, as required; 4)All materials will be furnished by BelPort (Owner provide all tiles and grout expenses); 5)BBR to use existing on-site electricity; 6) BBR to provide for proper disposal of all construction and demolition debris, and pay all fees associated with same; 7)BBR will provide cleanup on a continuing basis and all debris will be removed from site and nails extracted with magnets. We utilize magnets so as to minimize your exposure to personal injury and/or property damage from nails left behind at the job site. 8)Unaffected areas of the House (those areas where Construction will not take place)will be isolated from the Construction area during all phases of work; 9)Furniture in any affected area of construction will be moved to the unaffected area of construction by BBR and covered for the duration of the construction. 10)All affected Construction areas will be cleaned to move-in condition at the end of construction. Furniture moved to affect construction will be returned to its proper place after complete cleaning. 11)Any fees or costs associated with NStar Electric,National Grid Gas, Water Dept., Telephone Co., Alarm Co., or any utility to be paid for by Owner. Work to be coordinated by BBR; 12)If during any area of Construction(i.e. Demolition,Build Up,etc.)unforeseen evidence of rotting, critter damage, etc. is discovered, the Owner will be notified and an assessment made as to the corrective action and cost prior to proceeding; Acce ted b Date � �g This page is partctrand i conformance with proposal # 71 Angela way 1 of 4 i We hereby submit specifications and estimates to furnish.and install as follows: Item 1: Demolition - All demolition according proposed drawings/plans - Dust protection as possible - Cut concrete slab (drain for new shower) Item 2: Frame tight - 2x4 stud 16" o.c..all interior walls as per drawings - Rebuild-shelves (basement storage area) after shower added Item 3: Wall covering - Blue board/Plaster Item 4: Ceiling cover - Blue board/Plaster Item 5: Insulation - Walls: R-13 Faced fiberglass - Ceiling: R-19 Faced fiberglass Item 6: Tile work -Vinyl liner/pan - Waterproofing shower(walls/ceiling/floor) - Bath main floor - Shower floor& walls/ceiling BBR will supply all tiles and grouts as required. . Item 7: Trims and finishes - All new trims(to match with existing) -New wainscot paneling with chair rail (basement only) - Install all owner supplied towel bars and paper holders and etc. - Supply and install mirror over the sink - Shower glass door -Painting Item 8: Granite - Threshold/bench/jamb/ '/2 walls Item 9: Cabinetry - 30"Vanity Fairmont Cherry Shaker with brushed nickel hardware (Lower level) - Candlelight Shaker door with English Linen Sandoff The beaded solid stock for mirror frames Item 10: Plumbing - Plumbing work to co it water supply &drains/vents. -All fixtures install ook-up (shower fixtures; new toilet same location; ty) Acce ted b Date This pa e is paft oUnd in conformance with proposal # 71 Angela w4y p2 of 4 . i I Item 11: Electrical BASEMENT BATHROOM: - 1 Bathroom GFI receptacle = 2 Vanity light - 2 Single pole switch: toggle style - 1 Single pole dimmer switch - 1 install Fantech PB 1 OOH - 2ND FLOOR BATHROOM: - 1 two bathroom GFI receptacles on one 20 amp circuit - 1 two 20 amp GFI circuits for a Jacuzzi - 4 5" recessed light: white trim, incandescent bulb - 1 Single pole dimmer switch - 4 4" recessed light: white trim, incandescent bulb - 1 Single pole switch: toggle style - 1 Single pole dimmer switch - 1 install Fantech PB 100H -two low voltage puck lights in a cabinet on a dimmer - install a 50 amp 12 circuit sub-panel for new circuits - electrical permit Lower level Full Bathroom ./2"d level Full Bathroom Allowances: 1. Demo/Framing work/all finishes Labor&Materials �gtot/o $ 16,800 2. Plumbing Allowance Det ` 5% $ 6,800 3. Electrical Allowance -De- $ 4,750 4. Tile work Allowance $ 9,600 5. Tile materials (from Cape tile works) 5a�o De $ 9,540 — 400 = q, 6. Cabinetry Allowance ��� $ 11,686 . 