HomeMy WebLinkAbout0060 ALICIA ROAD �o C�e� �
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YIE Town of Barnstable *Permit
Tres 6 rrronthsfrom issue dote
• � srAB " Regulatory ServiceseCyGG �
Thomas F. Geiler, Director
A(/� Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-86 38 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION _- R]ESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/par Q Map/parcel Number Property Address 6 o t;"T �� _`,1/A—P"��..�
Residential Value of Work '15-(1 Minimum fee of S25.00 for work under$6000.00
Owner's Name&Address �T S ►'i'� Q V�/
Contractor's Name �c•<«®�� Telephone Number
Home Improvement Contractor License #(if applicable)
Construction Supervisor's License#(if applicable) �Z°77,66
9Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name &S-1
Workman's Comp. Policy# el Y%4
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
M—Re-roof(stripping old shingles) All,construction debris will be taken toC-c.c`� j
❑ Re-roof(not stripping. Going over existing layers of room -
Re-side
❑ Replacement Windows. U-Value (maximum .44)
*Where required: Issuance of this permit d omp'ante with other town department regulations, i.e.Historic,Conservation,etc.
. *** ote: P per Ow must sign P erty Owner Letter of Permission.
Ho mpr vem - etors License& Construct Supervisors License is required.
SIGNATURE;
Q:IWPFILES\FORMS\Express\EXPRESS PERM IT.DOC
'a
The Commonwealth of Massachusetts
Departntent of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston, MA 02111
wwiv.tnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le}~ibly
Name(Business/Organization/Individual): �. � C
Address: 0, c)13 U X 1 % S^
City/State/Zip: 120t= Phone.#:
Are you an employer? Check the appropriate box: 'Type of project(required):
lama employer with _ 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time) have hired the sub-contractors
` listed on the attached sheet. T. ❑Remodeling
2.E I I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g, ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• � 9. ❑Building addition
[No workers' comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 101]Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[:]Plumbing repairs or additions
myself. [No workers' comp_ 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.] n
*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.
xContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the 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: 0
Policy#or Self-ins.Lie.
U7 Expiration Date: a ( G!
#: 03 �� "' P
Job Site Address: o4, IL C_ City/State/Zip:1%0
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 crinrial penalties of a
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA'for inisganpe cov rification.
.1 do hereby eer • under pai penalties perjury that the information provided above is true and correct
Si a e: Date:
Phone#
Official use only. -Do not write in this area, to be completed by city or town official's
.City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
i
I ,
Inf®rmation and Ins t�° ��® s
fMassachusetts 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
persons to do maintenance, construction or repair work on such dwelling house
er who employs „
dwelling house of another P
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 Iocal licensing agency shall withhold the issuance or
too operate a business or to construct buildings in the commonwealth for any
se or permit .
renewal of a license p P
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 .
cce tabl e evidence of compliance with the insurance
nee of public work untri a mP
enter into any contract for,the performer p P
is of this chapter have been resented to the contracting authority.'
e uiremen P
requirements P
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), addresses)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
workers' compensation insurance. If an LLC or LLP does have
members or partners, are not required to carry
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 an 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" I.he 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: Anew affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would lake 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 Cbminonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston, MA 021 I1
Tel. # 617-727-4900 ext 406 or 1-8774AASSAFE
Fax 4 617-727-7749
Revised 11-22.06
www.mass.gov/dia
m
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Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Regis tfa�ton; 112536 Board of Building Regulations and Standards
Expn`atiura-=4123/2011 Tr# 281021 One Ashburton Place Rm 1301
Type: DBA. Boston,Ma.02108
ERASER CONSTRUCTION CO.
DEAN FRASER
104 TWINN VIEW[Mt
E FALMOUTH,NIA 02536 Administrator Not re
671-1 Wj
Boar o IWihggle�9g�AUl'
Vs an tan ar s
One Ashburton Place Room., 1301
Boston..Massachusetts 02I08
Home Improvement Contractor Registration
Registration: 112536
Type: DBA
Expiration: •,3/23/2011 Ti* 281021
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
COTUIT, MA 02635
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
Al 0 40M-08/08-DBSIJFORMCA108212008
• I l
I
127
I
RightFax C2-2 10/1/2008 1 : 00: 56 PM PAGE 2/002 Fax Server.
