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Home My WebLink About0390 PLUM STREET I M 0 'I �t C Y oxbTr NO. 1321/3 ORA r .;dJr�e Town of Barnstable Building Post This Card Sd,Thatit is Visible From the Street-Approved Plans Mtist be Retained on Job and this Card Must be Kept 6' $ Posted Until Final Inspection Has Been Made. = N Permit r +� Where a Certificate of Occupancy is Required,such Building shall Not'be Occupied until p�Final lnspection has beemmade. Permit No. B-18-2713 Applicant Name: BARR,ANDREW D& RUTHANNE Approvals Date Issued: 10/01/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 04/01/2019 Foundation: Location: 390 PLUM STREET,WEST BARNSTABLE r 4 Map/Lot: .196-017 4-� Zoning District: RF Sheathing: Owner on Record: BARR,ANDREW D&RUTHANNE `�` _ Contractor Name` Framing: I t Li t tracor License:Address: 390 PLUM ST Con � 2 WEST BARNSTABLE,MA 02668 + - - Est. Project Cost: $700.00 Chimney: ( y: Description: New Sheetrock,insulation,front porch railing system remove(due Permit Fee: $85.00 Insulation to storm damage baseboard heat and replace Fee Paid:;' $85.00 Project Review Req: W .� Date: / 10/1/2018 Final: F^r I Plumbing/Gas ' Rough Plumbing: 'r Building Official Tt. Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ; """""""" "�"" - Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: .. Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department � Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �Z�I ��,R � �r� p�� 5 i i Application Number.................!.......... ..� `�............... - a . . sa 2 e manes. 9'60 1 .J b Peffi .:... it Fee..................:...... .........Othea Fee.................:...... :J Total Fee Paid....................:.............................................. - - 6 TOWN OF BARNSTABLE Permit Approval by...U.B ............on...lQ....�.........._ BUILDING PERMI T Map........... I �p............................Parcd.........0-1..*1...................... APPLICATION Section 1— Owner's Information and Project Location :Project Address 3 5'0 ODMM S t village W Owners Name Owners Legal Address L� City state zip owners cell# . G , 3 �-i' )email A13 (ytS F— Section 2—Use of Stractare Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3—Type of Permit BUILDING DEPT. ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Ch 2 18 ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty BOER 0BAPINSTABLt Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation n ❑ Pool ❑ Insulation Other—specify I`. dj CD L-d vJ L114 q U� �A-i► � S'�dl/1 � + /i�LScti 1_ Section 4 -Work Description v C / .J s(C t, a..) r&a.AJ—JPAVLC14 T sect nndsb!%i-219=19 i Application Number.................................................... 3 Section 5—Detail Cost of Proposed Construction 0 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public 'vate Sewage Disposal ❑ Municipal ite Historic District ❑ Hyannis Historic District MAd Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last minted:2/92018 Application Number........................................... Section 9—.Construction Supervisor Name Telephone Number Address City State zip License Number License Type Expiration Date Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10—Home Improvement Contractor Name Telephone Number Address City State Tip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I end the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your EUC... Signature Date Section 11—Home Owners License Exemption Home Owners Name: 62 Telephone Number 1j Cello Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required b 78 the Town of Barnstable. CSignatim Date d APPLICANT SIGNATURE Signature Date Print Name Telephone Number ",2 E-mail permit to: /� � �r f N c'A--s s/ ,J d? r e..F 11mnnio Section 12—Department Sign-Offs Health Department ® Zoning Board(if requited) Historic District Lid Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the f re deparbnent,for approval Section 13—Owner's Authorization L , as Owner of the-subject property hereby authorize to act on my behal4 in all matters relative to work authorized by this building permit application for: i I (Address of job) I Signature of Owner date Print Name • i I 1 i j I i i r/ J r Lest wdatc&2/9R018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Legibly Name(Business/Organization/Individual): &VVh. Address: 0 V" kjl S 1'. City/State/Zip: U� , Je3,41?d Phone#: S�_s Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, [ H iolition -� aLT13U L L working for me in any capacity. employees and have workers' 9. ❑Building addition �ahomeowner 'comp.insurance comp.insurance.: 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3, doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the for insurance coverage verification. I do hereby certi under e p an penalties of perjury that the information provided above is true and correct Sibafore: Date: O Phone# J O y Y??g Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-mork until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-774R www,mass.gov/dia TOWN OF BARNSTABLE PERMIT CHECKLIST IN{� Sign Off lours for Health and Conservation are 8-9:30 a.m. and 3:30-4:30 p.m. A complete permit application includes filling all sections 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"x17" (plans may require a stamp by an architect or engineer). ❑ Residential - 5 Sets of floor plans no larger than 11"x 17" smoke/co detectors marked c y ❑ Worker's Comp. Affidavit and policy (if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council (IECC) ❑ Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑ Performance bond made out for$4.00/foot of road frontage (new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3.-DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail (if new framing), ❑ Pools—Barrier details,pool specs (engineers design) ❑ Workman's Comp Affidavit and policy (if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑ Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. !Ij! (1 P THE Town of Barnstable 7`OF ►�� BARNSfABLE. Regulatory Services 9 MASS. 639 Building Division prFO MP'a - 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice d j Type of Inspection llLocation 3`/O /1-u/9.c sz' Gt�d Permit Number Z� 9 Owner K.c� A�ke Builder -'One notice to remain on job site, one notice on file in Building Department. The following items need correcting: /po c��.c� 770G Cy �n/ �7�r f1 v� .•/.rJ �`/0�S � --� / A yzG d k G LC r /�� /u�/PG �Mt3-tom GD G�« !o Des/l�G ��l/O ��titi•��7'� SG _ fe A oGxr-. S f Please call: 508-862-40=38-foree-Fe Inspected by Date C;,It 7 a �t„E rq Town of Barnstable *Permit# (� Expires months r m issue date Regulatory Services Fe 163p 2015 Richard V.Scali,Director Building Division �I -�0 8 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number lot Not Valid without Red X-Press Imprint �T Property Address �� V /0 Li0e A4 Li 73 4ra,,6 f ❑Residential Value of Work$Tt Q O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ke,_j Contractor's Name at„/,,/`� Telephone Number e'-j / Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) - ❑Workman's Compensation Insurance (010 0 - (,� \ v\A� 4�w�? Check one: r �+v ❑ I sole proprietor � `�I141 �15 (��f am the Homeowner "` ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ R tde / eplacement Windows/doors/sliders.U-Value �✓ (m'aximum.32)#of windows (� t- t -- - ` #of doors: 63a ❑ 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. o y of the Home Improvement Contractors License&Construction Supervisors License is req red. SIGNATURE: / Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 a Tlie Comynomwealtjh of 1Vassachusetts Departmment of Indusbiar Acciderrtr Offwe of Invesfigations { 600 Washington Street :.:n ti Boston,AMA 02111 f drvtu mass govfdia Workers' Compensation Insurance Affidavit:Bi3ilder-dCantractars/EIechicians/Plumbers Applicant Informaf an Please Print LegibIy Name(Busmess/orgmuzatianlfndivi�}nal �i✓1��1 � � Address: 3 7 0 PC 4,�4 s 1� Cityistattl : ru '3t 1� Phono 4 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑I am a general contractor and I employees(full andfor part-time)-* have hired the sub-contractors 6. ❑New comsbnrction 2.❑ I am a sale proprietor or partner- fisted on the attached sheet, 7- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in.any capacity. employees and have wodcers' 9. ❑Building,addition [No wo4m, comp.insurance comp_insurance. r ] 5. ❑ We area corporation and its 10_❑Electrical repairs or additions 3. offices have exercised am.a homeowner doing all work 11.❑Plumbing repairs ar'stlditions myself[No workers'comp- tight of exemption per their MGL 12.❑Roof repairs insurance required,]F c.152,§1(4X and we have no employees-[No workers' 13.❑Other comp.insurance required.) *Aay appticaud that cherla box g1 anise also fill out the section below showing then wa2ere compensation policy infurmafian. l Eameawmn who submit this d£rdatdt mdk tm.q they are daiag all'wad and they bite outside contractors mast submit a new affidavit indicating sash. (Contractors that check this boat must attached as additional sheet showing the nne of the sub-contr=m and state whethm or not those entities have employees.Ifthesob-contmctors have employee%theymustpmvide•their workers'camp.policy number. 