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0008 MARCHANT'S MILL ROAD
n� � �� � � ,� � � i. I (I III ,�" { � � R ;a Town of Barnstable *Permit# i Expires 6 monift from issue date / Regulatory Services Fee 00 Thomas F.Geller,Director Building Division P Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 TO ®ax:?0�7 230 EXPRESS PERMIT APPLICATION - RESLDENTIA.L ,c B Not Valid without Red.*--Press Imprint �/g�s,7• Iv p/parcel Number ,perry Address t ► 1 o-YI n i Residential Value of Work �A. Minimum fee of$25.00 for work under$6000.00 rner's Name&Address ire kea /� • �C6�1- t ntractor's Name_ (.0++ �J. l� �'(� Telephone Number -Sd _2 .me Improvement Contractor License#(if applicable) 111suactionSs-1✓ictmst �fappliealrlej o '� lWorkman's Compensation Insurance + Check one: I am a sole proprietor y} ❑ I am the Homeowner } ❑ I have Worker's Compensation Insurance Durance Company Name orkman's Comp.Policy# ►py of Insurance Compliance Certificate must be on file. mvt Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to / ; ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ 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: roperty Owner must sign Property Owner Letter of Permission, copy of the o rovement Contractors License is requiied. GNATURE: Forms:expmtrg vise061306 �= The Commonwealth of Massachusetts Department of Industrial Accidents u Office of Investigations a 600 Washington Street Boston,M4 02111' www.mass.gov/dia ' Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Legibly Name(Business/Organization/Individual): Address: 6 3 City/State/Zip: r r`"�4 14, ()26`lS— Phone.#: Are you an employer?Check the appropriate box: :Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part time):* • have hired the stab-contractors 6. ❑New construction . 2. I am a'sole proprietor or partner- listed on the•attach ed sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition 'working for me in any capacity. employees and have workers' $• 9. ❑Building addition [No workers' comp,insurance comp..insurance. 10.❑Electrical re airs or additions required.] 5• ❑ We are a corporation and its P officers have exercised their 3.❑ I am a homeowner doing all-work 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12$Roof repairs c. 152 + insurance.required.]t � §14( )�and we have no 13.❑ Other ���e employees, e Cl`T o workers' co .insurance required.) • mp n q ed.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-cont actors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy_ and job site* information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and enalties of perjury that the information provided above is true and correct. Si tore: �` O Date �-2�2�`—� Phone#: Official use only. Do not write in this area, to be completed by.city or town official City or Town: Termit/License# Issuing Authority(circle one): A.Board of Health 2.Building.Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1�1UI"Ill�.l;11J�11 A.11t,l. ill�t,l 1���.iV11« • Massachusetts General Laws chapter 152 requires all employers to prcvide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the. owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced•acceptable evidence of compliance with the insurance coverage required." AdditionaIly;MGL chapter.152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evidense-ofconlpliaace withtlre insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out'the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members•or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Towti Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a'call. The Department's address,telephone-and fax number:_ The Commonwealth of Massachusods Department of lndust al Accidents Qffim of Investgaflons 600 Washington stmet Boston,.MA 0.2 TO. 617-727 4W ext 406 or 1- 7-MASSAFE Faye#1 617-727-7749 Revised 11-22-06 W.ffic�SS 86V/tli8 "AGE 12/21,2009 09:41 7E!1 7 .99500 SCOTTI INS ;2 1 Town of Barnstable f1 a Regulitory Sakes E •, rk'0 4s F.Gmple r,]Director 7 � 1 Buildids] M310)m 9 Tole Perry,CBO padding commb imr 200 Msil,Street, Hymmis.MA 02601 ffi— 509462-038 ems: 506.7904230 Property Owher Must Cpmplete and Sign This Section If Using A BuUder. 05 Omer of+,hc sub"ect pxopertp htteby authaxiza_. 'can C ,l�:rid: to act on my bed¢, in aU mmers relatire to wosk authorized by this buildinj p=nit tpp4cativa feet; (Ad6esa of Job) G _ Siplkture of Date O '1' Print Name .,,.4 071 . '� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistrafCon , 147812 -Expnatort ' y�e IndIvidJal SCOTT BRATCHEf� SCOTT BRATCFIRr 635 DEPOT ST. HARWICH,MA 02645 Administrator �"�' �� ✓bee {DoonirreaiuUea�,Ctc a�/�aaac�uid�.t7' BOARD OF BUILDING iREGULATIONS License: CONSTRUCTION SUPERVISOR Number GS 091804 Birt_ftdate 04MJ1962 `r. r Ecpires 04/05/2009 Tr.no: 91804 Restricted= :O(1 SCOTT D BRATGHER 635 DEPOT ST HARWICH, MA 02645_._ Commisstorier Town of Barnstable *Permit# _ 0 0( 3 IS Expires 6 months from issue date Regulatory Services Fee 1 • �� Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �P O Property Address -R 6414Kj ` ` l ' ` CY ®Residential Value of Work_5,006 b Minimum],,fee of$25.00 for work under$6000.00 Owner's Name&Address M te_4CQ J�cc' * D. 0 rAA-�`� Telephone Number�0 7-Y 3 z—c-I C 4 Ll Contractor's Name P Home Improvement Contractor License#(if applicable) /y7?12 Construction Supervisor's License#(if applicable) 09 C SU ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: 9 I am a sole proprietor J U L 1 3 2007 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman'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 ❑Re-roof(not stripping. Going over existing layers of roof) r t Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does nonexempt compliance with other town department regulati�..i.