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HomeMy WebLinkAbout0009 DACEY DRIVE J Y II 1 I �T t (V4_ C) C i P V i Application number..:.....` a Date Issued................1.�.1(�_�,.1�. � MASS. //� ' ep�a6gS. Building'Inspectors Initials......... . ..... ,,�� Map/Parcel.....°?-a b 3 ........ ........ ® ' A� STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION N PROPERTY INF®RNltA'fl'I ON Address of Project: LS&Epf R STREET VILLAGE Owner's Name:_4 Phone Number,SDI 7 90 ",3 Q Email Address: Cell Phone Number Project cost$ y6�ts Check one Residential Commercial ®'dV N1'UW S AUTHORIZATION . As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See A,�oQ � 1, 'ram Date: TYPE OF W 71 Siding Kwindows (no header chan )# Insulation/Weatherization Doors (no header change)# Co tai.Doors require an inspector's review I 1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name l 1-2� Vr,1 Home Improvement Contractors Registration(if applicable)# //2-7 8 S (attach copy) Construction Supervisor's License# 07 CO 7 / (attach copy) Email of Contractor Swe �[f See 5M 4 • C c3 Phone number °yo/- 7IV- 6 3'�9 ALL PROPERTIES THAT HAVE STRUCTURE OVER 75 YEARS OLD OR IF THE.SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUE®. 1 APPLICATIONNUMBER..................... ......................................... *For 'Vents 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. 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 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-4:30pim Commercial events may require Fire Department approval *WOOD/C®ALdPEEEET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMTTI®N Homeowner's Name: . Telephone Number -Cell or Work number 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 PAPPLICANT'S SIGNATURE A P�P:L I�C Signature Date All permit application are subject to a building official's approval prior to issuance. Home Improvement Agreement: Pagel Home Depot License #'s - For the most current listing www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Janice Campbell Salesperson Name: Registration No. (if app icable): Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. CURLEY MARY New England South I 1-AULWGSI Customer Cast—Name Customer First Name Store #/ Branch Name Customer Lead/ P # 9 Dacey Drive Centerville I MA 62632 Customer Address City State Zip (508) 790-3539 1 1 ianice_campbell@homedepot.com Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 1 IShrewsbury MA 01545 Address City State Zip Or Email' I customercancellationnortheast@homedepot.com Service Provider Email Address BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING,'UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 12/06/2018 Customer's Si nature Date Contract Price and Payment Schedule : Payment of the Contract Price i due upon signing unless a different payment schedule is required by law, specified below or in a pay ent addendum. Contract Price: $ 14647.80 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ o.00 (If applicable) *Maximum deposit ONL Y applicable in MD, MA, ME(331yo), NJ, Wl(99%) Dep. 125.0 % Deposit Amount $ 11161.95 Remaining Balance $ 3485.85 The Home Depot-2455 Paces Ferry Road, N.W. Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-4664337 460 HDE Customer Agreement(24 Jul.18) v 0.1.7 Comnonweafth amassastutsettS ision Of Professianaf Licensure Board Of Building Regulations and Standards Canstr ri�§4 rvisor CS-$f { S3TI ires: 1213012020 JOSEPH C 15 FAf:.L ST WAREHAM MA Cmmissioner i Yy ./s:.= �f.ir ii114?!!.r>-✓i�`�.��;l�<:��zrr!l�Yrlvf."%,�s _. � - Oftice of Consumer Aftairo&t min s Repubman HOME IMPROVEMENT CONTRACTOR Registn�on aaitd for insf�vidusi use only � } TYPE:Par[netst» before dee eapiratian date.:tf found e"t, ' g: Re�ssttatfo F�cstir�tian . o fice of ConsmerAffai Arw eus sSRegt►�on ; 132 0111=021 t0il0Y644ngt6rtstreet-S ke710 - t3ostan M A tl2i18 JOSEPH C.DUARTE DB/A J&J REMdDELiNG. {}. JOSEPN G.pUARTE 15 FALL ST. Qt.vaffd without sgnatare ,WAREHAM,MA 02571 Linder etary r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): dividual): �.J b . ' Address: 15 S l City/state/Zi �J n 024-7 Phone#: 77,-fl- 746 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have • g, Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.* 9. Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing'all work officers have exercised their I LE]Plumbing repairs or additions +! myself.[No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' I3.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section.below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation.insurance for my employees.Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: _ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer 'y unde the pain nd penalties of perjury that the information provided above is true and correct. Signature: �� Phone#• 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#: 2.r,f =:= Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22/2019 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Update Address and return card. Mark reason for change. '- ❑ Address ❑ Renewal ❑Employment ❑ Lost Card Office of Consumer Affairs&Business Regulation = -- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only - - TYPE:SuDQlement Card before the expiration date. if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 112785 04/22/2019 10 Park Plaza-Suite 5170 90ME DEPOT USA INC Boston,MA 02116 ANDREW SWEET 2455 PACES FERRY RD C-11 HSCithOul signature ATLANTA,GA 30339 Undersecretary g S Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 191 Boston,3,L4 02114-2017 .41 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appficant Information Please Print Le 'blv Name .Business/Grgmmtion/Individual): qolne, — Address: 9B �6 S �yRN>9t Citv'State/Zi : s� sd /� disY.lr Phone fi#: 7 ;2 a-�•�� sou an employer?Check_ the_ propriat Type of project(required): 1 J am a employer with �y v �• am a general contractor and I 6. ❑New construction employees (full and/or part-time).* ve hired the sub contractors i I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, r Demolition working for me in any capacity. emoiovees and have workers' t P �'• 9. U Building addition [-tin workers' comp.insurance comp.ircnrance.= 5. ❑ We are a corporation and its I0.❑Electrical repairs or additions required-] j officers have exercised their I I.❑Plumbing repairs or addition ;.[ 1 am a homeowner doing all work myself. TIo workers` comp. right of exemption per MGL 12.❑Roofrepaks insurance required.]r c-152,§1(4),and we have no empioveeg. [-No workers' 13•1 Other _ comp.insurance required.] I , •.•kr.y apoccant that checks box d1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. =Contwton that check this box must attached an additional sheet showing the name of!be sub-contractors and state whether or not those entities have employees. s the sub-contractors have emplovees,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 informartiom Insurance Company Name: r/Lr 2 dN�� (/N/Onl �'//'G �AA< Policy b or Self-ins.Lic.#: x W �i 7 I o Expiration Date: 3 ` Job Site Address: City/Stateaip.. ` t Attach a copy of the orkers' compens Lion 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 uo to$1,500.00 and/or orte-y;g imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day ag ' la lator. Be advised that a copy of this statement may be forwarded to the Office of Ir vesnQations of the DLA ce coverage verification I do hereby cerdfv un e i at the information provided abov is a and correct Si ature: Date: Phone#:L only. Do not write in this area,to be completed by city or town officialn: Permit/Licensehority(circle one):Health 2.Building Department 3.CityrTown Clerk 4.Electrical Inspector 5_Plumbing Inspector rson: Phone : DATE IMWDD/YYYY) ACORV CERTIFICATE OF LIABILITY INSURANCE 02/222018 `� 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 have ADDITIONAL INSURED provisions or 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 CONTACT PRODUCER NAME MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER arc No: 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA.GA 30326 INSURERS AFFORDING COVERAGE NAIC 0 CN101642069-HaneD-GAW-18-19 INSURER A:Oki Republic Insurance Co 2047 INSURED THE HOME DEPOT,INC. INSURER 8:New Ha hire Ins Co 23B41 HOME DEPOT U.S.A.,INC. INSURER C:HaneRisk Captue Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA.GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-OD4353430-16 REVISION NUMBER: 3 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. ADDL SUB POLICY EFF POLICY EXP INSR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/D LIMBS LTR A X I COMMERCIAL GENERAL LIABILrrY MWZY 312717 OM12018 03101201/ EACH OCCURRENCE S 9.000.000 CLAIMS-MADE AI OCCUR PREMISES Eaocc%nce� S EXCLUDED LIMITS OF POLICY XS � MED EXP(Any one person] ;S EX..LUDED OF SIR:Si M PER OCC PERSONAL&ADV INJURY S 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 90�`� X POLICY PRO LDC - PRODUCTS-COMPIOP AGG S 9.00Q000 JECT S OTHER: A. AUTOMOBILEUA6ILITY MWTB312718 03/012018 03ro120t9 CEOaa��oEQDISINGLELIMIT 5 1.000,000 X ANY AUTO - BODILY INJURY(Per person) S OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Per accident S AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE - 4E.L.EACIH TE S S pED RETENTION 5 B WORKERS COMPENSATION WC 014122577 (AN,NH,NJ VT) 031012018 031012019 ETH- UTE ER B AND EMPLOYERS'LJABILIIY Y 1 N WC 014122578 WI 031D12018 03/012019 5,000,000 ANYPROPRIETORIPARTNERJEXECUTNE ( ) ACCIDENT S OFFICERIMEMBEREXCLUDED? � N I A 5,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S