HomeMy WebLinkAbout0348 BISHOPS TERRACE
Town of Barnstable *Permit# � Co�
Expires 6 months from issue date
r 'LC1
�- Regulatory Services Fee ''77
1 Thomas F.Geiler,Director
° Building Division
Tom Perry,CBO, Building Commissioner
�� 9y 200 Main Street,Hyannis,MA 02601
0 www:town.barnstable.ma.us
Office: 508-8 �3860� / Fax: 508-790-6230
+f S P I IT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number ;
ZT
Property Address 3tl� TJAACL,t KLAA� �'l r9-
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*Residential Value of Work Q(5 0 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
3y Q,� ,4 - N
Contractor's Name F-A!vim Telephone Number .5Q S--
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) C �D o
Oworkman's Compensation Insurance
Checl one:
❑ I am a sole proprietor
❑ I am the Homeowner
0,I have Worker's Compensation Insurance
Insurance Company Name T g(11 ))
Workman's Comp.Policy# _ LL 2 — o 3 Li l rn ,5
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
3-Re-roof(stripping old shingles) All construction debris will betaken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*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 is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306 —
F
r -
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
i
600 Washington Street
Boston, MA 02111
Y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �/1 0 �iti L LC,
Address:
City/State/Zip: j` .t,� 'V�A- 0oQ 3s Phone #: 56 9 — s Qa
Are you an employer?Check the appropriate box: Type of project(required):
I ZJ am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ 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.] f c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
xContractors that check this box must attached an additional sheet showing the name of the 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. #:- �, a — 0 3 57,5 6 — 0 � Expiration Date:
Job Site Address: 7 D (/A&)P' � T-A, 1 at t_ City/State/Zip: (T
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 certi he nd pe lties of perjury that the information provided above is true and correct
Si ature: Date:
Phone#: �5a Yoe
Official use only. Ito 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#:
hightFax N3-2 10/1/2008 1 :56: 31 PM PAGE 2/002 Fax Server
........................
.::...........
X. • ISSUE DATE
� •::•: 10/01/08
i
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW.
WISE&QUINN INSURANCE AGENCY COMPANIES AFFORDING COVERAGE
449 PLEASANT ST
BROCKTON MA 02301 COMPANY A HARTFORD UNDERWRITERS INSURANCE CO
LETTER
INSURED CoaiPANY B
FRASER CONSTRUCTION LLC LMER
PO BOX 1845 COMPANY C
LETTER
COTUIT MA 02635 COMPANY D
LETTER
cow
E
Lary ER
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,TERJvi OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIPICATE 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
CO TYPE OF INSURANCE POLICY NU11•IBER POIdCY POLICY LIMITS
LTR EFFECTIVE DATE EXPIRATION DATE
OAMD/YY) MM/DD/YY
GENERALLIAHIIITY GEMtxet AGGREGATE $
❑COMMERCIAL GENET AL LIABMITY PRODUCTS-COMP/OP AGG• $
❑ CLAIMS MADE ❑ OCCUR PERSONAL&ADV.RIMY $
❑OWNER'S&CONTRACTOR'S PROT. EACHOCCURRENCE $
❑ FIRE DAMAGE(Any Ow Fire) $
IDED.EXPENSE(Any oneperson $
AUTOMOBILE I LABII IT Y COMBINED SINGLE LIMIT $
❑ ANY AUTO
❑ ALL OW m AUTOS BODILY INJURY $
- (PerPason}
❑ SCHEDULED AUTOS
❑ MRFDAUTOS BODILYINMtY $
(Pv Accident)
❑ NON-OWNED AUTOS
❑ GARAGELIABIISfY PROPERTY DAMAGE $
❑
EXCESS LIABILITY
❑ UMBRELLAFORM EACHOCCURRENCE $
❑ OTHER THAN UMBRELLA FORivI AGGREGATE $
STATUTORY IIN13TS X
A WORKER'S COT•IPENSATION EACH ACCIDENT $500,000
AND UB- 09/26/08 09/26/09 DISEASE POLICY MDT $500,000
0341M556-08
EMPLOYER'S LIABILITY DISEASE-EACHEMFLOYEE $500,000
OTHER THE
PROPRI E7MR/PARTNERSADMCUTI VE .
