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HomeMy WebLinkAbout0085 CAMP STREET p5l=flmp -S� ACTIVE ', I Town of Barnstable ��pTHE Toyyo Regulatory Servicesi P Thomas F.Geiler,Director t • ' sa+. _ -� Building Division �'°lefl Mpg a` Tom Perry Building Commissioner - 200 Main Street, Hyannis,MA 02601 Office:..508-862-403 8' _ Tax: 508-790-6230 COMPLAINVINOUIRY REPORT �+ Date: Rec'd by: a: •. .�;�°� `� . : -eo ; - �_ - f ,F Complaint Name: = Map/ParceL „ Location, -� Address: �y Originator Name: �(„� i,� C a Street: Village: -( a hnyj State: Zip: 2 e • Telephone: ComplaintDescription: cjsfi 2� � ,� _� �,, ;e ��, 0 �„�,,� . - CIA,4,1 4' c FOR OFFICE USE ONLY. .Inspector's Action/Comments Date: Inspector: v Additional Info.Attached 6� 't d �v n �`^ r � M ,�'*,► a. s � "�++^ .Ri �'.+'4. ,meµ 0 r Mt - �yt. et.`- - lilt n • _ P _� r, {, k IF 1;;; � .rt_ 1 as "m�.• , ( i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ,)"e Parcel 1 Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village�, 7a S Owner 1,Lir i� 4� /I Address �5 (a M/" S)-- ham, Telephone l70�S q 570 0550 Permit Request Fm&elig, e-r7JICe f`r�dp— If,,/ 6fn14-eed llkm2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation, 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 SNo On Old King's Highway: ❑Yes al _O Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing nE Number of Bedrooms: existing —new � p} +C .F Total Room Count (not including baths): existing new First Floor Room Count�2 ar Pa Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ? ,n Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/Coal stove` ❑Yes ❑ No ry, r Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing .b new" size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � << �,1 � Telephone Number 722_ OM Address /2 I ( wil (� License # , Home Improvement Contractor# )-72 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOv»��e SIGNATURE DATE r r l ` FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. '4 ADDRESS VILLAGE OWNER 4 ' r DATE OF INSPECTION: i FOUNDATION "z. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL x GAS: ROUGH FINAL r FINAL BUILDING i t r DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M,4 02111 w„ ,• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name(Business/Organization/Individual): . 4l \ Address: City/State/Zip: \ �'ll"�.S _ ( f 3�6 Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1.El I a em to er.with` 4. ❑ I am a general contractor and I p y 6. ❑New construction 2.Vemployees(full and/or part-time).* have hired the sub-contractors 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 . workingfor me in an capacity. employees and have workers' Y p ty 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P 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. 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 der_ pains a s of perjury that the information provided above/is true and correct: Si afore: Date: Phone#: l � ) f 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.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written. ..= An employer is defined as`.`an individual,partnership,.association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal.representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25.C(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 mill 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone and fax number: The Commonweaith of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. ##617--727-4900 ext 406 or 1-877--MASSAFE Revised 11-22-06 Fax##617-727-7749 twww.mass.gov/dia r °F'THE r° Town of Barnstable ti Regulatory Services �sz"M G, y ass g Thomas F.Geiler,Director 1679 A, Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwwtown.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, &arl 60/eA as Ownet of the sub'ect ro e' l P p ftY . hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit: 01 IZ (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspec 'ons are performed and accepted. atut Owner Signature of Appli t Print Name Print Name Date Q:FORMS:OWNERPUMSSIONPOOLS 6/2012 ��t r Town. of Barnstable Regulatory Services sARwsresr.E. Thomas F.Geiler,Director v MASS. . WA 1659. Building Division rfD MA'1 A � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.