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Home My WebLink About0120 CASTLEWOOD CIRCLE i zo oad. G.zre 3/2?It o �'THEt, Town of Barnstakde *Permit# Q„ Expires 6 ntonlhsJrarn re slate = z3,,xrrsreBrE : Regulatory Service Fee ►6 9 �m Thomas F.Geiler, Director Building Division om Perry,CBO, Building Corr(missioner ; a.. 200 Main Street, Hyannis, MA 02601 �J201d� www.town.barnstable.ma.us Office: 508-862-4v Fax: 508-790-6230 TOWN A 0iSKER111MIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Impri t Map/parcel Number Property Address �p �►�5rl waaa0 C i �ljT t'►iw EY'Residential Value of Work 'UOye Minimum fee of$25.00 fir work under$6000.00 Owner's Name&Address �120 m4iiq Rlm l� LLe_ Y�ic.f�i9q� f ��✓. DDTbs a Ny��t�►s, n�. Contractor's Name 6A&u &2Al�pi �adgifin C' Telephone Number �►92� � tL p Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if al..plicable) (., orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [?fhave Worker's Compensation Insurance Insurance Company Name f9Tz qA,,7 Workman's Comp. Policy# ty c y b 1 U 57 9 t70�✓ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingle,') All construction debris will be taken to u 3Aee ❑ Re-roof(not stripping. Going river existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) "Where required: Issuance of this permit dl�s not exempt compliance with other town department.`egulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permis ion. Improvement Contractors License&Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\ExpressTXPRESSPERM IT.DOi Revise060409 V i f i zHEr, Town of Barnstgble Regulatory Services Thomas F.Geiler,Director N�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_b arnstab 1 e.ma us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner must Complete and Sign Thin Section If Using A Builder I, A ,1 b t N/9( PeN , as O!,,avner of the subject property hereby authorize aA Pam L U- (x A,I!! to act on my behalf, in all matters relative ito work authorized by this building p rmit application for. r J c -(Address of job) bo I. _ Signature of Owner Date Print Name 1 If Pro e Owner is applying for ermit Tease complete the P rty . P P . Homeowners License Exemption Form o the reverse side. The Commonwealth of Massachusetts \ Department of Industrial Accidents y Offee of Investigations ¢ 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Conmbers actorslEl P ase Print Legibly A licant Information � /1 Name(Business/organiza-tion/Individ al): Cry'?l n ac- Address: (7�b o t Phone.#: City/State/Zip: ---- Are you an employer? Check the appropriate box: Type of project(required}: T,� 4. 0 I am a general contractor and 6 ❑New construction 1.LJ I am a employer with have wed the sub-contractors employees(full and/or part-tima).* 7.. E]Remodeling listed on the attached sheet 2.[] I am a'sole proprietor or parhner' These sub-contractors have g. Q Demolition ship and have no employees employees and have workers' 1 9 Building addition working for me in any capacity, comp.insurance.$ [No workers'-comp.insurance 5 We are a corporation and its 10,❑Electrical repairs or additions required.] oCem have exercised their 11.[]Plumbing repairs or additions 3.❑ I am a homeowner doing all wo"k right of exemption per MGL 12. roofrepairs myself.[No workers'comp. i C. 152,§1(4),and we have no ether insurance required]t z 13.[] h employees. [No workers' F comp.insurance required.] licant_that checks box#1 must also fill but die section below showing their workers'compensa>�on policy mfDhOn' `Any ape are doing all work.and then hire.outside:contr rs must submit a new affidavit indicating such. t Homeowners who submit this affidavit indicating ey S tcontiractors that check this box must attached air additional sheet showing the name of the sub-contract and state whether°r not those entities have employees. If the sub contractors have em1.ploye,they must pravidt their workers'comp.Policy I am an employer that is providing workers'compensation insurance for my employees. Below is the policy grid job site a information. '. Insurance Company Name: Y e �'R it y cation Date: Policy#or Self-ins.Lic.#: E � �, !