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0008 NEWTON AVENUE
8 `�v.�ron �z� �� _ _ — � Application number. Jl. S,5 �q �.. )ate Issued........10 `................................... BARV5TABI.E, 16:y �� OCT 2 3 2019 Building Inspectors Initials .... TOWNn p i u pp��II rr,, Q..� O� BARNSTAB Pap/Parcel....Z. �1......1....... ........................ TOWN OF BARNSTABLE , (Q EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /� �e NUMBER STREET VILLAGE Owner's Name: _ Phone Number ,09'-7j1—53-73 Email Address: Cell Phone Number Project cost Check one Residential V11 Co mmercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 5 e� A-44 cle � C� {ram-� Date: TYPE OF WORK I� Siding Windows (no header change)# F� Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review J Roof(not applying more than 1 layer of shingles) / n Construction Debris will be going to 0 a s4e-121 alga I Pl.r/P� CONTRACTOR'S INFORMATION Contractor's name (fir�.a `7�n.►,so - So,. e�n 42�J Home Improvement Contractors Registration(if applicable)# 17 3 Z.q- (attach copy) Construction Supervisor's License# bj S-7 07 (attach copy) Email of Contractor $,,Jef� qS ; . C M Phone number L10I- z 2 R -J X OLD ALL PROPERTIES THAT HAVE STRUCTURES VIER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS 1Af A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ i" *For "Tents Only* Date Tent(s)will be erected Removed on number of tents total s lease attach floor plan with exits marked) Does the tent have sides? Yes No (If ye p Dimensions of each Tent X X I X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLE'T STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOVINER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand any 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 Signature Date � All permit applications are Subject to a building official's approval prior to issuance. - •J"12•� r��i�fi�o_�lJi/�L��IGG�,t'i� ��G�(%�/:i�>��G�C��Qi�T�. Office of Consumer ,affairs and Business Regulation 1000 Washington Street=Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,LLC;= ':; Expiration: 09/18/2020 10 RESERVOIR ROAD - SMITHFIELD,RI 02917 - - - Update Address and Return Card. SC.I i s 20Ni-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: RegistWi6n Expiration Office of Consumer Affairs and Business Regulation 11324V-_' _ 09/18/2020 1000 Washington Street-Suite 710 - t Boston,MA 0211 SOUTHERN NEW EM1IGLAND WINDOWS,LLC Ifl \� - BRIAN DENNISON 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 ids, ai Without signature Undersecretary Charon wealth € f Massachusetts Division of Professional Licensure Board of Building Regulations and Standards i r . tl.on s UUctron 'Supervisor CS-095707 _ p i res: 09/01202.0 q: '- BRIAN ® DENNISON 8 BLACKWELL=DRIVE CHARLTON MA 507 C®irnil ssioner r RAellfWal Agreement Document and Payment Terms �" - Cr�en' dba:Renewal B Andersen of Southern New F� 3' gland Angle Bye i Legal Name:Southern N64 England Windows,LLC 8 Newton Ave RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Hyannis Port,MA 02647 �fyp a pMtex 10 Reservoir Rd I Smithfield,RI 02917 H:(781)771-3212 Phone:401-349.1384 1 Fax:401-633-6602 153[es@reneovaisne.com C:(508)771-5573 Buyer(s)Name:,Angie Bye _ Contract Date: 09/05/19 . Buyer(s)Street Address:,$.Newton Ave,Hyannis Port,.MA 02647., . Primary Telephone Number:;V41071-3212 Secondary Telephone Number:,.(508)771-5573 Primary Email:Gigiangie�msn.eom ,',, Secondary i Emal. - Buyers)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $16,001 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $5 333 Balance Due: $10,668 Estimated Start: Estimated Completion. Amount Financed: 6-8 weeks 6-8 weeks $0 Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: $5333 cc dep, 1/3 at start. 