1 an[art entplgvr tliatis providing workers'coitgmLsatiart inuarance for my enrpinyees Below is the ptrticy and job site informatiom Insurance Company Name: Policy 4 or Sqelf--ins.Lic. FxpirationDate: Job Site Address: City/Statel7,ip: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. M can lead to the imposition of criminal penalties of a Sue up to$1,500.00 andfor one-year imprisonment,as well as civil peualties.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of8le DIA for insurance coverage verification. 1 do thereby c ruetd tke pains aced penalties ofpedury that the informationprm-idedabove is barb and correct Sitmature: Date: Phone 9: 2 Y�3 CJ Official use only. Do not smite in this area,to be campteted by city or town official City or"rams: PermitUcense# Issuing Authority(chile one): 1.Board of Health 2.Building Department 3.CitylTowa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instrudions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pnr snmantto this statzIt,-,aa:MPIZyee is defined as."_.every person m$me service of another under any contract of hire, express Or implied,oral or wri tom-" An errrplaya is defined as"an individual,parinersh�,association,corporation or other legal entity,or any two or more of the foregoing engaged is a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwell n house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurteuaat thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required-" Additionally,MGL chapter 152, §25C(7)states"Neither time commonwealth nor 2�iy of its political subdivisions shall =ter fi to any contract for the performance ofpublic work until acceptable evidence of compliance with the iumm an ce.. re ui e cents of this chapter have been presented to the contracting mithouty." Applicauts Please fill out time,workers'compensation affidavit completely,by checking done boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone ntmaber(s)along with their cext ficate(s)of ir,ctt,-ance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requirced to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidayit maybe submitted to the Department of Industrial Accidents for confirmation of insm7mce coverage. Also be sure to sign and date the affidavit The affidavit should be retommed to me city or town that the application for time permit or license is being requested,not the Department of Industrial u st-rial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Depactnaent at the number listed below. Self-insured companies should enter their self-fi sTM-axce license number an the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the)event the Office of Investigafions has to contact you regarding the applicant Please be sure to fill in the pen litllicrose number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications m any given year,need only submit one affidavit mdicatmg current policy in.c ration.(if necessary)and under"lob Site Address"the applicant should write"all locations in (city or town)-"A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fA=permits or licenses A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial YenfITe (in. a dog license or permit to bum leaves etc.)said person is NOT mquirEd to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The wt1aZf of M s.sachusatt-. Depa dment of lidustial Accidents Office of jAVeSV9afio.� ��4�a�biugtan Stce�t Basto-n�MA G2111 Tf,-L 4 617 727-4900 Qxt 4€6 or 1-977-MASS AFF Fax 9 617-727-7749 Revised 4-24-07 mast �fc�ar oFIKE r°h, • swarvsrests. • - Town of Barnstable ArEp�� Regulatory Services Richard V.Scali,Director Building Division Thomag Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must i Complete and Sign This.Section. If Using A Builder I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. `- 1 QAWPHLESTORMS\building permit forms\E)MRESS.doc Revised 040215 Town of Barnstable Regulatory Services �oFVWE TOityr Richard V. Scali,Director Building Division STAB Tom Perry,Building Commissioner Mass. 1639. �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print . DATE:"- of JOB LOCATION: 3 7 1 L-AtAl S-i— (�-J number - "street village "HOMEOWNER": �►��zt_- � / b — a 3 yg!i wine -home phone# - vark ghQRQA__ j CURRENT MAILING ADDRESS: ✓ {.rcity/town state ` l 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 ersi ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection dure and requirements and that he/she will comply with said procedures and requirements. e-of-Homeowner, 11 i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILF-S\FORMS\building permit forms\EXPRESS.doc Revised 040215 Barnstable Old Kings Highway Historic District Committee B,„„STAB,$ ; 200 Main Street, Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)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 all categories thaattaa ply; 1. Building construction: ❑ New ❑ Addition LV Alteration 2. Type of Building: LrHouse ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole * ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE All applications must be signed by the current owner Owner(print): /:/..l C) 12 L't.J 3,4/ Telephone#: Address of Proposed Work: 3 9 0 �L i4 M S rl Village �.1 j� Map Lot# Mailing Address(if different) Owner's Signature Description of Proposed ork: Give particulars of work to be done: 1lt' d C. i t Agent or Contractor(print): p s j J Telephone#: s4 A Address: Contractor/Agent'signature: For committee use only. This Certificate is hereby APPROVED/DENEEIR Date Members signatures C •� RECEIVED HP 24 2015 GROWTH MANAGEMENT Z05 Town of 's N 9hWay Old King mittee Gom 1 Q.(Boards and CommissionsiOld Kings Highwayl0KF1 Applicattonsl0KH2O11 Cert Appropriateness.doc i CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 Copies J Foundation Type: (Max. 12"exposed)(material-brick/cement,other) Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar other Color. Chimney Material: r Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (specify on plans for new buildings, major additions) Window and door trim material: wood F other material, specify Size of cornerboards size of casings(1 X 4 min.) color Rakes Ist member 24d member Depth of overhang D,y116 rJL )� Window: (make/model) &91 -sg:Y material 'v l k4 Y L CLAD color W 14-1"fL (Provide window schedule on plan for new buildings, major additions) aF Window grills(please check all that apply_-: << true divided lights_ exterior glued grills_ grills between glass_removable interior None Door style and make: material Color: Garage Door,Style Size of opening Material Color RECEIVED Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Deck material: wood other material,`specify Color: GROWTH MANAGEMENT Skylight,type/make/model/: material Color: Size: Sign size: Type/Materials: Color: -Fenee Type(max 6' ) Style—�1 r-,,o S material: W LY 1 L Color: '13 f , rW OCT 14 2015 Retaining wall: Material: lawn of Barnstable Old King's Highway Lighting, freestanding on building illuminating sign Committee OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint ors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) cam.-.----- Print Name /A-1✓917 Wy 2 Q.Woards and CommissionslOtd Kings HighwaylOKHApplicationslOKF12011 Cert Appropriateness.doc TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION m // r��ll Map V(D Parcel 1 Application # Q o Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis CP_roject-Street Address pLa/M ST, Villages 9.)S t L� Owner .✓ A- L' f4j /Z Address S L' Telephon�"e'er a;K - 2 —y 2? -:Permit Request (a ✓� �2T( 6/ R � �iL-N✓I k 1�5 [A] Lf�iT.� h 4-0 a A/ S 4 1,47M Ste! -Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay CP_r_oject Valuation_ )a C Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new d o Total Room Count (not including baths): existing new First Floor Roo' ount c Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/al stove: O Yes C' No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: C' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nam_e��►2Lv� ,��2� Telep onh e Number Sf 2 Y2 Address 5-9 0 A�44 S f- License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �SIGNAT-UREA �� ' ...............2 � � y 8 FOR OFFICIAL USE ONLY •APPLICATION# DATE ISSUED MAP/PARCEL NO. ` r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION00 Q� `g�o/1 VAX i 4 /o ® �G 6 fee- FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: . ROUGH FINAL FINAL BUILDING Qkm CLOSED OUT A$S�_,iATION PLAN NO. c ' Of we of brvesfigations 6001WashhTton Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly CN—E e-(IBus'incWoiganiz c)n/Indiv ffi4: �9 r2 L, City/S Zip: 1 r9-Ytn1 _5121 <<_� -Phone#: 64 Are you an employer?Check the appropriate boa Type of project(required): L❑ I am a employer with 4. I am a general cot-actor and I . employees(toll and/or part tine). * have hared the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees' These sub�turs have 8. 0 Demolition working for me in any capacity. employees-and have workers' [No work 'Comp.insurance comp,insurance t 9. El Building addition r ed_] 5. We are a corporation and its 10.