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Home My WebLink About0410 CHURCH STREET � � r r NO. 152 1/3 ORA EELT - - 1 ova Y� L .-.. -. T . .. .+n . �.� ��. �r. �.. .+ - , ... r- r �-r�('• '1...r..•..r �r..�•.. r . r • .. �r 1r r"+r ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parcel 0 O G` Application # Li Health Division Date Issued ,3 Conservation Division Application Fee Planning Dept. Permit Fee '(�3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village (A) c r A Pnic lam- -M 2 tF- Owner iiEk,�, �'�2 Address 4W C-ifLhW tSt b Kf4 l�2GG� Telephone (o G 2C) J ST5 a- Permit Request €:3>,iLCTI NA n aF�n-r,-F NSF,) 0CcraaxX,4 ►.ur 970i-L2nc:�- �� 1��3 Aa N ,I t�'i�JZ tc, Lam/ Square feet: 1-st floor: existing/N'Q? proposed 2nd floor: existing '?2 proposed Total new :Zoning District Flood Plain Groundwater Overlay Project Valuation Xoea Construction Type Lot Size ,�. -24 evcneS-. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ull Two Family ❑ Multi-Family (# units) Age of Existing Structure /(1 Historic House: Et Yes ❑ No On Old King's Highway: ❑Yes 0 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: 1 existing —new Total Room Count (not including baths): existing OV 9 new First Floor Room Count Heat Type and Fuel: S 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_ N_ --I Attached garage: Uexisting ❑ new size _Shed: ❑ existing ❑ new size Other L Ln Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -- co Commercial ❑Yes ❑ No If yes, site plan review# -v Current Use Proposed Use w APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name , Telephone Number �26 9-g 22 Address License # c<; _ /O `� 2 2 U i LQ ,Ad A 0-2- Home Improvement Contractor# 3 2 2 3- Email M I C 4A eL D Qb(-)E @ 6,M40' i C ,Cate Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G c&(?,t C SIGNATURE DATE 17 ' A/ FOR OFFICIAL USE ONLY Y }. APPLICATION# 11ATEISSUED F I ` MAP/PARCEL NO. M , ADDRESS VILLAGE , I OWNER DATE OF INSPECTION: _ FOUNDATION .` FRAME INSULATION f /3 AA- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL I ANAL BUILDING DAL�E CLOSED OUT ' , • it � .� AS:§:60?!ATION PLAN NO..' TIw Common gfMassachuse #s Dqwtamf of'hu=lrid Acddentr tce rf' esns 660 W gfaff s reef f02.1 it WPVW M4VMgm,1d= Warkersa Campensa5€auInsurance Affida Ba:ffders/CantractorsMeciiicians/PTnmbers knit InfarmatJian Please Print Name GtyfSfa efl _(nnIMLU(UC. M 6 0 6 5rPhow4-- �'�� ' `l 20 Are:you aii employer?CheckMe appapriate boss Type of project @-eqldr ed-- I❑ I am a employer with 4. [)I as s ge aural contractar and I ❑ employees{fall agdlorpart#ime}* havehireatbe sublco rs.. 5 I�Te�won 2,W I am a sole proprietor or partner- listed on the attached sbeet. 7- ❑Remodeling slip and have no employees These mb-matrartors have 8- ❑Demolitica working forme is any capacity. emplayem and have Wo&.-is' 9_ ❑Build-mg addition [No WMImrs'comp.ins xance comp_,nsarz„m 1 5 ❑ We are a corporatianand its 10:0 E ectrical repairs or additions 3_❑ I am a homeowner doing all work officers bave eaerased their IT--,Plumbing repairs or additions nr: It[Nowork='tromp_ right ofesempfioa per bIGL 120Roof repairs inmuance regaire&]T c-152, §1(4) andwe have na employees [No Wotisrss' I3�Other comp-insurance required.] Anysppfi�utbutAh boz#1umst also U out t�secl b9awsbn�5feirwa&mi'mmpem�aupeLeyinf�azL SMily es vrho submit tins ETulxvff indvrstiag they am doing¢II V=X sad&M hue onside combmctors musr submit s nec�sffidasst an t mrh s tw check this bow mm,snarled Za addi8nn11 sbae t dLov nag theme of&a snb-camftxcbm xad We xhether ornot thaw eltim i;ave amplcyees. Irthemff?<�haw e=4agyw.%they=ntgmvidetheirwadmss'comp.policymanbet yam arz employer that is prw iWffg workers'compenmlfiun inm4rance far nzy exgAfnyeas BeIotr is the paficy and job situ irzforrr:Qtian. , Insurance CompmyName: Policy 9 or Self-im Lit;; FxpirationDate: Iob Sif;e-Address City/Sbtelzip: Attach a Copy of the wGrkers'compensation poficy declaratiou page(showing the poUcy number and expiation date). Failure to securecoverage as mgaimdun&r Section 25A o€MGL c.152 ran lead to>gte impositi=ofcrimh al penalties of a fine up to 31,500M and/or one-yearimgasonmen,as w&as civil penalties io flie foffi of a STOP WORK ORDER-and a tine of up to$250-00 a day against the violator_ Be advised that a cDgy of this statement maybe forwarded tor the Office of Investigations of ffie DIA for+nars*+re coverage vecificdion- I do hemby eerh;fy ender thepains dp Was fftetffia uefbrmativn pratdded above fs bma mid.corract SiEmature: Date 7 " Phone 9- cc 20 — Q.ff kiai use mi£y. Do not wriia in this area,to be canfpL-W by city ar town officiaL City or Town: PtsnittUcense if Issnfeg Anthordg{circle one}: L Board of Health 2.Bing Ihgartment I Cityffawn Clerk 4-Bectrical Inspector S.Ph=biaglaspector 6.Other Contact Persa PIFone#_ 6 Ir r Information and Instructions Massachusetts General Laws chapter 152 requires all.employers to provide workers'compensation for their employees. Pursuanfto this sfatote-,an.employee is defined as"..-every person iu the service of another under any contract ofhire, 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 ofthe foregoing engaged in a joint enterprise,and including the legit 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 man•rtcuanw,construction or repair work on such dwelling house or m 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 Iocal 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 ofpublic 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 numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with Do employees other titan the members or partaers,'are not required to carry workers'compensation insce. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance Coverage.- Also be sure to sign and date the affidavit The affidavit should be rammed 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 pemuittliceuse number which will be used as a reference number. In addition,an applicant that must submit multiple pumit/license applir;ations 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 fur future permits or licenses. A new affidavit must be milled 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: as eommanvyed&of Massachusetirs De att=at cif I&iustial Accid mts Qfitce ofkvestiotiGm �(}�l�asshin�tan.Street Bastmu=MA 02111 Tot.