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HomeMy WebLinkAbout0027 KILKORE DRIVE -- --�._ i Town of Barnstable IKE Regulatory Services Richard V. Scali,Director t F t k 'N I F Building Division Z (f , • snxxsraBLFE • M^ $' Tom Perry,Building Commissioner ff`l , .i639 �� iOrEn 39 A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4638 `} Fax: 508-790-6230 Approved Fee: Permit#: U HOME OCCUPATION REGISTRATION Date: (� G Name: Phone#: 'S—e Address: IZl Z- Village: - - Name of Business: 2 Type of Business: Map/Lot: INTENT:. It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried.on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,.and not within the required front yard. • There is no exterior storage or display of materials or equipment. + • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned, ave read and agree wi the above restrictions for my home occupation I am registering. j Applicant: Date: / Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: �y Fill in please: Lv Fsn�uf APPLICANT'S YOUR NAME/S: Z ;2 ,/�0,M eV 7 m1�;y".�1""fir' h BUSINESS YOUR HOME ADDRESS: 7 A01 WCX7 1144 0 t' y a TELEPHONE # Home Telephone Number ). ` - P NAME OF CORPORATION: NAME OF NEW BUSINES5 -� S ' t ° 3L TYPE OF BUSINESS IS,.THIS A HOME`OCCUPATIDN? i/ . YES O p ADDRESS OF BUSINESS j e f MAP/PARCEL NUMBER � �5 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need: You MUST GO TO 200 Main St. (corner of Yarmouth. Rd.& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSION R'S O701- A MUST COMPLY WITH HOME OCCUPATION This individu I e W-or y rm requirerr� nts that pertain to this type of bysir� ES AND REGULATIONS. FAILURE TO u�_oriz e 'g star * �' COMPLY MAY RESULT IN FINIVO .. 2. BOARD 01 HE TH This individual he i for d rtain to this type of,business. Authorized Sign re** MUST COMPLY WITH ALL COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map� Parcels O t y Permit# ®�$ Health Division �- l a 3 a t to wP ', X _ Date Issued Conservation Division Fee Tax Collector OEC' 13 _ AM 9, 2 5 l r Application Fee �b- Treasurer "�------ _ ` Planning Dept. Lq i t i F ` Checked in B CONINEC6 , )T Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis _b Project Street Address ` ( I `D r_Je,_ `�- Village Owner CC,4 GtfJ?N� �O�L J fiAddress d l � � (1� - T> Telephone ���pp ( Permit Request I l C� ��1./,tit �' d U L')v Square feet:JAt floor: existing proposed 2nd floor: existing proposed Total new Valuation ` Zoning District Flood Plain Groundwater Overlay Construction Type �1�� L��J'�1w�4 ZYf"-S `A� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure "t Historic House: ❑Yes o On Old King's Highway: ❑Yes o Basement Type: 3 Full Cl Crawl ❑Walkout ❑Other ti - 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: 4Yes ❑No Fireplaces: Existing © New Existing wood/coal stove: ❑Yes alo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn: ❑existing ❑new size Attached garage: FlYexisting ❑new size Shed:❑existing ❑new size Other: • x Zoning Board of Appeals Author'z/ation ❑ Appeal# Recorded❑ Commercial ❑Yes S-4 4o If yes, site plan review# Current Use Proposed Use ` -- - BUILDER INFORMATION Name- � Telephone Number Address l �-� �� �►` License# ClV e'SA-4all �Ay_6 Home Improvement Contractor# � ` Worker's Compensation#(DZ7 j� D U j C L17).0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �- DATE FOR OFFICIAL USE ONLY a , PERMIT NO. t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ,w FINAL GAS: ROUGH FINAL FINAL BUILDING :I Fit Cz DATE CLOSED OUT ASSOCIATION PLAN NO. =� i Department of Iridastriai Accidents Office.of Investigations ; 600 Washington Street : < Boston,AM 02111' ,•� www rnas&govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricaams/Plum bens Applicant Information ]Please Print Les:ibiy Name(Business/Or,gar;'ationadividuan: S � ( d✓�,f`c Address' C>lty/Stirp.to/Zi ��- �� Phone#: Are o�iai.employer? Check the,appropriate boa:. Type of project(required):• 1. I •employer with �- 4. ❑ I am a general contractor and I ' 6. ❑New construction to ees(full'and/or part-time).* have hired the sub-contractors ' ❑ �g � Y listed on the attached sheet.$ 7. Remode 2.❑ I am a sole proprietor orpariner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any'capacity, workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. 0 We are a corporation and its 10.0 Electrical repairs or.additions required.] -officers have exercised their right of ex lion per MGL 1'1•❑ Phunbmg repairs or additions 3.❑ I am a homeowner doing all work , 1 4 ,and we have L myself-[No workers' comp. ( ) 12.0 Roof repairs t employees.[No workers" insurance required.] 13.0 .01her comp•insurance required.] *Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policy infb=tiou: ! ' t Homeowners Who submit this affidavit indicating they=doing all work and then hire outside contractors must submit a new sffi&a it indicating such " tC ontractm that check this,box must sttacbed an additional sheet showing the name of the sub-contrabtors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. ' Insurance.Co Incur Company Name: Policy#or Self-ins.Lic.#: �, 7 ° Expiration Date: n ,I Job Site Address: C ` �� �L •� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and-expiration date). tr,t Fatiure to,secure coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminalpenalties of a as fine up to$1400,.00 and/or one-year imprisomnent; 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 lie forwarded to the Office of !