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HomeMy WebLinkAbout0016 MARYALICE LANE l� 1�'1 a-r ��t..-t; cam, �a��n�. r, . Town ®f Barnstable BAfLY3CACi.E, Post This Card So That rt is'Vis�tile.From the-Street Approved•Plans Must be Retamed.on Joband�this�CardMust;be Kept" v Permit 6� `�$ Posted Until Final Ins ect�on Has Been Made e . =Where a Certificate of Occupancy is Requiredsuch Building shall Not be Occupied a til a Finallnspection has been,"made':W $ ,. Permit No. B-19-3205 Applicant Name: ELDREDGE, ELAINE Approvals Date Issued: 07/13/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 01/13/2021 Foundation: Location: 16 MARYALICE LANE, HYANNIS Map/Lot: 291-072 Zoning District: RB Sheathing: Owner on Record: ELDREDGE, ELAINE Contractor Name: Framing: 1 Address: 16 MARYALICE LANE contractor License: 2 z; HYANNIS, MA 02601 Est. Project Cost: $30,000.00 Chimney: Description: ADD A BEDROOM ON TOP OF THE GARAGE AND A BATHROOM IF Per Fee: $ 203.00 POSSIBLE. ON THE TOP OF THE GARAGE I HAVE ATTIC RIGH F e e'Pai d.>' $203.00 T NOW Insulation: Project Review Req: Date �rC``pp 7/13/2020 Final: " Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzedilythispermrt is commenced witFiin six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the'approved construction documents for whicfrh this permit has been granted. All construction,alterations and changes of use of any building and structures shall�be in compliance with the local zoning bylaws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or:road'and shall be maintained open for publicinspection for the entire duration of the work until the completion of the same. Final Gas: . � .' The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire.Officials are'provided o'nthis permit. Electrical Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing ry a �� Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed a Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: WorLshall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: U LD ING �c,'a T, Application Number..... ..�... ........ Q � 7 r aU MASS. V9TQ 20�9 Permit Fee.......................................Other Fee:....................... 'TOWI\J OF SAt-i€mj fA3 t= TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval bY ................ �1 � 3 ... BUILDING PERMIT �`�, Lap.......................................Parcel......41. . ........................ APPLICATION FleSCE Section 1-- Owner's Information and Project Location Project Address \kO L Owners Name f Owners Legal Address City 1 j State Zip oZ(00 F 10� Owners Cell# ���'A_ E-mail I Ou �� � y Section 2.—Use of Structure Use �Grou � - ~ p ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm. Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑_. Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description 1 n a c T a +. A.+.A• 11/14MA14 Application Number.................................................... Section 5—Detail of Cost of Proposed Construction Square Footage of Project `ED rh I I 1NnL. Age of Structure G (L)5 =l Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Ch ck SCM. WFCM'Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply 1:1 Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information 4i 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 T The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Invest1gations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly _- Name(Business/Organizafion/Individual): Address: Phone CCity/State/Zip� �' Are you an employer?Ch4 the approp ate b z: Type of ro'ect(required); YP p. J ( q d); 1:❑ I am a employer with- 4. I am a general contractor and I 6. New construction employees(full and/or part-time).*, a have hired the sub-contractors ❑ 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.. . 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for mein any capacity.acitY• employees and have workers' 9.-❑Building addition r�o workers' eon insurance comp.fimzance tJ �] P• 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions myself.