#61 r7-727-49 Qxt 406 or 1-9 MA& E Revised 4-24-07 Fag#617-727-7749 . gov/dia /ze �Pdrrmaarecue�cll/.a��ilccd�cce/zccde�7i _ - Office of Consumer Affairs.-Si Business Regulation License Or registration valid'for individul use only ME IMPROVEMENT CONTRACTOR y , i egistration: before tf►e expiration date. If found return to: y' . ;.173228 Type: OffiC1O o4'Con§umer Affairs and Business Regulation xpiration::;,.g/:171201.4.: Individual 10 Park Plaza-Suite 5170 MICHAEL DODGE Boston,.NlA 02116 MICHAEL DODGE = 297 POND ST ... OSTERVILLE,MA 02655'•'' Undersecretary d t Not valid wi tore i i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-103262 NUCHAEL F DOD6`E c P.O.BOX#38 OSTERVILLE WA 026,;• ' . Expiration. Commissioner 06/19/2015 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(9911n3)of -enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. www•Mass.Gov/DPS For DPS Licensing information visit: t WE Town of Barnstable RegWatoLry Services MASS -Richard V.Sca1%Interim Director 16 .� 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.Must Complete.and Sign This Section If Using A Builder PAI, -,as Ownet of the subject property heteby authorize-M.( to act on mp behalf, in all mattets relative to work authorized by this building permit 04.t0 C H3 2Q_ w (B IgTc ys-I)g Q(C- (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and accepted. 4. ?tie. 4,,*.ut, Signature of Owner Signature of Applicant Print Name Print Name Date Town of Barnstable - -. - Regniatory Services - prr Tok� Richard V.Scali,Interim Director °-� Bnilding.Division : - s�xrsresu, II Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION ; _ Please Print DATE: JOB I.00ATIOI+I number street tillage -HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town stale 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 ofBm stable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowacr Appinval 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 EREM7TION 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 1091.1-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,Riles&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 i I , i �ZEv c5 .-Y ab i BEDROOM BEDROOM kk 4 7 RESTORE ' FLOG VEL _a REMODELS .S - i BATHROOM ' SINK �. %LTV TUB c3eg door .-e 0' 0o ao ; 2' ,4 PAD WALL R PLUMB'& 1 i O NEW ' RTITION tf ' = MASTER SINK - NEW P ( BEDROOM I BATHROOM 'V FOR = I CELL '' EXISTING r:- FOAM ' FLDOR ATION ' LEVEL � < 4 PROPOSED PLAN 1/4" 1'-a' DATE: DRAWING TITLE SHEET NUMBER: 10 APR 2014 PROP05ED 5EGOND FLOOR PLAN .E, MA Scale 1 /4 . 1 '-0" 0 4 e 16 r � Q CD t of cu ZZ era w _ era w �— in e'er 1 \r y� _tty BEDROOM BEDROOM ATTIC s`= / iW J(+j� .. .s -- ---• \I _ ,--.�" IIII Aso"�=-.�''�_RE5✓ETLO RE0 ��,.-,_-,. .IIIIIx l3 • x+ N .•.� _s „ I.. - S S S ___ NEri TILED 4,-5' SHOWER REMODELED rSTALL NEW s 'BATHROOM (lk OER Is'-4°STLL NEW PEDESTAL SINK RMERFLOORLEVEL SUNRISE SPECIALTY 6m-, K"d{4C — — { 66°GLAWFOOT TUB PAD WALL r' ( FORPLUMV6 � NEW L f i RTITION � 1 I MASTER D/NIN&ROOM GHIMNEY5 NEW PEDESTAL SINK I NEW P I BEDROOM r� I BATHROOM I 'r d L : PAD OUT EXTERIOR WALL TO ALLOW FOR -- 9}°CLOSED CELL I •` EXI5 TING SPRAYFOAM FLOOR = PROPOSED SECTION __ INSULATION - - A-1 1/4"- 1'-O" i \) (TYPICAL) tl, SjE%ED A 6 AREA OF NE WORK ( •: .- ..� #= W NEYi WALLS a"No.5603 :. EXISTING 4 PROPOSED PLAN ' 3 ..<-. WALLS A—1 1/4"- 1'—O' ff�l rN OF MASS'` PRO)Err. DATE DRAWINGT77E SHEET NUMBER w HICKOX W LLIAMS ARCHITECT'S AITKEN 10 APR 2014 PROPOSED SECOND FLOOR 58V7..cS-1,B.s ,qMm h--02108 4 10 CHURCH 5T PLAN (617)542-1080 Fss-.(617)542-W7 Y4E5T BARN5TA5LE,MA Scale 1/4"=1'-O" 0 4 e 16 i -- - ._ _ ATT/G iL -ON N / a — -- —� REMOVE 1 ' F/XTURE5 t ' I / /, I / �a.e F/Nl5HE5 I // // �� . r ar I STAR REMOYE� /'/` I' ram: HALL I _ /�EX/5Tl//✓G ON RA/5ED — ----- I I I I I I D ENTRY/N/NG ROOM CHIMNEYS I !�i�- MASTER cv' BEDROOM P I I y�. I I _ 1 EXISTING SECTION I — X—1 1/4'- 1'-O I ` .- _ -- G`SSiRE RC AREA OF I 11'6r ?�' Derr" •'4 Fe / DEMOLITION I I NEYV I r I o YVORK I e EXISTING I ' `--------------/ •y - y WALL5 / EXISTING PLAN '9/M or MPs —1 1/4'- 1•-O' PROJECT: DATE DRAWWGTMF. SHEETNUMBEN HI ITE N 10 APR 2014 1 CKOX WILLiAMS ARCHCTS AITKE EXISTING SECOND FLOOR _ sew=S=c%Busmn,Mmsxhwe®02108 4 10 CHURCH ST PLAN (617)542-10e0 f=(617)542-"A' YiE5T BARN5TABLE,MA SGale 1/4"m 1'—O" 0 4 e 16 x a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 74� ? &0 Parcel v Application ` Health Division Date Issued Conservation Division' Application Fee Planning Dept. Permit Fee f? 3!1 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 9 to Ck",t.i, s+. Village . '- Owner � A W'11 Address s<%4- Telephone Ci-i—777- 7,41 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation )yw Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ' Dwelling Type: Single Family Er 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 �-- 4ii Basement Finished Area (sq.ft.) Basement Unfinished Area (sq�ft�j Number of Baths: Full: existing new Half: existing913 a nevv� Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor RooF nt'= 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 Mike McCarthy Construction Telephone Number PO Box 52 ' Address Weyt Dennis, MA 02670 License # Cell (508) 280-6964 C-SI -58633 HIC-111 6939-3 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE. FOR OFFICIAL USE ONLY ' 4PPLICATION# 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 DATE CLOSED OUT } ASSOCIATION PLAN NO. �(q_��-3.r» � r Town of Barnstable Regulatory Services I S Richard V.Scali,Director i63A �0 ,u•�` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MAN 02601 wMy.towa.barnstable_ma us Office: 508-8624038 pax: 508-790-6230 Property Owner Must Complete and Sign TWs Section If Usino,_A Builder I, A 1111 1 }ah c 0 kKY A 1___rY4,A1Qwner of the subject property herebyaurhorize McGo Maf ptic�-,0,A) to act on my behalf, in all matters relative to Rork authorized by this building permit application for: 'tlo C \ _S - W , RC.yNkS�clbtu (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted_ Anna Aitken(Doc 18.2014) Signature of Owner Signature of Applicant Print Name Print Narm Tate Q:FORMS:OCdJQFRPI-R1�IJSS).ONPUUL; Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCAR PO BOX 52 ; W DENNIS MA 6267�(VV f714-^• —� " "� ` Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY - P.O. BOX 52 -- WEST DENNIS MA 02670 ---- - 1 Update Address and retu'6-card.Mark reason for change. 