HomeMy WebLinkAbout0016 DARTMOUTH STREET �I�2���I%i���� /���'^�rC!�f 1. \���-!O
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TOWN OF 8ARNSTABLE. CAP
E COD
g: O # INSULATION
®�
III/p GLASS 3[AMIISS SPp4T IO4M SUSP/NUITI
SATTS - OUTTIYS INSULATION ,.CIILINO/
0,V-17 O 1-800-696-6611 _
Town of Barnstable ,
Regulatory Services a
Building Division
200 Main St
Hyannis, MA 02601
Date:
Av
Dear Building Inspector
Please accept;this Affidavit as documentation that Cape Cod Insulation, Inc. performed &_
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance:to the specifications listed on the building permit
application.All work has`been inspected by d certified Building`Performance Institute
(BPI) inspector, All work preformed meets or exceeds Federal &State Requirements,
Property Owner Property Address Village
44A,7M mfIV S7-
Insulation Installed: Fiberglass:"Cellulose R-Value Restricted Unrestricted
Ceilings ( ) ( 4)
Slopes
Floors
Walls ( ) ;(•_ ( ) ( • ). ( .:)
- �'iv�r�y Gvor k .her�C'orr��►al A„� ' �,lt
S
Sincerely
H ry E ssi r, President
pe C Ins ation, Inc.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Ma 07
pp S'0
Parcel Application J
Health'Division Date Issued 47`1 S ��
Conservation Division Application Fee
Planning Dept. Permit Fe
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address
Village
Owner �� /�CJ, V e?re Address
Telephone
Permit Request ��G �r��,a c���'� �Zoe-,
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation c2fev O, d 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 H ighway;;p❑Ye'd VNo
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other y
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.fC) `""i M
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name �P ze Telephone Number 1 /2/°�'
Address Af_ 1&14W4�4W Cl/Z License # /Do 1
Home Improvement Contractor#
Email Worker's Compensation # mo o D V-3 J Ye-9,0
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
/ 2/ Z
SIGNATURE Z24 A DATE /7
FOR OFFICIAL USE ONLY
1
APPLICATION#
DATEISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
4
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
" GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
mass save icounvion
g
.PERMIT AUTHORIZATION FORM
(, Todd Paquette ,owner of the property located at:
(owner's Name,Printed)
16 Dartmouth St Hyannis
(Property Street Address) (city)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
x
Owner's Signature
Date
FOR CSG,OFFICE USE ONLY.,
Conservation Services Group has assigned the.following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating Contractor Date
For Owice use only
Rev.12132811
r
Massachusetts Department.of'Public,, Safety
.,:Board of Building Regulations and Stand
ards
dards ,
Construction Supel•visor 4
License: CS-100988..
HENRY E CASSII}'
8 SHED ROW
WEST YARMOUTH �B
)rw Expiration `,
Commissioner 11/11/2015
Office`of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts,02116
Home Improvement Contractor Registration
Registration: 153567
T.Ype: . Private Corporation
Expiration, 12/15/2016 Tr#'259188
CAPE COD INSULATION, INC.
HENRY CASSIDY t
18 REARDON CIRCLE —
SO. YARMOUTH, MA 02664
Update Address and return card. Mark reason for change,
+.i.2oM•osiii Address ' Renewal ❑ Employment Lost Card
_ 0e e o4imaoouuealC/01QA&4dao/%crae0a' _ ... .._ .
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date,,If found return to; -
egistratlon: 1T 3567 Type; Office of Consumer Affairs and Business Regulation
xplratlon::;:12/15/20:1.6 Private.Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
RE COD INSULATI.O. INC € .
iNRY CASSIDY
REARDON CIRCLE
). id wi ut sign e
YARMOUTH, MA 02664 Undersecretary N val
1'lte Commonwealth ofMassachusetts
Departm6it of Industrial,Accidents -
Office of Invest gations '
600'Washlizpon Street
Boston, MA 02111
4, `www;m ass,go v/dia'
Workers' Compensation°Insurance'Affidavit: Builders/
A licant Information ContractorsLElectricians/Plumbers
Please Print I,e ilrl��
qq
Name (Business/organizadon/Indivi(ival): A �i
Address:
City/State/Zi .6�V ° Av &b a V l A �0
Phone.#.