7. Fixtures Allowance �0% A $ 7,748 "' 8. Shower doors 1 $ 3,900 9. Granite (Carioca Gold (St Tropez Gold) SO% pe f $ 2,950 10. Double Andersen Windows ADH 2648 (2"d level bath) $ 3,200 Total project Labor&Materials allowance: $ 76,974 - -7S,, Work&Payment schedule will be submitted at preconstruction meeting. Job is estimated to commence approximately 1-2 week after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately 4-6 weeks If acceptable, (both) initial here: WARRANTY All labor and materials by BelPort Building& Remodeling,LLC are guaranteed for a period of one [11 year upon com t' n, free from defects in workmanship and materials, under normal use and service. Acce ted b ''� Date This page is fan in conformance with proposal # 71 Angela wgy p3 of 4 Lumberyard runs will be subject to extra charge. In the event of rot repairs,roof repairs or any related work requiring immediate attention,we will proceed without customer approval. BelPort Building& Remodeling, LLC will provide cleanup on a continuing basis and all debris will be removed from site. All products installed by BelPort Building & Remodeling, LLC will be to manufacturer's specifications. All work will be performed by insured professionals. All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and/or specifications submitted for above work and completed in a substantial workmanlike manner. Any alteration or deviation from above specifications involving extra costs executed only upon written orders and will become an extra charge over and above the est' This Contract not valid unless signed by Corporate Officer Acceptance of Estimate The above prices, specifications and conditions are satisfactory and are hereby accepted. BelPort Building&Remodeling, LLC is authorized to do the work as specified. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. i Date: Q �� Signaturesen I � Note: Noin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. oo ) CoHr eacf.• ,� o 0 a, J �C c rQ SO°o ode2 = 3 ?7� 6"4� 50°9 oae,r Accepted b Date This page iga!X and in conformance with Proposal# 71 Angela wqy V4 of 4 ,, � , a , . a °� �� e , ��. 1 p � O 1 C R O add L •N ; ` .D '17J 7 • i. O O C r 1_�' .O •y y •L O 7 • •; A 4 �r••1 .: L C fl to .R MD C � O d 0 Oco O.yO n O y 7 00 a: CW.Q C,- a.� N � N y'QQ tDfb n J y A .7• .' O Z eo = UZ f0 J - W ao O lnv n—O �• , W Q W I1fiIIyfIII�II1`�11It,'W1 1 •1' �' a o e++ to t II�.lJdor w W, F j a = u) F J Z Qcli W �� ,.�� �• m N U � III i Levy' A CAA 934 14432 i N ��_�% ' CO TOILET-1 ---- - -A 21 _ - _ 159" fl VOC All dimensions size designations given ale This is an original design and must not be Designed: 11._._ . subject to verification on job site and T E C H N OIOG I E 5 released or copied unless applicable fee Printed_11/5/2009 adjustment to fit job conditions has.been paid or job order placed. i Lar ioseoh All ry Drawing#: - - - j 242, G, - I � N1 A7�N cowvre2-'�G 1 - N i Cop -. . .. . . Town ®f Barnstable *Permit# 2 00 76`i_V�'— Expires 66 mo nthfrom Issue date i ,n�,arm Regulatory Services Fee r . L( MASS. 1es . Thomas F.Geiler,Director q Building Division Tom Perry,CBO, Building Commissioner 07 200 Main Street,Hyannis,MA 02601 Cl www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790 230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / 3 30 -;Z-6 Property Address a (��-� t:�-2�b 1 �t , �.,� Yesidential Value of Work 41VlTZ77Z Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Ole Contractor's Name_ Telephone Number 50 g—q a 'a.Q k Home Improvement Contractor License#(if applicable) 1 oC J`J 3 6� Construction Supervisor's License#(if applicable) 0workman's Compensation Insurance � ¢ M �� Check one: ❑ I am a sole proprietor g❑ I am the Homeowner � ���� I have Worker's Compensation Insurance _® (( I� PERMIT Insurance Company Name ' A� ' — 2 2007 Workman's Comp.Policy# C( R T ni Copy of Insurance Compliance Certificate must be on file. BARNSTABLE 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 El Replacement Windows. U-Value (maximur�r 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. :•.+ _'. . gut'+ *?RE: te: ro Owne ustsip canerL t><CritiflTler•'mi9sion: Home tras ense is required. SIGNAT - ;i t`: ` .•`';, :` - Q:Fom+s:expmtrg Revise071405 r 7` Fraser Construction Roofing & Siding Specialists P.O. Box 1845, Cotuit MA. 02635 Email: fraser_construction@verizon.net www.fraserroofing.com Phone 1-508-428-2292 &FAX 1-508-428-0123 RED CEDAR �3 0� RE-ROOFING PROPOSAL �3 PARTIAL DATE: June 19, 2007 NAME: Larry Joseph PHONE: 508-451-7752 MAIL ADDRESS: same JOB ADDRESS: 71 Angela Way West Barnstable, MA 02668 FRASER CONSTRUCTION herebyproposes to perform the following services in neat and P P P g professional like manner and in accordance with the manufacturer's specifications and local building codes. -Remove and haul away all of the old Wood Roof Shingles -Re-nail all plywood sheathing as needed Pressure Treated *****RED CEDAR RE-ROOFING**** Supply &Install Pressure Treated Red Cedar 1.8" Perfection Shingles Supply & Install 8" Brown Drip Edge on Eves Supply & Install CERTAINTEED WINTER—GUARD: (ice & water