ISSUE DATE
:{`-;: {i{':}-i}:` 10/01/08
:• MAN
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW.
WISE&QUINN INSURANCE AGENCY COMPANIES AFFORDING COVERAGE
449 PLEASANT ST
BROCKTON MA 02301 COMPANY A HARTFORD UNDERWRITERS INSURANCE CO
LETTER
INSURED COMPANY
OMP'E� B
FRASER CONSTRUCTION LLC
PO BOX 1845 COMPANY C
IEITER
COTUTF MA 02635 COMPANY D
LETTER
ANY
COMP E
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 V'
CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS
LTR EFFECTIVE DATE EXPIRATION DATE
MM/DD/YY) MM/DD/YY'
GENERAL LIABILITY GENERAL AGGREGATE $
PRODUCPS-COMP/OP AGO. ^y
❑COMMERCIAL GENERAL LIABILITY
PERSONAL&ADV.INJURY $
❑ CLAIMS MADE ❑ OCCUR.
EACH OCCURRENCE ^y
❑OWNERS&CONTRACTOR'S PROT.
FIRE DAMAGE(My On:Fire) ^y
❑ MED.EXPENSE(Any one person $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
❑ ANY AUTO BODILY INJURY $
❑ ALL OWNED AUTOS (Per won)
❑ SCHEDULED AUTOS
BODILY INJURY �
❑ HIRED AUTOS (Per Accident)
❑ NON-OWNED AUTOS
PROPERTY DAMAGE y
❑ GARAGE LIABILITY
❑
EXCESS LIABILITY
EACH OCCURRENCE $
❑ UMBRELLA FORM
AGGREGATE I
❑ OTHER THAN UMBRELLA FORM
STATUTORY LIMITS X
A WORKER'S COMPENSATION EACH ACCIDENT $500,000
AND UB- 09/26/08 09/26/09 DISEASEPOLICYL.IMIT $500,000
0341 M55"8
EMPLOYER'S LIABILITY DISEASE-EACH EMPLOYEE $500,000
OTHER THE
PROPRIETOR/PARTNERSIGXECUTI VE
OFFICERS ARE INCLUDED.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES INSURANCE ENDORSEMENT AUTHORIIE9 THE PAYMENT OF BENEFITS FOR CLAIN9
MADE BY THE INSURED'S MA EMPLOYEES IN STATES OTHER THAN MA.NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFIT$IN ANY STATE OTHER THAN MA IF THE
INSURED HIRES,OR HAS HIRED,EMPLOYEES OUTSIDE OF MA.THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA.
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE
�,r•t,.. ..t•SIN...1.{•}}ii}}.•.•:.•:.•}}:•:.•::•}}}::•}:_}:_:{•}}}:{•}}}::•}}}}:•>}:•}:_}}: :{i}}?i}i'..A} ic4. •;::::;{{:;{{{{:_:..::(i{ {i:_: {{{{:;:_:[}(i:;::::_ ...........:
{•fu� •l1k G;IJ71:I.[ill8h:•.:=}}}}::}ii::::::::::::::•::::::::::::::::c•::::::::............ i�p71�uEL
..... .:....... . ....... . ......................................................
ERASER ENTERTERPRISES LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAR.
PO BOX 1W LO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOW RR NAMED TO THE LEFT,
COTUIT MA 02635 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABHXry OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES
AUPHORMW REPRESBM'ATIVE
jV,4,1ULs4 4AS7M-&/(I ER
::... ............................................................................ ................... -:......... .......
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Fraser Construction, LLC
CONSTRUCTION
P.O. Box 1845, Cotuit MA. 02635
ROOFING SIDING- SPECIALISTS Email: fraser construction a,verizon.net
www.fraserroofingcom FAX 1-508-428-012.) u�
508-428-2292 HICL#112536 CS#97668 cam'
� - lqr 1A
K WORK PROPOSAL
DATE: June 30, 2009 PHONE: 508-790-1482
NAME: John Alden
MAIL ADDRESS: Same
d'^
JOB ADDRESS: 60 Alicia Rd Hyannis, Ma 02601 (o 3
�5 09'- 56 y-
FRASER CONSTRUCTION hereby proposes to perform the following services in a neat
and professional like manner and in accordance with the manufacturer's
specifications and local building code.