OFFICERS ARE INCLUDED.
i
IDESCRIPnON OF OPERATIOmaA)CATIOM%WMCIW/SpBCIAL yMLS
THE BVSi1RFD'S&W WORKERS COA114ENSA770N POLICY Alm ITSLRIQI'ED OTHER STATES INSLIR ANCE ENDORSH1IEdY1'A[IfHORIZES THE PAYBRtl7C OF BENEFITS FOR LARI 6L1DE BY TUEINSURED'S 11L1 E 6EPWYEES IN STATES OTHER THAN BW.NO AUTHORIZATION IS GIVEN TO PAY CLAIAIS FOR BENEFITS IN ANY STATE OTHER THAN BLA C IF THE
IS
INSURED HBTPS.OR HAS BMW.FRB; PEES OUTSIDE OF B W.THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY SrAT E O•IHER THAN 11 W.
THIS REPLACFS ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COURT COVERAGE
.:•. ... .... .... �,h:�-fib:':-';::•":•.::}:2: c} ::•.:{{:�:�:{{::{:{::i. :}::; ::{}:::;{::::{:;::: �::
TOWN OF BARNSTABY.E •..........•.•....•.....••. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ME
PO BOX 40 E iPIRATION DATE THEREOF,THE ISSUING COnD'ANY WR L ENDEAVOR TO DWII,
HYANNIS NIA 02601 to DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAt1B3D TO THE LEFT,
BUTFAHAMET05LAMSUCHNOTICESHALL BUIOMNOOBLIGATIONOR
LIABILTI'Y OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES -
alriHoa>�p B>�RBSmvrATrvs
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Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration; 112536 Board of Building Regulations and Standards
E1p1ration' 3-123/2011 Tr# 281021 One Ashburton Place Rm 1301
Type: DBA Boston,Ma.02108
FRASER CONSTRUCTION.C.O. ,
DEAN FRASER
104 TWINN VIEW LANE
E FALMOUTH,MA 02536 Administrator Not re
I
I
tile 40
Boar o uil in e ula g g ons an tan�rs�
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 112536
Type: DBA
Expiration: 3/23/2011 Tr# 281021
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
COTUIT, MA 02635
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
CA1 is 40M-OB/08-DBSLIFORMCA108212008
L
1
C
R-28-2009 08:12 From:HOUSE D 5087906437 To:95084280123 P.1/2
Fraser Construction3 ,LLC
CONSTRUCTION p,o..Box 1845, Cc>tui:t M.A. 02635
• Cmail; fir�ticr consq!!u On uwcri ol7.nct
www.fr, err10.1 .com IiAX. 1-50K-421�-i1123
508-428-2292 H1CL#112536 C'5197668
RE-ROOFING PROPOSAL
DATE: April 270 2009
PHONE: 508-$62-8259
NAME: Lance Kun>tzrnan
EMAIL ADDRESS: lkuntzman@gmail.com
JOB ADDRESS: 348 Bishops Terrace Hyannis, MA 02601
FRASER CONSTRUCTION hereby proposes to perform. the following services in a.neat
c►n.d professional lilts manner and in. accordance with the man.ufacturcl-'s
specifications and local building code.
-Remove. and Haul*away all of the old, roofing material
-Re-nail all plywood sheathing as needed,
Su 1F and Inatall - CERTAINTEED LANDMARK /WOODSCAPF AR 'i
Warranty, S year Sure Start Protection, CLASS A FIRE 'RATED, a'�ll.00 30: 30 - Year
Resistant,
elling, Multi - Layered, Architectural Style, fiberglass
Extra. Heavy Weight, Self S
Based. Asphalt Shingle with New England's Exclusive COPPER/QCERAPMICw Stones
a Full 10 Year Wa ai m nes with
rranty against ALGAE Contain en Y
rc��;ictt�a 0 Warranty with six nails in common bond area, Fraser construction
includes six nails in common bond area at NO additional cost. See. aCtua,l warranty
for specific details and li.mita,tions.