❑ ss Electrical repairs or additions C=31 --yam a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs irmn ance mViired_]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.rasurrnce required-] *Any.applicant that checks.box#1 most also III out the section below showing their wormers'compensation policy information_ t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �Contractms that check this box must attached an additional sheet showing the nzme of tine sob-contractors andsbd--whether or not those entities have employees. If the sob-contractors have employees,they mnstprovide their workers'comp.policy number. I am an employer that is provuUng workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip. ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to 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 airs and penalties of perjury that the information provided above is true and correct S' Phone-#:----�_ S d 2 _ -2 y_�— l -2rj official use only. Do not write in this area;to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3. City/Town Clerk 4.Electrical Inspector S.PIumbing Inspector 6.Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires aIl employers to provide workers'compensation for their employees.. , Pursuant to this statute,an employee is defined as"._.every person in the service of another under any contract of�lire,. express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in'a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant therein shall not because of such employment be deemed to be an employer." MGL chapter'152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not prodaced.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 pm-Rance of public work until acceptable evidence of compliance with the insu�mce requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance.ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please ca111he Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line.' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/licens(.-number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required t.o complete this affidavit The Office of Investigations would hike to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax munben The Commonwealth of Massachusetts Department of Industrial Accidents Office of kvestigatio-na 600 WashiVoa Street. Boston,MA 02111 Tel,If 617-727-4900 ext 406 or 1-877-MASSAFB Revised 4-24-07 Fax 9 617-727-7749.' N/F LUCY E. ELDREDGE 64.00 HE Ira Sic 1098_40 SF +�- o 2 y � 0 2 0 0 0 A `W V 2 90 �Q 2 64.00 PLUM STREET NOTE: STRUCTURES ARE "GRANDFATHERED" WITH RESPECT TO SET—BACKS AND LOT DIMENSIONS BUT MAY NOT MEET CURRENT REQUIREMENTS. MORTGAGE LOAN INSPECTION MLI2354 SAGAMORE SURVEY ASSOCIATES SCALE: 1 IN.= 40 FT. P.O. BOX 28 DAT • JUNE 14, 2004 SAGAMORE BEACH, MA. 02562 Ts 508 888 8067 jy cl PtTBRtAN� I CERTIFY TO CAPE COD COOPERATIVE BANK THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS �O' f�� , TO THE ZONING OF THE TOWN OF BARNSTABLE I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD ZONE AS DELINIATED ON. MAP 0.01 C CO MU ITY N0. 250001 PLAN EF E: BA STAR REGISTRY -REGISTRY OWNER: BOOK/PAGE: BOOK 10305, PAGE 329 LOT NO.: LAND PLAN, BY: WHITNEY & BASSETT BUYER: DATED: MARCH, 1946 INSPECTION ADE FROM AN INSTRUMEMTAND IS NOT T6 BE U FOR FENCES, HEDGES OR TO ESTABLISH LOT LINES. POR USE"OF BANK ONLY. f Regulatory Services THE rotyy Richard V.ScaIi,Director Building Division MASSL Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 CEOs www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 2. / / Please Print CDATE;. ' JOB IACATION: 2 number--- sheet village &210utn/ C--- - ,/ �-"HOMEOWNER": � Q 6 �— y q `.~name home phone#---_ work phone#- CURRENT MAILING ADDRESS:�� T�% C-city/town l __state_ (zip code- The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit .'(Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigne 'homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum;inspection procedur� r - ements and that he/she will comply with said procedures and requirements. 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 persou(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction-Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our.Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in .your community. Q:\WPFII,E3\FORMS\building permit forms\EXPRFSS.doc Revised 061313 Town of Barnstable Regulatory Services MAS S. Richard V.Scali,Director �r►'�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, /eection www.town.barnstabl Office: 508-862-4038 Fax: 508-790-6230 Property Owne Complete and Sign T If Usin A Bu as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho ' d by this building permit application for dress of Job) I*Pool fences and ala are the responsibility of the applicant.Pools are not to be Me or utilized before fence is installed and all final inspections are p rformed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QYORMS D WNERPERMISSIONPOOLS EXI5TING DWELLING EX15TING DWELLING FX15TING DWELLING ------------------------------------------------------ ll I'll It 11 EXI5TING 2X8 PT LEDGER BC TE INTO RIM J015T CHIMNEY W/CONTINUOU5 FLA5 IINII 2X8 PT JOISTS Q 12 O.C. � II I II I II II II II II � }� MATCH TO 5TA1 CA5E 13ELOW HATCH TO 5TAIRCA5E BELOW T N fV N v Y EXISTING04iv 5TAIRCP5E 8'50NOTUBE '0 ' 10 W/51MP50N O MN B E � D_N 5IMP50N TRIPLE PT \` TIES 2X8 BEAM 16-0' Existing Plan Proposed Deck Plan Deck Framing Plarl PPROVED 1/4"= 1'-0" 1/4"= 1'-0". 1/4"= 1'-0" JUL 2 3 Z014 Town of BaHghway able Old King' Committee scale rev. sheet no. Project: Barr 1/4"= 1'-T Barr Design Location: 390 Plum Street design draob n rev. West Barnstable,Ma project no. date Deck Plan 7/15/14 ; I I I' �I T , I. _ I I I I I 2X8 HEADERiT :r 1 , L FOR NEW _ R . i , I 5UDER !EX15TING I I i CHIMNEYY. EXISTING CHIMNEY I I SUDER I I HATCH TO STAIRWAY BELOW IX4 MAHOGANY Tr` L DECKINGT f 2X8 PT J015T5 Q 1 2.O.C. _r---------------r_r_________________________- I I I I I TRIPLE FT EX15TING ' i 8°50NOTUBE--,,� ' I l i r 2X8 BEAM �5TAIRCA5E r-J I EX15TING CB CB WALLS. r-J i 5TAIRCA5E r-J i 4 WAL5. I I r-J I I I I I I I I I r-J I I I I I I I J r I APPROVE I I J I I I I I I I r- I I I I I __-_1_1------1_____________________________J 1 ---------------I-J Proposed Section Proposed Rear Elevation JUL 232014 1/4"= table I, nn 1/4"_ 1 I-On Town of BaHghwaY -V old 14�ng•1mrttee scale rev. sheet no. Project: Barr 1/4"= 1'-0" Location: 390 Plum Street desig Barr Design West Barnstable,Ma n drawn rev. ab ab• x 1 0 project no. date Deck Plan 7/15/14 Ol Kings g way stork District ommi ee r 200 Main Street,Hyannis,Massachusetts 02601 (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXENTTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings, or photographs accompanying this application: / Date - o? —/ Address of Proposed work, Assessor's Map and lot# 6 /017- A House# 3 V2.�/ G Street s 1/ /1� ��_ Village: 7 �C (� g (� !� �r This application is.for an exemption of the proposed construction on the grounds that work El Will not be visible from any way or public place ., Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑. Other Description of Proposed Work: P(,e t �1) 010d �J�L Li ry C?RCN►6 )C 12 S-r-2 L-V- �a-,��T—�-��c✓��-�z! S' o Agent or contractor(please print): Tel.no. Address Owner(please print): �„�2 , ) / ��/ Tel no.�G J- 2 V 1 y� r Owners mailing address: Signed,Owner/Contractor/Agent i For Committee Use Only This Certificate is hereby Approved/Denied Date: Committee Members Signatures: Tom,of Bwnsiaole . Old King's Highway . Any conditions of approval: Committee C:IDocwnents and Settingsldeco11ik1Loca1 SettwgslTemporarylnternel FilesIOLK110KHExemption Form 07.doc N/F LUCY E. ELDREDGE 64.00 . NF z 10,840 SF z o = 0 0 0 _/ O A g 3O. 90 y APPROVE JUL 2 3 2014 64.00 Town of Barnstable Old Kin g's Highway PLUM STREET Committee NOTE: STRUCTURES ARE "GRANDFATHERED" WITH RESPECT TO SET-BACKS AND LOT DIMENSIONS BUT MAY NOT MEET CURRENT REQUIREMENTS. MORTGAGE LOAN INSPECTION ML12354 ISAGAMORE SURVEY ASSOCIATES SCALE: 1 1N.= 40 F D� T. �Noswn, P.O. BOX 28 JUNE 14 2004 SAG MORE BEACH, MA. 02562 ,1 THOMAS, 508 888 80671T8RrA1M I CERTIFY TO CAPE COD COOPERATIVE BANK THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS "XI TO THE ZONING OF THE TOWN OF BARNSTABLE I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD ZONE AS DELINIATED ON MAP 0015C COMMUNITY N0. 250001 PLAN REFERENCE: BA STABLE REGISTRY OF DEEDS REGISTRY OWN : BOOK/PAGE: BOOK 10305, PAGE 329 LOT NO.: LAND LDATED: AN' BY: WHITNEY & BASSETT BUYER: MARCH, 1946 I I T A OM A i S RU AN U ER FENCES, HEDGES OR TO ESTABLISH LOT LINES. FOR USE`-OF BANK ONL7. ,v �f I a «% R 1"Y ` ,,. . t, r " . - -• .,. � .� '�, ,y say 40 - e The Town of Barnstable Barnstable 367 Main Street, Hyannis MA 02601 1 I sIAB www.town.barnstable.ma.us OMNMASK. 'O�Fn 39. 