� .01Ly1 Job Site Address: �0 5�l�wta�i? Gt rd.. Ctt /StatelZp: h�ti per e f?l ation date). Attach a copy of the workers'cotmpensation policy declaration page(showing>he policy number and expirenalfies of a coverage as required tiler Section 25A of MGL c. 152 can lead the imposition oWfO criminal and a fine Failure to secureg fine Itip to$1,500.00 and/or one-year imprisonment,as well as civil penalties to the form of a S against the vtoltor. Be advised that a copy of this statement may be forwarded to the Office of of up to$250.00 a.day ag_ Investigations of the DIA for insurance'coverage verification. I do hereby certify under the pains an 1penalties ofpedury that the information rvveded above true and correct signature: - y i Phone#• _77K_gbi Official use only. Do not write ut this area,to be completed by city or town o1leiaC .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 Phone Contact Person: ® DATE(MMODIYVYY) .��V CERTIFICATE OF LIABILITY INSURANCE 01/31/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. -THIS• CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 'IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 0039' -001 CpNTACT -NAME: Horgan Insurance s rance Agency,Inc. _Ar e.Ext),,,_(508)775-5830 L .NoPO Box .: Hyannis,MA 02601os}tss: _. _..,.._ .. .._..._.—INSUR (S�F-Ep ON __.._.. ._.__.__._'INSURERA. Atlantic Charter Insurance Company VDAC 44326 INSURED LFII5URI3H.@ Graham,LLC -- - -...- -- INSUARR. =.... ... _. -- 358 West Main Street Hyannis,MA02601 INSURER F, 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 DESCRIBE HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS5R TYPE OF INSURANCE -ADOLSUBR, POLICY NUMBER -- - -- -P --'Y BPF POLICY EXP LIMITS LTR ,INSR_\WD_. .. - (A7MIDtuYYYY).iMMtDDIYYYYL.. GENERAL LIABILITY EACI-.CCCURRENC=_ $ COMMFRCIAL GENERAL LIABILITY ]A.UAGE TO RENT?D $ .. ,_.. " _ _iyn Mi .E$.( S CCturre-nCe) _ C!AI-MS-MADE OCCUR - MED EXP(Any cne porson) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE_iMIT APPLIES PER PRODUCTS-COMPIOP AGO S POLICY PRO- .IECT LOC AUTOMOBILE LIABILITY C64tBiNEO S'INGiE'LtMir •-$ ANY AUTO BODILY IN.i4'RY;Per perseni 3 ALL OWNED - SCHEDULED BODILY INJURY(Per accident).-$ " _ AUTOS AUTOS NONOWNED —------...— ,. r+:RED AUTOS . PROPERTY DAMAGE S AUTOS tPer Hccimnu_. - $ UMBRELLA LIAO OCCUR EACH OCCURRENCE -a EXCESS LIAR CLAIMS MADE ACGREGATE $ yyp KDED RRyE7IFNI"iONN S 77 5 gqANNDEbAppPLpO��YERppSqq',,LIgqAgqBI�NNQTaaY. X ..,OYLIAMI(fS. OfF1�6R�MEFAi3ER�XCTUSEW� ECUTIVE YYN• NIA A WCV01059006 1129/2019 01/29/2020 E.L.EACH ACCIDENT 5 500,000.00 A — (Mandatory in NH) . - E L.DISEASE-EA EMPLOYEE $ 500,000.00 �b na Policy Coverage State MA '�ff Y¢as.d .�-gyp +ye, aa77 DISEASE-POLICY LIMIT S 500,000.0.0. . Gary C Graham is covered by the workers compensation policy AND Laura A Graham is not covered by the workers compensation policy. DESCRIPTION OF OPERATIONS t LOCATIONS)VEHICLES(Attach ACORD 101,Additional Remarks Schedule.it more space is inquired) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 230 South Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Attn:Mariann Hughes WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE :0 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY } Registration valid for individual use only before the expiration date.,ff found return to:' ! office of Consumer.Affairs and Business Regulation ' 10 Park Plaza-Suite 5170 Boston,MA 02116 + . _ Not valid without signature Construction Supervisor Unrestricted-Buildings of any use group which contain Less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts _ State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl ' . dTe Vln�ir�irnrztuerrll�of'G>�lLaaJrc�lriJellJ -- Office of Consumer Affairs&Business Regulation. HOME IMPROVEMENT CONTRACTOR ' TYPE:LLC Registration Expiration -:.�182219 06/02/2019 1 GRAHAM LLC = c r GARY GRAHAM �.Q C� - 358 WEST MAIN ST. ' y HYANNIS,MA 02601 " Undersecretary e , ` - ® Commonwealth of Massachusetts Division of Professional Licensure Board of Building-Regulations and Standards Const%,&t""' A4pervisor CS-042246 E Tres: 03/20/2020 *n r.1 GARY C GRAHAM 66 BRANT WAX HYANNIS MA 02601 ' r� ;f [U�t1� } _. Commissioner CIL . PERMIT oFtHC - Town of Barnstable *Per # -E mo roarsue date Regulatory Services F U _ ,'� � Thomas F. Geiler,Director �rEp MA't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis, MA.0260] www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X:Press Imprint Map/parcel Number Property Address / Z t7ikslL Wz2aJ Cie. 1-1 ce&ioli S MA 0 •U Residential Value of Work 35'3R J Minimum fee of$35.00 for.work under$6006.00 Owner's Name&Addresses -P a U hxz lr- Or. C-EQ41ev iii t(e 0 z(o-3 1— Contractor's Name dAt—)ao Kl a y1 z— Telephone Number s 3 718 /6'// Home Improvement Contractor License#(if applicable) i Z E F Construction Supervisor's License#(if applicable) 0 G 9 Cc,, e p ❑Workman's Compensation Insurance lm one: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name N&H. .S S C [► W-8Fl(rflftf14,Grrtp. Policy# 9 12 f 7 r-1 1 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 autCl _'girl Eli ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ,�,/ #of doors IZ9 Replacement Windows/d ors/sliders. U-Value 01 `3 i (maximum .44)#of windows Q �t�V�. lw-k Avu;�cs5 ev+ ,r..