It yas,describe under Continued on Addtional Page EL.DISEASE-POLICY LIMIT S 5,000.00D DESCRIPTION OF OPERATIONS below L --- C Excess Auto 297-1-10011-00-2018 03r012018 031012019 Umit: 4•�•� DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED .IN BUILDING G2D ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 101642069 LOC#: Atlanta A �® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA,INC. NAMEDINSUREDTHE HOME DEPOT,INC. POLICY NUMBER HOME DEPOT U.S:A.,INC. 2455 PACES FERRY ROAD BUILDING C-20 11 CARRIER ATLANTA.GA 30339 NAIL CODE .EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number WLR C64783191(AL,AR,FL,ID,IA,KS.KY,LA,MS.MO.NE,NM,ND,OK,SC,SD.TN.WV,WY) Effective Date:03/01/2018 Expiration Date:0310112019 (EL)Limit:S1,000,000 Carrier New Hampshire Insurance Company Policy Number.WC014122576 (DC.DE,HI,IN,MD,MN,MT,NY,RI) Effective Date:03101/2018 Expiration Dole:03/01/2019 (EL)Limit:S1,000,000 Carrier ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ,CA,IL.NC,OR,VA,WA) Effective Date:03101/2018 Expiration Date:03/01/2019 (EL)Limit:S1,000,001) SIR:$1,000,0D0 SIR for the states of AZ,CA,IL.NC,OR,VA,WA Carrier.National Union Fire Insurance Company policy Number XWC 4595580(QSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT). Effective Date:03/01/2D18 Expiration Date:0310112019 (EL)Limit:$1.000.000 S1,DDD,000 SIR for the states of CO,ME,NV,MI,OH,PA,UT S750,000 SIR for the slate of GA S350,000 SIR for the state of CT Cartier:National Union Fire Insurance Comparry Pdicy Number.XWC 4595581.(QSI)'(MA) Effective Date:031012018 A Expiration Date:031012019 (EL)Limit:$1,00D,000 'r SIR:$500.000 TX Employers XS Indemnity.. Carriedlinios Union Insurance Company Policy Number TNS C4916693A(TX) Effective Date:03012018 Expiration Date:'031012019 (EL)Limit:S111000;000 SIR:S1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I TOWIl' of Barnstable *Permit`#J�a�, Expues 6 m.onths from-sue date R .SS 'P'-- Regulatory Services Fee 3 5' X Thomas F.Geiler,Director OCT - 9. 2012 Building.Division C l0/1? 12-. Tom Perry,CBO, Building Commissioner BARNSTABLE 200 Main Street,Hyannis,MA o2601 TOWN OF www.town.barnstable.ma.us Office: 508-862-4038 Fax:•5.08-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint, Map/parcel Number �✓ I ' Property Address 9 � T1 QYI rl 1 S /Residential Value of Work.4A coo O Minimum fee of$25.00 for.work under$6000.00 Owner's Name&Address Contractor's Name `' Telephone Number Home Improvement Contractor License#(if applicable) .Construction Supervisor's License#(if applicable) 1 I I 9 " ❑Workman's Compensation Insurance CheA one: am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy.# 1 Copy of Insurance Compliance Certificate,must be on file. Permit Request(check box) Re -ro.of(stripping old shingles) All construction debris will be taken to C"7`ri ❑Re-roof(not stripping. Going over existing layers of roof) . ❑ Re-side ❑ Replacement.Windows/doors/sliders. U-Value (maximum.44) *Whcre required: Issuance of this permit does not exempt compliance with,other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own mus sign Pr erT79wner Letter of Permission. , A c y of th Ho prove en ontractors License is required: SIGNATURE: QTorms:expmtrg. Revise061306 - pfJHEy : 'I'OWn Of Barnstable: Regulatory Ser. sax�sre�zE. : vices . r� MAS& Thomas F. Geller,Director �n Building DI-vision Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wWWAormn.barnstable.ma.us Office: 508-862-4038 Fax: 50E-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property' herebyauthorize to act on my behalf, in all matters relative.to work authorized bythis building pest application for: ( ddmss of Job) Signatlu of Owner Da e Print Name WORMS:OwNERPERMISSION i - The ComIrtonweatth ofMassachusetts Departirrent ofd�ndlustrialAdeldents " .Office oflnvestigattons 141 " 600 Wash ingtot,Street Boston,AAA 02-1-7X www.rn ass.gov/dia Workers Comp ensation)nsunneAM e Applicant Informatio davit; guilders/Conn actors/Electricians/PIlxmbers 1 n Please Print Le 'bi Name (Business/Organizationllndividual) u : - ` •Address: ; I City/State/Zip: 61m6 �o Phone.#: � I 4u:n Are you an employer, Check the appropriate box: 1.❑ I&a employer with 4. ❑ I am a general contractor and I Type of project(required):_ employees (full and/or part-time).* have hired the stib-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 Working for me in any capacity, employees and have workers' 8' ❑Demolition F; [No workers' comp.insurance comp.insurance.$ 9. 0 Building addition required_] 5. [] We are a corporation and its 10.[]Electrical repairs or additions .3.0 I am a hOMcDWner doing all work officers have exercised their myselh [No workers' comp. ., right of exemption per MGL 11.