2007 Office: 508-862-4610 Fax: 508-790-6226• Email: tom.lych@town.bamstable.ma.us Thomas K. Lynch,Town Manager MEMORANDUM TO: Tom Perry, Building Commissioner FR: Tom Lynch, Town Manager DT: 1/13/14 RE: Andrew Barr,390 Plum St., Electrical Issues Tom, please respond. Thank you. v 00 TKL: smo c w N � I Attachments �O January 6, 2014 Town Manager Thomas Lynch Town of Barnstable 367 Main Street '14 JAN -g All .0 Hyannis, MA 02601 Dear Sir, This past November I contracted with Cape and Islands Construction to replace my roof,facade siding and rake boards. Everything was going smoothly until the electrical service came down to the ground, almost contacting the ' workers. Nstar was called immediately to shut down service from the pole.This occurred on November 12th.The contractor called me up to inform me that an electrician was needed to make repairs. All work had to be stopped until repairs were made and my wife and I had to find another place to stay that night as there would be no heat.You see,the previous installation wasn't done correctly.The bolt that was to hold the length of wiring from the pole wasn't thru-bolted into the end rafter as it should have been. Instead, it was lag bolted into the rake board which was being taken down to be replaced. The next morning(Nov 12)electricians(see invoice)arrived and worked in the cold and snow to make repairs. Later that afternoon Nstar arrived to turn electricity back on and the town's inspector arrived to ok the work that was done.That same morning I went to the building office to see when this service was installed (which I believe was in the mid '90's) and who inspected it for the town.The woman there told me that"we regularly throw that paper work away after 10 or more years"which surprised me. I believe this service was originally done in the mid 90's as that was the time that the previous owner who had purchased this old church meeting house and converted it into a dwelling.Work like what was done to this building most certainly would have required filing for a permit and inspected as it was/is a high profile West Barnstable building.As one can see from the street,the amount of work carried out, in full view of people traveling down Plum Street,to bring power to this converted occupancy almost certainly was inspected by town inspectors.There was no way the owner could avoid the inspection process. When the inspector arrived to inspect this emergency work, I asked him "Don't you think that this work was originally inspected by the town?" and he said "I don't see how it couldn't have been." The point I am trying to make is I believe the town of Barnstable is responsible for the improper installation of the original electrical service. If it had been done correctly and inspected properly,this service wouldn't have fallen down.Therefor I am asking the town to reimburse me for the$750.001 had to pay for these emergency repairs. I've enclosed the invoice for you to review.As far as Nstar is concerned,there was no charge for emergency work such as this. Since ely, Andrew_Barr 390 Plum Street 508-243-4891 i : .;� Invoice Alan O'Reilly Electrician. P.O. Box 145 Bill To: Sandwich, MA 02563 Cape & Islands Construction Co. Mass. License#E51570 P.O. Box 210 Phone: (508) 648-91.27 Centerville,MA 02632 :Date Invoice No. Terms Project 11/1.8/13 808 390 Plum Street Item Description Quantity Date Amount Labor (2 Men) 11/12/13 - Remove existing service drop & replace 4 110.00 440.00 as needed. Also install attachment bolt. Labor (1 Man) 11/12/13 - Meet with inspector& pull 2 60.00 120.00 permit/request inspection. Also pick-up material needed for emergency service drop. Material Service attachment bolt 1 50.00 50.00 Material 1. 1/4inch PVC weatherhead 1 12:00 12.00 Material 1 1/4inch PVC pipe - per 1.0ft lengths 4 8.00 32.00 Material 1 1/4inch PVC LB connector 1 6.00 6.00 Material 1. 1/4inch meter hub 1. 14.00 1.4.00 Material Service connectors 2 5.00 10.00 Material #2awg service cable - per foot 30 1.20 36.00 Material Miscellaneous screws,clips, couplings, etc 1 10.00 10.00 Permit Town of Barnstable Electrical Permit 1 50.00 50.00 I Total Due $780.00 �Aft- nn S-r i n 1 -� �OA IF R C I , I � e b —1-- �n+e Tay Town of Barnstable *Permit 6Q0309a Expires 6 months from issue date Regulatory Services Fee— - S 9 !�. + BAMSfABM v� ntAas. $1639. Richard V.Scali,Interim Director ♦0 Building Division X- PRESS PERMIT Tom Perry,CBO,Building Commissioner R 200 Main Street,Hyannis,MA 02601 NOV - 8 2013 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDED( PALCON{ MSTABLE /)Map/parcel Number y� / Not Valid without Red X-Press Imprint �q( U a ' . Property Address ( 0 e'Ltw— l7�-•— i/`� l jGr ir, �c lL ❑Residential Value of Work$ v Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4 Contractor's Name C _ Telephone Number S-7 6 ({ :3 T Home Improvement Contractor License#(if applicable) 16 Cj C, 3 Email: L o 4. Construction Supervisor's License#(if applicable) C) y & (1 v�. c Wworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 1z, Lw �q ,.- (— Workman's Comp.Policy# �/G� — 3I 5 — 377 �&o 1 0 ` -2) Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) M,Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to eR I,,�z ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) egRe-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 o e Ho a Improvement Contractors License&Construction Supervisors License is requi d. SIGNATURE: Q:\WPFILES\FORMS\buil permi rms RESS.doc Revised 061313 the CommomveaM of Massachusefis Department of Industrial Accidents Office of Investigations 600 Washington Street ,y Boston,MA 02111 wms,.mass.gov/dia Workers' Compensation Insurance Affidavit Blinders/Contractors/Electricians/Plumbers Applicant Information Please Print L e-j bly Name(Bllsinessiorganizationflndividual): J f C C Address: 5Le>!!� �2 /r7 City/Stat&Zip: a , 7e �r Are you an employer?Check the appropriate box: T of project r 1-WI am a employer with 4. ❑ I am a general contractor and I Type P 7 ( �1��= employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp-insurance.I required-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]T c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any app&caut that checks boa#1 mast also fill out the section below showing their workers'compensation policy in€ormation. 1 Homeowners who submit thm affidavit indicating they are doing all work and then hire outside contractors mast submit anew aff davit indicating such- FContmctors that check this box mast attached an additional sheet showing the awe of the sub-contractm and stare whether or not those entities have employees. If the subcontractors have employees,they moist provide their workers'comp.policy number. lam an employer that is protading workers'compensation insurance for my eniplojwes. Below is the policy acid job site information.Insurance Company Name: Policy#or Self-ins.Lie.#: 17 Expiration Date: ., v Job Site Address: 71,1 it A, 4- _ �f'r City/State/Zip: W 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 crertify undeTth ,ts 7nitaIties of pediity that Me information pro Rded abm a is and correct Si tare: Date: f Phone#: 1 Official use only. Do not write in this area,to be completed by city or town official, City or Tovim: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cit)TFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I DATE(MM/DDNYYY) A CERTIFICATE OF LIABILITY INSURANCE 512013 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 FRANK L HORGAN INSURANCE AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE A/c No: PO BOX 250 HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation6 INSURED INSURER B: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURER C: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17541359 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDfYYYY POLICY EFF MMIDDYNYYY LIMITS EXP LTR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY r PRO LOC $ AUTOMOBILE LIABILITY Ee acccidentIND SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED R SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ $ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31S-377540-013 5/7/2013 5/7/2014 wCsTLATU- J OP- AND EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE YIN N N/A E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD WIT NO.: 175 359 Anne chandler 9/ /2013 7:25 a ge 1 of.l s certiyicate cancels ana supersedes �� previously issued certificates. i Da ay Cape & Islands Construction Co. { Jy F Po Box210 ' s t-< r,r ICY r; fk;J�rj Centerville Ma. 02632 �"` � Terms 508.775.7663 ShiO,.yia • . , ..+-a4&C �-.�•- 'Ship Date° r' �� R •r r u`- ri� T-.� �..frJ s a�::.�>r -.�,}h''Y 3�: 7 Y- f�fi.l•,.t -:* a i • Andrew Barr (508)243-4891 390 Plum St W. Barnstable MA. United States Description . • CERTAINTEED Certainteed Shingle Roof 4,250.00 Strip existing shingles from roof. Secure any loose sheathing. Install Hicks brand vented aluminum drip edge. Install Wip brand Ice&Water Shield to all eves, rakes, valleys and all protrusions. Install Surround brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME architectural shingles. Storm nail all shingles. (State building code requires 4 nails, we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent II ridge venting. Remove and dispose of all job related waste. leave your property looking like we were never there! Provide all manufactures warranties and 15 year labor warranty, it's the longest in the business. Please note our wind warranty is also the best And longest available ANYWHERE! Total(0) $4,250.00 Signature i •�._-�. .� sue`t��,r�Estlmate ` N ;;r {;� �< .� e661 3 N Cape & Islands Construction Co. Vk Po BOX 21 O #`'�AKaQ, r 2 yr� ',.s S. Centerville Ma. 02632 ' *y r' ;w z k 7yt • �-yr.,7 y,.