HomeMy WebLinkAbout0002 COMPASS CIRCLE � �� pa s s C i r,
��
i
Town of Barnstable Building
Post;This.Ca'rd So°T,hat it.is.:V�sibleFrom f he Street .Approved PlansrMustMAS!L be"Retained onJob and this Card Must;be:Kept^ E-
:_
' Posted Until;Finalans
1� .�� •„...v ua�,...,..8 r s.""' `,gyp.e. ".Jb s ,,,..� ;"?�' �S ..:: tr. 'e,.,J�a � ae �TMp. �:3 .¢°. ,i� 4r' -�.t�a'�
Where.a::Cert�fica'teof Occu' anc is,Re ureil;suchB;uilhn shall�Notbe';Oc pied until a�Fnal,Insp ction'has been;made �,'
Perm
Permit No. B-20-2050 Applicant Name: BRIAN DENNISON Approvals
Date Issued: 07/31/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/31/2021 Foundation:
Location: 2 COMPASS CIRCLE,HYANNIS Map/Lot: 310-390 Zoning District: RB Sheathing:
Owner on Record: LOWE,ETHAN&KATHLEEN g Contractor Name:-.SOUTHERN NEW ENGLAND Framing: 1
WINDOWS LLC
Address: 2 COMPASS CIRCLE 2
{ -Contractor License: 173245
HYANNIS, MA 02601 Chimney:
Description: INSTALL(8) REPLACEMENT WINDOWS NO:STRUCTUR43 ,Est. Proje¢t Cost: $ 14,634.00
Per.mit:Fee: $74.63
Insulation:
Project Review Req: GLAZING REPLACED IN HAZARDOUS LOCATIONS AS EFINED Y
, Final:IN 780 CMR MUST BE TEMPERED OR E4UAL. ! Fee Paid. $74.63
Date. 7/31/2020
Plumbing/Gas
,O
` Rough Plumbing:
"Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by thi�, pproved
permit is commenced within six months after i�suance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the construction documeAts,for which this permit has been granted.
s
All construction,alterations and changes of use of any building and structures shall bel'in compliance with the local zon i ing by laws.an8 codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. Electrical
,. Service:
The Certificate of Occupancy will not be issued until all applicable signatures by'the Building and AFire Officials are provided;on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Rough:
kr
1.Foundation or Footing
2.Sheathing Inspection Final'
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation -Low Voltage Final:
7.Final Inspection before Occupancy _
Health `
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Final:'
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site ` Fin.al: .
biJ TN E
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
•
A414 Application number... ...... ................... ....
Fee .........................3:S...............................*........
# f t Building Inspectors Initials.. .
Date Issued...1. �I�l.a......................................
Map/Parcel........ .........5? .b...........
TOWN OF BARNSTABLE ---
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: ('{`L(?—Ss C,°rc%
NUMBER STREET VILLAGE
Owner's Name: t�� j� L, Phone Number�? l c 0
Email Address: ° / co.r-e-c wS-e P�, �:., s F _ A t- Cell Phone Number S,1�c w C�t S,C-e-
Project cost $ o�, d00, 0 Check one Residential�_ Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accorddnce with 780 CMR
Owner Signature:. Date:
TYPE OF WORK _
f
siding- , ,❑ Windows(no header change)# Q .Insulation/Weatherization
0 Doors (no header change)# Commercial•Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to Cc-Imo S '
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s) will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No____,if yes, a gas permit is required.
Natural Gas Yes No , if yes, a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
F/ HOMEOWNER'S LICENSE EXEMPTION _
Homeowner's Name: 'I�.r^�
Telephone Number(7-2 C/O Cell or Work number SGn-w
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date 1��d -
APPLICANT'S SIGNATURE
I
ignature Date / L/
All permit applications are subject to a building official's approval prior to issuance.
~The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Info m�ation Please Print Legibly
Name (Busi es' s/organization/Individual): f v1 Lp C-.Le
Addre�ss � G'
City/State/Zip: Phone �`7�� Cge'— 3
Are you an employer?Check the appropriate box: Type`of project(required):, ,
1.❑ I am a employer with 4. ❑ I am a general contractor and I - -
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. ,7. ❑Remodeling
ship and have no employees These sub-contractors have.