1/3 at comp, permit/taxes PD in Barnstable Buyer(s)agrees and understands that this Agreement constitutes the'entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has'read this Agreement,understands the,terms of this Agreement,and has received a completed,signed,and dared copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to:a copy of the contract at the:time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/09/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Iega(Name:Southern New England Windom,LLC dba.Renewatj of Southern New England Buyer(s) Signature of Sales Person Signature Signature Seth Grize.y Angie Bye Print Name of Sales Person. Print Name Print Name UPDATED: 09/05/19V _ Page 2 / 11 l f The Commonwealdt o,f Alassacitusetts Departttrent o f'Indusind Accidents 1 Congress Stree4 Suite 100 Boston,.MIA 03114--9017 www mass gov/dia A-arkers'Compensation Insurance Affidavit.Builders/Contractors/Electricians/ mubers. TO BE FILED WITH THE PERINIrITL-YG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organirationtlndividual): S(.3(A f h e ff'L- /JQ U Q LJ�t I r , Address: (� UDt r �J . City/State/Zip:_S M 1_f4 e-Q/t! O-M i 7 Phone#: �/Dl—Z2, Are you an employer?Check the appropriate box: Type of project(required): 1 am a employer with �� mployees(full and/or part-time).• 7. ®New construction 29 am a sole proprietor or partnership and have no employees working for me in $: Remodeling, any capacity.[No workers'comp.insurance required.] 3. I am a homeowner do' all work m selE 9. ®Demolition ® _ � y [No workers'comp.insurance required]t 4.D f am a homeowner and will be hiring contractors to conduct all work on my property. I will 10®Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 5.®1 am a General contractor and I have hired the subcontractors listed on the attached sheet 12. Plumbing repairs or additions. These sub-contractors have employees and have workers'comp,insurance.: 13.[]Roof repairs 6. We are a corporation and its officers have eeercised their right14.®Other of exemption per MGG c. 13-2,g1(4),and we have no employees.[No workers'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 anew affidavit indicating such. =Contnrctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whefher 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 poUcy and Job site tnjormation. . Insurance Company Name:_ �p - Policy#or Self-ins.Lic.#: Cjq�l.�Or /� Ybe y Expiration Date: f' I d ZO Job Site Address: City/Stattaip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance . coverage verification. I do hereby ceriR under the I r enalties of perjury that the information provided above is true and correct Si re: Date: Phone Official use only: Do not write in dds area,to be completed by city or town offtciaL 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#• CERTIFICATE OF LIABILITY INSURANCE DAT / 12128/Z8/20/8 Y) 018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CoBiz Insurance, Inc.-CO PHONE 303-988-0446 F 1401 Lawrence St., Ste. 1200 c A!c No:303-988-0804 Denver CO 80202 E-MAIL COMailiMcobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED ESLERco 01 INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England en ofS u hernLLC INSURERC:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New England 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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. I�TR TYPE OF INSURANCE AODL SUER . POLICY NUMBER MN/I/�DY EFF YYYJ MPP POLICY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/112020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES a occurrence $300.000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY ElJEC LOC PRODUCTS-COMPlOP AGG $2,000,000 OTHER: I I $ A AUTOMOBILE LIABILITY CPA3158728 1H/2019 1/1l2020 COMBINED SINGLE LIMIT a accident $1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A X UMBRELLA UAB X OCCUR CPA3158728 1/1/2019 1/l/2020 EACH OCCURRENCE $15,000,000 EXCESS LJAB CLAIMS-MADE AGGREGATE $15.000.000 DED I X I RETENTION$ $ B WORKERS COMPENSATION WCA315872924 1/1/2019 ill/= X PER OTH- ANDEMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRILTOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,0oo,000 If yyes,describe under DE, PTIONOFOPERATIONSbebw E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/l/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES-ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building e t 'Post This Card S,o Thatrt is:V�sibl iFrom he StreetA roved:PlanshMust a Retained on'Job.antl>this Card Nlustbe Ke t ':r Wt3Vl3;ABt$ -` .� .��, � :t 's .••' `�-,. ^ei�.,:ee � . > t. .r > Pp� , �;:,�� F 2. b :fir,.., �;.� :1 �\�sz.