Are you an employer? Chk he appropriate box:
1, I am a employer with 4, ❑ I am,a general contractor and I Type of proje-ct.(rouired): l
employees (full and/or part-time),* have hired the sub-contractors .R 6. _Z rlew'construction
2.❑ I am a sole proprietor or partner- lisitedon the attached sheet, 7, ❑ Remodeling .
ship and have no employees. , These sub-contractors have
working for mein any capacity, employees and have workers' 8' Demolition
[No workers' comp, insurance comp; insurance,; w 9.,. Building addition I
required:] 5, []:-We are a corporation and its 10. Electrical repairs or additions
3.0 I am a homeowner doing all work .,officers have exercised their', 11.� Plumbing repairs or tuidi+:ions !
myself, [No workers' comp° rift of exemption per MGL
insurance required.] t c, 152, §1(4), and we have no 12, Roof repairs
3a,® I am a homeowner acting as a ees
em to .
general contractor(refer to#4) employees. [No workers 13. Other ��I�( �b G
comp. insurance,required,).
'Any appUcant that checks box#1 must also all out the section below showingtheir workers co cation' U
mPcn Po cy information,
t Homeowners who submit this affidavit indicating they are doing all work and then hire°outside contractors must submit a new affidavit indicating sucli,-
tContractors that check this bo)'must attached an addidonal sheet showing the name of the sub-contractors and stato whether or not those endties have
employe,". If the sub-contractors have cmployecs, they must provide thenr workers comP•Policy olic number,
1 am an employer that is providing workers'compens
information. ation Insurance for my employees. Below is the policy and joCr11siPe ^^
UAMa
Irisui-aace Company Name: - ��LJNI
Policy# or Self-ins, Lic. #: Wd 51- �
q -►-- -- Expiration Date:
Job.Site Address:�� �f301�LJD�J
Attach a co of the City/State/Zip:� ®JAL 6�/
copy workers' compensation policy declaration page (showing the policy number and expiration datc).
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 anr.). a fin(
of up to $250,'00 a day against the vi'glator. 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 Gerd un the palns and penalties of perjury that the information provided above is true and correct,.
Si a
Date: _.._ .
Phonon
e #: :
Official use only. Do not write in this area, to"be completed by city or town official
City or Town-,
PermitlLicense #
IIssuing Authority (circle one); -
1. Board of Health 2. Building Department 3, CitylTown Clerk 4, Electrical Inspe 6, Other ctor 5, Plumbing Inspector
Contact Person:
Phone #t
From:Central Fax Fax:(888)507.0822 To:+15087785735 Fax: +15087785736 Page 2 of 2 06/30/2015 9:25 AM
CAPECOD-27 JFERGUSON
ACORU` DATE(MMIDDrYYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/30/2015
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 pollcy(les)must be endorsed,- If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
NAME:
Rogers&Gray Insurance Agency,Inc. PHONE FAx
434 Rte 134 Arc o Ext: Alc No): (877)816-2156
South Dennis, MA 02660 E-MAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Peerless Insurance Company•see LIBERTY MUTUAL
INSURED INSURER B:SAFETY INSURANCE COMPANY 39454
Cape Cod Insulation, Inc. n INSURER C:Endurance American Specialty Ins.Co.
18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP
South Yarmouth, MA 02664 INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: RE (SION 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.
INSR
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE' $ 1,000,00
CLAIMS-MADE OCCUR CBP8263063 -• 04/01/2015 04/01/2016 PREMISES Ea occurrence $ 100,00
MEO EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY - $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,00
X POLICY PRO-
JECT F,�LOC PRODUCTS-COMP/OPAGG $ 2,000,00
Y
OTHER: $
AUTOMOBILE LIABILITY COMBINED
accident)SINGLE LIMIT $ 1,000,00
BIx
ANY AUTO 6232707 04/01/2015 04/01/2016 BODILY INJURY(Per per—son) $
ALL OWNED �( SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED
X AUTOS PROPERTY DAMAGE $
Per acciclent
$
X I UMBRELLA LIAR X OCCUR EACH OCCURRENCE . $ 21000,00
C EXCESS LIA8 ICLAIMS-MADE EXCI0006635000 04/01/2015 04/01/2016 AGGREGATE $`
DED I X I RETENTION$ - 10,000 Aggregate $ 2,000,00
WORKERS COMPENSATION _
AND EMPLOYERS'LIABILITY Y/N S TATUTE ERN-
P
D ANY PROPRIETORWARTNERIEXECUTIVE WCE00431901.. 06/30/2015
OFFICER/MEMBER EXCLUDED? N I A 06/30/2016 E.L.EACH ACCIDENT $ 1,000,00
(Mandatory In r E.L.DISEASE-EA EMPLOYEE $ 1 000,00
It yes,describe under antl �. � � ,
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached Yr more space Is required)
Workers Compensation includes Officers or Proprietors.