Color: Colonial Slate (suggested) PRICE- $6,250 Initial
Price includes Ice & Water on entire porch area
Sup ly 8a Install - CertainTeed Winter - Guard: (ice &water shield)
Waterproof Underlayment System. (311, on eves and
valleys, 18" on rakes, Walls, and skylights)
1 & Install -- Roofer's Select 1lnderlayment Paper (as recommended
Stt
g by Cermin'feed)
Sup AV & I nstall -Hick's Ventilated Drip Edge or 811 Aluminum Drip Edge
Supply & Install - Aluminum & Neoprene Soil Pipe Flashing
gR"11& Install-Air Vent Ridge Vent (as recommended by Certaij-ijGeed)
Clean & Remove - Debris from work area daily.
p 5087906437 To:95oe4280123 P.i__1'e
*4 Stair Warranty Upgrade will he applied if proposal ie signed tied
returned within 10 days'. (see ellel"ed brochure)
2% Discount if paid by check immediately upon completion
NO MONEY DOWN - NO 1'aymen.t at the start or part way thru
payments accepted are:
CASH - CRECK- MASTERCARD VISA -AMERICAN EXPRESS
Any payment;not Made within 30 days of completion will he charged 1,5'% far every 30 days tile
Ianymi:nl:is late.
will
one
Possible Extra-After the shingles are removed from the. s othewl wood sheathing
of
g
plywrood to make sure that the in.sulat:ion is not up age ventilRtion panels will be
preventing ventilation from the eaves to the ridge. I.f it is, turning the
installed by; rem.oving the. plywood sheathing, installing the p;:.is w ul ,
over and then re-ii1sl'alling the plywood, if:needed, this would 'be charged for
plywoodpanel p including Materials & Labor. There Eire 6
as an extra at the. rate. of 600 per
panels per sheet of plywood.
plywood sheathing,
Possib le Extra-Any rotted or otherwise deteriorated trim boards,
d flashing, or. other, carpenl'ry needing replacement k�l bma.te►-e°�d.ls d chargccl for as
lea g lus 15/� m p
an. extra. at the rate of$60,00 per hour, p
FRASER CONSTRUCTION Warranties the labor for 12 yeaxs
]ZpSER CONSTRUCTION Warratl ties the shingles against
F Blow-Offs for 10 years.
CERTAINTEED Warranties the shingles and labor. 100% through the. Sure Start
Warranty duration.
TAINTEED Warranties the shingles to be ALGAE resistant
ed the duration of theCER
Sure Start Warranty depending on the shingle that w� p
Any deviati
on or alteration frorrj above specification will be estimate Upon
writte"I
greements
orders and will. becom a
e n extra. charge over and above the
ent upon, strikes, accidents or delays are bey on the above work. We, f not
our control. owner should
contingent P
carry'fire, tornado and other.necessary insurance UP
os�
accepted within thirty days may withdraw this prop
s Compensation and
FRA
SER CONSTRUCTION, LLC: Carries Workman'available upon request Public
Liability Insurance on the above work, certificate
DATE OF ACCEPTANCE:
i
Fraser Comet on, LLC
'Homeowner .t .
n
'y
�s
J75EP D...DALUZ TELEPHONE: 775.1 120
&dd�ng Comminioner
EXT. 107
6r
TOWN OF BARNSTABLE
BUILDING INSPECTOR
TOWN OFFICE BUILDING
HYANNIS. MASS. 02601
November 6, 1981
Mr. Charles Corey
_,Corey Roofing -- ----�
348 Bishops Terrace !
Hyannis;., MA. ' 02601 -
Dear Mr. Corey:
This office has received complaints that you are operating and advertising
a roofing business from your home. For your information, your dwelling is
located in a-residential zone and a business use is not permitted. The
complaint eludes to three trucks parked in the streets.
