The URL can be used to link to this page

Home My WebLink About0038 BUMPUS ROAD , ll oFt l Town of Barnstable *Permit 43 , 0 Expires 6 the from ' ue date * Regulatory Services Fee t sAxxsrABLE, s Thomas F. Geiler,Director Building Division om Perry,CBO, Building Commissioner X-PRESS FERNY 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-A21403�80 I,011 Fax: 508-790-6230 TdV11N OPF LP FP�R�VIIT APPLICATION - RESIDENTLAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work ` &-z > Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresses S '7L� ,P ,� a U✓ n1- r� /�y �,�J j1 b Contractor's Name_ �`�tifF:�is'Z , Telephone Number, Qom--13 ,6 Y_ 7 -- Home Improvement Contractor License#(if applicable) / 6(r,2 9 Construction Supervisor's License#(if applicable) j D 75-3 ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner i ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each,permit. Permit Request(check box) . Re-roof(stripping old shingles) All construction debris will be taken to ��%►� s J G _. ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (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 uired. SIGNATURE: Q:IWPFILESTORWbuilding permit forms\EXPRESS.doC Revised-0701-10 ----------- _----__ .—_ ..------=--------- - ---__�=_Y_.. - --=---- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ �`' i'e{/�, -9AIW C L,_0 Address: .� wcU1 ) City/State/Zip: 0.v Phone #: — ?o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp:insurance comp.insurance.$ 9. Building addition required.] 5. ❑ We are a corporation and its 10.E Electrical repairs or additions 3.❑ 1 am a homeowner doingall work. officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL c. 152 12. Roof repairs insurance required.]t , §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 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 ce u r t e pains and penalties of perjury that the information provided above is true and correct Si ature: ! Dater p Phone M a lob 1 14�.� Official use only. Do not write in this area,to be completed by city or town official , City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r .n/ / •� s From: 06/22/2011 16:25 y543 P.002/002 UP IU: KAC A`O'RO CERTIFICATE OF LIABILITY INSURANCE F DAT06/asn2oonrrr) vll 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 INSURERS), 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 CONTACTr 978-998-6896 NAME: MasBPay Insurance Services,LLC 978.998.6847 PHONE FAX 27 Garden Street Unit 19 U_uc,11s,Eall: _..:.,_. _�c�o►: _ Beverly,MA 01915 E-MAIL Jason Maxwell ADDRESS: - --•'--.-_--- JCON4 PRODUCER L CUSTQgIEtt.ID r;._ . INSURER_ (S)AFFORdNO COVERAGE NAIL it INSURED L J Construction Company INSURERA:Western World Ins Company Jose Tomas Lema INSURER a:Assigned Risk Pool — 255 Winter Street - — ----. _ _-_.-- Hyannis,MA 02601 NsulTaRc: wsuRER o INSURER e INSURER►. 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 PAID CLAIMS. -- ---._...__. POLICY EFF P�LI�Y E1IP- . INSR TYPE OFfNSURANCE�� wVn UCYNUMBEA --YYIMID r----- _..._.-LIMITS GENERAL UA8IUTY EACH OCCURRENCE i 1,000,00 dA0f6REN-(EtJ— X X COMMERCIAL GENERAL UAeILITY 'NPP1297980 12/02H0 12/02H1 !pREM15 Ea ocourr n s 50,00 _._. CIAIMS4MOE X�OCCUR ; !MED EXP(Any one person) = 5.00 PERSONAL 11 ADV INJURY 3 1,010,00( GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APrPLIES PER. i PRODUCTS•COMPIOP AGO. f 2,000,00 X POLICY PRO- I LOC ' i `— { --'----- AUTOMOBILE UABXJTY l COMBINED SINGLE LIMIT (Ea aetlder0l) I= -_ ANY AUTO ! BODILY INJURY(Per person) S -_---- ALL OWNED AUTOS I BODILY INJURY(Par accident) S SCHEDULED AUTOS • PROPERTY DAMAGE I S HIRED AUTOS I i (Per accident) NON-OWNEDAUTOS f ! UMBRELLA LU18 I OCCUR I I FAGGREGATE RRENCE if EXCESS UAB CLAIMS MADE CEDUCTIBLE _...._..-RETENTION WORKERS COMPENSATION TU-AND EMPLOYERS'LIABILITY YINMITB ANY PROPRIETOR/PARTNER/EXECUTIVE WC002-25-3741 12102J10 12/02/11 CIDENT 100,0 OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NN) E.L.DISEASE-EA EMPLOYEES 100,00 H yyes,describe undo I ------------._._.— .----- - ---- 0 SCRIPTION OF OPERATIONS belay I E.L.DISEASE•POLICY LIMIT { 500,00 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANacU ACORD T01,Additional Remarfts Schedule,I more space Is required) Evidence of Insurance 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. AUTHORIZED REPRESENTATIVE 101988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD PDF created with DdfFactory Pro trial version www.odffactorv.com (272e o„vnzan�uea a o�✓�i'aaaac�ivaell2 Office of Consumer Affairs&Business Regulation !