�+ k r'7t-�` ,`,�-x -r a +t�"?.r *�to '�. � � 'EF` 508.775.7663 hip�V ias� a r 7t-i 4'q" ant` :"` • Andrew Barr (508)243-4891 390 Plum St W. Barnstable MA. United States lb Description Ext Ph• • CEDAR SHINGLE Cedar shingle siding 2,800.00 SIDING Strip existing cedar sidewall shingles from front gable and front entry only. Secure any loose sheathing. Install Typar brand house wrap. Install new Eastern white cedar sidewall shingles. Dispose of all job related debris. **Deduct$200 if done in conjunction with roof** Total (0) $2,800.00 Signature Office of Consumer Affairs&Business Regulation U—_ —. HOME IMRR6 '�16MENT CONTRACTOR _ ; Registration: 5936 Type:. Expiration_._4/9420.14 Private Corporation CAPE&ISLAND GO.NSTR:UCTI;ON CO INC. JOSHUA.KOURI r_.g 55 ELM AVE. ==3 = HYANNIS,MA 02601 ` Undersecretary / u Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074660 JOSHUA X KOURt PO BOX 210 CENTERVILLE MA 0 �VU Expiration 02/12/2015 Commissioner valid for._individul use only.' License•or.registration_ y f. before the expitation-Rate: If found return to: Office,of Consumer Affairs and''B,usiness Regulation ' lO,Park Plaza--Suite 5170 Boston,MA 02116 y .1 thoot signature f U Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074660 JOSHUA X KOUT�f l { PO BOX 210 )A CENTERVILLE NIA �11P " 1$ Expiration Commissioner 02/12/2015 l TOWN OF BARNSTABLE i i. .' CERTIFICATE OF OCCUPANCY' PARCEL ID 196 017 GEOBASE ID 12191 . ADDRESS 390 PLUM STREET PHONE (508)548-3940' W BARNSTABLE ZIP - LOT BLOCK LOT SIZE DBA J DEVELOPMENT DISTRICT WB I PERMIT 31593 DESCRIPTION REVERT CHURCH TO PRIVATE RESIDENCE PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services ( TOTAL FEES: BOND $_00 THE , i CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY RARNStABLE # MASS. ' 039. A�O� • ED MA'S i BU,ILL. .VI O B�G� --� DATE ISSUED 06/16/1998 EXPIRATION DATE TOWN OF �BARNSTABLE �( BUILDING PERMIT PARCEL ID 196 017 . ;.� GEOBASE ID r1,12191 � ADDRESS, .390 PLUM STREET ,. ; g, �� (, PHONE . (508)548-3940, W. Barnstable ZIP 02668- LOT BLOCK`:, ,w"� - f LOT`S T ZE llBA DEVELOPMENT DISTRICT WB r PERMIT I 1628'7 `,DESCRIPTION CONVERT CHURCH TO PRIVATE RESIDENCE, PERMIT TYPE " BREMO�ll 1 TITLE RESIDENTIAL ALT/CONY • t CONTRACTORS: CUMMINGS DEVELOPMENT COMPANY Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: ,! 1 $31.00 BOND �� `� � - $_,00--2 ``- CONSTRUCTION COSTS $10,_000.00 434 RESID •ADD/ALT/CONV 1 PRIVATE; P:.4*''E:.: t HARN3TABLE, ; 1639. OWNER LARK, BRIF ADDftS,S .36+y ALMA.ROAD D FALMOU�'H, MA BU ILDING' VISION. BY � �� DATE ISSUED 07/03/1996 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE.DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS. HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL PLUMBING AND MECH- ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. r 4.FINAL INSPECTION BEFORE OCCUPANCY. o VISIBLEPOST THIS CARD SO IT IS I BUILDING INSt�P+EC,TION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ' Sr ce e � � 2 �� 2 •� 2 �� ,L//O/jG(� .aiivre• G-ate�� /d 1 HEATING INSPECAON APPROVALS ENGINEERING DEPARTMENT 2 0 p-0Et'L LT BOARD OF HEALTH OTHER: _ /R� AL-A�� SITE PLAN REVIEW APPROVAL z QN57 A ��" 1 02/ LT WORK SHALL NOT PROCEED.UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS I' THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-• TIO . NOTED ABOVE. TION. I � I r. I 1 I I • I ' All l , Gad w�J� «�'s pew I JAIA y. i e . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ? Parcel / Permit# ,%Health Division 74 l 4 1;.3)013CO> � Date Issued �u"t;`i! OF t'Aiir"tiST � conservation Division �n ` © ` pxfplication Fee Tax Collector 2603 SEP 23 P,, 2 Permmit Fee '1�72. ° Treasurer `__..----- �_. _ SEPTIC SYSTEM MUST BE __ Planning Dept. dJiV _I01gk__T.A M IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITNTITLES ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN RECULXTIONS Project Street Address _�ri� t "1UM Sri- Village _�JC {- / oy-m Owner o-56 r gum ->�Soi/► Address�41✓7r`��n� Sf-: (.Je�1-�ruse Telephone Permit Request //a ae LACV0,fe_ or4- Cd bnserhs�lF- ✓� 4,0 4-c.b bedvoornc� . �y aU S Q Qc e- I&OLugu1 S . Square feet: 1 st floor: existing Coo -�- proposed A* 2nd floor: existing proposed Total new O� Coo Zoning District Flood Plain Groundwater Overlay *Project Valuation/O o00 —/5'oo 0Construction Type Lot Size Grandfathered: ❑Yes NT No If yes, attach supporting documentation. Dwelling Type: Single Family f9 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl OWalkout ❑Other Basement Finished Area(sq.ft.) �►/6 b 4 3 . Basement Unfinished Area(sq.ft) �6 Y Number of Baths: Full: existing / new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing f new�� First Floor Room Count C;? Heat Type and Fuel: ❑Gas W Oil Cl Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 29 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:N existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes WNo If yes, site plan review# Y Current Use - - Proposed Use _ BUILDER INFORMATION q Name 4 S Telephone Number LDS 3a / Address' �� f�� S� License# Home Improvement Contractor# 1 4 Worker's Compensation# ALL CONSTRUCTION.DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i j SIGNATURE DATE �_/ -t/07 1 „' ' t FOR OFFICIAL USE ONLY A PERMIT NO. _ k DATE ISSUED MAID'/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION if/I .21AJ1/-7v03 FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1,9AAA. 1 boo 4 O e _ DATE CLOSED OUT ' ASSOCIATION PLAN NO. A j , The Commonwealth of Massachusetts ` = Department of Industrial Accidents Office 01/0ye AY21iONS 600 Washington Street •,y Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit a ...� • ea . ' '� � name: location:, / 1'"1 ct W 2-5-� �a s"�Cab�e— phone ,�9%- 3.71` cl92- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [] I am an employer providing workers' compensation for my employees working on this job .a e-z 4-�'-c r z T_—r-t ?� •,K _.f '4: R y c' sr •� 'fg'�'^ =a. es"� w�?' :'yT'*ai' dwv t z Fa �Ff��r .t3 , "-1a ..,t. r:a . j54 a� _ c )r3' i. y" ? 4i�...t F t{YF:,r,[ �z -,+�> .t,.�T^t1 'r, x' y."Y� irk j ,s• �. x• n �>' t "� .f 4..�x '4`.4 `' ki•' '� 2s�-�c� r{ sFs r Fa ^'•firF �Fr'.3 � r-,rr F� ' ^X_r )"ZM-0 }•7`4jr r ',, aFz '.f 9 r -.k 3•'f. 7r' `-•,+.t , .v -Y y r t Y x,.g• ,°"': x ;r- U:a:F v �• :ta. �� .w4 - ` t a,.*•.7c, :�- �,n �, ,,•:is,�r s� ,. t� -a+:.e'�c,.t�r �' rt '-.c:..2'r. :hr h-:,�A'>.f+ lt; .,}e cv,�/F 'i••S: L #iL .r 1 LSr� +•tti_ j4- ` firtd4'.jrrE3 ~• p "f+i` 5 ' u+rrM1�t .."`u 9,y:. .a^ '+ ,�,,tw,t * 2 w a•' Y. a 4c• ,, dr.w+sV i".�t+S,'`' ,-f•.fik 'rS" ,ty It .i�.,n �t.c �-S+my 'rt,. �rtt�cy c ie F''.ry:�r;.r i.'�5• -f�c,a ? rt } '�'d',yMv-r ',t-lr rev-•y��: [ ,,.. &.t �m vt. } er at_�rr yy v4f'rS _$ -t'�r .i •t 1}'S ih 19., aUdr � wrr rH r� t9 rF ' w Zr C� y:! i-t1P ru v> a rlgF y ��>rs � id �' ,. a fh ar �eY iy �e� ?�.Y¢'• n! Athi. c s ? Jy nNF f' a7 S<��f€^" � �t? 7 t v i ° tit 1 ,+-• INS"fir t •'' :' F...:s ,"°A.y-fi .'-.� �y� .j7, r ;r's ',.'%,r �.+' .XC sY,c iFi'S�,,3, �;` �$�F jS�e„;,,, 3 u d •'rr'„lY+ k.: t"y '$ e, i°St !� a3.•dF DI'�`r�,.7` F ��+t+Tv�-tij,,.F}jyr..s.ryr f`3 '",kG�.yt,`'� 4in F-kV '•T�,. honet#:-S�Yq y�-fix t�'r].1•.. F t{ "S4T?"yrrF,y�c. Y,' ? ? �•xv. .•3 3C1 + ti a �lri v ry. _ s. �4YY ri`+C�'`rfi��..�^K{'�'�.-,• r r� +�s,f�•C �sr�,��n;'{}'',t^ ��'b�.�' ��,J-�.s� ��i-1� � •t �'4Su:.yf.�•yA.. lcn-)�l' � ',G,�?�l13"�hyj '.,wk��`3aY�w .r�. � '�w ra -.•:1'Yr :V H itf �• ...i �� 5•��.� � �.Y� if' 7 '!.-r� t .Ir. '""1��3 � "".61� 3'�r�v�{,�, �. +.'1'i�'.;� ��• ,i.�.�M. ryi�y'49.r, at t�2�,r pr�4y. .�� :rt,�r� r 4,�.hr , t r s t�# v�o t -?� k �r�' ,t 7" I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices r--+ 5-. 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'ta+�.-+1 .c'' J-'k3. .�.''hi' .fk ,L.L'�Y:a �'":--••-.a��'�i1�1' 'a1�4' x 1�-c.A,��~�� " ?��,f�� -� .y�� d�`"FF3iR"- r�� +4. �!t7 •�`� h0�•1e Pa.-r3.� "'t' +...x t-� t•> .Y � h .Y•-ti•�"rr C x�J' s "S L �.n 't > -✓ � 1SS., c'?;i':y� L^'4-No/..:,.+ „��Y�. •-'S,� �y } s 1011MR. „ yr" L I`,..�t.a � �at�•i�•� n rs:F„C� Zya s. ^T..:,.. ;,.��;'i i�.7k..�i�-"'..:..'`� OIIC:�ifF,?y"� ,...,a�+��1r��..v'.�Ftkn � '�''•.`c" -hi'.. _ ;�"?{!.,r?, ►nsuranceCa�'X '�r'Fe � s, ,l�� .fi:r. ",.'-.,>-i rR'F,"1 r?. '" +,•,Gt'h t.+TI• ^f�t ..tr, C7h-aTY' :r'Da rri ;.�tv'w'''_� ?-r.1••e:.>a•{'�`l 1'�'?'77y}an"�$tfe .- Y• -: Se:;r1.•,�� ;�. .:�; .. :;`Fj�;'v' "`��+'f LA;.r Y u v^ *i { rJ' � ��ty,r••t. Y. c-�3''•��"'- ��" is „� � fi yA,+-a,ttC rb:r� •,tt'�n.,i 1&~w `^ilrs ';t".•Sgoe;•`1- 9t.,°r:^'1•crl�'LyY�W .�,� 'n.' alter:�,r;.r .{r`' •y dry.}*y�2t A'm �+ +'9F.i5 ,�y � r•rJtt1.12.r,a�••a,.tt,� +.r��..•.'1�. �.t.°J. a1.', � ..� a�. _- 74 '•' y :. *�'i't�`' ..r x't'"rYt'... .. Zt t '1• tt•s c 7 � sA�- FCOm:ao rname 4P yiF�S`arr^ rr �Y. `,f *sF ,. '! ±,.•.a.: :",+••. .--..r: '�y'fy141it9•s.,. r ka'•�"C,a,-""�-tj kt''er'Yr�ps ar'-•i``aS�:k'•eE�''�%�F+�,�-r�'y�+.g'w`^4r�"ei:,,'i�.1r,7?��h S.�ux!a•:�t c'.eo.'•a 5...�!-'{efi n.:'t.H,x5 r rr,n/y'rFrg-'c•1tv`^rP�'"fi,k'.pk 4.RC t.ir�sa`S.�•YFj�S.t3'.-�i.yn+F-,.t,kan5 �h'''.,,",}r.ry.4- �r 1tsa`'+�a..4^..✓cN•�i-�'Y�Y Y;r n'"�7..'`r''VT,-4�:-r,s'',4,.{�4, .,,3.l�P.ui•y 1a..�'h rr t'i?r -MIN M ° C .f kisr It's J r�: _" 7 �." N 3r�rU, i15 , N...F tidy yr 6�.e.'=� ��-•rI�Y''�aQ �,c a, a'e# ,�e-� 3Y� :� �s4�t ccs'Y; '`Y; d i k Tv - , xkl t-ri !�' e �S'�c4�'t`� aY��"�. t ,+SrL-S,''.r�• '"• .a�. � S�° 9- Cc�r- '°�v*` � � 3 e+... s-c�h ar c, sv� ,fi�.er� �1��'�a',P.�-' •-*M .4 +Y ? G f•r` x ,F r ,,J..� K r 1v .� t'1*' -. u .s h ,�•C'•S 'S. ea t$ • €P^ `„1-,dry' ,�,��t`.