< 8. ❑Demolition= -
Demolition-
working for me in any capacity. - employees and have workers' .
Ae # 9. ❑Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its -10.❑.Electrical repairs or additions`
�3� 1 am a homeowner doing all work . officers have exercised their' 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.JZ Roof repairs
insurance required.]t s ;4 c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.
t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have .
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 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 morkers' 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 aAday 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
Sign tore: Date: `Id-ZI y
` 6
/ r
Phone#: (77 iS' —E3 el b
Official use only. Do not write in this area to be completed b city or town official
;
f.1- . Y , ►np Y tY ff, .
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#:
k
Information and Instructions
r
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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call. .
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
vvww.mass.govfdia
c
Cape Save Inc.
7-D Huntington Avenue
South Yarmouth, MA 02664
Tel: 508-398-0398 Fax: 508-398-0399
8/15/16
Thomas Perry CBO
Town of Barnstable
Building Division
200 Main St.
Hyannis,MA 02601 .�
RE: Insulation Permit B-16-1968
Dear Mr. Perry.
This affidavit is to certify that all work completed for 2 Compass Circle,Hyannis has been
inspected by a third party Certified Building Performance Institute(BPI)Inspector.
All work performed meets or exceeds Federal and State Requirements.
Sincerely,
Willi 1VI T
am c luske C Y
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 3 9 V Application # 410
Health Division Date Issued -7 L"r l4
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board }
Historic - OKH _ Preservation/ Hyannis
Project Street Address
Village Y p
D 1 s
Owner ;_' G.n 1-15W Address g �°
Telephone `s R 3
Permit Request +o
VA �w bw .
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Vqoo Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished AANN 4/%
FP
Number of Baths: Full: existing new Half: existing iio, new
Number of Bedrooms: existing _new TOw 112916
Total Room Count (not including baths): existing new First FI orR6%g4�gpt
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes �No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Qp
Name 1ful Telephone Number
Address tr License# :T LID
AGMs to g Home Improvement Contractor#
Email Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
s FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
L} r
MAP/ PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
i FRAME
t' INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL 4
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
i
FINAL BUILDING
z
'DATE CLOSED OUT
ASSOCIATION PLAN NO.
s
_The Com.monwealth of Massachusetts
� S Depart`nent of Industrial Accidents 'z
s . I Congress Street,Suite 100
Boston,MA,0211 -2 7
oM www.massgov/did
NN'-orkers'Compensation.Insurance Affidavit:Builders/ContractorsMectrictans%Plumbert-.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Anulicant Information Please Print Legibly
Name(Business/Organization/Individual):Cape.Save,lrlc
Address:7-D Huntington Avenue
South.Yarmouth,MA 02664 = E,
City/State/Zip: Phone:#::508 398-0398
Are you an employer?Check the appropriate hot:, s
Type of project(required):
1;✓ Tama employer with'_ 1.5 em to ees full and/or art-time.'t c.
P .y (. P ). 7. New construction
2. I am a sole proprietor or artneishr and have no.employees workin for mein
P P P P �- working 8: Q Remodeling
any capacity.[No workers'comp.insurance required.]
9.,1 Demolition.
3.M I am a homeowner doing all work myself:[No workers'comp.,insurance required.]? .+
10[]Building addition
m 4.M I a a homeowner and will be hiring contractors to conduct all work on my property. I will.- r—
ensure that all contractors either have workers-compensation insurance;or are sole 1 L❑Electrical repairs or additions
proprietors'with no employees.' , 4`i 12.❑Plumbing repairs or additions
y
5.❑-Tam a general contractor and L have hired the sub-contractors listed on the attached sheet. 13 ❑Roof repairs t
These-sub-contractors have employees and have workers'comp..insurance.-
6.❑We are a corporation.and its officers have exercised their right of exempfion per MGLe. 14.[R]Other Insulation.
152,§1(4),and we have no employees.[No workers'comp.insurance required]
*Any`a licantthat checkshox#1 must also,fill.out the section below showing their workers'PP g compensation policy information. ••
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affiidayif indicating such.
*Contractors that check this box-must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities.have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. '
I:am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site
information: _ '
Insurance Company Name' Star Insurance Co.
