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Home My WebLink About0047 BISHOPS TERRACE -=-��J- -__ y.._ __ -` / �� -- I i - - -�- - - -- �_..._� _ _--- -- - I \ r ��"e► � � Printed On:7/9/2020 Complaint -Gall Report 47 BISHOPS TERRACE, HYANNIS Case# C-20-92 Case#: C-20-92 Address: 47 BISHOPS TERRACE, Date: 2/28/2020 HYANNIS Owner Info: Property Info: MORGAN,ANDREW R& MBL: SHAUNA-KAY T 47 BISHOPS TERRACE 251-206 HYANNIS MA 02601 Owner Notified?.- Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Illegal Dwelling unit, Building Code, Medium Priority Mail Complaint Summary: 47 Bishops Terrace has recently changed ownership (sold 12/10/19).A permit was pulled for insulation 02 `12/18/20 (B-20-493), but according the letter,there are now foundation cuts for two full sized basement windows as well. They assume these new full'sized windows are for additional lower level bedrooms. Action History: Action Taken Date Description Fee Inspector Close Case 7/9/2020 Permit Issued and $0.00 bowerse completed Inspector Assigned to Complaint: bowerse Filed by. scaliam Comments: Comment Date Commenter Comment Date: 7/9/2020 w Town of Barnstablerv~' -I SMIL D I N G D E PT Application Number......... .....��.o.........IS... ........ "r * BA MASS. ' t........................ A83. MAR 0 9 2020 Permit Fee..................................ZoningDis 039. ` �- OWN OF BARNSTABLE Total Fee Paid.............. 9 TOWN OF BARNSTABLE Permit Approval by... . .................On. .....O BUILDING PERMIT .. ................Parcel...... ... .... 0.... ........... APPLICATION Section 1 — Owner's Information and Project Location AN 0 3 2020 Project Address , :S h0 pf Village Owners Name Drew Owners Legal Address i' �� 0(e . e Cityfl%ianlli State Zip W( O J Owners Cell # E-mail Apotla bee Gh / ( co F_ 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 a ❑ 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 ❑ Foundation Only, Other—Specify Section 4 - Work Description j Last updated: 1/31/2020 a Application Number. � . r..................................... l Section 5 —Detail ` Cost of Proposed Construction Square Footage"'of Project ' 'V Age of Structure Dig Safe Number # Of Bedrooms Existing ,3 Total # Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA"Checklist ❑ WFCM Checklist ❑ Design Section 6— Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors r Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply El Public ' ❑ Private I Sewage Disposal ❑ Municipal ❑ On Site Historic District [] Hyannis Historic District ❑ Old Kings Highway i{ Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7— Flood Zone .Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8 — Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 SCANNED 711 . APR 0 3 2020 Moor 6 0 �H i LM t _ - 71 . : . ....: . .. I' LaLlnL� r�ge" I iI i � j LU l 8; -77 u Y Y I� S Legend s � �•, 0 Parcels � � �" � �` "��' "� ` _Town Boundary -41 51212 F ( Railroad Tracks ;: # d Buildings a Approx.Building Buildings —Painted Lines 251205 Parking Lots { #61 � � � r Paved i I t �.e. -�. L' ^r :;J Unpaved - L, Driveways J [3 Paved Unpaved �• Roads 4" .:�w El Paved Road 25�� $�Unpaved Road 0I �X �� .. #5 �� " �Bridge - " 93•Paved Median j ' : � d - Streams E Marsh Water Bodies " ILI . . 25 206 } 251214 251196 #205 . ;. : �at2107 I : i Map printed on: 3/6/2020 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026ot O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. gis@town.barnstable.ma.us Bowers, Edwin From: shauna - kay beecher <shaunabeecher@yahoo.com> Sent: Friday, March 13,2020 6:54 PM To: Bowers, Edwin f Subject: Re: Permit/Application:TB-20-731 at 47 BISHOPS TERRACE, HYANNIS for Building - Addition/Alteration - Residential Good day Mr Bowers, The intention is to install a bathroom in the basement. There is also the intention to replace the drywall/panel in an existing space. Thanks On Friday, March 13, 2020, 12:55:59 PM EDT, Bowers, Edwin <edwin.bowers(cD-town.barnstable.ma.us>wrote: Hello Shawna Our records do not indicate finished space in the basement. I will need you to clarify the building permit application Description. If you are adding a Bathroom in the basement. The application now reads (Rough plumbing). If you are installing a bath it must say install Bathroom. I Do have you on the schedule for 3:30 today We will go over the floorplan and Scope of work'then. Edwin Bowers Town of Barnstable Building Inspector 508-862-4025 CAUTION:This email originated from outside of the Town of:Barnstable!.Do not click links;open attachments:or reply, unless you recognize the sen;der's email address and know the.content.. s safe!; 1 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Invest1gations 600 Washington Street Boston,MA 02111 wwM.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiricians/Plumbers Aviflicant Information Please Print Lezibly, Name (Business/Organiztion/lndividual): dia) afl Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with- 4. 0 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.acitY• employees and have workers' 9. El 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 I LEI Plumbing repairs or additions / myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 isproviding workers'compensation insurance for my employees Below is thepolicy 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. 1 do hereby cerrtti/ffy under the pains and penalties of perjury that the information provided`above`is true and correct. Sign attne //� Date: a /�4lio Phone#' 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#: t 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 id 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 biuildings 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)naine(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 Commoawealth of Massachusetts Dgmlmemt of Industrial Accidents (fie of Investigations 600 Washington Street Bastan,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877 MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia - 1 Application umber................:.......................... Section 9— Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # 1 understand my responsibilities under the rules and regulations for Licensed Construction Supervisor 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 license. Signature Date Section 10-Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I 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 required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section.=llHome Owners License Exemption ��ewners Name: Y T.eleph-qn—e-Nurrlber— -� 1-- Gell-or WorkNumb-er �0 1 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. —�S'ign�ature ate `LO b 2 J RUG r Signature = Date Pint-NameT/n��W fl ' �� Teleph" e-lurrlber„ �� y t� 9Cv E-mail permit to:— -olly C Last updated: 1/31/2020 Section 12 — Department Sign-Offs Health Department ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ i Fire Department ❑ i Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13 — Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all i matters relative to work authorized by this building permit application for: j (Address of job) Signature of Owner date Print Name f 1 3 1 i J i 9 9 Last updated: 1/31/2020 3 j Town of Barnstable I y� gi` �`"""'�..�9",'. ,,;� �, s. x^-g,%t• 'atL� ' "" �. �?�; y�<; �s • �°•,=er�.,- s r^�.