Since it appears that you are operating a roofing.business from 348 Bishops
Terrace (telephone directory yellow pages/page, 250) I must advise you that
you are in violation of zoning-and -this practice must cease. I shall expect
to hear from you within ten (10) days of receipt of- this letter as to what
steps you propose to use to correct this very serious violation. Failure
to comply could be very serious with -the end result a session in Court and
I trust that step will not be necessary.
Peace,
Joseph D. DaLuz
Building Commissioner
JDD/gr
cc: Town Counsel
Board of Appeals
Certified Mail #358 287 413
R.R.R. D
ran ®SENDER: Complete items 1,2,and 3. •~ M.
�+ Add your address in the"RETURN TO"space on
0
� reverse.
_m 1. The following service is requested(check one.)
❑ Show to whom and date delivered............—ot
❑ Show to whom,date and address of delivery...—a
m ❑ RESTRICTED DELIVERY
o Show to whom and date delivered............_¢
❑ RESTRICTED DELIVERY.
Show to whom,date,and address of delivery.$_
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
m Mr. Charles Corey
C 348 Bishops .Terrace
z Hyannis, MA 02601
M
3. ARTICLE DESCRIPTION:
M
�^ REGISTERED NO. I CERTIFIED NO. INSURED NO.
.74
358 28741
m
(Always obtain signature of addressee or agent)
rn
"4 I have received the article described above.
m
M SIGN RE OAddressee (]Authorized agent
rn
c I4f NN I .
1, 4 DA E O E ERY P TMARK" ,�
m n`
Z 5. ADDRESS(Complete only if requeste 13
m
n X919181148]
6. UNABLE TO DELIVER BECAUSE: *GP
UNITED STATES POSTAL SERVICE
1 OFFICIAL BUSINESS
PENALTY FOR PRIVATE
SENDER INSTRUCTIONS USE TO AVOID PAYMENT
C Print your name,address,and ZIP Code In the space below. OF POSTAGE,s300
1 - U.L':MAIL
• Complete items 1,2,and 3 on the reverse.
i • Attach to front of article if space permits,
i
otherwise affix t5,back of article.
f • Endorse article"Return Receipt Requested"
adjacent to number.
RETURN
TO .
Mr. Joseph DaLuz, Building Commissioner
Town of BarnsNafef Sender)
367 Main Street {
(Street or P.O.Box)
�I
Hyannis, MA 02601 n
(City,State,and ZIP Code)
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map o7SCn Parcel Permit#
Health Division Date Issued /4 O 2
Conservation Division � Application Fee
Tax Collector �2— /O ARk L Permit Fee�3 D
Treasurer �G/2_ /OF316-yof
o %�
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address _3 "Aa s :2 / 4z&e
Village �y4 014 � S
Owner t1� tnHt ✓1�_S Address 1ShDo l�ej2f?GC�P
Telephone
Permit Request / F12v���st�,� 1� �S X
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation f066c. 60 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 0/ Two Family ❑ Multi-Family(#units)
Age of Existing Structure S� Historic House: ❑Yes 9 No On Old King's Highway: ❑Yes ®'Iqo
!4
Basement Type: Gull ❑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 x
v`:
Total Room Count(not including baths): existing new First Floor Room Cunt
Heat Type and Fuel: dGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes YNo Fireplaces: Existing l New Existing wood/coal stove: ❑Yes ❑No
Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing Cl 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 _
BUILDER INFORMATION
Name U h v\ n vt t �?icd� Telephone Number 7 c/
Address 91ShpS � yaae' License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
1
FOR OFFICIAL USE ONLY
w
.4. t
PERMIT NO.
r . � -
DATE ISSUED t=
MAP/PARCEL NO.
ADDRESS ` _ VILLAGE i
OWNER /r r
DATE OF INSPECTION:
r
FOUNDATION
FRAME
INSULATION '
FIREPLACE
ELECTRICAL: ROUGH FINAL'-
- { -
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING '.
DATE CLOiSED OUT
ASSOCIATION PLAN NO.
i .