shield) Waterproof Underlayment Paper 36" Eves, 18" perimeter, cheeks, skylights, 36" valley Supply & Install Tri Flex 30 - High Strength Polypropylene Underlayment Supply & Install 1 3/4" RING SHANKED STAINLESS STEEL ROOFING NAILS. Supply & Install Ridge Roll Copper Cap on Ridges Clean & Remove Debris from work area daily. TOTAL INVESTMENT: PRESSURE TREATED RED CEDAR: Price includes all roofing with the exception of recently done section on the left s' of hip roof. PRICE- $44,250 Initial TRIM WORK: Remove trim on all fascia& rakes and replace with Azek PVC. Price includes remov' & re-hanging front gutters. PRICE- $7,995 Initial 2% Discount if paid by check Payable immediately upon completion NO MONEY DOWN—NO Paymente AT nts acceptedISTART OR PART WAY THRU CASH—CHECK—MASTER CARD—VISA—AMERICAN EXPRESS *Any payments not made within 30 days of t comletion e be charged 18% for every 30 day the paymen lat POSSIBLE EXTRA: After the shingles are removed from the roof, we will lift one sheet the plywood sheathingofplywoventing od to make sure that the insulation is no pagainst ventilation from the eaves to the ridge. If it is,ventilation panels will be installed by removing the plywood sheathing, installing the panels,turning the plywood over and then re-installing the plywood. If needed,this would be charged for as an extra at the rate of$4.00 per panel including materials and labor. There are 6 panels per sheet of plywood. POSSIBLE EXTRA: Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$50.00 per hour,plus materials,plus 20%overhead mark-up on total extras. I FRASER CONSTRUCTION Warranties labor for 12 years. � FRASER CONSTRUCTION is'the Only Approved Applicator/Member of The CEDAR SHAKE and SHINGLE BUREAU on CAPE COD I THE CEDAR SHAKE AND SHINGLES BUREAU Warranties the shingles for 20 YEARS if installed y approved applicator. d will become an ers Any deviation or alteration from above specifications will be executed upon writte adentsnor delays are beyon extra charge over and above the estimate. All agreements contingent upon strikes, acc our control. Owner should carry fire,tornado, and other necessary insurance upon the above work. We, if not accepted within thirty-days may withdraw this proposal. FRASER CONSTRUCTION carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 0 A�Z1 2 FRASER CON TRUCTION HO EO ER S --- --------- ILI The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UF www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Name(Business/organization/Individual): "L�Xjj � Address: P CD gy_," City/State/Zip:—C&LI—mc— 09,63S Phone#: Are ,Are you an employer?Check the appropriate box: Type of project(required):—1 Crl am a employer with 4. El I am a general contractor and 1 6. F]New construction . employees(full and/or part-time).* have hired the sub-contractors 21 am a sole proprietor or partner- listed on the attached sheet. 1 7. 0 Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp. insurance. 9. E]Building addition [No workers' comp. insurance 5. El We are a corporation and its 3 E] required.] officers have exercised their 10.El Electrical repairs or additions 1 am a homeowner doing all work right of exemption per MGL I I-0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 125CRoof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.El Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.Policy information, I am an employer that is providing workers'compensation insurance for my employees. Below is the— information. Policy and job site Insurance Company Name:� Policy#or Self-ins.Lic. . Expiration Date:_ Job Site Address: *workers'compensation City/State/Zip:_Lj. 'eat4tokL6& d !z46r of Attach a copy of the workers'compensation p�oflcy claration 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 herebyretla er t and per ry that the information provided above is true and correct. Signature: � Date: Phone#: I yp- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: � ....:.:.... .. ;.......... .;. :t •:[E.:•: tt:::. :.;:>:: ::. :........;......: ..:.::.»:;;::::::::._:::::;:.:.;;;:-;::.:::::.;:::.;:'::::::::: PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, WISE & gUINN INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR, 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BROCKTON MA 02301 COMPANIES AFFORDING COVERAGE COMPANY 24 A INSUREDED HARTFORD UNDERWRITERS INSURANCE COMPANY COMPANY FRASER CONSTRUCTION CO B PO BOX 1845 COTUIT MA 02635 COMPANY C COMPANY D ::...