0 SCA 1 40 20M-05/11 E] Address [---'Renewal Employment Lost Card �lr` y The Commonwealth of Massachusetts Department oflndustrirdAccidents Office of Investigations 600 Washington Street Boston,Mt4 02111 whphp.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers `. Applicant Information Please Print Legilil ike McCarthy Construction Name(Business/Organization/Individual): PO Box 52 Address: West Dennis, MA 02670 City/State/Zip: CSlpa§§#3 HIC-169393 Are u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole propridtor or partner- listed on the attached sheet;t 7. ❑Remodeling ? ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.Insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required] officers have exercised their !0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself.[No workers'comp, c.152,§1(4),'and we have no 12,[]R If repairs insurance required.]t employees.[No workers' comp.insurance required.] 13. they *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. t Homeawners who submit this affidavit indicating they are doing all work and then hire outside contractors rust submit a new aff davit indicating such. tCoatractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy Ir6 madom lam an employer that is providing workers'compensation utsurance for my employees. ,Below Is the policy and job site krformatlon. Insurance Company Name: • T M-A A Policy#or Self ins.Lic.M V WL i W-tau'l1G4- r Expiration Date: Job Site Address: yIc, City/State/Zip: t 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 ofMGL c. 152 can lead to the Imposition of criminal penalties of a fins;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 far insurance coverage verification. I do hereby cer7/fy rt d e pa a enallks ofperjury that fire information provided above Is true and correc4 1 � Si lure: Date: 1 I Phone I Offle al use on Cy. Do not write in tb/s area,to be completed by city or town ofJ?c1aL } City or Town: PermifMcense# l Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other - Contact Person: Phone#: TE o CERTIFICATE OF LIABILITY INSURANCE DA07101201YYYY) `� P 07/10/2014 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 pollcy(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 lieu of such endorsement(s). PRODUCER 01962-001 NaO€ACT Bryden&Sullivan Ins Agcy of f Dennis Inc NC.No.Et): (508)398-6060 ,No,: (508)394-2267 PO Box 1497 �SEss: So Dennis,MA 02660 — 1 RE AFFORDING COVERAGE _NAIC# IN URE A• A.I.M.Mutual Insurance Company _ _ 26158 INSURED IN—SURER 8: Michael McCarthy Construction Inc INSURER C• P O Box 52 INSURER D: West Dennis,MA 02670 — INSURER 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. NOi MTHSTANDING ANY REQUIRENIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 1A1-IICH 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. ILTR TYPE OF INSURANCE I SR � POLICY NUMBER MM/DD/YIrYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RPREMISESIE.ENTED occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ j �OLICY ��COT �0C AUTOMOBILE LIABILITY COM caBIN SINGLE LIMIT $ 'd nt _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F- SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTYDAMAGE HIRED AUTOS AUTOS 'de $ —_ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yyo I KDDEEERRDgg QQMM R��EggTppENN�TIIONNN $ yy�g7p7� 7}{ $ AND EM�PPLRt)�YER8�LIABILITRY� X TORY LIMITS OER A OFFICER/MEMBER EXCLUDE07 ECUTNE Y N E.L.EACH ACCIDENT $ 500,000.00 0 CE LU �Y NIA VWC-100-6017656-2014A 7/17/2014 7/17/2015 (Mandatory (�IIn�NH) ��tj E.L.DISEASE-EA EMPLOYEE $ 500,000.00 DES9CRIP710N�UPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 196 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / l ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CCARTHY ^ C k RUCTION CO. id ''dal and Commercial Builder ; 'Till Its A177ON SPECIALIST v, H October 21, 2014 Town of Barnstable Thomas Perry CBO N UZI Building Commissioner �. \ 200 Main Stret ire Hyannis, MA 02601 r7 0% RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#0 at 410 CHURCH ST has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed.Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction ` IL a�r Ue _ r;b 1 f �4M±. 41•• _ SUs - R.. 7.A 1'- De:ns t� - ! 11 _ _ Company .p- Cod lflsulation Phone . - 1: WA w Applicator Name Adam Glenn InstallationDate1 Jobsite Address 410 Church St.W. Bamsta. - i • - Lot Ws 21-12001 NumberPermit : •e Lot Ws1 Location.of Insulation _ Thickness. Total R-Value:. : APproxirrtate Sq 11 -,..:In u... afin ..E1sed.....:,..:. �� . . :�.: •�: � l.QcatY� 'n . ' g .o• :� Thickness; `Couera •�Rae'• CAPE COD INSULATION VIM GkA-1 f-ANL-q WkAY f*" KU -NOW . 1AtTi OUi7-tl INWLAflON CIKIN01 1-800-696-6611 FAX TRANSMITTAL DATE: TO: FROM: CAk C'ocO �b cA— FAX: . ( g36 FAX: 508-778-5735 TEL: TEL: 508-775-1214 CC: PAGES: COMMENTS: K� i .; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1' STg;n Map Parcel Application 13 Health Division ` ��4t1 �� -' G 2 Date Issued Conservation Division Application Fee Planning Dept.'.�;" Permit Fee D�lai�.�'t — Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address DD 910 Village Owners tPc� �;d1.��-- Address Telephone 0 Permit Request �Ix Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family 2"' 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 0 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 Mike McCarthy Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 CSI,,-S8633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO cJ7'1- Y.in SIGNATURE DATE /9�f E FOR OFFICIAL USE ONLY 4 APPLICATION# 1 ' DATE.ISSUED: MAP/PARCEL NO. ADDRESS VILLAGE OWNER <- DATE OF INSPECTION: FOUNDATION FRAME ;• INSULATION } FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: HOUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE:CLOSED OUT f • AS�SOPION PLAN NO. f OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize- (Subcontrac or) an.authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature (-lot-f Date y"Ze ar�ur�aaru�euCG/z o�C�/l/�ioaaclbcoeC6 Office of Consumer Affairs&Busi ess Regulation License or registration valid for indiv,idul use only - OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: egistratio,n: T69393 Type: Office of Consumer Affairs and Businest Regulation . - ? xpiration: 6/16/201.5. Individual 10 Park Plaza,--Suite 5170 Boston,MA 02116 MICHAEL MCCARTHY= _N e MICHAEL MCCARTHY,' _ � ; \s t:.