�,;..p z ' Posted•U,n�il!anal Ins � � �� Permit �Where:a:Certificate of O.ccu anc is�,Re u�red such Buildin shall,Not be-0ccu ieduntil a Fmdllns ection has been made Permit NO. B-17-610 Applicant Name: Carl Rebello Approvals Date Issued: 03/09/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 09/09/2017 Foundation: Location: 8 NEWTON AVENUE,HYANNIS Map/Lot 287-127 Zoning District: RF-1 Sheathing: " 411 Owner on Record: BYE,WILLIS E&ANGELA H ' $ Contractor Nme Carl J Rebello Framing: 1 Address: 8 NEWTON AVE X Contractor Ucens�e CS-084358 2 HYANNIS PORT, MA 02647 Cost: $3, 53.00cstroJe Chimney: D F P Description: Wall insulation. ermit•F e: $85.00 Insulation: Project Review Req: Wall insulation. i Fee Paid;: $85.00 Final: Date . . . gg p 3/9/2017 Plumbing/Gas Rough Plumbing � r i a Building Official Final Plumbing: ®R This permit shall be deemed abandoned and invalid unless the work autho pied 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 which 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 b�yzla'ws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access sheet or oad and shall be maintained open forJpublic�mspection 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 signatures`iby the,,Building and Fire Officals are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: . 2.Sheathing Inspection µ 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 S.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 MG c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r Town 'of Barnstable' :D 200 Main Street, Hyannis MA 62601 508-86274038 Application for,Building Permit Application No: TB-17-610 Date Recieved: 3/7/2017 Job Location: 8 NEWTON AVENUE,HYANNIS v Permit For: Building-Insulation-Residential Contractor's Name: Carl J Rebello State Lic. No: CS-084358 ' Address: Swansea, MA 02777' Applicant Phone: (508) 567-4109 (Home)Owner's Name: BYE,WILLIS E&ANGELA H Phone: (508)771-5573 (Home)Owner's Address: 8 NEWTON AVE, HYANNIS PORT,MA 02647 Work Description: Wall insulationrn - �, cs r� Total Value Of Work To Be Performed:' 3 1$ 53.00' Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with'the Workers' Compensation Act(Chapter_568) I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Carl Rebello. 3/7/2017 (508)567-4109 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,153.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: -$85.00 3/7/2017 $85 00 Paypal Paypal ......... .......................................................... .s. .. .......... Total Permit Fee Paid: $85.00 3 Town of Barnstable *Permit# Expires 6 t rom issue tF °T Regulatory Services Fee BASNSfASIX NABS.9 163 . Thomas F.Geiler,Director �� �ptfOMA'IA Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X--Press Imprint Map/parcel Number- o`Ig9'/ la-7- Property Address g VyccvZ�Oh �. /� /09 e�7_,> 06'5(--z �-O 24 Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address .8 v Contractor's Name Ai�;r/Zc;�> /G/�// y Telephone Number Home Improvement Contractor License#(if applicable) /K3 4Yd- Email: Construction Supervisor's License#(if applicable) O�/_f�5�/ 5?Workman's Compensation Insurance X®■ RESS PERMIT Check one: ❑ I am a sole proprietor AUG 2 6 2013 ❑ I am the Homeowner to I have Worker's Compensation �Insurance 47 Insurance Company Name � L (��'��ff�C7 TOWN OF 8 FIN89TAKE Workman's Comp.Policy# 1�<Ye '1/J6-coe1�1— $ _/3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 4 ` Re-roof(hurricane nailed)(s�ng old shingles) All construction debris will be taken to J �J �2cr.GL2s (7rei� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value �,Z� (maximum.35)#of windows #of doors: 0 ❑ 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 O mus ign Property Owner Letter of Permission. A copy oft o Improvement Contractors License&Construction Supervisors License is required SIGNATURE: C:\Users\decollik\AppData\Local icro d , s\Temporary Internet Files\Content.Outlook\8R76BDVA\E)PRESS.doc Revised 061313 Office of Consumes Affairs & Business Regulation License or registration valid for individul use only � before the expiration date. If found return to. [W- OME IMPROVEMENT CONTRACTOR ,. . Office of Consumer Affairs and Business Regulation egistration: 173709 Type: Expiration: 11/112014 LLC 10 Park Plaza - Suite 5170 y ' i Boston, MA 02116 ULEIKA BUILDING COMPANY LLC. IKTAR TULEIKA 125 BERKSHIRE TRAIL `r BARNSTABLE, MA 02668' Undersecretary . Not valid thout signature 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 Legibly Name (Business/Organization/Individual): OG//� 194,ei`C3'l �Q Z44(_. Address: �a6 �.��s�'�e Z�r� . �, 136 71,0_61e City/State/Zip: Phone #: ,�D$ u�8✓� _�✓�$S Are you an employer? Check the appropriate box: I am a general contractor and I Type of project-(required): 4. 