[No workers'comp. rat of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.E]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 mast submit a new affidavit indicating such. <:Contnrctorsthat check this box must attached an additional sheet'showmg the name of the sub-contractors and state whether or'not those entities have _ If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providfng workers'compensation insurance for my employees. Below is thepolicy 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 may be forwarded to the Office of Investigations of the DIA for insurance coveragaverification. I do hereby certify under the pains and penaNes ofperjury that the information provided above is true and correct �i` .lure:= gn 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not!because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every'state'or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into"any'contiact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 446 or 1-877-MASSA.FE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia 1 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Townrof Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number ' Address City State Zip Registration Number Expiration Date I understand 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 required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... 1 Signature Date FSe� ction-11=Home=Owners License-Exemption Home Owners Name: Telephone Number gor Wo Number M I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature, Date, A�PPLLCANT-SIGNATURE-=-� q�. `Signature cDate�� l 0�6— r Print Name._ � La I �`� � I T(/ T`� elepho ne Number �U� qtv,, � E-mail-permitto: N C � Last udated: 11/15/2018 A a Section 12—Department Sign-Offs .'. 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 department 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 building permit application for: (Address of job) Signature of Owner date Print Name _ a �v 1 i Last updated: 11/15/2018 Town of Barnstable ° W ' „ems' acet "*JAing c.,'X,.: -kt- PostT.h�s Card S �Zh #tt�sU�s�ble Fr m h�.Street. ,A roued.�Plans Must be,Reta�ned on Job and this,Card� ,ust be Ife t,, ' . ._ •v Posted�Unttl F na .,n p, c"„I, �H Been Ma a .;., .. , ,, ,, �, Perm . Wher a Certificate;of;Occw an" �s Re ;aired ouch Buildmshall Notbe" ,ccu a �.0 td,a�;Finat•,Ins ection'ha .been.<made :. �-. ..,. �....?'��a,%' .s�,��.%����...' �,�._".�....,<�p-�. .s�.a. Q'ra.-<�.�t"-�. ,-"� Csa't �`gsz .�". .-:..+,,, ap°�:><.'.. ::�.1. ':`': ��;..ip.,".' ;:�. .. •,: ..�c.r.:. -��,.:�`�'s Permit No. B-17-1226 Applicant Name: CAPE COD INSULATION, INC Approvals Date Issued: 05/03/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/03/2017 Foundation: Location: 16 MARYALICE LANE, HYANNIS Map/Lot 291-072 Zoning District: RB Sheathing: Owner on Record: ELDREDGE, ELAINE Jg Co t cto Name: CAPE COD INSULATION, INC Framing: 1 ;r Address: 16 MARYALICE LANE Contractorlicense > 153567 2 Al HYANNIS, MA 02601 Est Protect Cost: $4,900.00 Chimney: Description: Weatherization ' # PerrnitkFee: $85.00 � g Insulation: Fee Paid $85.00 Project Review Req: Weatherization r Final: 5/3/2017 2� r � Plumbing/Gas Rough Plumbing: I � Buildin` ,• �, � : g Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized;by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the,"approved construction documents•for whichthis permit has been granted. r- WI All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning°by laws�and codes. Final Gas: ' % This permit shall be displayed in a location clearly visible from access streetdor road'and shall be maintained open for publ'ic inspection for the entire duration of the work until the completion of the same. f Electrical The Certificate of Occupancy will not be issued until all applicable sign Lures by,the,Buildmg andFire Offrcialsare'provide�d on this permit. Minimum of Five Call Inspections Required for All Construction Work '• Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection ` �' 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_:. 2'Persons,conttactiri with:unre inter-ed contractors_ g, g ave access to;the guaranty'fund .