+ram': .6 RANGLEY LN. „ SOUTH DENNIS, MA 02660`•"-y'" Undersecretary Not valid without signature ! u Massachusetts -Department.of Public Safety Board of Building Regulations and Standards Construction Supervisor a License: CS-058633 MICHAEL J MCCR . PO BOX 52 W DENNIS MA 62670 I Expiration Commissioner 04/10/2016 a NI A E> CERTIFICATE OF LIABILITY INSURANCE DATE(MMrD°'YY;/Y' 10/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER 01962-001 ;CONTACT NAME: Bryden&Sullivan Ins Agcy of Dennis Inc A/ .NN0.Ex): (508)398-6060 (FAX 508)394-2267 PO BOX 1497 I EMAIL So Dennis,MA 02660 I ADDRESS: -_—_------ :.--.-_,_--,__„-_INSURERLS)AFFORDIjJs,COVERAGE_,-. NAIC# INSURER A•__A_LM_Mutual Insurance Company 33758 INSURED i IN_SVRERB__-_______ Michael McCarthy Construction Inc ------ -- ------- ---- - -- - — ---- IINSURERC_- - - ---...---------------------- - -- WBox 52 e t Dennis,MA 02670 INsugER o;-- •_---- -------------------_-- _-. II IN5URERE ---- ------------------------�--------- INSURER F j 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 CONDIT!CNS OF SUCH POLICIES.LIMITS SHOIAW MAY HAVE BEEN RCGUCED BY PAID CLAMS. - I INSR;.. ADDL SUBR -- ---- --------T POLICY EF�POLICyy EXpp------ ------- - ---- -- LTR' TYPE OF INSURANCE INSR I WVD I POLICY NUMBER )(MM/DD/YYYY) MMIDD/YYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I I DAMAGE TO RENTED - _. PREMISES La occyQence) -_L..._---------.. i I CLAIMS-MADE I OCCUR i' I MED EXP(Any one person) $ --- - I i ; L ERSONAL&ADV INJURY ! $ GENERAL AGGREGATE is ,GEN'L AGGREGATE LIMIT APPLIES PER: ' PRODUCTS-COMP/OP AGG $ •__..... ,. ...POLICY _PRO- t_ JECT LOC -—---...- i AUTOMOBILE LIABILITY 1 j ' COMBINED SINGLE LIMIT ;$ 'ANY AUTO BODILY INJURY-(Per person) I 1--------------- ' ALL OWNED I SCHEDULED i _ AUTOS AUTOS I ! 1BODILY INJURY(Per accident);$ j HIRED AUTOS ; NON-OWNED I PROPERTY DAMAGE AUTOS I ? ! er accide F F( UMBRELLA LIAB :OCCUR ! I ---- _EA--------— - - -----...---... I i I CH OCCURRENCE —I$ - j EXCESS LIAR i CLAIMS MADE AGGREGATE !$ DED RETENTION $ $ W RKERS C MPENSATION 1 A D EMPLO ERS'LIABILITY .I I X 'TORY LIMITS i _.�ER AN PR R R/PARTNER/EXECUTIVE Yf NI' i E.L.EACH ACCIDENT $, 500,000.00 A of ICE MGM EXCLUDED? rY I N/A VWC-100-6017656-2013A 7/17/2013 7/17/2014 r— -- ---- — ------- ---- (Maniator;In NH) I I I E.L.DISEASE-EA EMPLOYEEI$ 500,000.00 If�ID �RsSON O6 PERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500 000:00 I I i I i i I I I 1 I I 1 I ! DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) i t CERTIFICATE HOLDER CANCELLATION I TOWN OF SANDWICH Attention: BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �• ©1988-2010 ACORD CORPORATION.All rights reserved. tnan ?7,/,>nin/nrt Town of Barnstable *Permit# Expires 6 mot rom issue date Regulatory Services Fee "'A-Sa S Scali,Interim Director RFD MA't� JAN _8 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF SARNSTAMP www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number � Cry Property Address �� W RCr./1 ❑Residential Value of Work$ �4L��y� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ��%L�/G G1� Contractor's Name 2LZ� s�- Telephone Number S Oil-dt-.P 51" Home Improvement Contractor License#(if applicable) Af FI Email: /n bL t/NieOD F>-`V6 In A/L Construction Supervisor's License#(if applicable) /OYO76 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name Z VC f G K Workman's Comp.Policy# U Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [g-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 7"oU✓w0P P-eft4'ry E�vp y I ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #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. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 CJvuia�aclu�v r License or registration valid for►ndividi x pftibe n:ivohsamer Alfa+!s&BaS�pess Regulahou before the expiration date. �f found refi rY �PRO �T CpN �TCP Type Office of Consumer Affairs and Busine! 0� 187e261 t, -� egistr on, i Park Plaza:-Suite 5170 xpiration 8130' :Dt'. .; Boston,MA 02116 1 MULLIN ROOFING AND SIDING V;' M. � xi MAirK MULLIN':' q>. 7 CONNEMARr ItJAY pa r Not va w. lid without signature YARMpUTH,MA 02679` ::';; `Undersecretary I; Massachusetts -g g Department of Public Safety Board of,Buildin Re ulat .ions.and Standards.. Construction.Stipen isor Lii eiise: CS 1O'4076 MARK M"MULLO r. 7 CONNEMARA* _ West Yarmouth NIA 0Q267a3 Expiration Commissioner 09/07/2015 r i I I I MULLIN ROOFING & SIDING INC. CONSTRUCTION CONTRACT This Construction Contract(the "Contract") is made and entered into,as of 11-24-13 (Date),,by and . between Peter Aitken (Name, hereinafter called the "Customer") and Mark M. Mullin; DBA Mullin Roofing and Siding, Inc. having its principal office at 7 Connemara Way, W. Yarmouth MA 02673 (hereafter called the "Contractor"). Property Location: 410 Church st. West Barnstable, MA I In consideration of the mutual promises hereafter set forth and intending to be bound hereby, the parties hereto agree as follows: Contractor's Obligations_ Contractor shall complete the following Project herein described in and shalLprovide supervision necessary to,commence and finish the Project expeditiously, in a workmanlike manner, in accordance with the"all applicable codes, laws ordinances, rules,- regulations and.orders. Description of"Work". Contractor shall do all the work in accordance with the terms of this Contract, as described: Remove existing roofing on the front of the home while protecting the home and landscape. This does not include the garage section of roof. Inspect the roof decking:for rotted or damaged decking. Replace up to fifty square feet of decking included if necessary.Nail down any loose decking to ensure a solid roof deck before installing new roof. Install ice and water shield on all eaves, and around the chimney. A high performance synthetic roofing underlayment will.cover the remaining roof deck. Install cedar breather over the roof deck. I Install new pressure treated red cedar shingles using