1.V3 I am a employer with ❑ g 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. ❑ 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. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. ' right of exemption per MGL. y �o workers comp. 1.2.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no n 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. I 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 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. /J � Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: -"—h Job Site Address: ��v�®� �iiP. /� Q��� Pi-Y/City/State/Zip: CW 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 vi lator. Be advised that a' copy of this statement may be forwarded to the Office of Investigations of the DIA for sur ce coverage verification. I do hereby certify unde , and penalties of perjury thitt the information provided abov is71; and correct. Signature: Date.. zZ 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#: op1ME • snstvsenst,e. • MAW Town of Barnstable Regulatory-Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usirg A Builder n L( QNe , as Owner of the subject property hereby authorize To 1 dae- hoM IR PJ L L C to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job w er Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 i HOME IMPROVEMENT CONTRACTOR Registration 161544 Type: Expiration: 1-9 /27/2012 DBA U. NSTRUCTIONi"� =. VIKTAR TULEIKA� u V-k 125 BERKSHIRE W.BARSTABLE,MA 02668 Undersecretary Nlassach`usetts Department of Public Safet}" Board of Buildim-Regulations and Standards Construction.Supervisor License License:.CS 91854 VIKTAR V TULEIKA 125 BERKSHIRE TRL. W BARNSTABLE, MA 02668 �, C7�- Expiration 2/20/2093 Commissioner ner Tr#: 13464 �}Y V+.us►►� .�. w�.M.•,/s�..4 ►�.•r.�sr.+w•O�wa�W o�w�alw•®ram► .iM� iI �►I� . 1421 a TULEIKA BUILDING COMPANY,LLC VICAR TULEt" R 125 BERKSHIRE TRL• W.BARNSTABLE,MA 02668 RATE�- D 2. 53•7107.2113 n PAY � /7� Ic of (: .l.ecr�"oiP_G� Ott �SSr�n/���5 • '- •,������JJ'A r '�t Ae Jam//Ll.��•�C.v� DOLLARS r , rl Vs . ca»ai FOR 000b42In'. -e:2113? &0784 89 SO&SISW vv s Details 8/23/13 8:30 PM The Official Website of the Executive Office of Public Safety and Security(EOPSS) Mass.Gov Home State Agencies Details Vemogap hic Information Full Name: VIKTAR V TULEIKA Gender: er Name: icense ddress information ddress: ddress 2: ity: West Barnstable tate: MA ipcode: 02668 o nt : United tates icense inTormation , License No: CS-091854 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 3/18/2013 Issue Date: Expiration Date: 2/20/2015 License Status: Active Today's Date: 8/23/2013 Secondary License: Doing Business As: atus Chan e: 18 Prerequisite inTormation No Prerequisite Information pine No Discipline Information ocumen um close window.: ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license id=280929& Page 1 of 1 w a00 7 �oFz Teti Town of Barnstable *Permit# O Expires 6 months from i s ue date Regulatory Services Fee snaxsrnatE. r HA Thomas F.Geiler,Director HIED MA'I A Building Division `A - Tom Perry,CBO, Building Commissioner M00 Main Street,Hyannis,MA 02601 No V y 2 20og www.town.bamstable.ma.us Office: . . . 2-4038 Fax: 508-790-6230 of S IT APPLICATION - RESIDENTIAL ONLY of Valid without Red X-Press Imprint M-ap/par-eel-Number Property Address 5 residential Value of Work caC, Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1• r7 Contractor's Name ,+ _ r--- Telephone Number Home Improvement Contractor License#(if applicable) 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 Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) side 0 �"! p 'v #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *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 • requ' e SIGNATURE: �' r Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090909 The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 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,,/Or anization/Individual : Ze &Pj� Address: /2G� City/State/Zip: c - n/ (5 1)1/� O O Phone #: 77Z'�{/3� Are you an employer? 6eck the appropriate box: Type of project(required): l.0 I am a employer with 4. 