„ Investigations.of the DIA for insurance coverage verification. I do hereby certify under the p ' andpenalti s of perjury that the information provide/dd ove is true and correct: • Si mature: Dater U °` �� � ®�-s— • 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 ones 1.Board of Health L.Building Department 3.City/Town Clerk 4.Electrical 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. Massa. erson in the service•of another under any contract of hire, pursuant to this statute, an employee is defined as"...every p ; express or implied,oral or written." ' ' • :«• , association,farporation or other legal entity,or any two or more An emp y e, _- to er is defined aS�:�inctivi¢tia],.pa�ers#iP of the foregoing•engaged in a Joint enterprise' and including the legal representatives of a deceased employer,or the • receiver a trustee of an individual,partnership,association or other legal entity,employing employees- liowevter:the owner of a dwelling hous a 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 woikvu such dwelling house thereto shall not because of such employment be deemed to be an employer." or on the grounds or building appurtenant d the ce MGL chapter 152, §25C(6)also states that"every state or r to construc licensing ildings fn the�agency shall wommolnwealth four any r • •renewal of a license or permit to operate a business o 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 for the performance of public work until acceptable,•evidence of compliance with the insurance enter into any contract his chapter have been presented t4 the contracting authority" Tequirements oft Applicants the boxes that apply to your situation and,if. . Please fill out .'the workers'compensation affidavit completely,by checking apP name(s),address(es)and phone ninnber(s)along with their certifieate(s)of necessary,supply sub-contractors) insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships urac a)LLC or LLP does have �the members or partners; are not required to carry workers mp ' re ' e& Be advised that this affidavit maybe submitted to the Department of Industrial a oli is �' 't d p cY affidavit. The affidavit shout employees, on of insurance coverage. Also be sure to sign and date the Accidents for coafirmati he Department of be returned to the crt3'or town that the application for the permit or license is being requested,not t 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, S'e1f-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Tited legibly. The Department has provided a space at the bottom Please be sure that the affidavit is complete and p of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicantt Please be sure'to fill in the-permit/license, which will be used as a reference number. In addition, an asp that mast 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"'th'e applicant should write"all locations in (city or )."A copy o€the••affidavit that has been officially stamped or marked by the city or town may be provided to the toivn applicant as proof that•a valid a4davit is-on file for•future permits•orlicenses..A new aff idavitmgst be fled out.each e owner or citizen is obtaining a license or permit not related to auy business or commercial venture year,Where a home (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit like to thank you in advance for your COOP and should you have any questions, The office of Investigations wfluld 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 Ofe of jnvestigations ,• .600-Washington Street. . Boston,MA 02111., Tel.#617-727-4900 ext 406 or•1-,877-MASSAFE Fax#617-727M49 Revised 5-26-05 www,mass.gov/dia Town of Barnstable Regulatory Services s�►� Thomas F.Geiler,Director Building Division rEa►� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME JMyROVEMENT 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: ;�v� d Estimated Cost Address of Work:--,—' Owner's Name: G Qj Date of Application: I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law []Job Under$1,000 []Building not owner-occupied s []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: � itj Date Contractor Name Registration No. R Date Owner's Name Q:forms:homeaMdav �o�tHErQ,,, Town of Barnstable * Regulatory Services ,STABLEBAM 9MASS. � Thomas F.Geiler,Director s639. �0 t639ra Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �J , as Owner of the subject property hereby authorize � l,l�� � V LL(� to act on my behalf, I in all matters relative to work authorized by this building permit application for: (Address of Job) Signatur caner Date of Print Na e i Q:FORMS:OWNERPERMIS SION 12/07/2005 18: 48 5087717864 VANGO 1111 PAGE 03 Page 1 of 1 — ��J�.(QClitiD� f�-1 NA'` 0(4- http://207.190.197.68/sketchesOS/20672_21353 jpg 12/7/2005 P k �. F , 3 JA \ ` cc Ft . Yfia"`,.� M`+ tauk:ViM4,,w, ,::y..•.riY'S,!i.��,�.,_ ._i..im.�.a�'9...as-.i1s n.G.°�',".,:u!.$M • � ' Y fie�ammzv�uue �.�.aaa�cc/ucaeba a a` BQARD OF BUit_D!N'G REGU�ATlONS i '. license CON STRUCTIQWSUP,kVISOR Number GS 079315 I Btrthdate 06/06F19§7 Exptres 06l06l20:d7 Tr.no: 14467 � 4 Restrrcted 1r .. i SE N, COUTINHO.. 