Additional Insured status is provided under.'Ihe General Liability and Auto Liability when required by written contractor agreement with the Certificate Holder.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES'BE CANCELLED BEFORE
TOWN OFYARMOUTH HEALTH DEPT. THE EXPIRATION DATE THEREOF, •NOTICE WILL BE DELIVERED IN
HAZMAT LICENSE RENEWAL - ACCORDANCE VUTH THE POLICY PROVISIONS,
1146 ROUTE 28
South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Town of Barnstable *Permit#
Expires 6 months fr m issue date
Regulatory Services Fee
* snxtasrARM «
Mass. Thomas F.Geiler,Director
i63q. �0
ArE p�.I A 0
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
Not Valid without Red X--Press Imprint
Map/parcel Number
❑Residential Values e o W rk-$t:-' 5d 0 Minimum fee of$35.00 for work under$6000.00
Owne'r's Name&'Address=,S= (®(,jd � "f e
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable) X-PRESS PERMIT
❑Workman's Compensation Insurance
Check one: AUG — 6 2013
❑ I am a sole proprietor
am the Homeowner
❑ I have Worker's Compensation Insurance TOWN OF BAi NSTABLE
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑'\Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
1 �
❑ale-roof(hurricane nailed)(not stripping. Going over ' existing layers of roof)
®,Re-side Pkeecv�rj
�] Replacement Windows/doors/sliders.U-Value 0,11 (maximum.35)#of windows
I . #of doors: `�►
Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
ISeparate Electrical&Fire Permits required.
*Wh ere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE:�
Q:\WPFILES\FORWbuilding permit forms\EXPRESS.doc
Revised 060513
The Commonwealth of Massachusetts
Departmaent of Indm& al Accidents
0,Tce of Imwtigations
600 Washington SS reet
Boston,MA 02111
wmv.mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians{Plumbers
Applicant Information Please Print Legibly
Name(Susmessldrganirationllm3ividnat)_ i12
C1tylSt2it�elZp: i S 0 j Phone
.�__._
Aire you an employer?&eck the appropriate box: Type of project r s
4- I am a contractor and 3� p�' J (required):
I._❑ I am a employer with ❑ 1 6- ❑New construction
employees(full and/or part-time).* have hued the sub-contractors.
2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling
ship and have no employees These sub-contractors have 8_ ❑Demolition.
working forme in any capacity- employees and have workers 9_ ❑Building addition
[No workers' comp-insurance comp_insuranml
required-] 5_ ❑ We are a corporation and its 10_0 Electrical repairs car additions
B_ I 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. Roof repairs
insurance b c.152,§1(4},and we have no ❑
required.]
employees_[No workers' 131❑Other
comp-insurance required.]'
*Any apphcmt that checks boa#1 must also fill out the section below showing their worker;''compensation policy infflnmtiom-
T Homeowners who submit this affidavit indicating they art doing all worlt and then hire outside contractors mast submit a new affidavit indicating such
TContractots that check this boa must attached an additional sheet showing the name of the ssdreo&actors and state whedw ar not those entities have
employees. If the sub-contractors have employees,they must pmvide their workers'comp.policy number.
I am an employer that is providing H orkers'compensation innirance for my enVAEoyees. Beloit'is the policy and job site
informadort.
Insurance Company Name:
Policy#or Self-ins-Lic_k: 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 maybe forwarded to the Office of
Investigations of the DIA for insurance;coverage verification_
I do hereby certify tinder the pains andpenalties ofpet kry that the information provided above is taste and correct
/`Date:4_'(c
6
Official use only. Do not write in this area,to be completed by city or town officid
City or Town: PermitUcense it
Issuing Authority(circle one):
1.Board of Realth 2.Building Department 3.CityfI`own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer;or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced\acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter,152,E§25C(7)states"Neither the commonwealth'rior any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)nay e(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies C"LC)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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts '
Department of Industrial Accidents
Office of fnvestigatious
600 Washington Street
Boston.,MA 02111
Tel.A 617-727-4900 W 406 or 1-977-MASSAFE
Revised 4-24-07
Fax# 617-727-7749
www.mass_gov/dia
�I
i
�VE b Town of Barnstable
Regulatory Services
9snsrE$ Thomas F.Geiler,Director
Q) i639- ��
1639. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstabIe.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
_-^ Please Print
DAA
JOB LOCATION'1`l0
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT-MAILING.ADDRESS: Do ckVVUZ iJVL1 ,)
PA
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 period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The 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 Homeo+
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
F me rq�, Town of Barnstable
ti
Regulatory Services
snatvsrAsi a Thomas F. Geiler,Director
1639. 6'. Building Division
Tom Perry,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 j
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit.