(asset-.forth in--MGL c>142A)o:not o Fire Department'' Building plans are to be available on site Final All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- 8UApplication Parcel IL®0�G # D pr Health Division Date Issued'. Conservation Division APR2 6 Application'Fee Planning Dept. PoW/v 0.8� Permit Fees�11.5 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Er"►�zL S�'�" Project Street Addres - 1: . �", U-- Village % GIB ) Owner . �i �' Address Telephone 06 Iko 0 7 Permit Requ O t (✓ at , ma- aAlk ,ewatv, &g"w Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain g Groundwater Overlay Project Valuation Construction Type l Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name l / Telephone Number Address License# WYA&16r"" Home Improvement Contractor# c Email 04i"� Worker's Compensation # wwM ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE I BE TAKEN TO SIGNATURE DATE �� I S t FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. L L ADDRESS VILLAGE t i OWNER s 7 DATE OF INSPECTION: r FOUNDATION >� FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT .< I 4 ASSOCIATION PLAN NO. `t t, sue. The Commonwealth of Massachusetts Department of Industrial Accidents x Office of Investigations i; I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia . Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatioMndividual): Cape Cod Insulation Address:18 Reardon Circle City/State/Zip:South Yarmouth, MA 02664 Phone#:508-775-1214 Are you an employer?Check the appropriate box: Type of protect(required); 1.MEI am a employer with 48 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working .for me in any capacity. employees and have workers' [No workers' comp, insurance comp.insurance. t 9. Building addition required.] 5. 1771 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11,❑ Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12,❑ Roof repairs insurance required.] t c, 152, §1(4),and we have no employees, [No workers' 13.X Other Weatherization comp.insurance required,] *Any applicant that checks box#I 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 subcontractors 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:Atlantic Charter Policy#or Self-ins. Lie.#:WCE0043WO2 i 6/30/2017 Expiration Date: Job Site Address: C11 La � City/State/Zip: Attach a copy of the workers' com ensation:policy declaration page(showing the policy numbJ 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$1,300.00 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 violgtor. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do!hereby certify under the pains and penalties of perjury that the Information provided . . . ab Is tr a and correct, Signature: Henry Cassidy Date: - Phone M 508-775-1214 Officlal use only, Do not write In flits area,to be completed by city or town offlctal. 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#: `' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSID-Y,�\ 8 SHED ROW u ° WEST YARMOUJH 0 Expiration: Commissioner 11/11/2017 e` Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma I &" usetts 02116 Home ImprovemantC.o.,tractor Registration -, Type: Corporation t'r � zr` ��% .� Registration: 153567 Cape Cod Insulation, Inc ,,, _-<..,..,,t.:./� ;I .•-w=== +• Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 '` --}'" Update Address and return card. Mark reason for change. SCE 1 15 20M-05/11 �e tpamrmaaracuecc%C/c a��t�caamc%ccde� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only r T, e: Corporation before the expiration date. If foun urn to: F .c <%;Registretlon Ex Irtz ation Office of Consumer Affairs and sl ss Regulation =8a667 tp/1q/2018 10 Park Plaza• e 5170 ,.. Boston,MA 11 Cape Cod Insulatiaft- Henry Cassidy +_ 18 Reardon Circl' So.Yarmouth,M .tf Vndersecreta rY t al hout si atu CAPECOD-27 KDOYLE ACORIL7� CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 03/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER ACT Rogers&Gray Insurance Agency,Inc. NCO No Ext: (FAX No: 877 816-2156 434 Fite 134 South Dennis,MA 02660 mall@rogersgray.com INSURERS AFFORDING COVERAGE NAIC i INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C-Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Compairiv 44326 South Yarmouth,MA 02664 INSURER E: INSURER F s COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICYMMID 'EFF POLICY EXPLTR LIMITS A X COMMERCIAL OENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE �OCCUR R/0 CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RENTED $ 100,000 MED EXP(Any one erson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY j �T