21 PIGKEREC,'UUAY FORESTDALE, MA 02644 } Commissioned! ✓tie Larn�naruuet �� a��lLaasrxu6e%�6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR UIVY Registration: 149014 Expiration: 11/18/2007 Type: DBA SEAN COUTINHO SEAN COUTINHO 21 PICKEREL WAY qua FORESTDALE,MA 02644 Administrator ' - e Town of Barnstable *Permit# Expir ont ram issue date ® Regulatory Services Fee Thomas F.Geiler,Director Building Division S T EP 1 j 2 p.r erry,CBO, Building Commissioner �VVnl OF B 006 200 Main Street,Hyannis,MA 02601 AR/�Sr www.town.bamstable.ma.us Office: 508-862-4038 ABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �q Not Valid without Red X-Press Imprint .Map/parcel Numbt OOc�1 d�9 Property AddressC2- 7 1� o,� A Residential Value of Work !� VD-0c Minimum fee of$25.00 for Wor under400.00 Owner's Name&Address Contractor's Name B'l ® +K ���i��� Telephone Number HomejImprovement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �rkrrian's Compensation Insurance Check one: ❑ I am a sole proprietor ❑�am the Homeowner L� i have Worker's Compensation Insurance 4 Insurance Company Name Worknman's Comp.Policy Copy of Insurance.Compliance Certificate must be on file. Permit Request(check box) �/Re-roof(stripping old shingles) All construction debris will be taken to [S ®SQ, S<�o✓r`� ❑Re-roof(not stripping. Going over existing layers,of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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 P rty Owner Letter of Permission. op y of the Ho r em t Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 Department of Industrial Accidents Office.of Investigations: 600 Washington Street Boston,MA 021I1 . 'i ,y• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kDDlicant Inft rma#ion Please Print Le ibl 1 vane(Business/Organization/bdividual): - o`( n I 67we, Address• Sg amity/State/Zip: Phone ►re you an employer? Checkthe•appropriate box:: Tape of project(required): I am a employer with 4. ❑ I am a general contractor and I 6.— New cor<s'truction employees(fbE*and/or part-time).* have hired the sub-contractors❑ I am a sole proprietor or partner- listed on the attached sheet t 7. Remodelin❑ g ship and have no employees These sub-contractors have ' S. [] Demolition working for me in any capacity, workers' comp.insurance 9• ❑ Building addition [No workers' comp.insurance 5• ❑ We area corporation and its officers have exercised their 10.❑ Electrical repairs or.additions required.] - . . . . ❑ I am a.homeowner doing all work right of exemption per MGL M❑ Plumbing repairs or additions ' 'myself:[No workers' camp.' c. 152,§1(4), and we have no 12APRoofrepairs insurance required.]t employees. [No workers 13 [] Other camp.msurance required.] ny applicant that checks box#1 must alsq fill out the sectioa.below showing their workers'compensation policy information: iomeownw who submitthis affidavit indicating they are doing an-work and then hire outside contractors must submit anew affidavit indicating such. xtractDri that check this box must attached an additional sheet showing the'name of the sub-contractors and their workers'comp,policy information. - !m an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site Formation. rp mrance•Comp any Name: licy-#or Self-its.Lie..#: to 60 �y Expiration Date: b b Site Address: ��( /!`©A6, ��f City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number d expka#on date). ilure to.secure coverage as required under Section 25A of MGL e. 152 cari lead to the imposition of criminal p ena'Ities of a ,e up to$1,500,.00 and/or one-year imprisonment; as well as civil penalties in:ie form of a STOP-WORK ORDER and a fine up to$250.00 a day against the violator.. Be advised that a copy of this statement maybe forwarded to the Office of restigations of the DIA for insurance coverage verification 'o hereby qrfift u r t pains a pe It s of perjury that the information provided ab.ove is true and correct: attire:. - Date: ��• j�-6 one# 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 L.Building Department 3.City/Town Clerk 4.Electrical Inspector-5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and. Instructions , - tassachusetts General Laws chapter 152 requires`all employers to provide workers' compensation for their employees. arsuant to this statatl%an employee is defined as ...every person in the service of another under any contract of hire, xpress or implied,oral or written." �n employer is defined a�•:"an?z�divislua�.P P�:association,corporation or other legal e�tityVor any two or more f the foregoing-engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,paTtaershrp,association or other legal entity,employing employees. Howeypr.the• .weer of a dwelling house having not more than three apartments and who resides therein,or.the occupant of the wain house of another who employs persons to do maintenance, construction or repair wort;on such dwelling house g ,r on the grounds or building appurtenant thereto shall not because of such employment b e deemed to be an employer." vIGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or •enewal of a license or.permit to operate a business or to construct buildings in the commonwealth for any ipplicant 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 r the performance of public work until acceptable•'evidence.of compliance with the insurance into an contract for p P ;stet m y • . . -equirements of this chapter have been presented to the contracting authority." Applicants Please fin out the workers' 004 ens ation affidavit completely,by checking the boxes that apply to your situation and,if aecessary,supply sub-contractors)name(s),addresses) and phone number(s)along with their certif eate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L•LP)with no employees other than the members orpartners; are notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may ba submitted to the Department of'Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their. self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is.complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure'to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current -policy information(if necessary)and under"Job Site Address"*the applicant should write"all locations in L(city or Xo�vn)."