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.LIMffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR POLICY NUMBER TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION DATE(MMU)D\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL UAE31 TTY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE r FIRE DAMAGE(Any one fire) $ AUTOMOBILE LIABILITY MED.EXPENSE(Any one person) $ ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS UMIT SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per Person) $ NON-OWNED AUTOS BODILY INJURY (Per Accldent) $ GARAGE LIABILITYPROPERTY DAMAGE $ ANY AUTO AUTO ONLY-EA ACCIDENT- $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLAAGGREGATE $FORM i A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-794X619—1—06) , 09-26-06 09-26-07 STATUTORY LIMITS THE PROPRIETOR/ EACH ACCIDENT $ ' PARTNERS/EXECUTIVE X INCL OFFICERS ARE: DISEASE—POLICY LIMIT $ EXCL OTHER DISEASE—EACH EMPLOYEE $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTIN G WORK :.::: .;•::.�:�I�.&T�:�(r#�.EJ�&�::.::::::::.::..:::::::::::.:;:.;:.;'.�:::.�:::::::::::.;:.::::::::::::.::::;:.;:.:::.:.�:::::.�::::;:.;�:::::::. . :...:.:...;..::....:..::..................... ERS COMP COVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ERASER CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE PO BOX 1845 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR i C 0 TU I T MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ... .TT.:. ...ii:isisi::i::i:::::i::4i:•is4iiiii}?iiiii:.:.ii�.:�:::::::::::::'::::.:�:.:�.�:::::::•.::::::::.�:::::::::i�:::::::::::.�::::.�:v:::::.�:::::::.:_:'::::::v.:�:::.:::: .. ........ iiiiiii:_i:•:�iii:v}:•i}i:::isi:::::ii`.:'ii:'iii:<::ti::t::f::2:::::::::iv:::ii:::::::ti:::::::ii::i:::i::i::::F::::isi::::::::::::Y.:::::::i.'v.:iii:F:::Li:::�i:iii::::''::::i:::{?:}ji::L:::::::.......:::i::::::ii::::}: -� F12, Board ®f Building Regulations and Standards One Ashbug-t ®n Place - Room 1301 Boston- Massachusetts 02108 Home 1m,3rOvement pact®r Re, istrati®n FRASER Registration: 112536 ®SARI F CONSTRUCTION CO. TYoe: D13A DEAN RA 45R Exoiration: 3/23/2009 C Try 127920 ®TUIT VIA 02635 OPS-CA' (y SOM-OS/0"C9490 __• Update Address and ern card, ❑ Address ❑ Reneaval liar&reason for eh _ Sage. I�oardofl$ - F0ardOIW un�g Regulations and standards ❑ E""Y"_ ant ❑ Lost(Card IiWP ftV'TW NT CON�CTOR "tense or registration top Regi-"ration: i 12536 before the raUo vabd for indMd� �Niratiain: 3/ D9 Board of 18aud n tfon date. If found return to:use®nl� `6e: .p� Try 927920 One Ashb � lations and standards ERASER CONSTRUCTION ®stpmm Ashburton Place.�1301 DEAN F CTIOiV QO.y ja ' 02108 RASER � 4556 RT 28 COTUr ,r,MA 0263.5 Adu,!W rator lVot valid without . . slgnatpre i Engineering Dept. (3r�floor) Map t l33 Parcel Permit# 2--T2-8 oD House# �` ( �JS= - Date Issue Board of Health(3r2&floor)(8:15 -9:30/1:00-4:30) 0-7) i Conservation Office(4th floor)(8:30-9:30/1:00-2:00) aY 19 SEP CIC SY T"E —� INSTALLED CE TOWN OF_ BARNSTAB WIT DE AND . BRONMEN Building Permit Application TOVIN REGULATIONS Project Street Address �� �9�1/uG�1/� (,lii¢^y/ T_% Village~ Owner 2 Address 7/ Telephone Permit Request 4L0 4 a ' Co-,he_ �6� - 5 6 a2 C.Z- CA�,�r First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ og�'>e::�50, aD Zoning District Z� Flood Plain Water Protection Lot Size yf6W S5 rT Grandfathered ❑Yes ❑No DwellingType: Single Family yp g y W Two Family ❑ Multi-Family(#units) Age of Existing Structure /0 ,� Historic House ❑Yes ❑No On Old King's Highway JZLYes ❑No Basement Type: ❑Full ❑Crawl &Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ��csZs Number of Baths: Full: Existing New Half. Existing 12. New No. of Bedrooms: Existing_j' New /° Total Room Count(not including baths): Existing /0 New First Floor Room Count 1 Heat Type and Fuel: ❑Gas &Qil ❑Electric ❑Other Central Air ❑Yes on-No Fireplaces: Existing -3 New Existing wood/coal stove ❑Yes "o Garage: ❑Detached(size) Other Detached Structures: &Pool(size) c7V V-40 Attached(size) o�`7� �� ❑Barn(size) ❑None ❑Shed(size) v ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ZNo If yes, site plan review# Current Use Proposed Use •Information ,Name elephone Number dress License# Home Improvement Contractor# orker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE e 4L5 7 BUILDING PERMIT DENIED FO&JHE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY C PERMIT NO. R DATE ISSUED " MAP/PARCEL NOS ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION sna 0 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GAS: R, FINAL ��� FINAL BUILDING � ® a- a.. Aba DATE CLOSED OUTl F- Q mr ASSOCIATION PLMr.