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Home My WebLink About0017 FOREST GLEN ROAD C i f C-LEV m Town of Barnstable Building s Post This Card So That it.is Visible'From the Street=Approved Plans;Must be Retained on Job and#his Cacd Must be Kept rnaw�re e 1 Posted Until Final Inspection Has$een Made ?r m jluct� Where a Certificate of Oc cup ancy is>.equired,such•Buildmg shall Not be Occupied nunt�la Final Inspection has been made Permit r Permit No. B-20-307 Applicant Name: HOMEOWNER IS APPLICANT Approvals Date Issued: 03/04/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/04/2020 Foundation: Location: 17 FOREST GLEN ROAD,HYANNIS. Map/Lot290-023 Zoning District: RB Sheathing: Owner on Record: YEE, LAVINA M Contractor Name: HOMEOWNER ISAPPLICANT Framing: 1 Address: 17 FOREST GLEN ROAD �: Contractor License: EXEMPT 2 HYANNIS, MA 02601 Est Project Cost: $20,000.00 Chimney: Description: Bedroom in Attic space and Replace Windows t Permit Fee: $ 152.00 Insulation: Fee Paid-e $152.00 Project Review Req: Current Attic/second floor is in conditioned space-Insulated Final: Date,, 3/4/2020 ' Plumbing/Gas _ Rough Plumbing: .. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six,months after'issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shalibe in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or roadland shall be maintained open for,public inspection for the entire duration of the Final Gas: work until the completion of the same. k '- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ` Service: 1.Foundation or Footing R ` 2.Sheathing Inspection µ _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Y_ 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 IVIGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 66 Application Number................................. . ....... 11AMMAEM NAM Permit Fee.........' Other Fee:....................... s6;q. Total Fee Paid.................. 2..... C/!. .......... ...... Permit Approval by... Ea—D..............On..3...... ..........- Y TOWN OF BARNSTABLE BUILDING PERMIT Q�2 q0 ...Parcel....... Map......... .. .:t............. ..................... APPLICATION Section 1 — Owner's Information and Project Location Pr5j ect Address 4:70kgs-r Ate( Village SCANNED Owners Name— Z-A-VI A/ MAR 0 5 2020 Owners Legal Address e!5�� i' 'City. State /0 zip, Owners Cell # E-mail Section 2 —Use of Structure Use Group_ EJ Commercial Structure Mover o%&V El commercial Structure uU4@rJ5e00 cubic fee ❑ Single/Two ii6w# Ming2020 Section 3 — Type of Permit ❑ New Construction E] Move/Relocate E] Accessory Structure Fj Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Aiarm. Rebuild El Deck Apartment ❑ Sprinkler System ❑ Addition El Retaining wall Solar 'Renovation ❑ Pool D Insulation Other—S o pec Section 4 - Work Description Tact nnrlAted- 11/1 inns R 1 Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project 9W.- Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist WFCM Checklist ❑ Design 1 Section 6—Project Specifics -,;IAVit=vc '" ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas . ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public 0 Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7-Flood Zone I � Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) a Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 f Y L r N. ;2: t, N ` c c w CD L _ ZZ s CY I pop SCANNED S . 10KE•DETE F x.� VED 4b MAR 052020 R; S; .BEBI NG ^ tt �J BOT , ES ARE BEQ r AWING Y I � _ cr < � v l �. V • � ''1>> I" � _ _ ., � �, T C _ • S .. �` v , � � a - '. 1� . �4�. i. , t` �_ . -�_ • � . --�-... - . �- - _ 1 _. - ` � 1� � .. _ .: � � � z . 1 - -: l / - � . . 4 _ � _ .. J . ,- - f _ � ( � ' ' � �� ` �� i �� - �, -- ;�� _ __. TOWN OF BARNSTABLE PERMIT CHECKLIST Sip off hours for Health and Conservnttlnn a , '8 30 am. and 3:30 4:30 p the 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial— x require a stamp by 'tect or engineer). Residential Sets of floor plans no larger than 11"x 17"smoke/co detectors marked Worker's Comp.Affidavit an ❑ Res Check or COM check from the 2015 International Energy Cod Council(IECC) `t Letter of financial Interest for new houses only(not required for rebuild after teardown) El Performance bond made-out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) �� v ❑ Everything above plus shut off letters from following utility compamues: V " D Gas ❑ Electrical ❑ Water ❑ .Sewer(if required) 3.-DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail(if new framing), ❑ Pools—Barrier details,pool specs(engineers design) ❑ workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑ Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia r . . Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): LHi111 k �6r-, Address: � RD City/State/Zip: Phone#: 6 `r Are you an employer?Check the appro rate box: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction . . employees(full and/or part-time). ` 2. 