The URL can be used to link to this page

Home My WebLink About0090 BURSLEY PATH y 96) :y I i Oxford NO. 152 1/3 ORA ESSELTE 10% ; n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp Ma Parcel ' � A lication # p 6 Health Division Date Issued 0 7� Conservation Division Application Fee tS Planning Dept. Permit Fee 1 i Date Definitive Plan Approved by Planning Board 1� Historic - OKH _ Preservation/Hyannis Project Street Address 90 &rs\tA QcVt-�, Village cj_t - &r _ Owner u� O`►Y��l�-� Address 90 Telephone Permit Request W-t- T<_4 a �r�:�1� �o cr,►�ry �, - rc l - ):)-�rcw- . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 100000�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 gNo Basement Type: g Full ❑ Crawl ❑Walkout. ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing I new Number of Bedrooms: -3 existing new Total Room Count (not including baths): existing _ new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other a_ Ventral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:_i Yes ❑ No a CDDetached garage: El existing ❑ new size—Pool: ❑ existing El new size _ Ba n: ❑ existirs ❑ igw size_ A o Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -n Zoning Board of Appeals Authorization ❑. Appeal # Recorded Cl Ln —a Commercial ❑Yes ❑ No If yes, site plan review# - Current Use Proposed Use w c APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ( ' Address 2!1D License # �2r Home Improvement Contractor# f4.$5S� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 5-kS C-94D SIGNATURE DATE � s k _ FOR OFFICIAL USE ONLY I' APPLICATION# 4 r t DATE ISSUED ,_-_-_jv z k MAP/PARCEL NO._ i QR y �A ADDRESS VILLAGE z OWNER E DATE OF INSPECTION: � :.FOUNDATION,"-! eb r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL E T PLUMBING: ROUGH FINAL r ;GAS ROUGH ra- FINAL :FINAL BUILDING�'_� i%'C 46 ^ r x DATE CLOSED OUT . ASSOCIATION PLAN r - -- - The-Commonwealth-o 11�assaehuset-s- -- --_ ^_= ---- --------—- Department oflndustdd Accidents Qffice of Investigations 600 Washington Syreet - Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractars/FIectricians/Plumbers Applicant Information n Please Print Legibly Name(Busiaess/Organimtimaodivich4:. Ad.dms: IV Qg.ca, N,,A— \o.. City/State/Zip: \\-rr"Ck , Wyk 0Z0Y�' Phone.#: -8 -00 Are you an employer? Check the appropriate bos a of i o ect(required):., 1.❑ I am a to with �4. �I am a general con.tactor and I 6. P c ( . Qio � employer "rya 6. ❑New constructicm . employees(full and/or part-time).*. ve hued the sub-contractors 2.❑ I am a'sole*oprietor or partner- listed an the-attached sheet. 7. g RRemDdeling and have no employees These sub-contractors have -ship �p Y 8. El Demolition working for mein any capacity. employees and have workers' [No workers' camp.inettranre comp.insurance.$ 9: ❑Bmlding addition required] 5. We are a corporation and.its 10.&Mvctdcal repairs or additions 3.❑ I am a homeowner doing all-work officers have exercised then 11.gPlu[Mbing repairs Or* additions ' nyself [No workers' camp. r�rt of exemption per MGL 12.❑Roof repairs insurance required.]t c.152, §1(4), and we have no . employees. [No workers' 13.❑ 09uer comp.instance required.] *Any applicant that checks box#1 ttmst also fill out the section below showing their wmtkets'compensation policy information. t Homeowners who submit his affidavit indicating they ate doing all work and then hire outside contract on must suhmit a new affidavit indicating such. 1Cont actozs fat check this box must attached an additional sheet showing the ttame of the sub-contwtors acid state whetter or not ffiose entities have employe-.s. If the sub-oon' ' Tx bave employees,they mustPnn ide their workaa'comp.poticynumber. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: C=G Policy#or Self-ins.Lic.P "S'oa I�il T 0A g-Q,k Expiration Date: I0 p r, Job Site Address: /Siate/Zip: [ �- t✓ _ uJ�t- T Attach a copy of the workers'*comp on 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 cininal penalties of a fine up to$1,500.00 and/or one-year imPns=melr, as well as'civil penalties in the form of a STOP WORK ORDER and a Ene of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investizations of the DIA for insurance covemEre verification 16 hereby c the I and p ' of perjury that the information provided above is true and correct Si tore: - Date: O-1.'L -- it Phone# 7w-mo%,t Official use only. Do not write in this area to be completed by city or town official City or Town: Permit/I.icense# -Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone# 9 C9-o�-� J cµ.