- < �� m o4�E r The Town of Barnstable ti Department of Health, Safety and Environmental Services • EARN SIABU. 9 MASS. Building Division 367 Main Street, Hyannis MA 02601 vArfD µA'�A Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration ���j /3 Date:_ na'c� 26 Name:����� Phone #: 5-0 —362--3 oy Address: 7/ /�n� �,` („/�� Village: G✓ &a�.nS �G Type of Business: !5kr4 ICJO :n1 oS Map/Lot:_ G 70 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the divellin; there shall be no increase in noise or odor-no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise, vibration,smoke,dust or other particular matter,odors,electrical disturbance, heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary-Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the . dwelling unit. 1,the undersigned, have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: /72" 2 ,ff W Homcoc.doc j THE The Town of Barnstable. • , • 9�� ►`�� Department of Health Safety and Environmental Services Eot 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 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: �A�R�� o�c'fio Est.Cost (9 • Address of Work: 7/ �✓t/6�1� u-� ���� Owner's Name 77o4?AT— ass Date of Permit Application: [hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job 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 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 7 Date Owner's Name f The Cunrnrult health of:1 fassac It*sett.% Dc ptirnizei nj Indus trial Accidents Miceo/loves 192110ns 600 !i'a.vhin,tun Street Boston- Alas- 02111 Workers' Compensation Insurance Affidavit i li :int infortnatitiri• Plcise PRINT Ie�'i'' """"'�� "'��•� ^"��V-- ~- - �namc: �C)s S } c a'L/ t, t nn• X1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [j I am an emplover providing workers* compensation for my employees working on this job. cntttpanv narne: addres�• sits phone#: . insurance rn. nniicv a [1 I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices: cmmnanv nnme- address� phone 0- in-mrnncc rn. nnlicv N cmmrinnA, nntnr: addresc: pit%•• nhone N� insurance cn. policy 0 Attach additional sheet if necessary: ^--•i --di' �Si _- �•:r. _ ^�'•`�•� � � �•�_�_ Failure to secure cm-cratm as required under Sey eta n 25A of AIGL 1.52 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur unc�cars• imprisonment:t. %%•ell:ts ciVil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that n Copy of this statement may be furwnrded to the orrice of investigations of the DIA for covcragc verification. 1 rlo herehr certil rider the pains and penalties ojperjuty that the information prorided above is true td correct. i Sicnaturc� Date Print name 1 ►c� d Ul 1 �e7 S S Phone 36--Q—1-7 y U .."ofticial Ilse unly do not write in this area to be completed by city or town official city or town: permit/license># r111uilding Department oUccnsing hoard C rrC3 check if immediate response is required C3Seicetmen's Office f k 011calth Department contact person: phone#: r j0thcr S.: I information and Instructions Massachusetts General La%%-s chapter 152 section 25 requires all employers to provide workers' compensation forth tYOY? ennplm"ce"s. As quoted from the "la%%`. an employee is defined as every person in the service of another under any contract of hire. express or implied. oral or written. An emplo►er is defined as an individual, partnership, association, corporation or other legal entity, or ally two or me the foregoing cn�gaucd 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:? owner of a dwelling house haying not more than three apartments and who resides therein, or the occupant of the d\vclling house of another who employs persons to do maintenance , construction or repair work on such dwelling lic or oil the rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyc MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance of renewal of a license or permit to operate a business or to construct buildings in the commonwealth for uny 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 perfornnance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking tine 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. Tine affidavit should be returned to tine city or town that tine application for tine permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are require, to obtain a workers' compensation policy please call the Department at the number listed below. I City or towns Please be sure that tine affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple be sure to fill in the permit/license number which will be used as a reference number. 