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 S The current exemption for"homeowners"was extended to include_owner-occupied dwell ir ;;of`six units or:legs and_i , to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNEA'J�7"' `''''��, 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),r> .. '3'`' The undersigned"homeowner"assumes responsibility for compliance vrith.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 i �... 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(§)for hire,to.do sych 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 Y.. 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. C To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit applicatfon,'" 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 The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 The Commonwealth of .- Massachusetts William Francis Galvin 'r Secretary of the Commonwealth, Corporations �A Division One Ashburton Place 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 CAMP STREET PROFESSIONAL BUILDING, LLC C Summary Screen Help with this form Re ues at Certifc a The exact name of the Domestic Limited Liability Company (LLC):Com an : CAMP ) STREET PROFESSIONAL BUILDING, LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 203723056 Old Federal Employer Identification Number (Old FEIN): 000908665 Date of Organization in Massachusetts: 10/31/2005 The location of its principal office: , No. and Street: 110 MAIN ST. City or Town: HYANNIS State: MA Zip: 02601 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: EVAN S COHEN No. and Street: 4 LICHEN LN. City or Town: FORESTDALE State: MA Zip: 02644 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code MANAGER EVANGELOS G GERANIOTIS 110 MAIN ST. i http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummar... 10/25/2012 The Commonwealth of Massachusetts William Francis Galvin Page 2 of 3 :z HYANNIS, MA 02601 USA MANAGER ROBERT R HARTNETT 90 RED OAK LN. W. BARNSTABLE, MA 02668 USA MANAGER EVAN S COHEN 4 LICHEN LN. FORESTDALE, MA 02644 USA The name and business address of the person in addition to the manager, who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code SOC SIGNATORY SAME AS ABOVE SAME SAME, MA 02668 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code REAL PROPERTY EVANGELOS G GERANIOTIS 110 MAIN ST. HYANNIS, MA 02601 USA REAL PROPERTY ROBERT R HARTNETT 90 RED OAK LN. W. BRNSTABLE, MA 02668 USA REAL PROPERTY EVAN S COHEN 4 LICHEN LN. FORESTDALE, MA 02644 USA Consent Manufacturer — Confidential — Does Not Require Data Annual Report _ Resident For Profit. Merger Allowed Partnership Agent — — Select a type of filing from below to view this business entity filings: ALL FILINGS .{ Annual Report Annual Report-Professional Articles of Entity Conversion 'S Certificate of Amendment http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummar... 10/25/2012 The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 Vie;;Fir-, f1 r New SearcFi;Nme� 1 Comments ©2001 - 2012 Commonwealth of Massachusetts Q All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummar... 10/25/2012 r Massachusetts - Department of Public Safety Board of Building Regulations and Standards Consiructicin Supervisor Specialt License: CSSL-105951 ' FATRICK CLIFF 42 BALDWIN R(YAD� Dennis MA 02639. Expiration Commissioner 06/02/2016 Assessor's map and lot number .............................I............. yDi TN Er Sewage Permit number . .................................. ...... ........ I IIARNSTLBLE. House number ................................................................ ...... V MASIL 1639- MAY TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... ..............0.(...X....... TYPE OF CONSTRUCTIONF'ovN ......W 060 "" Z441 L ............................................................. U. 1?............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �N 1-5 Location ....... ......��!�nf......571z.rc..�.................f�y ......./V............................................................................... Proposed Use .... 0,-V1 Z>^) f lrzl�r 14�4-00rz- 1-gz-, 0 A-0 0 k;j 'n #-j $EC 0 A)40 /�Aolbg, .. .................................................................y................................................................................ ... ....... . ....Zoning District ..........................................................Fire District ....ffln..NNJ.