F
Th'e Coynmonwealth of Massachusetts
-+ _- ,Department of Industrial Accidents
- Office ofINY95 20,7s.. -
600 Washington Street
Boston,Mass. 02111
`j Workers' Com ensation Insurance Affidavit /
Y1tot
.
location: -
•
V.IgamL
homeowner performing all work myself
❑ I am a sole propnetor and have no one workin in ca achy
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FaIIure to secure coverage as required ender Section 25A of MGL 16 cahiead to the imposition of crlmuss,penames of a fine up to$1,500.00 and/or
one yearn'imprisonment as re as ecl penalties in the form of a STOY wORK ORDIgR and a fine of$100.00 a dap against me. I u nders4�md that a'
ge verification.
copy of oils statementmay be forwarded to the Office of Investigations of the DIA for covera {� :-
Y he, -and-penalties-of-perjury-that-the-information-pr•osidedxh' easlu� ciid correct
I do hereby certzfyu ' / -
Date
Signature �� ^��,�;• T .,. .�. , •• .:Phone# '
Print name � '� � -
official us a only do not write in this area to b e completed by city or town ofEcial
"permit7license# [jBudlding Department
dty or town: ❑Licensing Board
❑selecfinen,s Office
phone n;
contact person: r
f..via{19J95 P1P.1 � �•
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
d from the `law", an employee is.defined as every person in the service of another under any aorztract
employees. As quote
of hire,'express or implied, oral or written.
artaers , association, corporation or other legal entity, or any two or more of
An employer is defined as an individual, hip
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 xesides 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
' urtenant thereto shall not because of such employment be deemed to be an employer.
appu
rtenant
MGL chapter'152 section 25 also states that every state or local licensing agency shall withhold
for iauahnce br"fine"w"' al
licant who has
of a license or permit.to operate a business or to construct buildings to the commonwealth y pp
not produced acceptable evidence of compliance with the insurance,coverage required. Additionally,neither the'
commonwealth*nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box�t applieses to y�our y be
1pplyfg company names,address and phone numbers along with a certificate of _ _.
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 i
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law'o iif yQu
-� lease calltlie Depaituierit at the number listed below:.'
are requited.to obtain.a workers' compensaticax policy,p
City or.Towns 4
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofrle
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P1e�se�
ei which will be used as a tefeieiLce numli'er. The affidavits maybe reui? tE?•.
in e. ermrtlhcense pupa
the Department,LL3�44 a of FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have,any questions, .
please do not hesitate to give us a call.
11 MA:
The Department's address,telephone and fax number.
The'Commonwealth Of Massachusetts
Department of Industrial Accidents
ghee of investigations -
600 Washington Street , '=
Boston,Ma. 02111
fax#: (617) 727-7749
: phone#: (617) 727-4960 eat. 406, 409 or 375
°*IHE� Town of Barnstable
Regulatory Services
saxxsz'AsLE. ' Thomas F.Geiler,Director
�' A`�� Building Division
TED MP'�
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions, along with other
requirements. .�
Type of Work: / �.�Yl1�,t�S �y/2/ � x z Estimated Cost �L7��
Address of Work: :3�
Owner's Name: j C�i,�1 � ✓1 -
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
nWork excluded by law
[]Job Under$1,000
[]B lding not owner-occupied
boner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
Date Own s Name
Q:forms:homeaffidav
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street (� �r� village
"HOMEOWNER':�C��n e on 1 V) J�8` ���� )z—1 7 1 SVC)
name G I home phone# work phone#
CURRENT MAILING ADDRESS: ��t� � S �y 0 S I'e)eP,a-t-`e
����IdtiS 1M+44 d�� f
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
proced eG✓"'�d requi�ents
Si re of Home er
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." I
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 personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible,
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit
application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.
O:FORMS:EXEMPTN
i
FITZPATR:ICK HOME BUILDING CO. INC.
