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HomeMy WebLinkAbout0132 ARROWHEAD DRIVE e . Town of Barnstable Building �Post.This Card�So�;That rt�s:Visible,:;From,the Street .Approved,_Plans Must be Retained on>Job and this Card Must be Kept � Permi +� 6 aPostedUntiF�nal Inspection Has Been Mader ,� t Wherea�Certificafezof Occupancy is Required;sychBuildmg shall Not be Occupied it a Final Inspection has beenmade,� Permit No. B-19-891 Applicant Name: _ JOE REALTY GROUP LLC Approvals Date Issued: 04/01/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 10/01/2019 Foundation: Location: 132 ARROWHEAD DRIVE, HYANNIS Map/Lot 270-155 Zoning District: RB Sheathing: T7 Owner on Record: JOE REALTY GROUP LLC as ContractorName'' <,y Framing: 1 Address: 359 CANTON STREET Contractor,�License t 2 Est Project Cost: $9,300.00 RANDOLPH, MA 02368 Chimney: Description: Replace basement existing windows(2) Insta;llgnew entry door.with Permit Fee: $97.43 stairs and railings and ate " Insulation: g g Fee Paid $97.43 Project Review Req: Per email:tv room and playroom. Outside stairway and entry Date A 4/1/2019 Final: to basement q Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced monthsaft within siz er;issuance. All work authorized by this permit shall conform to the approved application and th'e:approved construction documentsfor which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures4511 b'e in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street 66fbiid and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building nd Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:,,,- Service: 1.Foundation or Footing 2.Sheathing Inspection �� Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons n with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). � Building plans are to be available on site Fire Department, � 2 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENTnal: ~O Application Number............................................................. snxxsrnsr.�, � ll9 DING DEF°T MASS. � Permit Fee.......................................other Fee........................ E;, A` MAR 2 0 2019 T0 V v w Total Fee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by...... `..................on..., . ... ........ BUILDING PERMIT Map........................................Parcel............................................. APPLICATION Section 1 — Owner's Information and Project Location - Project Address -1'�J' ;2_ A({C7(A) Village A /l/( Owners Name ( � Owners Legal Address City "!Do State MA Zip Owners Cell# j a '3l c;W E-mail 9 E, Section 2 —Use of Structure 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 ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation. Other—Specify Section 4 - Work Description 204ACrg- EX f ,ri'A uJ'kK-)au6 1, ;�LU,, � Last undated: 11/15/2018 r Application Number.................................................... Section 5—Detail Cost of Proposed Construe Square Footage of Project AJe 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 r ❑ Wiring ❑ .Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas - ❑ Fire Suppression El Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ .Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old 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? 11 Yes ❑ No i 9 Last updated. 11/15/2018 Mckechnie, Robert From: Wellington Souza <wscapecod@yahoo.com> Sent: Friday, March 29, 2019 12:57 PM To: Mckechnie, Robert Subject: Re:Application for Permit#TB-19-891, 132 Arrowhead Drive, Hyannis Good Afternoon, I just spoke with homeowner to get the necessary information. 1. Room 1 will be tv room and room 2 play area for kids. 2.The two windows are 28x40 casement window. 3.Stairway is on the outside with railing gated: Thanks 2 Wellington Souza Sent from my iMac On Mar 29, 2019,at 9:40 AM, Mckechnie, Robert<Robert.McKechnie@town.barnstable.ma.us>wrote: Good Morning, The following is required in order to complete the review of your application: 1.) The rooms in the basement need to be labeled with their intended use.Your plan is shows "Room 1 and Room 2". 2.) What size windows are being replaced? 3.) Is the new stairway on the outside of the house? Please provide this information as soon as possible to avoid delays in processing your application. Thank you, Robert McKechnie Local Inspector Building Department' Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links,open attachments'or reply, uniess you recognize the sender's.email address and know the content is safe!' ' 1 The Commonwealth of Massachusetts Depariment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers7T pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant'Information Please Print Legibly Name(Business/Organizationdndividual): Qk� ,,j f /� A dress: l'� - , it City/State/Zip: 6 0-6e)k Phone#: Are you an employer?theck the appropriate box:,,, Type of project(required): 1.El am a employer with 4. yI am a general contractor and I employees(full and/or part-time).* Aave hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. NtReinodeling 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.insuranre.t required.] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their 11. Plumb'mg ❑ mg 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.faOther comp.insurance required.] j U4,LD o `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepohLy and job site information. Insurance Company Name: t (�q;C L %AA/' Policy#or Self-ins.Lie.#:_ 1.1� 60 �'� '70, Expiration Date: Job Site Address: C &1O LL)tk49 City/State/Zip: ff-YAAIV, z j -.A o o26 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 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 the DIA f5JWmwwr,,coverage verification. I do ° cerli nd the an allies of perjury that the information provided above is true and correct Si , Date: Phone#• _ o Official use only. Do not write in this area,to be completed by city or town officiaL . City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or 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 pennit/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 manber: The Commouweslth 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#617-727-7749 www.mass.gov/dia r AC ate. CERTIFICATE OF LIABILITY INSURANCE °A03I19f2019 n THIS CERTIFICATE 13 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 0ONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder Is an ADDITIONAL INSURED,the pofty(les)must haveADDiTIONAL INSURED provisions or be endorsed. 9 SUBROGA71ON IS WAIVED,subjectto the term and conditions of the policy,certain policies my require an endorsement A statement on this cortificato does not confor rights to the certificate holder In lieu of such endomemont(s).. PRODUCER 00M Gabrid DeSouza Atunay&MacDonald Insurance Semioes,Inc;. k� : (b08)540=2400 A (508)289-4111 550 MacAdbur Blvd. 94MIL gabrl islMvice,com A°°RESS: INSURMISIAf>FORDING COVERAGE NAIL d Bourne MA 02532 2NsUa9R A: ARbdla Protection Insurance 41360 INSURED INSURGR e: Guard Ins Gmup 31470 IN.Wafinglon Souza I.NSWElR C: 126 Arrowhead WVe INSWO R o INSURER E: I#yanrlf5 MA 02601 1IVASAF: COVERAGES CERTIFICATE NUMBER: 19.20 fM810r REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE LOWHAV E BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REO,UIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCU M ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN RSSUBJECTTO ALLTHETERMS, EXCLUSIONSAND CONDITIONSOF SUCH POLICIES.LIIA17S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: LTR TYPEOFIN$URANCE POLCYNUMBER mmoor ten P LISIITsA X COMINIMCIALGENEERALLIAeLM- EACH OCCURRENCE $ 1,000,000 CLAING-A1AV I!%I OCC1A S 100,000 AIEO EXP t{yny or7a as rii $ 5,000 A 952007156302 02,26I2019 02126=0 PERSOAAL&A0VIAAJRY $ 1,000;0D0 MOTH6111 LAGGREGATEMOTAMESPW, GENERALAGGKGAIE E 2,OOD,000 POLICYE]ACT 0I`CC PRODUCTS-COMAI7PAGG S ZOOb,00tl OORtlractQr�(RrRlrnerCiBl $ AUTOMOHLEUMLJIY 60A1eW�6�R8�ls'1RT $ d ANYALITd HODIAYfNil32Y6+eepatseirll S 01414w}. SCHEDULED _ 9ODfLYINAIRY(P4?aWdeft) $ AUTOSONLY AUTOS IIIPEOO NOtI4YMEO PRRO?d R7i'0AMAM $ AUTOS ONLY AUTOS ONLY 3mreoei'dere $ UMBR.ELLALDIH OCCUR EACHCCCURR94CE $ EXCESSLMS HCLAINISAIAM AGGREGATE S OIL 1 1 RETENTION$ $ NRORKERSCOMPENIIATK)N PER OTW AND EMPLOYERV LLAG ITY v N EA 500,OOD ® ANY PROPRITORIPART,NERIrOWCUTIIA NIA WEWC041797 O2Q6Y019 0212612020 E.L'F ACCIDENr $ OFPICEIRAIEMBEREXCLUDED? 1==1 jAbara"in NIq EL,OISAAS E-EA LAIPWYEE $ 500,000 d ytes,deWbe ur&r rJ£BCIRIPTRON OFOPERAT*NS Wow E.E.I3 A E•POLICYLLUtr $ 500,000 OESI'FOP TRDNOF OPERATIONS I LOCATIONS IVEHICLES (ACOR I)1RH,A00ka lOwnaftSclwd4a;amybeAteMOO Newsspaabvequ$gd) CERTIFICATE HOLDER CANCELLATION SHQLLDANY OF THEABOVE DESCRISEOPOLICIES BE CANCELtEDGEFORE Jose carix THE EmRAT1oN oATETHEREOaF,NDTCEIIUILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. m canton st AUTH00N0 RE MOM TAiIVE Randolph MA 02368 0 ISM2016ACORD CORPORATION, All rights reserved ACORD 26(2016103) The ACORD nam and logo are rogiStarad marks of ACORD C • i Application Number........................................... Section 9- Construction Supervisor r 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 Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 r 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 H.I.C... Signature Date _I Section 11 Home Owners License Exemption Home Owners Name: Telephone Number 1 —,"( Cell or 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 by 780 and the-Town of Barnstable. Signature — Date APPLICANT SIGNATURE Signature Date-0-1 � n Print Name 56 L (� Telephone Number E-mail permit to: _W5C kQ�;a 9 (���,�lfpo . Co'tk Lastupdated:11/15/2018 r Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ 1 Conservation ❑ For commercial work,please take your plans directly to the,ire department for approval, Section 13- Owner's Authorization I ,. 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 j ob) Signature of Owner date Pfm. t Name i i Last updated 11/152018 L awn— I 6N j 6S oy arc,- -�-- OD t a o _ `tt 1 Va +5Z6 c�L�GC� J (eQ tACC � �1ocd { o i o K � i t .