^; �� ,�„�+.' �v�� ' ` Building Post This Card So That rt is"1/isible From theStreet, Approved Plans Must,beReta�ned on Job acidrth�s Card Muste,be Kept Posted Until Final InspectionHas B en Made ' Permit Where a Certrficatef Occupancys Required;such Bu,ildmgshall Not be Occupied�un#i!a Final Inspection has been mae ,. Permit No. B-20-731 Applicant Name: HOMEOWNER IS APPLICANT Approvals Date Issued: 03/20/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/20/2020 Foundation: Location: 47 BISHOPS TERRACE,HYANNIS ## Map/Lot 251 206 � Zoning District: RC-1 Sheathing: Owner on Record: MORGAN ANDREW R&SHAUNA-KAY T Contractor Name: ,HOMEOWNER IS APPLICANT Framing: 1 Address: 47 BISHOPS TERRACE Contractor'License". EXEMPT 2 HYANNIS, MA 02601 Est Pro57 tect Cost: $ 1,000.00 Chimney: Description: Two Windows 30x35 in basementPermit Fee: $85.00 Rough plumbing Insulation: Fee Pau&. $85.00 New Bathroom in Basement area z New drywall and insulation in basement finished area � Date 3/20/2020 Final: 7 f 7, Project Review Req: Not Egress windows Not to be used for sleeping g � Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work a uthored bythis permit is commenced within six moWnths after3.issuance. . All work authorized by this permit shall conform to the approved application and:the approved construction documents f'r which his permit has been granted. Rough Gas: All construction,alterations.and changes of use of any building and st uctur shall be in compliance with the local zonift"by law and codes. This permit shall be displayed in a location clearly visible from access street pr road and shall be maintained open for public nsp&tion 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 byxthe Building and Fire Officals are provided on thirp permit. Minimum of Five Call Inspections Required for All Construction Work •3 Service: 1.Foundation or Footing ', �. g p Rough: 2.Sheathin Insection .. .�. ., �. . �., ; 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) _Insulation Low Voltage Rough: 6.Insula 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 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: d tHE rp x � Pnnted On 302020 Complaint ZIA: Reporter } • BAItIiSI'ABIB 3 3��'✓ T o- a v ;� .. •'.,'; E � pmv Case#: C-20-91 Address: 47 BISHOPS TERRACE, Date: 2/28/2020 HYANNIS Owner Info: Property Info: MORGAN, ANDREW R& MBL: SHAUNA-KAY T 47 BISHOPS TERRACE 251-206 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Building Code, Illegal Dwelling unit Medium Priority Mail Complaint Summary: , 47 Bishops Terrace has recently changed ownership (sold 12/10/19).A permit was pulled for insulation 02 2118/20 (B-20-493), but according the letter, there are now foundation cuts for two full sized basement windows as well. They assume these new full sized windows are for additional lower level bedrooms. Action History: Action Taken Date Description Fee Inspector Close Case 3/2/2020 complaint entered twice $0.00 bowerse Inspector Assigned to Complaint: bowerse Filed by., scaliam Comments: Comment Date Commenter Comment oo � p FOB E R A R tie lii;i"��i#ltrisi�ii�:�!"��ti�.li.iii�. _ ..�.. .s s � 3 i s � F;� F 1 e f s. s s F � F{� i i -p s ;s ., .�� ,�- r . � �'�q t � .. , � _ - � �� _�„ �,�.,fs�,..,;;�.,_... BUILDING DEPT. FEB 28 2020 TOWN OF BARNSTABLE e- de-V tloo- e- �or 5 5, P p e3 LL) &-VLJ Lc)e- Oct C 7 r, �P Z,)� e r, L/ e 0 If of 61!t4 0-4 (our C )4d . )6i A e-- v)f-o V`--- I- V7. o r r BUILDING DEPT. Application number......."QQ....�...`��..................... Fee ...................................... S.r.............................. ASM FEB 18 2020 BARM HAM � Building Inspectors Initials...... , .................. TOWN OF BARNSTABLE '] ( n Date Issued.......�1`. L .�. ...16................... Map/Parcel.........a5l...........ql�......................... TOWN OF BARNSTABLE SCANNED EXPEDITED PERMIT APPLICATION: FEB 2 4 2020 ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 47 Bishops Terrace NUMBER STREET VILLAGE Owner's Name: Shauna Morgan Phone Number 774368-4630 Email Address: not provided Cell Phone Number Project cost$ 2500 Check one Residual yes Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ijeme WGl1�5 e to,--/ to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK El Siding E Windows (no header change) # V3 Insulation/Weatherization D Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name HomeWorks Energy---,_. 181138 Home Improvement Contractors Registration (if applicable)# (attach copy) Construction Supervisor's License # 103822 (attach copy) cell:508-207-2713 Email of Contractor neil.do nag hy@homeworksenergy.corn Phone number 781-305-3319 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ 1 *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event ;Check one: this event is a: for profit non-profit event Check one: Food served Yes No q Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model /I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's 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 spections and documentation required by 780 CMR and the Town of Barnstabl Signature Date 2L(R' APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Office of Consumer Affairs and Business Regulation 1000 Washington Street..Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: cnrp=tian w� T" Registration: 18tt38 HOME WORKS ENERGY,ING Exphatiar: 03(OV2021 101 STATION LANDING STE 1 16 MEDFORD,MA(12155 Dpdele Addross and Ratan Card.. om"at e9i caasuROVEMENT CONTRACTOR Rmar seam A Husi."s:Rottman tiolAE DNP strptton valid for imlivldual use duly TYPE:conw anon baler.km expiration data.If found return tm R�giiVetl4ZY Explradon Office of consumer Affairs and 6ue1ne"RaguMWI - i8i Q8 1 DDo Wash o Strael•Suite 71D HOME WORKS ENERGY.INC. Boston.M 0211 " MAXVEGOEBEIRG 101 STATIONLA140ING STE 110 p valid Without signature MEOFORDJOA 0156 Underswelary - Commonwealth O7 Massachusetts r Construction Supervisor Specialty , Division of Professional Licensure Board of Building Regulations and Standards Restricted to: 7 Caftstruct�i�orr:S�p&igy>r Specialty CSSL4C-Insulation Contractor F� CSSL-103832 �.r. 6tires: 1 011 3/2 0 2 1 t I ., '.p SCOTT VEGCTEBERG 8 COVINGTOIN ST#1 BOSTON MA 92127 t kovv " Failure to possess a cur dition of the Massachusetts State Building Code is c. or revocation of this license. Commissioner ---- For inforrr1at113ii about this license � � Call(617)7273200 or visit www.mass.govidpt The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.g ov/dia Workers Compensation Insurance Affidavit: Builders/Contra r p Builders/Contractors/Electricians/Plumbers s/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Homeworks Energy Address:101 Station Landing Ste 110 City/State/Zip:Medford MA 02155 Phone#:781-205-4520 Are you an employer?Check the appropriate box: Type of project(required): l.A I am a employer with 200 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. El New construction 2.❑ 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 I LE]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 Weatherization 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 anew 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: NH Employers Insurance Company Policy#or Self-ins.Lic.