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•oflibenses..A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office.of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate tb give us a call. The Department's address,telephone and,fax number: , The Commonwealth of Massachusetts . ., ' -• Department of Industrial.Accidents . . .. > ..Offre gf Investigations . 3 600'Washington Street 4 Boston,MA 02111. Tel.#617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 evised 5-26-05 WWW-lnass.gov/44 1 I E,O''ti Town of Barnstable Regulatory Services snxxs�+si a Thomas F.Geiler,Director' 1639. . � Building Division TfD MAy Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder (� 6A as Owner of the subject I C ) l Property hereby authorize 'G C`ia2 A to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name i QTORMS:OWNERPERMISSION 09/09/2006 07:29 5087476629 PAGE 05 AR _ . • HOME IMPROVEMENT CONTRACT Brao.ch Name: (J Sold,Furnished and Installed by: Date: ' T14D At-Home Services,Inc. Braocb Number; Tob d/b/a The Home Depot At-Horne Services One Marlen Drive,Robbinsvilie,NJ 08691 #: Toll Free(877)513-3768-Pax:(609)631-9099 NJ Lic#L044942 Ref#9723181-0O3;DE Lic#J 997112310 Installation Address: 4 _ Federal ID#75-2698460 r p Porchaaer s City tatt,~ - Zip A R, Last 4 DI its of Briver's LIc.#&Ex .Mu/Vr: fi°MD AJ'T �¢ Work �d/Phonee Home Phone: "O I ) ) ( ) Hume Address: ( (Ifdiffereot From Installation Address) E-mail Address(to receive updates and promotions from The Home Depot): State Zip 0 tect Info—imation; 1/We/you("Purchaser"),the owners of the Contract with mat1Cpro ert De of U. Y located at t P S.A. Inc1 p he a described on the attached Spec Sheet p one Depot to furnish,deliver and arran e f Dove installation address,offer to oi. g or the installation of,all materials as incorporated herein by reference and made a part hereof: Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Rome Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract DEPOSIT PAYMENT OPTIONS PD-fP >yn6ff (Subject to find verification and/or credit approval.),IUu PA yM IOW- 1, � CONTRACT AMOUNT 2 I 1 Check,Cashiers Check U' 7 � � 4a.� or 5 Postal Service Money Ordu�- ---i-- (Made payable.to The Home Depot). Pg,b, *LESS DEPOSIT $ AtCN,06 2. Credit Card"and/or other payment options-Circle One Below tr&A-Af //61AL Viaa MasterCard Discover American Express tsf= BALANCE DUE 22// OQ The Home Depot Home Improvement Loan The Home Depot Credit Card ON COMPLETION $ 03C (3 New Account 0 Exlattng Account (}#IL&HDCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:S i!G vd (H1L&HDCC ONLY) execution of this contract Acet#: Exp.Date,' '--' Name as it appears on card: �+ L7F{[I 4a4nA7TE' Indicate Payment Method For By my/our signature b___e.low,I//We agree to allow Ilolne Depot to 13ALANCE DUE ON COMPLETION: charge th bove ref cnc5o credit card for the deposit indicated. C holder's-SiNattilo As� A.�L"96`7_ HIL or HDCC Authorization Codes De osit Final Payment All n°SSVq # Purchaser agrees that,immediately upon Comppletion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. ncing agreement,contain the ete Entire areement: This agreement an and its or modified unlessding any in writing lone separate agreement signed by botlalpartiesCemcnt a not be amen between the particti and can NOTICE TO PURCI-IASI R Do not sign this contract before you read it, You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it contract protect your rights. Do not sign a Completion Certificate before this project is complete, Law prohibits home repair contractors from req rOr equesting ecthe contractmpletlon Certificate signed by the owner prior to the actual.completion of the work to be performed ee Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract You may cancel this transaction at any time prior to midnight of the third business day sifter the date of this contract. S amount if the job is caneelled by Purchaser AFTER the third business day. TERMS F TI-IIS BY By My/OUR RECF.,IPT OF OW, VWE A COPY OF THIS CONE TO TRA OUA D�WOICOMPLETED COP OFCONTRACT.THE NOTICE ACKNO OF CANCELLATION. THAT THE AGREEMENT IS SUBJECT TO REVIEW OF LiY OUR CRF SIGNATURE TORE'AND AUTHORI E HOME DEPOT TO VERIFY AND REVIEW MALL LIABILITY CREDIT MY O RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM iNA VERTENT OMISSIONS OR ERRORS. Date: �bG' . SUBMITTED BY:. I C s n, — �f gate: ACCPTEDBY: tiomeuwner Date: Homeowner NOTICE:ADDITIONALT AND AND ARE PART OF CONDI I IS CONTRACT ON THE REVERSE SID> 7-t8-06 C-SC Whita—Sranch File yellow—customer Pink—Sales Consultant r .v MARSH , CERTIFI�-ATEQI° 11`ISUTAlVC ` r.