� Q l� � �.��, ., ., , .., F . registration valid for individul use only•`�i� �J�J License or reg n to: C�//�ao „en � N$uf'i, e�$,� before the expiration date . If found retul . . ulation lI Office'b CTOR Office of Consumer Affairs and Business Reg HOME IMPROVEMENT CONTRA Type: 10 park Ylua-Suite 5170 Registration: ,�1 A 02116 y48552 pBA 1.0(412013 Boston,M Expiration: , i . CO UCTIO I F2 g. NSTR tom= Y=f It JARED REEVES`\^�:E �nJ _3 + �� , N out signature 340 QUEEN ANNERD :. ,, Undersecretary. 45 HARWICH,MA 026 ,E a_y:l-' __ ` Massachusetts- Department of Public. Safety i , �. &tard.;' Buildin�u Regulations.antl Siandur(Is Construction Supervisor License License: CS 92058 Jim JARED A REEVES 340 QUEEN ANNE RD HARWICH, MA 02645 Expiration: 3/25/2013 ('ommissiunrr':r Try; 12118 BIKE ti Town of Barnstable Regulatory Services sARNABS, Thomas F.Geiler,Director Fn rru►. 1% Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, r � ��► ��u. , as Owner of the subject property hereby authorizer to act on my behalf, in all matters relative to work authorized by this building perrnit. (Ad 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. I Signature of Owner ature f Applicant Print Name Print Name 3- lo- �Z Date Q:FORM&OWNERPERMISSIONPOOLS 9 OF'THE ram, r Town of Barnstable . Regulatory Services a w . sARNsTABLE, . Thomas F.Geiler,Director 9 MASS. 039. Building Division lCD hAAI A 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: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt I Mtn ' J , f c 1 � 51 i 1-, . 4 �0*1KWE Town of Barnstable *Permit# y Erplres 6 niontlis frond issue date �03 Regulatory Services Fee BARNSTABLE, MASS, Thomas F. Geiler,Director ArfD NlP't A Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valit!without Red,Y Press Imprint Map/parcel Number_ 5 Property Address q o /Residential Value of Work OC) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1 Contractor's NameWn A e'. vfq Arne ; W Telephone Number �M F 30 7 `�6176 `C Home Improvement Contractor License#(if applicable)�f�G�(,C-` Construction Supervisor's License#(if applicable) C 5 /, ` ces ❑Workman's Compensation Insurance -PRESS FELT Check one: 1�EC Y 5 ZOU9❑ I am a sole proprietor �❑ I am the Homeowner 1 OWN OF SARNSTABLE i have Worker's Compensation Insurance � (p Insurance Company Name /j,�G-'�P�yZL.0 0? ii 6n to-c; Workman's Comp.Policy# Copy of Insurance Compliance Certificate must.accompany each permit. Permit Request(check box) A_Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ .Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e:Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors Licerfse is re uir SIGNATURE: Q:\WPFILESWORMS\building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts ILL Department of Industrial Accidents Office of Investigations I' 600 Washington Street t Boston MA 02111 ,4 ' fviviv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �pn f' D- Please Print Lep_ibly Name (Bus iness/0rganization/Individual):W� l/ o ""`� Address:yQV�i /`�'4 City/State/Zip: /1/1�(. . P� Ahone #: 6 2;s7/ Are you an employe Check the appropriate ox: Type of project(required): . 1.❑ I am a employer with 4. am a general contractor and I + have hired the sub-contractors 6. ❑ New construction employees (full and/or part-time).* 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 Y� 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12oof 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 employccs,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. /f Insurance Company Name: /t/a��/ fi�/ -- Policy# or Self-ins. Lic.