#:#4001017 Expiration Date: 1/1/2021 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 �a"nd�penalties ofperjury that the information provided above is true and correct. Signature: "�`�'�" Date: Phone#:781-205-4520 / wxpermitting@homeworksenergy.com 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#: �—� HOMEW-1 OP ID ILL CERTIFICATE OF LIABILITY INSURANCE DATE/2 912 01 9Y) 03/29/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 978-686-2266 c NTACT Lisa Lariviere Foster Sullivan Insurance M --- 163 Main St. 11,vH�NN,Eat:978-686-2266 FAX -686-6410 C.NP.978 North Andover,MA 01845 i E-MAIL ,ce I Icates @fostersullivangroup.com Foster Sullivan Insurance LLC --- INSURERtS1 AFFORDING COVERAGE NAIC If INSURER A:SAFETY INDEMNITY INS CO 39454 INSURED Homeworks Energy Inc. INSURER BALM MUTUAL INS CO 33758 101 Station Landing Suite 110 Homeland Insurance Co of NY 34452 Medford,MA 02155 1IINSURER C: INSURER D: INSURER E• INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING.ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY P_AID CLAIMS. - INSR-7 �___-_�-- - OOL UBR -�-..__---.___---------------------- --- POLICY EFF POLICY EXP TYPE OF INSURANCE IN D Wyp POLICY NUMBER I(yp�Dn.YYY) ( jYY LIMITS C 'X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE n OCCUR 7930060650002 U41U112019 04101/2020 DAMAGEroRENTED 500,000 ARE-IsAISES/Ea acwrtencel 10,000 I MED EXP(Any one Person) 1; PERSONALSADVINJURY S 1,000.000 GEN'L AGGR GATE PLIMIT APPLIES PER: i GENERAL AGGREGATE 2/0001000 POLICY JERCT a LOC PRODUCTS-COMPIOP AGG 21000,000 OTHER: A AUTOMOBILE LIABILITY COMBIN�eD SINGLE LIMIT S — 1,000,000 (F_a aci_ _ ANY AUTO I 6244378 04101/2019 04101/2020(BODILY INJURY(PerPerson) S _...._-- OWNED SCHEDULED i AUTOS ONLY X .AUTOS I BODILY INJURY(Per acadenU P OPERTY AMAGE IIqqEE ,— ppyyyy pp _RR_ D . X AUTOS ONLY I,X ANRMNEV _(Per ecgaent] i S _.—_..._ .L$____.._ C UMBRELLA UAB X OCCUR EACH OCCURRENCE 2,000,000 X EXcessLwa CLAIMS-MADE i 7930060660002 04101/2019 04101/2020 AGGREGATE E 2,000,000 DIEDX I RETENTIONS O S B WORKERS COMPENSATION i X PER OTH- AND EMPLOYERS'LIABILITY YIN I MCC-200-2000552.2019A 01/01/2019 01/01/2020 S ER 1,000,000 ANY PROPRIETOWPARTNER)EXECUTIVE E.L.EACH ACCIDENT $_._._____ ' OFFICER/M%T EXCLUDED? N/AI 1,000,000 (Mandatory In NN) E.L.DISEASE-EA EMPLOYE Ryes,descnba under - 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT I DD Cq �p CVIO61n W'dnPyERATIONS/LOCATIONS I VEHICLES(ACORD I..Adt illonal Remerka Schedule,may be eM.hed if more ePaea le required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Homeworks Energy 101Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE A ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HomeWorks IT- Energy, Inc To whom it may concern, Scott Veggeberg is a current employee of Homeworks Energy Inc.and operates under our insurance policy. Policy numbers that Scott is covered by are as follows: Commercial General Liability:793006065002 Automobile Liability: 6244378 Umbrella Liability: 7930060660002 Workers Compensation and Employers' Liability:ECC-600-4001017-2020A All HomeWorks Energy permits are pulled under his CSL license. The insurance provider is AIM Mutual Insurance Company. If you have any questions or concerns please contact Director of Weatherization Adam David Glenn at 774-365-2446 or adam.plenn(@homeworksenerey.com. Thank You, Adam David Glenn Director of Weatherization HomeWorks Energy. Construction Supervisor Re;Address u 7 ,�tk '_95 t/' /,�(or)application# Name Scott Veggeberg. Telephone Number508-273-7593 Address 101 Station Landing Cfty-Medford State`MA Zip 02155 License Number 103832 License Type Expiration Date 10/13/19 Contractors Email NSA, Cell# 508-273-7593 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 Z e f t f Insulation/Air Sealing Permit Authorization Specialist: Cameron Pontes Company: HomeWorks Energy Email: cameron.pontes@homeworksenE Address: 101 Station Landing HonneWorks Cell: 774-888-8265 _ Medford, Ma 02155 Phone: 781-305-3319 Customer: Andrew Morgan Address: 47 Bishops Terr Email: shaunabeecher@yahoo.com Barnstable,MA 02601 Site ID: 3968864 Phone: 508-29244§6 I, the owggr of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner HA to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization w.ork.on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. Customer / Signature: ` Date: 2/10/2020 Andrew Mor an f SCANNED -7-7 t-�- 3 6 G -ci�'�U FEB 2 4 2020 ShjAun6L122 'h00 LoF4ANVIEW L7Lq UG Name: An&rP,-, M&rciw; Site ID: 3% 006 Finished Sq.Ft: 't-1 -A Phone: ' a, E, y y�{� Year of House: ( 9 Electric Acct#: ' Address:Li `&,-i'o0Y2'S -fir #of Floors:. Gas Acct Ge2� ) ,,yiV (0601 'Unit#: #Occupants: Housing Type? r1Gg� DUCTWORK INSPECTION Ducts insulated? 1 ' Duct Linear Ft. Duct Square Ft. lYi Duct Air Sealing Hours + Duct Insulation - 43 Duct Insulation Removal t. - BASEMENT INSPECTION ate{ Existing Spec'ing Ln/Sq.Ft. " Bsmt Wall AG Crawl Ceiling kT 3 Crawl Rim Joist L �t Bsmt R1 w/Sill Bsmt R1 NO Sill z Vapor Barrier --_ .agft7; Bsmt Door Y N Blower Door? WALLS&GARAGE Drill Location? Siding Ceil.Height Existing Spec'ing S .Ft. Framing Exterior Wall 1 �L . "� x x Balloon/Platform Exterior Wall 2 x x Balloon/Platform Overhang x x Garage Wall x x Balloon Pla orm Garage Ceiling x x- ,AL` �- Insulation`Removal�-�' .`SQL Sweeps:; ' WX Skrtppmg:. WORK SPEC'D BUT NOT CONTRACTED ROAD BLOCKS PRESENT? ANDATORY) Attic Iasernen,/Crawlspace I Other:. K&T Y Moisture Y N Combustion Sfty IYVA Kneewall Overhan /Gars a Asbestos Y J Mold>100 sq.ft I Y kXCO Detector Missing ly kW Ductwork Exterior Walls - Vermiculite Y N Structl Concerns I Yf N Cher: Notes for Lead Vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? t7i " OR 1(W SLOPE AND GABLE END Blind Spec? ❑ Why? Why? FRAMING EXISTING SPECING so,FT, FRAMING ERISTING SPEC'fNG SQ.FT. WALL X X SLOPE X - _.. ,. FLOOR X X / i GAPLE X x e ACCESS X TRANS x X 2^ TRANS X X I ATTIC ATTIC SLOPE I X X. SLOPE X X j EXISTING VENTING?' u EXISTING VENTING? EXISTING PIPES?Y j N HW Venting V°m OF OF,- se Oamming Sheathing Access Temp Access AVV.dnR Vcnt8F Temp Access . i S D P ter• ,. ; 1 Inzulated Will ' Reed Light r0Ins.Hose liF'^Ventui Chim.ICH Uaminlor Wlluot Vent f.RV� - N Alr handlerM Temp Accesst��}� 1-pull Down DS Hatch ElNull Hatch-/ Do°snJ R'Recf Vent BRV) Vol: X .0058 sior x x ATTIC Blind Spec? 0- ?. X 15.dt2SlLslto X x ATTIC Blind Spec.. ❑ roryl� - Existing Spec'ing Sq ft Existing Specxing Sq ft 13e t3 acnryJ Unfloored 1 7 I? f UnFlo r _ UWE Pusses Cross Batting Floored - Floored Mixed Insulation Duct Work Cath Slope _ Cath Slope >6"Loose None Wails Walls Access CXh. - a Access '-- Venting Propavents Vent BF 3F Hose DamrnIn ennng Pro avents Vent BF BF Hose Dammin r [Existing �14 Temp Access CL SheathingAccess:tos FU 200_q. - _(F.fst.NFA Venting)= (ac:.dM sn.Ft/3ap= (t Is:r;FA:'emfngl= INceded Venting? NFAvcnringl ExiStinE Ventirl ? NFAventine) RooiType: r r Proposal Terns Customer: Andrew Morgan Specialist: Cameron Pontes ! nc Site ID: 3968864 Date: 2 10 20 0 HomeWorls / / 2 o NOTICE CONCERNING SPONSORSHIP:Customer understands and acknowledges that HomeWorks Energy.is not an agent,vendor or sub-vendor-of the sponsoring Utility with respect to the installation of any energy efficiency measures.In the event of the failure of any energy conservation device to perform as expected,Customer agrees that Customer's sole recourse is to Contractor and not to Clear Result or to the Utility. The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed.Customer understands and acknowledges that its participation in the MassSave Home Energy Services Program is voluntary and that it has consented for Contractor to install the propose energy conservation measures.Customer agrees that it shall not hold Clear Result,the Utility,their affiliates or operating'companies liable for