-�............................................... Tj5 S-riZi:--f-T .Name of Owner . ..................................................................Address ... ............................................................................. Z Name of Builder ............E '\�. � � ..........:....Address...............Address .. .. .. ... .................o.................... ... .. Nameof Architect ..................................................................Address ................................................................................... Gov C Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ...........7:�................................................. fm(11 A) T(*Z S I "j ............Roofing ....... .................................................................... C)C t:� Floors .....P.Irif...................................................................Interior ...................................../.............................................. /' Heating ... 19 i4o A 7-r- R 11�1 ...........................Plumbing ................................................................ Fireplace VVA.fj.(-.Y.. Approximate. Cost4 . CD -0...r................................................... Definitive Plan ,Approved'by Planning Board -------------------------------19--------- Area .. Diagram of Lot and Building with Dimensions Fee ..........C-71 ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH A 0 0 1 -1 of,) t�ox�c ao ► 7(Uz I T OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the#To,6-of Barnstable regarding the,above construction. ..................... N a MAI ...... .... ................. ... .................................... .......... Construction Supervisor's License 1 CARCHRIE—FELTUS,J ROGER A=328-191 No 26821 Permit for ADDITION Single Family Dwelling ............................................................................... Location ..85 Camp..Street........ ...... ..................................... ann .................Hy �s.............................................. Owner ..Rober Carchrie-Feltus ................................................................ Type of Construction .. ............................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...AuguSt...a..................19 84 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's map and lot number .............'.............� ............ THE MUST CONNECT TAT TO Sewage Permit number .............................................. ... ' Z DAWST LE. a i House number ............../................................................ ......• 900 039. ♦� M TOWN OF BARNSTABLE BUILDING INSPECTOR — � a APPLICATION FOR PERMIT TO �� ........................Tf f .............~.°A) TYPE OF CONSTRUCTION �r©!U.C..;I -C .. � !�.�.�.u� a ... .................. A ... IR& ........ .................19. f• TO THE INSPECTOR OF BUILDINGS: The vndersigned�hereby applies for a permit according to the following information: Location .......8..7...........!:A �;p........5 ! ... Tl.. N N i.s...................................................................... Proposed .Use ....&? N•6- A-00I-et c,rJ ..F(e2�1— 1C4:CU0YZ- D/Z-C.°.`.`�....p. ...... .,C60A)0 16vr,) ZoningDistrict ..!, .+.�..........................................................Fire District ....ff� ............................................................... ,pcol C /Z JS S�' Name of Owner .. �`� ��2 H4Lf `�. .. Gf�✓Vl� f �T 1�....................................................................Address .... .............................................................................. Name of Builder 1 �Uc . 9 , /J ( ` ✓�•f`� P\)A A 0�-Iv L Address ...................... ....................................,................... . �t Nameof Architect .......... .......................................................Address .................................................................................... Number of Rooms C.O� . .........................................Foundation ................� ..Tf............................................ Exierior ..U...�A.J �2(M S fl[N V 1-,f� S fs°NA.. ............�............................ ................Roofing ....... ......................... ,. Floors k koC.� . ...................................................................... Interior ... ........................ .....1.....T.R\✓ ............. Heating 9.v. .�-.L�........�°. ......�!`!.�T�-.1...........Plumbing ............... ............................................. ............ �/lJ ct{I✓Vl W�Y f S7av EAPP 7'1 � C).0.�.................... . Fireplace ................... . ................ ........................................A roximate Cost ... ...... .. ...... ........ �6,� S. i Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..... ............. Diagram of Lot and Building with Dimensions Fee ......... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I 135 Rdf'0�>&® AoDf 'r,ofO - T - 02 0 I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To f Barnstable regarding the above construction. / •'k Na2 ...................1.... Construction Supervisor's License .. .1. ..1..�.. .......... i MCHRIE—FELTUS, ROGER No .26 !..... Permit for{ADDITION . . Sin le Famil Dwellin r V /yy Location ...85 Camp Street ;� _ 4 f� � Ow Ro er carchrie-Feltus "" ..........�........................ .......... , r r am TYp f Construction .....F.-r .......................... Plot......................... Lot f Sl Z ? Per F Granted .....:August..8.�.. ...;... ..A9 84 i `� 1_ Da of Inspection . ..................... _.. �19 Date Completed a l 9`� .... t �. s rn. Lei t / , Town of Barnstable *Permit# 7 D Expires 6 uiontlis from issue date awxtvsrABLE. = Regulatory Services Fee �2 —v .MA SS. Thomas F.Geiler,Director �p t6gq �0 IfDN'0'`A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid►vitltout Red X--Press Imprint . 2 X / )9 ) Map/parcel Number Property Address ®pp 5 c1ctA n Residential Value of Work Owner's Name&Address �O Gf 21' �7CJ.5 lI ` p Contractor's NameC n l z !TO IN1P� it7Lj 1(/Q e 4 Telephone Number 7!a if`- 9c�/0 Home Improvement Contractor License#(if applicable) /CO J 7 Q Construction Supervisor's License#(if applicable) C) orkmn's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I n the Homeowner Ea4lave Worker's Compensation Insurance �,/ Insurance Company Name' /►�/l�1.k�/ '0/�.(.L. Workman's Comp.Policy# C J UC aL510,2 00 Permit Request(check box) ❑ Re-roof(stripping old shingles) X-PRESS PERMIT ❑Re-roof(not stripping. Going over existing layers of roof) SEP 0 9 2002 ❑ Re-side TOWN OF BARNSTABLE El-Replacement Windows. U-Value (iimaJximu�m.44) ether(specify) r r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 I °F1HE r�ti The Town of Barnstable '• BARNSTABLE Department of Health Safety and Environmental Services 9 MASS.� a i6)9. �0'prFOMa� Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection IX rlv c' 2O a Location &'S C,1 in P S T Permit Number //yr9OVw� Owner 0 C FA F C4 i v ,Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: EidSf /007- r d1' 5 tS4`11e, T Please call: 508181,62-403 for re-inspection. Inspected by <v ✓ Date g l w TOWN OF BARNSTABL,F BUIkLDING PERMIT APPLICATION Map Parcel I Q Permit# 5rP Co�, Health Division Date Issued Conservation Division 1® %(o ZAP% Fee ') Tax Collector . i �I� d SEPTIC SYSTEPA MUST EE l I1 STA �� 01w COMPLIAN A q Treasurer = � "d l I �' � � WITH TITLE S � Planning Dept.:r�l- G. )k �� 16 IVIRONMENTAL CODE N TOWN REGULATIONS Date Definitive Plan Approved by Planning Board . kt,6) Historic-OKH Ok Preservation/Hyannis Q K •r`'�b �E Project Street Address Village Owner a (t c. Address SIk W Telephone — �O; 3 W 6 3 0 �i 1 Permit Request ir- Win e_� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 000&z Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/ 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• D � � C Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ OCT 1 7 2001 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use By BUI DER INFORMATION Name' r . G Telephone Number 362 s'V Address d T License# C5 0'79 2L-3 a h n"o— Home Improvement Contractor# !L Worker's Compensation# A,17 — Ta`606 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13 av h daC_ Ou &,,o SIGNATURE DATE O S� -.FOR OFFICIAL USE ONLY r y C _PERMIT NO. r DATE ISSUED _ MAP/PARCEL NO. ADDRESS , VILLAGE OWNER- = - if -F +t 4 _ • DATE OF INSPECTION: V FvUNDATION -2 FAME INSULATION j J. FIREPLACE I� ELECTRICAL: ROUGH= : r II� FINAL I'• PLUMBING: ROUGH- r FINAL GAS: ROUGHS ' .- _ FINAL ' FINAL BUILDING ± f. DATE CLOSED,OUT ; ASSOCIATION PLAN'NO. Y y! T U Commonweauft of massucause4la - _-`-- Department of'Indttstrial Accidents '" — � 011fceollarastlpsdoos 600 Washington Street s; Boston,Mass. 02111 Workers' Compensation Insarance Affidavit name: � � •. a- o location: • N hone city ❑ I am a o eowner performing all work myrrh: ❑ I am a sole Pr=etor and have no one worldrig is aavMMM===r workers'crop ensation for my oa this job. : Y.Y..::.::::-..4:%. .r.. ....... ...... ..........::.. .:.}..... ... ::::: }: .Fn am name.:. .... .cam ...:........ ...: ...:.:::;:::::<.::::.::•}-::::,• .::.{«- .. .:.. .{ :?s-« �L�w«•'..