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0078 FOURTH AVENUE (HYANNIS)
� - J r *M�>o TOWN OF BARNSTABLE Permit No. .36745 BUILDING DEPARTMENT I 1l'LU3T TOWN OFFICE BUILDING Cash Yl ` A7V n 9�ouY� HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Robert Cowan Address 78 Fourth Avenue, West. llyanni.sport USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. I Auqust..1.8,. 19.9.4............ Building Inspector 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A� DATA BARNSTABLE, MASSACHUSETTS NQ 36745 t'=,Z46 103 19 �_ .1 �:rERMIT DATE 14— AQPLICANT ij-"f3_,-1 S.i 1v Ln ADDRI'-SS (NO.) s_i I c E5c E ROFUNITS PERMIT TO )JU Ltd dwe 1 NUMS i b ly. I STORY DWELLING (TYPE OF IMPROVEMENT) NO. ZONING 13 4th Ave.avle DISTRICT— AT (LOCATION) (STREET) (NO.) AND BETWEEN (CROSS STREET) (CROSS STREET) ....... ---- LOT LOT BLOCK—SIZE SUBDIVISION BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN.CONSTRUCTION BASEMENT WALLS OR FOUNDATION- TO TYPE USE GROUP fTYPEI Sewq,v� #94-202 REMARKS: bOND 1.1(A PERMIT Ot.) AREA OR 1525 oq- ft. ESTIMATED COST $ FEE VOLUME (CUBIC/SO DARE FEET) Robcrlt. Cowan OWNER C ;�)40 BUILDING rovillFe! huat 1 1: toyt 8 4 u 11 BY ADDRESS UF-T-HrS-PERMIT'130ES-NOT-R-E CEASE'T RE-'A P rLt r A(4 T__F NOM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS PERM H IT APPL I CABLE SEPARATE PERMS ARE REQUIRED FOR INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AMID ALL CONSTRUCTION WORK: MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.. I.'FOUNDATIONS OR FOOT S�UR'NG� AL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 2. PRIOR TO COVERING STRU, MEMBERS(READY TO LATH): FINAL INSPECTION HAS BEEN MADE. .1. FINALONSPECTION,BEFORE, OCCUPANCY.; POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS & 6_%_)_')1�10_;��v 2 2 ENGINEERING DF.PAR MENI HEATING INSPECTION APPROVALS C-T 0 HE LIH OTHER SITE PLAN REVIEW APPROVAL D VOID IF CONSTRUCTION INSPU:IIUNS INDICATED ON THIS(ARD CAN RL WORK SHALL NOT PROCEED UNTIL THE INSPEC-. PERMIT .1 L BECOME NULL AN�, 2 T", WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TFI EPHONE ()R WRITTEN TOR HAS APPROVED THE VARIOULIS STAGES OFI PERMIT iS ISSUED AS NOTED ABOVE. NOIIFI(-,^-IION CONSTRUCTION Io b o em[x c�xux[v g 5 5 • _-.. - - -- rxrcn ua vw n smxc .oa.x ; We! E8�£5 _ _ __ _ •r � •�/."o wtt� svwnss(rvv.) $g¢E B�g BEE OEM ®® Right Side Elevation -> Front Elevation in os i Fr— CrD u Rear Elevation Left. Side Elevation r .w...or.a m,a L. �=�e..c,w °L..5•.a eL*.LL.a,e.s 5/.aawc RAIL DETAIL src,nac a oLa �. ms,.eoTM nms ura a,moc. m u�x,y ea=�rto ro`m�w a nc or ua 5 b o o ro oz,ww.navwc r< s-r w-r ga NOTE ga@-a .� x : wnu aon wwwR L DECK iRgMiRG TO BE PRESAIRE 1REnTED IIa--C.m—a— a /(wDLw,wi2ED.LO LBS./CU.R.) 'P ato.rn,oL �i a aLL R,RDwgRE a wgiLS i0 BE GgLvgw�2ED .-1 w,« �n-.�_•c.L,.,..oba ea,s o eo-nc ' ---------------------,- - --T' In sQf a DECK & RAIL DETAIL Full Basement J �2 3 's .ram•—// <s � T Y-r rt r-r a-s•n s-r •/aww=00I srw[s C:.c r=aoa ea Kw. b t. a.'isw"'`"`..ca.w+soo+wc CnL___o 'z Cl. Bedroo Hell Bath t b f--'2' 3 _ r--1 2 •�r-.-n, n � tf= -------7- z oLiving Hau Kitchen .vcusw..o.Luvs p., U z •J• - 5/rn �� I A51 Z .. e e" co r �•,�°° � Y 'e�a.L. Foundation Plan o fl6=LL 9• Fwu Baaem ne s' J f:' p sin -v rn co SI Typical Cross Section r _ � a s b I FLEA WINDOW SCHEDULE` j}, Q r-e ve•.._e,I� e�[�. ,p. i-ta- 00 1 L .1 -- .3 I I (Wood Deck I.I 8 r-a,rr.r-],/.- ,�o�m,[rcgn«.� �� �. _j. t 'e 1_K1tChen ;I:, Atli,}S1z•I;�;".I ;_ 6,,,• Dining_ I 'I II „. a ©wa�u¢.. r-e�Ir.._s./.• ..ineaic w w+w. I _j_ _ -_ t,'6•v,t•Y � I I i �I;;��I I I I� � 3« � W„� OD .x� r-o sA-.r-os/r - w ® , tll :III iII; I! lili l'll &8«igpm xx•< I I I I fr�M $5$ h 2 ~ Y �Y�Etlg��� DOOR SCHEDULE 90.OF SIZE QTY. R.O. CJ ^'�* Bedroom '�" G m I� Living_ e 5 03 o s/.- _o x/e- u•s+tz•tQ e b �� s"6,try r s U).E • ' tr-s z'>•-** cd a°« as ?3 i 21 co m zSS f ]rd r-ou •-,c 0 r-r 0 r-c � s•-c � e•-e• Yvd b L { }St Bath..:... b « I First Floor Plan A Bedroom xs� Pe` Bedroom �41. S-f'•-T z � o q Cto9[x L (7 p � F Ell { o V STORAGE STORAGE u 'd }st Second Floor Plan I g i;, r�z� " .'� t } ` �„�, i v ,t.` •''. t.. ,.. 3..+ i �'k.:. ��.. i "("': ti -7"+ri, 7 � i j i 1 .�.• t � t T .,..� �1� i v S i .� ! � / � i , � �j' # Y fit-t �.•-#- , s 'l���a`-3 i .i 1 y j ...� i is s -7, A. "� { , �a f . „ },. ,•,, ._,. � .., ., ... ..; ,.,x..:,. � t �_L �, (- "�"i'I} F`l �_`` } r} � ! t 1'a::, 7� ._t t ` ...,...i f + �� �s S l r ,—� ...