LOC' PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ tE, id no ANY AUTO 6232707 COM 01 04/01/2017 04/01/2018 BODILY INJURY Per erson AIURTEODDES ONLY X AUUTNOOSyUyLNEEDD BOODILY INJURY Per accident 1,000,000 X AUTOS ONLY X AVTOS ONLY Pe�acEcIJ nt AMAGE $ C , X UMBRELLA(LIAR X I OCCUR EACH OCCURRENCE 2,000,000 EXCESS LIAR CLAIMS-MADE R/O EXCl0006635001 04/01/2017 04/01/2018 AGGREGATE $ DEO RETENTION$ Aggregate $ 2,000,000 D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N WCE00431902 06/30/2016 000/2017 E.L.EACH ACCIDENT 1,000,000 MFICER/MEMgEREXCLUDED? N/A andatory In NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 11 more space is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required-by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f f Town of Barnstable 4 Se i d tIriard V.Scale,b':recros aA Rididi"Division Tom Perry,B69ding C:ommisdoner 200'Mak Street-HAn►is Ak 02661 tiv�w.to�vn,ba�'nstabIciriays Of w: 508-862-4038 Fax: 5087-79"230 . roped)r Ownf.,r Must Comp } lete- 44-S.igaThis Sectiaii I 7Sx t, ,1 $WIder y 1�1-2 QpV Croft 1e"itb0c P.QP {:� ?w hez byatltharizeC �( ,` W StV61: mybdbalf, .n in.all maners melative to work authorized by this badirlg per=i application for �. a n-� RAj - 4,. Pool fences and ahims are the res owlI Y of tie a p.=tmaut.Po& are not.to.hel&d pr=Ized be(,are-ien;,c�is install :J-ud;aU fibal, ulspecddils a:re performe4-an f.ac cepied. { : Sigmum of.Owner �-- Sigaatuiv of Appkaut h t a a: Print Name PnnG Name ,`a y— �� x Date !fit Q FUMS:O1WERPEWSSIONPOOLS , w; OFtHE Town of Barnstable *Permit# ryes 6 onths from issue date Regulatory Services �ee . •ARNSTABLE, i �i�� MASS. g41Va Richard V.Scali,Director 46391, rE°;p�plp Building Division - uG `` Paul Roma,Building Commissioner Q �N90 200 Main Street,Hyannis,MA 02601 �� www.town.barnstable.ma.us Office:508-,8.62-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number l lJ 4� eJ L 4 Property Address residential Value of Work$ .lJIJIJ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1� Contractor's Name lephone Number�C Home Improvement Co actor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ' I am the Homeowner ❑ I have Worker's Compensation Insur ce Insurance Company Name )tJ IJC7��a/ KJ p Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles),All construction debris will.be taken to ❑Re-roof(hurricane nailed)(not stripping...Going over existing layers of roof) ❑ Re-side "� 1 ,TYReplacement Windows/doors/sliders.U-Value (maximum.32)#of windows a w #of doors:. ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. **,*Note: Property Owner must sign Property Owner Letter of Permission. A`copy of the Home Improvement Contractors License&Construction Supervisors License is required SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC 06/20/16 a 27W Comm,ormealth o•f Vassadirrsetts De,partrnent cr,fIndustrialAccidents - -- Qffl-ce ofImwtrgatromrs. { 600 Washington Street. M Boston,MA 0211I kRFV11-mr7a—mgOv difl N%rurkers' Campensation Insurance Affidavit-BuildersJCuntractorsMectricianrdPhEmbers y Applicant Infarmaiian Please Frint E*aly ' 'NatDe(Btrs�essl0iganization/ln�t'dnai} Address: City/statelzig phone Are you an employer?Checkthe appropriate box: Type of project(required): I.❑ I am a employer with 4 ❑I am a general contractor and I 6- ❑New construction employees(full andfor part-time).* Dave hired the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet~ 'i- ❑Remodeling. snip and have no employees. 'These snb-confractors have g• ❑Demolition worl-ng forme in any capacity. employees and have wodcess' . 9. .E]Ruilding ad&tioa [No nrodmrs' camp.itasumme comp.insurantj--# equired I 5.`❑ We are a corporation and its 10 ❑Electrical repairs or additions 3. I am.a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself[No workers'comp- right of exempfion per MGL 12_❑Rcofrepairs innIxanre required-]i c.152,§1(4h and we have no employees.