-,. ;�}••}:.}:.>::.::.:......:,.,.,..:..:.}'.:':.}'<;...::;•..i.::•.::.:::::.::: ..... ........ ......... ........... ................... .. .......... .... :i,. .{ .}.. ..:.4.::{:-. .'.tt{)4.,^ki!}iiiY;?;Oi::!i}:i.,.-v,:.}i::;:y:Y:«:"i:i�:?+:'} •:•H Y.4 •.Y�v}i::.v.;;irn:.vr:?vn:w::::::.:::::•.::::.::.�::i.. .... ....n .. ........ ::v.. ... ................. .. ��.....:.:::v.:•-•.v: .. •w":iw;y:;}Y.-'...; }:+v'.::i : :>.::i':v. gddress ::::... .:...:.:................... ................:..... ... ., 4...n....vv ..t , .}M ... ♦ :. :X?'::v. .......::+:' :-`ct' ':`` .... .................................. 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INN ;,.}{h--:n♦:.:{:?. ............. ......................... vv::v�:«•:«v w....«.....•:.vnw::n« .: 4.{ ......6.r!. h4.xx Iddes of a fine up tc and/or Faflm•e to secure coverage as required under section 21A of MQ.ISZ eaalead to the impositlm of aizotosi peo 51,500 00 I tmderstaid that a one years'imprisonment as wen as civil penswes in the form of a STOP fWOM ORDER fine ovai0f�na.00 a day against me. copy of this statement may be forwarded to the Oftiee of Iavrstiptions pains an itd enaltier thatthrutfosnt n p"Wided above t7u� 1 do here by certify raider tke P P Date sipature Print name f)a AD U!j�tll. Phone oincial use only do not write in this area to be completed by city or town official DePartmeat city or town: - P QI.lcaesint Board [3selecuneWs Office check ifigun•diste response is required C3gesith Deparft-nt contact person Phone fin ❑Other (yevum 9/95 PJAJ Information and Instructions ,w Laws chapter 152 section 25 requires all employers to provide workers' compensation for their Massachusetts General employees. As quo ted from the"law",an employee is defined as every person in the service of another under any coact of hire, express or implied, oral or written. oration or other 1 entity, or any two or more of An employer is defined as an individual partnership,association,Corp � to or the receiver o; the foregoing engaged in a joint enterprise.and including the legal representatives of a deceased employer, partnership,association or other legal entity,employing employees. However the owner of a trustee of an individual,p p� . or the occupant of the dwelling house of dwelling house having not more than three apartments and who rwades them house or an the grounds or another who emplovs persons to do maintenance,construction or repair work an Such,dwelling building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency Shan withhold the issuance who has enewn of a license or permit to operate a business or to construct buildings in the commonwealapplicant not produced acceptable evidence of compliance with the insurance coverage required. Additionally, publictberthe wow unfit commonwealth nor any of its political subdivisions shall eater into nay camdract forthe performance of acceptable evidence of compliance with the msm==regmremeats of this chapter have been,presented to the con=ctinQ authority. _ Applicants and Please fill is the workers' compensation affidavit compkWy,by�gthe.baxthat applies to your sitnatson lying company names,address and phone numbers along wi&a certificate of insurance as all affidavits maybe supper a f � af Also be sere to sign and _ nxdm submitted to the Dep ortownthatthe application for the permit license's date the affidavit. The affidavit should d strW ed i the city you have�y �regard the law"or if you being requested,not the Department of Industrial Arad D� �attlie nmaber listed below. are required to obtain a workers'compensation policy, City or Towns _ . .._....._. ._.. . provided Please be sure that the affidavit is complete and printed legibly. The Department has P a space at the bottom of the appliCa�. please affidavit for you to fill out in the event the Office of Inv dgatioa has to contact you regarding the eimitlIicense number which wfit be nerd as a refe:en,ce number. The affidavits may be retmnod to be sure to fill in the p have beeamade. the Department by mail or FAX unless other ar aag� The Office of Invwtigations would like to thank you in advance for you cooperation and should you have any questums• please do not hesitate to give us a call. Ow The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Introstlpttlons 600 Washington street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406,409 or 375 I ��p THE T The Town of Barnstable a pARNSTAB LE. MAS& g Regulatory Services 6`0 Thomas F. Geiler, Director, ED MA'S Building Division Peter F. DiMatteo, Building Commissioner 367 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. . � timatedCost— Type of Work: 2 Address of Work: s L4Ai Owner's Name: Date of Application: Id V16 /6-/— hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME HE ARBITRATION PROGRAM OR GUARANTY` FUND UNDER MGL cMENT WORK DO NOT c. ACCESS TO T . 