Contractor's failure to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage.to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures o ENERGY BENEFITS:The sponsoring Utility is entitled to 10D96 of the energy benefits associated with all Energy Conservation Measures,excluding the value of energy cost savings by the customer, but including all rights to all associated 150-NE Energy, Capacity-and Reserves Products.HomeWorks Energy agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and products. o CLEAN UP OF THE WORT(AREA:Weatherization projects can generate dust,some of which may contain traces.of_lead.The Contractoragrees to follow Lead-Safe Guidelines and to make reasonable efforts to control dust and other mess through the draping of cabinets and furniture with plastic, hanging plastic sheet walls,and cleaning.floors of dust and any paintspatter. However,the Contractor will not leave the interior white.glove clean. Outside work areas will be left broom clean and all debris and trash removed. The Homeowner should be.aware however that minor amounts of cellulose and wood chips—which are harmless and biodegradable—may be left on the ground. The Contractor agrees to be conscientious about picking up nails and other fasteners,but Homeowner should also be prepared for the occasional fastener that escapes contractor's notice. ® CUSTOMER INFORMATION ➢Storage Removal: o Perimeter of the Basement ❑Attic ❑Knee Wall ❑Crawl Space ❑ Interior Walls Notes: **If the storage is not removed,HomeWorks Energy will charge$0.53/square foot of storage to move It. D Wall Insulation:There is a chance your walls may crack due to the pressure that is required to achieve a dense pack.If your walls crack,We will hire a plasterer to plaster over the cracked area.You will be responsible for repainting. Please review and sign the wall disclosure form. 9 Insulation Removal:Insulation must be removed from the following locations: *!f it is not done,HomeWorks will charge$1.26/squar6 foot for the removal. ➢Parking Permits:If the energy specialist or operations manager determines that a parking permit is required for installation'and if you do not have. a pre-existing solution,we will procure one and add the cost to your invoice. ➢Bath Fan Venting:Installing a hose and flapper to an existing bath fan may increase noise levels due to proper venting procedures. ➢Exposed Pipes:If the energy specialist finds pipes that may be exposed to cold weather,leaving pipes outside-the thermal envelope may cause them to freeze. The auditor will recommend a solution to the best of their ability,however,HomeWorks Energy will not be held responsible for any damage caused due to frozen pipes. ➢ crawl emptied of storage and 3 foot clearance from the basement walls. o DEPOSIT: A$50.00 deposit may be required when signing this document.It is completely refundable until the weatherization work is scheduled.The remaining customer copay it is due in its entirety upon completion of the weatherization work. o DISPUTE RESOLUTION:The Contractor and the Homeowner hereby agree in advance that in the event the Contractor has a,dispute concerning this contract,the Contractor may submit the dispute to a private arbitration firm which has been approved by the.Secretary of the Executive Office.of Consumer Affairs and Business Regulation and the Consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws, Chapter 142A.The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not separately signed.by the parties. Customer Signature: Date: 2/10/2020 Andrew Morgan Auditor Signature- ,.r. � Date:. 2/10/2020 Ca ron Ponte -j` I Page 1 oC 1 0 n- PomeWorks mass save Energy, Inc PARTNER _ 9 l 101 Station Landing Ste 110,Med ord.MA 02155 (7E3)305-3319 ext.120 Customer Name:Andrew Morgan Email:shaunabeecher@yahoo.com Phone:774-368-9630 Premise Address:47 Bishops Terrace,Barnstable,MA 02601 Mailing Address:47 Bishops Terrace,Barnstable,MA 02601 Project ID:3982467 Date:Feb.10,2020 Job Description Measure Deserlptton Location Quantity Unit. Total?Cost v� CustomerYCbst AIR SEALING 1 hr $80.00 $0.00 f WEATHERSTRIP DOOR&ADD SWEEP 3 each $240.00 $0.00 GRAWLSPACE CEILING THERMAX 360 SF $1;458:00 $364.50 CRAWLSPACE: R-19 FG BATT 360 SF $738.00 $184.5C Project Total $2,5116.00 Weatherization incentive - ($1,647.00) Air sealing incentive ($320.00) Total Program Incentive $1,967.00 Customer Total $549.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the materiaj and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signatures �f' ' G% Date:, U Customer Phone: /1 Specialist Signatur : - � Date: ' \U UMITED 71ME OFFER: The prices and incentives in this contract are subject to changein accordance with the sponsoring utility MassSave Home_Services Program offers. Proposals can be sent to:.7nbox�n�HornelNorksEnergy.com Project Summary Name: Andrew Morgan HomeWorks Energy,Inc, o Phone: 508-292-4496 101 Station'Landing �j Email: shaunabeecher@yahoo.com Medford,Ma 02155 HOMC'UVOf Site 1D: 3968864 781-305-3319 MASS SAVE Cost Incentive Air Sealing $320.00 $320.00 Weatherization $2,186.00 $1,639.50 Duct Sealing $0.00 %00 Duct Insulation $0.00 $0.00 . MASS SAVE REBATES Incentive Preweatherization Barrier $0.00 IC Rated Lights $0.00 tDryer Vent $0.00 tAttic Floor Removal $0.00 *Rebates may only be applied as reimbursement of your cost to the Contractor for services rendered. SUMMARY Cost Incentive Mass Save $2,506.00 + Beyond Mass Save. $0.00 TOTAL PROJECT $2,506.00 $1,959.m Total Copay $546.50 Customer Deposit Applied $50,00 FINAL C®PAY (due on completion of work) $496.50 HomeWorks Energy, Inc. agrees to perform the above summarized work (Mass Save & Beyond Mass Save), furnishing the material and labor specified for the,contract price (Total Project). All work is subject to change,and homeowner's approval is required for completion of any and all work. Preferred Day of Weekfor.Insulation Install: Customer: , UP Date: 2/10/2020 Andr Morg Specialls . _� — Date: 2/10/1020 Cameron Pon camero ontes@homeworksenergy.com 774-888-8265 v.17 (' 0 Mpi HoMeWoftV, 4p Energy, Inc 0zorti Insulation Affidavit HomeWorks Energy has installed insulation at the following address that meets or exceeds Massachusetts building code and IIC.requirements. Project Address: Permit Number: Name Unknown 47 Bishops Terrace. 26 `V q Barnstable Massachusetts 02601 - Location Material Addt'l Thickness final Assembly R-value 6r W1 sPGC6 Glib 4it -eq ! VVPrK Sincerely, Scott Veggeberg y HomeWorks Energy Inc. CSL#103832 HERS Certification#3081658 HomeWorks Energy 101 Station Landing,.Suite 110 Medford,MA 02155 wxpermitting@homeworksenergy.com 781-205-4516 b Parcel Permit# Engi*eering Dept.(3rd floor) Map aZ a House#^-. ki 7 Date Issued Board of Health(3rd floor)(8:15:.9:30/1:00-4:30) ; .. # FeeIV • Conservation Office(4th floor){8:30-9:30/1:00'`2:00) 1 Planning Dept. (1st floor/School Admin. Bldg.) �, �'�;sYs v T BE Definitive Plan Approved by Planning Board 19 INSTALLED CE NI5' TOWN OYBARNSTAB. RONIw E AND TOWN REGU TINS } Buildin 'tApplication �- 9 Project Street Address Village 17a7 ' Owner Address "7 Telephone �7 r Permit Re uest D W 1yJ G osl. First Floor C square feet Second Floor square feet Construction Type Estimated Project Cost $ woli k Zoning District im- / Flood Plain Water Protection Lot Size ! Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Struc5re X 0. Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_ New Half: Existing New — No. of Bedrooms: Existing y New Total Room Count(not inclu ing baths): Existing New First Floor Room Count 7 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes l co Fireplaces: Existing New Existing wood/coal stove ❑Yes Garage: �`Atached(size) ched(size) Other Detached Structures: ❑Pool(size) C% YA ❑Barn(size) ❑None 015hed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No yes, ite plan review# Current Use J/1;a< 4 /`Gi` Proposed Use i� X - udder Information Name G Telephone Number �/0 'V,�� Address P ` ® License# (129�7 7 1 L0 iz Home Improvement Contractor# YuAnh Worker's Compensation# 0M 760 If NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXIS ING,AS L AS PROPOSED STRUCTURES ON THE LOT. If ALL CONSTRUCTION DEBRIS RESULT NG FR M I ROJECT WILL BE TAKEN TO (,�1'a'1 SIGNATURE - DATE BUILDING PERMIT DENIED FOR kEFOLLOWING REASON(S) ` FOR OFFICIAL USE ONLY , PERMIT NO. - •• `~-.`t + � -_ = ' . � .._ ' J - -- r -•, DATE ISSUED - _ - MAP/PARCEL NO. t j _♦ - i F 1` `•, - . ; - d - "' ' - �' f - . !' r - x � ^� • - n.+ � .0 - ` ti by VILLAGE ADDRESS _4 _ ".OWNER. ,. _ - -' • . ' •t 1 - I - � ".'. tip: DATE OF INSPECTION: FOUNDATION 9 FRAME INSULATION' FIREPLACE, ' AL - f ELECTRICAL:'t ROUGH FIN # ;.� + PLUMBING-" ROUGH-1 FINAL 'r ' GAS: FA co(awe FINAL rcoR a FINAL'BUILDING �p' I c �y,}� f DATE CLOSED OUT� �•o w,� J °'ASSOCIATION PL}Ali O. s , r „� .... 4.y. _._�, ...,,+,+�r: �+.:✓ "r, 't„ �Y.- ,K'kF'°.�.-`�Y.f L+�� .tea.! . _. -.;M ' .- .x-:u:�...4n..z:if��y`i.�- ,...,5.. Assessor's map and lot. number rA......................y Sewage Permit 'number ........................................................... Q T"ET°�° 1 TOWN OF BARNSTABLE �' Z H98HSTeD41 i ,. "6 9. ,.� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........:.........:::. �'.: ...... .. ...........�`-`. _� TYPE OF CONSTRUCTION ...............................[�(.....................................................�................................................ ...............;/ ..".2.?.......19�b TO THE INSPECTOR OF BUILDINGS: The undersigned hereby. applies for a permi66ccording to the-followin`g+-information: Location l..t,G� (N i ,�' ¢ Q-- ProposedUse ............ .......................:... ................................................................................................I......................... Zoning District ........................................................................Fire District .................................... Name of Owner + , .. `�*�+ ... . ............Address Z 2 1 ,z+�- , . �J. • i/ .........`w ......... ,........ _. jr Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .................... ......................................Foundation ................. ................................................... ! V Exterior ...... . t R ^ !mod*# ...Roofing Floors ..:?'?'. ..+. 'P Interior I �?nr- ..............!......._.... _....................................................... iHeating ..........................................Plumbing ............... . ................................................................ . Fireplace ................ /..............................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area (0............:......... Diagram of Lot and Building with Dimensions Fee ......f ' SUBJECT TO APPROVAL OF BOARD OF HEALTH l I hereby agree to conform to all the .Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... . A...... ............................................. Breen, Joseph A=250-97 13790 1 1/2 story, No ...........Permit for ..................................... sit�gle family dwelling .. .... ... . . 17 Q Z>J............. .......... ...... Location ........... s Drive.............. ..........................Hyannis.............. ... ........... Owner ........jq§Ap4..Brg ............. - .................. Type of Construction ..... . frame...................... . ........ . Plot ............................ Lot .........#2....................... Permit Granted ......lilvember...2..............19 76 Date of Inspection .................................19 ............:19 Date Completed ............��..........................19 I PERMIT 'REFUSED ........................................ ... ............. 19 ................................................................................ ................. ......... ................... .... . ................. ......... ......................... ..........Z/ ****-*-** * * ........................... .............I..................................... Approved ....................... ... .................. 19 ................................ ...........................................7 ................. ................................................ �a 71 Al 1 fccel e i (r y I SwF L'�•�!!' , ...;.. .---^. � .I ' ' , i _li _ - I • • r �- i I .. �. I � �t -"h •�'/�� • F .� I _ 'f i F i I I i I I , I I � • I i I I I i I I I I I j I I I i I 12 caM��cr rlu. -- a .01 I 1 y I PLAN f - ^� y . • . . , -�, c.- , ; � , - -�-----.__ -� o 1 _.._._... - . r —t-- .,_ I o _ �s, .� ,, N .. ,�, 'I � � �� ---t_.."'_.- - � —, of. �. �. � IUx._L�[�C.,.K (� .. __ i - ... - ; � ^ �•. � ,. __ _ � � .._ � �� i ; ° p 1 - �, ., ^�, � �_ - ^ � ; STEP. � _ - N": < _ __ ' .. - it - . ( �. k J � -- - � , . � ,. - . i , j l i i .............. i -' - TT ---may: I I i , -- i i! t�/1T7 C:E,1--------------- 77\R Sl.illt.G ES ii .... .-... . LEFT .EL.LVA-71 o N COMMONWEALTH OF MASSACHUSETTS -- DEUAK MENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET -ames.: Carn:nec BOSTON, MASSACHUSETTS 02111 ornrn:ssione• WO RS' COMPLNSAnoNr SURANCE AFFIDAVIT 01ccnscclperminec) With a p ' cipal place of business/resi nce at: (CarylsmtrlLip) ' do hereby ccrtify, under the pains and penalties of perjury,that: 9 1 am an cmplovcr providing the following workers compensation coverage for my cmplovccs working on this :ob. I✓C/ 2 c Insurance Company Policy Number ' a [) 1 am a sole proprieror and have no one working for me- [� I am a sole proprietor,general contractor or homeowner(eirde one) and have hired the contractors listed b-ow who have the following workers'compensation insurance polio Namc of Contactor Inst:rnee Company/Policy Numbe: N-amc of Contactor Insurance Company/Policy Numbe: flame of Contactor Insurance Company/Policy Numbc: am a homeowner performing all the work myself. NOTL Picise be aware that while homeowners who employ persoas to do maintenance,construction or repair work on dwc'ling of not more than three unit, in which the homeowner also resides or on the grounds appurtenant thereto are not gcner:h- eonsidcrcd to be erzployc.-s under the Worker:'Compensation Act(GL C 152.sect. 1(5)), application by a homeowner for a lice:sc or permit may evidence the legal sutus of an employer under the Worke 'Compensation Ilet 1 undc-stind that a copy of this iutement will be forwuded to the Deparzne::of Industrial Aeddena'Once of insurance for eoverae: vciacation and tha failure.to secure coverage u required undo Scction 25A of.MGL 152 can lead to the imposition of eiiminal pim _:s cor.sisong of a finc of up to S1500.00 and/or imprisonment of up to one yG and civil penalties in the form of a Stop Work Ordc:a.