1 am a sole proprietor or partner- listed on the attached sheet•_ 7. Remodeling ❑ P � P These sub-contractors have ship and have no employees 8. ❑Demolition worcing for mein any capacity. employees and have workers' 9. ❑Building addition o workers'com insurance comp.insurance.:��] P• 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.d I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself:[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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. 1 do he're certify under thepains andpenalties ojperjury that the information provided above is true and correct Si az/u :. Date. 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.CityPTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person hi 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 irmm ce. 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 pennit(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 Investigations 600 Washington Street Boston,MA 021.11 - Tel.#617-727-4900 ext 406 or 1-877 MASSAFE Revised 4-24-07 Fax#617-727-7749 WWWw maw.gov/dia N b w z � o 0 J 1 G� ( POP SMOKE DETECTORS REVIEWED (3-34 RNB A BUI D G D 3 'c FIR D R T BOfi 4 p FOR PERMITTING ARE REQUIRE i �- i � I j w, d r rri I 1 ---- -- I • l� 1 Application Number............................................ Section 9- Construction,Supervisor. Name Telephone Number Address City State Zip f License Number License Type Expiration Date Contractors Email Cell # 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.Attach a copy of your license. Signature Date Section 10-Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand m responsibilities under the rule and regulations r y sp s gul ons for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature Date Section 11 Home Owners License Exemption Home Owners Name: WZ�V M Telephone Number S9 r 5 d Cell or Work Number �i I,,understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 wY CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentatio required by 780 CMR and the Town of Barnstable. Signature= /lll . APPLICANT SIGNATURE S�ignatur ' e Date Print Name kyIlUA /�I c Telephone Number � �-2 � E-�mail- ermit to: Last updated:11/15/2018 Section 12—Department Sign-Offs Health Department Zoning Board if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ I Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization i L , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: . (Address of j ob) Signature of Owner date Print Name Last updated: 11/15/2018 - p Application number . .. .. ............... ......... BUILDING DEPT. �'••.a C-a G Date issued....... .............. ° BAMSTABLE. ° .� MASS. FEB 2 6 2020 Building Inspectors Initials.—SA& ................... AFCMP`�a Map/Pareel.....ag0...o .3 TOWN OF BAIRNEZIABLF TOWN OF BARNSTABLE SCANNED EXPEDITED PERMIT APPLICATION: FEB 2 8 2020 ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY ® TI®N Address of Project: /7 rores:� �/P� �a��t 1' S NUMBER STREET VIL AG& Owner's Name: LJ yP� La,,i nw ,�� Phone Number At 7 e fo -u.2. Email Address: Cell Phone Number Project cost$ /q Check one Residential- Commercial OWNER'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: �eP -��-� Date: TYPE OF WORK 17 Siding U Windows(no header change)# /0 Q Insulation/Weatherization t ❑ 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 LJ 5�e CONTRACTOR'S INFORMATION Contractor's name ee t or (r}t �oSton Home Improvement Contractors Registration(if applicable)# � 0,� S (attach copy) Construction Supervisor's License# 07 2-7 7 2- (attach copy) Email of Contractor w ee 4 a I.c a rn Phone number 7 S�1 — R 3 2- S q?O ALL PROPERTIES THAT HAVE STRUCTURES OOER 75 YEARS OLD OR IF THE SUBJECT PROPERTY/S IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER y *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-5 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-4:30pm. Commercial events may require Fire Department approvap *WOOD/C®AL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOME®WNERIS LICENSE EXENTTI®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 CAM the Massachusetts State Building Code. I understand the construction inspection procedures,specie inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date LICANT'S SIGNATUR.E Signature _ Date All perms a ons' are subject to a building official's approval prior to issuance. Window World of Boston MAHICRegistration */C�rw Offices&Showrooms Number: U 1SA Cummings Park U 295 Old Oak Street '3 1000 Boston Turnpike 168025 Woburn,MA 01801 Pembroke,MA 02359 Shrewsbury,MA 01545 Federal to# (781)932.4805 (781)826.6281 (50B)845.8676 82-0896432 i II www.WindowWorldolBoston•com Customer: v! Phone(h) Install Address: FD -404 gd Phone(c)re�7 �oCJ-g731 Slate:MA g 60 J E-mail C �P1GK•..