{. �•�-CO.00 d � f � ,:. a.,,.,. r {�.f � t - r a * ; _ jlt� R. # ,... � K [ i , } r.f i_..� ' t d ! a e „ 1" lop Pp' i i P�►�G C PAPER) `3t' 1=T w�� r t �:. r i l ; f t > > —ti �iZt1 + Iy 1 .at a A 4- VT JAI ,: a' + E •���. .. � '-:_. + a � ",fix � � I � {a-t 1 � k " .y , � i t 3 � �^�•� i «}•. , +>t 1 Li F3 , S,H c�vi►-,t �'-FARE'o+� i oo n•�t?L �_._,-_ � + _ ...'._: _:l ". "T}-4E'Y SI�E L�►-tE �D-t ��'M.aAo1G' ; ��cA'T[ot�l � � ,��N E, '�I"�E�T; ;• , ; 1iv�E- ,�.crS ,cF :'r�•F�, -raw r...► �6,R - +- r w 1=sr. i t-+-� Af�Css�r{ LE:. tk i-o0 t 5 �tcyT' t, `Lc�c sE' ;. A►a N�s Po�r ! � .,�. .:. t ` •,_•._ �',6�Le': # I o ; � Tom, i o5 2-7 94.` W �THl s j-Me . a I Q.��Pam•►JG:� .,�-. o S 47 i•R4 'T}'1'1 St �aYIJ t5 T � ,ItS£fl ati A"u - . L1 ST 2A-j MsN T £mil r4 N 'r R-tW • . i i. rm o FS E^5. �I-Fow� t L.o ►jZmb i31� /1 :. '� i i►.�c.; T VS�O TO p Cm QM►N� LC>f' L I N �. Y—F 61S.'T �2 6 Ltk tt . �iQvLti/o Q'3 z.l A'PPLeMA xr ,`�`yL.V tA. SyLv/A .` APR 29 '94 01:45PM O'MALLEY & 'PIZZUTI M11MMMM ' P.1 s O'MALLEY,PIZZUTI& MuRmo P.A. ATMRMYS AT LAW e�®omm Nuar "ANNIS,,KA9SACHU8E7U 0=1 XAMV J.O'MALLEY,d&,,.P.C. TELEPHONE t M)776.7100 STBV>IN.J.PIZZUT[ FACSIMILE(6911)TNMZ HICHABI,J.MURPRY + January 27 : 199,4 Town of Barnstable .-Building Department South< Street Hyannis, MIA- 026D1 : ATTN: Richard Hearse, ,Building Inspector REs Lots' .241,243,245 Fourth Avenue, Nest .Hyannisport Dear Mr. Bearse: l (� Per the request of .Robert D. Cowan, I have conducted a title rundown: relative to the above-mentioned parcels so as to determine when the lots , were last held in common ownership. The recorder reveal that Robert D. Cowan,. purchased from Edward J. and Marian Cowan the three lots on or about November 15 1969 by: deed recorded in Barnstable County Registry of Deeds in Boots 1455,`Page 329 Prior, to that date, Lots 243 and 245 ware deeded from Sea®ide Park Association to Edward J. and Marian Cowan on or about February 19, 1937, in Book 526.. Page 136. Lot.'241 was deeded from- Seaside : Park Association to Edward T and Marian Cowan on or about April 25, 1931, , 1n .Book 480.. Page 442. The records also 'reveal that. Robert D. Cowen does not .own or has never owned any other lot which is conl;iguous to the- above_ mentioned parcels. Should you be in need of additional _. information, please :feel' free to contact me. - Verb tr rs, P i sJPlppb �, M �P t r s4 J ,£ 1 £ . . .. I x ,1 :� A 4 1 t o '! A 1 II • k r v i''t - , .,�- , , . :1 . . , , a . .�,�,���.;,� ,':; , ,,, , . I [. _ _ - :..-,-'L..'o-�.,:,��'��I..,_.,'�....,-I1�,,-.:--t�*-,.,.::.,,,�. .S _ ...4�. .. :,�-I��".,-o--:"-���_l.�I7.,I-.-1,,.I_,4".I_!-`�,ffl.---1�I:�_..,�;.-.�:,�_-;'I�I_.'_a I��I-I,��,�.-.F._.,�I,,-�IF.�"�--�%_-':,8I-.,.,.-,:r.t`�I�e�I,-3:l"1'�I,,��-R-.�',..I"l1 I.�1,--.."P-�4fy..:.,t,7�,....-1I.,:,x":I...�,,,-,.1-v'.,1-.V.;..�7,�,..-,,'-,.����..�.Ie6�1,.,,...X_�I;.�-��,.,I`;"-.'.:��I:,��rI..,.`-7..'.i,,"g,.�.�.,_��I�,,�,i,I5.--.`-,--�,,.��I7z,,.�',,-,.I�:..-7.,1a'�:��;..1-Id,L,,_.1,�-. >i r # ,' F.' - etoposs"taadrr"t . 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M N T ., ass ebusattt8t8t A :; COM O WEAL H DEPARTMENT OF PUBLIC SAFETY: ;.81 B�UdldO.•• , OF = ONE ASHBORTON PLACE Coda/sciasslorinOQtlOp ;oltA/sl/cawsa. ".MASSACHUSETTS 0 = BOSTON,MA02108 " r f i ;+ .3 , ;. CAUTION, - EXPIRATION DATE '=t :; L� I. ..�,-.�I:�:� I: >. i_• _ FOR PROTECTION AGAINST `'EFFECTaVE DATE "'LIC NO: RESTRICTIONS THEFT, PUT RIGHT THUMB E; ; - . ., . . :. ! h' ,\` T E j °.• L o INT IN APRROPRI T PR A BOX ON LICENSE: Y.. of .l r _. .' , C,. BLASTING'OPERATORS - f -r- w=. _ sM UST'INCLUDE,PHbTO :- - '_ _ PHOTO(BLASTING OPR ONLV�. FEET - - - _ 1 t . ,...... - ••..� ,.'_•�• �.!,_1..: i,l,!• y NOT VALID Nil'''1 NED BV UCEN EE AN 1 • Y _.: -' :� .,:•`•,�'rc ,, U L S G S D OFFICIALLY `,,1,..` �a '. +'M x ' - .. i. ��j-'W, STAMPED OR:.SIGNATURE OF THE COMMISSIONER:.: .•'"�,. r. x'.' Y a HEIGHT Syr DOB: 4 } `F /N ` Sr .., r, ,� r __ v . THIS.:DOCUMENT,MUST BE i. SIGN NAME IN FULL ABOVE'SIGNATURE LINE - i=..�:.`> _ -CARRIEDONTHEPERSONOF�'r SIGNATURE OF LICENSEE •r� - a !'` -J F SHEHOLOER WHEN EN F •' :I-!.A!,-....I 1_.—.-,-I.I,I.�"-I,....�:,,.���.,I�..�.-�-.,.�-"��,1,..�.".,-�l,,",���,�,''��:"�I�.I;�1,�.-�� ��s I_ ATHERS RIG HT,THLIMB PRINT .GAGEDINTHIS000UPATION +8s',P 8 ® ;¢, a 'j IAf -4C -.'�.I.,�,,,.I'..I�,I I:,��_.%,I,��I�..-��."�:-,-,1.,�-��...�,,I.l,.�..I.��,-_��2�,.