[]Plumbing repairs or additions insurance required-] t 12.c. 152, §1(4),and we have no ❑Roof repairs employees. [No workers' .13.0 Other camp.msmance required.] °Any applicant that ebecks box#1 must also fLH out the secdon below sbowing their workers'c t Homeowners who submit this affidavit indicating they are doing all work and then hire outsides o tractors mucmalion sts bmit a new affidavit indicatin sue XContracto,-that.beck this box must attached an addition al sheet abowing tho niuno of the sub-contractors and state whether or not those entities havo h employees. If the sub-contractors have employees,they must providb their P(OTims'comp.policy number. lain an employer that is providing)Ijorkers'compensation insararicefor my employees Below is- y an thepol[calJ'ob site information. Insurance Company Name: Policy#or Sclf-ins.Lic.#: --- IT Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(sho-wing the policy number and e Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of c ' fplrahon date), fine lip to$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form or f a STOP WO ORDER and of a of up to$250.00 a day against the violator. Be advised that a co of this statement may be forwarded to the Office a one Investigations of.the DIA for insurance coYera c verification.COPY yof 16 hereby certify:r der ih ins-a d penalties of perjury that the information provided ab ve is ue and correct; Sienatttre: Q `/+!• Date: Phone Official use only. Do'not write.in this area,'fo be completed by city or town official City or Town: Permit/License## Issuing Authority(circle ones L Board of Health' 2,Building Department 3. 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YY %a+..•sY ,,-,-:::re-N- 9r.-,gR • ^Y '+MW...i:^.`re,!"--.t.t .�zq<.:et?.:.ia.. .+e1*.i:<>�+,,..sr�.:^a f .nwt S'i'. rr' . x s:� i - `e..-1 _ :.ir`: ..Y - :,7 ^_`a 1- - `oF1HE r � The Town of Barnstable o� BA MA9%A E. MASS. Department of Health Safety and Environmental Services Y �! t619, ,0 �FD►u.+A Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of•Inspection Nr l Location q n/k-.,. Permit Number Q Owner ff�-e,�, ', n� ra Builder n ,,,c w k_0 One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: (3 Q �3 � �C �4X6`1 r O ua 11 \ l kc� \ r4 Y'q Q V � k I,A f-)/I 'j 1:�_i'i�'eN'r )9P (po-a ot, N_\' x'U"-g.�aTt tip CA_c4 Please call: 508-790-6227 for reeinspection. Inspected by � Date �- I e VC i - � Q Irv�TLUCa p.l. _ f -a WILUA 4 �i "� } �. . f G EQTtF-1ED P Lb'T' Pt-..•1�1J Y1.E `�,LI � , 19334 ( i �. I tloC aTlo" gip►N'I�Is �.. i ! AA / 1 1^i f_:G.rSTiF=_��L1�. .r ' - r ` ' C�L � t 7 �V' SAT I✓� 1�..' S-j� Tf-1.AT_*T1-1r-V.' ,0 pLYS; W ITN -rWt . 51DE=.l.i►-16 a S,o A^uD_'SE�"C3�EIC± SgEQUjIZE TS. �F -rNC �_�� LoGL�►T��;. �/.-�-�t�ltt..l troop` ��-. gis,X'rG�Z �. u�E• ��c. . i.; f. _.�. •� �� : .\ ,� ` ,` REGISt-c-1Z�D i1 CATS �; DSTE2V1l.tL- o ArtaSS. u'oT ' 5 T t•-115 1 d . i 1:1.T�LUMEI:IT:Suc�V .fk ; Tti�� U��S�rS S�d'o!�l.n APPt_1 e.L.►-!-r �S\aE ���G fk3 i4l ��T' L 4 i�l i= _. u c� P _. hirr esc- 5 , ,2 9 n5P FT-HI _ "ij I • I � I -- R,1C- S 1 D_E CLEVATIO(_�� ' -r- -- --- - - - - ® \ l2 GI_T 1ZOOF SHIrJ GLFJ _. - -. .. ..•.�-_ .. _----__-__. _ LAP C _ C A-f ,4L r �J ALL4 - I F;R0"-- ELEVA-rtC-", Psu,Lpih1 R=VISEq U�AFL. �✓Cn C�//�rT Fr rtf Q�-000 -LAK-E-_'ISl_ES.r_P�2Eh1-r.N�O.-__._.._._C E N T C.2-V 1 L.L_E. - :EN1.112GE..'GA24G.L To .24' G-S-'2A/sE \_F g- l�r,2.G_,-!r7 I 12 I I I I I 1 w I LL 16 I I I — ---- -- Y+— I r3s�nr � ASPHALT ROOF 5�--lINVLESJ � � I ��"� ASPHALT of SH11�101_ES 12 ��VS 4 iI 1 CARAGE SLA/SI 1Zt-•Ga _EVA7 fZ El100- - --- (, 1 O/A 1 T To 24 RePLAGE J -8„ .-Ix4/nnoc, - 9EGK.IN6 ut FcaiA I LY rcoo 1�1. o� 0 Ij cntxne-r — I i f � I ! Qt I �3l•GV6 'Z C E k . t ' •AIM I rl rl �I �• :: I I A O.0 ,-'•;t' kq► O za^ II ti !tj.r of vv.! tq2 I' -5'•4' z.o S`•`4' .1. 14`•lo^ VfNVL DIKING zoo/� PE AT Ii $NWg 10 L;i JO.CEIUN(s� Isl_op[ O�1fG 11`:GFJL... t Ier L. II LI[ • - KIz c1-tEN o� � vi.vvc ' 2E F2 I � � � � - =NnLf't•Iourt 9oorz.. 2_8'-� -� �-,^ —� 8' a o gl z �2'-2 � �Co`-o` �1'•¢I I �— _ -----__.\ oRIC ' I,-- 12'cEtU NC. ^' GAR.AVE --.__. ._ LIV II-,:G d-3BL_ A'rzctNF c_4NG2 S'"r-f ' mi pt'rct-t z�• To 000a. I _: 8''4.ce.-` - : ki rLOo/✓, I 6EDR00/�" GRRPET CARi¢T .� _ -. swv�•' I sro e 1 I cc� <NO�..- S((pNS O//\._AGXj',y .9'OX 11• OEGC,,,, U y.r Zx to FIwAG d.n Ic. , i I 14 aoNc2 .4 P/ZoN. : co ( _ 2.0 ...__gt o !'�-'=��1� 9`-0^ 'I2 o f �•.g.. - �;•s.. �� 4•,•2,•. � 2�.y,.= �.,-o.. L' m ¢' .14'-0. � � � � _ �:'o... 20•.o: C�4'-od I L4.t I I I I • � I � i i iJ d _ a, 3 '2 I II o O rj i i ,� _I -�o _1 _ram•' Y Ic•• 'FcbTlr-,Gs I' , 1�2'm L1 I i Cot.Jn.we.u_S I_— - •� I � II Vl L" CCA tji— Oa-: F �S l j TY n i .I q� -I I�Eo, POGO. r � p EA/A d p� , I i G i FLILt /J NE.Y CGLJ GT Ci7 J I �J•/Z"GIN I . 4'_rz.�}>JFo2ce� court SLGP,'I I I I e oea ae 7� .