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Home My WebLink About0082 LOMBARD AVENUE i Cf&)cO e No.2 HASTINGS. MN ti tZ a i i i _./ - - __ �o�tc�oGac� �i��e� <� �b�� a vast' oFTwe ram, Town of Barnstable *Permit# - I � Abi Expires 6 mouths front issue date Regulatory Services vices Fee _ 9� 639. ,0� Richard V.Scab Director /I"" j UU Building.Division DEC I�P4 Tom Perry,CBO,BuildingCommissioner ner- E 1 V� 4 ?0 200 Main Street,Hyannis,MA 02601 01V()f 8 www.town.barristable.ma.us Office: 508-862-4038 Fax`'5087.90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number °(�rJ� �C, Property Address Z L,0 M i9 Gl l-o( Ave- W. a✓yis 4oL b l e_ esidential Value of Work$ 3 16�a llginimum fee of$35.00 for work under$6000.00 Owner's Name&Address p-ta121 lE✓OW Yl Pb 3 o)< `71 g �V- ►3 w(LN S I' ,�1C__ t PLA- Contractor's Name .P A U!_�.1. CA ZC A U %1'' -f- SooJS Telephone Number Home Improvement Contractor License#(if applicable) 0-2 Email: Construction Supervisor's License#(if applicable) S I o g ( S �- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ve Worker's Compensation Insurance Insurance Company Name l—'r o I DJ.s Lo g_-P Workman's Comp. Policy# ki G 5- ;j 13 '� 33, to 6 -3-6" o Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(--heck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to vm .POUV7- f'o17+ 5?e h ,, a-y,Icy ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) vSeaKI,__ -ho Sid,vYuL ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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: f C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 The Commonwealth of Massachusetts Department of Industrial Accidents Of lce of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organization/IndividuaI): 0 �*V S CA Address: l03/ /L-tA iAi City/StaWZz : Os r-15 1LJ_.,L Phone Are you an employer?Check the appropriate box: l.�am a employer with IS'- 4. ❑ I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors . 6 ❑New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling 9 slip and have no employees These sub-contractors have g_ Demolition working for me in any capacity. employees and have workers' I [No workers' comp. insurance comp, insurance.# 9•. ❑Building addition required:] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL in 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no nn 3a.❑ I am a homeowner acting as a employees.[No workers' 13.COther K"P _)2,eOF general contractor(refer to.94) Comp,insurance ce required.] 'Any applicant that checks box#1 matt also fill out the section below showing their workers'compcnsation`poliry information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. 'Contractors that check:this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for m-employees. Below is the policy and job site informattom Insurance Company Name: L M C o k p Policy#or Self-ins-Lie.#: PV C S31 S---?9 6 6 3 602 6 Expiration Date: 0 1 k Job Site Address:_ S�L ✓1-,LJaVGQ ayeCity/State/Zip: GJ: 3&rr0 G 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 e. 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 DU for insurance coverage verification. I do hereby cerq' under the pains andpenalties of perjury that the information provided above is true and correct Si afore: 19 /7 fi Phone Official use only. Do not write in this area, to be completed by city or town off,ciaZ .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#: I �_�A'_ 1� s s A' •�t� /`, -). J f•/'i3 < /. '3' :fa a"-;•<' 9r f• /`� /i�/ tN '7•7: •� :'j�,.,, ( �.,;, ��..y r�1-;Td.'v. ..=^.�. .