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. , OR Date Owner's Name q:forms:Affidav:rev-070601 r ; RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftj >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS. Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) ^^ Permit Fee A /1& �Q �vvo ( � , uv'd vvke�� �v A'k_ vVtP-�e n ' �✓K,I je �/e. nay,, projcm BOARD OF BUILDING REGULATIONS Ucense:.CONSTRUCTION SUPERVISOR Number;CS 074823 Expires 04l1312003• Tr.no: 74823 - Restncted,.To: 00 JAMES C MCDONO UGH, 61 RUSSELLS PATH MARSTONS MILLS, MA'02648 Administrator NICE OF ASSIGNMENT 205417 MPLOYER: JAME S C MCDJNOUGH INC BUREAU FILE NUMBER STATUS OF EMPLOYER 1471 OLD POST RD 186636Y CORPORATION MARSTONS MILLS MA 02648 ADDITIONAL INSTRUCTIONS COVERAGE UNDER THIS ASSIGNMENT THE WAIVER OF OUR RIGHT TO RECOVER FROM APPLIES TO MA. OPERATIONS OTHERS ENDORSEMENT IS AVAILABLE ON POOL ONLY. FOR COVERAGE OUTSIDE POLICIES. CONTACT AGENT FOR DETAILS. OF MA.9 APPLY TO APPROPRIATE POOL OR PLAN. AGENT ROGERS C GRAY INS AGCY INC INSURANCE COMPANY: OR 640 IYANOUGH RO TRAVELERS INDEMNITY CO OF ILLI , PRODUCER: HYANNIS MA 02601-0000 MS JACKIE DENNIS P. 0 BOX 3556 ORLANDO FL 32802-0000 (800) 842-9886 TAX IDENTIFICATION NUMBER: 04-225-4905 CLASS ESTIMATED ESTIMATED CLASSIFICATION OF OPERATION CODE TOTAL ANNUAL RATE PREMIUM REMUNERATION CARPENTRY-DETACHED PRIVATE RESIDENCES 5645 201000 10.62 $ 21124 EMP_OYERS LIABILITY 100/100/500 .9845 STANDARD PREMIUM 29124 EXPENSE CONSTANT 0900 244 ESTIMATED ANNUAL PREMIUM 21368 DIA ASSESSMENT 4.7% OF STANDARD PREMIUM 100 EST, AINNUAL PREMIUM PLUS ASSESSMENT $ 2t468 INSTALLMENT BASIANNUAL REQUIRED DEPOSIT PREMIUM $ 21468 COMMENTS COVERAGE EFFECTIVE 12.01 A.M. ON , 07/25/01 WITH ABOVE INSURANCE COMPANY. DATE OF NOTICE 07/25/61 PREPARED BY-THERESA SCHOF IELD EXT 542 # VOLUNTARY DIRECT ASSIGNMENT * # F EMPLIYER COPY MASSACHUSETTS WORKER'S COMPENSATION ASSIGNED RISK POOL i � • i „rram� THE COMMONWEALTH OF MASSACHUSEM Board of BuNng Hegplations One Ashburton Plea and Standards T an°°Na 'Room 1301 Boston,Mmu dmseM 02108 Rq*miian No. ;r AppIication for Registration as a ntt$e tm' i3raaire Due Home Imprw meat Contractor'or S • MGL Chapter 147A, CMR 780-6 r FOR OFRcF 4USE ONlY Dam 1, Name C. for the (act both) Print the dame of the iodividtul or batts� 2. Maiiwg Addmu 0 v Arta Code dz T�otte N ba m 3. -�A �f diQett ot) LP ,. Slttxt Address c . Print strew Sad Numbs(P.o.sort trot aeeepsabie)Q Ttas< Q Fat ❑ Pttblio C=Psa•dw S. Iadividttat ❑-DMA ❑ P tmaa the DMA or Vahlom ttutta'law-MGL a 110.as S a 6) (See ittturu==on bade:t�i a dq ate tows was Nwaber of EmpioyQs 6. SOCW Setauity a Federal W Number F 8 WdMdml=Por sW9 for Place lwPttt@eat Goctssas L Fiot BE Sons►Set=q No. 9. Titk of individtd z for Plosse Imp:o�Cmum ❑ adiv[dml at6es Dios Schad Stan;dry,toss Bourses cr t Ya No 10. i?oa tabhtlrTciwq*wths ba ms. Uw addtt=A P W ffi0e°On�' Name of 13oase Nolda Type Ctetsse or 0° lasoed By'. ttaEba' DM • t .._. o. a ... ttttatet3.o door .Use lit and�.essicu Pw ar psi of owams6lp) it. List an pattsas. . • �hese ff Yoo aiah to tteoeirs add for�tl In ands for key pmo� addition!Papa if neeesusy (� oD btts� Addm$ tsst Fh3t.' Mtdale btltltl Tftis fn APp+iam Mtabm %Chars See tha m the but) N IZ is the appiiaat daimis6 CKII atom the eo�orve�>��p Bt=orIf ym ay ;ndnde a Dopy of a tmZteat SaP�O�Be== S Ford fee m&=* Ft»td'. ALL APPLst:ANRS MUST ig. P;cPuuion tee eadomI a--.ase mtosced"moo FW6-we mStimd'GttStanry lttdude two separate otxtiBed dttxi�s or Fss�IF F�'r FROM TIC REGIS M=N FEE See is aiam oa bscic for amount of tees INCLUDE A GUARANTY FUND FiU; to"Commoawahh of Massadwsws� S a1oe an ccrd d ttwb or motley atlas P Pd& 6=aad�49A.I a�s+oPe""""der tbt P ”"of Pe*"that I, pormust to M==*m w GGe d us s uaw and Pall au data I—required adder law. to my best Title held with appliaw Signat re of applioat or appiioat's A f answer to aa7 4�tbO in fhb app 11��11lum grounds for smpeasioa or reronlioa of be aPPlieaat's registrsUoa. TOWN OF B'ARNSTABLE BUILDING'PERMIT APPLICATION t , Map -3 0�S Parcel .l q'1- Per # 7� Heap-Bivision 'Date,Issued Z2 • � Fee q�S.rJ� .