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS 62012
,y�'� ► Town of Barnstable *Permit# '5-a-9fp C�
Expires 6 months from issue date
aAxtvsrAatA : Regulatory Services Fee ;
y MAM
0 9.` �m Thomas F.Geiler,Director Building Division
.Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street; Hyannis,MA 02601w X.PR �'a� PERMIT
Office: 508-862-4038
Fax: 508-790-6230 AN R 2002
EXPRESS PERMIT APPLICATION
Not valid without Red x-PressImprint TOWN OF.BARNSTABLE
Map/parcel Number ��
Property Address 0 Uk1h
(Residential OR ❑Commercial Value of Work X50• i V
Owner's Name&Address
Contractor's Name Telephone Number '�j C�f,S l
Home Improvement Contractor License#(if applicable) 6 o ZY-62
Construction Supervisor's License#(if applicable) _5 0.7 70 3e),
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I pai the Homeowner
ve Worker's Compensation Insurance
Insurance Company Name —�
Workman's Comp.Policy
Permit Request(check box)
❑ Re-roof(shipping old shingles)
❑Re-roof(not stripping. Going over existing layers of rood
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
[]/Other(specify) —A dVl c d! j id �/'l�'I �f)f (-i !� l�tJl /1 d� (AI S
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservl2n,et
c.
Signature
expmtrg
TOWN OF BARNSTABLE , permit No. r
STA Building Inspector s,
. 1 S.Un.0 - cash - --
039
t OCCUPANCY PERMIT Bond
`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''therefoi
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. `Tom C3p7 z Z]Z r Address°'
Lot # s5 IE Dartmouth Str t 14vanni g
-. ,• ' •r f� w -
wiring Inspector Inspection date
f
Plumbing Ihspe ftor p Inspection date
� � � r
Gas Inspector Cho y /� �� ` Inspection"date
ti Q,eaw,. *3•G _..rnnr. �+YT art G, n
Engineering Department - s���A. Inspection date
THIS PERMIT WILL NOTBE'`•VALID, AND° THE BUILDING SHALL NOT ,BE..OCCUPIED. UNTIL -
SIGNED BY THE"BUILDING INSPECTOR UPON, SATISFACTORY COMPLIANCE''WITH TOWN
REQUIREMENTS:
`- , 1 �iyll' t ,
19. / "i ` ` : " l �
411...... � .3 Building Inspector
20 7- 1627 /";z
Assessor's map and lot "nu ............:............................... -T
THE
Sewage Permit number ....... ........................ SEP'=' ,SYSTEM MUST
......... ....... ..... ......./4�............ ........................ INSTAUE6 IN COMPUA BARNS,TAB
House number ...................... . . VATHTITLE 5 MAO&
. . ENVIRokM 039.ENTAL CODE A .
MT 0 MAY
r-til-ATIONS
TOWN OF - BXR 'TffL
BUILD'ING' INSPECTOR
APPLICATION FOR !PERMIT TO ....... ....................................
................. .......... ...................................
GC�
TYPE OF CONSTRUCTION ....... ........
.............
9.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ....... ....... ....... ...... �..t.. .. ...........
ProposedUse ......... 44w.�" ......................................................................
Zoning District .... .4:NAJ:�.'S...................................Fire District ....... yelo�...,s.........................................
ib
Name of Owner ..............1.7............ .................Address .................................
...............................................
( Cl-OAI_�&t-- .:......Address .... )i-
cr-
Name of Builder .... ................... .....................................................
...... .. 11,11-1-1-11-1-1
Name of Architect ............ .............................Address .....I.......................1-1........................................................
...... ........... ...... ...
-1�............................................Foundation ......P Number of Rooms .................. .................. .............
Exterior ....... ....... .. .../ / a a fi n g ......... ............................................