�1.IM,:I1--._,::�,--;, t �`.; a I, _ . — — — — 4` t , - ° ., .. _ .,r _ -. .. .. £", 4 _ f fi y i 4 4 y q Fy t - i fit I I. - - ` %, i i ;1 F # 1 .. . - . -- I - r - r s r ''4 +/�� . II I. - .. • . r v: .. - - ' - - . Assessor's office(1st Floor): . Assessor's map and lot numbe 't I SS Co�THE>o Conservation(4th Floor): INSTALLED Bv COM� " Board of Health 3rd flo �� L� ( �a ��A W7�'H �'IT'L.ESrAntc ! Sewage Permit number � � � �l��S�®� g �'! �o rua Engineering Department(3rd floor): jam/ �/ �� o639- ®� TA�.. C0�E House number 1 0j�(�'��®NS Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN ''F OF 'B—ARNSTABLE 3 'BUILDING a INSPECTOR ' APPLICATION FOR PERMIT TO I U i L S I N G P 1q V W' , L Lj � o y �, TYPE OF,CONSTRUCTION ®O� --I IV" ' � V TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for apermit according to thee following information: 7� '7� ,, Location -7 b 4 R A v E: �l� S� �t4 4�SN Is PO IL M Pr d 2 6-7 Z- Proposed Use 1 'PA M I L Ll I ® I I o h-roc N 1 Zoning District Fire District -�-- y-lo �I-� �Ot//l�r Iv 2 1 0 �9 Name of Owner Address �`R 1 N a I IS Y ��;4 d Name of Builder �1 LV 14 t UV 1 V ' �S S��'' Address (61 1 tA k 1 N ?1— CENTUIV I LL E Name of Architect A L Address irm E f o0"n Yti C�' 101C ���- Number of Rooms S Foundation �Nc'�TE i'I L�, ( (,� 1 Exterior Y y o o Roofing Floors �- All PE T— Interior V 1�vl �i L L-- Heating v' ` I Plumbing Fireplace Approximate Cost 1 Area 1 Z � �Z Diagram of Lot and Building with Dimensions Fee . 070 l: OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na Construction Siipervisor's License i C9WAN, ROBERT �. No 36745 Permit For BUILD DWELLING Location 78--4th Avenue, W. Hyannisport _ Owner! Robert Cowan Type of Construction - Plot Lot Permit Granted May 31 19 94 Date of Inspection: ; Frame 2v 19�L' Insulation Fireplace 19:?y Date Completed 19 _ t 0. 1 t t ` 4 i t r r I I ��t Application number........................L.................... Fee....................................................... .............. MAss. I wlNi 0 UA.HNS ABL_Building Inspectors Initials......... t63p. A � �FOMA'� Date Issued.................. s.`.�. ....................... Map/Parcel...... .N.` .. ..�. .........................• TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WI DOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: .I i F 0 i) J�a 1--1 A V E W, H YA N N I S PO R j, 118. NUMBER STREET VILLAGE Owner's Name: N Phone Number y o b^ 3 3 9 - 0 3 g Email Address: r !C S tom Cell Phone Number Project cost$ 6 3 0 0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK 0 Siding 0 Windows(no header change)# 0 Insulation/Weatherization D Doors(no header change)# Commercial Doors require an inspector's review E Roof(not applying more than 1 layer of shingles) ~" Construction Debris will be going to YQ i mx%(A ti t3- CONTRACTOR'S INFORMATION Y Contractor's name A N(-,w S Ar FA VQ-Yfi AZ ` Home Improvement Contractors Registration(if applicable)#�. g 3 Z O 2 (attach copy) Construction Supervisor's License# j Q 6 ( p 2 (attach copy) F Email of Contractor Lo a -�1 t Phone number �0? �7 7 6 2Q D o ALL PROPERTIES THAT HAVE STRI AFS OV 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent 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 pm4.30pm.Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 JCMR and the Town of Barnstable. Signature Date 04PY LICANT'S SIGNATURE Signature Date Qo�• O �_ All permit applications are su ject to a bui ing official's approval prior to issuance. C0R' z' : y ' " Th F Roofers " 67 SEA STREET A T#A4, HYANNIS NIA 02601 RTA- 1_10 LA R ID ;A R LIIFETZ ; E -A LGAE E TART AR.CH, IT CTURAL STYLE REmR.00 xKQ_ PROPOSAL November 13.2018 ROBIN LEAHY 78 FOURTH AVE. M: rleahy@leahycs.com W.HYANNIS PORT,MA el: 804-339-0389 COREY & CORES'hereby proposes to per rm'the following services in a neat and professional manner and in accordance with the manufacturer' specifications and local building codes. Remove and Haul Away All of the Old Asphalt koofing Shingles(One Layer)from the Entire House and Both Sheds.Re Na' 1 it All Plywood Sheathing s needed. Supply and Install CERTAINTEED LAND AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, ASS A FIRE RATED,COPPER/CERAMIC STONES fora FULL 10 AR WARRANTY AGAINST ALGAE CONTAMINENT,240 PO JND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGO W III HURRICANE STORM/HURICANE NAILED (6 NAILS PER SHINGLE MULTI-LAYERED,LAMINATED ARCHITECTURAL,STYI.E,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: GRANITE G 4 Supply and Install 8"WHITE ALUMINUM I RIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WITS