�.I ntor'i 1` _9>,�"lion,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A cop of e om ent Contractors License is required. 7 SIGNATURE: L9 10l Q:Fomvs:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations _ 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Busiuess/OrganizatiowIndividual): . 5Z1443 AA-L <"r ►zv� Address: 635 S� City/State/Zip: /A"el A4--• G 2 C�•t S_ Phone.#: 5-D g �f 3 C N Are you an employer? Check the appropriate box: Type of project(required) 4. I am a general contractor and I 1.❑ I am a employer with � 6. El New construction employees(full and/or part;time).* have hired the sub-contractors 2.; I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity.acitY• employees and have workers' $. 9. 0 Building addition [No workers' comp.insurance comp.insurance. required.] 5. We.are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumb' repairs or additions 3.❑ I am a homeowner doing all work . g myself [No workers'comp. right of exemption per MGL 12.E•Roof repairs insurance required.]f c. 152, §1(4),and we have no employees. [No workers' . •13. 4 Other S'td fk—i comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce Oundert e s.a re alties of perjury that the information provided above is true and correct Si ature: Date: Phone# — 3)L L/ - Official use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two_or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwellfng 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,M(jL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compaauce with the inr.nce requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-confractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies•(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towu 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 mimber. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. Thek eommonwoalth of Massachusetts L. DTartment of Industrial Accidcnts Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov(dia Town of Barnstable KAM Regu��tory Services . .E Thomas F.Geiler,Director . Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Tice: 508=862-4038 4 Fax: 508-790=6230 .Property Owner Must gomplete and Sign This Section If Using A Builder. j Ci G �) ,as Owner of the subject property p t9 hereby authorize 7.Ld to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) - 3,d Signature of Owner Date Print Name, ; Yorms:expmtrg evise071405 ,per � �le -�o7.vmoozufea�/ o��/l/laaaactueaella ' •, �\ r Board of Building Regulations and Standards i 6 HOME IMPROVEMENT CONTRACTOR. Regi;;&*Iori,,:147812 Expiration . 9/2007 Type _Individual SCOTT BRATCHER , s 1 4 x ,SCOTT BRATCHER'- '635 DEPOT ST. HARWICH,MA 02645 Administrator r License or registratio before then vi Board ofBe din expiration date' Iftound�vidul use only g Regulations retu rn to: OneAshburtrn to:Boston,Ma o n Place Rrn 1301 and Standards 108 ot va tl i _ without signature — — r vDAC ISSUING OFFICE 181 LIBERTY Workers Compensation and INFORMATION PAGE MUTUAL. Employers Liability Policy ACCOUNT NO. SUB ACCT No. Liberty Mutual Insurance Group/Boston 30 46 60 10000 LIBERTY MUTUAL FIRE INSURANCE COMPANY 16586 POLICY NO. TD/CD SALES OFFICE CODE SALES REPRESENTATIVE CODE N/ 1ST YEAR C2-31S-304660-01698/4WESTWOOD 101 ASSIGNED 300011 96 . Item 1. Name of JEFFREY L BOGGS DBA J B CONSTRUCTION Insured 28 A NORTH WARREN STREET WOBURIN, MA 01801 FEIN 014589334 Address Status INDIVIDUAL Other workplaces not shown above: Mo. Day Year Mo. Day Year Item 2. Policy Period: From 07 27 96 to 07 27 97 12 : 0 1 AM standard time at the address of the insured as stated herein. Item 3. Coverage - - - A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability_ under Part Two are: Bodily Injury by Accident $ 100 ,000 each accident Bodily Injury by Disease $ 5 0 0 , 0 0 0 policy limit Bodily Injury by Disease $ 10 0 ,0 0 0 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06A D.- This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium—The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.All information required below is subject to verification and change by audit. Premium Basis Rates LINE 1 1 0 Estimated Per$100 Estimated Code Total Annual of Re- Annual Classifications No. Remuneration muneration Premiums SEE EXTENSION OF INFORMATION PAGE MA ASSESSMENT S 151 Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ 4, 155 Interim adjustment of premium shall be made: ANNUALLY Deposit Premium $ 4, 155 *N*9N00* ARC 238 This policy, including all endorsements issued therewith, is hereby countersigned Authorize Representative Date 08/23/96 Loc.Cad Term.Oper. J A C Audit Basis Periodic Payment Rating Basis Pol.H.G. Home State Dividend 1 8/23/96 1 NR MA NEW / GPO 4033 R1 WC 00 00 01 A / Copyright 1987 National Council on Compensation Insurance ��V// i TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE O Lti(-C j7 JOB LOCATION Number Street address Section of town "HOMEOWNER" a 9'—Zl�,� Name Home phone c Work phone . PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners„ was extended to include owner-occupie 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: Person (s)• 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 Offic: on a form acceptable to the Building Official, that he/she shall be responsil for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the S 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 with said procedures and requirements. HOMEOWNER'S SIGNATURE 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. 