— Ity: WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung Ali-Weld $249 ID SolarZone Elite-Dual Pane $129 !?A0 2000 Series DH AIIWeld $259 10 4000 Series DH All-Weld $2892" _Triple Pane S299 6000 Series DH AEI-Weld $309 WINDOW OPTIONS `2 Lite Slider S429 Glass Breakage Warranty(400016000) $Is INCLUDED 3 Lite Slider ui,a ins S669 —`112 Screens $g INCLUDED Picture/Fixed Ute(0.83 UI) $419 _Picture I Fixed Lite{84.130 UI} $539 _Foam Insulation on Jambs and Head St t INCLUDED _Awning $359 Double Strength Glass(400016000) $15 INCLUDED _Casement Plus$49(DH Sash Pall)$379 `Double Locks(>26') $5 INCLUDED � 2 Lite Casement $659 Full Screens $25 j 3 Lite Casement S1029 _Colonial Gilds(Contoured/Flat) $65 +Basement Hopper S469 _Prairie Grids $75 _Bay Window-Soffit Mount/INS Seat S2859 _Simulated Divided Lile $162 _Bow Window.Soffit Mount!INS Seal$2999 Tempered DH Sash(8S0)(TSO) $75 _Garden Window $2179 ^_Obscure Glass(BSO)(TSO) $75 { _Bay,Bow,Garden Oversize 1+109 Uq 5979 Oriel Style(40i(S0 or 60/401 $75 _Beige/Almond $49 Foam Enhanced Frame $35 DSO i Wood Grain Interior ISeries 400016000onk)$100 = PRE 1978 BUILT HOMES(RRP SAFE RENOVAf (Light Oaki Dark Oak!Cherry/Fox Wood i Rich Maple) MY HOME WAS BUILT IN THE YEAR In 181 _Brown Exterior(Arch Bronze I American Teria)S100 MISCELLANEOUS _Designer Color Exterior $179 _Speciality Window $ Custom Exterior Aluminum Cladding(Two Bend) U Textured SgO 3 G•8 Smooth$90 $ WindowColor _4k! /a +1P Facing Color_ InsideOutside Multi•Band.Cladding $20 j NON CUSTOM DOORS -Zo Insian Interior Exterior Stops S50 Agoo _Vinyl Rolling Pala Door 5R.or 61t. $1219 Install Interior Casing Starts At S95 _Vinyl Rolling Patio Door Bit. $1329 _Repair Sill.Jamb or replace sill nosing S75 i _Add to base pike lorCuslomRonngPaliooaor 1259 _Full Sub-Sill(Single)replacement $175 _French Rail Sliding Patio Door 5R or 6. S1539 _Insulate Weight Boxes S20 _French Rail Sliding Patio Door Oh. S1639 Mull to Form Multi Unit S30 I _French Rail Sliding Patio Door S1749 r _Custom Exterior Cladding S300 _MulhonRemoval _ $50 Soiar2one Elite 5309 Metal Window Removal S75 _Grids Patio Door $210 —New Construction Vinyl Removal S175 _Woodgranlnt s 5399 New Const.Ext.Retro Fit $11SO _Exterior D er Colors $599 Roof for Bay/Bow Windows S500 _Interior sing 2+2 3+* 5279 _Removal of Existing BaylBow $250 _Handlesel.Options S _BaylBow Conversion Ext.Petro Fit $450 _Interior Blinds(six 1001 only) 5859 (New Siding Will Not Match) S O ROUNDUP FOR WINDOW WORLD CARES Door Color ! �! St,Judo Children's Research Hospital $ j inside Oursida Customer declines exterior wrap and understandl painting and/or repair may be d Inlife Customer declines grids on X4' windows/doors inil DISCLAIMER:Customer Is responsible for the leaamng In connection with this contract Painting.Slalning,Alain]SysA aecennecl Building f elmd lees In excess of$25.00.Homeonaerand or Condo Associatian Approval,Historic 041 icl Approval City of Boston parking&sldewatliPermil lees in connection with installation. i NO EXTRA WORK IF NOT IN WRITINGI Customer agrees to the terms of payment as follows: Extra Labor&Materials S f530r— �1�r� Site Set Up,Permit,Disposal&Delivery Fees S 89.00 � �Qr Total Amount $ 71, .f Custom Order Deposit 331; $_�W4Cl(# ( Project Start Payment 33% S-4 Balance Due Day of Installation $ Amount Financed $ Window World at Boston anticipate$starting this work on — LP&Q and beingsubsenliallycompletedid dairs,SecurltrylMe,soles I>bl� Any deposit required In advance of die start of pia wart SH L NOT exceed 3 It3%of the total contract price 01 Ira adu31 cost or. r arty matend or ii—quIpinlivill 01 a { speeW order or custom made nature,which must be ordered In advance of the stall of the work to assure that the project will proceed on schedule.No llnal patmcal I she&bo demanded limit the contract is completed to Ina satisfactlon of both pantos. All lame improvement contractors and subcontractors shag be iegislaed and that any Idquiros about a contract m subcontractor selslurg to a registration should tit, i directed to:Office of Consumer Affairs and Business 80gulstion,ten Park Plana,Build 5170 Boston,MA 92116,Phone:(617)973.8700 No work shall begin prior to the signing of the contract and Itanstmllal to the owner at a copy of tuck contract. i W rldoir World of Boston wader provision of Chapter 142A at eta general laws Is tequlmd to apply for and Maio all conslrueUon•felsted pamiiU.Wuidmv%Valid al Boston shag nalbe.din mid responsible fat delays In the wart described In this agreement caused by iagulatoly,permit green ng agencies.authorities or eitpvWuals v j Nonce:H the PURCHASE8(8)obUlns bit own condmcUlm related pmndlk for the work described under this agreement at deals with enagldamd coalraclon, _ Me PURCHASERS)Is bsrehy advised Thal In the event of s dhpule,judgement and nonpayment,Ng PURCHASER(S)will not be entlDed IQ make a claim or collection Irani The guaranty fund established by chapter 142A,M.C.L. I You the buuyyer mill gancei this transaction at airy t Me prior la mldnig t o 160 third business