� Town of Barnstable Building , PostThis CaARIMrd So Thai rt is V�s�ble<From;=the Street ;A roved Plans Musibe�Reta�ned on;Job:and this Gard IVlus be Ke t,, , .trii.6, • ;A "' .r '%4 x -:.�.'a ✓h r�5 :.� az,., '4 -, .,., °..- `< ^yu�i �' f s 'p `-bz. • 36 " PostedUntil Final�lnspect�on HasBeen Made T 3 : ; rR Where aGerhficate'of Oecu anc is Re aired such Buildm shall Not be Occu iedunt�l a Final Ins action has beenmade -'� Permit ,. _, �.,�: p "p Permit NO. B-18-2877 Applicant Name: Wellington Souza DBA WS Painting Approvals Date Issued: 09/21/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 03/21/2019 Foundation: Residential Map/Lot 270 155 Zoning District: RB Sheathing: Location: 132 ARROWHEAD DRIVE HYANNIS ' Contracto Name TARCISO A TONANI, III Framing: 1 VC Owner on Record: HILL, LULA MAE ` �� Contractor License CS089115 2 Address: 359 CANTON STREET k Y' Est Pr ject Cost: $ 18,000.00 Chimney RANDOLPH, MA 02368 _ S Permt Fee: $ 141.80 room in Insulati dd o on: Description: add one half bath&laundry on first floor.Alone full bath Fee Pald $ 141.80 basement Date `e 9/21/2018 Final: 4 Project Review Req: N Plumbing/Gas Rough Plumbing: Ale Building Official y t 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 ssuance. Final Gas: . � All work authorized by this permit shall conform to the approved application and the approved construction documents;for whichthis permit has been granted. All construction,alterations and changes of use of any building and structures shall&in compliance with the local zornng by laws aril codes. s Electrical This permit shall be displayed in a location clearly visible from access s�treetor,road and shallbe maintained openfor public inspection for the entire duration of the work until the completion of the same. Y ,• Service: The Certificate of Occupancy will not be issued until all applicable sign atures,bythe Building and Fire Officials are;providedron this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with :e:,ser)ed contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �c �.v Application Nimmber... .�../47'..a... ............ i # I /.. # i XASELPermit Fee........ ... ..........Other Fee.................:...... TotalFee Paid............................. .................................... TOWN OF BARNSTABLE Perms Approval by... •• BUILDING PERMIT .... �...................Parcel....... .... APPLICATION Section I—Owner's Information and Project Location Project Address__ W fW ) —��� � e Owners Name A LA l L�•4 '� Cpwners_Legal Address OwFe—mueit* Section 2—Use of Stractare Use Crrop Commercial Structure over 35,000 cubic feet u ❑ ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling USection 3-TI-e ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire AlarmFLE','f F Rebuild ❑ Deck Apartment ❑ Sprinkler System ' ❑ Addition ❑ Retaining wall- ❑ Solar SEP 0 6 2018 ❑ Renovation ❑ Pool ❑ Insulation TOWN 01-BgF?Nur48Lz Other—Specify ,,,Seetion-4---W--ork-Description r V f E M77d YJ 1 Act ands 2A201 S I Application Number...................................................... Section 5=Detail Cost of-Proposed Construction � '� 00-31 0.3 Square Footage of Project I Age of Structure Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method E] 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 ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway r Debris Disposal Facility: I an using a crane ❑ Yes ❑ No Section 7—Flood Zone R Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ i Section 8-Zoning Information j Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percen 1 tag tage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required _ Proposed Rear Yard Required Proposed f Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No LasttIDdated. n/ZOlS �� �_ q ��a 4 4 r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print `Legibly ly Name-(Business/Organization/Individual): � gt�(!� N f [A`ddr-er sus-: ,City/State/Z-ip: 4 MAJ - lA- oi-b© Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with-' 4.;g 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. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance.1 required.] 5. EJ We are a corporation and its 10TIElectrical 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.] *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 contractor;must submit a new affidavit indicating such. tContractors 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 thepolicy and job site n rmatio informan. ��,` � n tio om an Name: Policy,# r S oelf ins:Laic.#: lie UJ C q 721 u 5 Expiration Date�.