�t s eornpne rE, Cn2oJEL I I m' -1zLT-C,u per¢._.2•-Te::.naorZ.,- , I I I - - P�cu.'r c.c eun L- - I _ d: I G ,w1 GS _f u7rPorT jr-fS6o lCS DROP TOP F06U I YZ.Py7SL-O-_.-/AArzck,.19ce oMwZ F,IzrLACC f3A YS tpE 3uI-p IriC�.Co INC F3u 2cu>=L-I_- f.nR..r•_ �. ,.. r k•.FI"s REG - _/Z"GOX - --GLQ pr3oA fLc Fwor --- �.i F SNIN 6_E-MC-It - i - 2Ktc�dlL" •'����� - _ 2+•�TRF-nt G-O SlU t - -ON SI UL•l'1 t1.• C '_& OM(W S'MAX. - '�ON co NGfLLriE:) r� T m iDGE SN11.1GLG3 :r -�_ 2r to r_toc.e �Lal�L l:! 2 pt32�GLnz ?L1Jn C<TWtL' -- 2" ni•zplv.v_. '( oo� t=.Or_r_�� a 'ts.. / ���r.�z. �J2t?=n i-G ..._. -_-� I/1•' SFIE CTRouC - .. - - 44 k V I T c - =Ow ibl FteJlSu`F�a,�yR SHEFTRc.xx C l2 j Son�oTU*�,.G PtE¢5 00 rII l3`•o• -_—. NO ..3�2�Nf1C.kA•g S`f'7�'g'•GO I.Klt ­JALL:S .. .O NI -1�pKlO".FOO SING h1 C� -T o o6o o4::nn -®q6 31 Assessor's Office(1st floor) Map Lot C J ' Permit# ' Conservation Office(4th floor) �1V;�::� a\ �`'q'� Date Issued 9 Board of Health 3rd floorz1,6 Engineering Dept. Ord floor House#'i! Planning Dept. (1st floor/School Admm,':Bldg.): i „ ,IMABL9,NAM s Definitive Plan Approved by Plammn wBoard a':" 19 .A lication rocess 8:30-9:30 a.m. & 1:00-2:00 .m.) � oR 10 .TOWN OF BARMTABLK 'Building Permit Application` 2-57 36 ) u� Pro-ect(Strddress � T Villa e Fire District jkf 444v Owner A,. du-c.. Address Telephone yyee 7 7 f lJ pD � w ,,� Permit Request: Z! ,4 YC V� 'TA Zoning District /2 C— I Flood Plain Water Protection Lot Size 0 Grandfathered 2oning Board of ApMls Authorization Recorded Current Use Proposed Use —e- Construction_Type (,! 1AA,2 Existing Information Dwelling T e: Single Fan-dly Two family Multi-family Age of structure Basement tune &W& C.t1`Lt.Ca�71� Q Historic House `�! Finished Old Kings Highway Unfinished Number of Baths No.of Bedrooms Total Room Count not including_baths First Floor 7 Heat Type and Fue �'l " aA Central Air Yv-d Fireplaces Garage: Detached Other Detached Structures: Pool I Attached ( ,��, Barn ` Non Sheds �3�'Ya Other Builder Information amc �r%�J ��t.G. Telephone number Address ray '7 License# 90 G q!� Home Improvement Contractor# Worker's Com nation # WC! 3 l Z : ZCt l7 E 3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. Au�ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Pro'ect Cost Fee /-A$ x 316 �® SIGNATURE / DATE� / 1 g BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T * FOR OFFICE USE ONLY ADDRESS• VII.LAGE OWNER - T { DATE OF INSPECTION: FOUNDATION FRANT e 1 INSULATION k1 lAio 14 FIREPLACE ELECTRICAL:` ROUGH FINAL ; PLUMBING: ROUGH FINAL r GAS: ROUGH FINALv. f f 7 _t FINAL B�MDING: DATE CLOSED OUT: } i ASSOCIATE PLAN NO. y. i { 1 r i 1 4 • • i ff i t + 9 " � '`- ► TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID ..000 000 0.46 GEOBASE ID ADDRESS f9 DACEY DRIVE PHONE (508)771-1040 HYANNI.%, MA ' ZIP 02601- LOT 36 BLOCK LOT SIZE _ DBA DEVELOPMENT DISTRICT PERMIT 16129 DESCRIPTION SINGLE FAMILY DWELLING (PMT_#13890) PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL- FEES: BOND Tt1E CONSTRUCTION COSTS $3.00 756 CERTIFICATE OF OCCUPANCY BAMRrABLE, MASS. OWNER BAYSIDE BUILDING, INC. , 1639. ADDRESS P.0.BOX 95 FD MtCI CENTERVILLE, MA BYI .DATE ISSUED 06/26/1996 EXPIRATION DATE - TOWN OF BARNST.ABLE' _ BUILDING PERMIT PARCEL 'D 000 000 0 4 6 (F02A SE ID hDDRS-2)2' S DACEY DRIVE PHONE (508)'7*i'1.'_,.�.- 14YANN 13, MA �j i P 02601— LOT C BI.00E LOT SIZI . llL?A DEVELOPMENT DTS`1'RICT !'1 fe-1( `.1 1.3890 i�ESC I TLON SINGLE FAMILY DWELLING (SEW.PHIT. 095--e;(.78 P_Et.�M P.3 TY11)"E �?,UILI `I'I�L'i�,a ��a}SW tE:;1DENT ,7->.L BLllG FMT 31k S i_q ?3U 1 LvD 1 N(3, INC Department of Health, Safet3 and Environmental Services :, ''u:B;:' . f uDS.i C �Im IC 00 i"AM HO AR.t`JH`L'Y P. i y tir a BUIL . DI. ON (; tLhVIL, r; 1. ii BY,��� �— EXPIRATION P � %GL•a�L'a �:� ��.�'.? .,4_,, ,�il��;;; i�ri:R.-A T1C��1 DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS `PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 6 2�1��� e 2'G 2 iNSL� �Z�•�� ��� 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 FH A r I;�T o A OTHER: �C SITE PLAN REVIEW APPROVAL � . WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 508-457-1133 nginaring Co. STRUCTURAL & CONSULTING ENGINEERS ° 'Si RED BROOK ROAD• WAQUOIT,,MA 02536 C. F. FEWORE,A.S.C.E P.E. .x 7 May 1:996 ° Bays ide Bui Iding Company,, P.O. Box 95 Centervi 1 le,°MA ..02632 Re: Garage Ceiling "Framing . 