Policy#or Self:ins.Li c:9- WC085540700 ': �:Expiration Date: 4/9/2017
Job Site Address: 2 Compass Circle City/State/Zip:Hyannis
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL-c. 152,§25A is a:criminal violation punishable by a fine 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$250.00 a
against
the violator:A copy of this statement may,be forwarded'to the Office of Investigations of the DIA.for insurance
overage
,.Y
1 do hereby certify under fh pains and penalties of perjury.that the information piovided above is true and correct
Signature: Date: 7 8/16
Phone#:508-398-0398
Official use only:.Do not write:in this area,to be completed by city or town offic at
T' • City or Town, �_- -t - tl PermiflLicense# -
Issuing Authority(circle one): {
1.Board of Health 2.Building Department 3.Cityl-Town Clerk 4.Electrical Inspector 5.Pllumbing Inspector
6.Other
Contact Person:. Phone#:
ACORD DATE IMMIDDA YYY)
CERTIFICATE OF LIABILITY INSURANCE 4/12/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS.NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
I
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on his certificate does not confer rights to the
certificate holder in lieu of such endorsements.
PRODUCER NAME ONCT Lusk Strategies .Company
Risk Strategies Company a00r o E �781)9H6-4400 FAX No:091)963-4420
15 Pacella Park Drive ADDRESS:randolphcld®risk-MAIL
Suite 240 INSURER(S)AFFORDINGCOVERAGE NAICS
Randolph 14k 02368 INSURERA:Selective Ins. of America
INSURED INSURER Allmerica Financial Alliance Ins Cc 10212
Cape Save, Inc INSURERC:Star Insurance Cc
7 D Huntington Ave INSURER D:
INSURER E:
South Yarmouth MA 02664 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL1641211375 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'THE POLICY PERIOD
INDICATED: NOTWITHSTANDING ANY REQUIREMENT,TERM OR:CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N ... POLICY
-POC EXP . .
LTR. TYPE OF. POLICY NUMBER MM/DD MMI00 LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGO RENT'o
A CLAIMS-MADE �OCCUR PREMISES 100,000
PREMISES jEa ocwrrence $
X 01004480 10/10/2015 10/16/2016 MEDEXP((Any one.person) $ 10,000
PERSONAL&ADV INXRY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY-�'E �,LOC PRODUCTS-COMPIORAGG- $ 2,0,00,000
._.. .. ..
OTHER: $
AUTOMOBILE LIABILITY LIMITINGLE $ 1,0,00,000
Ee eccidont
B ANY AUTO BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED AWBA46796600 11../6/2015 11/6.12016 BODILY INJURY(Per accident) $
AUTOS AUTOS
X HIRED AUTOS X AUTOS NON-OVW (PerED P OaERdT AMAGE $
$
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAWS-MADE I AGGREGATE $ 1,000,000
.. DED RETENTION.$ NIL �81994480 10/16/2015 10/.16/2016 .. $
WORKERS
AND Et COYER3'LJABIL�TY YIN Officers Included for +. ,X STATUTE �OER
TH
ANY PROPRIETORIPARTNERIEXECUTIVE coverage. E.L.EACH ACCIDENT $- 500.,000
OFFICERIMEMBEREXCWDED7 NIA
C —
{Mandatory in NH) WCOSS54070.0 4/9/201.6 4/9/2017 E.L.DISEASE-EAEMPLOYE $ 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPnON'OPOPERATIONS I_LOCATIONS(VEHICLES(ACORD 101„Additional Remarks Schedule,may be attached If more space.le required)
National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial. Gas Company and NStar
Electric are all included as,.Additional Insureds with respects to the General Liability coverage of named
insured. as required by written Contract,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Housing Assistance Corporation 7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS,
Barnstable County
460 West Main Street AUTHORIZEDREPRESENrATIVE
Hyannis, 1rfA 02601
Michael Chris tian/CLC ='^
D 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025,(201401)
Town
it
tom. owe. of Barnstable
t Regulatory Services
la vsrwsu. *' Richard V.Sudi,Director
1
s� JBu id.iu )Division
Tam Yeriry,Building Comnussio'cor
200 My in Street,Hyannis,Mik 02601
tii vwAown.barws ble nia:vs
4flce: 509-86240-8 Fax: 508- 90-61M
PropextrOvalex Must
Complete:and Sign Tluis Section
zf�s ABuilde
I, ►f,,/� �..�4(;a. �• ,ac::C?�-Tier ref.t]ac:subject p1'��Petty
licrch-authorize QR(n 2G� to act.onmybehalf .
iii all=acr; relaziv'e-to ccork authorized.by t4► biii C6-,p`i it applicat on`for:
(Address of job)'
job)
ool fences and alar=q are t6 rt✓spons ilit r of e applicant. Poc 1s
afe riot to.be fiRed'car utilized.before fexi �5 ins,14ezd and all ii al
inspections are pexfcurnerj and accepted_
.�:.