�� — HOME IMPROVEMENT CONTRACTOR Reg istrations;,-3168298 Type: . Expiration: xpiration 1131%2013 Individual i{ PA L FOWLER F 3 I PAUL FOWLERa 446 BAY LANE CENTERVILLE,MA 02fi32 A'-cb f -_� ;,. Undersecretary Massachusetts- Department of Public Safet% t Board of Building Regulations and Standards' �VJ Construction Supervisor License License: CS 50753 PAUL M FOWLER 446 BAY LANE ' CENTERVILLE, MA 02632 Expiration: 2/24/2013 ('rmmissioner Tr#: 10331 QRIV,ER'S 6:1 ' t�S =' �6529476b �,�T` , rX. PAUL`fad• 1 ,�� v ,, * �, +� r� 446 BA�4Mn.� r THE brti Town of Barnstable Regulatory Services snartsres[.L. : , MASS. g Thomas F. Geiler,Director o►ru►y" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA'02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 F Property Owner Must Complete and Sign This Section t If Using A Builder- as I, IF•1�1/v�Q.�� , as Owner of the subject property - , l P P rt9_ hereby authorize to act on mp behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. -Pools are not to be filled before fence is installed and pools are not to be . utilized u it all final inspections are performed and accepted. 3 Signature of Owner Signature of Applicant Print Name Print Name o Date Q:FORM&OWNERPERMISSIONPOOLS �1HE ri Town of Barnstable Regulatory Services RAnrtsTAer,E, : Thomas F.Geiler,Director y Hrnss. 1639. .m� Building Division rFD MA't A 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: !p� �0 JOB LOCATION: number street Vmm t1 village "HOMEOWNER": Ll.\y(D' ZVA- �42j, f name home phone# work phone# V V l CURRENT MAILING ADDRESS: V �uQ\\S lm r - C Co�1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling 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 undersign "hom4ad e/she understands the Town of Barnstable Building Department minimum insp cti pents and that he/she will comply with said procedures and requirements. Signature of HomeoMner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt THETo�°� TOWN OF BARNSTABLE EAMTULt i Mb 9 �e� BUILDING INSPECTOR am a' APPLICATION FOR PERMIT TO ........... ... . ... . ......�..... ... . . ................................................................ TYPEOF CONSTRUCTION .........I . ............... ................................................................................. . ........ ......................19.7.A TO THE INSPECTOR OF BUILDINGS: The undersigned hereby/alp�li�es f r a per it according to the following information: Location ...... .3.S..... "Y!!i.... . ..... ® .. .. ✓ .. ....................................................................... Proposed Use .......'....!!.. .. .... .................................... Zoning District .. ........ Fire District ......#- ............. ` ��..� �% . Name of Owner .. ... . .... . ..... Address lJ.... .::� ..:.... Name of Builder ......c? ` ... ....................Address ............ . ... ................0........................ Nameof Architect ...................;/�....................................Address .......................:.r''"................................................. Number of Rooms .............. �...!.........................Foundation ...... .: - -.. ..... ... . Exterior ...(,lV..l ... SQ.......................................Roofing ............ Floors ......... ...................................................Interior ..................: Heating ......... .................................................................Plumbing ........................y......................................................... 41,/S®v Fireplace L ..............................................................Approximate Cost ............................ Difinitive Plan Approved by Planning Board -------------------_-----------19________. 02 7� c� o Diagram of Lot and Building with Dimensions ••�� Li.[ °� s .z ^J W ` ^ M C� i-- LU Lij -� Lc. U I cj.. J\ O o Cp u� c �y� a ,\O O co Z t X n � Q < 00 } � ul v < < o Zoe 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . > ..Name .......... ....................:....................... Maudliapo-, F. � ^ ' .. � ��No -. — Permit for — �� ----. ' ---.—.—.--.—...—..._.-----..'-.--. ' ' Location ........ ............................. '` . ....................... A��.-----------.-. ' � C�wxn4�^--- —.:..��Rf��g��................ � ` Type of Construction .................Srage�............. ................ ........................................................... . / . / Plot ............................ Lot ................................ | | |Auust 9 72 Permit Granted ---.—..�.......-----.l9 ' | Dote of Inspection lg ' Date Completed .� ' � ( ` . . � PERMIT REFUSED ! � .----.~—..—...-------..-- lR � —'-------------'-----------'' � r —_------.---.--------------- . ' . ----'—^^—^—'—^^'-----'`~^'~—^'—'—'' —'---~^^—'~—~----`^^^~^^'`^'''^^^^^'—' Approved .............................................. lg =~� ^ � -------'~-----.—.--..,—.-----. � � --------.--.-------.,~....—.—... . / � ` . � �Q*THE T TOWN OF BARNSTABLE 6�Q y O•w• BARNSTABLE, i " BUILDING INSP! R �p 3q. CEOm `00 i6PY�`' APPLICATION FOR PERMIT TO .4 i! ;V S Q/U1� / /l�%SEiV/ ...... ............. ... .................................. .................... /? �'Ti �;No�vl� �tv�L TYPEOF CONSTRUCTION ...............................1...}...... ................................................................................... ........Aw.... 9.................,92 TO THE INSPECTOR OF BUILDINGS: The -undersigned hereby applies for a permit according to the following information: 3 �v�naysv�� .r Location .............................................. ........................................................................................................................................ i�� Proposed Use .........L... .................................................................................................................................................... ZoningDistrict ..........................�...,..........................................,......Fire District ............................................................/................... Name of Owner U �!/.!T!.'1 �'l��I��SO�f! Address s u,)A`Da.��../��1��Y�cj .... .............. .. .......... .. .. ....../................ q.. ...... Name of Builder ..............................Address ...,/ )j! /........G// 5. 5`.................................... ........................ .. Nameof Architect ..................................................................Address .................................................................................... Numberof�dRooms ............... .... ...........................................Foundation &-.vka� :.......................................n........................ Exterior ...W9�'%.......................................................................Roofing �0).kr..l, h J $1 1!1��5,��. ... .�? .�P�.n��...... Floors ..... a/...........................................................Interior .....z .v.. `/(•........................................ Heating 4o;rE.R ............Plumbing �f� GlTW os ............................................................ .... ..... . .... ...... . ......................... dY Fireplace JFa.........................................................................Approximate Cost �f�• ........................................................... . .. Difinitive Plan Approved by Planning Board -----------_------_-----------19 . -O Diagram of Lot and Building with DimensionsC _j)(?0TbV-, A,)'DtT10AJ SHOWN IN 0 > CV < :1; L 0 Ll, �' s' Lr� Lo a 0 riL � < O , �& ffi-T-1 A Ltd -1 E (9 --� UZr' I: —I — <� w � �1 n H ® _v < z to < /-V SCE��e I hereby agree to conform to all the Rules and Regulations of the To , n of Barnstable regarding the above construction. Name .................................................................................. Maddison�', Arthur 8, Kathleen � - -- lCa'�� - ^=« «��- No _ ... permit for .....add..to..2rud__.. ' ---. ------------------'----' * �� dv�p OR �ro^_ _ Location .......q8. ..Iouad_________ � . ...................... ......................................... /\ [ ` � Owner '& ......... . ! � Type of Construction .............fr=H.----- ' —.---...—.-------------.----- ' Plot ............................ Lot ----------.. � ` Permit Granted -- .24---]g 7� ��-----' -' v ' Date of Inspection ............ — .....lQ } ` � . � Dote Como��a6 --��/��..��----lA �Completed �r � / / � � . PERMIT REFUSED / \ i --^^—'^--.--..----.--.-- lV ( � .---.-----.—,..—.—..--~.---..--.. ^---'~'—`^'^^-'--''--^^^--'--'---`—~' } ' � | —.---...--.-----......--..—.—...—.. ' > —.—.—.----..---,.--..~.,—....---.. . Approved .................................................. 19 / -------.--.----....--... —.. . ' ^ ' . . —,— ' ----.----.---..-----.---....--.. . ` . � ^