77ne affidavits may be returned tine Department by mail or FAX unless othcrtarrangements have been made. The Office of ltiyesti=ations would like to thank you in advance for you cooperation and should you have any questic 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 «'ashington.Street Boston,Ma. 02111 - fax #: (617) 727-7749 777-.19nn r%.-r. 016. 409 or 375 a • TOWN OF BARNSTABLE •BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. - .. ... . . . . . �. ... . DATE JOB LOCATION_ Number Street address Section of town "HOMEOWNER" Name Home phone Work phone - - PRESENT MAILING ADDRESS 7/ A �,¢ Zl City town State Zip code The current exemption for "homeowners" was extended to include owner-occuoie; 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: Person(sj 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 Offici on a form acceptable to the Building Official, that he/she shall be resuonsil- for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes , responsibility for compliance with the St Building Code and other applicable codes, by-laws, 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 said procedures and requirements. HOMEOWNER'S SIGNATURE ` 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. 01 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne_ shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for .licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly 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 ''Owner-' actir. as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her 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. Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION �.�c�7� SIDING TYPE �lA�bd,�P� COLOR �bw�t/ CHIMNEY TYPE COLOR ROOF MATERIAL a-ODJ�3 S147'Z 6AS_d COLOR PITCH WINDOW SIZE TRIM COLOR y f74C DOORSCOLOR SHUTTERS COLOR GUTTERS PECK GARAGE DOORS COLORw� SIGNS COLORS FENCE COLOR I NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and.elevation plans, when applicable. Site plan should show all structures on the lot to scale. SPECSHT i T NOT LiE T FL nn�l� PL A/it/ b• So C. A. ,r . PC o \ J • MAY ' f TGlWN GF BARNSTAE I`IN'G',S HIGHWAY G R. r1l ��'D FOR � pR:4fCE NOES �c LOT 22 A�/G E L .9: y✓A Y S C'AG� •.. /...= SO•' .OATS : ✓[�.vE ZS, /9BG C i ,.0 �2T/F Y THAT �WAI-4 T /S SHO 3✓N ON . TN/S PL,9N T X1S7ZS-. Off/ -7igE G,ROUND ADO CO�/FD�/`1S :Th'E - T?03+%iV ,4FGCJG i4T/O�/S AT rPFG/STEvPQA�/� �SU,"F YF'YOR lPSI LA too 1 � bV, 401 }1 �,�.� ter.- ..... -�.�. :���• -'� r 'a.�,rrLr--_riii�r+..-�..-�r"M,- ".���"p�3x`�,.sX+�� •. r . O `ejF-p 4 ► L,-!__ • M - - ----- ------ ---- :_:---:- - ----------- ( .V PT/ ` i 'r''1 t.,••t+,r'-•'.~':' •,i I ..._ .,. ." •'•"' �'t . .. t•.:Y}+C:�::9 y:'y�r♦�'q, a �_ :L1w "'�P1Yu '���rt,(, � � PINK-DEPT.'FILE COPY/WHITE-FIELD'COPY/YELLOW. APPLICANT COPY " o i. BUILDING # :• J• . :;,. • ' TOWN OF BARNSTABLE, MASSACHUSETTS � ,�a �'''��• ` PERMIT: 1 , +{VALIDATLON ay! T,7 June 30 86 ;T+ :F➢�� I� DATE 19 ' PERMIT NO. Kevin F. Drake 3R�a�n St:., Coh�saet, SA APPLICANT ADDRESS ' (N0.) (STREET) ICENsxIk PERMIT TO Build dwelling (2 1 STORY- Single family 'dwelling OWELLRNG'UN TS -afts a y 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED'USE) - i:.t,. -;:F.<••51+':j�;1r, •ypq�,a+ ytj '•, -AT (LOCATION) lot 22 71 Angela Way, West Barnstable _:�r'�s ":ZONING a4 DISTRICT (NO.) (STREET) BETWEEN a �5• AND (CROSS STREET) ^' (CROSS•STREET)• •',••'';a't?Y':)7til.tr; SUBDIVISION LOT t + •r`rs'y : ` : LOT BLOCK SIZE F BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT IN Hoo EIGHT AND SI(ALL'CONFOR)A,IN GQN UCTfC r 77 TO TYPE USE GROUP BASEMENT WALLS OR FOUNQATIQNk .•rtrE � ' 'tom ... 4 314 }' ',IsYPE) i REMARKS: Sewage #86=523 r n°f' •. t ` •xa `�- "„,.• I?T. Po � < ' AREA''OR ., .yFi' Sr�`BUND , t r L VOLUME 2360 SQ. I t. � �:-PERMIT:' ; { i ESTIMATED COST .$ 2O0 s OOO FEE 5OO i') { (CUBIC/SQUARE FEET) s 1.k•� Y F't 1 i OWNER 'Drake Homes ' BUILDING QEPT.c :.;'ADDRESS 413 North Main' St CohaS et DIA BY; ' F'ROM T !DEPA DEPARTMENT � ttvn. Dtncct Un ALLr-T IJKAUcs AS WALL AS DEPTH AND LOFATION OF PUBLIC SEWERS MAYBE OBTAIN FROM THE'DEPARTMENT OF PUBLIC WORKS.• THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE OF ANY APPLICABAPPLICABLE_SUBDIVISION RESTRICTIONS. ;APPLICANT FROMIIIE CONDITIC .- `ts•.MINIMUM OF,!'THREE CALL APPROVED PLANS MUST BE RETAINEDAON aOB,AND THIS WHERE•'APPLICABLE'SEPARATE I INSPECTIONS REQUIRED FOR ,i'FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN •PERMITS ARE4 REQUIRED ELECTRICAL;:'PLUMBINOW4AND 'I. FOUNDATIONS'OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- -MECHANICAL.4NS.T.ALLATIONS: 2. PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING• SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTION TI To LATH). FINAL INSPECTION HAS BEEN MADE. + , 9. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SOJT IS, VISIBLE FROM--STREET=t , .•'d.:t(', BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPE6TION'APPaOV.,AL4 -v 2All }� ` :�.•�„• . //fir./;/)���,�`` ;' - ' 3 HEATING INSPECTING APPROVALS REFRIG TION:INSPECTI'ON APPROVALS _ G 4 RI G�`33t S OTHER 2 2 / v BOARD k. . .OF�NEALTH 1 WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL. BECOME NULL AND VOID IF CONSTRUCTION INSPECTOR HAS APPROVED THE VARIOUS IN INo CA D'ON 7HI STAGES OF CONSTRUCTION. WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE -CAN BE-ARRANGED,FOR BY TELEPHO PERMIT IS.ISSUED AS NOTED ABOVE. OR WRITTEN,NOTIFICATION .,.i�{�['hv i'}kC3a•`'; ,+"`}y`t^ ` Pvk , 4.ifi. b� ,i` t .`�3d.'." "o,.;.`�"""^"�"r e ! 'yoftrs>, TOWN OF BARNSTABLE 29583 Permit.No. ................ r ~� f`NBUILDING DEPARTMENT D°81T «► OWN OFFICE BUILDING Cash rw HYANNIS,MASS.02601 Bond .......... .... �•� CERTIFICATE OF USE AND OCCUPANCY Issued to ° Drake Homes Address Lot #22, 71 Angela Way West Barnstable, .Mass. ' USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT'BE"OCCUPIED UNTIL, SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE I; BUILDING CODE. Nevember 23, 19: 88 :....:..................... .... ........ ....... uii ing InsP ector TOWN OF BARNSTABLE _ BUILDING DEPARTMENT TOWN OFFICE BUILDING rua i6J9' HYANNIS, MASS. 02601 �OIIAY�' c� MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #.. v............. !.......... ............................................................. ................................»_. issuedto ................... r//-Q........... ................... ». »»...» Please, release the performance bond. O UE / o � L T 22 O S it/o T G E /A/ PL.4,IAI t 31 � a ti 4 9, 0/8 f ° I 1' 33zLP 3/ JOHN z� tia 4p� � �G " �,✓ y'I PATRJ� �O�. � 7G� rvB• , - c 4ER rlIC74E. ,o .�� oT .1:'ollz .qw �� �'OR •• 0.4AK E /moo HES ' TO>✓N OF 8AR mot/S'T.9 B L E, /`-1fI L Q T ' z2 �9ivG E L .q Yi/A Y �1' SCALE .- / "= SO' .OATS •' Jv�E ZS, /98G � / Cfi'?T/F Y TN.4T �'✓N•9 T /s .SHO 3✓N ON Tf�!%S' PL i9N /S ,4S /T EX/STs'_ O�V Tiy� GROUNO- A/v0 CONFOyP/`fS 7-0 - M Th�E `=7-OWIV r4�'GUL�T/O�/S' AT Tf�E T"/t1E O rP.EG/ST,�iQF`��N� BUR YEYOR } w ODYL 5Iva IA f /e/.-v A•SSO C /NC. 7 /�fOy2/N AYE, a. L T Application to B�JNaStP PKAJ`N - e 6PPN OENE`NS`'�PF\NS •� is EPS Old Kings Highway Regional Historic District Committee___ in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS FEB :1 2 1986 Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction:X New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK--�� 71 1 t2eP/rl - ASSESSORS MAP N0. / 2 OWNER \� ASSESSORS LOT NO. 1.6 - HOME ADDRESS TEL. NO. C�La n FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR 214 TEL. NO. ADDRESS '��`� /d /�� DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). �. Signed Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C.Date The Certificate is hereby Mate (3/6,r/� , Time ` n` r By Approved IMPORTANT: if Certificate is approved,approval is subject to the 10 day appeal period --- "J` provided in the Act. Disapproved ❑ Assessors office (1st floor): l Assessor's map and lot number ' Q THE Assessor's ` /Jn.� .�C) r �o o� .......................... . ........... Board of Health (3rd floor): 6 �E' SEPTIC SYSTEM ML'S.'19E 4 Sewage Permit number .............................................. ..:.. 1oySTALLED IN C®P�BPLIA�1�E Z BAUSTA LE. MAM Engineering Department (3rd floor) M tj • a WITH TITLE 9°o 163 House numberE. 9 �: .............f.�... .: ............ •, N �e At APPLICATIONS �lVIR® M� E 5 .��T/4L C®®� AND YP APPLICATIONS PROCESSED 8:30.-9:30 A.M. and 1:00.2:00 P.M._only, TCWFN REGUL-ATWN' TOWN 'O' FBAR.NSTABLE BUILDING:: INSPECT-OR . y APPLICATIONFOR PERMIT TO ....................................................... ...................... 1....................................... TYPE OF CON'STRUCTION ........... ...................... ...........iN. .. ..1�` ................................ t n / '�/•...... �n............ .19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 0 7 .a�....... �!� �ff..... �1- .. ,.... 7�sGj....:/./YlQ/115., ..li�./.J��/✓.�7�Q.��Location .............-.�....... �.... Proposed. Use v. . ... Zoning District /. .. ...........................................Fire District � S /�,4 I Name of Owner ...�AJ . �....