-.CERTIFICAiENUMBER.., - ATL-000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR ALTER THE COVERAGE MA.YA IVICCLURE(404)995-3206 OR AFFGRD EG BY THE POLICIES DESCRIBED HEREIN. TAivll ROUSE(404995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAG17 34-5 PIEDPNIONT ROAD,SUITE 1200 - --- A 1 LAiU l A.GA 30305 �100492-IPUSA-G'/VA-03iO4 A STE:`__%FAST INSURANCE COI`-IPAN`r_— — INSURED j ccm1 Aw - HOME 5 IIC'c5 INC. B ZURK111 AMErR;IC.'•.`1 INSiiR;\'iC:E COi4IFAM`.' i DBA.THE�iOME DEPOT AT-HOME SERVICES,INC. — -- -- - i FICIME LDEPOT'U I co'.1PANY r 2455 PA,t tS FERRY RCA.D I Pv/ NE' i'.AMPSi-it '- INiS COMPANY E!iLDIPJG C-8 ------ - ATLArlTA,GA 30339 CCIIIPAN`( D AMERICAN HOME ASSURANCE COMPANY C.OVER'AGES ;r Thrs,certifcate supersedes,antl,reglaces any-p�evlously Issued cectifcate for;the,policy penodwnoted below �3: ,,, .:a THIS Is TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY-PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY.ARE EXCESS' PRODUCTS-COMPIOP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL 8 ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire). $ 1,000,000 MED EXP(Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) i HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X ELF-INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY=EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: Tb EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID,MD,VA) 03/01/06 03/01/07 )( WC STATU- OTH-; *tias�'v EMPLOYERS'LIABILITY TORY LIMITS ER '. �a,t.,;•::< C 6610995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03101/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 P ERSfEXECUTIVE 6610999(NY,WI 03/01/06 03/01/07 E OFFICERS ARE: EXCL ) EL DISEASE-EACH EMPLOYEE $ 1,000,000 EOTHER WORKERS E COMPENSATION CONTINUED 6610997(FL) 03101/06 03/01/07 D 6610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS - _ 1 CERTIFICATE HOLDER ,Z0 '"rxa � � � ��$��g� ������ CANCELLATION � ��� '��3 {,"x ..e. ;> x�....a:.: .a max?:,.c�... n' ,:,:*z -�.z x'.., s .�.. ..,.' «w':..a, a ,.�•';�`�"' ,..; .ss..w_.„r .at .,�,_..,.�`,a <7 ,..„' .. +, ., 3. .x; SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL sn DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR • LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. By: Walter Gilstrap f � � INM1(3l02) &` VALID AS OF 02/27/06 '� KSTM .,2- x c ..,�4 r" T .� b.fir , r= _, 3' „z�, '; `. -�: ; { , �. DATE(MMIDDIY`!� )D:I,TIONAL INF0RMATpON � 4 ' ATL00091590711 02/27/06 COMPANIES AFFORDING COVERAGE PRODUCER MARSH USA, INC. COMPANY ATTN:BRENDA BOOKER (404)995-2594 E ILLINOIS NATIONAL INSURANCE COMPANY MAYA MCCLURE(404)995-3206 OR TAMI ROUSE(404)995-3430 FAX(404)760-5663 3475 P!EDMONT ROAD,SUITE 1200 COMPANY ATL.ANTA,GA 30305 i F 100492-IPUSA-GWA-03/04. ;NSUR50 i COMPANY THD AT-HOME SERVICES INC. G NATIONAL UNION FIRE INSURANCE COMPANY DBA THE HOME DEPOT AT-HOME SERVICES,INC. HOME DEPOT USA,INC. 2455 PACES FERRY ROAD NW COMPANY BUILDING C-8 H ATLANTA,GA 30339 7777777777 7777777777777 TEXTS s j a. , ,_xx ` 1 - k; CERTIFICATE;HOLDER: R ,. FOR INSURANCE PURPOSES ONLY MARSH USA INC.BY Walter Glstrap V&ht d ..._X, , y'?8..�p�`, rsr k �a'� # .S°��.,.a�" a T. omznz.ynusea/ ../G�u�azchcae� Board of Building Regulations and Standards HOME AIM. OVEMENT CON- TRACTOR Z, Registr,Wo\& 126893 �ira[ti�in 3q-006 yelement Card THE Home DePq�t Fit1CMAEL BEDA - Icf 3200 CO-,BB GALL.. 20 iGUNmy� p ALTANTA, GA 3033 >- Administrator i .� Page 2 of 2 parmstrong@kingstonmass.org; buildit12@aol.com; pdichiar@north-attleboro.ma.us; min sogna@medford.org; poriando@town.rockport.ma.us; pstringham@wbridgewater.com; pftacy@yahoo.com; pbryson@mail.danvers-ma.org; pjohnson@southboroughma.com; plombardo@town.hull.ma.us; tartakoffp@holliston.k12.ma.us; dweinhold@adelphia.net; ralph.gandolfo@peabody-ma.gov; rgaudet@city.waltham.ma.us; rasmann@townofmaynard.net; building@town.tewksbury.ma.us; rhanks@townsend.ma.us; rghaupt@aol.com; macdonald@town.duxbury.ma.us; rmanfredi@townhall.plymouth.ma.us; rosborne@cityofhaverhill.com; lancasterbuilding@choiceonemail.com; rreynolds@gardner- ma.gov; building@stow-ma.gov; building@ci.mashpee.ma.us; rmtrifero@aol.com; rbersani@cambridgema.gov; bbullock@virtuainorfolk.org; camachorf@MSN.com; bob.curran@whitman-ma.gov; rdarling@lakevillema.org; rgalewski@townofbraintreegov.org; rhill@ashlandmass.com; ivesb@ci.marblehead.ma.us; robertkirby@hotmail.com; bob@rjkoning.com; dsimpson@ebmass.com; rnelson@beverlyma.gov; rnicetta@townofnorthandover.corri; r_quimby@cityoflawrence.com; rjsperoni@townofinedway.org; robert.thatcher@ci.new-bedford.ma.us; rwhln@middleborough.com;jlennon@townofmarshfield.org; rpalmer@town.raynham.ma.us; rlaporte@townofbourne.com; camish@Littletonma.org; ralarie@th.ci.shrewsbury.ma.us; desantisr@town.grafton.ma.us; Robbins, William (DPS); Holmes, David (DPS); Novak, Gene (DPS); Cardarelli, Giovanni (DPS); Bailey, Gordon (DPS); Putnam, Jeffrey(DPS); John McCarthy (JJMcCarthy@MassMail.State.MA.US); Wojciechowicz, John (DPS); Joseph McEvoy (Joe.McEvoy@MassMail.State.MA.US); Vera, Louise (DPS); Piepiora, Paul (DPS); sean.macdonald@massmail.state.ma.us Cc: Bedard, Mike Subject: HOME DEPOT HOME IMPROVEMENT REGISTRATION Importance: High To All Building Officials, For your records, The Home Depot-At Home Services, Home Improvement Registration # 126893 is current and does not expire until August 8, 2008. Please issue their building permits accordingly. Thank you. Estee Ormont, Program Coordinator CSL/HIC Complaint Division Department