-Remove and Haul away all of the old roofmg material
-Re-nail all plywood sheathing as needed.
Supply and Install - - - 30: 30 Year Warranty, 5 year sure
start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self
Sealing, 3 -Tab,, Fiberglass Based Asphalt Shingle with New England's Exclusive
COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE
Containment. j
Color: Colonial Slate to,� 3g PRICE- $3,410 Initial
Price is for main house-only to match existing family room
Supply & Install - CertainTeed Winter- Guard: (ice & water shield)
Waterproof Underlayment System (3ft. on eves and
valleys, 18 on rakes, walls,.and skylights)
Supply & Install - Roofer's Select Underlayment Paper (as recommended
by CertainTeed)
Supply & Install - Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge
Supply & Install - Aluminum & Neoprene Soil Pipe Flashing
Supply & Install'-'Air Vent Ridge Vent (as recommended by CertainTeed)
Clean & Remove - Debris from work area daily.
X4 Star Warranty, Upgrade will be applied if proposal is signed and
returned within 10 days. (see enclosed brochure)
i
f �r
*****WHITE CEDAR SIDEWALL**** .
EAST GABLE
Supply and Install 16" WHITE CEDAR CLEAR R&R SHINGLES
Supply and Install Tyvek house wrap
Supply and Install GALVANIZED FASTENERS
Supply and Install New Window Cap.
Clean and Remove Debris from work area daily /
Price is to re-sidewall East Gable only PRICE-$2,015 Initial
V
WINDOW REPLACEMENT
Supply & install new Anderson 400 Series Windows
Trim: Colonial Casing Interior - Primed Pine Exterior
(2) East Side @$700 Each Labor & material /
(2) Rear of building $700 Each Labor & material C/
/ Initial
/
Building Permit $50 Initial c
2% Discount if paid by check immediately upon completion
NO MONEY DOWN - NO Payment at the start or part way thru
Payments accepted are:
CASH - CHECK- MASTERCARD - VISA-AMERICAN EXPRESS
*Any payments not made within 30 days of completion will be charged 1.5%for every 30 days the
payment is late.
Possible Extra -After the shingles are removed from the roof, we will lift one sheet of
plywood to make sure that the insulation is not up against the plywood sheathing
preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be
installed by; removing the plywood sheathing, installing the panels, turning the
plywood over and then re-installing the plywood. If needed, this would be charged for
as an extra at the rate of$6.00 per panel including Materials.& Labor. There are 6
Panels per sheet of plywood.
Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing,
lead flashing, or other carpentry needing replacement will be done and charged for as
an extra at the rate of$60.00 per hour, plus 15% mark-up materials
FRASER CONSTRUCTION Warranties the labor for 12 years
0
FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years.
CERTAINTEED Warranties the shingles and labor 100% through.the Sure Start
Warranty duration.
CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the
Sure Start Warranty depending on the shingle that was purchased.
Any deviation or alteration from above specification will be executed upon written
orders and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays are beyond our control. Owner should
carry fire, tornado and other necessary insurance upon the above work. We, if not
accepted within thirty days may withdraw this proposal.
FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public
Liability Insurance on the above work, certificate available upon request.
DATE OF ACCEPTANCE: / a
Homeowner Fraser Construction, LLC
To C---
'I Date `7 r Time
WHILE VOU W OUT
M
of
Phone
Area Code -Number Extension
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU URGENT
RETURNED YOUR CALL
Message
Operator
AMPAD 23-021-200 SETS
EFFICIENCY® 23-421-400 SETS CARBONLESS
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OPERATOR:
0 23-024-400•SETS 23-027-200 SETS
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0 23-024-400 SETS 23-027-200 SETS
1
Engineering Dept.(3rd floor) Map Parcel ''..Permit# 2 02 k-*�o
House# ® Date Issued Al
.