•� irs�Gi3. dl � L- Office of Cons-w-aer Affa �nu' sz ness Regu_atYon ? = , 4 ., 10 Park Plaza - quite 5170 ,;. ` `' Boston5 Musachusetts 02116 Nome Improvement Contractor Registration Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2018 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. scA I s� 20ah•05r11 ❑ Address n Renewal Employment Lost Card ;, %�/r . ..;;�n�r•�iricrr%/n nf�l>rt�.rr.:•�r%«•f/,i Office of Consumer Affairs&Business Regulation License Or registration valid for individual use only bAOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation y. Registration:. 1'03714,. Type: 10 Park Plaza-Suite 5170 Expiration: ;7%g%2018 Supplement Card Boston,iV A 02116 PAUL J. CAZEAULT&SONS,-INC. RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE,MA 02658 Undersecretary Not valid without 4- nature 1'v { Massachusetts • Depart-rent of Public Safety � r Board of Buildi.n.g Regulations and Standards � Construction Supervisor Y h License: CS-108157 �' I RUSSELL CAZEAUxT. - _ t 2071 TvWN STREET Brewster MA 02631 Commissioner 1112312018 { i _URANCE DATE(MMIDD/YYYY) 08/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY (A o (508)775-1620 a No: ADDRIESS, Sullivan@doins.com 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC 8 HYANNIS MA 02601 INSURER A: LM INS CORP 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC INSURER C: INSURER D: 1031 MAIN ST INSURERE: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 76558 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER MM/DD/YYYY) (MMIDDNYYYJ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ POLICY❑JECTPRO ❑LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER: $ AUTOldOBILE LIABILITY CEa acOMBINEDcident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ HALL OWNED SCHEDULED AUTOS' AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS Per accident NON-OWNED PROPERTY DAMAGE $ AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE ' $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ Is VJORKERSCOMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY JANYPROPRIETOR/PARTNERIEXECUTIVE YIN E.L.F�ICHACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA WC531 S386670026 08/10/2016 08/10/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govfiwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul Cazeault ACCORDANCE WITH THE POLICY PROVISIONS. 1031 Main Street AUTHORIZED REPRESENTATIVE Osterville MA 02655 D-0 C Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i .......... Property Owner Must Complete & Sign This Form If Using a Roofer 1 Builder. 1 (print) 0'eyiyi t' S a 1A/ki , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job y L y✓1'l. �.r a( Ave- , tA/ cl�41 vP1 S��P Signature of Owner s Pt n, — Mailing Address of Owner PO LN- ✓k�, A&A b 266 8 Telephone # Sb Date Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com t r' ♦_.a H- v�tti,.'r �. ... .-:... ,. t..__.Fi _ w-.f.-Ja++Cti:�.'.3 .o:lLlws-tiF..�v+l��.... - .._ :-�..• _ iY nr#�•+iikiY'�.�L'IJeii '� SW,^ceSp.(.. Y tkT.f+»'5.-w, `oF,HE r � Town of Barnstable BARNSTABLE : Regulatory Services T MASS. S 6}9• �0 Building Division prFO MP'>• . 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection " >('�G Location Z Ae- . 013 Permit Number Owner �e-nh i s l rszm Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting:. to q. . OS� Please call: 508�-862-4@8 for re-inspection. Inspected by l '� Date �� I 9 Oz 2/0.3 .Own Of Barnstable i owxxarwaet. i g Pert:nit# � 3 a ee►as. Re ]data ]'Lrt/Jnontht 79• �� r Servi(!eS J>oJ Luur dare o ` Thomas E.Geiler,]Director Fee Building Division Tom.perry, Bullding Coarmiaalonet- Office: 508-862-4038 200 Main Street, HYauais,MA 02601 Far; 508-790-6230 E"RESS PERMIT"MICA.TION a !i'o9 VWid wilhoutRedX-Pree�Incpr(��ENT 4��j0 03 Map/parcol Number 5� O Q- =�oWN OF BAnNSTA Proparry Address U a BLE �Rcsidential Owncr'e.Name&Address Value