0, Construction Control. HOME OWNER' S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owner 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 iwarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home '•bwner actin as supervisor is ultimately responsible. ro ensure that the Home Owner is fully aware of his/vier responsibilities, man communities require, as part of the permit application, that the Home Owner 7ertify that he/she understands the responsibilities of a supervisor. On the azt page of this issue is a form currently used by several towns. You may :are to amend and adopt such a form/certification for use in your community. r - JEFF BOGGS INSURED � 617-935-5347 FREE ESTIMATES b+7- 7%-4aas -� J. B. CONSTRUCTION Complete Home Remodeling Additions • Roofing • Carpentry All Types of Siding 28 NORTH WARREN STREEC • WOBURN,MA 01801 :' • ' `+ dui♦ '� The Cannttonlrcttl!!t (!f 1fussachusclt Department of hidustrial.4cciticnts • " � ; -�!� O�ceall�eastlgallons �, ' _�•:� 61111 if udbinhtun Street j 4 +: Bustat.Mays. 02111 Workers' Compensation Insurance Affidavit I lip!clot information P1Ws-e PRINTI bLl?lY s cat• n• , in nhnn•+� - ❑ I am a homeowner performing all'work myself. I am a sole proprietor and have no.one working in any capacity ❑ 1 am an empiover providing_ workers' compensation for my employees�workirig on this job. cninimm• n tmt• •tddre�c• cin phone�• nplicv .—..... .... .-ty ..fir.w...w��w'...� _ ❑ 1 am a sole proprietor. general contracto homeowner(et le one) and have hired the contractors listed beiow who the following workers compensation polices: �com rim• Warne• �• � cin J ✓ phone • in-mrnnrc rn ��2� / noiic� c�e�,��s�d���d-ors .�•_ cnm nm• nnmc- addresc- rill" phone insur•tncc co _ - Itolicy Attach additio_na!sheet if necessary w "" '"'�'`•' "'"'• Failure to secure coverace as required under Scctton:SA of NIGL in can lead to the imposition of criminal penalties ol'a line up to S1500.UU ant one.cars'imprisonment.as well as civil penalties in the form of a STOP NVORK ORDER and a fine Uf S100.00 a day against me. 1 understand thn cope of this statetneut ma% be furnvarded to the Olrcc of Investigations of the DIA for coven CC vet iftcation. 1 do herehr cctrif}• trier drr prrha mid pettaitics ojprry'um that the information prorided above is t nd correct. Sicnature• r Date ®�-1�- Print name Phoner; T J. .�.e•.:�...... -- -- ---- --- ----- ---- — w� official use univ du not ivritc in mis area to be completed by cin or town ofrcial .' city or town, permitilicense it rRtluiiding Department ` C3ucensing hoard E selectmen"'orrice t_ [ check- if immediate response is required atlmith Department I ' f .lassachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their mployees. As quoted from the "la►►'". an enrph rer is defined as every person in the ser►-icc of another under an%• ontract of hire:"express or implied. oral or written. .n rnrpinrcr is defined as an individual, partnership, association. corporation or other legal entity, or anv two or morc is furcuoitnu enc:tged in a joint enterprise. and including the legal representatives of a dcccascd emplover. or the ,ceiver or tnistee of an individual , partnership. association or other legal entity, employing employees. Howe%,er the caner of a dwelling house having not morc than three apartments and who resides therein. or the occupant of the .xCililm, house of another who employs persons to do maintenance , construction or repair work on such d►velIing hous oil thu :_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. ':GL chapter 152 section 25 also states that every state or local licensing, nbenc}, shall withhold the issuance or ne►val of a license or permit to operate a business or to construct buildings in the commonwealth for any �icant who has not produced acceptable evidence of compliance with the insurance coycrnge required. iditionali . neither tine commonwealth nor any of its political subdivisions shall enter into any contract for the rform::nce of public work until acceptable evidence of compliance with tine insurance requirements of this chapter Ira en presented to the contracting authority. p icants ase f il' in the workers' compensation affidavit completely, by checking the box that applies to your situation and phIm company names. address and phone numbers as all affidavits may be submitted to the Department of ustriai Accidents for confirmation of insurance coverage. Also be sure to sign and elate the affidavit. Tile —Wit should be returned to the city or town that tine application for the permit or license is being requested. the Department of Industrial Accidents. Should you have any questions regarding the "law- or if you are required ,stain a workers' compensation; policy. please call the Department at the number listed below. 