�'s-� >ti^.�� r'"'�_, rr 4a ';�. .rc.'a r �.u,.. r "�v 3� s �,.-.° t rz ,Y � h �`'f. r � aG,..._ c,• See -c"•' 't r f, Ft1 �x'+'i '!,' �.`Ra jw • F r.J:. ' ��r i _ t r r is+ 'T,��N Pr,>�i A�..:. ,.�:. T.r?�r -t-s?.r�,.�`c1:c„$7�+�,",,.181��}far 4. a,�r'k i rs Y;✓".,�+.,>' ,�,4:;. �F -S�Sn .„�., s ,•�.�'" n a j tJ'r''rs y , -"ihSr� �r ^dn.}r Kr ,s i?a k r,c=C�" '+. e �+s*''s�.... y T; a *:91et,. -Fr.�•YE; y t} it=; h-_�.,t'3�'�i.nn�::t:<i �.e„�`i, tr'`'rH t '��t?.�..._ O11C.;�?,-�x5...>S: r.. `�.: !i.:kr t�»n� w=,4 .{' .. .. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,SOOAO and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of that the information provided above is true and correct. Signature Date +Print nar LA Phone# _�� official use only do not write in this area to be completed by city or town official city or town: permit/license# MBuilding Department ❑Licensing Board s []Selectmen's Office check if immediate response is required Health Department contact person: phone#; (-10ther (revised 9/95 PIA) t Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the`law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer-is,defned as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased'employer,,or the •� receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the ; owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. a MGL chapter 152 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 the commonwealth 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 have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and i supplying company names, address and phone numbers along with a certificate of insurance 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. MEN 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. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to j 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. 6 - TheDepartment'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) 727-4900 ext. 406 °FINE r° Town of Barnstable ti Regulatory Services snarrszwsLE� ' Thomas F.Geiler,Director - MASS 9 ,16J9. `0� Buildin Division ��E�MAA g Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-962-4038 Fax: 508-790-6230 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.ofWoxk: ddnLa9 i,A_ba.seg&"4- Estimated Cost sow —10 000 01, Address of Work: K41 Trfj( M 4f- 9 WeSfMGYUS�Cik� Owner's Name:_ �j ri�o r,()a.eg-c C4 Date of Application: q/1. p I hereby certify that:. Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied NjOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME UY2ROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR o so Date OwngPs Name RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 F'EE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 3 square feet x$64/sq.foot= 23 L x.0031= 7 plus from below(if applicable) GARAGES (attached&detached) square feet x$32/sq,ft. ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) . Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming-Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) 072 QZ Permit Fee The Town of Barnstable .Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION I j Please Print DATE: i f 116 �j 1 JOB LOCATION:' �q O �l y IN e s�-��✓�s- i,hl number street viEage "HOMEOWNER": —:5ika V,0__ 16L+SO4S S name 61 home phone# -work phone# CURRENT MAUING ADDRESS: CIO V City/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more-than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiremen . Signature orWmeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed•Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. L , i WA-1 Ic-wr [vie i 9A57:a- s-A f r # . M �—r - — - s_ t . wt dtoA — ...__. IL --------------- 1x _.--.................- L Sr No 1/ too .°�1 "E' 6 The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services MASS. 0a �EOMP+ Building Division 200 Main Street,Hyannis,MA 02601 ee Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection 62A/q e Location q0 �'L tltl S T Permit Number Owner S)Y A We Gl/A % Sd 4/ Builder o W 41-P R_ One notice to remain on job site, one notice on file in Building Department. The following items need correcting: �17 � R)) g 4 , ,` 'jyG. ,19 A a 11yv2) `l , 7 tr " �V h �-1) AZ2 F e �T R-'c/tZ <', G f/ FF 7- Please call: 508-862-4_3.846r re-inspection. Inspected by .,/� �l Date 4I/ OU �` IMPORTANT MESSAGE Forf A.M. Day- -J Time j �30 P.M. M Of ff �y CY41 / Phone- 1 1 /0a C) :�Lq� �0 FAX Area Code Number Extension MOBILE Area Code Number Extension Telephoned Returned your call RUSH Came to see you Please call Special attention Wants to see you Will call again Caller on hold Message Signed uniVersal'48023 LITHO IN U.S.A. m 5 k-3 9 ya Remember Lujean Printing for all your printing needs". 428-8700 •4507 Falmouth Road (Route 28),Cotuit Application to l R ' 0P' CEP.NSA pP'M pNs 0PE A �EMPN Old King's Highway Regional Historic District Committee 7 in the Town of Barnstable for'a 7 CERTI FICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES.THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition R( Alteration Indicate type of building: (House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: [ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing si n 4. Structure: ❑ Fence ❑ Wall' ❑ Flagpole ❑ Other L X 6?t✓oit GILD/NG CON5% P4IN'T (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE/r` 7 . IY 7 ADDRESS OF PROPOSED WORK _3 9O /EG vM 5 w• ?jARN. ASSESSORS MAP NO. r 46 OWNER AN LARK ASSESSORS LOT NO. 017 y HOME ADDRESS 320PLE11VI 5%•. We,5`f, ;57/11PraS14. OZ(.(o$ TEL. NO. 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 Obit/ TEL. NO. 362 —75'93 ADDRESS (�L Venn Sf. We- Rwsl S�,YJCc- 02 8 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including f 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). oA) L�� D�= Try T "/f 6), C1v��/ Signed Owner-Contractor-Agent Space below line for Committee use. t-�—Received by H.D:C.• =~,j Date ? !The Certificate is hereby "ate APR Ti me By...... G144 Approved. ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ i Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET CHIMNEY TYPE IUJN COLOR ROOF MATERIAL f-1 S��y l J ��COLOR l PITCH (?— l Z- WINDOW 0006/? iTcJ tllq SIZE 30(• x 5 �'• TRIM COLOR DOORS VU O O L7 COLOR SHUTTERS NO/yF COLOR GUTTERS WOOD OOD DECK FRO /VT PORCH; WOOD GARAGE DOORS /\/O/\/r COLOR �— SIGNS ( V ON r COLORS SIGNS COLORS SIGNS � COLORS .FENCE 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'I .except for new homes, but should show all structures on the lot to scale. SPECSHT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map Parcel Q 1-7 K Permit# 3939( • Date Issued Fee p�2� ® �- ,, fax Collect • r reasur r d by Planning Board /,6 S Project Street Address i9UL1 f Village_ / i L ' Owner iY fS ��i4 `W7/Address o, Telephone �� / 9 ` Permit Request ts Ste.[ 7 S K.y G/cAi2 • �/ (f lei (f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost - ` Od Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.' Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: Cl Yes ❑ No Basement Type: ❑ Full ❑Crawl- ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) existing�. Number of Baths: -Full: g new Half:a f. existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count V Heat Type and Fuel: O Gas El Oil El Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:O existing ❑new size Pool:O existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:O existing ❑new size Other: 0 2 Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ' VA t Ut lm (/� W0C_L G� Telephone Number s �d�� l�- Address Z `( 7 + tc?x. 6�! License# • C S D�9 Home Improvement Contractor# A?e::� 9�� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ a .S ��9' t FOR OFFICIAL USE ONLY PERMIT NO.`i { DATE'ISSUED MAP/PARCEL NO. r , ADDRESS ,,1 VILLAGE OWNER DATE OF INSPECTION FOUNDATION FRAME , INSULATION - FIREPLACE h' - ELECTRICAL: ROUGH FINAL, PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL ' FINAL BUILDING -- �'� ' J DATE CLOSED OUT ` ASSOCIATION PLAN NO. 4 • { i ' ' "' ' r ?''"r.• " '' Department of Health, Safety and Environmental Services 4► + BARNSPABLE. . MASS. i639' A�O� ai _ r '` �r• ED BUILDING DIVISION ff BY- r .� _ • ND E - . r r ,rJ� /VJr�i a� Cxc�� N►ft55 , /�eS, cf2�^fr v � . � /� Qv Cl Cv • IL 942i� T E,::: LE7,VA ions . � - - • � � Project�- . � -_ � . 3qO. P LuM ST, T3 LAAK En Mark Marna ' ~�. "Ar Ohl' Aect , ° w"�. -.... sc fr'�1: c• �^ �iAd �1` 0 G M/ n i 1 - _. ._ ... 00 no . °O ° LAP N5 LL S7ti _. i . �i Iz�T �Loo►Z - •. ��'.-ham..�,,._. ._. . i .� A. i;ili 'I ti1 � 2: 19 r. ----------------------- I { .` W i �► F1 El G I I i:. f ' i I �� d � •I III 4r of FED it F11 j ;j I - I `17 �_-__ I; •� :ill Imo- �— -- I• ri� I I i ` I ULl a _ Rom, N J UI i N I y r I 3 � v � �'t�2_I�F•� +IJi� li s i c -7. Z,33 M I • 1,L'i ► �'` c _ The Town of Barnstable NAM • �vsrwetE. • &659. Department of Health Safety and Environmental Services ; Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date r 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: 0, .fkywof y )1y5Tq'LLR)0 Estimated Cost er v Address of Work: 390 CA/rh Owner's Name: 40?-".