77 y`9
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) /�3 Fee _ o
1�
Conservation Office.(4th floor)(8:30- 9:30/1:00-2;00) -7_Q '
Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC 'MUST BE
IN ' PUANCE
Definitive Plan oved by Planning Board Y 19 -
_1 6 .
ENVIRO CODE AND
TOWN OF�BARNSTABLL To 1_41TInNIS
�r Building Permit Application
li Project Street Address *r ® A 1 i aI ca_ Pcki 13S
Village �4vot,-,V, 14
Owner J OLtn K5trQr, JNot P,,, Address 66 Al I
Telephone G -7 01 d 1 e.�- ..
k.
Permit Request Covas- �--
v c 0- w oa �roi r» � ►�. ►.r .t I+` I� X 'l b
frU1n iN t
First Floor 2 ' square feet Second Floor square feet
Construction Type
Estimated Project Cost $ wo . Do
Zoning District Flood Plain Y t 0 Water Protection n a
Lot Size `/S7-. BD' :t Grandfathered PQ Yes ❑No
Dwelling Type: Single Family f� Two Family ❑ Multi-Family(#units)
Age of Existing Structure 2- Historic House ❑Yes ONo . On Old King's Highway ❑Yes ❑No
Basement Type: A Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �qG
Number of Baths: Full: Existing_ _ New Half: Existing New
No. of Bedrooms: Existing Z New
Total Room Count(not including baths): Existing New I First Floor Room Count
Heat Type,and Fuel: `A Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes No Fireplaces: Existing New Existing wood/coal stove ❑Yes WNo
Garage: ❑Detached(size) Other Detached Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use '3a c
Builder Information .
Name L v fs s4e-(2 S Telephone Number 3is— g OS
Address 1101 19e&C ze;. License# D
%4 4 t-L }n d- - ®�(7.3� Home Improvement Contractor# f 1 6
Worker's Compensation# �� S 7
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. Z[_
DATE ISSUED r ,
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER r '
DATE OF INSPECTION: `
r
FOUNDATION .a1�4 ° e
� FRAME
E _
I
INSULATION I
FIREPLACE {
ELECTRICAL: ROUGH FINAL ,-
PLUMBING: ROUGI � FINAL
cv
GAS: UGIPCI FINAL c }
FINAL BUILDIN =� ` �`��/ _• •_, _
DATE CLOSED
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ASSOCIATION P! NO.v c
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HOME.IMPROVENENt CONTRACTOR .
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TYPe re DBA f�X
4 r` N7Ezpiration 49/20/91
u�-,+ x: ji•Y tih aYs.Grrr r': 9'� �v1
, THE STERGIS COMPANY a
tMIS�A lTERGIS
"BEACH ST ;
ADMINISTRATOR g: ENNIS NA 02638 '
R
✓!ae � rreo�zur o� acl u teCt I,
DBPARTgNT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Nu�bei Expires:
Restricted Tor. 1G
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LOUIS A STERGIS
161 BEACH ST
DENNIS, NA 02638
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ES. 2_(TAE ALICIAROAD
THIS ' 'MOFZTGAG-E I NSPaC::-r ION PLAN_ IS FOR
BANK USE ONLY
TOWN: EARNS- REGISTRY OWNER:_MICfgHeL 6 JA -Q1 ) Y i F-c gmltEE�j
DEED REF:_ylZ/' BUYER: J-Q-IN KAR�:N � jat n(
DATE: PLAN REF: SCALE: In= O' •
he y cert y that the ui ing
shown on this plan is * located on ��cN of MRs YAi�IKEE :E>UR _VEY* !