1' or Towns :se be sure that tine affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in the event tine Office of Investigations has to contact you regarding the applicant. Pleas ure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to :)eparnnent by mail or FAX unless other arrangements have been made. Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. se do not hesitate to give us a =11. Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents _ rr r office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone (6I7) 7274900 cx-t. 406, 409 or 375 Opt11! The Town of Barnstable 9 & Department of Health Safety and Environmental Services "613�°r� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissi 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 w' h other re uirements. Type of Work- Est. Cost �J'5 Address of Work: Owner's Name�i�2-�—��` Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. ing 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. to Contractor Name Registration No. i S� /� 73 r✓/Engineerin l Dept. 3rd floor Ma Parcel = it _ 1 House# FJS ' ate Iss d /Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) '" s .Fee - SEPTIC UST BE itive Pl uedP1��:::°.�.s .,,,u.,: t,--=- IN PL1�6NCE A Q 6 V TOWN OF BARNSTABLEENVIRON c®�E � �P� ' Building Permit Application T®W�9'RE���9i-,�`'�'''?���' Project Street ddress � MVM41,17 1)2i GL Village /y2i AI)5 r Owner % � �� Address Telephone73c�� Permit Request r f� First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ n Zoning,District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure / - Historic House ❑Yes )r0 On Old King's Highway ❑Yes Basement Type: ❑Full Crawl ❑Walkout ❑Other tt\\ Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing r---� New No.of Bedrooms: Existing New "— Total Room Count(not including baths): Existing New First Floor Room Count Heat"Type and Fuel: ❑Gas �Vil ❑Electric ❑Other Central Air ❑Yes `�10 Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: 'Detached(size) ;?® Y ' 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 (lj, �/�j�/� j Proposed Use Builder Information Name d �� �i' � Telephone Number 7 7Z c, 3�`R 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 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) � 7 r 41 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE° t 3 OWN _ 3 DATE OF INSPECTION:' ' r FOUNDATION r FRAME INSULATION 4 , FIREPLACE 4 i kt _ r ELECTRICAL: ROUGH FINAL r, r PLUMBING:',, R VH FINAL GAS: 4H , F°• 1 FINAL + FINAL BUILDING 64 S - _ n , DATE CLOSED OU Icy ;mfl3 ' ASSOCIATION PLAUIT. 6�17 &;ce /✓4 . i✓y or 2e IN E House num64rr, NAM 039. BUILDING INSPECTOR _~/��� APPLICATION FOR PERMIT TO —.._"~ ..=. ......�. ���==J�K �.�����',...............--...—^--.- TYPE ^ OF CONSTRUCTION ......................................................... .............................. , .....................l6\w.., TO THE INSPECTOR OF BUILDINGS: The 6e | o6 hereby applies for permit according to the following \. -} R � Zoning District -------..�.~--------------'' na »a�s� ~~�-�~ �]�� ~��, -~rnr�' ^ ° , ,,' Nome �f.{kwne,/\`��cs �'....'~�.00^./.�x �_,.—..-'._ `- ,eo .. �`c`'� .. ���� _ Nomeof Builder ----------------------'A66rex ................ ................................... Nome of Architect --------_------------..Ad6res .........................Number of Rooms -----.i_--.------------.Fuundotioo ......... ........................................................ Exiehor ----'--*J . ---------------'—RooGng ______.f_ .,._._________,.. / V Floors -----!��\!i���'l��~,—.--�--------]n��icv -------.--------------------.. Heating ----------.--.-------------..p1um6ing -----.—.----.---------------- Fireplace ----------------------.----..ApproxhnoteCoo --------.---.—..—._,~__,.. Definitive Plan Approved by Planning Buon6 lR----. Area --u .--4----'��� Diagram of Lot and Building with Dimensions Fee ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH - ,- ' ~- ` � ' OCCUPANCY PERMITS REQUIRED FOR NEVV DWEL L11 | hereby agree to cnnform to` all the Rules and Regulations 'of the Tow n of Barnstable regarding the above ' construction. ^ Nome -.���]\�.....j......~............................ .......................» � W°w-��' �~ ` Construction Supervisor's License ------------ � ROSE M. SCOTTI, TRUSTEE A=266-29 25283 Build Garage No ................. Permit for .................................... Accesstory'to Dwelling ............................................................................... Location ... .10..Marchants Mill 61 ...................................................... Hyannisport ............................................................................... Rose M. Scotti, Trustee Owner ................:................................................. Type of Construction Frame . .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .. July...5......................19 83 Date of Inspection ....................................19 Date Completed ......................................19 . ' Town of BarnstableBuilding Post,This Gard So That.rt=isUisible:Fcom.the=Street-:A roved"Plans„Must.be Retained on Job and,this Card MustbeKe t ; 6" " Posted Until°Final Inspectlgn HasBeen Made �� 3 a =Where a Cert�ficate:of.Occu anc isRe uiredr such Buildm shall Notmbed..