_._ _...._�.. 5i nat'=of Owner Si,nat�tr6of Applica<lt
Print Name Punt:-Nam.
Date
Q;FORPIS:O�YNF.�tf'ER1rt1SS�.ONPC){)l
Office of Consumer Affairs and Busness�Regul'atlor
Park Plaza .Suite 5170
Boston,<Massachusetts
Horne.Improvement:Contractor Registration
Registration 171380
Type Corporation
t.�.
Expiration: 3/14/2018 Tr# 41.9291
,.
CAPE SAVE INC. ss
��
WILLIAM McCLUSKEY
7—D HUNTINGTON AVENUE
SOUTH-YARMO'UTH AMA 02RA
664
v Update Address and return card Mark reason for change: .
Add"res§. .�;I2eneival 'Employment [' Lost card:
sca i 20W06/11
.�1@�a�cUneo�uuercfl�"a�'P/�Ci1.r�nc�cc.;eGt '
Office of.Consamer Affairs;&Business Regutahoa License or.registration valid for in4ividul use.only
Ka-
HOMEIMPROVEMENT CONTRACTOR before the expiration date If foundreturn fo
Registration 171380 Type: airs°and Business Regulation
P Office of Consumer Aff 70
Expiration 3I1412018 Cor oration I&Park Plaza Sdite 5
' Boston,MA.02116
CAPE SAVE INC.
WILLIAM MCCL'USKEYjf`
7-D HUNTINGTON.AVENUE
L
SOUTHYARMOUTH MA.I)2664
Undersecretary" ".' Not valid' ' signature
Massachusetts-:Department of Public Safety
Board of Building Regulations andStaridards
l tj/11i1 Ullltill Jlf rlC l'\I1111 J�/Ll.ld'}L\" .}B„ '� ,/�� r • "
License: CSSL 102776
W ILLIAM J MC CtU '•p.
37 NAUSET ROAD
West Yarmouth IRA
Exp
. i
,J..4.,,...dj�•: "ration. .
Commissioner 06128t2017 ;
1 -
1
�VHGE t Town'of Barnstable *Permit
Expires 6 month om rssr a date
Regulatory Services Fee
MASS. •� Richard V. Scali,Director
C ArFD MP'1 p
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Z." Not Valid without Red X--Press Imprint
Map/parcel Number 3/d.
Property Address
Residential Value,of Work$ 300 ` Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address (! '
IPA
Contractor's Name C' �AR lYPL/?%ac Telephone Number -5�-7
Home Improvement Contractor License#(if applicable) 1;7,e0g"�T E,' Email:
Construction Supervisor's License#(if applicable)
a
❑Workman's Compensation Insurance .
Fk one:
am a sole proprietor MAR $ �016
❑ I am the Homeowner TO 1 A TOWN
El have Worker's Compensation Insurance N OF
BpRNSTABLE
Insurance Company Name(6m'I
Workman's Comp.Policy# /l
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Requ t(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to,,Nz
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*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. '
w_ A copy of the Home Imp ovement Contractors License&Construction,Supervisors License is
4_reuired.
SIGNATURE:
Q:\WPFILESTORMS\building permit forms\EXP .doc
Revised 040215
ne Commurrivealth Of Vassachusetfs
Deepartrgentoflnd, DialA.cciderLt,
O we Of M-WI5'11giQ iem
600 Washir;•gtoxt Street
Boston,MA 02111 -
wipm:inasmgm1dia
Workers' Campensaisan Iusurance Affidavit~B•uitders/contracturslEIectricians(Plumbers
Applicant Infarmatian Please.Brim I AW''bIy
Name(l3tesstOFganiiationlrndividual L
City 'fate( : a 2 Phone
Are�o'Z:,o..employer?Checkthe appropriate box:
Type of project(required):
I L am a employes v�ith 4. 0 I am a general contractor and I
ogees(full aaldlor part-timer
* have hired the sub-contractors 6. ❑New construction.