��kG,-Zwu,-,k S t 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 req it d. SIGNATURE: .� _.__..s 2-4 2r U Q:IWPFILESIF0RMSlbuilding permit forms\EXPRE90, Revised 670110 _ S 307 Ma atr i2c! Y� �o a� ` Sgutl-t Dennis, MR Q266Q a MA.:Uc 4069680 copecodwrndows com i i iC #124793 f (866) 398 1511 oii Free (50.8) 398 151 i . i3ertnis, Q i PHONE DATE TO. /M William Nye: 508. 775-.7462`; 5/9/2011 27 Deepwood Circle JOBNAMEI LOCATION n " ne' And.erse Si lverli " windows Centerville MA 02632 120 Castlewood Circle Hya`nn is;: MA:02601 JOB NUM ER JOB PHONE 74 — —62� REVISED 508 364 189.1 jWe hereby submit specrfieatrons and estimates for.;: 1 Remove nine pair.- of wooden°;double hung window sashfbalances, and one wooden picture window sash, and replace/ zstail with nine ali vinyl 11,And ersen:'tSilverline" replacement windows and one all ,vznyl: Andersen ">Silve'rline" picture window; sash:: in same locations. New Andersen "Si:lverl ne" iaindows wi11 have a white:;vinyl•-exterior with'a white vinyl. int'erior,? white hardware full screens, `;tiltwash ability, aid .Low-E3 argon gas filled insulated: glass Ne.r windows-willYiave 'grilles between.ahe':glass with the same patterns as the existing windows have 2 Insulate cavities of :new windows and ta1. ke :old w;andow sash/balances to the dump. 3 Make :arrangement:-for `delivery o.f new.:windows 4 ::Supply: town: of Barnstable building permit-at coat, (: estimated cost of $ 25.00 ) , payable upon frsa scheduledw payment Any, repairs to .the windows, rnust:keep to the same size as measured, other wise I am not respon sib 1e for the windows not fitting. properly ::or at._alI. This proposal, does riot` include any pain ti,iig, staining;, or other 'repairs not described above*' . * .All An'derseri products 'described :above: will::.be prepaid.:by the home owner. * Any changes to tYi>s proposal musa be :done :in writing:°and. accepted by both parties. *: If this proposal is satisfactory, ..please :sign .the YELLOW copy and return with payment achedule. . ** :Please make a check payable to Vasco: unez Carpentry in the amount '.of .$ 2,413.17 for your new Andersen windows: described .above:and please include this check with your. signed proposal. Allow 3 4. weeks for:: delivery,:: this isa factory order. ..Upon completion of this job I will �glve you^the invoice for our new windows P.rO Ose hereby to furnish matenal and labor complete in accordance with the.above specifications,for the sum of: three Thousand Five Hundred Thirty Eight and 17/100 Dollars 3, 538.17 dollars($ ) Payment to be made as follows: . - Labor: 50% Down payment to start at time of start, plus permit fee. . . . . . . . . . . . . .$ 575.00a Zabor: 50% Upon completion at time of- completion. . . . . . . . . . . . . . . . .$ 550.00 Total labor and permit fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 11125.00. All material is'guaranteed to be as specified.All work to be completed in a professional Vkl manner according to standard practices.Any alteration or deviation from above specifications Authorized — involving extra costs will be:executed only upon written orders,and will become antxtra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or , delays beyond our control.Owner-to carry fire,tomado,and other necessary insurance.Our Note:This proposal lay be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 15. days. 3 Acceptance Of Proposal--The-above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are aut rized to do the work as k C JJ specified.Payment wilhbe ad as dined above. Si nat a !'-.