of-Work80.0 Contractor's Name Gv{ ` ' Q Home.Improvement l Contra Telephone ctor License ��1 Number J(� H #(if applicable) U.3 7 j y Cognscruction Supervisor's License#(if 4PPbcable) 0 a � t�7 Wor �3 Iaaaa's Compensation Insurance Cbeck one: ❑ I ano a sole proprietor ❑ I am the Homeowner (P I have Workcr's Compensation Insurance Insurance Company Namecf WorlQaan's Comp.Policy# Pi 06—q-a Q Permit Request(check box) �&Re-roof(atrippiag old shing)es) All construction debris will be taken to ❑Re-roof(not stripping Going over egg Iayt rs of roof) ❑ Re-aide ❑ Replacement Windows. U Value��( im um.44) ❑ Otbcr(specify) Where squired: issuance of Utis pQtrat doer sot txenryt catrpliaacc„tth other w wa dryamnent regulations,I.e.t'tlstOlic,Conservation etc. signature • !:Forma:M rrg eviacdl21901 TO 39Cd w .r4i81 Vy !y�.p��Vr1 'fits G w x -m�'r fir r k . }N f•�,.1.1 Y.��i'Qf 3'k �-F {�1°tf/4F ) �"fS �4 @�e'c-, as�ratt�i� +'tifF�tf ay+`F'T t a f ,lt�`u �ti�._-yay.:cif :r ,yrt�.�."a.:{✓ a_ e- 'i P. ti .'S'j' .i.° :4u. i2:!y, .r s... �.... _-... r.i. ,s.. _-{ I.fvtfE Dennis Brown (Fi'(�t$) (i2-24it7 April 16 '_003 STREET ' 82 Lombard Avenue i -CITY 1'R wN I West Barnstable, lt1A 02668 'Remove existing shingle roof. 'Re-nail any loose boarding. Install. .032 aluminum.heavy drip edge. i Install.WeatherWatch or Storinguard ice and water shield on bottom edge, in valleys, and around penetrations. jInstall Shi.ngl.emate underlaym nt felt. l Install.GAF 30 year shingles. ..,All shingles to be storm nailed. Vent pipes to receive new flashing. Cut.open and install Cobra ridge vent. j All roofing related rubbish to be removed. provide GAF System:Plus Warranty (covers both labor&material)see brochure. i t . COST-l $4,840.00 for Marquis shingles 1 Four Thousand,'Eight Hundred, Forty Dollars $ 4,840= � Pa)>n nt tr;be made as tdlan�:- �`' 1/3 due with.signed contract,.1/3 due when job is half done, lY3 due upon completion t Credit Cards.Accepted (Mastercard, Visa, discover) All matter is guaranteed to be as specified. Ali work to be completed to a skillful manner according,to standard practices, t Alt agreements contingent upon strikes, accidents,or delays Esirmatcd beyond our control, Owner is to carry fire,tornado,and other Note:This proposal may be.withdrafmi l — necessary insurance. r . C days by us if not accepter.vRhin jCustomer Signature l The above prices,specifications,and conditions are — saftstactory and are hereby accepted. You are authorized to do the work,as specified, Payment to Date of Acceptance be made as outlined above. vS1L u:?tir:. 3.4, .i 11•i'�. ti� C RT FICATE 4-CORD.., E I F LIABII-ffY INSURANCE A 10AVIT.1; t.)i: -Stela I:lsuraI)ce Agency, ]-nc . AmD CONFERS NO 101311-1:- U110i,j Cj:jj,fjj Suitow-1 TIW; CERTIFICATL DOI`,, NOT A.H(LiqD. THI.- COVIAIAGI: AFFORD U[) 13Y 'III' POLICII-; 61.1 M, 02655 ).8-.4 2.07.9 oil INSURERS AFFORDING COVLHAGI: RED Paul J Cazeault & Sons Roofing Inc Roofing, Inc. Royal & Suncxlli�kjjco Travolo:cz; Indciiuii�.y Co Z,t :E 1031 Main Strout OsterVille-, Ma 02655 i R n n-6 VERAGES IE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUI-1)T0 ,I I-jj- IWA 11 it '110111:01-11REME -TERM OR CONDITION OF ANY CONTRACT ()IT 01'i I(jj ,,I Wj I I I III T,( IY RE -"N1 - J)1 --0 ABOVE-[.(.)I 1 1*1 it'.pOLICy 1-1:111, W PERTAIN. D-il-- 11,13UHANCE"APFORDED BY Ti-ir I VVI II(:I I I I It:'- ---I-I(111:11�A I I 10A,1 Iq j�;:,k it I I%.11 )LICIF--S AGGHECIATI. - POLICIU�,['it It 1: 1',-)At I- I I it,'I LI jjvj:�.1. SHOWN W,-(1-!A%il--Bi--i'N I .. .1) Pid!)".1 id;.;." 110I.H."?111,11,4111 it n.v I 1 I I r Irvl. ;I'i)l ICY I X1411AIR)II IJA I I*(romil I I'm 1:. GUNCIIAL LIAIJILITY I.A0Ii,l(A.IIIIItINCI 1., 000, 0 0 ) NII III XV(A..V,.