dayoiler t e dale o 1 s lrensnslian• Hollaa of cancellallon must be In willing postmarked no later than midnight gl the tollw(ng third business day, INS Window Word'FrancNss Is bNr er dwi8 owned and u rated b�L R P 8ostors O rorefin+,hle under artaiss hum iNti %v wutit.Inc. ! i 4t_ �/M(�it9•ty �j 1 6780 99y 3173 _ __�• r o._ I nun D l elan H "so s arc any blank apecaa.Uara 1 20 V - - - aioaman,Da not 2n If that are any brank spacer. Da • owner Do not tl 1 Ili o lira any eiank apaeoa Dan tti BoamOa-la WIIda Cnm.Orininnr. �ntb...r•...,.. u.. n..,,r•.,,,,,.e. ll+.r,n•en1,N M,,Ile i i I Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards :ar?5tr�stlir�* Superv!sor C S-072772 Expires: 04/07/2020 JEFF C STEEII 24 SHERWOOD AVE DANVERS AAA 01923 Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYRE:LLC Reyisdratiort Ettoiration.. 166t125 04/1112020 WINDOW WORLD OF BOSTON,LLC. JEFF C.STEELE CG% 15A CUMMINGS PARK WOBURN,MA 01801 Uflderswetary DN r :7?e a! vj I�.11-i�rrlrahAc ci —w Boston, K4 0 .1114-01.7 www mass.-ovidira J '�,A'avfcers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. To BE FILED WITH THE 1PEXV11TTR4G AUTHORITY. Applicant Information Please Print Letiib�ly alne (BusinessiOrganization Iudiv?dual):/�L S o/tf� s�/ii�aw �J� �d fill i`( Address: I /A Ct )rn„ City/State/Zip: 1,/ M Phone 4: 7,?l 1 0 _ire yo an employer?Check the appropriate box: Type of project(required): 1. I am a employer with�� employees(full and(or part-time). ]. New construction 2.0[am a sole proprietor or partnership and have no employees working for me in 3. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.01 am a homeowner doing all work myself.(No workers'comp.insurance required.] ❑ 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with ao employees. . L.❑�Plumbing�repairs or additions 3.71[am a general contractor and I have hired he sub-contractors listed on he attached sheet. 13.[]Roo .;pairs These sub-contractors have employees and have workers'comp.insurance.+ o.❑We are a corporation and its officers have exercised heir right of exemption per,.VfGL c. 14. Cher W i i\dg-W 152,31(4),and we have no employees.T o workers'comp.insurance required.] rejo red-7.7e i+ *Any applicant chat checks box..41 must also all but he section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside-contractors must submit a new affidavit indicating such. :Contractors hat check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing ivorkers'compensation insurance for my employees. Below is the policy and job site information I Insurance Company Name: A c i a,i e G eM O1 uyP t- 5 Policy#or Self-ins.Lic.#: tw'G C. -7 00- 5-o 1 g o c?t- Z c)/ 9 A. Expiration Date: y—_ 7- Z O Job Site Address: /7 f o re S G/per o/ City/State/Zip: A6¢�ni ►`1r Attach a copy of the workers'compensation policy declaration page(showing the policy numb r and exp' tion date). Failure to secure coverage as required under ibIGL c. 152, §25A is a criminal violation punishable by a fine up to 31,500.00 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 Aolator.A co no this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific 'on. I do hereby certi and he pa a enalties of perjury that the information provided above is true and correct Si ature• Date: �Z�, 'o20 Phone#• 8-,\ Official use o 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 G.Other Contact Person: Phone#: I L DATE WMIDDIYYYY) ACGPR0' CERTIFICATE OF LIABITY INSURANCE 03/26119 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. It 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: amy roberts M.P.Roberts Insurance Agency Inc. PHONE 978-683-8073 A No: 978-683-3147 g y A/C No Ext 1060 Osgood Street E-MAIL North Andover, MA 01845 ADDRESS: amy@mprobertsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# ' INSURERA: WESTERN WORLD INS COMPANY INSURED INSURERS: MERCHANTS INS COMPANY L&P BOSTON OPERATING,INC INSURERc: ASSOCIATED EMPLOYERS DBA WINDOW WORLD OF BOSTON INSURERD: 15A CUMMINGS PARK WOBURN, MA01801 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDNYYY MWDDNYW LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �p DAMAGE TO 100,000 CLAIMS-MADE /` OCCUR � PREMISES a occurrence S MED EXP(Any one person) $ 5,000 A NPPS525379 04/05/19 04/05/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECa LOC PRODUCTS-COMP/OP AGG $ 1,000;000 OTHER:. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) S . B OWNED � SCHEDULED MCA1002569 04/05/19 04/05/20 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS x HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident - $ x UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMSfiMADE AN065362 04/05/19 04/05/20 AGGREGATE $ 1,000,000 DEC) I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE ER H ANY PROPRIETORIPARTNERIEXECUTIVE Y YIN E.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBEREXCLUDED? NIA WCC-500-5018609-2019A 04/05/19 04/05/20 (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORED REP EMTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r�.