GUARD (Ice& Water Shield)WATERPROOF UNDERLAYMENT SYST M on Roof Eaves&Valleys Under the Step Flashings,o i the Skylights and Chimneys. Supply and Install CERTAINTEED'S 11ROOI RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VEP T II RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM& NEOPREIP E SOIL PIPE FLASHINGS Clean and Remove Debris from work area after j r b is completed. TOTAL INVEST NT ------------- $6,300®00 i COR, E'y ii`: 44 Th Roofers POSSIBLE EXTRA CARPENTRY: Any Rotte I or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Walliju g or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materh is Plus Labor at the Rate of$60.00 per Hour. PAYMENT SCHEDULE: A Deposit of One H. if is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediat ly Upon Completion. WORK SCHEDULE:All Roof Work is Schedu ed for Completion Within 90 Days of Acceptance and Deposits Received are Non-Refundable After a hree Day Cooling Off Period from the Date of signing. Please Mak Checks Payable to: CORE & COREY COREY& COREY Warranties the Shingl s and Labor for 10 years. CERTAINTEED Warranties the shingles and lab 100% for the First 10 Years and the Shingles your LIFETIA IE if the shingles becomes defective. CERTAINTEED Warranties the Shingles up to a CATEGORY III HURRIC NE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Al ae Resistant fora Full 10 Years. CORE & COREY carries Workrnan's Co pensation and ublic Liability Insurance on the above work DATE OF ACCEPTANCE: // (5/0y)tr 0 ACCEPTED BY: SUBMITTED BY. R" LEARY ARMEN SAFARYAN ROMEOW1vE F COREY & COREY HIC # 183202 CSSL# 106102 Office of Consumer ' Affairs and Business Regulation - One Ast bd on Place - Suite 1301 Boston, MaSSaChusetts 02108 ` Home Improvement Contractor Registration .�� Type: Individual ARMEN SAFARYAN Registration: 183202 67 SEA ST APT A4 - Expiration: 09/13/2019 HYANNIS, MA 02601 ' _( t 1 O 20M-W17 i Update Address and return card. Office of Consumer Affairs;&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual 's MlStration valid for individual use only before the expiration date. If found return to: Registration _Exp1mon - Office of consumer Affairs and Busin Regulation 183202 = 99/13/2019 1 O Park Plaza-Stine 51 ARMEN SAFARYAN Boston,MA 02118 D/B/A COREY-,N. COBEY,_ ARMEN SAFARYAIV ^ 67 SEA ST APT A4: HYANNIS,MA 02601 - Undersecretary Not valid without gn e' 7- Massachusetts Department of Pubiic,Safety ' d y Board ofrBuild'n r 9 Regulations and Standards * . Li cense. CSSL_�06102 Construction S;upe isor S ARMEN E Specialty � SAFARY 6T SEA STREET A4 a _ .. HYANNIS MA 02601 - t. /�'��y,..�i• .Z Gam_ + t commissio, r Expiration:. 10102/2Q20 i i i ;46 o® CERTIFICATE OF LIABILITY INSURANCE DATE 09/13201(MMIDD8 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group PHONE (508)997 6061 FAX (508)990-2731 No Ext: AIC No 439 State Rd. E-MAIL apaiva@easterninsurance.com ADDRESS: P.O.BOX 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B: Armen Safaryan INSURER C: DBA:Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD MM/DD COMMERCtALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea occurrence1 $ 100,000 MED EXP(Any one person) $ 5,000 A 952004644104 09/18/2018 09/18/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ E 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED ASCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY UTOS HIRED NON-OWNED I PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY _ Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE - AGGREGATE $ DED I I RETENTION$ - $ WORKERS COMPENSATION _ PER �/ OTH- AND EMPLOYERS'LIABILITY STATUTE X ER YIN N 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE � E.L.EACH ACCIDENT $ A OFFICER/MEMBEREXCLUDED? ❑ NIA 952004644104 09/18/2018 09/18/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 s Boton,MA 02114-2017 1Www.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anoticant Information Please Print Legibly Name(Business/Organization/Individual): F} .L S l-(:�JI R yO A/ Address: -7 S 1 P S 1 City/State/Zip: 14 Y 0►V N l�; n�} `L�' 1 Phone#: S' -7.7 z.q o v Are you an employer?Check the appropriate box: Type of project(required): 1.❑[am a employer with_ employees(full and/orpa -ti 7. New construction 2.❑I am a sole proprietor or partnership and have no employees tme).'working for me in any capacity.[No workers'comp.insurance required.] 8. Remodeling 3.[J I am a homeowner doing all work myself.[No workers'col.