(��,�9 Job Site-Address "�t,��6�ou1c `J 6 f'I�{1( "`T / (City/State/Zip: �� �— Attic'h 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 civ' 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 y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifica I do hereby cew r*WU7�ajndpenaldes erjury that the information provided above is true and correct. Si ature: --`1�ate: 02w Phone#:--r D Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r 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 work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or 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#617-727-7749 www,mass.gov/dia DATE(MM1001YVyY) AcC)R"- CERTIFICATE OF LIABILITY INSURANCE 13tD11Ld1Q THIS CERTIF(:AIL:.IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE C;i3E:4 NC;t`AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALrER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CF11TIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S(,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. !f thr,cC rtlf caua holder is nn ApL)ITIONAL EN51JRt:0,the pollcy(igs)must ha�q Ai)DtTIONAL INSURED provisiuris or be endorsed. If SUBROGATION IS tYdAIVED,aubjgcCto the tirnits Nerd coRditipns o1 the po!ley,cgrtairs`palicies a,ay,rogirira an gndarsgment:A statgmgr Y nR this cgrtiticnta dges nvt contor ric)lits to the ccrtlficatp i(oldar in lieu of.such c0dgrscrncrtt(y). CUNTAr T G ltlrlq)Dq""a(`U7 r PRODL4E2R NAME - _ — -- P9urra-Y'M:wDnr:eililnsurn+"L..:erlvlt:es,IiR:. ION ( 0Jj +fI-d40U Afx.No I508)-ZQ9-A111 -- Y lAtc No) [;.MAIL al rltl4itr.�k:ttl\ICq CU"tt 0 t':4.1"Uuu R,!r d t, t r<F --_-- "-*ufat:RIS)AFFONOINO COVERAOL i NAtCa I?our,,,x tVA O iNSURLti.A. Aab�A FhlJtralin ufan p 1700IP tNsurecD ,ursuRLR q --- !r c I,'1f•C t I,, r .(?!6: INE,U_R_rR O,___....,._.._._....,...,.._..,...__.... _. INSURC:L,-E IAA 02WO INSURER F:. - COVERAGE.& CERTIFICATE NUMBER: 1f-I".7 h;aeyltsr REVISION NUMBER: THIS iSTO c.._z1IP.Y.1`r. ri 1-+'C7LPCIES O!•'INSURANCE LISTED.BELOW F,AVi BFEN ISSUED to TIi1_17S)EiFD NANIEDABOVE.FOR THE Poucy PI:m,30 I:dfiiC•A'rED. -rVrt'':'H I JJ+i,t;;:LNY REQUIREMENT.TERM OR CONDITION OF ANY CONT!VCT OR r TI I`R'-X''S!0mENT WfTFI RESPECT TO WH!C11 THIS I-E'ClTIFIGATL'1\-:31:I,„Jc L'`fri3 AAAti'PERTAIN;l'NE.INSURANCE A(rOkaicO CtY TkiEr.PCLI(.Ir.4 0>al,kSli!?r<f tiC-:REIN IS SUBJECT TO ALi.I H..eG.RMS. 1 J i,LLIJILIJ N) r I I t:,nl OI UCH POLICIES,LIMPS I-I WtJ MAY i A!I OLf N E I'OUt t D fly 1 II r PrMAS, _.,.., .�.. _.._..._... ATf6C., HR .�•... �.��tSl.ILJ'I I C 7 iI()I.I(;y 1`.7CP: NSri I rit I taP W', RAN.P _ _ IN§O WVD �. VOl 1 Y NUMrICR _.__. 1MMtOn YrYY tMR1'OOMIYY ..__. LIMITS ! COMMLRCIAL a Nr it '.AD!l.frV rr GH t?(:CUIIRLN4F. Z 1 neoA9t) _ ._ ESAT?K rLrF l'FR'I"3 I J 10U,9(30�_...._ -- — 5000 i Mtn EXP IA-ml,pt'r5+inj i A 'i5?OI1%t55;3 011.726 2_v1£. 02120t2019. FEI ,0I4A'&AJ)VIKJUA• b 1.000.000 r;t;!a•I:}r r,,,TI 1M 1 r r ,_';�b Cpt- 2;000,000 CFNZILAu A 2,G I I LIj 1,,1E $' i AU TOtrf1N11 -L-AIHLIIY �l AW }� DOUILY ItdJURV{r Irn':,a! �'5 OGhN t C- LLCh NCOILY INJURY D i I 1 I) I b ;f ,J i .(y I{'ONLY 4�P --- } I'S IIMRkt ilAtir ALII(A`L lttRl htL 7 b WORKER COMPENSATIONi i Ill it Efi ANP F'M I LO! R i.it`,1 l Y y I 1 c t t A (.Ac I1f)FNT 5 500,000 +tltrlllxr NrA 4NVVi;y71iA.i G�,!'�61>>1t -�2!'lfir`L09�9 s Oa I:I uei r1 r+ 1 r a 500,000 IMnl drto yll Nsl LgfEtilr CAFA4Pl.OYLE S I1!y -- •�a !� _ .`...._�.._.— F L OISrAS r POI ICI IaMI1' g SOQOOU _....... _»_._,.. J, Dr.SCRI'PTION OG OPHIA110IIIi t a.�)t;Al IUNBf VEHICLES(AGURD 10f,AddH17 ni 11-101k,50.duk-mey br.Atad,.d It n m,:si>n,.n in ra7ui�ed) CER2'TIFiCArE HOLLER i� CANCELLATION, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Alvarez Neiia THEE XNIRNrION vArC THEREOF.NOTICE WILL BE DELIVERED IN ACCOROANCE WITH IHr,POL,ICY PROVISIONS.. 132 Arrowhead Drive Hyannis MA 02601 AurNC01ZCn RCPRLS=ETITATive /11/ i t Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 251?01:tIG'31 The ACORD name and logo Are registered marks of ACORD- °PINE ram, Town of Barnstable Building Department Services * BARNSTABLE, * Brian Florence,CBO y MASS. �bArf039. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �� I, ��,` ( nn��'t � � , as Owner of the subject property hereby authorize -dw r- to act on my behalf, in all matters relative to work authorized by this building permit application for: V NI Uila&AD V;Cj ' r�yg �� A (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is ins and all final inspections are performed and acce Signature o Owner a Signature of Applicant I IJC-LA A Lyy !J6 Qa CnvZJ, Print Name Print Name tog - o Date 1 QTORMS:O WN ERPERMISSIONPOOLS Rev:08/16/17 `t The Commonwealth of Massachusetts Department of Industrial Accidents - - - Office of Investigations f 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual).��(2�i f�.` t✓A Address: )-1 N Nl t City/State/Zip: f bN Phone#: 00 J"0 - 3 6 a W 69 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 2.19 1 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.$ required.], 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t , c. 152, §](4),and we have no 13.