-: PAC S912908 0'4 3 0 0 2 04/30/03 1 11 1 1:;OmAi &AI)V IN.11 11 ly - I.ItAl I At'I pl.It C-I"At I IAI AC.1 ll it(-.A I 1 2. 000, 000 L. I 1 000, 000 P(N ICY I 1 1 11-A,-.6 AU MOUILI:IJAIJII-1 I y ANY AU 10 I 0)[Al tl[-Jl I I it'll I ALL OWNEU AU(C)6 5CI ILDI-II.I'D AUI 011:1. IN.I(114y HIRED AUTOS NON-0VVNI--D AU'I():; I It0DII.Y ItIlAt M PliOl-I HIYUAMACI. GARAGE LIAUILITY ANYA1,J10 At)I ONI.y.I-A A(:(;Il ILN I 111i IAN IAA(I: EXCCSS LIAUIUTY AU I ONIN: At:G, OCCU11 CLAIMS MADE 71 Ara,l 11(-.A I I" OIJAK'111111.1: $ HVIENTION $ WORKERS COMPENSATION AND E-MVILOYLItS'LIAUILIT Y A I I I- 7 PTUB-9 2 2X6 5 3-5 0 2 ot"/.1.0 0 2 08/10/03 I I I ACI I A0:11.1 NI 10 0 000 I W:IA:A.- FAIMPI.i�yl-1 100, 000 01,1101 --il'I ION OF OPERATIONS/1-OCATIONStV mollSum:, :ERTIFICATE HOLDER )C ADDITIONAL INSURED;INSUHr-H LETTIE-H: CANCELLATIO�j S"OUL0 Ally OF THE AUOVE lit.CAI-I(;I:l I.EJ)III I()III:I Ill.I-XIIII;1*11 I I'E 1:""U'"G lllSU'U'%'ill-1 I 1101-AVOIJ If., 10 IW,!,Will 11:. ll()rl(,L 10 111(:GUIT11-ICAIL IIOLDLIJ HAMI.()10 111C LIA-1.(JI)I'VAIL11111]'to Ill) 11a1'05L NO OIXIGAllotj OR LIA1.111-Ify 01:ANY kit-11)UPON'I III:INS11111 Ak,Ctqi:,(II; AT IVES. AU I JO Fit /I-0F1t3-I1IIL5LNr Tlyi: ACORD 25-S(7/97) CI ACORD CORPORATION Onc Ashburtont` ; �'• Ici1.i��i L3OStonI I Ma o,_ I C.� � I•G I t:, DUI Lh✓I�C�I� l_ICI_f\l;;I.. �iL::.IrlClu�l •I.. 1 � ' X �;T r,• . i. ill • :�:ir li.l, L.I i.:r.�:III .nl�l'�.i..n,•; : r.l .uLlic�.'. lu.lilli..ilu�il. UOAkD.,OF UUILUINf:; Itl_GUI_i\IlUll;;Licunuu: COM;,rkUC,I•ION :;Ul lil,vt:,l t`lugluur:'C;; C)irl1lCl:11.u:.i�•p/<:�)/Ili:;f _ Lxpiru .::10/:_'0/::00:. Ri 4'iclucl:°00 MAUL J CA!_L:AUur 1585 MAIN ";*I- OSTERVILLL', tv1A 0-,,G55 'r' Board of Building Regina ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Conti--actor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 - - Orleans, MA 02653 Update Address and return card. Mark reason for change. Address I : Itenc�val I l:mpluy jen( Lost Card � :��:: t!.r�inf.nfu/finrn.�l� o/�..:!(ArJJa<•�I/de�lil linard of Iluilding Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 103714 Hoard of Building Regulations and Standards Expiration: 7/9/2004 One Ashburton Place Rm 1301 Boston, Ala.02108 Type: Private Corporation CAZEAULT&SONS, INC. zeault )h Rd. ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parcel y Permit# Health Division Date Issued Conservation Division A _ Fee Pe26 ' 06 Tax Collector Treasurer b Planning Dept. ` Date Definitive Plan Approv d by Plannin��Board Historic-OKH (��I 3�� "f�rese�ri+ation/Hyannis ' Project Street Address 40 Yyi 69--P-Z 4EAIU.0 Villa - �J)5AJAJ1 S Bko 0 M Address Telephone �� o?q`f q' Permit Request aDei� R195.0aY-� FkQ/19- 544 e6 J, E Va-6 a am LE 4- P��i�i 4- Pgte&U DS at (.J 5rh j9 z,& QNC145.-47 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost !az_ Zoning District Flood Plain Groundwater Overlay Construction Type CJ 05re-- Lot Size Grandfathered: ❑Yes eNo If yes, attach supporting documentation. Dwelling Type: Single Family U Two Family ❑ Multi-Family(#units) ;V7 d� Age of Existing Structure Historic House: ❑Yes Qofio On Old King's Highway: C es, ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces:-Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 9-fvo/ If yes,site plan review# Current Use Proposed Use / BUILDER INFORMATION Name / /ZZi ��"Yn�,� ,T�,Pi� Telephone Number 9 Address /L6 7324V License# Ca `�oZ lI CD M a-ram 11A 4,12/O 1-3-5, Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��P��'C�-► L � SIGNATURE DATE _ l�ha FOR OFFICIAL USE ONLY PEWIT NO. DATE ISSUED MAP/PARCEL NO. _ ,I - t ADDRESS - VILLAGE OWNER DATE OF INSPECTL N: ; "r FOUNDATION FRAME r `i INSULATION " F FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT 1— 1 L,-ko ASSOCIATION PLAN NO. s � R JUL- 7-99 WED 2:46 PM BARNSTABLE. PLANNING. DEPT FAX NO., 508 790 6288 P. I M Application to " .