2. ' I am a sole pmpnetor orparbier- Misted on the attached sheet 7. 0 Remodeling
ship and have no These sorb-contractors have
employeest
$. ❑Demolition
waddn,cr far one in any capacity. employees aard have wodrers'
[No U-0doers'comp.imnuance comp-msurance 1 g. 0 B.uilding addition
required-], 5- 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 3.❑ f am a homeou�er doing all work 1 L❑Pluanbsag repairs or additions•
myself[No workers'camp_ tight of exemption per MGL ry
insu ce retliiired.]o c.152,§1(4h and we have no 1. afrepairs
employees-Wo worms' 13.0'Other
comp.insurance required_]
'okayap KCMtdatcbedmbos#lmn alsofillovtthesection below shmemgtheirworkers'compmsa&aporuyiaformsacM_
Ham-who sabmit this ifi]dmat mEtating they are doing aII wort and&m him outside coat xctorsmmSt submit a new affidavit iFl�-writ
40autzact m that check This box mast attached as addiaional sheet sboukg the name of the sub-contrsc ms and state whether or not Those entities bay
employees.Iftbemb-contnrctorsbaveempTopee%they=nTPm4-ddetheir workers'-wmp.policy number
lam an erlaproyer fraatispr'n'Obrg workers'coagwisir an inmirance for My errrprio-Wes Ee110Jv is flee pvticy arzd jab srte
in,for mafion.
Insurance Company l`=m:
Policy or Self--ins.Lic.4: Fxpiratio .Date:
Job Site Address: Citylstat zip:
Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and respiration date).
Failure to securer coverage as required.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to,$1,500OD and tor one-year imprisonozeat'a as wen 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 ofthe DIA for insurances coverage twificatioa.
Ida raereby c f� order f}te pair rdpon ' o.fpetrury trratf7te irrformatimi prmided abm e s bus artd correct
Si�ature: Date: 3 mod'
Phone 9: '5-,0 q
Of dal use only.,,Do stot write in this area,to be completed by city artown ofj`rcidt
City or-town• Perr WIAcense if '
Inning Authority(circle one):
1.Board of Health 2.Building Department 3.Ci yfrown.Clem 4.Electrical Inspector S.Pivaubmg Inspector
b.Other
Contact Person: Phone#-
Information and Instruc-ions '
Massachusetts General Laws chapter 152 requm all employers fo provide workers'compensation for their empIoyees.
pm:saant`tD this SbAUt'e,an.ezrployee is&fined as.--every Person in the service of another under any contract of him,
express Or implied,oral or wlltfEni
An.vnPTvye�r is defined as-an.individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged is a joint ent prise,and including the legal representatives of a deceased employer,or the ;
receiver or trustee of an individmI,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 -
dVe1ji g house of another who earploys persons to do maintenance,construction or repair work on such dweI[ing house
or on the grounds or building appu tenan:tthemto shallnotbecanse of such employmentbe deemedto be an employer."
MGL chapter 152,§25C 6)also states that"every state or local licensing agency shall withhold the issuance or i
renewal of a Iicease or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has notproduced acceptable evidence of cdmpfiance'with the insur-an+ce.covex•agereq=vL"
Additionally,MGL chapter 152, §25C(7)states"Neither the commanwealth nor nay of its political subdivisions shall
enter into any contract for the performance ofpnblic work until axeptable evidence of compl=cewiih the insurance..
requir=Cuts of this chapter have been presented to the contracting anthoiity_"
Applicanfs ;
Please fill out the workers'compensation affidavit completely,by cher_Iong&e boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)andphonenu n er(s)alongwiththeir certificates) of
i o=ance. Limited Liability Companies(LLC)or Limited Liabfiity Partnerships(LLP)with no employees other than the
members or partners,ate not required to carry woricers' compensation insurance. If an LLC or LLP does have
employees,a policy is regnired. Be advised that this affidavit maybe submitted to the Depa-fraent of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date+he affidavit The affidavit should
be retumed to the city or town that the application fur the permit or license is being requested,not the Department of
„ . Accidents. Should you have nay qn estions regazdmg the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number Usted below. Self-in�companies should enter their
self-fi gnu auce license nuruber an the appropriate line.