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct,all work on my property. I will I ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I LC]Electrical repairs or additions proprietors with no employees. I; 12.❑Plumbing repairs or additions 5.C:]I am a general contractor and I have hued the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.�We are a corporation and its officers have exercised their right of exemption per MGL c- 14.❑Other 152,§1(4),and we have no employees.[No workers'comp]insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. l Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby certi u der th i and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone#: �O*t- 7 1 f Official use only. Do not write in this area,to be completed by city or town ofciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 1 Contact Person: 1 r Phone#: r Docket: IJ'Vttii' rsvx y3se2 Date: November 24;2015. State ofez , x Mercer Coun Surragt r tY In the Matter of the Estate.of Doris F. Cowan,:Deceased. :LETTERS TESTAMENTARY I,Diane Gerofsky,Surrogate,do hereby:certify'the aonexed to,be a:arue copy-of the Last°Will and Testament of the above named decedent,late of the County of Mercer,and`State of New°Jersey,;adm ited.to Probate on this 24th day of:November,"2W by the Surrogate of Mercer County and that Letters Testamentary are'hereby granted to Donna J Crafford:and Robm J:Leahy.`., the Co Executors;.named, therein,who are duly authorized to take upon themselves the admini`stratiori of the'said testator°according'to; law and the,jelmsrrQf he.said LastVJll and.Testament.. l I f , -WITNESS my lurid and seal this 24th day of November,2015. ne Gerofs a, t ... fix'`y-v i Y 3 5 rt?••^ J x..„, T'.-ems" ,.sca'� is z I Dons F. Cowan;domiciled tn.Meircer.County,°New Jersey; revAb inv pry 'Wills and Codicils and declare this to be my Will. _ L`DEBTS,EXPENSES;.,DEATH TAXES: (A). I direct my Executor,to pay the expenses pf my funeral,burial, and:last illness as soon after m :death:as ma.bye ract�catle ,and to: a m debts as ma 6e;re uired b y Y p PY Y y 9 Y law: (B) All death taws(inciudmg;any interest thereon,or penalties)imposed because of my:death on"the property passing underytlus Will shall be:paid:from the principal,ofmy estate as if they were a ministration expenses,without apport oim—60.or Pioration II. TANblB PERSONALAOURTY (A} I give all automobiles, verso''n nd household;effects;'and,other tangible< personal,properly owned by_me at:rny death,,together with all.insurance thereon, in such;shares; and proportions and to;such persons,who:shall survive me,by tturty"(30}days, as I;$hall have,.set forth in a written memorandum dated.and signed by me and addressed.to my'Executor:- (B) To the extent not effectively"disposed,of by`such memorandum,T pve%such; property to my spouse;Robert D Cowan; if he:survives me bythirty(30)days;otherwise.I give t such property to.,my,descendants who survive me by thirty,(30)days,'per st mes.1 (C) The-costs('including`iitsuranee)ofpackmg_and shippingJ prnspassing under this Section shall be paid by my Executor-as expenses of adm ustedgri fhy estate. l w - ; Y POE o $s,R isk ejP JN r x a s . III .DE S—E OF R:E.AI. 3 . (A) if I am the sole at the time of.my.death,of that:certain.land aM improvements known;as lots 241, 243, and 2451 on'Fourth Avenue Hyannisport;Massac '"" ,as shown'in_Block E; Section B on,a.plan drawn by Fred O. Smith C. E. entitled"Plan:of Seaside : Park at Hyann spoit, Massachusett'i ixted by the.Seaside Park Association;,August, 1893", recorded yin Barnstable Registry of Deeds;'Book 205, Page.601,I give and'devise all of niy-right, tithe, and interest°in.and to said land'and improvements to:my:daughter, Jo Cowan:Leahy; if' she survives me by'thirty(30)days Af mysaid daughter fails to survive me by thirty-(30) days,1 give anddevise.all of my right;.-title, and anterest:'in:said land and improvements to`my said daughter's descendants who survive me by,. i' (30) days;per stirpes,; If neither my said, daughter nor any of her descendants shall so survive me;I give and devise:all.of my.right, title;; and interest in-and to said land.and;improvements to my descendants who survive me by thirty (30) days,per stapes. l (B) If L&A the sole at the time of my death of that certain land and improvements known as lots 139, 140,.141,and 142,Btock#111, Unit#3, on the Map:of Inverness-Highlands'Subdivision, Citrus County;Florida, I give and devises all of my right, titlell. and interest in and to said land'anddin rovements to my-daughter, Donna Joann-Cowan Crafford,. if she survives,me-by thirty.