� 4. t Sign ure Date of A tance: I �� The Commonwealth of Massachusetts I ^ i Department of Industrial Accidents 4 � Office of Investigations '600 Washington Street Boston, MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): VASCO NUNEZ SOUTH DENNIS,MA 02660 Address: City/State/Zip: Phone #: -1 �`1 F3 /5_ l 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. $ ? ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI.Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.K Other [� (M .-07 comp. insurance required.] vi *Any applicant that checks box#I 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 their workers'comp.policy information. 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.#: P"[ (",�' Expiration Date: 0 ")z Job Site Address: 1`ZO l-�t, � �A City/State/Zip: t�1 MA Attach a copy of the workers' compensation policy declaration page (showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a . fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a.STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under qthleains andpenalties of perjury that the information provided above is true and correct Signature: Date: ,712V ZCJI f Phone# 5�1 t Official use only. Do not write in this area;to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written.". An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the,performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)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 submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license.is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the_affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant. that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-WSSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia VE A Town.of Barn-stable ` Regulatory Services , sARNSTABLE. Thomas F. Geiler,Director - 16y9L. w�� Building Division Tom Perry, Building Commissioner 200 Main Street,`Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 Property Owner Must Complete`and Sign This Section If Using A Builder I, UW4 , as Owner of the subject.property hereby authorize VASCp �_ �/1pZ." to act on my behalf, in all matters relative to:work authorized by this building permit application for: , (Address ,of job) n � Signature of Owner Date. s Print IN, If Property Owner is applying for permit please complete. the Homeowners License Exemption Form on "the reverse side. Town of Barnstable �ofz�ray ReLyulatory Services , Thomas F. Geiler,Director 1.lRNisrA.BLE MAEM 16s9. ,�� Building Division PrfO^u'{A Tom Perry,Building Commissioner 200 Main.Street, Hyannis, MA_02601 Rrww.town.barnstabl e.ma.us Officer 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or,intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who-cons"as 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 buildinl?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that,he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and. requirements. Signature of Homeowner Approval of Building.Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOiMEO WNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisi ons of this sec don.(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pc son(s)for hire to do such work,that sur h 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, Rulcs&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/ccrtification for use in your community. Fallure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license... Refer to: WWW.Mass.Gov/DPS License or registration valid for ludlvidul.use only before the expiration date. 1f found return to: f Office of Consumer Afhirs and Business Regulation t . . 10 Park Plaza-Suite 5170 �. Boston,MA 02116 All Not valid hoot srgne Massachusetts: Departmet>t 1 tf Public Sai'et-. Board of Building Regulations and Standards Construction Supervisor License One-and Two-Family Dwellings License: CS 69880 - VASCO E.NUNEZ III: 79 MAYFAIR.RD S DENNIS, MA 02660 Expiration: 1002D12 t pnimi.�{over Tr#• 342a � II ✓Re�O�t�aooa ./�aooaa�i - Office of Consumer Again&B siness Reguluttl n.:.:. HOME IMPROVEMENT CONTRACTOR Registratto � `124793 Expiration; 18fd5A-2 Ts# 286910 'B►pee lndiuletual ;- '. Vasco E.Nunez,Iti i Vasco Nunez,III*'.