City or Town Officials .
• T -
Please be sure that the affidavit is complete and printed legibly. The Depatment has provided a space 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 pen litllicense number which will be used as a reference number. In addition,an applicant
that must sabn>ii multiple pennit/license applications in any given year,need only submit one affidavit indicating current
p olicv-h l =a-tion(if necessary)and under"lob Site Address"the applicant should< {e"aII locations n (city or
town)--A copy of the•affidavit that has been officially stamped or marked by the city or to may be provided to the "
applicant as proofthat a valid affidavit is on file for fotue permits or licenses Anew affidavit must be filled oft 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 fn bum leaves etc.)said person is NOT required to complete this affidavit
like to thank you in.advance for your cooPeration and should you have any qu�ons,
The Office of Investigations would
please do not hesitate to givens a call
The Department's address,telephone and fax number-
The Oa-MMoMweaZf of Mass achu3e±s
Dtpadment of ISdustdal AQCZeD:�
BQAoa.,MA 0211£
`e,-L 4 617 727-4M Cx- 4-06 or I-�977-MASSAFF,
Fax 4 f 17-727-7M
Revised 424-07 Mas.5-ga r1dia
BA 324STABM ;
.
i639019 Town of Barnstable
9� � ���
ArED MA'S�
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must.
Complete and Sign This Section ,.
If Using A Builder
as Owner of the subject property
hereby authorize _ w Y� �7�z to act on my behalf,
in all mattets relative to work authorized by this building pertnit application for: `
40
(Address of Job)
A6�k � Z r 3IF 1C
Signature of Owner Date
r 44 L-0 �Q 1
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side. _ f
QAWPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
r
Town of Barnstable
Regulatory Services
pfrt rqy Richard V.Scali,Director
Building Division
* txsraare Tom Perry,Building Commissioner
MASS.
v 1639. ,0� 200 Main Street, Hyannis,MA 02601
�ATFD 6 www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone# .
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year ear 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 reMonsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval ofBuilding Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible. .
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EEXPRESS.doc
Revised 040215
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ions
Chadw TPardy
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West Wareham KA W76
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—�
Office of Consumer AMrs&Bfyiptess I alatioa
N = HOME IMPROVEMENT CORM
CTR
_ RegLstrado»:;t,;176686
_ Expiratioffl,�,.•J_/1 IndNidual _ y
CHARLES T.PURDV)J -! = ..
zi
CHARLES PURDY7.
=` =
12 BLACKMORE Pam ' " 3
WEST WAREHAM,MA 0166
UaAersetetery
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A.hl,30 0 41, Peeeie"ag Ta"" in6 � �7
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f
Assessor's map and lot number .........................................
(I
SewageaPermitinumber ......��t.. f............ ................................
FTNEt TOWN OF BARNSTABLE
i •
i $AHHSTAIILE, i
03 9. , BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ............^::.:. ........................................................................................................
TYPE OF CONSTRUCTION ...................Wood Frame...IhaellinQ...............................................................
................1Q .19...................19.7.8..
TO THE INSPECTOR-OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... r „ ,.c.. .,-...r.'....^ ..: L' ....................................................
Proposed Use ....'.TM:c .' ' „^
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner .. />/I!.:�..... ..lt' . .n Ua ....Address ............ . ....� / n yr �<'.-./ /,lrl.�.J..............
. . . ... .
r
Name of BuilderA ..........
.................Address........ ... ......................... . ............... .
Nameof Architect ..................................................................Address .....................,
Number of Rooms 4......................................................Foundation ....C!?n .....................
Exterior �.I`iite cedar Shi.nal pS Roofing ...,,.....Zt r,ha 1 i- Gh; nr11 tac
.............................................. .................................................
Floors ...............C.:.rpe.t�. ..........................................................Interior ..........►)r��t.ra'. ........................................................
. ... .. .. .
Heating +Jt `crr2tc�r nil Plumbing ........... -t �E.....: .fe... ..............................
...............................................................................
Fireplace '..................................................................Approximate Cost ..t a..^.^. :.
Definitive Plan Approved by Planning Board ________________________________19--------. Area ... ......_.........^........�.r
Diagram of Lot and Building with Dimensions Fee �1 . !'�............................... . ...