[N workers' 13_❑OtFier, o comp_insurance required_) #Any W iczntd at checksbos Fl mast also flloutthe sedion below showing Their woxReW compensationpaticpinomadon- I Romemmers who submit dais d5dndf iad3ratmg they ate dying zu vroA sad then hire outside coatr=mrs-n- suhmit a new amdseft indiczdna=CIL FContnctass tfiat chectih s box must attached an sddffi=l sb eet showing tiaenmne of the sub-ccntmctots.aed state whether or not fhose eatitieshme employees.If the sub-contmctoishaveemployees,drey=uTptovidetheir workets'tomp.palicynumber_ I am art srripla�r Heat isprcrtzdirrg yvarIiers'conrperesru`iotr iuszrra>tcs for Trey*enelvlv3�ees �8eloav is fltePo��'rued job sitar €nforazation. < Insurance Company Name: Policy or Self-ins.Lic_ Expiration Date: Job Site Addte= 1 Y CitylStafe/T= Attach a-copy of the workers'c ensationpolicy declaration page(showing the policy,num and expiration date:). F Failure to secure coverage as required.under Section 25A of V-GL c-M can lead to the imposition of criminal penalties of a fine up io SI 50a.OU aadfor aria-ytRirimprisi3nmmt,as will as-civil penalties,in the form of a�STOP WORK ORDERand a Eme of up to$250-00 a day against the-violator. Be ad-t ised that a copy of this statement maybe forwarded to the Office of Iuirestsgations ofthe DIAL.for insur�nc coverage-v�frcation l rIa ter'rRtry c rut�d,�(r�th9 'ns airrtpsr alifies o perjur}'that the ineformation-protirlad abmrs fs hue rd correct 5 Sitntattzre: �d><J I t1(. Date: S Phone 4- Ob7cial use an1j•-�Da rrat write'in this urea,to be cwrnpleted by city artoini ofoiciall City or TaWa: Permitf ikense# Issuing Authority(facie one): L Board of Health 2.Ruil ing Department: 3.CitylTorwa Clerk 4.Electrical Inspector 5.Pharmbmg Inspector , 6.Other Contact Person: Phone 9: - ---- --- - - - 6 r - ormation and Instruefions Massar_l offs-mineral Lxws tea 152 all Ioyers`[n de wo�eas'compensation for fheg employees. �1 chap requmes �p )�i p this ,an m pkgme is defined as`—every person in the service of another under any confra ct of hie, express or implied,oral or writ bmf An ezpp&yer is defined as"an i adividuA pmdam14,assodaiian,corporation or other legal entity,or ray two or more of the foregoing engaged is a joint entm: ise,and including the legal represent afives of a.deceased employer,or the to to ees_ However the tr receiver or ostee:of an mdivi�.parinersbip,association.or other legal entity,�P Y��P Y owner of a.dwelling house having not more than three apartments and who resides therein,or the occupant Oft - dw Ui g house of another who employs persons to do maintenance,construction or repair wow.on such dwelling house or on the grounds or budding agpmtnatrtthereto shall not becanse.of such employment be deemed to be an employer_" MGL chapter 152,§25C(6)also sues that"every state or local licensing agency shall wnhoId the issuance or f a cense or renewal o li permit tooP erate a business or to construct buildings in the commonwealth for any applicant-who has not produced acceptable evidence of compliance with the snrance coverage raquired," Additionally,MGL chapter 152, §25C(7)states-Neither the counn axwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compHEpce with the fimu @n ce.. regzmemeats of this chapter have Been presented to the contracting avihoiity_" A Pp4caxts Please fiDl 0-atthe wo&ers' compensation affidavit completely,by checking the boxes that apply to your situation and,if s alo with their ce�cate(s) of s nam s address es and ne number() ng • necessary,supply sub-contractor() ,e(), ( ) pho no Io ees other than the antes C or Limited Liao �P " s )with emp Y msrrrance. Lnnx�d Liability Come (LL ) �Y al�e�slllp (� members or partners,are not rbgaimd to cant'woikers' compensation insurance If an LLC or LLP does have employees,apoIicy is rmpfied. Be advised that this affidayit maybe sub to the Department of Industrial Accidents for confumaEon of in z-an ce coverage. Also be sure to sign and date the a mdavit The affidavit should be ret L=t d to the city or town that the application for the permit or license is being requested,not the Deparmmenf of Tr do yt,ial Accide�. Should you have any questions regarding the law or ifyou are,rego±.