�D Ft r Town of Barnstable Permit# � � Expires 6 month o iss e + .+ Regulatory Services Fee t R1 RNf.�P1RiY t - - - 9� MASS Thomas F. Geiler,Director. prEO Nip't� 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 Numberoc Property Address Residential : Value of Work `TQ .. Nhnimum fee.of$35.00 for work tinder$6000.00 Owner's Name&Address 1 Y /VI / �Z Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) PR �� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance FEB ® 12012 Check one: ❑ I am a.sole proprietor ,'I am the Homeowner TOWN OF EARNSTAELE ❑ I have Worker's Compensation:Insurance Insurance Company.Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going-over existing layers of roof) ❑ Re-side" #of doors 1 Replacement Windows/doors/sliders:U-Value ., (maximum .44)#of windows R _ *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License'is required. :GNATURE: OW - .z. NPFILESIFORMMbut7ding permit formslEXPRESS.dpc :vised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations d `600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit- Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Legibly Name(Business/Organizationdndividual): /,.�P J ` Address: City/State/Zip: it S &)L-6-.4�L+hone.#: Are you an employer?Check the appropriate box: Type of project(required):' 1.El I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction' . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. gRemodeling ship and have no employees These sub-contractors have g; ❑Demolition• workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.)g I am a homeowner doing all work officers have exercised.their 11.0 Plumbing repairs or additions myself. [No workers' comp.- right of exemption per MGL. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subnut anew 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.#: ExpirafionDate• 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 ertify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: QQ AAAAK21. A Date:Q^ / 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): A.Board of Health 2.Building Department 3.City/Town.Clerk. 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact-Person: Phone#: r Information andj'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&.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 submitmultiple 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 io 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:. .ThQ Con=6nwea1th ofMassa4husets' 'Department o£lndustriW Accidents w Office of Investigations 600 Washingt9h Street Boston,IYIA 42111 617-7-2.7-4900 ext406 or 1-877-MASSAFE Fax Cil?-727 7749 Revised 11-22-06 vvww.mass..gov/dia ' t } Town`of Barnstable Re ulato *Ser� i' es g r3' v c * sexxsrnar.E, * Thomas F.Geiler,Director Bu><ldingYDv><sionT _. N Tom Perry,Building Commissioner 200 Main Street, Hganms,MA 02601 ¢. b. www town' barnstable.ma us Office: 508-862-4038 Fax 508-790-6230 K HOMEOWNER LICENSE EXEMPTION Please Print ` DATE: JOB LOCATION: 4 number street village, "HOMEOWNER": :� name-. ; home phone# ^�s work.phone CURRENT MAILING ADDRESS: Et U: L M city town s F' fate zip.code The current exemption for"homeowners"was'extended o include owner-occupied dwellines`of six units or`less an to allow homeowners to engage an individual for hire who does not,possess a:license;provided that the owner acts as"* .supervisor. x � DEFINITION `.OFHOMEOWNER ' Person(s)who owns a parcel of land on which he/she resides or intends 16i reside,on which flier"e is, of is mtended�t . be,a one or two-family dwelling,`attached or detached structures`accessory to such use and/or`farm strictures:'A "person who constructs more than one home in a' wo-year period shall not be considered'aa homeowner. Such "homeowner"shall submit to the-Building Official on a form acceptable to,the Building Official,that.he/s)ie shall be responsible for all such work performed'under the building_permit (S'ection 109.1.1). The undersigned"homeowner"as responsbihty for compliance with the State Building Codeand other applicable codes,`bylaws,rules.and regulations: < The undersigned`,`homeowner"certifies that he/she understands the Town of Bamstable:Building Department minimum inspection procedures and requirements and that he/she•will comply with said procedures arid, ''` XV equirements. Signature of Homeowner x Approval of.Building Official y> Note: Three-family dwellings-containing 35,000 cubic feet or larger will be requited to comply with the ' State Building Code Section+127.0•Consiruction Control: .. HOMEOWNER'S EXEMPTION + The Code states that: Any homeowner performing work for which abuilding permit is required shall be exempt from the provisions of this section(Se6tion,109.1.1-Licensing of construction,Supervisors)_provided that.ifthe homeowner engages a person(s)for hire.to do