�/6� Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: z 9 D e Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav i , ��-,-\ . . . _ The Commonwealth of Massachusetts ` -- ' Department of Industrial Accidents -- Office 01/ores0affm 600 Washington Street S11 J4 Boston,Mass. 02111 . I: Workers' Com ensation Insurance Affidavit 1. name: (:.11)1-LJ*1 4 aL-1 oc location: -L tf 0 ✓n ( 1 cw& tly city 1�Pe q1J re4e M 1- '0 !—�/ phone# 9%� ,?,39-3 ❑ I am a homeowner performing all work myself. . [B I am a sole r rietor and have no one worlds in ca achy %/%%%%%%%%%%%%% % %%/O%%%%%%%��%%%%//////%/%%% %%%%/ %%///� %// ❑ I am an employer providing workers' compensation for.my employees working_on this job.: ::::: :::::::: :::.:::::::::::?::::::::::: ...8 6;':"i'i%2<?%isiai : ? i i isi isi %i 3 3'i y i i i!i ''i?'"iyi E1`i>`i :i? ?% ... <:i i i:i i i i2 i i i i i i iiYii i'i i %' S'i?? i'S i'i%?4'i ?`ii'i'3i£'i<iiiiiii £:<r "'Si%i 2 i i i nisi i i 'Cozh anV n addrC SS ri is5< 3 4i?i : #%i i ii 2i :i Si`i i iY: S<?3 i' i'i%"` :?: iiii`%ikii :2i>i:? i:`i> .....—iiE'E<i2 i2?S i i 'i ii 2` ii'% i>E% i i'i iE'E 5 E i iE iEi i i 2`i;i'i ? :..:.::::.:::::.:::............:::•:::::::-:::::::::::::. .........•:::-.:::::::.:::::::::.............::,--,I.:::::.:.:::•::::::::::.:::::.::.::.:::::. ci insurance /// ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: company`i18111e'''<i%3:3-.-.?:i'i?i:::I iy:2%:C[F[ i s<'s 2:%:>#is i i:::, [%3>'iY y:Gi i 3i% i< 3 is i"i?i is?isii2 i i i i.i i:iyias:i ii isisi asis i;is 2 i i?:i:?2: ::is i2 is is?'is is is.... <i i :� i:i:i i 2:i: 2 .....::: adr :::::::::.....:.:.:..:::.::::::....................................... ............ r3>. :.:..:::::.<: ?:;:>>::::?:<:::::»>:::<:»::<>:::;::::::::;;;;:««:>:::<::::..-,::::>::>::::::::<::::<-':-'.:::::>:......;•::>:::>::»:>:::<:>::::>::::>:::: :>::»>:>::>::::>::>:»::;:::::::::::::::::::::phone city :<:>:: :•i:<;4??'fin::?i isii:vi?::^}::ii::??ii??::•isiii:is4 i::;:::;!:;::'."?i??rJ-'.-::v:jxx i.iii::ii:::nisi??:;:•ii:::<;:%;:<;:!iv:':''::i:<::i::::?:(<;`}!::;:<;: ;i'F,.j::i::$$jj::.';{:i ;:fi:•is4>•i?:':K:•'r:vi:}???:^:;�??`;i i:j�?: ......................... ::::::::::: ... .... ...�:.�::::::.�:.�::v::w:::•....................:........ ... ...... ......................... ..:::,.::...:....:...........:::::n................................ ............::w:". f.4:.i•:??:.ii?ii?:!::v:•.....r to ntv.................... .:;.....:»r.>:::•::.:::::;:>:.?x.?:?::>?:;;;<•?;:•;:.??>?:;;;;.?:.:a?:.::a:?>:.?:a>t:•:>??:<::::::??>:•>::ai::::::ii?i:✓:•:i:':':i::2::2t:�:::•:::?::iii::ii:�:•. inenrance.ca.::::: ............ ............................................. ..................... .......... ........ ...................................................................%%l///%%//%/ c--,eau - addres ........:...."'•;?:.::.::«.?:;:.??:.;?:.?:.::.;;::•;;:•;:.?:.?" *.*;•;:.;:.:>':>;::>s:>:::>::»:<:::»:::::::::>:::>s:::::::>:::::<:»>:>:<::<>:>::>::>::»::;:,:;>:::'::::::::::mien city-......... insuranc oliev �/ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,So0.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and coned Signature��lir'�tyi � l Date gk&,5-J — - Print name lam/I�/64/ E t� ,Z,C, i� Phone# �� > official use only do not write in this area to be completed by city or town offidal city or town permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is requited . ❑Selectmen's Office . ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJe) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the'occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 the commonwealth 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 have been presented to the contracting authority. 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 along with a certificate of insurance 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. 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. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investloatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i i rr p� r Application to n 1 5 1 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 bf 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: (ff House ❑ Garage ❑ Commercial ❑ Other. 2 Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK 3?a -4✓rw ST ASSESSORS MAP NO. OWNER 'Jd/ Cis / .O�s ASSESSORS LOT NO. HOME ADDRESS 'J� TEL NO. 3,>J — /2 >z9 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 7 xo �owLe� �O Du�rr� �•-` i k'fi7 LU►�9��" AGENT OR CONTRACTOR �/ �/Li TEL NO�� ADDRESS 2-1 E 1 / T ✓L &RS&W -31 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). -0/� 4�L 6 Q Signed Owner-Contractor-Agent S ce ) ec a �'�G a D .dT��/c/f S Ce ificate is hereby �- Date eMAY11 � g- Ti e B TOWN OF SAAinvwwqHIIG WAY Approved ❑ IMPORTANT: If Certificate s approve ,approval is subject to the 10 day appeal period ��..IJ..J Iw •tin And i Town of Barnstable Old King's Highway Historic District'Committee SPEC SHEET FOUNDATION SIDING TYPR,,, COLOR cHnaBY TYPE COLOR ROOF MATERIAL ai.S � COLOR PITCH /z WINDOWS COLOR SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS /1D%O o�2 z/7Z,c SKYLIGHTS .qi 50w- Ile9w"�,Y SIZE COLORS SIGNS COLORS FENCE 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. SPEURT Revised 11/98 DEPART.NENT OF PUBLIC SAFETY CONSiRU.tTION_^SUPERVISOR.LICENSE P: jx ires: Rest 'c$e To': Be WIIIIAN 6„HUIICK 24B KITCHEII LN BREWSTER,:.'NA..02631.,- r. HOME IMPROVEMENT CONTRACTOR Registration 126912 Type - INDIVIDUAL Expiration 08/05/00 BILL HULICK BILL G. HULICK ¢/MITCHELL LANE if ADMINISTRATOR BREWTER MA 02631 -` 1 r MEN IN MEN 0 �Mwomm rnowl MOSE MONOMERS No MMONSESOMMMEN MMMOMEME mmoommo�m am EMS OMENS SEEM mmm Sam am MONSES No MEMESE OMEN m mMEMnvWn onsmom ME ME MOM 1111111IMMENERM M SON No a ■ . M�C■� i�'WA� u�� iiiMiiri�iM MENEM NEE SON mommom ME SEEMMEMMEM SEEN mmommsm MEN EMMONS] BE nM m O��Hii�i�iiiiiiiC'... � ON MEMSEMSENN� so =ii�i�Mii�rii�Oi■iM■n iiiiiiimy ��iiiii?�iiiiuiim�ii =i�■ �no■'� �■��■■��i�riio on 0 11011101 iiii■i■'�INnIII mom ME MENNOMMENNO ME E EMEMEM. onommoommommm momMEN��Cn�■■SEEM�'MMI ■n�� ■��i i�inii ��niiiiiiui�i� M momio�ioiiiii�imm�■i�i�ii�moiii SEEMS mommommimomm on mom mommommMuriiinii�� _ ■i�i■i�nii=i■ SEE�m��i�� ■n ■■man n u�nENWyt�i�■ NINE �Eum inSEEi EiE MENME �m u�u111101MINI �i� ■ NMI MINE ol NMI Map Parcel Permit# Conservation Office(4th floor)(8:30-9:30/1:00- 2:00) 7 Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) �� , v Engineering Dept.(3rd floor) House# � O a t 'to 19 TOWN OF BARNSTABLE Building Permit Application Pr • treet Address 310 p L U M.. S 7I R E 1 Village W er. '8ArhS tA61C Owner 'Bri4l• " L pA k Address 3 G 41 mn R k F-A (M u 4� Telephone Sb9--S k-8* 3 �o Permit Request (?onueQ+- "C�v.ek -4o i cfence First Floor r7 79 square feet Second Floor IV I A square feet Estimated Project Cost $ good Zoning District R F Flood Plain / Water Protection —yQS Lot Size 16, 8-90 Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use C N V R C q Proposed Use Construction Type n M e W S Te e I ,S Commercial Residential Dwelling Type: Single Family X Two Family Multi-Family Age of Existing Structure f O D ¢ Basement Type: Finished (K Historic House Unfinished „"Old King's Highway Number of Baths O/y� No.of Bedrooms Total Room Count(not including baths) 3, + !!�4 e e�p a q o fi First Floor ( 4 L o F Heat Type and Fuel ©l'+- Lllot WA*r Central Air Fireplaces Y!t3 Garage: Detached h e Other Detached Structures: Pool At 0 Attached 1/0 Barn r' 0 None X Sheds N 0 Other TH OM A S ;', C t.M M i+� Builder Information Name ICV rA M 1 N,�S Lo V 2 ci rn Q n+ CD Telephone Number G 7 --2 3 Address 40 2 W S 7— License# ®OD 6 g3 We u ee S� M A- d 21 F/ Home Improvement Contractor# l 0 40 S 5 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 DEN D FOR THE FOL OWING REASON(S) r - A FOR OFFICIAL USE ONLY tl i i PERMIT NO. DATE ISSUED — MAP/PARCEL NO. ADDRESS VILLAGE =� OWNERa DATE OF INSPECTION: y FOUNDATION FRAME c INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL •s _, PLUMBING: ROUGH -FINAL GAS: �. ROUGH -FINAL y FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING DEPA$T!�lENT HOMEOWNER LICENSE EXEMPTION Please DATE •U.� . JOB. iOCATIoN O "Number Street address Section of town °$oMEowr1ER� . 3.21 /�-N G-��',� � � z -.� g�3 • • •::.•�: Name Howe phone Work phone PRESENT 'KAIL *=G ADDRESS AJ City town State Zip c: • The current exemption for *homeowners" was extended to include owner-occ, dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a . license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sl who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a- oneto six family dwell= rm attached or detached structures accessory to such use and/or fa structL A person who constructs more than one home in a two-year period shall not considered a homeowner. Such 'homeowner". shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resno for all such work performed under the building permit. . (Section 109.1.1) The undersigned !homeowner" assumes ,responsibility for compliance with the Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and'requiremE and that he/she will compl 'th said pro and requirements. HOMEOWNER c( /,7= S SIGNATURE �/� APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be requir to comply with State Building .Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for' wfi' ch..va- bu: permit is required shall be exempt from the provisions of this sectic (Section 109. 