9 Dacey Drive Hyannis, Mass Gentlemen p n _ . As requested, we visited .the16bove referenced ga rage :to inspect the f ram i ngtof the Ceiling joists. . . The ceiling joists span the full width'of the garage with no supporting beAm. Exh line of,. joists is (comprised of two pieces that' ar.e slightly more than half thespEna and lap in the center. At the, lap a vertical member extends 4).to6 rafter near the ridge and. is spikedto .it. We have reviewed this system; its members and connect ions , and n our opinion it w.J 1 1 satisfactorily. support the ,loads `required by code, Sincerely yours, STE.CO ENGINEERING COMPANY (� ,vU qar e► ore., :E; President F. FEWOK AL �as4359 s 0.3-20-1996 01:09PM FROM BAYSIDE BUILDING INC TO 79062.30 P.02 f 51►. l��4F3AC4 �JZdlJ3Z., i, %` 4 SEIC i;TA�I� 33v x;ia�;• 5 ,,v �� :. � i' •SiD • ' N ldti:' •i� po� , • �� •. � 47-(D/+� •��,;._ �,5�; , � , : � +^ ss; tom. � TOTAL Z�&)t6tJ ;eau '/ rH 7OrAL . DAi�,y )V T'MM VcLATtON: '; ;FA'SFit i~;.,;`.�k1J i il'L �� /• ri q.� riRW �o� -Eli GUM �ULLIVAN J +, lyo; 29733 Sy0lrAl �EG�EtZ FG�B FG- Y' TF =8� ve i Wi4Sl A4La ,5rzt CT'dtt�3 SAY ' � 2 ..G, 2 4G�7•� � o�u �PAG,� S�BtzviS�vr-1 ,.E 1(* 36 16d +v MAP 252151 2 /q In . IS uA; ` 'l�ia .I ScAL -�Gl1-j'lOt.� �J,'T�7LVlu.b / LG-,y , : +r baTJ=s _ M ,-7 (gqy �y 'C i f : Pt..4 N R 5 :svJT-K. le yy 5 �& 0 Pc. •8 L 5O5 5 3 r �a�t`t'er� w tt�l�! T'Fi ir.R T el�i �A�p cou_7 �5 hi,r � a�1 N tc1 pPaF 55�o�1��' �dc�o Su�v �a�5 5ut'z�i�•�� : A1J� •rt�� ' a FF5 ETA '�I�(J ST�vti4 cat' ''1 (� � iT�' � `U T"D TESTA PLI_�r{ tz-(. r?•v I C /VA,S i.. - ..L._ _. _�.. u _... �. .. : dPP�.tca�-t-s 7jaA,�sl� TOTAL P.02 • COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY r I` MsOraSQhl1A! a >'t>IBN o OF ONE A � _... SHBORTOM.eLAGE. f L ! - i MASSACHiJSETTS L.. SOSTO�iV;l411iC'w8 >, -•� ! I'�� +olt+�tall9e�n.. r LICENSE r CAUTION EXPIRATION DATE CONSTR. SUPERVISOR L, 04/19/'19 9b EFFECTIVE DATE LIC-NO. i FOR PROTECTION AGAINST RESTRICTIONS THEFT, PUT RIGHT THUMB NONE ',I n.F^r, 06/30/1 993 005645 PRINT IN APPROPRIATE �o �, BOX ON LICENSE. BRIAN T DACE Y z 62 FERBR OOK LANE BLASTING OPERATORS CENTERVILL MA 02632 m MUST INCLUDE PHOTO. _ PHOTO(BLASTING OPR ONLY) Ff b - _ PM NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF MISSIONER - - THIS DOCUMENT MUST B' - ! SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIEDONTHE PERSONO!' IGNATURE OF LICENSEE THE HOLDER WHEN EN OTHERS-RIGHT THUMB PRINT GAGEDINTHIS OCCUPATIOR. I E R - - ' c = COMMONWEALTH OF MASSACHUSETTS DEFAIuNEN-I.OF LNDUSTRIAL ACCID.VM 600 WASHINGTON STREET James J Camociel: BOSTON, MASSACHUSETTS 021I1 zornmasrone• WORKERS' CONIl'FNSATION INSURANCE AFFIDAVIT d • I, Qiccnsce/permirice) . with a principal place of business/residence an y7 6 .3 J (Cary smat Zip) do hereby certify, under the pains and penalties of perjury,that•. (J I am an employer providing the following workers' compensation coverage for my employees working on this job. - Insurance Company Policy Number O I am a sole proprietor and have no one working for me ( J I am a sole prooncror, nenl contmaor r homeowner (circle one)and have hired the contractors listed below who have the following wor ers compensation insurance polices: Name of Contractor Insurance Company/Poliry Number. Name of Contractor - Insurance.Company/Policy Number Dame of Contmcror Insurance Companv/Policy Number 0 I am a homcownc. performing all the work myself. NOTE: rlcasc be aware text while borneo»•oers wbo emoiovpersons to an m%inteoaneL,construction or repair-ork on a e,+•eiiint: of not more tz= tarec untu is -i3j6 the moroeo»•ner aiso resiaes or on the Frouaeu appurtenant there arc not scoeratl} confidcrrd to br er_Dlovcrs tmozr T!c WorYcn' Coruveasatrod AR (CIA.- C 152,secL 1(5)). appi1c2t1oh by i borocowt,er for a lieeasu or permit may MGCDGc tnc Ico sUN3 o1 = eroplOKr under the Q'orkcn' CoropeauLion AcL - - 1 understand 'hat : cmo�•of this statc:crnt will be for+wardcd to ties Ikoar.:•n tanQ for ent of Industrial Aecdena' Ofncr,cdlnsu �vsr>Pc .cr :l:s:jon an,. : sa: :>iiurc to secure t •cnrc as rccuircc unac El cS Sccnon ::rt'of 1iGi 15= can lead to the imposiuon of ai:.�ai Dcr•al. ccnsisone of :line of uc to S1500.00 and/or impruon> rni of up to one and aw penaiuc3 in the form of a Stop Qiorx Ortsr. sne a fine of S 100.c-: a day ifLns: me. F X. SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID"S REMODELING: (L) COMMERCIAL UNION- NB F82144,2 DAVID BIK: (L) MERCHANTS INS GRP- . BCM0278579150 (W) TRAVELERS - 176K337-8-94 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652. i PAINTING: CAMPBELL PAINTING: (L) TRAVELERS 1680251K4083COF' . (W) AMERICAN, POLICY - WCC._186604 ROUSSEAU, AL (L) MERCHANTS MUTUAL - 8CM0278570179 (W) EASTERN CASUALTY - ??? GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) C,OMMERCIAL UNION CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L), AETNA - MP0021014146 l(W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 WIRE SHELVING: CAPE COD .CLOSETS: (L) U S F & G - JBSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER .DOORS: L & M GLASS: . (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - `0071439933 LANDSCAPE & SPRINKLER: COY°S BROOK: (L) COMMERCIAL UNION - ABR345850 ` (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K53.0 SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL .,WC1312595563'023 EXCAVATION & SEPTIC: DRISCOLL, JJ: (L) U S F '& G - HGL 110093 (W) U S F & G - 7708711936 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 ., (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS . - 660873E5627COF92 (W) WAUSAU 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006CO023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 ROOFER &, SIDEWALL: JOHN MEE: (L) AMERICAN STATES - 01CD1486783 (W) TRAVELERS - 6NUB448K275894 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - ,N60689 (W) WAUSAU INS -TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 ,(W) MISCELLANEOUS INS CO. 0708878 91 1 PLUMB , & ,HEAT WHITELY PLUMBING: (L) TRAVELERS - (W) EASTERN CASUALTY POLICY IN MAIL ALARM SYSTEM: .BALTIC SECURITY: (L) °'FIRST_ FINANCIAL FF0131 G400831 - ,(W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & . G r _ - 7711099932 S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ILL Parcel / P-3 TOrp Permit# Health Division . C ���R STABLE Date Issued �'S- �6� f 2? 03 ,S'a /2- ' 2 Conservation Divi �sion � � O3 JAN 7 PM (. 2( Application Fee . /'Tax Collector.: _ Permit Fee Treasurer•':fS10 -�-.— EF MC SYSTEM MUST BE 1 , STALLED IN COMPUANO .17 Planning Dept. YM TITLE 5 Date Definitive Plan Approved by Planning Board EN"RONMENTAL CODE ANL TOM REGUUZIONS Historic-OKH Preservation/Hyannis Project Street Address �/ IJA cW kJn Village S Owner /Y a rr.,"ii,3 h C/ i-e usz Address `� �✓�c y /�� Telephone SS6 ,F- 7 7 Permit Request WV 4 %o/le c.)s-f_ 0 o kcneT 17&ded( i�oi/h I K/n m 2 .—s—��y Y Square feet: 1 st floor: existing_ proposed. 2nd floor:existing _ proposed 6 Total new 3S ' Zoning District Flood Plain Groundwater Overlay Project Valuation _6_6)'06, Construction Type Aeo,r��ACle'eeT Lot Size o� Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family l' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes No Basement Type: 3,F6_11 ❑Crawl ❑Walkout ❑Other r. Basement Finished Area(sq.ft.) //fo Basement Unfinished Area(sq.ft) GS® _ Number of Baths: Full: existing new 0 Half: existing O new 0 Number of Bedrooms: existing Q7 new 6 Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas 9'61 ❑Electric ❑Other .',Central Air: =ales „0 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No Detached garage:O existing Cl new size Pool:0 existing ❑new size Barn:O existing ❑new size Attached garage: xisting ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial U Yes ❑No . If yes,site plan review# Current Use Proposed Use / BUILDER INFORMATION, Name �Aeti h (,/n If Telephone Number Address 0'7 d License# d _ ed-G 3C Home Improvement Contractor# il6i'YD t Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTINGFROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE //J 7 FOR OFFICIAL USE ONLY d PERMIT NO. d DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: .f FOUNDATION FRAME INSULATION FIREPLACE 1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUyyG♦♦H ;: FINAL GAS: ROUGH " e ' FINAL FINAL BUILDING ,_ cj �� e .: cl DATE CLOSED OUT ASSOCIATION PLAN NO. ► i The Commonwealth of Massachusetts Department of Industrial Accidents — Office i flnyestigatfaos _ 600 Washington Street Boston,Mass. 02111 }� Workers' Co m ensation Insurance Affidavit location: lei city �p �s� ',6 phone# 77/ ❑ I am a homeowner performing all work myself. ®dam a sole r ri in ca acitp /%��etor and have no one workiu orkers co ensation for my employees working on this job. rovidm mP ................:..r•............:.:..}.::::;:{::v:.}5:{•5.,::Y:ii5;.5;?.:?;.}:v.;<}:;:><::;<{ Sv:i?;;:;{::i' :::5:::Y;:>••.. -.Ytih....n:...:..:.... an era 1 er g ...... ......... ........... ,...... ........... .-...... `?tic.....: .. ... : ..... .. ....... ....... v+?.:;Y:;i:;5ri+:•:{•S'I•}}:?•}5:•YY*v 7}'::.�;v.•vF.:',r,.•y{}:.}•::.: ..... ....... .........:... ...... .......t. ..........r....::.gin•.... :..::::::::-... -, .?•....., . .. ..... ..........................,...... .n .........,... ........n: .,.............. r•.:;•::J}:•:iw:{•7:?v::::::.v.O::.:,:"+':S$Si S::S+::..-y. ..... ...n. .... ....... ,....::.,.v:::::...... v......... ............ ..n-......... ............ ............... ....-................... --..v.......... .,... ...... .........nh:.v::n}•.}w::::...•:::• ,w:n?v:.{•'rv.v.:v::Y;`Y{.y{.C:;i�4.7}:.v 1:.4{.::v:::{w:::::;:•}?}:•)}.:::::.v:::•:•.::•.:..v.:.,•;{v.v:w?ii'.:?•:v::::::>?:�SSS r::i:{:${:iv:::r Sii JY:$:,- ^'�J:y:......:.:::::.i•.::.}};., Y4}:"�'•::i:i•}:.;{{!?. ..... ,....}r• n..:r.+r.?•Fd:4?77:v}:C:•}:{{?;{4:?{•}:v.... v:.... .. ..... ...:......x:•.v•::..•. .-.........:...v:.v::•::i:;�:•}:•}:�4Y'?Y•i:•?:?:v::•.:�'•!:•i:•}:J}v::::•:;:::::}'?•}:':•}'.}•:::;:{.v. ..{:b:Yi:?::•:??:•!:v:ri.}}:.::�:!:5:P7^:•}:.;v:.