the ground as 'shown 'and it PAUL 'yG' COIVSUL`i"AIVTS 1
Position does ' eonfora to the ' 70 RASPBERRY,LANE
zoning law setback -requirei2ent of MERTHEW y MARSTONS MILLS
9 No. 32058 �o`rA MASS 02648
and does not lie within the special °Fs �fGJSTE
flood hazard area as shown on s%yq� L�A�os°
the h.u.d. 'flood na dated
is p an not bade fron an instretnent
Paul A. Merithew, RPLS survey not to be used for fences etc
2Bog
The Conttnotnvealth grAfassachusclty
•!:� _� ��_ •Department of Ittditstrial.4ccidetrts
' office a//ayestlgallons
600 ti aWd";;ton Street
Bustin. Ma.u. 02111
�'• Workcrs' Compensation Insurance Afridavit _
AyoliEnt 1nformatitin•' - Plc_.gse PRINTIebt_Ij],'•�
C
Inc ttion
city nhnnc v vS'' 66 2
I am a homeowner perforating all work myself.
I am a sole proprietor and have no one workin:u in any capacity
[i 1 am an eniplover providing workers' compensation for my employees working on this job.
ennt tang name: �F
uldress:
city 1 S hone i!�
1261 rA
insurance co. iicy tl - � 6
[] I am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed below who ha-
the following workers compensation polices: '
cmmvinv nhtnc• —
1drkress•
cir%• nhnnc�•
inIor•tncc ro oilier _ _
cmmn•tn.• n•tmc•
•td d re!ov
rity nhnnc it•
incurnnec ce policy a
Attach additional sheet if necessary• ".Si - =- �1 -���• �� 5 i ��a�e'`•�"•wa.:�.r.
Failure to secure coverage as required under Section 3A of hIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur
one cars'imprisonment as is•cil as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
Copy of this matentcnt may be forwarded to the once of Investigations of the DIA for coverage verification.
1 do hereby cerrift•tut cr the.pains and penalties of prrjun•that the information provided above is true attd correct.
Si=nature Date
Print name Cv S A _ Phone
w -
'�oRciak use univ du not write in this area to be completed by city or town otrcial
city or town: permittlicense r'ttluilding Department
[ CUcensing Huard L
C check:if imrnediate response is required �5deetmen's UlTce ►••
�. C311eaith Department
k contact Person: phone te: r10ther .
Inlurniallun a] ructrUHN
Massachusetts General Laws chapter 152 section _'S requires all emplovcrs to provide workers* C0111pensation for their
employees. As puotcd Isom the "law". an eniplitree is defined as even,person in the service.of another under any
contract of jiire:;cxpress or implied. oral or written.
An enipinrer is defined as an individual, partnership, association. corporation or other legal entity. or any two or more .
the foreaoim_ en��aued in a Joint enterprise, and including the legal representatives of a deceased emplover. or the
receiver or tntstee of an individual , partnership. association or other legal entity, employing employees. However tltc
rnvner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the
iwcllinu house of another who employs persons to do maintenance , construction or repair work on such dwelling_ hour
)r on the arounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
:vIGL chapter 152 section 25 also states that every state or local licensing agency shall witltliold the issuance or
•enewal.of a license or permit to operate a business or to construct buildings in the conimomvcalth for any
rpplicant who fins not produced acceptable evidence of compliance-with the insurance coverage required.
kdditionaliv. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
)erformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter eta
'peen presented to the contracting authority.
.pplicants
!ease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
ippiyin`: company narnes. address and phone numbers as all affidavits may be submitted to the Department of
idustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tlie
'fidavit should be returned to the city or town that the application for the permit or license is being requested.
of the Department of Industrial Accidents. Should you have anv questions regarding the "law" or if_vou are required
obtain a workers' compensation policy, please call the Department at the number listed below.
try or•ro.vns
ease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
affidavit for you to fill out in the,event the Office of Investi?ations has to contact you regarding the applicant. Pleas
sure to fill in the permit/license number which will be used.as a reference number. The affidavits may be returned to
Department by mail or FAX unless other arrangements have been made.
;e Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
=ase do not hesitate to aiye us a call.
M.r_...�•._ ..•_•�••'VT-. .1��.��.Tw.t4��.��7T..I�w�-T•/��� •T'r.���Yw�..7.
e Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents _,•`i
Office of Investigations
600 «`ashinbton Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone #: (6I7) 7274900 ext. 406, 409 or 37S
. The Town of Barnstable
• uMA]" -
9� 'M �0�' Department of Health Safety and Environmental Services
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 1202. 02
Address of Work: 60_, wLE--bel
Owner's Name � i�i�-vim . Fez flt(.dao!I�
Date of Permit Application:lgne-
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:
>lbu 15 .t V 1( 4q
Dad Contractor Name Registration No.