❑Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under the pains and penalties of perjury that the information provided above is/true and correct. Signature: --- �q Date: nA/ f B Phone#: S dt - 3 b— y�.D 0 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 4 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 work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or 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 Y g year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth.of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston, MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFI Fax# 617-727-7749 Revised 4-24-07 www.mass.gav/dia f This is an official appliotion of the Commonwealth of Massachusetts Home Improvement `=' Offce oP Consumer Affairs&eusiness 0.eaulation C:Q Contractor Program ( tt ://www.mass.gov (htto://www.mass,00v/ocabr/) (httr):hww".mass.gov/ocabr/consumer- (httmllmass.cuov)• rights-and-resources/home- My Registrations ~imorovement-contract/1 • Your company Registrations and/or Applications with their statuses are displayed in the list below. • To manage or view any Registration,click on the appropriate Task button. • To register a new company as a Home Improvement Contractor,click the Start New Application button. Start New Application(/HIC/Register/Checklist?contractorld=0&applicationld=0) Contractor HIC Registration Effective Expiration Application Application Create Task Name Number Status Date Date Type Status Date Wellington Registration P 185718 Active 08/02/2018 08/01/2020 Renewal 07/16/2018 Manage Registration(/HIC/Register/RegDetail?contractorld=159&registrationld=3 SouzaIssued - -- _--.------__---- ..__.--_.. --- - ------------...---- Wellington Initial Registration 185718 Expired 08102/201608/01/2018 08/02/2016 Manage Registration(/HIC/Reglster/RegDetail.contractorld=159&registrationld= Souza Application Issued _._... ------ ---._... ---- -- --...-- -- ---- ----- - --- ©2018 Commonwealth of Massachusetts Commonwealth of Massachusetts ` Division of Professional Licensure Board of Building Regulations and Standards Constructioh S0pervisor CS-089115 Expires: 12/06/2019 y i r TARCISO A TONANI III q' :. 28 N MILL ST APT#3 HOLLISTON MAf611746 Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. a current of the Massachusetts ion Failure topossess Code is cause fortrevocat on of this license. State Building For information about this mass.eov/dpl Call(617)727-3200 or visit www. g 1 � , C� C &se--T- CLogc,T Lct . C(,a56- A�, A- Tc- � o ? o 4= c9O , E x 1r c- C L O S'E i" W C-O A LAV Pfl t y � Will, Q c A srA.(- k SEA , ,• � ` �iJ�'i✓,�CC j a O Y'. 9 p d3s NA- QN 7W a - bo SFpO tiara 0 ?ale (a 03CD V J - Application Number........................................... Section 9—.Cow fi`on Supervisor Name C( -5- A- 70 V A N (' Telephone Number Address g N Ak L �A Pr i City f o LL r S F-o N State /V A- zip_ O/ ?—,1 G License Number !.S ©'� j j License Type UP Rcsrgtc[?Q Expiration Date 1,t/0 6/2 0 Contractors Email Gj �(�0(W,COA Cell# - So I understand my sP re amiibilities under the rules and re . gnlations for Licensed Construction Supervisor is accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docummtafion required by 780 CMR and the Town of Bamslable.Attach a copy of your license. Signature Date (9 l 1 l Section-1.0 Home,-Improvement--Cote ctor Name ` r- f Qom/ Telephone Number (6� Address a6 .1 ffou)kAeo D City_P�f�n111 Gj State Tip 112�0 Registration Number Expiration Date 07)011),6 )-b I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation ' e and the To f amstable.Attach a copy ofyour EUC... ter• Signature Date Section 11-Home Owners License Exemption Home Owners Name: Telephone Number Cell or 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 by 780 CMR and the Town of Barnstable. Signature Date APPLIC= T T-SIGNATURE Signature �� Date 0� ` I Print Name � C4 S b /i I i� Telephone Number JOY `b - a f `V E-mail permit to: Section-=12--Department_STig Offs Health Department ® Zoning Board Cif required) ❑ Historic District ❑ Site Plan Review Cif required) Fire Department ❑ S Conservation ❑ ,I For commercial work,please take your plans directly to the fire department for approval t Section 13 Owner's-Authorization ------� -, as Owner of the subject property hereby I authorize----,, to act on my behalf in all mattersre al five to work authorized by this building permit application for: ' - � essrof'ob TAddy Sim ewof Owner date --�, Print Name Last vadatr&2/92018 � AA Town of Barnstable L111C�1n .'" . c ,. "... P iPOSt;This Card So That its�s�Vis lile,From he'Street A provedr;Plans IVlust'bexRetamed on Job and this Card Must be Ke t , µ ,, p »M �'a- .:�:°• r^�.TMc s u £�'y�ut -y "2''"`; N.' ,;� �a'� r .Ns '"" Posted;Unt�I Fin`al,Ins ection Has=Been Mader a2 py r_r � ,: m .;?� zb;4 ism . r Permit Where<a Certificate of Occu ,ancy�s Required,suchBullding.shall Not be Ogccupied.`until;a Final Inspection has been made Permit NO. B-18-2080 Applicant Name: john carroll Approvals Current Use: 3 Structure Date Issued: 07/16/2018 f , Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/16/2019 Foundation,: Location: 132 ARROWHEAD DRIVE, HYANNIS Map/Lot 270-1SS Zoning District: RB Sheathing: x_ Owner on Record: HILL tULA MAE �' g: r Contractor;Name:;K JOHN H CARROLL Framin 1 Address: 359 CANTON STREET Contractor License CS-106653 2 a RANDOLPH,MA 02368 r Project Cost: $ 14,200.00 Chimney: .. Description: install 11 replacement vinyl windows,2 entry doors and 1 sliding •. Permit Fee: $72.42 Insulation: doorz aFee Paid $72.42 Project Review Req: Date 7/16/2018 Final: - ` � � a� ate' �CA3+.SVY� Plumbing/Gas _ r Rough Plumbing: yBuilding Official FinalPlumbing: 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. Rough 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. 