such work,that such Homeowner shall act as supervisor:" " u. Many homeowners who use this exemption are unaware that they are'assummg the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Secti6n 2.15) This lack of awarenessoften.results in serious problems,particularly when the homeowner,hires unlicensed persons. In 4hts case.our Board.cannot proceed again"st the unlicensed person as it would with a licensed '. Supervisor. The homeowner acting as Supervisor is alttmately responsible To ensure that the homeowner is full aware of his/her res onstbilities,man ' q p p pp Y p y communities re uire,as.part the ermtt a licatton that the homeowner certify that he/she unders`tands:the responsibilities of a Supervisor. On.the last page of this issue is a`fotm cuiTently used by' several towns. You may care t amend and adopt'such a fotmlcertiftcation for use m your community P L Q:forms:homeexemptt ^ ` BIKE Town of Barnstable Regulatory Services • SAsxsTMLE, MIU& �, Thomas F.Geiler,Director i639. &1 Building Division En�r Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA U601 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 I, 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 before fence is installed and pools are not to be utilized.until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date v Q:FORM&OWNERPERMSSIONPOOLS dog - 3�'1 - q S� � DING ficate of Appropriateness t accept application package or in writing). -- ' 1 ,ct: egistry of Deeds ri I �q Doc: 1 7 090 7 034 05-19•-2008 12:34 BARNSTABLE LAND COURT REGISTRY (SEAL) COMMONWEALTH OF MASSACHUSETTS LAND COURT DEPARTMENT OF THE TRIAL COURT 08 MISC 371513 To: Albert R. Brown Case No. Nancy E. Brown and to all persons entitled to the benefit of the Servicemembers Civil Relief Act. Option One Mortgage Corporation claiming to be the holder of Mortgage covering real property in Hyannis, numbered 17 Forest Glen Road, given by Albert R. Brown and Nancy E. Brown to Option One Mortgage Corporation, dated July 5,. 2006, Registered at Barnstable County Registry District of the Land Court as Document Number 1038457, and Noted on Certificate of Title Number 180520 has filed with said court a complaint for authority to foreclose said mortgage 1 in the manner following: by entry and possession and exercise of powerof sale. If you are entitled to the benefits of the Servicemembers Civil Relief Act and you object to such foreclosure you or your attorney should file a written appearance and answer in said court at Boston on or before JUN 3 QS or you may be forever barred from claiming that such foreclosure is invalid under said act. Witness, KARYN F. SCHEIER Chief Justice of said Court on MAY 13 2W$ Attest: Deborah J. Patterson ATAUE COPY . .�;..,� Recorder 07-667OF ATTESP. RECORDER BARNSTABLE REGISTRY OF DEEDS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION- Map ,k Ma a� f Parcel �S Permit k ' Health Division s �t ?Date Issued t ^� Conservation Division 'Fee5�- �l7 Tax Collector Treasurer Planning Dept Date Definitive Plan Approved by Planning,Board Historic-OKH Preservation/Hyannis a Project Street Address t Village NLI&W Mr ' Owner No'ss Address Telephone , Permit Request IV Square feet: 1st floor:existing proposed 2nd floor: existing ° proposed Total new Estimated Project`Cos 1.odo Zoning District 'Flood Plain Groundwater Overlay 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 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)- Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing" new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air. ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes. ❑No Detached garage:❑existing ❑new size 'Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new `size ° Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use ` q BUILDER INFORMATION Name Telephone Number. Address r� License# l�G� � Home Improvement Contractor#129 �4 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - SIGNATUR DATE" r `FOR OFFICIAL USE ONLY PERMIT NO. r! DATE ISSUED. ' MAP/PARCEL NO: ADDRESS VILLAGE . , "OWNER } S DATE OF INSPECTION:` ' FOUNDATION FRAME INSULATION FIREPLACE = .l - ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL r GAS: ' " ROUGH - FINAL t ! _ a - ' '' ` • Wiz. ' ' I • FINAL BUILDING: DATE'CLOSED OUT y ASSOCIATION PLAN NO. # t -:_-��.. O1ffCCOf/DYeSllgBl%OIIS ashin t 600 W gton Stree �r Boston,Mass. 02111 Workers, Com isation.Insurance Affidavit c, WOMMA name: 9 ------------ location: ' home 0 city ❑ I am a homeowner erforming all work myself ❑ I am a sole aronrietor and have no one worlds in any M=.tv ��P��/!�'l%��' eusation for ruv employees woridng on this job.:: .:::::::::::::::Y:.:::.:::::::.>.;:::::::.::,:..:.;.::,.. workers ....,....,:.:::.:: ...:.:;::.:..::..:::::......: .;Y;:;;::.;:.Y:::;:.::.:;::.; ;;;;Y:..::;.. >;:::«::>:::«:>:»>: em lover ding CO ...... :..:.....::::<;..::::...:...::::::::::::.:,:..,::.:.:.:....,::::..:::y..::::.:...:.::::..::::::::: ::.::....:.:::..;:.:<:;::.;;:.comnan <><:>;»»::::>:<:_»:<:;;:.;::.. Al ... .:............