(3:0)_days. If thy said daughter-fails to survive me by thirty(3,0) days,I give and devise aU_.of my right; title, and"interest in saidTands and AU nprovements to`my said daughter's descendants who survive in thirty(30).days, per stirpes; If,neither my said. daughter nor any of-her descendants'shall so,survive me,,,I give And devise all>of-my;right,tittle; and interest tm and to staid land and mprovements:to my descendants who survive me by thirty' s (30) days per stapes: 2 LETTERS OF AUTHORITY FOR Docket No. Commonwealth of Massachusetts The;Trial Court PERSONAL REPRESENTATIVE BA16POIME.A Probate and Fanaily:Court Estate of: Iffarnstabl"e.Probate and Family C"ourt 31'95 Main Street Doris F Cowan PO Box"346'' Barnstable, MA"02630 Date of Death: 10/26/201.5 (608)375,"6710' To: Robin J Leahy and. 2112"Worchester Road Donna J Crafford Midlothian,'VA 23113' 4640 Province LM6 Road Princeton, NJ 08540 You have been appointed and qualified as Personal Representative in Supervised x� .Unsupervised' administration of this estate op May,26,.2016. ae These letters are proof of youreuthority:taact pursuant to"G. L::c: 190,13, except foe the foliovuing restnctiomif any: (] Pursuant to G:L.c: 190B,:§3 108(4) the.Personal Representative shall have no right"tospossess estate assets as provided in-§3-709 beyondthat necessary to confirm title thereto in the successors to the estate and claims;other than expenses-of'administration, if any,:shalFnot:be paid. [] The.Personal;Representative was appointed before March 31,2012 as;Executcr or Administrator of the estate ; (Do,Not-Write Below This Line-For`Court Use Only) t rX CERTIFICATION_ I certify that it appears by the records of this Court that said appointment remains in full force and effect. IN TESTIMONY WHEREOF I`have hereunto set my hand and affixed"the seal of said Court., Date May 26,2016 w Anastasia W Perrino, Register of Probate. MPC 751 (4/15/16) Docket No. Commonwealth of Massachusetts ORDER OF INFORMAL PROBATE Trial . Cotirt WILL AND/OR APPOINTMENT OF Probate:and Family court: PERSONAL REPRESENTATIVE � 1� " _. . 'Division . Estate of Doris= F Gowan irsi ame: i. e ame' as ,ame, Also Known As _ Date of`Death: 1d12$12015 .. 1. A Petition has beenfiled regwesting F] The appointnment`of a Personal Representative:; ,,; cod�clls• ® Informal;probate of the Will dated Ma ,2,1995. and Oates B of the above named decedent. 2: Upon consideration of.the Petit'en,1 determine.based upon the:Petition that:all of the following arearue: a. The Petitioner is an^interestedpersori and:has:fileda complete and verifed petifion. b. Venue is proper: i c.. The Petition was filed within the firne period per".v ed.by law d. Any required`notice have been:_given.or waived: ; e. A death 6ertificate,issu6d'=bya-public"officer is in the Courts possession: f: The,spouse.antl heirs are not incapacitated persons`,or'rnmors;or if;theyare,they are represerited by a:Guardian.or " Conservator otlierahan;the Petitioner. a 4 APPOINTMENT OF'PERSONAL REPRESENTATIVE, riori entitlm that person to appointment with orvfnthout appropriate 3, The<appointed Personal Representative hasp ty 9 noniination andlorrenunciatlon Any Wll to which the.requestedappointmeh, relates.has been formally or informally' probated. The folfowing per"on(s)a5/are`gualifiedto`seive.antl is/are.appointed Personal fepresentatwe(s) . Donna. J Craffori: Robin _ �Leafine 'First, ame. � ast ame. irs,. ame 2112:Worchesfer,Road 4640 Province Line Road„ p, rid, o.•e c Tess 231,13 ti Princeton:_ �, NJ, 540* Mjdtothian VA iiy own. fate i :awn ke Primary Phone#.{804).339-0389 Primary Phone.#(8U9)=924 15Z6 INFORMAL PROBATE;OF WILL.' 4, [] Th'e original,.pi'operly execuiedrand:apparently unrevoked Wll sin,the Courts possession, ` and any codicils dated The.Will dated are:referred to 6s t 11 he UVill. There are no;known prior..Wills which have not been exoeossly revoked by:a later instrument. The Wll s°admitted to informal probate. Anaufhen6cated copy of the Will,and any cotlicil'and statement est to in the State of . New Jersey. are in the Courts possession `offered for informal obatf. page. 1 of� 2 MPC 750(3719Y12) - Docket Nop � Doris' ;P• :Gowan Estate of: Fj(St Name- t e ame s ame, A duly authenticated copy of the Will"and;a duly'authenticated certificate of its legal'eustodian'that the copy_fled is a . - �� - Is'off'ered for