®c'cu ied'?until aF.,mal«Ins ectio'n has been;made Permit Permit No. B-19-328 Applicant Name: MARK R PIETROS Approvals Date Issued: 02/12/2019 Current Use: Structure Permit Type: 'Building-Addition/Alteration-Residential Expiration Date: 08/12/2019 Foundation: Location: 8 MARCHANT'S MILL ROAD, HYANNIS Map/Lot: 266-029 Zoning District: RF-1 Sheathing: x . a u , . Owner on Record: MCCARTHY THOMAS J&NANCY J ContractorgName H.I.P. CONSTRUCTION LLC. Framing: 1 Address: 1077 FAIRFAX STREET Contractor�Liceense�168302 2 BIRMINGHAM, MI 48008 x Est Protect Cost: $20,371.00 Chimney: Description: KITCHEN REMODEL. DEMO FLOOR,CEILING,AND CABINETRY, i Permit4Fee: $ 153.89 COUHTERTOPS. INSTALL CABINETRY,TRIM`FLOORIN6CEIL'NG, �:� ' Insulation: Fee Paitl:r $ 153.89 REPLACEMENT WINDOW,ENTRY DOOR. REMO�VI AND DISPOSE , Final: ALL DEBRIS. Date 2/12/2019 Project Review Req: ._ �! Plumbing/Gas Rough Plumbing: • .; Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authoraed by�thls permit is commenced within sa months after,issuance. All work authorized by this permit shall conform to the approved applicat on and�the approved construction documents`•for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structes'shall be in compliance with the local zoning by laws and,codes.ur This permit shall be displayed in a location clearly visible from access streetorrroad and shall be maintained open for public inspection for the entire duration of the Final Gas work until the completion of the same. 7, '. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on�this,permit. Minimum of Five Call Inspections Required for All Construction Work: ' _ Service: 1.Foundation or Footing ' 2.Sheathing Inspection �, .�,, Rough: . 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT _DIIV r 1HE Fps 1 �® JAN Application Number.......... .-Iq...✓..;MAE& OF eta�'NS Permit Fee.....Total.Fee Paid _ TOWN OF BARNSTABLE Permit Approval by..................... BUILDING PEIIIMT /_ wrap. Z.�� .. pamet.... ............ APPLICATION Section I Owner,9s."Information and Project Location Project Address i( Village S D ` 1 Owners Name # Owners Legal Address 9_&(&47z� City �� State Zip Owners Cell# 7��' 3`-��03 E-mail t m c.C.a.,-�k a)M o h ct C,, c Section 2--Use of Structure Use Croup ❑ Commercial.Structure over 35,000 cubic feet 0 Commercial Structure under 35,000 cubic feet Single l Two Family Dwelling Section 3-Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure [J Change°of use- El 'Demo/(entire structure) 0 Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild [] Deck Apartment.: Sprinkler`.System ❑ Addition ❑ Retaining wall 0 . Solar Renovation Pool ❑ Insulation Other-Specify. Section 4 -Work Description ------------------ t4 m I l&poled 't o o r-. Last updated:11/15/20_18. I Application Number.. Section 5 Detail Cost of Proposed Constructio 20 3 Square Footage of Project. Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6-Project Specifics F-I 'Wiring D Oil Tank Storage : 0 Smoke Detectors [] Plumbing ❑. Gas D Fire;Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply 1 Public ❑. Private Sewage Disposal ❑ municipal ❑ On Site Historic'District: :0 Hyannis Historic District D Old Kings Highway Debris Disposal Facility: 570 _�/ I am using a crane ❑ Yes No Section 7--Flood Zone k F1ood.Zone.Designation Within or adjacent to a wetland;coasfaT bank? Yes ❑ No ❑ Section 8—Zoning Information, Zoning District Proposed Use _ Lot Area Sq.Ft. Total Frontage_ _ Percentage of Lot Coverage #of Dwelling Units(on site) `Setbacks Front Yard Required Proposed.. Rear Yard Required Proposed. Side Yard Required .Proposed Has this:property'had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated.11/15/2018 Application Number. ...... ..... , Section 9= Construction Soperviso>r Name Marl( ("1 ero_s _ Tel_ hone Number �O 1 ' S33" O-?,3 a Address z6--mOFQ ' t� CityD�ia s � State (� Zip O Z ql License Number License Type. S Expiration Date ,3 le4o�_6 Contractors Email ee-fg qf 3) GNU— . CoM Cell# 4/0 `-5-33- 623 Z I understand my responsibilities under the rules and regulations for Licensed.Construction Supervisor in accordance with 780 CMR the Massachuse tate Building Code.:I understand the construction inspection'procedures,specific`inspections and documentation re `e" y 0 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date ZQ Section 10 Home Improvement Contractor Name N 1On C Telephone Number -3 `d � ty ACDN . State. IZ I Zi Oz�/ Addresa L Df Ci p Registration Number Expiration Date I 3012- I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re 780 CMR and the Town of Barnstable.Attach a copy of your KLC... Signature Date t Section 11 --dome Owners License Exemption Home Owners 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. l understand the construction inspection procedures,specific inspections and documentation required by 780 CMR md.the'Townof Barnstable. Signature Date APPLICANT SIGNATURE Si tore Date t �� Punt Name j� y rr�5 Telephone Number '-P l— �J'�j—02-�— E mail:permit to::. _. Last updated.11/152018 I , Page 1 of 5 Final Quote for Labor. HIP Construction 401-942-7897 2c Morgan Mill Rd www.hipconstruction.com Johnston, RI 02919 l.e Kitchen Specialist: Brad Weeks Customer Information Thomas McCarthy 248-283-6637 'Date:12/08/2018 8 Merchants Mill Rd tjmccarthy@monaghanpc.com Hyannisport MA 54321 Measure PO# 12498265 Trade Trade Total Demo $4,579.25 Cabinet Install � $4,065.00 Backsplash Install $1,500.00 Carpentry Work $2,975.00 Electric $3,050.00 Plumbing $950.00 Flooring $2,301.75 Appliance Install $950.00 Misc. Labor & Field Quotes $0.00 Final Quote Total _ ~.