�:>:}Y:::::»::�:;c.:: ii>YYr;::.;:.�::r:;t;;i:.:;:•Y:::f•:;isS:r::::r::::;•Y:.:r;Y:.::::>:.:.;.�;G;:: v name.. ,........... ...... ................{.............:...:............... Tess. ..:... .. ........... ....................... - :� .:. ..�: ;•.•.::.:....: •.;. hone#: , ...::.�:.::.::i::i•::::::::.v':::•:::.:::........Y:•:::•:: ...::::.:.:. ..... :Y is�'- insurance co. circle one and have hired the contractors listed below who ❑ I am a sole proprietor, general contractor, or homeowner ha`-e e follotivtn w coensation polic ........� ::.::::: ........ ..;.:;., ..... conDanv name. ,•„.:• •::...... .::.......... ...... .-..{•..¢...., .....,................:.................... . .. _. address. ...... ........ .....:..... ........... ..:::..:.::::.::�............... .............. .. }. ....v:A .....:•...:::. .....:...... is\•:. •.w;{:r :':�i:;is ............ .... 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IMMAM COMT) ........ ... x•::::.:.........:::::::. ::•::::•:.. .:.::.:................. ...... a v n to addresv. n tv. .......... .......................... ::................:::::....... :;::;. .. .:...... .:::::i'...:':::......................:............ ...vxnti{{;{Y:}i}i}ii'.`:::}vrkXvi:{•}iY:::•:x•... .. ..... .. ...;::i:.ii::i4:iii:::•:i:Yi::::i;:;•Y::•:Y:•:�Y:::;•Sirs:•:;^}:•}}}YY}Y::•:nv:v:.................. .... imunnCe'CO.. a of aimiaal penalties of a thie up to Sr,S00.00 and/or FaIIare to securs coverage so required under Secdon ZSA of MG 1S2 can lead to the lmpos� one vears,imprisonment as well as civil penalties the fZe orm Inv of a Srop om of the K ORDER for e and nne off Sdr0oa00 a day a;a{uut me. I tmderstsTtd that a copy of this statement may be forwarded to the1 do hereby c under the pains and penalties ofPQlurY that the information provided above is tru,and correct er Date — S12M � Print name otIldai use only do not write in this area to be completed by city or town ofncisd perrnitNcenst q []Building Department city or town: �T�e�t Board x psdeetmcn's omu c: ❑ eck if immediate response is required �$eaith Department ch phone tk; ❑pther�— ei contact person: a. h� i i1rn+m 9:95 P]A1 The Town of Barnstable . �axsresr.c. 9� ,0� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. /�Q_ i��yyJ ) - Type of Wor?c: i(�S�AJ it2 /t /Cj It�1�t—1:' Estimated Cost 0 tiEIvJSP (VW)6 s ,Vi 6- Address of Work: Owner's Name: Date of Application:- /Jj/� �2 O I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 []Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME R"ROVEMENT 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 o r. Date Contra r Name Registration No. OR Date Owner's Name q:forms:Affidav fie Ua�rr�n�rali��z� a��/� �ac�uaeC1 ('_ I Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston . Massachusetts 02108 Flom- Improvement Contractor Registration Registration: 103714 Expiration : 7/9/02 Type : Private Corporation ?. NONE IMPROVEMENT CONTRACTOR r.; ': Re9istration� PAUI_ J . CAZEAO-IT SONS , I 103114 NC . �; Paul. C a z e a u l t S, Expiration: 719102 Type Private Corporatic 22 Giddiah Rd . P .O . Box 2781 y Orleans NIA 02653 PAUL J. CAZEAULT & SONS, I Paul Cazeault -if 22 Giddiah Rd. P.O. Box 2 ADMINISTRATOR Orleans MA 02653 TOWN OF BARNSTABLE BUILD,ING PERMIT PARCEL ID 290 ,023 GEOBASE ID 19537 ADDRESS 17 FOREST GLEN ROAD PHONE HYANNIS ZIP - ILOT BLOCK T SI IDBA DEVELOPMENT DIST CT HY (PERMIT 50679 DESCRIP I IP/REROOF SPHALT . PERMIT TYPE BROOF TITLE BU DING PERM T ROOFI CONTRACTORS: CAZEAUL AND SON Depart ent of He th, Safety ARCHITE TS: and En iron al Services TOTAL FEE $ 5.00 ME BOND 00 pX� , CONSTRUCTIO COSTS $6,00 .00 750 R FING AND SIDING 1 P STABLE, • MASS. 039. Al BUILDI D VI BY DATE ISSUED - 12/20/2000 EXPIRATION DATE TOWN OF BARNSTABLE 1. BUILX N%, PERMIT. PARCEL ID 290 023 GEOBASE ID 19537 (ADDRESS 17 FOREST GLEN ROAD PHONE . . .HYANNIS ZIP - LOT BLOCK T DBA - DEVELOPMENT DIS'gIt,ICT. NY PERMIT 50679 DESCRI"ION RIP/REROOF ASPHALT PERMIT TYPE BROOF TITLE B LDING PERMt�IT ROOFI CONTRACTORS: CAZEAU AND SON De par ment of H th, Safety ARCHIT Ts: and Enwironme ,tal Services IN (TOTAL FE $ 5.00 1 : 'CONSTRUCTIO COSTS $6-,0 0.00 750 FIN AND SIDING 1 P I AT, G * '�ARN3TABLF. �-----• MA83. 039. �FD \F BUILD D VI BY. DATE ISSUED 12/20/2000 EXPIRATION DATE TOWN BUILD ua„, #_.r, PARCEL�ID 290 023 GEOBASE ID 19537 ADDRESS 17 FOREST GLEN ROAD P14ONE ZIP LOT 1V DBA n ;LEVEL OPITEN`r DI ST , fT`JV Her PERMIT 5067E 1 DES CR.TPF :IoN ` IP/REROOF SPHAL PERMIT TYPE BRC?( r' T t;' L E ; �e But, NG SEER C30} C ; C° �� Te T AND BONS Department'of:Health Safety J ARC RI TE..ITS �, and Enwronmer�tal Services '.DOTAL FED ZS:_ � � BOND" � a a�� ... i 'TME CONSTRUCT"I014 C0 SITS 1$6,OC3 .GO..•. r -- �► , 75t7; V J NG AN'I7;.,��37 NC 3 L'1 E` ,I�. 1r E-- • 9 MA83. �► BAJRNSTAl BUILDI�rG�,D�VI fON • BY � DACE 18Supo . 