stainless steel ring shanked nails. Install I new red cedar ridge.boards.on the ridges of the sections that have been replaced. Install the ! lightning rod.system including adding fasteners that may be missing from the system before installation of the new roofing. i I i Contract Sum. In consideration of the performance by Contractor of its duties and obligations, hereunder, Customer shall pay to contractor the sum of '$9,100 Payment schedule: Owner shall pay the contractor 0% of the contract sum upon signing the contract, 50% upon starting the job, and the remaining 50% upon completion of the contract work. Contractor's Responsibility. Contractor is an independent contractor for all Work to be performed hereunder. The detailed manner and method of doing the Work shall be under the control of the Contractor. All employees of the Contractor performing Work under this Contract shall be and remain the Contractor's employees. E a. The Contractor shall supervise and direct the Work, using its best skills., 97oa r We- )a use- Df¢/AuJc. �ve�E-e�f SI\�,.b1eS . l i y Job Safety. Contractor shall be responsible for initiating, maintaining and supervising all safety precautions in.connection with the Work. Permits, Fees and Notices. The Contractor shall secure and pay for all permits and . governmental fees', licenses and inspections necessary'for the proper.execution and' completion of the Work. Such permits and licenses shall be the property of the Customer and , shall be delivered to the Customer upon request: The Contractor shall give all notices and ' comply with all applicable codes, laws, ordinances, rules, regulations and orders.of any public authority in connection with the performance of the Work and the Contractor's obligations hereunder. Insurance. Contractor acknowledges and agrees.that Customer or Owner shall not be. obligated to carry any insurance in connection with the Work for the benefit of the Contractor. Contractor's Insurance. Contractor shall at all times maintain.and keep in full force and effect, at its.expense, any and all-insurance coverage which is prudent; necessary or-desirable for the protection of the interests of Contractor.Contractor shall furnish to.Customer certificates of insurance for the following types of insurance: a. Commercial General Liability Insurance; b. Workers' Compensation.Insurance to cover-full liability under the Workers' Compensation IN WITNESS WHEREOF, the parties hereto have executed this.Contract as.of the day and year first above written. Customer Contractor Company . By: By: � 2�/%G'� Print : Peter Aitken Mark Mullin Mullin Roofing & Siding, Inca 7 Connemara Way, W. Yarmouth MA 02673 508 221'8591 Address: 410 Church st. Barnstable, MA Date: 11-24-13 Date: 11-24-13 Phone number: 508-688-4819 License No. CSL#104076 HIC# 167281 Email address mullinroofing@gmail.com Email address:hpabr@earthlink.net ACORN® DATE(Nwlloarvw) �. CERTIFICATE OF LIABILITY INSURANCE 12YYYY) 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(es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions.ofthe policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: Margaret J Grassi Ins Agency PHONE (508) 295-2007 FAX N (508) 291-1707 1188 Main Street E-MAIADDRL debmjgins@comcast.net West Wareham, MA 02576 INSURE S AFFORDING COVERAGE NAICN INSURERA:Colony Insurance Acrency INSURED INSURERB:Zurich Insurance Mark M Mullin INSURERC: 7 Connemara Way INSURERD: West Yarmouth, MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 ANDC_O_NDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. YNSR - ADDL SUER POLICY EFF POL'ICYEXP LTR I TYPE OF INSURANCE POLICY NUMBER MM/DDI, MMIDaYYYY UNUTS A GENERALUABILITY GL3818794 1/5/13 1/5/14 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISEEff $ 100,000 CLAIMS-MADE u OCCUR NED EXP(Arty one person) $ 5,000 PERSONALBADVINJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOPAGG S 2,000,000 POLICY PROT El- LOC S AUTOMOBILE LIABILITY E IBW�DNIINGLELM i$ ANY AUTO BODILY INJURY(Per person) I$ ALLOWWD SCHEDULED BODILY INJURY Peraccitlent AUTOS AUTOS ( ) $ NON-OWNED PROPS RTY DAMAGE $ - _ HIRED AUTOS _AUTOS ParaoEnt S UMBA LIAB OCCUR EACH OCCURRENCE $ EAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ B V40RKERS COMPENSATION 6ZZUB-5B78154-7-13 1/18/13 1/18/14 WC STATU- OTH- AND FJMPLOYERS'LIABILITY YIN T-ORYLIMIZSI FR__ ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCI DE NT $ 1,000,000 OFFICE RIME MBER EXCL UDEDI NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yYes describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIM IT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101.Additional Renerks Schedule,it more space Is requ red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I t ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQED REPRESENTATIVE - 1 Debra Martin ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: N' 77ke Commonwealth ofMassachuselts Department of Industrial Accidenis Office of Investigations 600 Washington Street y Boston,MA 02111 www.mass.gavIdia Workers' Compensation Insurance Affidavit Builders/Conti-actors/ElectriciansrPlumbers Applicant Information Please Print Legibly Name(BusitsessiOrganization(Individual): Address: 7 City/State/Zip: (N, yayn,, MA0-6 7 3 Phone#: 'S--O X;t 1 5'5-9 / Are.you an employer?Check the appropriate box: Type of project(required): 1.�aam 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. [:J Remodeling ship and have no employees These sub-contractors have g ❑volition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. rightof exemption per MGL 12.❑Roof repairs inmsrance required.]F c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.]' 'Any applicant that checks box#1=I also fill out the section below showing their workers'compensation policy information. *Homeowners who submit this affidn t indicating they are doing all work and then hire outside contractors tmtst submit a new affidavit indicating such. !Contractors that check this boot must attached an additional sheet showing the name of the sab-contracwn and state whether or not those entities have employees. If the sub-contractors bave employees,they mast provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Z U 1 Ca -�zug, sJ3 76 5- Policy#or Self-ins.Lic.