�•• �'� 247 Old Kings Highway Rao al Hi t Committee In the Town of Bamstsble for a CERTIFICATION OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470. Acts and Resolves of Massachusatts, 1973, as amended for proposed work as destxlbed below and on plans,drawing&or photo- graphs accompanying thls application. TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK /16 li'1/&lJ ASSESSORS MM F*M OWNER g ASSESSORS '—Q/?,,, HOME ADDRESS 0.Y�7r,. �� j�. ._��IS �9rL� Oa(o�S TEL.NO. AGENT OR CONTRACTOR 2i2fi Z Z.I l�29-6 _� Lf A ADDRESS 1(o1-s /u 725CcW K � Cg)q4,yri & 3S TEL.NO. This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. L"J (2) It is.within a category declared entitled to exemption by Old King's Highway Ryionel Htstpilo District Commission; ' (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot;and, if an addition is Involved,show• ing location of existing building. S TI2+p/REIQoa� (8�l� SQ�?0 i7?, r7 STY�EET s�a� S,CoPE HVEi9 a t�cy f?�zEaa�tnr�S•4�t6 of yQ1o0� �AeE%-0Q,t/ Sniqu RtWC 23�-a S o A C' S 7cm �.. ti . . CC 6F�lf tF Li..lJ - 06A , SIGNEDT7T— Space below line for Committea use. owner-CentrutorAlient t '" The Cetipticate ti hereh%, to {- ` .`• •� �� .... ..__ . .._.._. ... .... ... .... ..�� +.. ,...- _-� ......� AA i ' NSTABf:.E � . 9y A Date -- l d l 3 r 9 i Approved ❑ The categories of Disapproved ❑ the back of work entitled to exemption ere Ilued on .this form. a \ The Commonwealth of Massachusetts —� Department of Industrial Accidents r - excealla�est/patloos -` 600 Washington Sheet Boston,Mass. 02111 Workers' Comyensation Insurance davit %//r/7%/! " y "." / /i.:.,� name: 2/eO A location: 40 6,17-e U city 1J• �� `�/-� phone 0 ❑ I am a homeowner performing all work myself. ❑ I am a sole P=rietor and have no one working in any capacity ,y ,. �I am an employer providing workers'compensation for my employees working on this job. eomptinv name: address: AteUJ723gd Al city: 0 TLe i r aid Dair 3S 991 F insurance co. Enlicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle ore)and have hired the contractors listed below who have . the following workers* compensation polices: company name: address: ;,:•::.....: cite phone it• ..... insornnce cn. olicv o/ iiiiv/Ui�/ i //�//....../� eomnanv name: address: phone#: go a .. ngurance co. rrx# ssssD/////%ll/O/l/%//%///%/////////%///%%%/ / // FaIIure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 31.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Ounce of Investigations of the DIA for coverage verification. I do hereby certify under the pains andppenalties perjary that the information proszded above it&u:and correct Signanse�•�,el.� 211 _ Date 9 /7 1'7 9 _ Print natne r-AEdW CK- V. RA s c H_IIC cam;t� > . ��S'9 S S F-Us useJy do not write is this am to be completed by city or fawn otndat i perndtNceme N - ❑BuildinJDe=partrn=t OLicettmmediate roponse b required — ------- Sdeceu❑Health n: phone N: QOther 7.7.. (mvuea 9,95 PJA) he Town of Barnstable � s��uaTiwr 9WARM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. , Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:- SWe,Pl ge_,e 3b r l o� SO Est. Cost ` �/? ZQyyt Y{ai2�1 �. 6*)E t)bwe Address of Work: is5 0 Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. I Building not owner-occupied Owner pulling own permit j i Notice is hereby given that: IR OWN PERMIT OR DEALING WITH UNREGISTERED OWNERS PULLING THE CONTRACTORS FOR APPLICABLE H •h1 OR GUARANTY FUND UNDER MGLOME IMPROVEMENT WORK DO O 1422AA� ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: D 0 A Registration No. Date Contractor Name 154 e'f!P l IZ' 4rmL OR wner's Name m m V w CC '-•-. N i m � �c. m ai N 9 � � G w.. fn z •Z• H ��1� L •V H OJ 1 ti I: 7 T Ti ' i j 1` j It t . i •c V ' U Z H I CD O O Q ¢ Z U n O N O L- O W M W C W N N C �--� Z •--•� C O d O U 3 Z dy--1 by aJ 1 R/ N fa Z W -.