Floors ..
. ......j�M-P-p. . .... . .................Interior. ........�S L'4-
................ ........... .. ...........................;..........
Heating ........ ....................4...........Plum.ing ..........0....... ...........................................................
Fireplace .............�4!7t kt: .......................:..........Approximate Cost ....M.3.9+P5��.................. ......................
Definitive Plan Approved by Planning Board ---------------------------------t 9--------- Area ....... ..................
Diagram of Lot and Building with Dimensions 4 'N . -Fee ....7.<;;I./- ..................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
r.
L t
e
a-zj
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........ .. ........ . ... . ........ ...(.4.1-1 ..
CAPPIZZI, TOM
, EBUILDNo , Permit for .... ..............................
FIRE DAMAGED HOUSE
........... ...................................................................
Location kot....4.3.5...1.6...D.artmp.q.th...St.reE'!t
A .. .. ............ .. ..... .... ..
Hvannis
...........................;...................................................
Owner ...Tom....Cappizzi ...........
................. .................
Type of Construction ........came........................
..................................................................................
Plot ........................... Lot ................................
Permit Granted ..January 9�. ........19
.. ...........................
Date of Inspection ........... ....19
Date Completed ..... ............../
M
Cc � PERMIT REFUSED
M 4V
.. .. . ....... .. ............... ................. 19
J
. ........................ . ..................
.............................................................
1.7-
4,
a .......................................................
Approve
d ................................................ 19
.............e.................7.......... ...........
zle. W.....
Assessor's map and lot number ...:'......................... IN
Sewage Permit number ( 7 `��......
/t Z 3ARXSTADLE, i
—4 y MAO&
Housl rnumber ............................A....................................... oo i639
,pL Q NAY a.
TOWN OF BARNSTABLE �F
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .. ... t '.., ....�...............l''C... ........... ,o �� ram-' .........................
TYPE OF CONSTRUCTION ....... � /(��r?.......!.. �. .I1 ...........................:.........'..................................
 . los/per 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a/permit according tothe following information:
Location !._n r '-� / /1 ' fZllCc-Gc _ .C� .� { ° .r re.:l.!..:f.3.�..: ...............
......f.......................................................................... ................ ....... .... ..
ProposedUse ........................................................A1C, ltql j ...................................... ...
•
_ 1 rtt
Zoning District ......j .�..?til.tJ! �� Fire District .......... c_r�lf��..
................... ..............................
..........
v J
Name of Owner .. r.-X 1 i �f i/?�{r.2 �f................Address ....................................................................................
Name of Builder %f" 'l ��'. '`'`.?..........Address l(� �2k5._l.JC:t_ 1' `� �J. tj,# 1T;�}1S(_
.... ........... i........................
Nameof Architect ................................. Address ............................i.'.....................................................
Number of Rooms ...............:.r-�...............................................Foundation t" n� 2 �
..............................................................................
Exterior :....:.....I ........:>T..t ,a.3S `cz a. /„r,*/A 04:/Roofing .........f ............................................
� ': ���1 '2 r f
.... .... .................
,1 f n
Floors c r/ �.� ..'. / ..... �I :c -<..................Interior -�` /?t? r` >.......................................
o /
--- r : aFts �e i
Heating h 7 , i r i- f � :f.=?..................................Plumbing ..........::....... ........... .........................................
.............. . .......... .......................................Fireplace ..... Appi t Ct
Definitive Plan Approved by Planning Board ________________________________19________ . Area ........�. .ft. r ...................
Diagram of Lot and Building with Dimensions Fee ... . .:...............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
rp
I
n
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name d-(c
1 i~.. -5... ..
CAPPIZZI TOM A=307-127 /
No 22805rmit for .REBUILD
Fire DAq--Ag.e.................... .... ..............
Location Lot #3 5 1. ....6 Dartmouth.. . . ...Street... . ....... ....... .... .. .. ..
Hyannis
...............................................................................
Owner T. ...
om Cap. .izzi. ............................ ..... .. ....:.. ....... ..
Type of Construction .....Frame... ..................................
................................................................................
Plot ............................ Lot ................................
Permit Granted .......January 9, 19 81
i
Date of Inspection ....................................19
{
Date Completed
PERMIT REFUSED
.................................. ............................. 19
........................... . ..................................................
..............1���'�..................................
Approved ................................................ 19
...............................................................................
...............................................................................