-: finc of S 100.00 a day:gains: mc: Sifncd this day of , 19 Lice:isccl' c or e } HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building, Regulations and Standards_! , One Ashburton Place - Room 1301 Boston , Massachusetts 02108 1 - ___ ____ _______ _ HOME IMPROVEMENT CONTRACTOR r Registration 100871 Expiration 06/24/98 i w. ��„�,�,u � �. �, Type - PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR Registration 100871 Type - PRIVATE CORPORATION MARKWOOD CORP Expiration 06/24/98 TIMOTHY M . PEARSON 110 BREED 'S HILL ROAD UNIT 10 j MARKNOOD CORP HYANNIS MA 02601 TIMOTHY M. PEARSON t-lf10 BREED'S HILL ROAD UNIT 10 ADMINISTRATOR HYANNIS MA 02601 - xzJ 5 , INOU-21-1997 09:40 FROM 5087780770 TO / 7906230 P.01 /I(C• '��G�K�/tpi�crwnY�� (�. �Ia�13p.Y2ccar3(/J DEPARTMENT Of PUBLIC SAFETY COKSTRUCTION SUPERVISOR LICENSE Number: Expires; TIROTMY PEARSON POBX $19 CENHWILLE, NA 02632 TOTAL P.01 r+. s , T°� Town of Barnstable *Permit *1HE ti EYpires 6 montl ron!issue date ](regulatory Services Fee ' rt snaxsTasr.E, ' r MASS. $ Thomas F. Geiler,Director �A 1639. rFD MA't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid-without Red X-Press Imprint Map/parcel Number Property Address �'T t)15 tl Q n O� Residential Value of Work a Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 0 y1 0 Temicc , i nirl i s t i Contractor's Name _ qsse_i Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) D F C — 1 Z009 ❑Workman's Compensation Insurance Check one: TOWN OF BARNSTABLE am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Nnna&L Workman's Comp:Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders. U-Valu �'r3 (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e..Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE:. J Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Fy/ rvwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): k'lm Address: d box ' _6 City/State/Zip: v Q )Phone #: 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 * � have hired the sub-contractors 6. ❑New construction ginployecs(full and/or part-time). 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. employees and have workers' 9 ❑ Building addition $insurance. [No workers 'comp. insurance comp. 10.❑ Electrical repairs or additions required.] 5. ❑ We'are a corporation and its 3.El I am a homeowner doing all work officers have exercised their I Lo 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 41 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. 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 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 sins andpenalties ofperjury that the information provided above is trite and correct Date: Signature -C-- Phone#: 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 S. 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, constriction 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 1 Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia P, - i a SHE T� Town of Barnstable i r Regulatory Services BARNSUBLE, Thomas F. Geiler,Director 0,39. �`0� Build.ing Division Tom Perry,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 Usine A Builder I, 0\V-S ck , as Owner of the subject property hereby authorize kn Ss erg' to act on my behalf, in all matters relative to work authorized by this building permit application for. 7 r�J)a 12, eNr Ce (Addre s of Job) Signature of Owner ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O W N ERP ERM IS S I ON L ra Town of Barnstable ofz�ram, ,� o Regulatory Services T + Thomas F.Geiler,Director BARNSTABLE, MASS. 9�A 039. a,� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790=6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that lidshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FOPMS\homeexempt.DOC ' Has :D.Cp trt.mcnt of Publt S i et�r _ Bo;trd of:Bu�ldin!. Rc��ul tt�o s tnd Siratu ards Carl tru,ction Su'pervis,orzsp-q ijty license g Lit ense C--S SL .99406 Restncted to RF WS,DM KIM BASSETT _ 3775 MAIN STREET CUMMAQUI,D, MA 02637 ' - Expiration: 12/12/2011 -'i ('ununissioncr Tr#: 99406 ^5� 4 r nvnwozurea a ./t�cuaa �u�aeaa - h?" a Ow, ra of Funding Regulations and Sla�ivards .,:j ;.: �'� Op Ltcenseot regtstraU,on.valid for mdtvidul tiro tn�yysr HOME 1MPROVEMENr CONTRACTO'2jefore t �ex tratt n`datc ,If found return tg`1 �+ , Registra n 159706 Board df Bitildmg licgulattons anti Standards Ex iration One-Ash4 p 5�19/2010 Tr# 268660, ., pr ott P�afe Rrn 1301 pe I tl viduaJj l �astan�Mat.b2j O' y . KIM MBASSET ,-, loi KIM BASSETTIN 3775 MA ST '; r ''' 2(�/ — - -r s--- CUMMAQUID,MA 02637 Administrator Is .;_ Not valid without signature t, Assessor's map and lot number ') �/—a0 �� PROF 7H E Tp�f Sewage Permit number ..,.:,......( .a .�.:.ff .. ........ ........ Z BJHB9TABLE, i House number ............................r. ................... .... .............._... r rAea Cb a pi639. \e0 K 0 MiY a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,CONSTRUCT BREEZEWAY AND GARAGE .TO EXISTING HOUSE ........................................................................................................ TYPE OF CONSTRUCTION .......CEMENT FLOOR, WOOD CONSTBUCTION,ASPHALT ROOF ......................................... ...................... ..............ARCH:..1:b................19g�... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: `� BISHOP, S TERRACE, HYANNIS, MA. 02601 Location ..........................................................................................................................................................:........................... ProposedUse .....�".HICLE STORAGE...................................................................... ...................................................... Zoning District ................Fire District f7Y4.A,1611. . Name of; Owner ...CARROLL & MARIA FONSECA Address 47 BISHOPp S TERRACE, HYANNIS,MA. .... ..................... .......................................................... Name of Builder .....OWNER..................................................Address ....SAME..................................................................... 0.WNEE .Address SAME Name of Architect ..............................................................,.. .......................................................................... Number of Rooms ..BAEEZATATAY AND GARAGE Foundation •,•.CEMENT SLAB . ................................................ Exterior WOOD Roofing ASPHALT ........................................................ ............................................................. Floors C ONC.RETE..........................................Interior ....FRAME.................................................................. ............................ Heating ........NONE................y.............................................Plumbing .........NONE................................................................ Fireplace ........N9 ...............................................................Approximate Cost 11".13.S6'0O.QQ........ .............. ; ' Definitive Plan Approved by Planning Board ________________________________19________. Area ......,. .. ................ ............. Diagram of Lot and Building with Dimensions Fee -® � SUBJECT TO APPROVAL OF BOARD OF HEALTH Ila BREEZEWAY GARAGE OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and` Regulations of the Town of Barnstable regarding the above construction. Name614 OuL �. f /• Construction Supervisor's License .................................... ' Mari 288 ' -27 d b No .....*—.. Perm-it for ..................... , � and garage to dwell�n� ^ —.------------.-----..'------. 47 Bishops Terrace Location -----------------.---- Hyannis ................................................ ......-------- . Carroll & Maria Fbnseca Owner -----------------..