0 I am a general contractor and I ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction2.M/I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These stib-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. F1 Building addition [No workers' comp. insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10f] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. - I 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 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob 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 coverage verification. I do hereby Bert' under.the pains and. alties of perjury that the information provided above is true and correct. t Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or'town official City or Town: Permit/License# Issuing Authority(circle one): I.-Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: o .4 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 Linder 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, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(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 Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (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 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia �y���HE Toh Town of Barnstable Regulatory ServicesBAM . 9 M&Q- Thomas F. Geiler,Director 039. 39.E A,0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, lkll4i� ,- 13 ,as Owner of the subject property, y C hereby authorize ��� / ��✓ ��{ to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) �� G Signature of Owner Dat Print Name If Property Owner is applying for permit please complete the Homeowners,License Exemption Form on the reverse side. Q:FORMS:O WN ERP E RM IS S I ON w r , of rqy Town of Barnstable 'i E Regulatory Services i * i Thomas F. Geiler,Director. BARNSTABLE, MASS. 9�A 1639. A,�� Building Division rED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAI LING ADDRESS:- -city/town state zip code The current exemption for"homeowners"was extended to include owner-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. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or 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 buildin> permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This.lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FO RM S\homeexempt.DOC 1 I 41-- - Massachusetts—Delmrtnient of PUbli( S., ¢ tN Board of Building; Regyulations and 5t tnd4td'ds Constructign Supervisor License Lieense: CS 18096 e _ � v Restricted to: 00 � ' RICHARD E LEBOEUF 20 BACON RD HYANNIS, MA 02601 Expiration: 6I23/2010 ('ummiysioncr Tr#: 27051 —_gistration _ ., T � � ✓Gl r � , `` Board of Building Regulations and Standards License or rej 4I, before the expiration date. If found lreturn to*only f i; , ' HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards Registration 142516 One Ashburton Place Rm 1301 - ExptraUon 4/7/2010 Tr# 265725; Boston,Ma.02108 E-TYpedividual !!!E Richard E.LeBaeuf Richard LeBoeuf. �" �� Z yy - — tC i l 1 20 Bacon Road � a� Ni?d ot val_id without signature Administrator „Hyannis,MA 02601 R - I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel a7__ Permit# 0 0 7 Health Division —3 '�io �,� Ab A)" bpi S Date Issued '/ 74 0 Conservation Division /T Gi fl�r'O�IaSIF anlr,+��F�eccycl. Application Fee P6-0 Q® �I 1 il��l Y1 Tax Collectorop � � `71, Permit Fee � � ° Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Village Owner)/11S � Address Telephone 7 Permit Request �.� A A? /y ,A/ 647Z7 Square feet: 1 st floor: existing � � proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 049 Construction Type Ale, .1 Lot Size �Y_ 7 AA Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. • - r Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure 20 Historic House: ❑Yes ®'No On Old King's Highway: ❑Yes 4�No Basement Type: ❑Full Q Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: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 49 Electric ❑Other Central Air: ❑Yes B No 'Fireplaces: Existing New Existing wood/coal stove: ❑Yes El No Detached garage:�d 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❑ 0 Commercial ❑Yes 4'No If yes,site plan review# Current UseCN�r bk)l Proposed Use & 'l BUILDER INFORMATION Name Telephone.Number kfop_ Address License# ��/� ��� � / ✓� � Home Improvement Contractor# // �5-7 7 Worker's Compensation`#wcJ—L1V" O�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,AO!/ /OcT. SIGNATURE G DATE 1 � FOR OFFICIAL USE ONLY 6 �DERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER w DATE OF INSPECTION: r O � , • FOUNDATION d � _Q � l �( FRAME �./�i7/�? o) `r �S' C' y 0 �✓L INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH m FINAL GAS: ROUGH t- < O FINAL - • " FINAL BUILDING .ES 75�' ' ��,:.