true copy and thatthe' Will has.:become.:Iperative underthe Taw of „ informal,probate:_: 5. ® The appointment is;made;: without surety:on the bond. F-I .with personal surety on the bond'in the.amount of with corporate suretieson the.bond inthe amount of: 1 6: .0 Letters of Authority for Personal Representative shall issue. The-Personal RepresentatiVe(s)shall;comply with all relevant requirements under the-law,and the appointmentis sublect'to termination as provided in G.L. C. 190B,§§3=608-612. Date f agistrate I 0 Justice- The Petition'is DENIED/DECLINE6 because i This orariother Wll of ttie Decedent has been-the subject of'a previous probate,;0[der< Persons.with prior or equal priority have not renounced or nominated the Petitioner or his or her nominee: t } [J Notice'requirements have not been rget. E [] Other.. j I Date [], Justice . Q Magistrate NOTE: The denial,:of a Petition for Informal Probate cannot be appeale,.d A fo.11 rmal proceeding ritay':be initiate pursuantao G L.-c.190B,,§3401. If this Petition Is allowed'the Petitioner must publish an Informal Publication.Notice.{MPC 551)once in�:a newspaperdesignated by the Register_. The Publication shall not be motto than thirty-(30).days after informauprobate otappointnient pursuant-to G.L.c:190B,:.§;3=306(b) AHER KGISTER page 2 .of 2 MPC 750(3/19/12) dFTMe r� • The Town of Barnstable WARW �0� Department of Health Safety and Environmental Services Ec 59. Building Division a 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. Type of Work: a4 4041,�II /D� Est.Cost �ddress of Work: Owner's Name Z iP,-1 9' Date of Permit Application: Apyu-1� A97 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. wilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR _ . a_ Owner's ame The Connttonwcalth of Afassarhusctts -►i �--_==t!- Department of 111dttstrial.4ccidcnts ` office elltt vest lgatlons 600 !f ushingtnn Street 4'• �. Bustun. ,4fuss (1Z111 wt w Workers' Compensation Insurance Affidavit 6101-nt inftirmatitin•' _Please PRINT Z-Niv 77-7-- 'name Adew -P ( l�rci1,4 41 _.._ ..__._.._ location• �� �rl?.C�-� ,/ •t�• � fS' 0�=f ✓hop•>Y �� .S'`.SP I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity [� I am an emplover providing workers' compensation for m% empiovees working on this job. cmmtanv name: address� cim nhnnc ft• insor-tote cn. C ! am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed below who have the Following workers' compensation polices: comminv nnme, addrea;: tin phone 0- in-mrinre rn noiicv H -f�- �.•^.- _ �•'t••. :___.:__.._ram:.:r—'.�tT••r-r.._..y. •-.-++•s.__ --- ..s._._.. _. cmmrint' nnint•• addreyz- rip nhnnc#: i-ncttrnnce co, a Attach addititinai sheet if necessary_ i� �;+ �^+�' _.. .. rr .r•,:.:q_r'�..• �...s"��'��.. Failure to secure cnverace as required under Section 3A of 111GL 152 can lead to the imposition of cnminai penalties of a line up to S1.500.00 andiur unc cars' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a dap against me. I understand that a cop}.of this statement ma} be forwarded to the OlTce of lnvestig2tions of the D1A for coverage verification. 1110 1,erchr cerrtyjr tiler tlr• runs and penalties of pet jun•that the information prorided above is true uttd correct. Si=.^.atur• Date ra/rldL��i plc Print name /11/. ( / r4f1/ Phone � >r .. ;ofrcial -sc unly do not write in this area to be completed by city or town official w ' cit%.or tnwn• permitilicense it r1guiiding Department C3Uccusing Board L check if immediate respunse is required OSeleetmen's Omcc l C31lc2ith Department contact person: phone#; rJOther S. r. Information and Instructions Massachu.setts General Laws chapter 152 section 25 requires all employers to provide workers' amtpensati•an for th employees. As quoted from the "law". all emplitt•ee is dcfincd as even person in the service of another under any contract of hire. express or implied. oral or written. An emplorer is dcfincd as an individual. partnership. association. corporation or other legal entity. or any two or me the foregoing_ cr1La`_ed 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, empioying employees. Ho%veyer t owner of a dwelling house haying 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 h� or out the __rounds or buiiding appurtenant thereto shall not because of such employment be deemed to be an empioy MGL chapter 152 section 25 also states that even• state or local licensing no nc)•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 fins