� � $201371.00 i customes 5ignatur Date y, i This space intentionally IefU LanOe" OP o o.,TnM,;tal nnm 9 A 91 Page 2 of 5 Final Quote for Labor Scope of Work & Job Details Demo Remove/Dispose Cabinets (Per LnFt) 10 LnFt Remove/Dispose Laminate Countertop (Per LnFt) 10 LnFt Remove/Dispose existing Flooring (per SgFt) 297 SgFt Remove/Dispose Drywall (per SgFt) Y 132 SgFt Cabinet Install Job Set Up for all Jobs- Ram Board, Poly and etc. 1 Cabinet Installation (per Box) 12 Cabinets Pantry or Tall Cabinet Installation (Per Box) 1 Each Install Fillers (all Sizes) 2 Filler(s) Install Double Layer Crown Molding (per LnFt) 24 LnFt Uneven Surface Cabinet Installation if Floors or Walls are more then 1/2" out of level 1 Each Install Cabinet Decorative End Panel or Skin 1 Each Backsplash Install Install Customer Supplied Tile Backsplash and Grout (per SgFt) 20 SgFt Carpentry Work Install Customer Supplied Exterior Single Door- Same Size 1 Each Supply, Hang and Finish Drywall or Plaster (per SgFt) 150 SgFt Vinyl Replacement Windows Install Vinyl Replacement Window 1 Window(s) Electric New Dedicated Electrical Line- Includes ARC Fault Circuit Break 5 lnstall'Customer Supplied Light- Same Location 2 Add Sub Panel to Existing Electrical System 1 Install Microwave-Recirculating Vents- -- T_ 1 Install Dishwasher- Includes Plumbing and Install 1 Plumbing Install Dishwasher- Includes Plumbing and Install 1 Each Install Single Bowl Sink Drains and Faucet 1 Each Tnr);nitol-1 A 91 - ..I Page 3 of.5 Flooring Install Customer Supplied Pre-Finished Hardwood Flooring- Per SgFt 297 SgFt Appliance Install Install Microwave-Recirculating Vent 1 Each Install Standard Refrigerator "1 Each Install Electric Stove 1 Each Install Dishwasher- Includes Plumbing and Install ° 1 Each Additional Details/Scope of Work` y DEMOLITION: Remove and dispose of cabinets and countertops. Remove and dispose of the backsplash and related drywall. Demo kitchen and dining room floor. Remove floor to match adjacent room. Demo kitchen ceiling. CABINETS: Final design to be approved by customer with the kitchen designer. BACK SPLASH: Install customer supplied backsplash and grout, around 20sq CARPENTRY: None FINISHES: Sheet rock and plaster ceiling, smooth finish. All (or all other) painting, by customer. ELECTRIC: Electrical work was estimated using existing service panel labeling. Additional cost may result from incorrect labeling. re PLUMBING: Plumbing to a single bowl sink and dishwasher. FLOORING: Install customer supplied pre-finished Hardwood in kitchen and dining room. Around 300sq' APPLIANCES: Customer to provide designer°with any new appliance specs.. SCHEDULING: Customer has agreed to a 7 day notice for a start date. All dates implied beyond 7 days are subject to change. Obstructions that are obscured from view are considered to be an "unforeseen". Additional costs may apply to cure. Ship to: Customer. Additional charges will apply for store pick ups. CONTACT: OFFICE PHONE: 401-942-7897 or admin@�hipconstruction.com,for project scheduling and ship dates. PROJECT MANAGER: TBD Customer Supplied Material Selections Customer agrees all customer supplied material will be on job site, checked to be correct and in good condition' ' before.work commences. 7-17 This space intentionally left blank I �111.All r� Us `5' N r 4' t" mWoo fi A ' ` ` AS € i 1 °y e a, ,u art �y :. Ws M milb fr+ONA P d �t� r .a ilt i& t y - �,�� �.e' +' r � fir{: IV 46 ,r k � fi Office of Consumer Affairs and:Business Regulation 1000 Washington Street - Suite 710 Boston, Massa;chusetts� 02118 m Home Improveent contractor Registration 3 Type.: Supplement Card 4 Registration; 168302 H.I.P.CONSTRUCTION,LLC. Expiration:: 01130/2021' 2C MORGAN MILL RD. , JOHNSTON, RI 02919 ` , w` 4 d rk 8 f 1 Update Address and Return Card. 3CA t sS 20M'-05117 , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTORL Registration valid for.individual use only TYPE=Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 168302- 01/30/2021 1000 Washington Street-Suite 710 H.I.P.CONSTRUCTION'LLC r' Boston,MA 02118 "r Sa g' - MARK PIETROs L ; 2C MORGAN MILL RD JOHNSTON.RI 02919" Va Id Without Signature Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents x Office of Investigations h I Congress Stree4 Suite 100 Boston,M4 02114-2017 www mass.govldia Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Mar K K. t l rd�. Address: 1 4 C /Aa-F,-G Pr N City/State/Zi : _ d�NS/O&I"t ©QV? Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. [] I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. []New construction 2.' I am a sole proprietor or partner- listed on the attached sheet. 7. XRemodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. []Building addition [No workers' comp..insurance ' comp. insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work pfficers have exercised their I I.[]Plumbing repairs or additions myself [No workers"comp. right of exemption per MGL 12.0 Roof repairs insurance required.] r c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: oseanqDJI(1.S w . Policy#or Self-ins. Lic.