#: ra ExpirationI}ate: Job Site Address: 1Y/0 e-h U f('_ h S1-- CitylState/Zip: Qa r,1 5,7'�T b l`4e 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 certify under the pains and penalties ofpedury that the information provided above is true and correct Sienatnre: ./%/�i��/G//G%� Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ofriciat City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Application to 1997 215 Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id 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 j] Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence i❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE _ p, ADDRESS OF PROPOSED WORK C/f(-"tC'f ST ASSESSORS MAP NO. OWNER r/�El� f A-'1*V 7G"¢i'V ASSESSORS LOT NO. 9 HOME ADDRESS C�fy,�Cl� Sr 4t)- !��l/� TEL. N0.3��' - l Z L y 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 %TDG�A,eo co' `"��'«-�'cy TEL. NO. 3�L - Y`%/ ADDRESS Off' 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). /yl�UB l�GL� ,P w�/r/Orx.•u IiOG�'T<c�wr� 4 G7-6111fT al-r � 1 LR . l Signe owner-Contractor-Agent ce'belowiJaLfor Committee use. I D e vet b HF. The Certificate is hereby `� ---- Date f, A imp 14 TOWN OF 8,�NST g I- s-ii^.�Jtr,rnLE Approved ❑ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. V Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION Peu4el) 6;�,vc2 eta'' SIDING TYPE64tr' ��2 fel-''4eel COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH �Z— WINDOW /� s �� ,�� SIZE TRIM COLOR i"`<��G �?� J 7 DOORS / -" J51 e;�� COLOR SHUTTERS GUTTERS �* t 1nlU 1� y1 %lu DECK GARAGE DOORS COLOR 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. Plot plan need not be "Certified but should show all structures on the lot to scale. sPEcsar i fIKE r Town of Barnstable *Permit tt 0��y� � Of Expires 6 month rore date Regulatory Services Fee BARNSTABLE, Thomas F. Getter, Director MASS. g 1659• �� Building Division PIEby.t+ 1` Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508r790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 177 �e 0(n! r Property Address 410 06Z,QC14 5 844? S2r113A-C esidential Value of Work 5 Minimum fee of$2S.00 for work under$6000.00 Owner's Name& Address f-r2eh Contractor's Name V y�L/i/ �OJ L//�CSd�I Telephone Number i� ? Home Improvement Contractor License# (if applicable) orkman's Compensation Insurance X-PRESS PERMIT Check one: A P-f`am a sole proprietor JUL 3 1 2008 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTASL.E Insurance Company Name L,I Rep-d I"V/ Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e._Histo`�Cori)�Akti3n,etc. 'Note: Property Owner must sign_Property.Owner Letter of Permission. A copy of the Home Improvement Contractors License is required.`" (D-0 _4�2, SIGNATURE: 7'c' QAVrPFILES\FORMS\building permit focmS\EXPRESS.doc �1. The Commonwealth of Massachusetts Department of Industrial Accidents 1-71 Office of Investigations 600 Washington Street Boston, MA 02111 vj www_mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lef ib lama (BusincsdorgaIIlZatlon/Indivi(ival): t}—u p- RCIi K, • Address: '? �tA-ut n g � �-� - City/State/ZLp: tl�i�t fe ji-a-£� Phone.#: � `.� Are you "mployer? Check the appropriate box: Type of project(required): 1. _ am a Kloycr with 4_ EJ I am a general contractor and I 6 New construction ey�loyees (full and/or part-time).* have hired the sub-contactors 2. am a sole proprietGr or partocr- listed on the attached sheet 7. ❑Remodeling ship and have no employees These&ub-conhactors have g. Demolition employees and have workers' working far me in any capacity. 9. ❑Building addition [NO workers' �np.ins�tranrC comp.insurance.t S. we area corporation and its 10.0-Electrical repairs or additior gr rtured.] officers have exercised their 11.0 Plumbing repairs or addition 3.❑ I am a homeowner doing all work myself [No workers' corny_ rigbt of exemption per MGL 12 ❑Roof repairs incrrranc-r t c. 152, §1(4), and we have no �� employees. [No workers' 13.❑ Other comp.b1s urance required_] *Any applicant that ch=kX box#1 must abo fill out the section below sbowing their workax'cormpcns4on policy inforn7ation- t Hmneownas wbo submit this affidavit indicating fficy arc doing aD work mid then hire outside cmutraaors must submit s new affidavit indicating such. rCamtxaetars that eb=iC this box waist attaehcd an additional sheet showing the name of the suh-ennttactmrs and state whctha or not thosd cantina have employees. If the sub-contraetors have employees,they must provide:their workers'comp-policy number_ I am an employer that is providing workers'compensation insurance for my emptayees $eLow is the polity and jab site information. / insmi a_n_cr_Company Name: L./ /� t!2.0-`f I t C 01 Policy#or Self-ins.Lie.#: Expiration Date: fob Site Address: y C t�L)l2Ci4- C'/ City/Swrizip: 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. Emc lip to$1,S00.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a f of up to$250.00 a day against the violator. Be advised drat a copy of this statcmcrit may be forwarded to the Office of Investigations of the DIA for inzmmcc coycraz e verification. I do her ertcfy under ins and penaltirs of perjccry tfcai the information provided above u true and correct S> Date: B - Phone O facial use only. Do not write in this area, to be completed by city or town official City or Towa: Permit/License# Isming Authority(circle one): L Board of Health 2.Building Department 3. City/Town Clerk 4.EIecb-ical Inspector S.Plumbing Inspector 6. Other Op THETp�L Town of Barnstable Regulatory Services HA"STAB 'MAS& ; Thomas F. Geiler,Director r�orrv.�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Pax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder f I, l D /�/� , as Owner of the subject property hereby authorize �o -12 l-DX Co to act on my behalf, in all.matters relative to work authorized by this building permit application for: �16 (Address of job) i r Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeoamers License Exemption Form on the reverse side. r Town of Barnstable mop"(HE rphy y�� o Regulatory Services Thomas F.Geiler,Director swxrrsrwsr.>r, � . M` . Building Division Tom Perry,Building Commissioner . 