OR
Date Owner's Name '
75
CA n
L! - ---
�� 6 `
1
1 i 1
6
S 4 �!
-l5 f i I G
do
s
}
ofTNEro TOWN OF BAR.NSTABLE'
BARNSTADLE,
"6 9 �•� }
o w BUILDING INSPECTOR
� ar a'
67521
APPLICATION FOR PERMIT TO .........../.....................................................
TYPE OF CONSTRUCTION. '..:..aad l�........................................� // ................................................
` .� �?.........19.
TO THE INSPECTOR OF BUILDINGS:.
The undersigned hereby applies for a permit according to the following information: /
Location ..........
' !........../?. ..........� '� /�T�.... f. r� ...................
.......................................................
��........ '..
........ .....
Proposed Use ...... � �/r /�/ ...................................................
�.............. .......... ! .................. . .. ..........
Zoning District .....�4�c� r.................. .Fire District
Name of Owner ... s%Address ..................... ! J`! ,,JQ...........
01 .01
Name of Builder .....Address ...........
0
Name of Architect ...Address ...............��
Number of Rooms ............... ......................... ....Foundation
AO
Exterior ..C .J.. ...................... Roofing ..... ..:... ...................
�. .. ...............................................
Jt
Floors ..... !w...... L .................Interior .../. ......................................................................
Heating ..�/o'� ���
.. ..............................................................Plumbing ..................................................................................
Fireplace ............. Approximate Cost .........'mil�.. ..................�........�.: ....
Definitive Plan Approved by Planning Board ---� -f - /- -19 '?
Diagram of Lot and Building with Dimensions `/"
SUBJECT TO APPROV L OF BOARD OF HEALTH
SEPTIC SYSTEM MUST BE
INSTALLED IN COMPLIANCE
WITH .�%,R"EdCLE it STATE
SANITARY CODE AND :TOWN
,REGULATIONS, -Y— — —
Q
�3d
I hereby. agree to conform. to all the Rules. and Regulations of the Town of Barnstable regarding the above
construction.
Name
Wi]lixumID° Jr. ' .
�~~r
16070 one story
No .................. Permit for ....................................
single family` _ dwelling
--------------------------'
�°/7 Road
- '
u"~ ������a m
Location ---------------------'
Hyannis
. /
--------------------'------
Wl]liam ' Jr.
Owner ..................................................................
frame
Type of Construction --------------
----.-.--------------------'
/ .
� � '
Plot ---------. Lot ---..����---- `
Permit Granted --' .5............... P 73 \ �
' .
Dote of Inspection lA ^� �
Dote Completed .-�-��--
= /
PERMIT REFUSED
. ^
-----_-----.�--------- 19
� | / �` 1 '
-------------_-----------..
� | /
|
^-----------'-----^--------'
y
�
-^'---^'-'^----'^'-~~--`-~---''—
| `
----------------.--..-.-.--..- �
. ,
Approved ................................................. lg
^
---------------.--.----~---. ,
. .
----------------------.~...- �
!|
FRAMING SECTION
ALL DIMENSION LUMBER SHALL
BE KD SPF N0. 2 OR BETTE-R.
2 x RAFTER @ lb" O.G.
An' SHINGLE
l W/IS LB. FELT
i I
1
1
- Ix SPINE FACIA
R- 30 KRAFT FACED FG BAYS
R- UNFACED FG BATTS SOFFIT VENT
W�G-MIL POLY VAPOR BARRIER — PINE SOFFIT
(1 st 2Nd FLOOR)
F
1 "
I
1
1
/`
2 x g FLOOR TO I ST
(isr 2Nu FLOOR)
ti . .
1
SILL
SILL SEAL
�k 0 ANCHOR BOLT
@ 6'-0" O.C.
o. N CONCRETE
Ici ". o FOUNDATION WALL