LICENSE#045416 FULLY INSURED
P.O.Box 154 FORESTDALE MA.02644
(508)SM-3075
Proposal
PROPOSAL SUBMITTED TO: PHONE:
DATE:
John and Ronna Jennies 508-778-5129 10/3/02
STREET: JOB NAME:
348 Bishops Terrace
CITY,STATE,AND ZIP CODE: JOB LOCATION:
Hyannis,MA 348 Bishops Terrace H annis,MA
Add 8'x 25'Farmers Porch To Front Of Existing Home
10"Sona Tubes Filled with Concrete 4'Below Grade
Pressure Treated 2x8 Frame
1x4 Mahogany Decking
4x4 Posts Cased with#2 Pine
1 1/2"Square P.T.Ballusters
2x4 P.T.Rails
2x6 Ceiling Joists
2x8 Rafters
Facia and Soffit will be#2 Pine
1/2"CDX Plywood Roof Sheathing
3 Tab Roof Shingles to Match Existing as Close as Possible(Home Owner Must Pick Out Shingles)
NOTE:Owner Will Get Building Permit
NOTE:Ceiling is Not Included
NOTE:Painting is Not Included
NOTE:All Clean Up and Debris Removal Will Be Done By Owners
WE PROPOSE hereby to firmish labor complete in accordance with above specifications,for the sum of:
Six Thousand Three Hundred and Fifty Dollars dollars(S$6,350.00
Payment to be made as follows:
$2117.00 Down-$2117.00 after Frame is Complete and$2116.00 Upon Completion
All material is guaranteed to be as specified All work to be completed in
a substantial workmanlike manner according to specifications submitted,
Per standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders,and will Authorized
become an extra charge over and above the estimate. Signature
ACCEPTANCE OF PROPOSAL
The above prices,specifications and conditions are satisfactory and are hereby
accepted You are authorized to do the work as specified. Payment will be
made as outlined above. .
Signature �.
Date of Acceptance p a 00 a Signature
h
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[L®CAlk-ro DF PR®PEM ED � V N® T BE ^CCQJ E STANDARD LEGEND
— \� NOTE:not all symbols will appear on a map
71 . 2 GOLF COURSE FAIRWAY
r EDGE OF DECIDUOUS TREES
^ �^ EDGE OF BRUSH
ORCHARD OR NURSERY
... / V—v—v--V EDGE OF CONIFEROUS TREES
/ MARSH AREA
MAP 251 _
\ EDGE OF WATER
162 7 2 ❑ 6 —= DIRT ROAD
/ \ DRIVEWAY
PARKING LOT
# 336 PAVED ROAD
DRAINAGE DITCH
————— PATH/TRAIL
PARCEL LINE
**
r teAPno E-- —MAP#
21 PARCEL NUMBER
#INO E---HOUSE NUMBER
2 FOOT CONTOUR LINE
-- - 10 FOOT CONTOUR LINE
Elevation based on NGVD29
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4.9 SPOT ELEVATION
/ \ 71
1 r c STONEWALL
—XX— FENCE
p
RETAINING WALL
... RAIL ROAD TRACK
czzz:: � STONE 1111Y
MA Q
❑ �o� SWIMMING POOL
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# 348 / U 0 BUILDING/STRUMRE
DOCK/PIER
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-T O W N O F B A R N S T A B L E e E 0 e R A P N I C I N F O R M A T I O N S Y S T E M S U N I T v SIGN ® STORM DRAIN
■ PRIMED SCU.IN FEET *NOTE Tbis map is on enlargement of a **NOTE-The parcel lines are only graphic representations DATA SOURCES:Nanimehim(man-made feftes)were irterpreted from 199S aerial photogmphs by The James
v------ - 1°=I00'sale am and m NOT meet of n TOWER
w c P W property boundaries.they are not hue loaharq and W.SewaN Company.Topogaphy and vegetaRon were interpreted from 1989 aerial phofigmpiw by 6EOD � tf HLfiY FOIE
0 r 20 40 Notional Map AowmcV Standards at Hh do not represent adual relatimsh lis to 00ml obleds Coryoallon.PlanIww%�gaphy,and wwata ion were mapped to meet National Map kwmcv standards
s 11 01=,D 00* enlarged sale 11 on the map. of o sale of 1°=100'.Poral lines ware dpiiaed from FT2002 Town of Bamstable Auatmfs tax maps. LIGHT POLE O ELEI TRIC BOX
F:\dgn\conservation.dgn 09/16/0210:14:47 AM