of Public Safety/BBRS One Ashburton Place, Room 1301 Boston,MA 02108 e-mail: estee.ormont@state.ma.us 8/10/2006 T Y , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,1 Map aAtWf615 Parcel Gm T Permit# 7� 6 Health Division i owe se v* 3111-1 q-1-03 Date Issued 3 Conservation Division Q3 Application Fee Tax Collectors Permit Fee ✓ EQ -Treasurers Planning Dept. CONNECTION R RTAT MA MVEF XXGgJEDate Definitive Plan Approved by Planning Board ` CON rRUC10NDIM10NPR1p To Historic-OKH Preservation/Hyannis Project Street Address J rl k J L K®2-E VillageyJ�✓l//I//S Owner Gfill GgU,?10,,17` Address a 11"/LlKo2 J�k' 11/. : Telephone S 6 g 79 U Permit Request /7 /®x✓re., Square feet:`st floor: existing- proposed 2nd floor: existing proposed Total new Zoning'District in, " Flood Plain Groundwater Overlay Project Valuation 1) Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 9 Two Family ❑ Multi-Family(#units) Age of Existing Structure 1-I R,� Historic House: ❑Yes Colo On Old King's Highway: ❑Yes ❑No Basement Type: 5-Full ❑Crawl ❑Walkout ❑Other 4fr y` Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 Number of Baths: Full: existing new Half:existing + net Number of Bedrooms: existing new `= Total Room Count(not including baths): existing new First Floor RooA ount = Heat Type and Fuel: WLGas ❑Oil ❑ Electric ❑Other `�? = _ CD r- Central Air: ❑Yes ®No Fireplaces: Existing New Existing wood/coa stove: ,Ll Yes"'44 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:&existing ❑new size Cq A-Shed:❑,existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial__❑Yes___A No If yes, site plan review# _Current Use \ Proposed Use s ,BUILDER INFORMATION Name GA/ty ee GA1&m4)77_g. Telephone Number Address e52O��� �/L1 el License# / y�^'"-� S /mil✓JSS A 0 (gym Home.Improvement Contractor# Y ,Worker's Compensation#! ALL CONSTRUCTION DEBRIS RESULTING,FROM THIS:PROJECT.WILL{BE;TAKEN;TO SIGNATURE _ _ DATE t _ I FOR OFFICIAL USE ONLY _ PERMIT NO. s •DATI ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE ' r I OWNER DATE OF INSPECTION: c, FOUNDATION + FRAME _ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING i DATE CLOSED OUT ' ASSOCIATION PLAN,NO. p`pp tHEJp -6a The Town of Barnstable • BARNAS'S "I .T3 Department of Health Safety,and Environmental Services Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: l//,'? e'617- Map/Parcel: a? 7 a Cos- Project Address: f e Builder: ► The following items were noted on reviewing: / M o s T /,/,9 V e ,So AI A % v e Fs r 7 Reviewed by: V Date: q:buildinglorms:review The Commonwealth of Massachusetts �:t — Department of Industrial Accidents X - Office ofloyestioodems 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit Warne CA n-IV /46;/!%O 1y7 �9 v location � / crtv /✓/I��S /' sS 5 z9 2-6,G � phone# �4 I am a homeowner performing all work myself. . I am a sole rietor and have no one workinjcrp ca acity I am an P em 1 z roviding workers' compensation .............................:.:::.:::.:.:.:::..............:.:,:::::::.::........................:::..:::.:::.::::::::::......:.:....::::::._:::..:;:.>:.::.}:.:}:::.: .. :<?z ' a a S S ... Un. • r: :................;{..........................:::{o:+:i6;:.':Ci '<e>;;; p hon •: : al C V ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have n workers' compensation olices; follows P ........:.............................:.::::.::::::.::::::.}:.:::}:.:;.}:.}:;.}}:;.}::::::::::::::::::::•::::::;::::::::::::::}:;.::;:::::::::;;:;.:;.>., >.:..>,;...vv.,.n:::.•..,. the following ..................... . ..:.:............::.,:::::::::::::::.........:,:::::,::::..............................:.:::::::::::::...:::.:.n.::::::::........:.:::::::n•.::::::::,:..:.:.....:....:.:: :con an ;.name •:..:..;.:::. .:....:......:.. ...:::...... .................. :::.:{v;..:�•}:L}r:•.�:::.:•;?'n}:tti•.�`:'.: {-::Ji�Ci}}:vi:i:i% ............ .........................:::::::::.�::...................;................. .................... ..........w:n+.;L:•}}:}}:L}%Lis:•}}:{v%v.;:::;:. :::n:�:::::.}:.}}:{•}iss:�:Ls:L:•}:;•s}:L}'.}r::;•}:J:{L'r Lin}:::•}:S{4:•}}}}:{•}:L{;4::O::j.::•:::.w::::..........:x:........_..v v........::...:v... ..........wn:Y.:...v::::::.;.:..............;{•}:?:Y..............m:. 4•w.i•}Yw ............:::..:::v......�:::::..:•{•::•:isS?:•istv::•:�::�}:L:::v}.�::::::::::::n._.%^:w::.�::v::}'F.4}:!•}}'i::•:;v......::•ii:{L:^:•n•}:•?:x:.:.:.. ' i:�jj :}/'�y:':;i�{' :>?,'v,::, :;:;:;Y$::>�:•'.::iiiii:;:;:ij+.{':?:;:;j}:ti:;rH{}:i.:;?:::?<ti{;i:;:h:. ho :.f... ..:. ...... ?::.'-i:•}:?:;:L::ssi}i\v.L}:•:}::::::.�::•.:�:::. .}:::::•:•}}:L:L,�}:::s:{•}:{•'}•}s:L:L:: ...r...:::.y:::::-.:nv:v..::::.:::L$:{.}}%•i}:.}:. • ........................................ ................... .........................................n-.............. ...r...;..............:.:...::::}?:r•}}:;.:::X•r:::::}:t•:rv.•ry'rv..Y..`h�}.{if•%'}:::.'i.'}T ..........::..:..............:::...:........n...,•......:}::.....................:..:::.:.. ..v.......... ..::.::v.:. i'�•//.}:!::r::;?: ;.;};•':::{{:rii:'i<:;::i:::-:•iS;:.?:; i:;: ::}:::;etC•i%;•i:.^?:..::C•}:-?!::{�i::ti!�i::i}}i:{::�i ;...�.... ....:.....::>}.s:;{•:Ls}i:;{t;:;:j::j{;}:�{{:::{:.};•:Lvn}:•:;s}:L::•:{•:;{L;{•::y:•.:.::;};.{;i::;}';:;:.}•.}}•.}::rL:.?}:}?}:;•:}}::;::;.?}:{{{.:........-� ill nsttraRce.ca.::,.:.,....:.. HRH c ........:....:.............:...................................................._..._.. ...... ........ .........:..................:•:::::...................::::::::.:::::•::::::.::.;•::::::::::::::.::•::::::::::.:::....::.::::..,.:::::...::.:::.:..:%.,•::,.: t.........:.::::.: >�> ::. OM a'dtess, ...,.:................. .,.:::. . Rio n }}: : g?,.•; K- ........... 4}7= •... `...?v........?......:{'�':i�}iy< C? ':!;:`}: {.....................:i} ?`:;•';:+;$:�:';j: Q�''<;: iii{{'v ii:S ' }: / Failure to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby cerdfomlr the pai7anadenalties o erjury that the information provided above is true and correct Signature - Date 9 9f �� �i¢olno. V-Print a�eolno.-V7" Phone# «+ official use only do not write in this area to be completed by city or town official - • r city or town: permit(license# ❑Binding Department ❑Licensing Board ❑checkif immediate response is required ❑ a Office ❑11Healtealth Deparment contact person: phone#; - ❑Other.-_ f cYwd 9/95 PJIa Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe 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 instance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and ;j!. 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permrtllicense number which will be used as a reference number. The affidavits may be retmmed to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesugauans 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 �FTHE l Town of Barnstable Regulatory Services BARNSPABLF, " Thomas F.Geiler,Director MASS. g �ptE039. a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date Cl-9—o3 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: S N e� Estimated Cost 2a c• Address of Work: n � '<<�- ���'�'l_ Owner's Name: GA Date of Application: Cl—2—0-3 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 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. 9-9-o3 Sftzy g,0%1qumo1\J7 " Date Owner's Name Q:forms:homeaffidav t J !kl \l ) '.. ; -fit--'�•c:.-'^_ ._ ,€ ,� I .._..--....—— k it it + to .,o In 1 - .., ._ .. ._ ♦ -_ III I 1 ,1 a Z+ ro VW o - c- c i � h� ` Town of Barnstable f THE 1p� Regulatory Services • Thomas F.Geiler,Director SARNSPABLL MASS. 9qp 1639. s`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: q^ —L—O 3 JOB LOCATION:a number street �+ village . "HOMEOWNER': G)I K /_ SD-9 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occurred dwellings of six units or less and to allow homeowners to engage an individual.for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or fame,structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildjA permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requir ents. Signature meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use.in your community. Q:forms:homeexempt 07/07/400J M01'I 08:02 .PAX •++a OCONNOR • � I II i I I li i ,h rt l'I .4 �1 ! LOT 33 l� j LOT 34 LOT 35 148.85 yA Fr i i Ic� I t LOT"29 18028 S.f. I LOT 30 Fis OK. LOT 28 2 STORY I DW4t.11 I� !' a i i!� i •. I � L�125.00' I � i .I KILKORE ROAD ! 'i OF LAU11F'TANI it i n. 4t:0U;ta a>,;.•:IL:�<r, 40' 1' i AMERICAN SURVEY]NG COMPANY '! OF BOSTON INC. 1204 MAIN STRERT MALT�AM, MASS. 02451 •,! ! PHONE (781) 9934477 FAX (7E1) 099-7091 REGISTERED LAND SURVEYOR, Do HEREBY CERTIGAGE I T�TA7 THE MORTGAGE INSPEC ION PLAN '! ABOVE)IORTGACE NSaCDON !i LAN WAS PREPARED SW ' I L$`FARGO DATE: RECORDED AT, COUNTY REGISTRY OF OEE N CONNECTION WITH A NEW 0.1ENT: 9OOK:(„ 4.7—PACE a L.C. CERT k CLIENT REF.t.�- PLAN REFERENCE: 417=5 OR EPRE. AND IS NOT INTEND �•p• O09 03 DRAWN PER TOWN OF: NYANNIS ASSESSORS R REPRESENTED TO BE A LAND THE LOCATION OF THE ORIGINAL MAP/: PARCEL/: DATED: j PROPERTY SURVEY. NO DWELLING SHOWN HEREOF EITHER ADDRESS: ORNERS WERE SET, AND IT WAS IN COMPLIANCE V414 LOCAL BORROWER: AUMONI CANNOT BE USED FOR APPLICABLE ZONING BYLAWS IN " STABLISHING FENCE. HEDGE. EFFECT WHEN!CONSTRUCTED li M BUILDING LINES. THE LAND (WITH RESPECT TO HORIZONTAL SHOWN HEREON IS BASED ON DIMENSIONAL bEOUIREMENTS ONLY), rl' ! CLIENT:FURNISHED, OR IS EXEMPT FROM NOTATION II INFORMATION, AND MA� BE ENFORCEMENT ACTION UNDER MASS THE SUBJECT OWE UN �LT1ggS IN flppp ZpNE SUBJECT.TO FURTHER CA. TITLE V11,CHAP. 40A. SEC-7 AS SHOWN ON 7H N9TIONAL FLOOD INSURA 0 AM ; OUT-SALES. TAKINCS, kASIJENTS, UNLESS OTHERWISE NOTED OR INSURANCE FLOOD;RATE MAP DATED-L292 AND RIGHTS OF WAY.;NO SHOWN HEREQN;A CONFIRMATORY COMMUNITY /PANEL / 1°O 1msc - ESPONSIBILTY IS EXTENDED z INSTRUMENT SURVEY IS ADVISED HEREIN TO THE LAND OWNER OR WHEN STRUCTPRES ARE SHOWN I FIELDED I DRAFCH CK OCCUPANT. IT IS NOT INTENDED LESS THAN V-FROM PROPERTY OR BY: T Air RECORDED... I REWIRED 641ING SETBACK LINES. DATE:_ F.B. PCE:_ I 10. — _ rt 7T 1 I _ Y. \ 1 'LF'.VF3y1�- '".5ai-t-fl�YEtf� - I , res. l 4 $_s�b'g- -f x i 7-7!.F!OME IMPROVEMENTIM r.EWMN ROAD SCALE:-b ' I APPROVED BV:. 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'°1 L� f ry"?^ /'a4 a-,.s" 4r �v f+ f PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well 1 (lot. . . . .... .. .. .. ..ft. rear) . I butter s ' Abuttor's 3me Name Dt # �4 Lot # this is a If this is )rner lot, corner lol rite in name write in street. _ name of 04 other ,Q) street. . r� • / HOUSE e (lot. . . ... .... . . .. .ft. frontage) \ (NAME OF STREET) / Information / \ Supplied by - - .,"Kw•.d`.� . el .-,'tr �u..:.f f"jy. r_,.'ySr .c ry:t f 't1Y*vw.•..�'.o.�l�,'i.-n.-�"J"i-yi'n''.✓"e�'z..,l.}��t�"�x.:.._. 'i,�i-�.t'...) .`w� s 3L:.. �+..:.,��r' i.ri4 .