* 79 Mayfair Rd. S.Dennis,MA 02 Undersecretary Client#:647900 2N U N EZVA -ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE(MM/DD/ 512412011rrm PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSUHEU - IN'.i11HFH A: National Grange Mutual Insuranc Vasco E.Nunez III D16/A INSURER B. V.E.Nunez Carpentry IN SI IKFH C;: 79 Mayfair Road - INSURER D. South Dennis, MA 02660 IN;i11HFK F: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN H UD' POLICY tFFI:C I IVE POLICY EXPIHAI ION LI H TYPE OF INSURANCE POLICY NUMBER DATE IMMIDDIYYI LIMITS A GENEHALLIABIUIY MP05117J 09/12/10 09/12/11 EACH C1(ClJHHFNCF $2 000 000 X COMMERCIAL GENERAL LIABILITY DAMA�E�O RENTED -REM 1-1 $500 OOO CI AIMS MAW- OCCIIK - MFI)FXP(Any onr Pnrrc)n) $10 000 - PFHSONAI R AUV IN.IIIHY $2 000 000 GENERAL AGGREGATE $4 OOO OOO- GFN'IAGGHFGAIFIIMIIAPPIIIFSPFK: FROM ICIS-GOMFIOFA66 $4000006 f OLICY PHii LOC AU I OMOHIL6 UABILII Y - - " COMHINFU:ilNCil F I IMI I ANY AUTO (Ea mwiddn() AI I OWNFI)AtII CJS HCIIIII Y INJURY - $ SCHEDULEDAUTOS Irv,yelaun)' HIHFU AllI OS HODII Y IN.IUHY $ NON-OWNED AUTOS (Pnr arnnrnt) FKOPFHIY I)AMAGF $ (Par nrndnnt) GAHAGELIABIUIY AUIOONIY-FA ACC;IUFNI $ A14Y AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESSIUMBHELLA UABILII Y - - EACH OCG'IIHKFNCF $ OCCUR F1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE .. $ HI-IFNI ION $ $ WORKERS COMPENSATION AND nC:SIAnI e• CnH- EMPLOYEHS'UABIU I Y ANY r'Rn rRIETOR/rARTNER/EXE CUT NE ^ - - F.I.EACH AOCIOFNI $ OFFIC:FK/PAF MHFH FXC;I uul-uT E.L.DISEASE.EA EMPLOYEE $ . If yna,dumb"wlJelSPECIAL PROVISIONS buluw F.I.uI:'iFA:F.POI ICY I IMI I Is OI HEH - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements, Nothing contained in the certificate of . insurance shall be doomed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 1 HE ABOVE UtSC HIRED POLICIES kIE CANC ELLEU BEFORE I HE EXPIHA I ION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n DAYS WRITTEN 200 Main Street NO ICE 10 I HE CEH I[FICA I E HOU)EH NAMED 10 I HE LEF I,BU I FAILUKE 10 DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR UABILrrY OF ANY KIND UPON THE INSURER ITS AGENTS OR HEPHESEN I A I IVES. AU I HOHIZIA)�nf'E'PHESEN I A I NE - - ACORD 25(2001/08)1 of 2 #SB10671M71750 LS1 0 ACORD CORPORATION 1988 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parce Application # fv� Health Division Date Issued Conservation Division ;Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH o Preservation / Hyannis $' Project Street Address GAsiliew oo6 Ci Vil� '4`jA rXv1►S INAASS �wn�aA9ja&X lei'I! Address M W Q0 C-IQXJ CTelephoie y 0 -SQ(4 - 10891 CPermit"Request t4 A`%cs%C_-4e e!P YLA `►M-A Square feet: 1st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation'-y Ccm- Construction Type Lot Size t:Yam_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Wo`* Two Family ❑ Multi-Family (# units) Qs Age of Existing Structure `t C Historic House: ❑Yes Ck*<o On Old King's Highway: ❑Yes Colo Basement Type: Jofull ❑ 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 _4 a S; Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other �-, ® + _mot Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodIdoal stov1% ❑`�e��s ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: LY+sting Enev&�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# r Current Use Proposed Use APPLICANT INFORMATION ii (BUILDER OR HOMEOWNER) Na V-4 V_ W 1(5.5 /---Telephone,hopne,NumberW- 44-1 -�_ Address -Z Ae t1 TDLJ' &i &ApeD License # lJ h ow i cA (MJrSS 3 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0Asd!A \oj t,-SIGNATURE< kykk _CDATE- :D � t 110 - l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ._ DATE OF INSPECTION: FOUNDATION D FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL Y . FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. -- *� The Commonwealth ofMassachusetts Department of Industrial Accidents 1� Office of Investigations 600 Washington Street - t� C� Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber Applicant Information Please.Print Le i�bl Name (Business/organization/Tndividual): ��z �"C�-+�� Address: aw, -, w,04 Mkc.,S City/State/Zip: 92j 3 Phone #: '7 —Z> Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 employees(full an.d/or part-time),* have hired the sub-contractors 6, ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2. I am a sole proprietor or partner l 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.t. repairs oraddil 5. [� We are a corporation and its'. 10.❑ Electrical required,] 3.El am a homeowner doing all work officers have exercised their lI.❑ Plumbingrepa, irs:or addil myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required] t c. 152, §1(4),and we have no q ] 13.