#: �/C 7Y33 W( Expiration Date: Job Site Address: . U l City/state/Zip:(AJ 'tifl�/� A&I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement.may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cent fy uncle th pains' n enalties ofperjttry that the information provided above is true and correct. Si nature: Uu Date: 4,11sA-f Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction 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 buildiirgs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should 5 be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. Should-you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiUlicense number which will be used as a.reference number. In addition, an applicant that must submit multiple permitAicense 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 fixture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia Of THE row Town of Barnstable Regulatory Services �_"�'�'E8' Thomas F. Geiler,Director 0;A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79M230 Property Owner Must Complete and Sign This Section If Using A Builder . I, , G , ,Omn , as Owner of the subject property hereby authorize 661Gt /I(C." 6cfkrl'vj to act on my behalf, in all matters relative to work authorized by this building permit application for. cD !> (A dress of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 0ORMS:OWN ER-PERM ISSION Town of Barnstable Regulatory Services * Thomas F. Geiler,Director RA"Sr,�BLE, MASS.39. Building Division . pTfD 1iu'Ra Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print j DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone 4 CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns it 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 inspe._cton_procedures and requirements and that he/she will comply with said procedures and _ � . ........._.._ •1 \ •.��r�4:�, , . .� .� - ---- requirements. ' Signature of Homeowner Approval of Building Official gs containing 35,000 cubic feet or larger will be required to comply with the Note: Three family dwellin 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 d4 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:\WPFI LES\FO RM S\ho meex empt.DOC J ��Vl II N . n y'. N a J lJ1 ;I o BOaI' O Ul_ mg #egulaot(ont-s �tand+esaan One Ashburton Place LO - Room 1301 1 Boston, Massachusetts 02108 Q Home Im rovement Contractor Registration w ;:. � p :c`�i o r w. x r Registration: 145832 I �' 9 Type: DBA I NORTH SIDE HOME IMPROVEIVfENT ' Expiration: 3�4�2011 Tr# 28/soo ro m d f_w -------------- ; o`°� , WALTER WARREN J a J Q.0 �'ri 40 ALEXANDER DR. R. - i ` •Q o .Q I i YARMOUTHPO -- —--' RT, MA 02675 -----. _ Update Address and return card.Mark reason for change. 0PS•CA1 0 4010-08108-pBSLIFOAMCA108212008 • E] Address Ej Renewal Employment (� Lost Card as Boar o u mg egu atio sand Stan ar s a HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only Reg before the expiration date. If found return to: piratlon 145832 Expirntlo Board of Building Regulations and Standards n _3/,4/2011 Tr# 28190o One Ashburton Place Rm 1301 ?Ype DBA; Boston,Ma.02108 NORTH SIDE HOME IMPROVEMENT WALTER WARREN.JR= ' 40 ALEXANDER OR � ..,1��¢ � �✓�`r�, A YARMOUTHPORT,MA 62gy5 Administrator Not valid without signature 04/14/2009 12:29 508-790-0249 GOLDMAN & ASSOC. PAGE 02/02 CSR AB 1 13ATE(MM/DDIYYYY) F-ACORD CERTIFICATE OF LIABILITY INSURAINCE SANCH50 04 14 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEDMAN & ASSOCIATES INSURANCR HOLDER.TWIS CERTIFICATE DOES NOT AMEND,EXTEND ORANCIAL SERVICES INC. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.93 VALMOUTH RD, HXANNIS MA, 02601 NAIC# Phone: 50$'-775-6010 Fax:508-790-0249 INSURERS AFFORDING COVERAGE INSURER A; ATM MUTUAL INSURANCE CO. INSURED INSURER s: HECTOR SANCHEZ INSURERC: F X 1 L CONsTFUCTION INSURERD: CENTERVILLE MA 02632 INSURERS: COVERAGE$ R THE POLICY THE P ANY ROLICICS OF INURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE EQUIREMENT,g TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT WHICH THIS CEIRTIIFICATE MAOY BE ISSUED OR THSTANDING POLICIES AMAY GGREGATE THE INS L ANC SHOWN MAY HAVE BEHNI REDUCED DES RI PAID CLAIMS,SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH y LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MWOO DATE MMIDD/YY EACH OCCURRENCE $ GENERAL LIABILITY PREMISES Bo c0cw0nc0 S COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) & CLAIMS MADE I__J OCCUR PERSONAL&ADV INJURY S GENERAL AGGREGATE S PRODUCTS•COMPIOP AGO GEML AGGREGATE LIMIT APPLIES PER: POLICY r JECT LOC COMBINED SINCLF LIMIT S AUTOMOBILE LIABILITY (Ea eccidem) ANY AUTO BODILY INJURY a ALL OWNCO AUTOS (Per person) SCHEDULED AUTOS BODILY INJURY a HIRED AUTOS (Per ecddent) NON-OWNED AUTOS PROPERTY DAMAGE g (Pnr AColdonl) AUTOONLY-EA ACCIDENT S GARAGE LIABILITY +� EA ACC $ OTHERTHAN ANY AUTO AUTO ONLY: AGG S EACH OCCURRENCE. S — EXCESSlUMBRELLALIABILITY AGGREGATE S OCCUR CLAIMS MADE S DEDUCTIBLE r RETENTION S \ tORY LIMITS ER WORKERS COPdPENSATIONAND 04/04/09 0��04/10 E.L.EACHACCIDENT $100000 EMPLOYERS'LIABILITY 0329000900 E. ANY PROPRIETORIPARTNERfEXECUTIVE L,DISEASE•EA EMPLOYE SI OOO 0 O OFFICERIMFMBEREXCLUOFD? E.L.DISEASE-POLICY LIMIT S 500000 1t y?e,de:+cMbn undor ' SPECIAL PROVISIONS bRIQW OTHER DESCRIPTION OF OPERATIONB 1 LOCATIONS f VENICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ]'GREY TD DAYS WRITTEN BATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Y PVRPOSE S ONS�7C NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO$HALL FOR EVIDENTXAR ITS AGENTS OR IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER REPRESENTATIVES, MA AUTHORME NTT E / AM LO ACORD CORPORATION 1 ACORD 25(2001108) I AGO CERTIFICATE OF LIABQLI ! Y INZWMANUL 5{11/2009 PRonticER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMIATION l HUB International New England ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 265 Orleans Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR i North Chatham,FAA 02650 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 946-0446 raLSURED INSURERS AFFORDING COVERAGE NAIC P! Walter R.Warren INS 40 k Charter Oak lns Co 40 Alexander Drive INSURER B: Granite State Ins Co Yamouthport,MA 02675 INSURER a INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE —0 BE ISSUED TA MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFOR SUCH' POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR S TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLITY E Pi T1ON A GPA�RAL LIAOU ITY LIMITS t68025a5N66ACOE09 05/15/09 05/15/10 EACH OCCURRENCE $1.000Qfl0 X COMMERCIAL GENERAL LIABILITYDAASAC£TO RENTED CLAIMS MADE D OCCUR ffa $300 000 MED EJSP(Any one person) S5 QQQ X OCP PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLES PER X POLICY FIR LOC PRODUCTS-COMPIOPAGGJ CT S2 0D0 01)0 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY 114JURY (Per Person) S HIRED AUTOS NON-OWNED AUTOS BODILY IN.IURY (Per accdent) $ PROPERTY DAMAGE (Per aca dent) $' GARAGE LIABILnY ANY AUTO AUTO ONLY-EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSfULiBREL1A LIABILITY OCCUR CLAtM3 MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE § RETENTION S $ G WORKERS COarPENSATMN AND WC7433967 05/19109 05/19l10 X WC STATU- OTH- $ EMPLOYERS'LABILITY ANY PROPRIE OR(PARTNERrEXECIFiI1c E.L.EacHAccIDE�vr $10Q,Q00 OFFICER&FMBER EXCLUDED? YES_ 11 d'8�WTM� E.L.DISEASE-EA EMPLOYEE 5100 0QQ SPECIAL PROVISIONS balm OTHER E.L.DISEASE-POLICY LIMIT $500,00Q DESCRIPTION OF OPERATIONS I LOCATION$I VEHICLES I EXCLUSLOt4S ADDL-D BY oMORSE.ETENT I SPECIAL PROViS **Workers COmp Information" IOt4S PrOPAOtOrstftrtners/Executive OfcersJR+ller-4mrs Excluded: Walter R Warren-Excl,owner CER T 1ACATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Walter R Warren DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 40 Alexander Drive _ DAYS WRITTEN TO THE CERTW"TE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL FYarmouth Port,AAA L32675 IMPOSE No OBI.GAr-09 OR LIAStL r OF ANY FIND::-o:�TIME IR:,,UREp tis�I s cn REPRESENTATIVES, . AUi REPRESENTATIVE ACORD 2S(2001foa)1 of 2 #S249611W249M DL001~ 9 ACORD CORPORATION 1998 J TOWN OF BARNSTABLE Permit No. ..31482...... BUILDING DEPARTMENT ""n I Cash TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Peter B. Hawley Address Lot #32, 90 Bursley Path West Barnstable, !-lass. 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 BUILDING CODE. January 24 . 89 v/�r .. .... .7i,. A 7!.... ....... 19................. Building Inspect �i v ..... I ,.�,;� ....-+-..."�--..�r�1'y,•• -..�: , .-- �«r ..-�Y_ . a,,.�Y '„'��; ..rq•t: �.r^v`i.,jY''.r ""'.�.-r4_ a ti•-w,,,_. _�,. _.44 TOWN OF BARNSTABLE Permit No. . Al 8.2 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash •ML HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Peter B. Hawley Address Lot #32, 90 Burnley Path West Barnstable, Mass. USE GROUP t' ' 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 BUILDING CODE. ` i ......JEinuFlry..24, 19....8.......... Building Inspector eft `. � .a. •i=+J �,.;�1 3r )E• rvs�}'ME, •Ck?)k )N�'�@t� ,��F,�`Y�, ..