�'".`Ira,FlvM� Assessor's office(1 st.Floor): .• Assessor's map and lot number " 60 -� ' 13ps'?NU, Boardof Health(3r ber.r): ' Sewa a Permit number.. Dsaa9rsDtL . s : `Engineeri3ng Department(3rd floor): rPF- rus House number oo�oY�r,a\�� Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BA.RNSTA,BLE = BUILDING INSPECTOR-4 , r APPLICATION FOR PERMIT TO e � TYPE OF CONSTRUCTION 4 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ac,ording.to the following information: -` Location L NN! lY , c� Proposed Use Q� PPZPW#9 V Zoning District Fire DistricV'*" Y Name of Owner N 2 Address o 'q t•. . - `. Name of Builder 2 D e �,­Addres s Name of Architect /7Dve Address t n F` Number of Rooms r US �1r' Foundation Lj Aybl— Exterior P CP� J Roofing /o - Floors �itir2� Interior SC , s Heating P Plumbing ' Fireplace ' /VDly� Approximate Cost _��7, �0�. DD Area ' • y T} Diagram of Lot and Building with Dimensions �4Pq tt Fee 'ItI j J S 1 �wI OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to•conform to all the Rules and Regulations of the Town of Barn abl regar in ,the aboveFcoi(o:4 i Name 11 . Off` Construction Supervisor's License d BARRY, VINCENT A=272-005, 013 0 as�a�3 No 34507 Permit For Add Garage & Breezeway Single Family Dwelling Location 27 Kilkore Drive Hyannis Owner Vincent Barry Type of Construction Frame Plot Lot Permit Granted August 6, 19 91 Date of Inspection 19 Date Completed 19 HERMIT COMPLETED ob X 67v Era+ Assessor's office(1st Floor):,'- •- Assessors map and lot number °�7W` d l!J ' 9 43 a*THE tp Board of Health(3rd floor): / Sewage Permit number f� _ L Al sesasrante Engineering Department.(3rd-floor) r�1 rrua House number, �. ` vo Kayo. Definitive Plan Approved by Planning Board. 19 APPLICATIONS PROCESSED 8:30-,9:30 A.M.'and 1:00-2:00 P.M.only ' TOWN ,- OF y BARNST n 4 1 D BUILDING' INSPE:C•T0" i jlei APPLICATION FOR PERMIT TO [LY /9%�. `�` d ef I TYPE OF CONSTRUCTION, Au ��� �a t 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora,permit ac ording to the following information: Location Proposed Use C'PZe e N Zoning District, Fire District Name of Owner Address o IBIS Name of Builder Address w/ Name of Architect Dy2 Address Number of Rooms ' Hui � e- Foundation JExterior .a Roofing Floors �2A�� Interior S u Heating NL .Plumbing "Ale -Fireplace A49PC_ Approximate Cost �, zpe . ,yq i�y��2QeZew�y. /./�. Area 3sd A,e2 Diagram of Lot and Building with Dimensions Fee ��� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn ab regar in he abov con t ion. Name Construction.Supervisor's License ` BARRY, VINCENT No 34507 permit For ADD GARAGE & BREEZEWAY Single Family Dwelling Location 27 Kilkore Drive Hyannis Owner Vincent Barry Type of Construction Frame i Plot Lot Permit Granted August 6, 19 91 Date of Inspection / 19 Date CompUbled '? ��` z 19 C 4 4'fp3 ' 1 Assessor's offioe (1st floor): l Assessor's map and lot number Board of Health Ord floor): Sewage Permit number BAUSTAM Engineering Department Ord floor): M House number 39. . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. C'q At 3 rle u C r........ c.............................................................. TYPE OF CONSTRUCTION ...... 1.vGc£......... �'`rr.�;:�...........�`'uL0.. .. .��°�r` .................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .......................p ..../l/cNaAr �iZ_f-, Eiy�.�;.�.Ij f ..................................... ... ... .................................................................................................. ProposedUse .......................................... ...............J... .............................................................................................................. ZoningDistrict .........��.:............................................................Fire District ...................................................... Name of Owner ......C1.'rlF[°Na�..!� ........ o!C ....�.j...........Address ..f.'.. .........../0 .... f,wjt�'vr........................ Name of Builder .............. r.£............................................Address .................................................................................... ...... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...................................................:..............Foundation ..I7��.'� . .... .......C..G.ti(.Ct.................................. j Exterior Roofing C /Q (` / / Ir Nl L 4 ( ��' (/C Lt i Interior Floors ' ../........................................... .................................................................................... Heating .....Y..w! ........ ....n......................................Plumbing ................................................................................ Fireplace .........../A.!A A.10................................................................. Cost Definitive Plan Approved by Planning Board ________l__ -----------19__ 5. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 39 >< AlC7 v�S4/>1�L5 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. Name .. eY^���'. >1: L` ./.-IL......................................... Construction Supervisor's License �...........I.................. i� (� c) (DD 7 N Z I p cn : w -j tz N H N :00 O txl In O �d CD �. :(D :w C (D '. In o :r H. :� iw 3 F- +t : H. :o H• . • :� : (D : I : F� 0 ; (D ,.4 a : n - : H ; F� : r w F- ty t-r H- (� rt :E: �o •O 10% c L=J N r 00 �o r v H c� r t