#: Expiration Date: (Pfrift " 3 l Q'' y Job Site Address: U � City/State/Zip:dljq7�ukla�, mid .,attach a copy of the workers' compensation,policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided ab a is tr a and correct Signature: Date: 7 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:102893 HIPCONSTi DATE(oaMrou/YvvY) ACOREX. CERTIFICATE OF LIABILITY INSURANCE 9/17/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:It the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NCIADAJ;CT Kim Lelte Starkweather&Shepley 401435-3600 cNo:4014319354 PO Box 549 Ab%Aal Ss: klelte@starshep.com Providence,Rl 02901-0549 INSURER($)AFFORDING COVERAGE NAIC 401 435-3500 INSURER A Employers R7uWel Ire 21415 : INSURED INSURER a:Beacon Wtnsl In co 24017 HIP Construction,LLC INSURER C d/b/a Re-Bath of RI and Southern MA INSURER D 2C Morgan Mill Road INSURER E- - Johnston, RI 02919-6320 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTRR PE OF INSURANCE DIL B POLICY NUMBER pOIJCY EFF PO Y EXP LIMITS A X COMMERCIAL GENERAL LIABILITY SD5367616 09AM017 09/1S/201 EACHOCCURRENCE $1 000000 CLAIMS-MADE a OCCUR PREM13E5eaNcamDena $500,000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 00o 000 GEN'LAGGRE(nGA,TE LIMrr APPLIES PER: GENERAL AGGREGATE $2 000,000 LOC PRODUCTS-COMP/OP AGG $Z OOO,OOO POLICY 1 -1 JECT E OTHER: $ A AUTOMOBILE LIABILITY 5E5367618 9/15/2018 OWI 512019 COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $ AUTOS AUTNON43WNED OPERTY DAMAGE $ X HIRED AUTOS X AUTOS P r t A X UMBRELLA LIAB X OCCUR SJ5367618 _ 9/15/2018 09115/2019 EACH OCCURRENCE $1 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $i 000 000 DED I X RETENTION$10,000 1 $ B WORKERS COMPENSATION 71967 3/2018 OW03/201S X PER oTH AND EMPLOYERS`LIABILITY ANY PROPRIETOR)PARTNEPJE CUTIVE YIN E.L.EACHACCIDENT $500 000 OFFICERIMEMBER EXCLUDED N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$500 000 lr yss describe under DESCRIPTION OF OPERATIONS bet. E.L DISEASE-POLICY LIMrr $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more spew la required) **Workers Comp Information** Proprietors/Partners/Executive Officers/Members Excluded: Mark Pietroa-EXCLUDED,Parnter Sean Senno-EXCLUDED,Partner CERTIFICATE HOLDER CANCELLATION HIP Construction LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 15B Morgan Mill Rd ACCORDANCE WITH THE POLICY PROVISIONS. Johnston,RI 02919 AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1189844tM1189460 FMD i Section 12 Department Sign-Offs 'E Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department Conservation ❑ For commercial .work,please take your plans directly to the fire departtnent for approval. Section 13- Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all. matters relative-to work authorized by this bulding'permit application for: (Address of j ob) Signature of Owner date Print Name Last updated:11/152018 C v 3 -Ile _ . fau TT --S p wiesuTT i' yk Nam, fRANGEl-'O .BD16' Vy U2424908UTT,4 DX ROT 1 171",mr L B t:LZ08. _�xt1f181Eb 96=iIU5 =Zt N N � ✓� qJ r I — iI II ; II IIj II ! I � 1 _ It • I I rr r 1 c� i I FFFF1 I rF� rrFr`� rc � ! �r � I F_r_ i � _ ri LC; iLLLI ► ! i � �— 2 4 O ----� r — 2 0 0 2 5.4.. I I LF'r] i t r I I ' ! r FI j l EF>-I I j �� i i ZZ•8.. , �' O.N..SASN 28•..db 9-.4� �__ 29'6' - _-� --' — REFER?O PREAMBLE OF NOTES Odt_S:H__�EET Z_ t i _ STRIiGTURAL, DOOR,AND WINDOW DETAILS ARE 514ovN/N ON 514EETS 4,5)G D.ND 7, USE 17EPTH FF — AND FRONT DIMENSIONTO. ASSU E EW5. rrr� IF rF ci ! FFF q ' I t rF� , r r r1 ; i �J F SoN h. e _i I CS 1 I I EL1 OWN II��IIIIIII�1� I ', I _ .W.O.BOX _Z006. . LJ'..LI .:f' I - WESTPort-r, GT.o68So SIDE AND FRONT DE5)G?-` r1 24 0'. ARRANGEMENTS. 17g u SCAL StaEGT 3 OF - y• E r-. 'r� � �cz 1 d r.6 � I_ (p � T / - SEE TABLEt SHEET 5� 2'• - - rl.* FOAZ LETTERED OIM EN SIONS 00 SKYLIGHT. / Q I x (St3fi NOTE-K) _E , •.. _ PLATE- O +(p 2 (2.2r4) 2 ROOF SHEATH + �I rl RIo4E S 4 6. . g.2Yi (5e¢ NOT1=8) CETA 1 L. .t0/,�+� �JNw,nTow�i F I', I'-O. F (o isESTAe�sl -244 STuos �g/ ceq Y (ovER JOISTS).. 2x(aT1 Eel S AT ISITB i^ 2+'6'T16S AT ALL 3 9 2r8J015TS-•{� � J RAFTERS LAP ALL RAFTEf'Z5. OI FJ 10�0•LoNG ( ' (LAP Jo ISTS 1$,i`) (� 2r4 STUDS CSEE'MOTs.rj r.N N�` Jo1sTS'll%'-.55E SSE KOTES°f YlZ) II (OVER JOIST �S) II , - a io ri - NoT G. 5) . . f (, j II a 9RIbG'4 N SHIM(ov ClZJolZ7•S) 11rZ ly SE6.D67AJL I�_ ON SHEET 5 1' I s5g NoTtc 3 -- - o REAR .tad q,+b•. B�8(.3241 ) y G10. 2-2-G 2.2rG P•Z.r4 'VIF OISR 3 GIR D)rR(2.2w12 WITH •�(W„ .• P.W. SPACER) •J m O I'1j-O�•4,(bEC NOTie4 9) �2 .0I6AP4 STAI. (ae¢ do7IL l0 �H� JOIST.LE'N GT H-I6-O S. JAW DooR G0" 4ro-24 L14HT ' I I (SEE,NOTE 5;),'.t I Dr a N F u I WINDOW �Z 1'•4" 4'-11%C" N 17 s A s H 1 I LID5.10� See.NOTES (e n% I h..� �+� 31' 31" 4'•Or. %z • ANCHOR BOLTS'; 4 DIA, POST CIA I s SLIM NolrIF5 1. 1 AT MID SPAN ON w101WIIQALLY Go CTRS •� I6 16" 16•• 18 (SEE NOTfi 4) I M 16 l(o• lro K 2 4 5TUDS)Ifo"(J•C• 2xG SILL APRON (POUti r.� - ; •• -. _ ';. WITH A9) GI�'ADE M T .�I,...: L�. :: . ::).. SLAB • �.:: .. :: p. .+. . .. • . -� •�' :- CMADE A• Top OF FOUNDATION {�EAIZTH(TA M►) ott , '• I, ,`�� 3.2" I E%TEND SIDE ,F'$" •I; S7aN� ®ALLA ST �9 ' B•��-�i .I�' d• In F•D•-r WALL • r • 20-0' • .FOR FROST " 4 I• • 3-1%s� , i $'x$ }C£'NTEQ£D UNDER 4"POST �4'-+-t• 4... °• $•• HARR1 EiZ, r FROST LINE 24"x24 �� • '••.1• �NJ. ---- n �'.I I• '� 'N. SIDE L cuPOLA .{ •' ELEVATION' Ri�E - 24"x..24"(sEE FRONT 1 III-: �'.FURRLNG - EL.£VAYION) _ u I{ (STRI Ps - W 2r 6 RA trTEaS— �rllh O I I I1 It I • y A I � 3 l 1 .. In 20•D , - _ a % F2oNT Pt•ATst 4 (R6Af= - RAFTER TI ES ;M'AY 1:aE Z x N PL AT IY wl or SHOWN) LAPPED To EITHER SIDE•: D y N OF JOISTS AND "?AFT ;-a 1 x MRS (SEE NO•YE 9) ;{ 3 N Ire• t Roucl ONENINC� prow. Ito \ II trx<:. OISAPP'EAg1NCy sTAIRs ZKC� RAFTEt[S ¢* �P.W (56E NOTL 10) SOLE 2 (zr4) gIZIDG1N4 1 -2, TIES 2r8 JOI ST ATr SI DEj EL SE 1 TE)Z5, un1�EfZ RAs=T- IN — — E R:S SOLID 1%"to 1_o cK•C• OVER GIRDERS I JOIST D6lR Z ... I " J j 2Y8 ' .. - •..