-.... � s n •I r"a �`!'�C'' a �y'k"i'y"h �lF,fy�{�6�tY�Ri� • r 1�. t!t[/,� / Y„9 t-Y / �.I•r Lq 1.+�, 'r�{..d'f�J�'rw y+•9h�r� ( :Srl��r, � ppTr[�[�.f ®.�•� � � �. ��Y 't �. . � 'l J•,.' •1 ✓,!K() < Y„I .,l I 7 r .,,j.y 1 r-- {1'. gilt s• k'M it A (`E+,� � ,+,_''+K ,� �,t,, h p�t 4.YIfr,Yi. rt'°,•��,,q„ L { ,•rt4 '� 7,) rY''1 ,::r\ � �j,je 7 � ,M. It ¢,��,i3 { yl R.Y• r...s 'sl I I Y. "F�?.l.'f 17.•,/mso � a�lyyrtl�-•r i! • ram•' _ ibPl��'li� •" S�i i'�r. q. ;,� t�-t, i�'/��t. "��y,,,;•y�/y s � +'4+'• Y •1 Y a.:- "4 r� YY�a Y�i i L f..a t�i +�' ''�, r�v I{�,�r '��( `M�'�Y��Tnrit�J,F� �' . ,7yPc•� 73 yt t {.' f? 4.C,yi-r M ! e '�i+'VG"''(r �''1J I• ��.r M-i 1f' y.• A'} A�tr .......e;w3�✓±4 � ' .r.. I �'RC�a�'.'�t''- •'Y�� 't"r•}�'�i'.it�,�rr�c, w �r G ti a i :.. ..� 1 .tra ti •_'� tw.Z....`arivl.s•i T ' d I ^ I z ,' 1 'w3,°"� �,Bt?.1) .1 >` i c��°"rC` Q✓4'V !�'t '-1•',e„ M ')' I F r r i!•?� {. ''�d �y, :rc.s,��.rr��r�r�)6��P�a?•��:�)i9�t r :.S.{'",^,t�`„,#,S• ''�1`;= ' ;�,,+. .,,;y�s,:'r !��,^! !:;<-;�'rci'c'y:•rLrvJsy.'{� ;t�i '�f {r. .1'� ; ',I;i' '•jl. � .RI ; `'x"•rr�.'..a.+.d$)L°,YB' J� � � �lraP`�,.SA) rc)(� � 1_,.a P t• P f t r I r ). VT �G } '.,.� �t,,}}�r��+�.��y,,��.a � st:. � � -Y as r'� t"rr- i,j,,s:_ .M:bnra•�..,aa'.,..+. L ....._, z r l ) r _ s� `.� �"••avlai%F ��N R4 "{. Lam{ IHSf J � t �;y F �y((jt I � S 4>i w�`klY.• 1-r•'4e�f �7prj".rt•�11'S �t .�+'V^ 'C:. I`trS Hr'G�! 7�y7"�Ai art n ttla 1 - �� `T�^�f�� > � ! y )lJ��l .�. rJ J��^7 h✓rl.' fi) ��.�r i"f /{.Y .L r,. t � •V, � 7".t z 1 •�•'"wrr"K�Atr,N yr� •s:5' i' r�.„ '��"'�.ra rb�yi3ii�ni+ �:�riA�-1 ��'� {'1 a.,.r:u.r_�'._.s:rl lurs,..d" a.,v.> ?' 4 r♦ V. :.rr ��„� F 4 \� Y• a.''rt t�l.kl }` � ,!, Q :� �S'R}"�X��r.��i�`T 'd} ,r _ s t�)F� _- � y 3 y'�r roC F.LrA k.ri c tta t r ll1 s'7:�.f�•t.}`2�iY-i�`- �"' M i��_ t �` (, r + � - rw).�� i•{!r �y.F� FEW,,,,;� �1F> • T A ,r L9f � Y:/Y"-{c�'•1'�1�i,11'+t`•S•1`o-•l�lf�•�!� i_ 1k1 f-.. r�1.[S f '.i i7,�• �y;-r�r )3 1 ry.tir rG t'i ri) yr' ( } - r ;' { •2,.�it.t•y 4a,ayeekt 7 lc i. n y'y -v, f�" ••• • • s r r{ �r ; .! i r i '+f 4 jr' lt'ia•" l� r 71 P i(, FL. $ ,.�.!' t t7, • r r - 'SV c t �•2fTt� • Sr+ ♦ ,in)i��:r �] ';7-.. '3�r+,�Y'11�� 3 s i t .r ' rY�e •� . I G ,i' a I ..rY t �3" ' >'ri ��j'ozi'fp,,�aaor C. • -� _t 4« 1_C '•=fei2piEl. r �'a'X� '�-a�y��iJ,-Tras-'�Jrc,. '. t e ys't s r-� �t s ar AR�t�t' { y rtP" T .' .�n�tiC.�ihiC>f�iL•F.•aCidt .ra+a.�lw2..�N Y e>•.�' :i�,�r T }4r 1 n�) ♦ •�i � I� rdt� '�x }t� Sa:a, •v 4 4ir r ro�4.,�� tr t' r••k _ -Y 'r, E "'Y t;o,�,) ,r1 f �1 .i a ' r",?,D � '• r�Sfr"hFriN. �rt �, •�N S�,�[i ',M �r y,"?I'1 t t: I r"V. 't Y � '1 ti 3) -•' ,ity�'° 11r�r�, >. r :�"aa .( (Y. -Y. 'S T � � r t4 � 'r3 u rti �, i � a r 'r, r yti ry( �a ,� •y -'�J'ikf r � J: i♦ G?taIFC�4M•F67�;� t .: � ��V r��sll.Y:-`�'Jx� f+�J«i x�t.rr'i'£JJ ±r "Sv/1:"l�ri,Y�-M -?�r`l � �4�.(i 7.J ! +rr"�` + ��F��'I .,.f��[,;J M o o r`'t;t ..,y�;Z'i a �.. "; 3_.. 4A.'�.Y *+,�i'' '�' �r�. o�'r p r•ds F�. .�.r•1`�� •�l_e! '� -�,' It t .,, Ire• {{ c s-syrT i^'C��. � , � � ��li•6i•SIjYb x y. r ��'�`�� )�1 ,'s yrrL1` 1 i r rP'y9 t I ?>I t 4 .0 dG�'K� tC �. `5 i' yr 6 I ),� /7> ..;. Jr�}.�;,,..,,Y.+ -,��! hY!• � 7 ". s r r) � r h i•1(` .. .f p��,�� _ : - -. G, �r' is A 2 H `.A• +t 3 s_ ( Y r(tr 1 .�' ra t1 :;•1�Lai �tty7)s }% !'�lblpr{ ? � • •tr • - • e • rid.T�4 �p�f S.e �. o•ot ::.w 3 ��r -BUILDING INSPECTION APPROVALS -PLUMBIN INSPECTION APPROVALS 441 �A:,��,:^rye 4 r F� ,t��7,�.' i�f�lt•: r 'sa:,;w',�I:y�l, •��`,•' '(a t'�-a.`"'t�:�,' '^' girl® �,<^.•l2'S`'�InY?a�.gm�/A,r t.ii�•r; .sY. •� i S YrS t {${ t j �+{.+iv'i4�-orb �°�r."+c. '��'li�•3,''�Ot - �.•�i q I�S� -�j��-'•t F ��y�J `��°5�� w.0 � ,��:��rr`�.'S. t�� j..t��A l��°�c�,; 1..yr�,.. " .Y i��.. f.f f):L Mh'7••.:N a�.4 tom. �. ,f fl r�.yr t��e�`�� :�flr•T.: ;�-*Y :'�j 1j1 _ :�bF�4�.4'rrR''tN td{ %`�,at?'>1��,••C.�,�lSri. y,1c t F )typZzS�Sg�.:-�':i';:LtaY� .;•}� -�,�a: .;t..�}t�,', ��1`I�i� � ��'�'&'��`a,^�d,-�:r r: 't�..14a.f ��.7`�yr,..s Q�.?' �+�.•{`.[w��•a�'+ ""5•,F.�aCta`=. i�'rJ' i.?i•r'r��.")`+'r�'1 ..i t 'Srsf:t...w7.r .t25,.• ,.s+LSAFr�d:�la Y.aVi�t'.eSA.19;`k=r� .�V�y Pvh F:.n4� r ,:..'$'.'-8 Spa• Ti 11• r v `•7Z1)�v i- �'�'`.Y'x 1 jA�•FS.