200 Main Street, Hyannis, ?AA 02601 www.town.barnstable.ma'.us Office: 508-862-4038 Fax: 5.08-790-6230 HOM[kOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state rip 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. DEFINmON 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) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons 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 arc 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 rrsponstbilities 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/certifreation for use in your community. 1 D o o o• <.z.:m I I�III I��I n (, p -W tz u •.� �r X � s , � Z = = o D cn 0---...s�� O i fll • "CY, f sZ7 'I'll III•��' ^W F.. _ �� \6,•I^.Qp Ill�'ll'� II'•• � QQ r%) 00 Z o N �' w c m .00 0 o� 06 C u $. y' A 00 p' Town of Barnstable DIME r, ,P` o Regulatory Services srnsi.E, • Thomas R Geiler,Director snara Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,Na 02601 Office: 508-862-4038 Fax: 508-790-6230 PERAUT# FEE: $ ^ ' Uj SHED REGISTRATION 120 square feet or less �� Cv C�.v✓�� f. c G s�G �/r Location of shed(address) Village Property owner's name / Telephone number Size of Shed Mapgar # SignatufYDate Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) 1 --_� 3m/oa, PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE /ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forma-shedreg DCl/. 1t nn. . ' Application to n (11 • 1 �65 ' ®Yb Ring'o 30iobnap 3anional 3biotor%c ;Diotrict Committee In the Town of Barnstable VASS. 'CERTIFICATE OF APPROPRIATEN�ESS.-p 10 R1 .3: 27 Application is hereby made, with four complete sets, 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 APP Y: 1. Exterior building construction: 7 New ❑ Addition ❑ Alteration 1 e Indicate type of building: El House Garage Commercial Ot Sher /l O1 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: El Fence El Wall El Flagpole ❑ Other IvEw �.ars�c ooa�2.S TYPE OR PRINT LEGIBLY: DATE { ADDRESS OF PROPOSED WORK �`b C !r'E��h �� ASSESSOR'S MAP NO. 17 OWNER Ff e4 "� / P7 A�E�OR$ LOT NO. 40 q HOME ADDRESS -! J b G�L •, �� am s 7a1�7/P, TELEPHONE NO.Csb$ La I a ay FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR 1eirbOC— [J o r3( TELEPHONE N A ADDRESS a r U 1. h S` .•D DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. �aieAGf �CPJ/L' �i9iti> �.r/T 2 Signed D / O ner-Contracto gent For Committee Use Only O - G TWM his Certificate is hereby UDate Z `� 1 A� \1J/ 3 Approved/Denied Comm embers' Signatures: J AUG 022001 TOWN OF BARNSTAiB-EVg� , erg a een ern 2. 001 .9165 Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION n 0 ) i � SIDING TYPE 5 � )\( `t j,r � �/P . COLOR nv CHIMNEY TYPE COLOR ROOF MATERIAL "L r, / COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR DOORS / " COLORS SHUTTERS n v COLORS GUTTERS COLORS A ;�. E`�� DECKS � (� MATERIALS �,11a. U U GARAGE DOORS / COLORS O M SKYLIGHTS d SIZE. COLORS { ,�v SIGNS COLORS N Ov� I OL FENCE 1 COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 )00 1. N55°3716"E SDH��' ROBERT A'-FAIF BAIRN ETAL,TR. 27:66 ..SS3.: 'LC. 34248. CTF.600'06. : . 1, o N0'IL'`38"E N43'`28�f3u. °'E ., 86.30 N\ __ %'" FAIR�BAI RN ROBERT _` 3 ET AL. TR. i FLOW N':47°54'02- .'E h 50.33 - --- — — N �. s-- JL N 37°06 05 E _ 11 W 346.70 SWAM. �' �'�`� j0 IL N 28°'I8�58"E ',,� 51.87 Z;�. ; •r' ,��0� 0 Sp 0 G 2 ; — : .. _.N it %► _ AL —�-- �. ,1 N 18°'28 511I E ACRES -49.84 ��' ..... . ` o SPRI N.G . W �ENKIN94 46. ~z<!; PG. 1 ' M now— RIP \ ` cc i I ►.:►..�:,:.�.►. ► , C :ICD p. .� ,: .,..i,.l ►.l N i" y t' �!aa^xna?SFJfAF��:. 11'No to ,i 1 ..�. :: M 11 _ . . W N �•, " \:. - 7 do ' - 209..07. ... : ! _. :-. . =195,69 _ 4 = - R=IA50.35 5"W 326.'9.8 . - ' :. 0.20 1928' L'0:' CB ( SANDY STREET) CKU RCH . ' .STREET 7,� A PLAN. OAF: LAN D I N WEST 6 2-NSTABLE :, M'ASS .. � 3, � � INF.�ST. A.A. 5H . OF .�Bl��1VSTA�BLE 20 O ' 20 o . SEPT: 319:76 SCALE IN FEET E KEIvLEY . REG. LAND SURVEYOR.. : . ��. . T : CUMMAQUI D', 9 4ASS..H£REBY CE��a FY//T� H:AT �.H - �TUAL SURVEY'. WAS MADE ON,THE GROUND AN.D THAT ALL.. EASEMENTS , RIGHTS OF WAY OR .ENCUMBRANCES, AND PHYSICAL FEATURES' EXISTING. -ON TH.E . •�'``c�►of M•`' i` . I. Hc-REBY CERTPFY THAT TH`E.. PRO ..GROUND ARE SHOWN:. HEREON. `i~" LI-NES'SHOWN ON.THFS PLAN. ARE- ' - .f' DI t"IDI'NG EXISTING':OW.N:ERSHIPS SEPT: 3; 1976 REG. LAND SURVEYOR L eES.: OF THE'•STREETS AND WAYS <:,.,�::;• `'�:.` ARC THnSF. nF Pl•1Rl_.IC nR PRIVATI c� Engineering Dept. (3rd floor) Map j 7(,, Parcel - �Q �' Permit# �'Z House# 'y�d Date Issued — Board of Health(3rd floor)(8:15 -9:30[1:00-4:30) 9 7_S = Fee �� a�' �3,o`5 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) .06 �'' � ' ,�,r .517ST eE EI Planning Dept. (1st floor/School Admin. Bldg.) d`P .►+E ra, Definitive Plan Ap )rov b lanning Board 19 'rot ; MRNSTABLE. - MASS. 9. 2-6TOWN OF BARNSTABLE °rEc ••� Building Permit Application Project Street Address �(/O C#011 e 7- Village Oenr Owner o/zED -/A/ n-x Address 4/�O Telephone Permit Request / 41) /OY- 4 ✓nx iy �•�lr<.�Oltco: C9� CCk o U First Floor square feet Second Floor square feet Construction Type eJoz>b B`/lib-"� ' Estimated Project Cost $ 30, Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No i Dwelling Type: Single Family Two Family.'❑ Multi-Family #units Age of Existing Structure Z d t Historic House J@ Yes ❑No On Old King's Highway 9Yes ❑No Basement Type: ❑Full 4crawl ❑Walk ut ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) ;.s Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name &C,2W1V Telephone Number 364?- y<y� Address PD lv?,ov U3 License# d/��f 3 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE A) BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) Sc FOR OFFICIAL USE ONLY PERMUT NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS VILLAGE F OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL W PLUMBING: ROUGH FINAL GAS:, V ROUGH FINAL FINAL BUILDING 66/ I o ' DATE CLOSED OUT ASSOCIATION PLAN NO. U) In 4.! �1 � rl t j.) � / r / `1 1 IA v _ PLAN )P"r ell lie pa � 1 1 r r G . E . . . . • T BAR WES r dFTHEA L The Town of 'Barnstable 9 S& Department of Health Safety and Environmental Services "9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 '' Ralph Crosses Fax: 508-790-6230 Building Commiss: 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 preexisting 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: i� i�l TAG ESL Cost 30 Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under S1,000. Building not owner-occupied _ Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR WORK WITH DNOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT 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. �® Registration No. Date Contractor Name . ✓fie vi anvm�uuea� o� ' DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION-SUPERVISOR LICENSE Number Expires: Restrided Jo.." 00 HOWARO W 4(OOLLARO •�,j(?IrSW.PO BOX 26312727 MAIN ST BARNSTABLE. MA 02630 ' ,�d. � y ':fit t ^"'T�.