not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for tlae perforniance of public Nvork until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. A >I (>iicants pit corn letely b • checking the box that applies to your situation and affida� PP n ensation p ) � Please fill m flue workers compensation supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coyera`e. Also be sure to sign and date flue affdavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not tite Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are require to obtain a workers' compensation policy, please call the Department at the number listed below. City or,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pl: hich will be used as a reference number. The affidavits may be returned be sure to fill in the permit/license number w the Department by mail or FAX unless other arrangements have been made. Tlae Office of Investigations would like to thank you in advance for you cooperation and should you have an)• questic Please do not hesitate to Live us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents _.. Office of Investigations 600 «'ashington Street ., Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 72 7-4900 ext. 406, 409 or 375 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. ✓ DATE /J //y;G-7 / i / 7 / Z,TOB. LOCATION �} ! •._ Number Street address Section of town ZHOMEOWNERIIYd,� _X_adj (D Gn S�d. 77f SS��c�' ..'. . .. Name Home phone Work phone - PRESENT MAILING ADDRESS--Z. , ate . ' ity t wn State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Offici on a form acceptable to the Building Official, that he/she shall be responsih for all such work performed under the building ermit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code and other applicable codes, by-laws, 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 wi h said procedures and requirements. HOMEOWNER'S SIGNATURE v APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION -�w,�, The code state that: "Any Home Owner performing work for which a buildin permit is required shall be exempt from the provisions of this section g (Section 109.1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Ownez shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for .licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board Cann inlicensed person as it would with licensedof proceed against the Supervisor. The Home "Owner actir. as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. y I i i jaw z(' - Ho us, . - i 1 • ! I � _� I r - ..T_ _ __ ��� o_ �f..__ , �.£. ' Co WXN r ll�- ce If a&JA& (� �l �Q- yea ZY 14 • 1 t� t S w , 17 LIC)l 241 : 245 •o z�� 1'�1�..om �F:f T Q r 1 • � � O/i� L' S► i 7 9L9b * .. t , L NC P _ 1 H Of 4 Gr ' � t , 3 S �S -T EL 10 .L GE 2T F1/ Ti-FAT -n4a ��N aA^n o 1..1 C��TI�i�D r" LcT -kA w "T}-IE SHcvv►,...t t-FEREa�..� �or+�t PL1�5 w�� ;.. . : :_,__ _ ,. _ :.' _.� _ . .. SIDELN IE /SLID SETi!3Ac.IG �o u�Q.E M 8•►.rl`S o� "f't+�s �-aw r..l err - c ;W�sr -F+y A"►.�al�s AcQ r F3 f3t.L ir►.+0 ►S ►re�T Lacr4'TLo L. •• 40' , w IT?t� P L !t.-1. DA° : 05. 2-i.R4 1�� Trti s Y)..I �s -r ` irs E O a+.l A--,.� QL K 'S A4 P Fps E,'-S �Fow I� 3rtcv u� wsar i3� VSico To 0 cm QM t!vim Lc17" L J►•►��. �61 STiErL6� Li4K D �sQvEn.Yv �3 . AP PL ICAf.rr SyLV I A: � 5-I Lv/A . Engineering Dept.(3rd floor) Map _ Parcel Permit# House# Date Issued ��3 -'�/ 1 Board of Health(3id floor)-(8:15 -9:30/1:00-4:30). Conservation Office(4th�floor)(8:30-9:30/1:00-2:00) Fa� S1fS UST BE n. 1:�°� 9�LED CE Defi d e 19 WiT V® ONMAND TOWN OF BARNSTABLE TC,INN R ®NS Building Permit Application o' treet Address �O Aa`cey�6j '40 Village Owner. �� sk i'%S ct1CLi7 Address w Telephone :rO v 711 "- W Permit Request 1 '4-;,-i First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 4 022.Uri Zoning District Flood Plain Water Protection Lot Size IJ© X /0'O Grandfathered ❑Yes ❑No Dwelling Type: Single Family �2( Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes KNo On Old King's Highway ❑Yes No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name G ZrJ .QJL— Telephone Number Address License# Home Improvement Contractor# - Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) I, FOR OFFICIAL USE ONLY c Ems/' G F j - PERMIT NO. - L DATE ISSUED w i' MAP/PARCEL NO. s i ADDRESS VILLAGE ' OWNER ' DATE OF INSPECTION: FOUNDATION FRAME - INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH, FINAL ( i FINAL BUILDING) - ~ µ `{ DATE CLOSEDAl ASSOCIATION N� - ii