•r.•:r:-v:wn•;:.w::::p......•.;•.;..•-.. 1. ... .. ............y...?i-?:::.y.v.v...-:::;i9?y:::::{vY:h•:r,,{:J?.2Yr:.t•{:.•.;:•.y:::::.•• , J... .. ......:.............. ...::.n•::::.v::::{i•:::::::,v:v.v{{?.}:t•}}:}:v:}:n:w:::;}•:i::v,v....:r:'.i7:::...::........;:•:}::6::v'??:YYY:•. i,:<:Y XiY+j;:•,:Y}:::i ¢!7}:•>:•}'}}•.!:•;;.r Y•.tv.. :tiff\�.St•:;nv.•.. :::$:::.Ytiv}:;:v':Y'L.".r.}:{r•$'}i?$$iFl 4$i:Y:i i::.:>.2;::....v... ..::.. .:..:::;.}•.vn•...:...........y........; v::::;iL{'Y??:S:;S;4:Y:}�:::4$iiS:•7:{•ii::ii?;:?{:Yv iii::::i'<;•ti::}x:.}:ry:}::{:.v:.}':::..:::$:..-•i•�.•�.y}::?•!:??.tf.„•.:?..•.:.....:......+v::......v.,x..............F. r4?4:rv.::•7::7}:•:y,v:•;}v..::n}:wn:•q.v.v.;.;n;.,;v,;:•.:?:r:;•.?:•7:?•:•74?:'Y:$S$:::•}S?:•Y.?5;:.7:;:Y{:•:i;::::•kS:$;Y}:^v:M1::`:}:Yv.... 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FaIlme to secure coverage as required raider 5ectlon22 and a Sae of$100.00 a day aga in 25A of MGL 152 can Lead to the imposition of erimiaal penalties of a Sae up to S1,SOO.QO and/or one yam,�prlsonment as weIl as civil penalties in the form of a STOP WORK ORDER st me.I tmderstamd that a copy of the statementmay be forwarded to the Office of Investigations of the DIA for coverage verification 1 aia hereby certify under the pains and penalties o Penury that the information provided above is true and tarred Date 7 `7 Signature Phone# rVf 7 7/ /OJ' Print name cMdal use only do not write in this area to be completed by city or town official permit/Iicense# ❑Building Department city or town: UJAcensing Board ❑Selectmen's Office ❑checkii'immediate response is required ❑Health Department phone#; ��e! contact person: . � � (tcvised 9l95 PJA1 f Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the `law", 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 appurtenarrt 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 shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants ^. Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying any names, address and phone numbers along with a certificate of insurance as all affidavits maybe comp . submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign an �_ 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 can the Department at the number listed below. City or Towns 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 went the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pemiit/license number which will be used as a reference number, The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Inyestlgations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 - I� J Town of Barnstable Regulatory Services '* BAMSTABLE. ` Thomas F.Geiler,Director 7 NAM. �AIF1639.D MA.A�0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. _&W_� 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: A d� at, P1111— Estimated Cost Address of Work: / . IArG y Owner's Name: Date of Application: 3 I hereby certify that: Registration is not required for the following reason(s): OWork 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 IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' (�/P . C / 09 G '� Registration No. D to Contractor Name g OR Date Owner's Name a �� ,°�,� �x vnw•iuuea/.Uz o�✓f/laaaacliu4e� ` BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 006980 4 r, q , •` � Expires 04/04/2004 Tr.no: 20121 = Restrict6d QO ` GLENN B CLOUGH JR:. 37 OLD STAGE RD CENTERVILLE, MA 02632 Administrator - � . ✓fie "°o'v�no�uoealll a��/� iuvel� G Board of Building Regulations and Standards . HOME IMPROVEMENT CONTRACTOR Registration: 109404 :Expiration;°gj16/2004 TYP6::16dividual GLENN B CLOUGH JR GLENN CLOUGH A 37 OLD STAGE RD _ CENTERVILLE,MA 02632 ' 4dminictr�t�r WIGGIN PRECAST CORPORATION P.O. BOX 1138 POCASSET, MAS►SSACHUSEM 02559 MM: 508.%4.6776 FAX: 508.564.6770 Precast BulkheadWith Bilco Doors TYPE ND" ry 86' e 84. 1 /4' f «a,l 3d)Si v 6upoN-tt poaj.46 o}iaoul 1108 Y' .09 4 e a ti , T7Z, N. oil �7s � rT Pl— aO 14�7 (, S wiu.lara N+ LoC1aT1 o N rVA J C, z i o N Y E T- 4?:. P No. 19334�QQ —�--,' RCS= �E�JG44 A'o fu�`4 / pt..A ti l G�RTtF`1 Ti^-IA"F� T� Thl TtaE� �jlCrE.�lu� L-- GAT t-1FRc� �`tiPt��ISU`.. Em� �s �C�'� PkL �� .�,oG•.�"�� _ .w,t'r'ti•-<<t`~1 �' �....� R�G 1 s re.�c.t' tom.�-i C) Dt•-a� t,s �..loT � ��'S�.C-S ,i•la��ts� �,7Pt_t G,4r•..1"T' �J�� E.IJT' •SUS/ `( �; C L�:-1i�a _ r L=39.27. R=25.00' _ R �, '332 9,8 LOT#36 Z zz810 : . o Ne c_n LOT#37 � o w L_ 21.74 R=25.00' 60 8'F LOT#35 CONCRETE BOUND" W/DH. FND.(TYP.), OPEN SPACE '4 X ;. �0 Lctunc• r \' f�uC - cuv Pam• _ , F �......1' Flu c 4))4( _7, ,� A.M. FOR DATE TIME P.M. M PHONED,:: OF RETURNED PHONE YOUR CPl l. AREA CODE NUMBER EXTENSION PLEgSE CALk M GE MeLi -� 1NILL CALL; � a1N_ C 3G D-C �i /. SEE YCIU, V � Vt1ANTS TC�.< Q SEE Yf3U S GNED �nlverSal 48003 NOTES