� - .. _ %Z P.W. BETWEEN ENbS OF - JolST .I m\� �' RAFTER ANtl TIE IAT . 0 .Q I .2.2x12 41R;oeR Ali g' - (WITH'%Z P.W. SPACER) - RAF_TEftS IT SIDE' ONLY-SEC SHEET 5,) x 24" FRONT ELEVATION' N �t"P.W.SH EATNtNC /'� REAR • Q QxG (91N(7,L..E'PAN EL5) `f2EAR STRUC- 2.2 5GALEn I/4"= I' I WIOTNS AS SNOW N• A STUDS -TURrr: - SILL ". GUT To 11N65 INbI- II � I ; •n• CA7EDj SHK NOTE6 I I- Iry O•C. �.F DrT•N.� AND SWI.ET 7. 4 .° • •- II 1 O-O' 10.Or (STUD Art R'6..T"AT ALL ` DETAIL..A"ll 4" OIA.STtelr L POST uN- 2-4>a4 11' III 4s a CORN EFTS) J�IIn OCCL ¢GAR 611{OI=W� IffTflI II (SEE NOTE 7) (SWE ' 2x •. "I 1 ) NOTE 4) WOTES WILL't 19.E 4 - TOW OP.•• FOUNDATION r70P OF' 2.6'>'�11:L 3 I, •FOUND ON 51.166T I- •: h-4 �• - - - .. t IIr 'r I APRo H•.': •U� S L A B. M II'•I I i I s 0o r4 " aaAor_ - I E LI TOWN 5END Y 50.tJ I •• . .' A1.TRQ ON TTOF ►LL I 1 UNDER P.D. E30X •Zoos i �1.-1j• ° r" APRON ONLY) 12' 1•I• F VYN� '. • I. R¢AR 41RbER W1=ST POST, GT. OGSSO r1 w�IS: It Ehii WALL- 4' II. •.. ' 4- i�i-4 aooT,a 6� I 24"xz4" DEStGty t ^'. t + r -. ... . • � •,, . - STR.UCTURAL'., r T • • ^�. .:• , _ D ETA 'LS r+r4 179's } nnl1 /ifijmA M fi n -nq �. C, i \uALc, t j rL loiz CLA%rWIA16 — Lid :2 Fri �L a T� ma's r v nit) �-r/a nr WALL gIISGM6A rI UM -OIC665 TheTown of Barnstable Ci2c�ss -S�cr�� �1 Department of Health SafetN, and Environmental Services __ Building Division iiKF , I � fr f C'CI FM ; i P�FFI i ilil �F�� i �rFr F! FIT] FFci ! r rr r� i i l ; ll VE �— 2 4'-0 2 5.4" i 20-0' j 1 EFF - i ! I F I ; r Fl E�-,- � i FTTJ ILL 22=$" 20 -' +n9.3�� ' be}° be 0e•kfnx,,t(6 bio A46h. �Rif Irs +0&wo ahwal�S I. --— '--"'---"— REFER."r0 PREAMBLE OF MOTE SHEET a- %in FOAL -- , STRVGTUR,4l,., DCOQ,AND WINDOW DETAILS ARE I F F� --- - --_ -- SHOWN ON S BEETS 4,5,6 AND7� USE bEW T tHl- AND F•RoNT DlMEN510N O ASSCUG,ATE VIEWS. FF rF-FLFIi I �F Ii -1�rI OWE NSEND SON .. I I I r I I P.O.BOX 0,Z06 � i. ! I I i 'I -' j I r I . . WESTPOIZT,G7.0688C L��1�, �G� � AND FRONT DESIG' No. - ARRANGEIv1ENT5 179- •. t �8•=1=o SNEE7 3 or ':r . SCAtE• Ai s-bssor's map,and lot number ... ...... ?.. yoF toy . T E Sewage Permit .number ....................................................... t BgBBn3nT�LE, 9 • House number ......... ...�..'. '................................................. c r p 039. \0� • �E YPY a' T WN OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO !o..: ....::.... ..:...... ... .. . r�................................................. TYPEOF CONSTRUCTION ................................................... ..� ,�.............�... ...................................................... ...... .............19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby'-appli es for a permit accordi`ng- toythe_Jollowing information:.' y y Location F.....` `'6... .0 ! /t'�e��!9N/ �lL.�a�y 0.:�. aly..j ./� G Proposed Use .� ..............:... A4.....r... ::.. .....:... :... Zoning District ... �.. ............................ .......Eire District v, ...... Name of. . Owner ................................................. ... Address ..:................ ... ............1. Spa Name of Builder ................................r`...... e................. ..Address ................. ......................................................... ... .. Nameof Architect .:.:......:.:..:................................:..................Address .................................................................................... Number.`of Rooms Foundation Exterior Cl) �..... Roofing ..... L�'1.,,•...... ............... . .:.:.::..... Floors "°.�,.;........................:. . ..... .:Interior :........ ....... ............ .:. ...............:........... Heating ...................................:...............................................Plumbing .............................,..:..,............................................... Fireplace ...... ...........`J..................................................Approximate. Cost ..... .,v„ !....�................................... . .... ..... .. Definitive Plan Approved by Planning Board --------------------_-----------19:______. - .Area ....... Diagram of Lot and'Building with Dimensions Fee ! SUBJECT TO APPROVAL OF BOARD OF HEALTH 1%.0 - /f' J 01 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLS �j'jfrG '�fYf1S /7;�, CG Gc// yO I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above/ construction. Name ....M �.� ..... �:.0. � j Construction Supervisor's License .................................... AROSE M. SCOTTI, TRUSTEE 1 Build Gara e _ 25283 - f�»o ................. Permit for ............................. .. Acces.sory...to...Dwell ' ng............... ` Location 9"Marchants...Mi1,1...Way ,,,,,,, t' i ........... T taxini.sport............ ................. f Owner .R S e. .U.. .S .tee. ..._ .catti,.. .�r�as Type of Conif—ruction ...F. AMe.......................... y _ . i ..............................................................`_ Plot ............................ Lot ................................ C .. F} Permit Granted ..July...5; . ....:..........19 83 - Date'of Inipection .............�.. ..19 Date Completed ..... L. ...................19; 71 •j, -tea._ •"' � - .�, » s r �� � - � � `