3,' 0/2'000 EXl-'1,I.�7r.4',�T.ON 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 i ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE 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: I 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.000U- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE . ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN;MADE. 4"FINAL INSPECTION BEFORE OCCUPANCY BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 .t 3 1, HEATING INSPECTION-APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CONw 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.. ; _ - I _ I BUILDING PERMIT '�, �- TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION w 1 ti. F Map CXi C) ' Parcel' 0�� _Permit# AIS81 Health Division _ Date Issued f Conservation Division Fee �� a Tax Collector Treasurer ` ' ' D Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis . Project Street Address ��_ o'lea) . 1?61 t . Village AJt JA JJV/S - s .Owner (�6,9,SAddress n 6 - t Telephone Permit Request _&0 ic- Us�iD/f M dk1,h Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Cmo Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Cl Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes D No Basement Type: ❑Full D Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ,❑Gas ❑Oil O Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes D No Detached garage-LJ existing ❑new size Pool:D existing ❑new size Barn:❑existing ❑new size Attached garage:O existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Ll Commercial O Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Ax/ Address License# d��t'.��i'1 Home Improvement Contractor#v All Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `D 1AZ dd i - FOR OFFICIAL USE ONLY .- k - F i. PERMIT NO. + Ira DATE ISSUED " MAP/PARCEL NO: :;ti + ADDRESS VILLAGE _ OWNER : DATE OF INSPECTION-" k ` FOUNDATION -~ t FRAME - INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL # - PLUMBING: ROUGH FINAL - - GAS: ROUGH FINAL - { 3 FINAL BUILDING y t .I DATE CLOSED OUT ASSOCIATION PLAN NO. ' Y file Communweuuit oj,li'itis.Yacituseua Department of Industrial Accidents Office of/ayesagat/oas 600 Washington Street Boston,Mass. 02111 Workers Com ensation Insurance Affidavit name: location: thomol city `J hone#❑ I am aer performing all work myself. ❑ I am a sole r rietor and have no one workin in anv capacity �I am an employer rounding workers' compensation for my employees working on this job i com nnv name. address c� hone# t F oiicv# ` msurancc co. ❑ lam a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have n workers' compensation polices: the folio „ com anv name. address. hone# ....:::... ..:.:;:..>:.:::::.;::::.. ..... ... ::::.:.: ...: ::.::. .....:.:.. .....:.. ::.:. ..:. ........ insint'i+nce cii: :, ::::::................:::::. ::............: s:;;::. com anwname address: :: hone# X. . >; ::::::: .:. CV ininrancc co. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flue up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Me of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Ot11ce of Investigations of the DIA for coverage vertIIcatlon. I do hereby certify the airs and penalties of perjury that the information provided above is true and correct. �� Si lure � Date �+//��)d Print name 'i-7 l�— Phonc# official use only do not write in this area to be completed by city or town oilitial city or town: penmit/license# ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑check if immediate response b required []Health Department contact person: phone#; - ❑Other (fewed 9/95 PIA) The Town of Barnstable EMALELM� M IM� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 0 J. r �_ Estimated Cost o'r Type of W j t' . Address of Work: Owner's Name: kkt-d - Date of Application: 16 zc � O I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MWROVEMENT 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 o r•. Date Contraqbr Name Registration No. OR Date Owner's Name q:fbnns:Affidav wveal Board of Building Regulation B ce, Rm 1301 One Ashburton Pla2108.1618 Boston, Ma 0 E3 i rth d a is: 10120119 5cJ License: CONSTRUCTION SUPERVISOR LICENSE Restricted To: 00 026325 Expires: 10/20/2001 Number: CS PAUL.J CAZUAU.Q' 1585 MAIN S I 02G55 OS'I'L:RVII,I,I.;, MA Tr.no: 7665 Keep lop for receipt and change or address notif ication. I` "r= 1, na- 1`oard of Building Renula.L:ions and Standards One Ashburton Place Room 13O1. ;`-�;, E3oston . Massachusetts O21O8 Home Improvement Contractor Reg i.s;h.rat.i on I:r>W.strat:i.on= 1O3714 Exr_>.iral-. ion : 7/9/02 -1 y P e= Private Corporation NONE INPHYDENI COH1RACi0R 1-_ It Re9islralian> IM714 I '6`,lli :I .. r.:ft-'F_AUL_T & SONS INC Expiration: 119102 Paul ('!{:.'.F ;ill.l.Lt `= lype: Private Corporalio 22 1.. (w;.i.drJ:i,:ali Rd . P .O . Box 2781 MA 02653 PAUL J. CAZEAULI & SONS, I Paul Caieault A' 22 Giddiah Rd. . P.O. Box 2 M)MIW 114AIOH Orleans NA 026Si