•'.�r1-�.:'�.i�i��.'4..G.�. HOMExfNPROVEMENT CONTRACTOR' ' -Aegistration;'106615 f TYpe. INDIVIDUAL Expuation -47121/98 ��11: 'HOWARD W tN00LlARD 2727 Mal n 14 AoMNi MA 02630 St i TJtc• CUllJtlltlllII'cult/t )tassacltuscin _=12.- Deptirt»uflt of Industrial Acr dcflts 011iceallmreSM21lons •�\ ... _i;:�' 6110 !f'usltingturl Street 4, Btiswit.Muss. 0111 Workers' Compensation Insurance ARdavit �ltPlicant inforntati6 Plc•tse PR11VT le`i�tjj� name Incntinn cin nhnnc (.(J �/f• dr /� [•I I am a homeowner performing all work myself. am,a sole proprietor and have no one working= in any capacity Fi I am an emplover providing workers• compensation for my employees working on this job. cnotn•rnv n•tmr• •tdd rice- cirt•• nhnnc t!• incorince rn nnticv tt I am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed belww wno the �oilowing wori:ers' compensation polices: comnnns• n•ttnc• •ttirlrree• cir•• nhnnc�►• incur-nrr rn nnlicv a cmmnnns• namr: adtlrrcc• tin•• nhnnc ll• incttr-inrc rn nelic�•0 T_ Attach additional sheet if neceiSary c' _r/'•,•;a�Y�,�� .•• •r. •.-••,_-.• -.«r...ae......r._.:_ �.' .-a..�... _ -- - :are•—.. ••..w...�.n. Failure to secure cttt•criac as required under Section..'A of AIGL 152 can lead to the imposition of criminal penalties of a tine up to 51.500.00 andiur unc s cars• imprisonment as; well:ts civil penalties in the form of a STOP WORK ORDER and it fittc ofS100.00 a day against me. I understand that Copy of this statement ma% be furn•nrded to the Office of Investirntions of the DIA for coverage verification. !do herenr cerrii�r.uittller the pains andd penalucs ojperjur, that the information prodded above is our utrd correct. Si.natum �t `� "✓ ` '�"�� Oatc i/y -.. r /� i� (�.�L �le`t > Printt opine Phone 9 w - ' official use unly do not write in this area to be completed by city or town otTciat city or tms n permitilicense r¢ MUttildin�Department • ❑Licettsinr.board L n check if immediate respunse is required ❑ selectmen s Uffier t.. C Cillealth Department E contact prison: phone i!• nUttter�� information and Instructions Massachusetts General Laws chapter I5'_ section _'5 requires all employers to provide workers' cc inpensation for emnlo ves. As quoted f Qom the "ta��'". an emphtree is defined as every person in the service of attt)tlicr under uny contract of hire, express or implied. oral or written. - An enrp/arcr is defined as an individual. partnership. association. corporation or other legal entity. or an}, t%vo or the foregoing en�aa__td in a joint enterprise, and including the le;_al representatives of a deceaseti employer. or tic recciver or tntstee of an individual . partnership. association-or other legal entity, employing employees. Ho«e,.er o%viicr of a dwelling house having not more than three apartments and who resides therein. or the occupant of the d��cllin`_ house of another wlno employs persons to do maintenance ;construction or repair work on such dwellin;_ or on the __rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhuld the issuance or _ti�al of a license or permit to operate a business or to construct buildings in the commonivealtlt for sny icant who lies not produced acceptable evidence of compliance with the insurance coverage required. .Ad neither the commonwealth nor any of its political subdivisions shall enter into any contract for the periL)rnnz::ce of public work until acceptable evidence of compliance with the insurance requirements of this dtapte- be= presented to the contracting authority. .applicants Plcasc fill in the workers' compensation affidavit completely, by checking the box that applies to your situation an sucpivin:= 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 tine affidavit. Tile - ; it should be returned to the cin• or town that the application for the permit or license is being requested. r :he Department of Industrial .-accidents. Should you have any questions regarding the "law— or if you are req;:i- ;o obtciii a workcrs' compensation policy. please call the Department at the number listed below. City or Towns owns Pie-e 7e ;ure that the aMda\•it is complete and printed legibly. The Department has provided a space at the bottom tine a,'-da%•it for you to fiil out in the event the Office of Investigations has to contact you regarding the applicant. P? be _ _ to fill in the permit/license number winich will be used as a reference number. The affidavits may be returner -le Department by mail or FAX unless other aran`ements have been made. Tlie Office of InN•esti=atioils Nvould like to thank you in advance for you cooperation and should you have any quesm please do not hesitate to _give us a czfl. The Departments address. telephone and fax number. TIte Commonwealth Of Massachusetts - Department of Industrial Accidents -• office at Investigations 600 NVashington Street Boston,Ma. 02111 fax #: (61 i7 727-7,749 phone =. ;6171 "'7 --'900 exr. 406. 409 or 77 I ------- - -- - 11 . ---- .-"� - --I- Y " *�i' ,I -'�"-':..'�'..'."t',� ly':, ,�. , � � --'�� ." " � � " - � .. �� -,. ,�� ,�,'., ..-,��-. � . --.,,,--,:,.� -' '. .".. -� .-'. , �.!�.' ,-I... --.I- - I -- , , 1,-:�7 I -,-.,� ....c-!'.", ,.:., - "4�. ,, . : ,I,"� --:- .-, .1 - I -'�. .I - ,-'.�-I- -!�.'-k'- , .,. -I - . - -11 - - -7' - . I . ,. .'�'�"!'� . -.' .'jc.� " I. - . . � I � - ,I.' -� � 2-- ,.. �. , -It' " ! I, I - -1 - 7-7- ,Z...',- I . � I I .. , '�, � ".��-k ; ,,," 6 .". .. I - . � I. � ". " '('4' t�T-I;,:;,,.. . I�11 1�1 .1 " -";" �',,. .. , ".11 :'! .I's '*' �. I .. , I � , � . '.� - . I . �. I__; -,;,!,��'.�'�,I e " I . , - --� "' ---'T 7" - . . 1, 14��%- - -7 ',.- , 7;-�-- , " . . ' �, ---� . . . . . -. 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