1.1 - Licensing of Construction Supervisors) ; provided t Home Owner engages a persons) for hire to do such work, that such He shall act as supervisor. " ` � ~ Many Some 'Owners who use this�;exemption are unaware that they are as= the responsibilities of a` supervisor (see Appendix Or Rules and Regul for . licensing Construction Supervisors, Section 2.15) . This lack of often results in serious problems, particularly when the Home Owner h unlicensed persons._ In this case )our Board \cannot' proceed against tI inlicensed person as it would with licensed Supervisor. The Home dwr• as supervisor is ultimately icesponsible, r. ... To ensure that the Home Owneris 'fully aware of his/her responsibilit communities require, as partof the permit application, that the Home certify that he/she understands the responsibilities of a (supervisor. last page of this issue is a form currently used by several towns. Yr care to amend and adopt such a form/certification for use in your cow Ad N.t, CO . 6 MON 1 3 : 48 1 — 6 1 '7 - 2:35 - 7250 P . 02 , �.r�.yp�• yi5'i:M1 iS:S;:-.;f.:i:} .':M'ieJ:Vln :..Yii.iSF:: '-.N'}4/.'nAi Y:iS,y`iF;::<: �i'Y."i�:'r>i.j;n\�:7 i�i7.:Vi.�i s..o...-Tq :�' !�. �:;,+;:�s.;7��1 •is: ;:ss . 3��s's'n•:�'7. ' � RI�ii�3:7 :?.%� , T� Y., `s;f•. •'� � 'DATAQIM/DDIYY) .:Y::sa¢Y;r'?.Y.1F. •� ✓,7t, 06/13/96 'RTi :k:J'J&zr\S•ns�.•.? . ;:.Tltrs CERTIFICATE IS ISSUER AS A MATTER OF 1N[-ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 'b` ey W Spear Ins. Agcy. Inc HO LDER.1711S CERTIFICATE DOES NOT AMEND,EXTEND OR Brest St. PO Box�81.365 ALTER TIiC COVERAGE A'FF'ORDED BY THE POLICIES BrLOW. f el 1 e$1 ey Hi l l's••MA•02181' . COMPANIES A1�FORDING COVERAGE COMPANY Stanley W. Se�?ar. Ins. Agency A liberty Mutual 1NSii[[CD : COMrnrnr B COMPANY Thomas q.•.Cummings C _ Bdx..81260.- COMPANY Wetlesley..Hills MA 02181 D '•azs. �.iPr+:: sr; :�Y.� ..:s•,: :"?.ii5"�f•�oi�i: .s.:::p;sn.l::' .•iiri:��..„t:..�,;,:„is?;i` i•1^Yi•f4">� 'ii:i Cii'' ;;F�•' �v...�.�.;', :.s• :2•, <'1. .e :Ai•:ex'�Via':,•,.,•., ::f:.��,.,s....,1(,'1.S:n..,,,yi.,.:.,. ..;":G:,�•.;Y,V•,:'r„�.�ro�.:. :i�"' .•.,..,><.,.:i�Ea:i'('! •x¢•' .�.��11 y. •.<.s.:b :e.1�d�,�,o a °:�J a#,•1::; .. •�8:��. •¢�.; ,,:z:-•'7i"F+w:.� ,V'<ti7G!'1�. �S,,:a`i''�„+•e,afr.:.•I e.. ..,,.v:�.�:� 3cSi:i;'R•:f';a�'.' •� ,•;,• '� nn v. . .s ,..e: •s+:'.:; ., ..., .. .�..a�. •; ;,,. .i:,: ,. ":i:�;�:.;. ...��Svnt;'�.n..,....�;1,::;�:..c•J:ki;•�:'•.'ii.,.,k :,�:.,.,� i...S•,.� 'tHIS•IS'ISO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FIAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY,PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wifi RESPHC'r TO WHICH THIS CERTIFICATE MAY,BP:ISSUED OR MAY PL'RTAIN,THE INSURANCE AFFORDED BY THE POLIC1131S DESCRIBED HEREIN IS SUIIJECT TO ALL THE TERMS, _ EXCLUSIONS AND CONDITIONS OF kCH POLICIES.LIMITS SI'IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY 6F'PF� nVE POLICY WIRAT10 CO TYPE OF IN�URANCB POLICY NUM4XR LIMITS •.• Ll'R •. .•s. DATE(MMIDDIYY) DATE 014711DlYY) y Gf.NRRALI.IARILITY ; cr-Nn AL AGGRCGATB' ? S COMMIMCIAL OL•NCRAL LIADILf1'Y PItODUC13•COMP/Ati AGO >) 'CLAIMS MAMI F-1 OGC UR PGR,CONAL R ADV INIURY, S OWNER'$k CON'fRACTOA'S MOT CAC11 oCCUAlt1+NCd',: Plkrii DAMAGE(Agy.mx fire) S MED 1XP(Asry,one Nrslon) j AUTOM010LZ L1AUILiIT COMBINED SINGLE LIMIT ANY AUTO AL4,OWNED AUTOS % RADILY IN1l1RY sm.10ULCD AUTOS Mgt Dui wiiAi)AVf03 BUDILY INIURY NON-OWNED AUTOS (Pit nccliknl) _ PRUPURTY DAMA02 S " GARAGE LIA41L1]Y AU'1'0 ONLY•SA ACCtliCw s ANY AUTO O'1'NEk THAN AUTO ONLY: 11ACI1 ACCIDENT S AGGREGATE ' 6,' ' XXCFaS L A."IL[TY L'ACII OCCURklINCB Y IIMORCLLATORM A66141{MATE, S OTIIER.TIIAN UMAAELI.A CORM" i •wORKRRSCOMPIWSATIONAND w. RR sTnTu• O'I'sl• f, ";£! ff{^,), of.;:"r3' ;;: Flyl IAYNR4'1.IAD1LI71( :' BL EACH ACCIDENT S 100000.: q ; TIM PROPkiFTURI .X 1t PL. WC1312230395013 07/27/95 07/27/97 UL DISUASE•POLICY LIMir $ 500000, PARTNI3RV UXI:CUI*3 ' 5 ••01.1?Ir.CRS•ARC;';_� dXCL 1:1.DISGASP.•'DA CMt'I.OYf:O 111.100000 s IIEWRIM ION Olt OYBR,%TIONS/LO(:AT1VNWVXMICI.t:'4/SPVCIAI,ITEMS i ahjr end a1T operations at:.various locations .O'�uy.'fr '.aP,Li3,•, •i.Y,"4 'i'.;"yi !'L':' S.';.V:!'tn.� n5 i';b• i,p"� � p�1 �•1 :, �'V n•)?�;L...�,.yGn •.Vn4i4r�i�li.YiVM:.{i.r��r•r>....4a�a ;I•y"i•"•'�� L'uJ�:.:,,n..,•.r.r,i�..,••,.•r..l...ii'��.nY.,..��i.,'1.�.��'�.>�r;lfl,N.s,��...•ri:1;I:sSi�t,�•,7...�•i,it:�r,rtr.��'t��l•��...�11,.! CUMMI02 SHOUID ANY OF TIM ABOVE DESCRIBED POLICIES BE CANCELLRD MFORE 711E EXPWATION DATE THEREOF,TIIE ISSUING COMPANY WILL ENDEAVOR TO MML 30• DAl'R VVRrrm NO'[ICK TO TIIR CRRTIFICAT.110LDUR NAMI',D TO TtrE t,ii.-r Cummings Development BUT FAILURE TO MA11 SUCH k(MCB SHAD,IMPOSE NO 606GAiO.N OR LIMULITY. P0' 86s: 8 .Cummi ngs OF ANY KIND UPON THE COMPANY,ITS ACNNTS OR RVPii6_CFMnTIVF;C., •;:P0� Box 81260 � � - ' Wel 1 es1 eY.Hi 11 s .MA •02181 AVfIlOR1ZFV R 4i 1eSk:N1• TIVE J HOME IMPROVEMENT CONTRACTOR Registration .104055 Type - DBA j Expiration.. 07/13/98 THOMAS J. CUMMINGS J. Cummings ADMINISTRATOR 2 Washington St Wellesley.-MA 02181 i -- - /. �� ✓Gar DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number; Expires: 4 2 9 9 8 Restricted To: 00 �q THOMAS J CUMMINGS 2 LONGFELLOW RD WELLESLEY, MA 02181 �TMe The Town of Barnstable BAPMAJOA Department of Health Safety and Environmental Services 'OTEDr�na't� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work Est.Cost 16, 4722) -- Address of Work: (-394) ' 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$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IIVIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ` Date Contractor Na Registration No. OR Date Owner's Name ..r. ... _. I.' 1 r. .. ...- .. .- ....\P. ,.. •.i/�,i. /> 1.��.. • .',?.i•.. .t.li�fi_../.::.. .......h:...�.._ ...y. .. -I.�.. ........ .. ..r... The Coinnronrrcalth of Uassacllweff Department oflndustrial Accidents z #~ = Office affmWstl9 MRS 600 11 a3 hilln Strcrt Buy-ton.iffa= 02111 �-' Workers' Compensation Insurance Afridavit .---r- ._-- — — - - �- - - - ._. .... _ ._.._�_-•- h ' , nhnnC� ❑ I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity ❑ 1 am an emplover providing workers' compensat n for my employees working on this job. Add S! ' oa l�� •— — S33 ' cur•tn, •� � 3 as 30 9�o�3 eowner(drde one)and have hired the contractors listed below wh ❑ I am a sole proprietor.several contractor,or hom the following workers' compensation polices nvn ' phone#! nniiev# �-. •-.� .: --- Isran•�...•saw�-Q*r+T-�'et'"'.�"sF' - ---- �� r m anv na e- address- tin phone 0! inc policy g :Attach additltiaai'shees fCrieet�sar� *'� '�""'+..il•e''rme, Failure to smart coverage as required under Section 3A of AIGL 15I no iead to the imposition of eritaiad peowdes of a fine up to SI300.00 s une}ears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against ma I understand: COPY of this statement maybe forwarded to the Olnce of Investigations of the DIA for eorerage veriQatioa. I do rehr certify unt/cr the pains and petalfes of perjury that the infornmtion provided above is uue and correct Signatures me ? - 3 —q z T ,,I't�;� Print name / I�DYm C, t •d G S Phtme# l l a -5331 Fchcck nly do not write in this area to be completed by city or town oMciai town: permit/lttxase ti riguilding Department DUeensing hoard 4 05clectmen's Otnce mmediate response is required 011eailh Department on: phone it: mother— Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation fc employces. As quoted from the "faw". an emplitr►ce is defined'as every person in the service of another under ai contract of hire, express or implied. oral or uTitten. An rnrpinre►r is defined as an individual. partnership, association. corporation or other legal entity, or any two or the foreaoin-, engaged in a joint enterprise, and including the legal representatives of a deceased employer, or flit receiver or trustee of an individual a partnership• association or other legal entity, employing employees. Howev o,wner of a dwei ling house having not more than three apartments and who resides therein, or the occupant of the dwc1ling house of another who employs persons to do maintenance, construction or repair work on such dwellin or on-the arounds or building appurtenant thereto shalt not because of such employment be deemed to be an emp MGL chapter 152 section 25 also states that even•state or local licensing agency shall withhold the-issuance c reneival of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who fins not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into anv contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chap been presented to the contracting authority. Applicants Please 111 in the workers' compensation affidavit completely, by checking the box that applies to your situation a 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 requ to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottoi the atBdavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will be used as a reference number. Mie affidavits may be retum 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 ques-L please do not hesitate to `ive us a call. i• .' ,� _..._... .. �...ice .. .. ��• - ,• ....... .�•r.� ... The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents P r office of Investigadons 600 Washington Street Boston,Ma. 02111 fax #: (6I7) 727-7749