3 f This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public rnspectio,n for the entire duration o the Final Gas:. work until the completion of the same. :+`" ,' -i ` Electrical .The Certificate of Occupancy will not be issued until all applicable signatures by then Building and Fire Officials are provided on this'permit. .a "ea: ; '.: � ° x >i .�' Service: Minimum of Five Call Inspections Required for All Construction Work: ��� � �� w 1.Foundation or FootingElk, I . J Rough: 2.Sheathing Inspection 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy tow Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department `,, All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: � � .. u��j z .e_ _ � °�T"E Town of Barnstable wuvsrcai.E 200 Main Street Tel.(508)862-4038 Z rf a`0`p INSPECTION REPORT r Permit: Building - co Sid inglWindows/Roof/Doors Use: Date: 6/28/2018 10:48 AM Inspector: barrowsd Permit Number: TB-18-2080 Name: HILL, LULA MAE Address: 132 ARROWHEAD DRIVE, HYANNIS Unit No. Inspection Type Inspection Item Status Comment Building Admin - BA-Copy of Applicant's NIC need copy of licenses attached Construction License Building Admin - BA- Property Owner NIC need owner authorization attached Construction Authorization, if Builder is Applicant Building Admin - BA-Workman's Comp NIC need completed affidavit attached Construction Affidavit Building Admin - BA-Workman's Comp NIC need certificate attached Construction Certificate of Insurance Inspection Overall-Comment:. Overall Inspection Status: FAILED Re-Inspection Date: 1 . i , Inspector Signature Owner Signature Total Score: 100 Town of Barnstable RE�cE�P 200 Main Street, Hyannis MA 02601 508-862-4038. Application for Building Permit Application No: TB-18-2080 Date Recieved: 6/27/2018 Job Location: 132 ARROWHEAD DRIVE,HYANNIS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: JOHN H CARROLL State Lic. No: CS-106653 Address: Peabody, MA 01960 Applicant Phone: (978) 979-3494 (Home)Owner's Name: HILL,LULA MAE Phone: (727)804-3120 (Home)Owner's Address: 359 CANTON STREET, RANDOLPH,MA 02368 Work Description: Install 11 replacement vinyl windows,2 entry doors and 1 sliding door i Total Value Of Work To Be Performed: $14,200.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: john carroll 6/27/2018 (978)979-3494 Applicant Date Telephone No. 1 - Estimated Construction Costs/Permit Fees . Total Project Cost : $14,200.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $72.42 6/27/2018 $72 42 Paypal Paypal Total Permit Fee Paid: $72.42 - wa? �,eba.-,..:�.se, ...... -.,�'✓..�e�:as...a t�.,:wevaAL,� ..`�s,.wrwz+N�.. -t. kK. k�:::� ..,3 ' a'�, �, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel` G Application # d 0 ��I �2 o Health Division % � 3Z�7 Date Issued Conservation Division Application Fee Planning Dept. M'Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village .acs,.��S l� Owner k z=y f -4-lio l R K, 11 Address l Telephone_ G Permit Request �'1�- �, P �C l- l �L�`C �, L�`� �-,��V c �� c c1 �i G t-,- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4116d Ua 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) %z, Number of Baths: Full: existing new . Half: existing C,n nevy Number of Bedrooms: existing —new ZM Total Room Count (not including baths): existing new First Floor RC Cou10 nt "' o Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/o al stove❑Y ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ e isting Cane r ize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _(BUILDER OR HOMEOWNER)- Name j�/f�y �' yf_,Ife,zr Telephone Number s"a�- �- Address c'� License # ? ? 715�_ l Home Improvement Contractor# Y Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOc�..v SIGNATURE ( DATE 0 1,-2 L S2- s FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL NO. c ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Tire Comrnonwe,716t ofmcfssachusetts \ _Department oflndustriafAccidents Office of Invesdgatiorss 600 Washington Street Boston, AL4 02111 '. `, www.mass.gov/did • Workers' Compensation Tnmrance Affidavit: Builders/Contractors%.EIectri.ciang/Plumberg Applicant In_formatio>i Please Print Leebl Name pusinoss/Organization/Individual): Address: City/State/Zip: Phone.#: Arc you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and f 6 ew construction employees (full and/or part time).* have hired the sub-contractors I listed on the attached sheet 7. ElRtmodeling 2. am a'sole proprietor or partner- ' ship and have no employees These sub-contractors have g, ❑Demolition employees and have workers' working for me in any capacity. 9, ❑ Building addition workers' comp,insurance DOmp• insuranc.0 [No S. [� We are a corporation and its 10.[]•Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work oicers have exercised their 11.[�Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12:❑Roof repairs insurance requited] c. 152, §1(4), and we have no ❑ Other employe 13. es. [No workers' tut(�>--- comp.insurance required.] *Any applicant that chocks box#1 must also fill out the section beloW showing their work=' compensation policy infarmation. t Homeownt"who subrait this affidavit indicating they ore doing all work and then hire outside eontractor5 must submit a new affidavit indicating such. tConlracton that check Nx box must attached an additional sheet showing the name of the sub-contractars and state whcthcr or not those entities have employees, if the sub-contractors have employcm,they must provide their workers'comp.policy number. lam an employer dial 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/StatcMp: 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 fins up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator., Be advised that a copy of this statement may be forwarded to the OfEce of fnvesti a.tions of the IDEA for insurance coverage verification. I do hereby certify under the ains•andpen 'e of perjury tic.at the information provided above is true and correct Si store: '�� �-e'G Date; — Phone# 52 0� a P� - 3 S'�� Offecal use only. Do not write in this area, to be completed by city or town officiaL City or Town: Perait/License# Issuing Authority(circle one); 1.Board of Health 2.Building Department 3. City/Tow-a Clerk 4, Electrical Inspector 5, Plumbing Inspector 6..O th er Phone #: Contact Person: i '® Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their,employees; 2ursuant 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 ernpLoyer is defined as "an individual, Partnership, association, corporation or other legal entity, or any two or more of the forcgoing.ongagcd in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or t=tec of m 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 ouse of another who employs persons to do maintenance, construction or repair work on such dwelling house dwelling h eemed to be an employer." or on the grounds or building appurlcnant thereto shall not because of such employm ent bed P MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall tdthhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the cornmonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGLDhapter 152, §25C(7) states 'Neither the commonwealth nor any of its political subdivisions shall , enter.into any contract for,the performance of public work until acceptabic evidence of conxpliznce vtzth the insuraTice chapter have been resented to the contracting authority. requirewcnts of thisP Applicants Please fill out the workers' compensation affidavit completely,by checlting the boxes that apply to your situation and, if of necessary, supply sub-contractors)name(s), address(cs) and phone numbcr(s) along with their c mplo ces other insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships (LIP)with no employees other than the members or partners, are notrequircd 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 conf=MtiDn of insurance coverage. Also be sure to sign and data the affidavit The affidavit should be retumed to the city or town that thc'application for.the permit or license is being requested, n6t the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' l the Department at the nurgber listed below. Scif-insured companics should enter their compensation policy,please cal self-insuranco license number on the appropriate line. City or Towp Officials Please be sure that the affidavit is corriplete and printed legibly. The Departnent has provided a space at the bottom of tho affidavit for you to fill out iu the event the Offico of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/licensc number which will be used as a rcfcrcnce number. In addition, an applicant that must submit multiple permitdieeusc applications in any given year, need only submit ono affidavit indicating current policy information(if pcccssary) and under"Job Site Address" tho applicant should write"all locations in (city or town)."A cbpy of the affiidavit that has been officially stamped or oarked tense,�A new e City or must b milled out vided toeach applicant as proof that a valid affidavit is on file for future permits year.Whcro a hams owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i_e, a dog license or-permit to born leaves etc.) said person is NOT required to complete this affidavit. Tho Office of Investigations would Bike to thank you in advance for your cooperation and should you have any questions, please do not hesitato to give us a call The Department's address, tclephone•and fax number: Thf,, Cbmmorlwt-,4th of Ma&Q=hu.strM Dcpzztment of ludijsz 4 AAccid(-,ntS Office of lue#ipti.ons 600 VMashi 9tDn Str'eet Baton, MA 02111 TcL # 617--727-4SK0 rX 4.05 Qr 1-$77-MASSAFE Fax# 617-727-7749 Revised 11-22-06 WWW.Ma .,goY/tile f �oeYHerokti Town of Barnstable Regulatory Services auzxsrAs Thomas F, Geller, Director q huss. � �°rocb`� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.mn.us Office: S08-862-4038 Fax: 509-790-6230 P r.operty Owner Must Complete and Sign This