�! zU�t r: G'• ', • � ::r::. Ir:i4`fU�'3.�I.,a,�.f+;Li'!�."�f{;4/ t•.�,,w„;"tF I�,w,ii.� ::11..r,r�{:.fi{5�' }� c..'b�rt J�,�\ { 9i•ve�{i5::�ltrr f1:,b b 4 �. - y. c -- �•.. rf'. 4 Wes:„ fit♦I 1r .:y 4, �►� • ' yC'. F!oF}p!,o:tl°.1;^�,T'y�) -cif f r' • yr:Sig �I'`:•y!}t ttl' •• • •A.'M�t•r.g.. ... :v � !7r..:iF'=k.,t:crJ;:t`...,a-f •-).•{y'•,.,.. n,(,• ,,.y "•�S DATE� /act.(/ CONTINUATION OF, ROAD BOND BUILDING PEP-MIT # 3/ The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of .Public Works. loam and seejshoulders as soon as weather permits. other (explain) GZ-- ` LOCATION ; 31�,� K ' SIGtIEO rie /Contractor C1 v�% E 'GIt,EE I 1G AUTHORIZAT N 1 • N 70 N� N r c J 2.�K• n S.3 O , w gZ.45 45.70 'Ao iA 3 W r n 0 o N .V o N M � N o 8.9 N D • z Is NLl LOT 32to O J N v • R �312.fe8 BURSLEY PATH Ft o oD ZoA/E: 'C RE5. ZaAJ : QF FOUNDATZON CFRT= FICATION. -rowN RAR - IST B F PLAN . REF. 418 - 55 ' DATE 12 7- 87 SCALE 1 = 4 0 ELEVATION I HEREBY CERTIFY THAT THE ABOVE FOUNDATION IS LOCATED ON Yet M14E E SU.RVE �S THE GROUND AS SHOwN, AND �ZN OF dta�_ cortGuLTd}1TS ITS P05ITLON DOES CONFORM TO THE ZONING PA A. c '7o RAsp�ERR LN, LAW SETBACK REQUIREMENT � MEA►THE1N � y OF No. � y MARs-roN S M ?LLS, MA SURVE�� PAUL A. MERITHEw. R•P.L:S. /SSZ- 3Z As setor's offioe (1st floor): ///�/�� INE Assessor's map and lot number ....... Board of Health (3rd floor): Sewage Permit number . .........................r... 13AR39TABLE, Engineering Department (3rd floor): r NAM& 1639- House number ..................................... ...J.b... APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only DESIGNING ENGINEER MUST SUPERVISE INSTIA ATItil TOWN OF BARN. lXNERTIFY IN WRITING S` ' i O` E '° PLA":STALLED IN STRICT BUILDING I NSP APPLICATION FOR PERMIT TO .. ............ .. .......... ............................. ...............C�2-Adty . ......................... ...... TYPE OF CONSTRUCTION ............ ......................... .. .... ..... ....................... .............................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to th following information: Location ....................../P. .... .. .......&.,v. ............. ... Proposed Use .....h ....................... *P............. .................................. ........ Zoning District ... ..................Fire District ........ ... .. .. .... 1j)e... .................................... Name of Owner ............Addres Name of Builder Name of Architect ...... .................................Address .............................................................. ............ . .. ..... ...... Number of Rooms ............................................................Foundation3 el.X�)(0 --2..........t) y 2-(/..oQ.)(..... !7,V r .-..Roofing .......... ................. Interior ......0-orp.4.......................................... .....��S '�........ Floors ................. Heating .... ..............................................................Plumbing Y- � :5 Fireplace -12-g............A. 0 ..................................................Approximate Cost ......... ......0 0................. -2 Definitive Plan Approved by Planning Board ---------1 9,ia-- Area ../.g................... .......... Diagram of Lot and Building with Dimensions � e- el/ Fee ..... ?......... ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH �1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the T wn f nstabhe regarding the above construction. Name .............. .............. ........ .................................... Construction Supervisor's License HAWLEY, PETER B. 31482 Two St6ry �L_' 40 ................. Permit for .................................... Single Family Dwelling .......................................:�................................ Location ....Lot....#.3.2.........9.0...Bu.r.s.l.ey....Path W. Barnstable ............................................................................... Owner Peter B. Hawley .... ............. Type of- Construction .....................Frame..................... 3 ............................................................................... Plot .......... ................. Lot ................................ December 8 , 87 I Permit Granted .........................................19 Date of Inspection .......................... ..........19 Date Completed ...