-y ►-� �A .�. CD, T x Q C I 7 � Q • ��CC ^ d� Q 1 l Awiewwo's5 J Parcel �v(—t# /,5 as 1 i Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued 6�- 11 Board of Health(3rd floor)(8:15 -9:30/1:00-4. ) r3 -f//3OffW�41'PtFee G�� o� Engineering Dept. 3rd floor House# ME g g P ( ) � d�T �• 19 SEPTIC SYS i STALLED lid AHCE TOWN OF BARNSTA �o SAL CODE AND Building Permit Application TOWN REGlDLATIN,_3 JStt Address Village _ rj Owner Address Telephone 34�2 -o� 1-7 Permit Request First Floor square feet Second Floor square feet Estimated Project Cost $ /5d7_y • d� Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure IjAo oe-g _ Basement Type: Finished Historic House Unfinished ft Old King's Highway M Number of Baths No.of Bedrooms Total Room Count(not including bat s) First Floor Heat Type and Fuels Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name D Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r, FOR OFFICIAL USE ONLY ` PERMIT NO. �! v I D ITE ISSUED M P/PARCEL NO. t# i r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL e�1 N PLUMBING: ROUE',' FINAL GAS: ROti FINAL FINAL BUILDING � I E � h . n � W v'D � DATE CLOSED OUT (J ASSOCIATION PLAN f X Q a I � 9 N d� X . 0 � 1� \ one j X4 1 - 1 I I I \ I \ • J 12 X 4 .7 x � I I i X 45.1 %i .2 �� .. 16 X 41.1 0� - I � 32• 34.2 / 4.1.3 i/29.2 -- i TOWN OF BARNSTABLE BUILDING DEPARTMENT ' HOMEOWNER LICENSE EXEMPTION Please print. - DATE JOB LOCATION Number Street address Section of town "HOMEOWNER" Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupiE dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire. who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to rE side, on which there is, or is intended to be, a one to six 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 Offic on a form accaptAble to the Building Official, that he/she shall be responsi for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes _ responsibility for compliance with the S Building Code - and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Depar nt minimum inspection procedures and requirement: and that he/she will comp ith said procedures and requirements. HOMEOWNER'S SIGNATURE ' APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35 , 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for . licensing Construction' Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner act-4 as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On th. last page of this issue is a' form currently used by several towns. You may care to amend and adopt such a form/certification for use in your communit_ w • "'`" Tile Commonwealth of Massachasetts __ ��•_� �y� Dcpartinent of Industrial Accidents N _=1� 011lceol/a�galloas • 6111) 11 ashington Street :max Boston.Mass. 02111 E-' Workers' Compensation lnsurance.AMdavit .�nnlWant nformatio'n-- nameo ,n v ❑ 1 am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity t.�,,Fpw,..�.. L❑ 1 am an employer providing workers' compensation for my employees working on this job. coat any nnmc- address• city phone#: incur nee co o11sY# ❑ 1 am a sole proprietor,general contracto ,:or homeowner c one)and have hired the contractors listed•below who have the following workers' compensation polices: Company address- phone th - insurance co nelicv# 1• � „ems •.saw�4rrr•r--�eeRNse+.tFTC�., - -- -- ---- TsvFf?�lqr'Zt_%"7%T_�R!S »T'�'-' .d'R ��rt m v e• •address• city: phone#: - insnnnce co noliev# Atiach additional'shcet if tie"e-e' t T7-7* ^a.t•�..