�•g ®`� � •• - • n Y 1- rr DATE CLOSED OUT iASSOCIATION PLAN NO. rr, �? s "4 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= /1 ��/ x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SCE �square feet x$64/sq.foot= / x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= y (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 7w PProjcost Rev:063004 The Commonwealth of Massachusetts •. Department of Industrial Accidents' WCO afhowmff ' - 600•Washington Street Boston,Mass. 02111. ' workers' Cqmn ensation.Insurance Affidavit-General Businesses ��� �'�. ,a i:• .:,j.,Wyiy i?;Ps9 ' •�.�'It ��i r+.• 'ti y.'i: , .•$ '11 ; address' r � �zl 14te: . . . ._ work site locatiasi full address [] I am.a sole proprietor and have no one Business Type: []Retail 0 Restaurant/BaAating'F.stablishment working in any capacity. El Office 0 Sales Cincluding•Real Estate, Autos etc.)' ❑ I am an em toyer with etn to I am an�ployer providing vYorkers' compensation for my employees working on this fob. COIIl.8n'.I1ame. :..-;x. ,:1: ;ry• _ , N;�'.:,:: •t•,!..:r. J:;.i•;;: t• •.. ..5 sddr'ess: �� \/j Y :'�: `:,,,}' :�• .;t•.•. ,`:n'. •',.:fir •:1� •: '} : '•.'.• ... At •;,' , •;•• '•�'��'y/S9y �., �����,•�;i.,•1;,. Z.• o�fc••.#' '�:•,�"1�'�I•:•••' !t^• t�/J� �J•r`.;•'�:' •: ilrisurarice. / /j I am a sole proprietor and have hired the independent contractors listed below who havd'6e following workers' compensation polices: i .'t•'• t::(• ••h\ �'�` •�.:1-' y+• '•t:..'i _Y ry:• :.\. y'•v�•K{�.ai•°. •,nna�'.ti'•� vmr:8tu'•••'•I18ILYe<: .;. •;.:C• :•i• aY'`:•i'•]f• :+i:J COj.._ a Jp q•.«y ,r, _ �'. ;:1' %'f;'. 1 rt .+r.• 1. �:�_t y ''++,::r: t,'31:... ~.y,,.� ,: :Lit•• •r. •1 .•!.. Cl •nt :'a 'n' ;1"p:•i.�:`=.°�Lj'K••�. ��ttij:, ..�•^sl l.::• :,J•J'•',".; •`i``j.•�" .i;'i n�":•r:• •'r• •'�'•'• _ l v •:1: ;l, •• r:v,i':'i•!';`�'•:'; .�.+ .r: +• t.�•�::t• �•.h•�:: •.,b••.... '•i.^., .•5 •1:.+•.l� r• r:� '•r+• .5.:; v;:;' .F:•.'w:'i�.•i tl*:`'+`••; \.`JY}:' •+:• Icy*. t.1l:k'ti:,•.}'.,�,t: :-r�:'' :!:� ` t.a;.,i. s' insurance'co. Wo �<{;• fi' 't.!• cy',:t 'i: •i•. 5y: i>i•' ,,{.n.�'''•'h 0. :Fars'•.•'{.':�..i'�1+P�. ••1•`' - .t. •y .;\'. iJ•.^ .�•�.r,-' ,•i\; ':' •f%Y �'Lr•..;;: iJ, +r•i .:t:•,• '++'n'. •c'.• _ coin J. address: iyont CI .,i., .•� �•a. •'+•• •r,r :T°• .,y• .c: ':1:i•• ft�,t+ ..r 'i' '• .- .+ ;•i:;+ +d i.!i r �" "''�i. t•' .l•ti. ••fit• '•'+•• •,Y •�. •:l ti' •r� {. ., •9•.i. '•� "' S. r;:' i},:"�:J,�. ..O71C• �,{{yy i� :+ �t'''r ::t: •>: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criu►inalpenalties of a fine up to$1,500.00 and/or oac years'lmpr{yonment as well as'lull penaItfes in the foim o[a STOP WORK O ER and a fine of$100.00 a day against me. I understand that tL copy of t statement maybe forwarded to the Office of Invsstigatioas of the DIA.for coverage verltication. I do hereby certify under the pains ;!onaldesio h the 'j`ormation provided above is true and core !� Date ✓� Signature ; Phone Print.name ✓official use only do not write in this area to be completed by city or town oflicial permitfliceme# ❑Building Department city or town: ❑Licensing Board check if immediate response is required ❑selectmen's Office ❑ OHealth Departmeni contact person: pbone#; ❑Other ` (mv9ed Sept 2003) Inforixiation and Instructions. Massachusetts Geral Laws chapter�152 section 25 requires all employers to provide workers' co ensatidn for*their. to eel: As quoted from the law', an employee is'.defined as every person in the service'of another under any contract � y lie oral or written. )f hire, express or imp . 4n employer association, corporation or other legal entity, or any two or more of p er is defined as an individual,partnership, • Ile foregoing engaged a joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or iustee of an individual,p anoint. , association or other legal entity, employing employees. 