-4�._3?.........19 . .. .... .. .... IS C) M co '/7.tra''iit<q /- v/�/ Assessor's offioe (1st .floor): . ��/�/�� / HHH .- Assessor's map and' lot number . ./ Q o Q�f THE t0` :-....:.:. :...... .. Board of Health (3rd floor): s Sewage Permit number ....... Engineering Department (3rd floor)__ House number ................................... .�..U..:. ........... oho Apr°. APPLICATIONS- PROCESSED 8 30-9:30 A.M. and 1:00•.2:00 P.M. only TOWN OF k AR,NSTABLE BUILDING INSPECTOR , APPLICATION FOR PERMIT TO ....<. . ............. ............................. ............... .......................... TYPEOF CONSTRUCTION ........... ......................................................... ................................................ . ............ � 3...--------..........19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,[ Location /'?Q...t..... ..r> y; Si.`e-v ,....��1 ......lN...:......................P.-........ ... ` ...........� ..h.. .... .... '2- Proposed Use ��S �`Q k `� Zoning District ...........................Fire District I ...�.,i'..>.... .�.Y.'..�.e-.�?-: .............................................................................. Name of Owner . `Q `2 Y..... :. a C ��Q.1,1............Acid ress\./>:�.J..J.C>. ......� J1.... -..??,......(!{........... Name of Buil der#53t-4�4�L,/.y-A.-t.r-��. ..�OIIS t.....Address'�?../�i' �0.�? . �.Nl��lf� ..�lJll!c / Uz Nameof Architect ...............°Q...`...........................................Address .................................................................................... Number of Rooms �l ............................................................Foundationsa. .. ...�a y y a r�s .—..Roofing Floors ..! ..../�,2 Y.d�.�. /�Q S / ... . ............................................Interior ........... ........... ... .. . ................. Healing .... g ... .. �1% .'.-�'.....-............ - �- �-:-=Plumbin Fireplace �I . , Approximate Cost .......... / .................................. .. ............ Definitive Plan Approved by Planning Boar_dy- O U4�7------- / 19 c.Area ... ... .!... ........ .......... Dia ram of Lot and Building with Dimensions � �' ...../07i g, 9 �- Fee ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH f I f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............�........................... . .................................... \C;ont-truction Supervisor's License .D.v....... HAWLEY, PETER B. I" A-- 10-25-3 No ..3...14.82.. Permit for-..TWQ..5.tory.......... .. .. ..... Single. FAMj.j�y..L).W.e 11 ............ _ing........... Location ......Lot........#32........r.... ...P.a.th W. Barnstable ............................................................................... Owner .....Teter B. Haiwley........... ..................................... ............. Type of Construction ....FXEAM........................ .................................................................:............. Plot .:.......................... Lot ................................ Permit Granted ..... 8........19 87 Date of Inspection ....................................19 Date Completed ..........................................19 Oq BIKE T Town of Barnstable *Permit �. Expires 6 months from issue date Regulatory Services Fee ■AIRN nar E Thomas F.Geiler,Director —�- ��, 11 ,�� Building.Division AlE pr A Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790*6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I � Property Address % 1y &�J Residential Value of WJ CC(t .G40 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance X®PRESS PERMIT Check one: Vm a sole proprietor MAY 2 9 2008 m the Homeowner _ ❑ I have Worker's Compensation Insurance TOWN OF BARDS TABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) U [T Re-roof(stripping old shingles) All construction debris will be taken to ry�►Jw�i�Lz ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum., *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 is required:. :: .: . SIGNATURE: J. Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 ,per The Commonwealth of Massachusetts �\ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le 'bl Name(Business/Organization/Individuan: Address: 9a f.3�F&C7- City/State/Zip: 41, Phone.