SUBJECT TO APPROVAL OF BOARD OF HEALTH
_ I
_ � I
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........`..... ..........................................................f ✓ . ';(....
_ �
Cedar Acres Realty A=310-390
? c r
20993 one story
No ................. Permit for ....................................
sing?e family dwelling
2 Compass Circle
Location .i%......................
Hyannis
t s...............................................................................
Cedar Acres,,Realty
Owner ....................................
frame
Type of Construction ................. . ....................
................................................................................
Plot ............................ Lot ,........... �+A.............
Januar 24 79 d
Permit Granted ................Y.......................19
Date of Inspection'....................................19
Date Completed(.....................................19
PERMIT REFU ED `
... ............... ....... 19
�/. ............
..... .............
i
.............................................
P,
Y
t
Approved ................................................ 19
Y
...............................................................................
...............................................................................
TOWN OF BARNSTABLE Permit No _20993
Building Inspector.
SAWWAn Cash
V6,o f `+
OCCUPANCY PERMIT Bond _ X
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
j first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has .been issued by the Building Inspector."
Issued to Cedar Acres Realty Address South Yarmouth
lot #4A 2 Connass Circle, Hyamis
Wiring Inspector f ` _ Inspection date ` !
Plumbing lY�,spedto � � ,f Inspection date �•� _�` /�
V j
Gas Inspector Inspection date
i!t
Engineering Department '/ ral�9��J/ rim, Inspection date 7�;
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE] WITH TOWN
REQUIREMENTS.
r
19
1 Building-Inspector
3
144 vo
1
1 � a
144•o t
1
.. 49AI Spa W1.41
J
4 �
.1
P6,ssessdr's map and lot number SEPTIC
SYSTEM MUST SE
., INSTALLED
ESewaZ B 60 ,, � °N' COM®P LTIAt3
NpNC�
aPprmit.number ................ ............................ V � qaTICL TEtlA TRDODNT A N
THE
ARNSTODLE,
O�Y-a���0 BUR I Gr,� INSPECTOR
APPLICATIONFOR PERMIT TO ......... .$ui•ld.......................................... ..........................................................
TYPE OF CONSTRUCTION ...................Wood Frame...Dwelling...............................................................
...............:10—19...................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to 'the following information:
Location ....YkComgass...Cir.cle.,....H.yannis......Mass.�........................................
Proposed Use ...Dwel.l..ing.....................
ZoningDistrict ........................................................................Fire District .......................................................
Name of Owner .... ... ., . . ......Address ..........�.... .... ,yZ .. Z�K '..............
Name of Builder .... k,Z
��% �:} ...........
< ......... - ................Address ............... ~��.. � !d�/l �
Name of Architect ............ ......... ..Address ..................
Number of Rooms ...........i......................................................Foundation ....C.QnCrete.—.Full..........
..............................
Exterior White cedar„shine.5.....................Roofing ..........Asphalt-Shingles.................................
Floors ....................carpe,ts.......................................................Interior ..........Dxy. wall........................................................
Heating ........ .......................................Plumbing ...........P-1y -. —4 .....
Fireplace ........ONe..................................................................Approximate Cost .$ ...................:....................
Definitive Plan Approved by Planning Board --------------------------------19--------. Area 1...., .... �
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
4
Name ... ...
Cedar Acres. Realty
s 5
{
�20993........ Permit for /eooryN� ...... ..........
` single family dwellin i s
t
!. Location . ....� Compass Circle
.. .................... ,
..... .... F
Hyannis. r
r Owner ...........C,edar. Acres Realty...............
............................................- . _ .',sa•a,..a.j.
Sre.
eal
Type of Construction ............frame...................
............... ..............................................................
Plot ,
i
............................ Lot ...........#/.aA..............
Permit Granted .......January..24..........19 79 ,, t
Bate of Inspection .........................:...........19 I
t
Date Completed .......................................19 t
—Z
PERMIT REFUSED r ;
................... ......................................... 19
................................... .................................. + ± 4 . P. .c,... ..• i
........................... ........... ...................................
• ..... ........... ........................................ ...........
............................................................................... •s . - . :. � ...- f.r
.y
Approved ................................................ 19
...............................................................................
...............................................................................
F