'However the owner of a Swelling house having'not'more than three apartrnents and-who resides therein, or the.occupant of the dwelling house bf another who employs p�sbris to do.maintenapce, construction or repair work on such dwelling house 6r on the grounds or bg appurtenant thereto shall not because of such employment.be deemed to be:an employer. MGL chapter 152 section 25 also'states that'every state'or local licensing agency shall withhold the issuance or renewal of a license or perird to operate a business or to construct buildings in the.commonweaIth for any applicant who has not produced acceptable evidence'of-comp liante with the insurance coverage required. Additionally,neither the ' commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until ompliance with the insurance requirements.of this chapter have been presented to the contracting . acceptable evidence of c authority. . MINA FEE Applicants Please fill in .the workers' compensation affidavit completely,by checking the box that applies to your sitdation.;Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of In Accidents-for confirmation of insurance coverage. Also'be sufe 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 T?ep ai tmeit of Industrial Accidents. Should you have any questions regardin 'the"law"or if you are a;worker5'•compensationpplicy,please call the Department at the number'liS. below. required to obtain i City or Towns . F leas e.be sure that the affidavit is cbmplete and print ed legibly. The DepartrnEnt 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 fal.in the pemitllicense number.which will be used as a reference number. The,affidavits rnay.be.returned to the u' ' --nient b}.r� or FA•x.unless other:arrangements have been made. DepThe Office of Investigations would lie to thank you in advance for you cooperation and should you have airy 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 M of hivestipfts 600 Washington Street Boston,Ma. 02111 fax.M. (617)727-7749 phone#: (617) 7274900 ext:406 I _ _ _ 1 r 7/e v/arrvnwouuPai a�:/�aadrtc�uiae�la BOARD OF BUILDING REGULATIONS (License: C NSTRUCTION SUPERVISOR Nwmber�X,S.' 03986,8 .— • �' O Q�'�514� Bnhde 0 Tr.no: 24715 Res��� ROBERT J VER f PO BOX 703 MARSTONS MILLS, tU�72648 Commissioner .Board of Building Regulatiops and 8iandati' HOME P,R�LhI VEMENT CONTRACTOR a - Rec �ta wn 157 . ' ~ •f' t I2( /2004 . R.GLOVER BUIL[ N �` ROBERT GLOVER 1 POIBIOX 70/13 CURT IdIAF2STONS iJIILLS .NIA n2648 : "A i I 4 F�N�r Tow.n of Barnstable ° Regulatory Services Thomas F,Geller,Director 9q, s6�9 �•� Building Division prED � Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . _-- y".town.barnstable.ma-us _-- Faxr 548-790-6230 Office: 508-862-4038 Property owner Must - - Complete and Sign This Section If Using A Builder 9 rg ,as Owner of the subject property f hereby authorize 10 �o✓. � ,.to act on mybehalf in matters relative to work authorized bythis building permit application for. all (Address of Job) - Signature of Owner Date 9 YF print Name • 4 r I MAScheck COMPLIANCE REPORT 1 Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I I I Checked by/Date I i I TITLE: BYE ADDITION DINING ROOM CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other, (Non-Electric Resistance) DATE: 8-4-2004 DATE OF PLANS: 8-2-04. COMPANY INFORMATION: R.GLOVER BUILDING CO COMPLIANCE: Passes Maximum UA = 82 Your Home = 81 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 288 30.0 0.0 10 WALLS: Wood Frame, 16" O.C. 272 13.0 0.0 22 GLAZING: Windows or Doors 102 0.340 35 FLOORS: Over Unconditioned Space 288 19.0 0.0 14 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date r t , • yy Toga of Barnstable op•tHe . • °•� Regulatory Services Thomas A Geller,Director 16 59, k 331111 fng DWS10I1 . Tam Perry,Building Commissioner' ' 200 Main:Street, H yaws,MA 02601 office,: 508-862.4038 Fax: 508-790-6230 • Pennitno. Dad APTmA'YI'.0 HOME IMPR.OYEM&NT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION • MQL a 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owAeer-occupied budding containing at least one but not snore,than four dwelling units or to stractures which are aflj acent to •• suoh residence,or building be done by registered contractors,with certain exceptions,along with other require, ents. m . � . . • Type of Work: • y !gyp% � Fst�ted Cost Address of Work: . Owner's Name; Date ofApplicition:, I hereby certify that: Registration is not required for the following reason(s): []Work excluded bylaw []Tab Under$1,000 ' []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that; OyMRS PULLING TEEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABIIE HOME Z2ROYFZWT WORK D 0 NOT MWE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY PM UNDER MGL a.142A, SIGNED LMERPENALTIES OF PMUMY Ihereby apply for' ape ' a agept of er: l v Date ContmetorNan a Re4istrationNo. • OR , Owner's Name TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# " Health Division ; (600 —338 Date Issued 161A G Conservation Division 1 U//0/d y D f/c � UL 03`G ®� `� Application Fee �p '00 y. zy>c Tax Collector Treasurer_ SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED Ur,3 'hlk ',.JANCE Date Definitive Plan Approved by Planning Board ENVIRONki iFiv---=.j. Historic-OKH Preservation/Hyannis TOWN REGuLA i-luw Project Street Address /'!