#: 3,7r FY 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 . employees(full and/or part-time).* have hired the sub-contractors6. ❑New construction 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. gemodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp.-insurance comp.tnstuance t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions . ( myself- o workers' co right of exemption per MGL 12 Roof repairs y � �� c. 152, §1(4),and we have no � • inc�rrance required.]t employees. [No workers' 13.❑Other comp.insurance required] •Any applicant that checks box#1 must also fill out the section below showing their workccs'compcns;4on 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. i-_=tractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employ=,they must pravidb their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to se'cure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. Ido ereby certify e p stand penalties of perjury that the information provided above is true and correct ttmre Date: Phone# �� •�7b � 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 t Contact Person: Phone#• Information and.InstructionS ., Massachusetts General Laws chapter 152 requires all employers.to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregomg.engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)'also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s).of insurance. Limited Liability Companies-(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance'. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp 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 ono 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 aff davit 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 homeowner or citizen is obtaining a license or permit not related io 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 C6mmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 4.06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable �Op'If HE Tp�� Regulatory Services o; Thomas F.Geiler,Director • BARNSTABLE. . 9. ,�� Building Division �TED �p Tom Perry,Building Commissioner 200 Main Street, Hyannis, Na 02601 ww•tv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: -wo1_7.0 7_ JOB `?LOCATION: a c,ask!9 numbers G, street. village ' . ..HOMEOWNER":�L.Gt/ ✓ ��L�-G��-- �� .�7,�Q �� 2��C3�� name (� home phone# work phone# CURRENT MAILING ADDRESS: -[ ® �UQ5I W.%0Vrjs7V-b1c._ A A-- city/town " state zip code I 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. I The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department iminimum ins ection ocedures and requirements and that he/she will comply with said procedures and requireme S gnature 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." j Many homeowners who use this exemption aie 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 fomi/certification for use in your community. Town of Barnstable Regulatory Services ass M� Thomas F. Geiler, Director �p i63q. �0 lEn„�,rA Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must. Complete and,Sign This Section If Using A Builder 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 of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. �IH, Town of Barnstable Old King's Highway Historic District Committee • BABNSfABIE. MASB. r 200 Main Street, Hyannis, Massachusetts 02601 ' MPy (508) 862-4787 Fax (508) 862-4784 CERTIFICATE OF EXEMPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: j 2 Date 5 =�7 a .Address of Proposed work, Assessor's Map and lot# House#_Z Street l/R°S�£ Village: �.1�r421�3 T1� This application is for an exemption of the proposed construction on the grounds that work: ❑Will not be visible from-any way or public place I%( Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: I2V406,K- �?Xp C�6"2- P.- GJ I�-�. . tfr/g1� f�2dl'n-taell rNQ/� Agent or contractor(please print): � (L Tel. no. AddressButz Owner(please print): Tel no. Owners mailing address: GL2S �.S.�l �sT Signed,Owner/Contractor/Agent For Committee Use Only This Certificate is hereby Approved/ enied Date: Committee Members Signatures: �A), 01 MAY 2 7 2008 �V —,p V, TC WN OF EARNSTAELE IS ORIC PRESERVATION y Any conditions of approval: Q:IGMD-Groups101d Kings Highwny10KH New ApplOKHExemption Form 07.doc