� fO/'Yle5_...................Address ..`�.��.....1.K�....!<l Name of Builder ......�J C.?� ....T..... /!QI .K Address .,t./.3.. ,r�../!7/t!:!1...�. ...6,10 O-5.-re. ..dh!¢... Name of Architect .......�.W. lam 6.r,.� ..: .. l; 1.Address rr�oZ:... ,...,?T...... � ff�Y/YI,C .,... Number of Rooms .............l...D..............................................Foundation ......lQ..�� ......... ' !I......... . ......... Exterior ....e.PGX d " - ./."V.A. .........Roofing .......V..( � ��� ..............................................C�� �Q.......�!/� Floors .....0 !K....}> I�/?,rPe1<<..........................................Interior .......... ... ................................................ g ` ..........................................Plumbirig .................... y �1�� Heating ,� ... ...................... Fireplace ......................... ...........................:...................Approximate Cost ....... C�Dy. OC? Definitive Plan Approved by Planning Board ---OA,—L �-------19 __-- . Area ...... fOV... .......... Diagram of Lot and Building with Dimensions Fee X5............... .......... ...... L . SUBJECT TO APPROVAL OF BOARD OF HEALTHY 'V 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 . . .... .`..G7✓+�. .................................. Construction Supervisor's License ..Q.l .J'-5 ..... DRAKE HOMES No .... 9583 Permit for Two Stor .....Single..,Family„dwelling......................... A Location JiQt..22......7..,..A.ggP1a...W4x............ �5 %' ..................... ......................... Fs, Owner ........Drake„Homes.................................. r Type of Construction Frame.........................:. T, Plot ............................ Lot ................................ a Permit Granted ..... ..................19 86 s cc - Date of Inspection ...........:...19 Date C mplete• .......19 - Application to SP p+`'t+PP N 5 EP GP 0P pEP.NS�pP�peb Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a C i CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building [] Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existingisign 4 StructureJgFence ❑ Wall ❑ Flagpole Other la_JI� r) I (Pie*se read other side for expisnaticn ai rt U:�ementa). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK 7/ 410061A lti�9Y w �- ASSESSORS MAP NO. �33 OWNER � t a/' 2C's.5 ASSESSORS LOT NO. HOME ADDRESS 1 44t,57>q,6,L6 TEL. NO. --342 FULL NAMES AND ADDRESSE F ABUTTING OWN��clude name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). �IAmbs C-?-,C51- 5'-7 4,tl6e-c /a (,&, tw, c-sT O V G As S z,A v t 0'-4 -1) F_9-2 T V wt f� 12t.�. [,& C� AGENT OR CONTRACTOR � ' '`C- ?a TEL. NO. ADDRESS 105 SASkeif9 s'r 214'n0A 111,4. DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). LtL(2 Signed Y2���Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C. tle lei 0 Certificate is hereby Date IM r 3 g i r�_" �TOWN OF a STABLE • r ORTANT: If Cei Lificate•is`•approved;approval'is subject to-the 10-day-appeal peso provided in the Act. Disapproved ❑ A/O TE • L O T 2z OO ES NOT L/E iiv T.y� FL nn. PL A/4,/. Gl • �V �y 9, Ole tiY y + r� V 1-791 a TO CD rOF BgRNSTgeL� A� O 7- A/O TO ys//�/ QF•' $,4�2�t/.S'TA 8 L E /`-1A LOT ' 22 •9�/G E L A: y✓.q Y f=-tiJ S C'i9 L E .• / "_ SO ' Oi4T�' •' �./U�iE ZS, /98G /S AS /T EX/STS •O�/ Tiy�' G�PDU^/O .9�/O CO/uf0�/`1S � ' rP.EG/STE�?� Y r4/t/p �SU Y.:TY0,,2 r• Y1 Assessor's office(1st Floor): SEP_D INSTALLED SYSTEM e Assessor's ma and lot num r ALLEp IN Conservation Board of Health(3rd ENVIRONA' w Sewage Permit number ��1 a q' �N'r'AL Engineering Department(3rd floor): RCr �LA �0' House number s Ysr Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2%. P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TOL�S7�9 TYPE OF CONSTRUCTION _ (D0���� 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �1 A�6���� Proposed Use � J Zoning District Fire District Gr-1 57- Name of Owner S Address �� Name of Builder 1411" pdIs Address/ S,4�OwICfi� �% �/�hJdy� Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost - Q^ Area �(? Diagra ^' TF E F nOn ?GA/N. Fee 3�G x ti x • u y,F� 50 40 A. A OCCUFHNUT-wtMMrI ti—HEQUIRED-FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town-of Barnstab e-re arding the above construction. Name Construction Supervisor's License ROSS, ROBERT No 35107 permit For I1 STALL INGROUND POOL Accessory to Dwelling Location. 71 Angela Way West Barnstable a r Owner -Robert Ross z v Type of Construction Polymer/Vinyl E t d Plot Lot` f' Permit Granted June 8, 19 9 2 „ Date,of Inspection 19 lD Date Completed 19 ikyl g - VT .. ���q •.+,ITT .�� a