❑ Other 14AK «Pp� employees. [No workers' , comp. insurance required,] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit.a new,affidavit indicating such. �Contraetors 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 silt 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 dat Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties o: 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 of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby.-certify under the pains and penalties of perjury that the information provided above is true and correct Si nature: Phone# 5 official use only., Donot write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health .2, Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing,Inspector 6. Other 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 Linder any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the. receiver or trustee of an individual, partnership, association or other legal entity, employing employees, However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed.to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .. Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s).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 pen-nit or license is being requested,not the Department of Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled.out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit, The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to.give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston, MA 02111 Tel. # 617.-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Map Page 1 of 1 t Town of Barnstable Geographic Information System New Search Home I Help Parcel Viewer F Custom Map Abutters Map Size ® Zoom Out In f .......... ........... ........ ...- Full (� JPG Map: 273 Parcel 077 - Property ' Location. 120 CASTLEWOOD CIRCLE - Info I 273062 ��•r��I; N 109 Owner: NYE,BARBARA W j I 273076 - 273204008 � _- N07 N 79 _..._�_ _.._..........._.. _..___.____.�.._____ j 'Location Information— — JC{_ Map&Parcel 273077 a pi location 120 CASTLEWOOD CIRCLE # 2101 4 1110 U' ' Acreage 0.17 acres n� M IPA i:( .. �, +` Current Owner zu 3 Mailing Address NYE,BARBARA W .` 27 DEEPWOODS CIRCLE -F u� 273077 E CENTERVILLE,MA 02632 f n N.120 273204008 �dx ` jj 1 .a1?iV—kr i r q89 Apprarsed Value(FY 2010) Extra Features $3,100 ,r Out Buildings $900 Land $97,200 Buildings $85,600 329w i Total Appraised $186,800 272050 j Assessed Value(FY 2010) N 128 , ,._........... ... ......_...... .__..... ._...._.._. ........._-. ............-.. ,.. Y7Y4DY ^1 Extra Features $3,100 0 Feet NBe Out Buildings $900 Land $97,200 �r= 4i44 Buildings $85,600 Total Assessed $186,800 Set Scale 1" = 40 Aerial Photos MAP DISCLAIMER J Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions orcomments to GIS BarnritablcMA vl.2.3685[Production] 5c q(as • f R http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=273077 y 3/2/2010 Mar 02 10 11 : 01a JMD 561-278-2042 p. 1 Mar 02 10 ia:00a Susan Davies Suts-4za-barb P• r Town of Barnstable . Regulatory Services &UVnTA3LX Thomu F_Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Str=k Hyannis,MA 02601 www.towh.b arnrtable-m2.vs Officn: 508-962-4036 Fax: 509 Property Owner l V. t Complete and Sign This Section If Us' 1k BtzjI r as Qwner of the subject.PmPenY. bemby m taorize to xct oa ury 6eha]f, in in matters reiaiive to work-m6ori=4 by this binding Permit application for. (Address of Job) a-/6 tgnature of Owner Date I Print Name I€Pro e Owner is-applying for p ern-lit please complete the Horneovmers License Exemption dorm on the reverse "side. Nlassachusetts- Department of Public Safety g Regulations and-standards Building Rc*Matto Board of Bu ,. �. Construction Supervisor License License: CS 76391 Restricted to: 00 DALE,G DAVIES — 23.64*OWN ROAD SANDWICH, MA 02563 E•xpfration� 3/23/2011 E Commissioner Tr#: 12841 Board oing R ba atio5s anac `r i ^x i HOME IMPROVEMENT CONTRACTOR f Registration: 154345 t Exp1ration 228/2011 Tr# 280927 r type Individual ° DALE C.DAVIES i DALE DAVIES TIEWTOWN RD:. DV'JICH � A M4 02563 Z1tiw� oar � T V gg,30 ` IT rQ t n N m a�• oo I s� o ' PgvE� h2+u k3�};� /o' LAJ n_ N � m � y J m GS" I 'Z ...-vi tr L Li SA LP ti i Z�C(o c.4h fl%3oVG 9k' - X w f 3' AL. sro O-th Oao fZ- , Zvi r MaJ 5P.4c� A�3046 Z X 4 Bi19ClT . M rn/ L4nl L)/AI P- -=Q CL+40 S/yl i bT PT 9Ect-146- ra¢. 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