- to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-fi gorance license n=ber on the appropriate line.. l City or Town Ofaeials . .. _ Please be sure that the affidavit is complete aadpriuied.legiibly. The Departmenthas provided a space of the bottom of the affidavit for you to fill out is the event file Office oflnvestigafions has to contact you regarding the applicant Please,be sure to fi31 in the pan itllicense number which wM be used as a reference number. In addition,an applicant that must submit multiple penait/license applications in.any given year,need only submit one affidavit indicating cent policy information(if necessary)and under"Job Site Address"the applicant should wU"all locations in (city or- town)-"A copy of the affidavit that has been officially stamped or mauiced by the city or town may b e provided in the applicant as 'Proof that a valid affidavit is on file for fuixie penaits or licenses Anew affidavit must be fMcd girt each . . year.Where a home owner or citizen is obtaining a license or permit not related to any basin's or commercial venfure da "t to lete this affi vz i_e_ a do license or emut is bum leaves etc_)said person is NOT req�red comp . ( g P co erasion and should you have any q�ow, The Office of Inves6gaiions would like to thank you in advance for your op please do not hesitate to give us a call The Depa lmenfs address,telephone and fax number. C:a�W 116E Of Chn&tts . Dega�mt of 1adusfza1 ADeZenta (off ce of�e�g�tio� � �Q4an Stet , Baotou MA 02111 Fax 9 617`27 7M Kevised 4-24--07 - g�� �tNME Town of Barnstable Regulatory Services M 88 ` Richard V. Scali,Director 6 ►��` Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us _ Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must l Complete and Sign This Section If Using A Builder I Owner of the subject ro ~ p of hereby,authorize to act on-my behalf, in all matters relative to work authorized b building permit application for: (Addy ss of Job) , **Pool fences and al.arni.s e the responsibility of th pliant Pools are not to be filled or tilized-before fence is installe d all final inspections are per f ed and accepted. , �d Signature-of Owner Signature of Applicant 'Print Naive Print Name Date QTORMS:OWNERPERMISSIONPOOLS l I Town of Barnstable Regulatory Services s ptrtHE Richard V.Scali,Director 4 Building Division � r MANEMABM t Paul Roma,Building Commissioner � 16.19. `0� - 200 Main Street, Hyannis,MA 02601 ATED '�A www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 0 Please Print DATE: (] JOB LOCATION: '1 number a �j village "HOMEOWNER": Oam so v�o name home phone# work phone# CURRENT MAILING ADDRESS: !Q� �j N ✓ city/town to zip code The current exemption for"homeowners"was tended to include o -occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFWITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to-such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) ,s 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 pr "edures and re ' ements and tha a/she will comply with said procedures and requirements. Y�OM Signature of Homeowner 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,Ru-les&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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 �A uiCN - - --- C) IVED CD SMOKE DETECTORS REVIEWED I� BA NSTAB UILD G DEPT. DATE 11 �� FIRED ARTMENT DATE BOTH SIGNATURES ARE REOUIRED FOR PERMITTING �`5 E V 0-q�yti'NE f 9 tA 1 N cp� O O dJ0 _9 Nc< W VL d � - C �+N tiJ�C lC �m= l<�Al I 2 -0 FI �d2 SCANN�� i, Ir r Do02 t� 0 LO I «O co co N y O p IN mJO W U� m m _ C N W�fCC r= i i i j i i E - <i; P r I ( f f - r c�T�o NIA P - -- — — Ms.Elaine Eldredge 16 Maryalice Ln Hyannis,MA 02601-2635 1 Ic u/.5 715 ivT 4-- n V oo I � 20 J Ms.Elaine Eldredge Luiz Sgarione 16 Maryalice Ln 6 Pleasant Hill Ln. Hyannis,MA 02601-2635 Hyannis, MA 0260 SCANNED z I CI O 1 I i J i i I I I Ms.Elaine Eldredge 16 Mar yalice Ln Hyannis,MA 02601-2635 Luiz 5garione _ 6 Pleasant Hill Ln. Hyannis, MA 02601 f� /4v 9 ' 1 } d 1001 r _ � t i ScAk, L zo I i Ms.Elaine Eldredge — 16 Maryalice Ln Hyannis,MA 02607-2635 Z Luiz 5garione 6 Pleasant Hill Ln. Hyannis, MA 0260' /2.1-n.Te C'% m l�-j r,�,n Jeo 2v Pl �Ao sap,:, y rx 8,, i I � I� �► I r t/ Q� Elaine Eldredge 16 I j _ ..-. _ � 1� o(/ �e✓�C�j,a 16 Maryalice Ln { Hyannis,MA 02601-2635 W04 Luiz Sgarione 6 Pleasant Hill Ln. Hyannis, MA 02601 SCANNEL I X/ ST C V� 1 i i Iai Ms.Elaine Eldredge 16 Maryalice Ln Hyannis,MA 02601-2635 Lulz Sgarione - 6 Pleasant Hill Ln I 1 Hyannis, MA 026C _ IV z j Lc) fi— -- / pooC j boon_ t u r f 2� Ali Ms.Elaine Eldredge 16 Maryalice Ln Lulz Sgarione Hyannis,MA 02601-2635 6 Pleasant Hill Ln. l--yannis, MA 02601 9S9Z-109Z0 VVq`sluueAH ul aogeAGew 9 L OBPOJP13 aule13*SW SCANNED I/P i