__ Tax Collector. I OL 1 T , Treasurer Date Definitive Plan Approved by Planning Board Hois�14H P�esettiottfHparrms r 5 F Project Street Address 1)Z5 0,1 P M-Ci5t r Village A L1s Owner - _,5 ` Address Sa rr�� Telephone `7 Permit Request L$ ' C. R Lam• PJC7Z-i .e '�� Square feet: 1st floor: existing proposed " 2nd floor:existing proposed Total new Estimated Project Cost '7OD.0) Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes Cpif yes, attach supporting documentation. Dwelling Type: Single Family L]Y Two Family ❑ Multi-Family(#units) = Age of Existing Structure Historic House: ❑Yes U-146 On Old King's Highway: ❑Yes UNer-" Basement Type: O 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 O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 . r Commercial ❑Yes C&W If yes,site plan review# Current Use Proposed Use "BUILDER INFORMATION ` Name C"' 122 ^ fr X),WOR.. Telephone Number - Address UC W Z c,SXI w !c License# e y g2 2 �ntz4!r M A`. 1)&to 3 S Home Improvement Contractor# l'Q�?`7'® Worker's Compensation# f C i�42 &6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO (2AP1 ZZi Y � -IWIJ) _11 SIGNATURE Ag__Ck JZ DATE _ .� FOR OFFICIAL USE ONLY, PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS Y '. ^ s "- {VILL+AGE OWNER ' r. f _ i L_= fl` . r •#' +•ei ', _ r 1 '-r s ' - _ t x r J n DATE OF INSPECTION. FOUNDATION ,! • " t ` ' z �' `rt - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ` c FINAL`r ;'+ • , .% + • t + ^" or GAS: 1 ROUGH ', FINAL'` t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ZT1E l� - The Town of Barnstable 9 MAML �' Department of Health Safetv and Environmental Services ib19. �0 �, ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing .at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. �} Type of Work: �ilS)N U��tJ 41� Est. Cost Address of Work: 0 m/O Owner's Name 0 Date of Permit Application: �/� �� I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. I42A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: -5-)2j�l Date Contractor Name Registration No. �R P /17-1 4rmC -7� OR Date Owners Name iiie Lommonweaun o massacnuseirs —_ Department of Industrial Accidents OIIICV O/IMMS&OZ OOS 600 Washington Street " Boston,Mass. 02111 Workers' Com easation Insurance Affidavit name: Q �/� location: �'�� ej*-1/P 14 city V Azy" S z oo`/ Q OC I phone# ! 7 S 6 ❑ I am a ho caner performing all work myself. ❑ I am a sole etor and have no one worm in anvcapacitv I am an employer providing workers' compensati n far my ealplclpees working on this cam anv name. ;: address f ` ... .. Wane:# . . . 20 ansslrance Cp. IC. ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contract=listed below who have the following,workers'compensation polices::::::::,:.:::.:::.:::::::..::::::::::::,:::::::.:::::::::.::::.:::..:::.::::::..,......... ............ ... .. _ .._ ....... tb a v name. .:::::::..... .:..:........ :: . . ................address.: __ .... _.... ..... ..,. ..:.. .. :::.Nn1' :....::: ::::%::::::'"•:::::ii:;;::i::i :i:i'::i::::::ii:::::'. ":.':::.:is ii::i:.:{ .....•.... ::::"':':::::':j i:•.:4iiii:i:.iiiiiii::iii::: cites ;'::r: >::::.. ii ri.....:;:::.;": _. ..:...:.. ':<.:;::<::;:.;:;;::.;::.::::.;;'..'.::::;:;:� one:# :::.,.:.:::::..... It :..:: :. :..: :.:.:� ..:.:: .:. ... .... ..... :..:: ............................:.::.:.......... ihsn tsrtce.ca. ol'icv# i anv ..............t> .. : >;::.;'.::'.;:::».: .:....... . >.::. :.:;:.::..;::::.. cams :.: »; .:: :.:::.:. :;.: ::' adores . ..................:. ......................... ............................... bane#c :;.;:..::,.".::.::> ::::::>:>:::......:: rite ::::::•:;.::.:;.:;;:;.;:. .. ............................................................................ ...................:.;.....:..::..:::::.........::::.::::,,:.:.:.::.... ........ :::::.:.:::.>::::::::::.::;::.::::::::::.::.i::.;:;'.;::•::.::::.::::::::roe::.::a.�:::::•r.':::Y;:Ya::::n::r. �' Yi:Tii: •.: :...:::::.......:........:::.:.:::::.:::v: :.:•::. ::•:.:::::::::::::.�:::.:::.�::v::.:.:.:...::::::::.::.:.::.:.... ..... . :.::.:::::::::.::::::::::.::........::. .......................................... .).......... asnreace co... olive# Faitme to secure coverage as required under Section 25A of MGL 152 can lead to the tmposit mt of cstmiaal penalties of a Hue UP to$1,500.00 and/or one years'haptisorment as well as ctva penalties in the forts of a STOP WORK ORDER and a Hue of$100.00 a day against Tim I understand&ad a copy of this statement may be forwarded to the Office or Investigations of the DIA for coverage verincxtion. 