Section If Usitzg A Builder 7, 1,70 , 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: kl( o�� I (Address of Job) Signature of O ner ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Pbrrri on th•e reverse side. Town of Barnstable ywV op IHE rp��� Regulatory Services Thomas F. Geiler, Director BARNSrAUX, MASS. Building Division r67P. Prfo �A Tom Ferry, 3ullding Commissioner- 200 Main Street, Hyannis., MA 02601 -A-YtY.town.barnstable.ma.us Fax; 508-790-6230- Office; 508-862-4038 HOMEOWNER LICENSE EXEMPTION Plense Print DATE: JOB'LOCATION: street village number "HOMEOWNER": home phone N work phone# name CURRENT MAILING ADDRESS: state zip code city/town The current exemption for"homeowner g rs"was extended to include owner-occupied dwellins of six.units or less and does not possess a license, Provided that the owner acts as to allow homeowners to engage an individual for hire who supervisor. DEP'TNITION OF IIOItJEOWNER Persons) 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 t considered a ho such use and/or farm structures. A person wh cial that he/she shall be o constructs more than one home in a two-year period shall not be homeowner. Such homeowner shall submit to the Building Official on.a form acceptable to the Building Off 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. Tile undersi ned "homeowner"certifies that he/she understands the Town of Barnstable Building Department g e will comply with said procedures mininmum inspection procedures.and requirements and that he/s h p Y requirements, Signature of Homeowner Approval of Building Official Note; Three-family dwellings containing 35,000 cubic feet or larger will be required.to comply with the State Building Code Section 127,0 Construction Control. HOMEOWNER'S EXEMPTION ,Any homeowner performing work The Code states that: k for which a building permit is required shall be exempt from the provisions of this section(SccdQn 1o9.),1-Licensing of construction supervisors);provided that if the ho�ncowncr engages a persons)for hire to do such work, that such HDMCO)Vner shall act as supervisor," Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix � Rules&'Regulations for Licensing Construction Supervisors;Section 2.15) This lack:of awareness often results in serious problems,particularly when the homeowncrhires 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 hr/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 f0m-Vccrtification for use in your community. - i\'lassachusetts- Department of Public Safetc Board of Building Regmiations find Standa►d, Construction Supervisor. License License: CS 9975 Restricted to: 00 . t a BILLY E CALITHEN s h 86 BETH LN \� HYANNIS, MA 02601 "' k c Expiration: 8/13/2011 i r , My.•!-'a ,t ': '.4 '.!"" *' ate^ r.:r. ..'!�4y a ... F M;± ,..r ,,. 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BILLY E CAUTHEN t�86 BETH LN r. j HYANNIS, MA 02601' -- - �y� Expiration: 8/13/2011 ('onnn INS iuiSer Tr#: 2150 y - ✓1ze L�a�rvi�,uinasec��/� o��i�,z�teza/zuae�a �,s., i Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR Registration:4 116609 ExpIra on 6129/2010. Tr# 268043 ,•> • I' f't Type Individual I Yt k . r BILLY E CAUTHENx i i .r I BILLY CAUTHEN ' r-, 86 BETH LANE x' HYANNIS,MA 02601 Administrator I x. z Tit c E1,��• o 41 � o OP 1 � � Q Town of Barnstable Geographic Information System October 8,2009 a4 it TTI r ,rr t' � t 1 viv Kf '; 1 �' � a 1" a �` +�"� ����: „T'• sx.�' .ef d{- _ �I a, i. � r'J� +e 271201 ^ �."< I ML s. 271122 ,r 271125 ' m ` #126 I �� ��,, , � �� r r riM` :,rt +,t ^. j_ >N * '�'# �����y^•t 1.tt. ,,� .fi .,� � C' f ^+"„i,� r a� r i � � 40 ¢7�4' � C+� 1!'& L 'N ^� .�J` q^�.,xe�'�• -, ,d' � ����� M- ��y'tib-@,� '^� 270082002 r #1 ; -, a 271202 tom, � 33 t ��, a �i.• � lft ,}� �.. �'` `} ?,A'E� b• 'I� Rye,. �„ f £" '"�' #118 e�'€ �: 2 .� '�-n� ', _ �{ ,ata� ems•' � 17. G Q, - .. qW jf 132AE vi- r,} mom' � e - ►• "�"-Cx sy,,r�. �ryy :� , ,- x3 � ..�. � �>F�' �4*. "R/: ,tr�,-. ' � �' 3 . �iA �ASS "r+•,� w - '}'-' ��, .• r$`,s �' � �.: e''d�"�.L -Er: � ui '44., ' :fit'. 'I�;.. "9`�i .r. tr' Xs���� ': x a'_i '3- .� • �- � r � tea..� "�'.�„^ � � _ °�� r�r �q� � �" .�r�,�b'-:,a w&r� �7C�4'3�' � A.. 270101029 }` f lip, 34 d» k'��;�� ��� ,i• „kr`'" � �yrl #140 Ye.� .d� f f .}.� .,� %�a t 44"sue. LA I ; 'y4 i-J ,tam' `"'+�' *` •» _ r' +"_4 `1F�. 6 � ., 1 ' 4 "�7:'.. h� � ;'.,� aA<f <�;"yi.� `tir'�` �,y: r '�. Y.yr,,.. . ,�� � t,y,� •�+�w,s.?. I aµ r - u Y Aw .,fr;e <` �' ' .. .. ,• '�'' - r.L� .rj � ,t�� � � ua; 270101030 x. st r,. #59 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:270 Parcel:155 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:HILL,LEVI J&LULA MAE HILL Total Assessed Value:$251900 1"=100'may not meet established map accuracy standards. The parcel lines on this mapE. are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.22 acres Abutters '::::::; 7i1tf boundaries and do not represent accurate relationships to physical features on the map Location:132 ARROWHEAD DRIVE such as building locations. Buffer r/,;•/� Aerial Photos Taken April 28,2001