��--- ' frame � of Construction . -.._'-.------ --------------.-----------' ' ' Plot ............................ . Lot ..................... Permit Granted --.March- 27 . _—.lV 84 _- ----.�---. Dote�of Inspection —�----------'lA Dote Completed .......................�--- lg ; ` ' �� ^� � ` - [ . -- . '. . . . - ' ' ' r ' ` , . .. . . ' . . ^ ^ ' . . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a 5 i Parcel a O 6 Application Health Division INN , Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board V1. Historic - OKH _ Preservation/ Hyannis 1� FSdT Project Street Address L\ A0 rft>cC Village 4,A ti ik Owner 1�a,b s 0 n e ra i r a Address S a M, Y Telephone 7 H 3fl- S O B - Permit Request F}dd �-�� an a �`3 D k4e4 s 30 �1�e�;s�riss -h +ham C MIA 1soace, N'p l ne otg� bcvefrw - ! �I m. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )1 No If yes, site plan review# Current Use Proposed Use APPLICANT.INFORMATION _ (BUILDER OR HOMEOWNER) — 3 Name Lri, Telephone Number J(7398 0 3 9 a Address - j�h 11 fin a l'o n lq-✓t, License # G [ 0 �. 6 tAt n eve 1'` C)�� `� Home Improvement Contractor# k�l 330 Email Worker's Compensation # w e, n 6 51A0' -b 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Yartr.�w�� SIGNATURE DATE < < d b FOR OFFICIAL USE ONLY i APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER f' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING E i DATE CLOSED OUT ASSOCIATION PLAN NO. is 7�ThiFCvm nonwealthi�ofMassachusetts k , _�,. �P . • ; - ' I � j r, A ;u �:�^rip �t+3. , ,.. •., ; . - a Department of Industrial ccderits ` 1 Congress Street,Suite,100 .e�'� �, . tf s',�r-;, r't . . 'Boston,ltlA 02114-201.7s'ii?fl'r: Y`� • br .f:,` r +. -n V. n :i...tl:.aqr .1' _•�) : t'. 34",.. tit'• .�,J l:j' „:.1 j www inassgovldia NN%rkers'Compensation.IiWtii.ince"Affidavit:Builders/Contractors/Electticians/plumbers. TO BE FILED WITH THE TERMITTING AUTHORITY. Applicant Information - ' r Please Print Legibly l Name(Business/Organizaton/IndiVidual) Cage Save Inc. _ _ Address::7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664_. , ._,..4� Phone# 508-398-0398 , Are you an employer?Check the appropriate box: _ Type of project(required): _ ` - l.�✓ Tam a employer w# '`15;{ employees(full and/or part-time)° 7 New construction r ` `• . IL { L 1" rwzi 2,�I Mn a sole proprietor or parmdislji and have no employees.working for me m ,:t 9 r,` g,.M Remodeling any capacity.[ATo workers'comp insurance required.] a' �€t , +,.,'P ri ;1,• ti ', ,;�+ q i � q � ,. � ,#'.. s' 9: :�Demolition� 3:M'I am a homeowner doing all work myself 1No workers'comp insurance required:]t - - r .r!e 103E Building addition'. 4.O:Ian"homeowner and will be hiring contractors to conduct all work on:my property. I will-" ,• r " ensure that all contractors either have workers'compensationAnsurance.or are sole 11:0 Electrical repairs or additions proprietors with no employees." t 12.❑Plumbing repairs.or additions ' 5.❑I am a general contractor and lbave hired the sub-contractorslisted on the attached sheet.. 13.❑Roof epairs ' These:sub contractors have employees and have workers'comp,insurance:' + 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Insulation. 152,§1(4),and we haven ernployees.[No workers'comp.insurance required.] t 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information r ��'•z t Homeowners who submit this affidavit indicating they are doing all:work and then hire outside contractors mustsubmit a new affidavit indicating suck 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose:entities have employees. If the sub-contractors have employees;they must provide their workers'comp,policy number: t j I am an employer that compensation k is providing workers pensation insurance for my employees. Below is thepolcy and job site information. ._ ._ _ .., _ Insurance Company Name: - Star Insurance Co. - Policy#or Self-ms.Lic:# WC085540700 ~' — _'- '�` 3 •s Expiration Date:-P 4/9/2017' Job Site Address: 47 Bishops Terrace "City/State/Zp:Hyannis +' + Attach a copy of the workers'compensation policy declaration page owing the policy number;and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation:punishable by a fine upto$1,500.00 t 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:A copy.of this statemenumay be.forwarded to the Office of•Investigations of the DIA for insurance - -----, r ' coverage verification. u. i I do hereby-certify under th ::pains and aides of perjury tltatthe information provided above is true and.correct Si aturer Date: 10/16 Phone#:608-398-0398 Official use:only: Do not:write:in this area,' be completed by city or town ofjicia .a3 er;,.,-;' t,l C>ty'or Town:•-�°- �t..�t �_.�� ,:�;� „"i` ,.,rir:r •,� �._,.t w..._•_ Icense# 1 ' Permitl i 1 Issuing Autt[ortty(circle one)• -j•' �. 1.Board o,f Health.2.Building.Department.L3.City/Town Clerk 4.Electrical.Inspector 5.Plumbing Inspector w;i J 1.—.... 6.Other r. y Phone rson:Contact Pe j _, _. - -,. . . �r?.L.Mr. J. .•.,r• :s+ al ..r7 { . ',,p`' ;',,` i-i' C 0'./N • . . Via ,+ ,4c Rd CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) `....� 10/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .• IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER NAME[NTACT Colleen Crowley Risk Strategies Company PH�N , (781)986-4400 FAC No:(781)963-4420 15 Pacella Park Drive - ADDREs ;ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICS Randolph MA 02368 INSURER A:Liberty Mutual Insurance Co INSURED INsuRERB Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INsuRERc:Ohio Casualty/Peerless Insurance 24074 7 D Huntington Ave INsuRERD:Star Insurance Co INSURER E: South Yarmouth MA 02664. INSURERF: COVERAGES CERTIFICATE NUMBER:CL16101422377 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RERTED- A CLAIM"ADE X❑OCCUR PREMISES Ea occurrence $ 100,000 BLO1757246490 10/16/2016 10/16/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a ACT LOC PRODUCTS-COMPIOPAGG $ 2,060,000 OTHER: $ AUTOMOBILE LIABILITY , COMBINED (Ea eccident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCTODULED ANNA46796600 11/6/2016 11/6/2017 BODILY INJURY(Per aoddent) $ X HIREDAUTOS X AUTOSNON-OW�JED PR AUTOS OPTY DAMAGE $ A Per acddERent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE :,, , i, 1 AGGREGATE $ 2,000,000 DED I X I RETENTION 10 000 0S057246490 10/16/2016 10/16/2017 $ WORKERS COMPENSATION, Officers included for , e r X SEATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN Coverage E.L.EACH ACCIDENT $ 500,000 OFFICEPJMEMBER EXCLUDED? N❑NIA D (Mandatory In NH) 4 WC0855407 4/9/2016 4/9/2017,; E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,desonbe under DESCRIPTION OF OPERATIONS below r E.L.DISEASE-POLICY LIMIT $ 500,000 r DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Addidonal Remarks Schedule,maybe attached If more space Is required) Evidence of Insurance / Insulation Specialists , r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing-Assistance Corporation THE EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact ,. 