>trrr..�topr:``''='-- • �"` failure to secure coverage as required under Section 25A of A1GL 152 can lad to the imposition of crimittal petaldes of n fine up to SIS00.00 and/or une rears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day apaiast me. 1 ooderstand that a cop y "iftcnmay be forwarded to the Office of investigations of the DIA for coverage verification. Irder the pains and aloes of pejiury that the information pnnided above is true and conva x 7 Sisnatu Ll "ntne one# official use only do not unite in this area to be completed by city or town official city or town• permitAicense d 1`1Building Department (3Ucensing Board 0 check if immediate response is required QSelectmea's Office C3I1ealth Department contact person: phone#t. MOther Incised 1V P1A) Information and Instructions = ' Massachusetts General Laws chapter 152 section 25 requires all employers to pmvide workers' compensation for their employces. As quoted from the"law",an emplgree is defined as every person in the service of another under any contract of hire,express or implied, oral or written. j An emp/i!rer is defined as an individual, partnership,association.corporation or other : gal entity. or any two or more c 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 occupam of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling hour{ or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to be an employer. MGL chapter 1.52 section 25 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 tlia commomvealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally.neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha' been presented to the contracting authority. ..iw. '!•�tY�-e.. .}. f.,.1:. 44 •n. a� : :.. .4.• ww� t(i::. .n.• tI",{.:•�i ��• pa:iT% ;+. ..•.. •Z�. _ +. -.\:n .r.:. -• _:i+'�' •�µ: r.^M:.W"4+a.w i.'ir.?;:..o[••._... Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying-company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you 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. "'""° s.:.v:, .;:y.,;Yz,..:.. ,..w--•• �j`Y:r:`�^s:•.r�etax;s• '::•• - �.. .� :� ..... :Fr-.. .�:��...•:S.i7:in`r':• ..iii%.?:. .•%•i.r•9i�+"�{o"--..j!•••. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas( be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. » ��. ... .. .. _ �i �: -' �'.r...« i•:_�.«.�•ai�:....�1.,.«�i1..i�i: �-4:.%•r« .w«r�•:.'.+....`+'=v..':27ir: :yvjt••..:•.. y �,•;.r,sy;. +_�.i•.� :sue• . . '..,,av• =..*�_:. :+••-rr.: 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 fax#: (617)727-7749 •. phone#: (617) 7274900 ext. 406, 409 or 375 ° The Town of Barnstable ' KPA& $ Department of Health Safety and Environmental Services Building Division 367 Main Strut,Hyannis MA 02601 Ralph Cmssea Office SOS 790.6227 Building Commis F= 508-775-33" For office use only , Permit no. Date AFFMAVLT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 142A requires that the-tzconstrnction,alterations,•itaovation,rquir,modernization,aortvemon, impravement,.remcn- , demolition. or construction of an addition to any prz-aas owner adjacentare ied building containing at least one but not mom than four dwelling units or to sttacures to such residence or building be done by registered aoauactors,with eatain eroceptions, along with other loquiremcats- Type of Work: /-� O, �/� l� o � � Est Cost Address of Work: Y Oaner.Name• / Date of Permit Application: T I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 _ ding not owner-occupied Ownce ping own pit Notice is hereby green that: OWNERS PULLING THEIR OWN P LING W DSO NOT HAVE C��SS 'TOOT FOR APPLICABLE HOME RApROVMAENT HE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Con a Regisuation No. OR ' I n,.e O ncr's name