1 do hereby cceerrt under the pairs and penalties of peerjury that the information provided above is tru,and correct Signature C�f�LI,,.z:o-/� �/ /�/�Cc �i <"� Date 'J d 7/f7� Print name mil' 2,2, Phase# official use only do not write in this area to be completed by city or town offida1 city or to m: pernEwlicersse# ❑$rdldhng Department CILicensing Board ❑dreck if hnnedlate response is required ❑Seleetnren'ss OfMm _ ❑Health Department contact person: phone#; ❑Other rUTIMed 9/95 PIA) BUILDING DEPAR=l T CONSTRUCTION SUPERVISOR FORD: PLEASE PRINT: JOB LOCATION: C/�yr)P CST A9 S NUl'�c STREET VILLAGE OWNER OF PROPERTY: L U.S CONSTRUCTION SUPERVISOR: f�'��"�E�ICfC- V• 0�150-14 es Q YA f-ggoa // Nt, LICENSE NO. PHO\c N0. ADDRESS:9 1 b(19- e tj-jz 0 A1../ � . �QTG( [T yoZG..s- LICENSED DESIGNEE: /�7'i 2Z f rl0�ll. . ;y/yy�P�, �e7 d 7 c,/O (IF OTHER Tr AN SUPERVISOR) NA.Mr. LICENSE NO. N0, 2.15 RES PONS 13 ILITY GF EACH. LICENSE aOLDF.R: 2.15.1 THE LICENSE HGLD=R SH.A'T L BE FLZ LY AND MTLET_=:,Y RESPONSI3LE FOR ALL WORK FOR ro"HICH. HE IS SUPERVISING. HE S_-?L 3E RESPONSIBLE FOR SEEING THAT ALL WORK IS ,DONE PLERSL?NT TO THE STATE BUILDING CODE AND THT- DRAWINGS AS APPROVED BY THE BUILDING OFFICLAL 2.15.2 THE LICENSE FOLDER Sri?L BE RtS:ONTSIBLE TO SUPERVISE THE CONSTRUCTION, RECOt:STRUCTION, ALTERATION, REPAIR, =- jOVAL OR DtEY.CLI=ION INVOLVING THE STRUC---.L E7;-MrNTS OF BUIL:)ING AND STRUCTURES ONLY ?L354N-'T TO. THE ST:T_ BUILDING CODE AND Ai OTHER 4.PPL:CA3L= T S OF T__= EVE' ??� ? !r ER BUT 0�; _ - rur� Er? ".GtG T L C=NSF 'r.OLDER, IS NOT_ Tr.- ER'�IT HG'D `L' SU3 CONTRACTOR OR CONTR=_C:OR TO TOE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDERr Y NOTIFY T BUIL : G ' CaIIV � ' TA _ :._DISCOVERY OF ANY VIOL_'TIONS Wr.ICH ARE COVERED BY THE BUILDING PER !IT. 2.15.4 ANY LICENSEE WFO SHALL LlIiL. .;:._Y VIOLATE SUBSECTIONS 2.13 .1, 2.15.2 OR 2.13 5 OR AN,TY OTrd7R SECTION OF THIS= R L T 75 AND IREGU;_ATIONS OrAND ANY PROCEDURES, AS A`LENDED, Sr�?.. SE SUBJECT TO REVOCATION OR SUS?E NSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING P-:� TT AP?LICATICNS SHALL CONTAIN Nr'M�, , E T I -5= THi:* L S=GN ATUR.. A\D L CE., TU13ER OF THE CONSTRUCTION SUPERVISOR WFO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON- STRUCTION, ALTE`RATIO.;, RE?AIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF T*. E CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS , THE WORK SHALL I2121EDIAT7LY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS CUBS TT-lUTET) ON THE RECORDS OF T: = 3UILDING DEPART"r.NT. I HAVE READ AND UNDERSTAND MY RESPONSIBLL ITIES UNDER THE RULES AND REGULATIONS 'FOR LICENSING CO;t- STRUCTION SUPERVISORS N. ACCORDANCE ;SITn SECTION 109.1.1 OF T,-.E STATE BUILDING CODE. I LiTDERST: THE CONSTRUCTION INS:=�TION PROCEDURES A1ND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCE CCVEAA F. I have a current li ' ;;ity insurance pclicy or its su'rstantizl e-uivalent which meets the require-ments of MCLC;t.152 Yes No ❑ It you have checker_s, p'.erse irdic:.te the ;pe c^verage by checking the A liability insurance pc:ic/ -C'er type of :.'idennity ❑ tcnd ❑ OWNEA'S INSUR^` C' w:� N'ER: I am aware t`;at ;he rcensee d_es got have ;he insurance coverr;e reouirec :y hao er152 of the Mass. Ge^erai C Lzws, anc t::at .ry si}nature on tn:s permit .-piic:icn waives t~is reR_ire.+. _ _ _ / •_Check one: Owner'` Agent ©�Signat re of 0*ner or t?-ner agent r�� SIGNATURE: ��/ BUILDING OFFICIAL APPROVAL: I - _ + ✓fie vaninzaraureczll�'o�✓`lad:rucluaell OEPARTiNENT i P98LIC SAFETv :ONSTRUCTTO1 SUPERt'.,OR Number: .. CS d0°145; 02124 0 /ea Toornnnmu�e42a.0 /�aaaac%uae!!d - RestClcted HOME IMPROVEMENT CONTRACTOR �THOW CAP'I?Ci Registration 100140 1645 NEWTOWN ?C, Type : PRIVATE CORPORATION,` OTUiT, .IA a_E 5 v. Expiration `06/23/OO _ CAPIZZI HOME IMPROVEMENT, INC aS Capizii, Sr =A DMINisrRAToa 1 45 NeWtOn Rd` Y Cotuit MA�02635 4 - ', `6a..t f - ✓fie -�a�cvnzo�rzcueczllf a/ ac zu:;eCl, DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION-SUPERVISOR LICENSE Number: Expires: — Restricted Ta:: 08 THOMAS X CAPI2'tI JR 280 PERCIVAL OR r .l W 8ARNSTABLE, MA 02668 n�;__ ✓fe a7�ilwow&z eal o� G �acfuae�l DEPARTMENT OF PUBLIC SAFETY f.Sti• ,4'•z CONSTRUCTION SUPERVISOR LICENSE Number: Expires: RestrictetJo 00 _ FREOER-CK..V.-RASCN III �+ ems'i060 BOURNE RO PLYMOUTH, MA 02360