460 Main Street AUTHORIZED REPRESENTATIVE Hyannis, NA 02061 Michael Christian/CLC '� - O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Off ce of Consumer Affairs and Business Regulation 1.0 Park Plaza Suite 5176 B`oston .Massachusetts 0211b_ Horne Improvement.G'tractor.Registration n. Registration 1'71380 < Type ` Corporation Expiration 3/14/2018 T.r# 419291 CAPE SAVE INC. . t3 WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE a� SOUTH_YARMQUTH MA 02664` } , r 0 4 `Update Addre h7 rd Mark reason for change. Add Tess Renewat (� Employment Lost Card. SCA 1 %- 2OM-05/11 CJIG' lQC7iIlL771d7)CIJClG�7L O��fl"GC!'1dCLClLLGi6� Office of ConsumerAffairs 8c Business Regulation License oc registration valid for mdivI.id- use only HOME'IMPROVEMENT CONTRACTOR before the expiration date f found;retur n_to I : Registration 1713gp. Type, office of Consumer Affa►rsand Business•Regulation r Expiration 3/14I2018 Corporation 10 Par -k Plaza Suite 5170' Boston,_1VIA 02116 CAPE SAVE INC. __. WILLIAM MCCLUSKEY 7-D HUNTINGTON SOUTH YARMOUTH MA'02669 lJn,.dersecretsry Not valid' i `signature ' Massachusetts Department of`Public Safety Construction Supervisor Specialty Restricted to: Board of iBuilolingl Regulations And Standards CSSL-IC-Insulation Contractor 411111t111C ili/it Ju11C/v 1�11�JIICl1Alt_�` E"t® x, License: CSSL 102TI6 WILLIAM J MCU�{ 37 NAUSET ROAD I West Yarmouth MA Failure to possess a current edition of the Massachusetts .1.�.: Expiration State Building Code is cause for revocation of this license. Commissioner 06128120.1.7 DIPS Licensing information visit: WWW.MASS.GOV/DPS HOLE OWNER WEATHERIZATION WORK PERMIT: is PLEASE COMPLETE AND SIGN THIS FORM AS I THE APPLICANT HOMEOWNER. I_ �s^ t�• `/-C'� r , hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: I i i I i. i The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping;air sealing; attic&basement insulation; exterior wall insulation;ventilation x measures In consideration of the weatherization worts to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization worts is completed. I have read the provisions of this agreement and give my consent. r� Home Owner(signature) /cd�s,*>11 t e er:��! Home Owner email: Date: Agent:(signature) Date: `" Weatherization Contractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Tupper Construction Cape Cod Insulation C Assessor's map and lat numbe '' �a � :o�0 . .. V { r ?; t Sewage Permit- number % .. . . t F Z r' •t Y t J�EBMB�seTaO DaL House number ............................... . 0 MAI TOWN V ARNSTABLE ' } BUILDING',.-INSPECTOR APPLICATION FOR PERMIT TO . CONSTRUCT BREEZEWAY AND GARAGE TO EXISTING HOUSE ................................:.......................:.. TYPE OF CONSTRUCTION .......CEMENT• FLOOR. WOOD CONSTRUCTION,ASPHALT ROOF • t , x MARCH 16, f 84 ............................. .........19........ JO,THE,INSPECTOR OF BUILDINGS: r The undersigned hereby. applies- for a permit'acc'ording•to the following' information: Location .47 BISHOP! S TERRACE j HYANNIS MA.. .02601: ' Proposed Use .....VEHICLE STORAGE ....................... .. ................. . ............. Zoning District .....KC .............. ................. .......Fire District ..... T./Y6..V...All S....................................... CARROLL & .MAMA FOiVSECA 47 BISHOP$ S TERRACE, HKANNIS,MA. Nameof Owner ......... .................Address; ..................................................... .............................. Name of Builder• .....OWNER........ ..............:.....Address ..SAME, ...................................... •Name of Architect ' OWNER ..........Address SAME -` Number of Rooms ..B.REEZAWAY .AND GARAGE: Foundation .., CEMENT SLAB WOOD ASPHALT Exterior ...Roofing ::..... . .......................................................................... Floors C'OI`CRETEInterior• FRAME :.................... ......T........................................................ . Heating ........NONE ......................:..............................................Plumbing ........NONE ......................................:..................... Fireplace ......:.NQNE........ .....................:. .Approximate. Cost ,.5000O........... L I Definitive Plan Approved by Planning Board -------------------_:_________19________. Area ....................... 'Diagram of Lot and Buildin with Dimensions g Fee ....:..:...... ..........cJ SUBJECT TO APPROVAL OF BOARD OF HEALTH , BREEZEWAY N` GARAGE o "x2 'L OCCUPANCY PERMITS REQUIRED FOR-NEW DWELLINGS I hereby agree to conform to Nh f Rules and Regulations of the Town of Barnstable regarding the above construction. 'Name ... ../... . Construction Supervisor's License ..............:.................... Fonseca, Carroll Maria 1 -_ ._ _ _ r� A 26214 add breezcw ir No ................. Permit for .............................. i ► 'i and garage' to dwelling i 1 c ......... ............................... .... y 47 Bishops Terr ce Location ................................................. .... Hyannis .................................................... ................ * Carroll & Maria'Fonseea Ownerr .............................................. ......... Type-,` f Construction. .......................me Plot ................ Lot .. .... s .f`. r * ' t t 7' March 2 ' •� 84' Permit Granted ............. .. 7 19 < Date of 1 p if`or 'ice.......... / 19 �� ►. si �,� . 41 Date..Completed ... L .........J9 4 Ali e / r z. �. 3/!y/1-7 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2/2/17 Town of Barnstable Thomas Perry CBO BUILDING DEPT Building Commissioner 200 Main St.Hyannis,MA 02601 FEB 07 Z017 RE: Building Permit#B-17-62 TOWN OF BARNSTABL TO: Building Inspector(s), This affidavit is to certify that all work completed for 47 Bishops Terrace, Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey x Town of Barnstable Regulatory Services �FSHE Tp� o Richard V. Scab,Director s�axszwst.�. •`• Building Division areas Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-403 8 Fax:. 508-790-6230 Approved: Fee: Permit#:HOME OCCUPATION REGISTRATION Date: Name: SO N �/ f<<,�Cl Phone#: 5-0 8 2- Address: 1 S h 5 k-1'l Village: A k) 10 1 S ^ Name of Business: k1M C— C .,,Q � f��rV t 'J 5 � Type of Business: C�M Map/Lot:_ �� C.U( INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the . activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual. alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve She production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment" • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up track not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: c��Se 7� C' �ri.z� / Date: Homeoc,doc Rev.0620/16 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$4-0 0for�4 years), A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You m st first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St.,.Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: L� I 1 Fill in please: APPLICANT'S YOUR NAME/S: .?,D �. � (�15 d S -lh BUSINESS YOUR HOME ADDRESS: P 2 TELEPHONE # Home Telephone Number E-MAIL: LIS �f 11�G1 S� -4Q A P¢':' :n•+l k;t.l tt" thd!VSj}.+41'•^+;,; �- NAME OF CORPORATION: NAME OF-NEW BUSINESS - A J P` > '� �� TYPE OF BUSINESS 15 THIS A HOME OCCUPATION? �- YES NO / ADDRESS OF BUSINESS. . -A' 15 ✓yL6r MAP/PARCEL NUMBER a�I D (� [Assessing)_ When starting a new business thePe are.several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20DJZaln St. cotr�ner of Yarmouth ' Rd. & Main Street)..to make sure you have the appropriate permits Bnd licenses required to legally p MUSY�oC01�u/IPLY 1N HhIH � OCC��ATION 1. BUILDING COMMISSIONER'S OFFICE RULESAND REGULATIONS. 'FAILURE TO This in has been i for of any per ,-'Bquiremerits that pertain toTthiit�ypeof business. COMPLY MAY RESULT IN FIN . Q uthoriz d Signet re* COMMENTS: G ` 1;,rZ--7 c 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature*.* COMMENTS: . . I