� � � ✓�L� Village Owner bU O24/s� Address /Alm' Telephone 72 sr� Permit Request .��'�6 � C�/'Qi' � S" � �'. ��1�1✓ A/ S uare feet: 1st floor: existing t�Wl proposed 2nd floor: existing �0 q g p p g proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationv 0) (50Z> Construction Type <faAe—/-4 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 4W No On Old King's Highway: ❑Yes WINo Basement Type: 9&Full ❑Crawl ❑Walkout ❑Other / Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) ` _y 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 UM Electric ❑Other Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Q,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 0 Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Us �i Proposed Use BUILDER INFORMATION Name ���� ✓�' Telephone Number Address Pica License# d � z��IJLLCe 1W Home Improvement Contractor#�✓ / �� Lf 7 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE s *, FOR OFFICIAL USE ONLY �ERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL • 4 PLUMBING: ROUGH FINAL' \ GAS: ROUGH . — FINAL FINAL BUILDING c, DATE CLOSEEMUT ASSOCIATION-PLAN NO. r r , ti a OCT-13-2004 WED 01:29 PM KEYSPAN ENERGY DELIVERY FAX NO. 1781890489E P. 01 KeySpan Energy Delivery (I.� ;,•,. 127 W1105 Path South Y,rmoulh,MaSSaCIIINCII S 0?664 October 13,2004 • i To whom it may Concern: Re: Willis Bye-3 Newton Avenue, 11yamnisport,MA Tliis.Ietter is to confirm that we bave cut and capped the gas service at the gate box and removed the meter to the above referenced property on October 6, 2004. II'you should have any questions,I can be contacted directly at 508-760-7502. Sincerely, Joballne Ouellette Fiold Coordinator Cape Division f OCT-07-2004 13:19 BAR14STABLE WATER COMPANY 509 790 1313 P.02i02 B e Water Company Old Par a t� atr�e at 47 Old Yarmouth Road PO.Box 326 wswmunarCwNFrncvrweruuamM Hyannis, MA 02601-0326 00=5W778.9617 Fens.50-M.1313 Customer Service:M&775.0069 October 7,2004 Town of Barnstable Building inspector Town Hall Hyannis,MA 02601 RE: Service#533, 3 Maywood Avenue,Hyannis Port Dear Sir: Please be advised that the above water service was shnt off and the meter removed on October 7,2004. It is our understanding that the owner intends to have the house raised and a new.foundation and cellar installed. Sincerely, f Jane Morse,Clerk Barnstable Water Company TOTAL P.02 The Commonwealth of Massachusetts . Department of Industrial Accidents' 600'Washington Street - Boston,Mass. 02111'. WorkersI Coin ensation.Insurance Affidavit-General Businesses 1-2 T•aTilP CCCVVVVVV////// S i �d r/ state: c' work site location fall address ❑ I am.a sole proprietor and hand no one Business Type: El Retail❑Restaurant/Bai Bating Establishment working in any capacity. ❑ Office❑ Sal'es(including•Real Estate,Autos etc.)' ❑I am an erntoyer with ein'lo ees(full& art tim El Other I am an �loyer providing-workers' compeassaa1tii)on for my employees working on this job. :„ ,,5. sit 's'• r �itt�LLl •••t' :3V6A IF 't .+• 7 :' a: tt.{..�' _`. •'` sine: ',:• t .. +t.;:,. •:'r::,•� ;. •.; • ✓�•1.' + 't�'.:' •:i.,.w yF.:. �^..i:• - !.. :4 :!°' iv'�r: .t. t Tom~^i%•:... t. sd'dr'essi' rf'.s s .w'�: • � '.� hone# - .. ;.•...: 't r • `•�.• "} '•,��. �'':' odic.'.#' >,�., :;• � `t'' � nsiifirice.eo: Iam a sole proprietor and have hired the independent contractors listed below who have the following workers' .compensation polices: .'`.:. _ `,,• ..,4 .5 ..liu.,��• :.Tj�V.Y ..✓1Ft:!i't •%;':.2: COIn �l.. ,t•.x.,_ _ ::1`r.fr i..''.. .1 i ., ..t• 'rt•`•.t'.' ..e. Via,+" 't.i Sy .. address:. '"' :.4'•+- •,,; ,';' :� ,",<,- _ ty •�• '•^`%•ti.�.••J,•;,1 t., �'1, •'i}t. vr�� eta: •_I,�..S. L: •r. ;, ;.;,;. ,T_ i:_r;�.. `None. ;• :',;':' .',: ' ;i, 'r'' =2:t Wiz. :];. •'.�-�- _ :••t:' � '' r ,o•.":fi'.;,tik:• :':`. !:.''••OZ1C :#�•'.,t.?'f;X�.:.. `fa.. �'r . . Ins'urance'co. :*' => :t: (q;Ct• ''i�. '�:`� '•.7i,•.', 'a:j rs'•.''d,•ir.,•:'1s�'i. •t''{•' - coin an. paste. address:.,Y cI - rt_ i•i :r::...,1:.'t i.. �.l •n: 1. K:., :�' J' r+t: :)::'�j,. :t' a,�:` ` insuranee co i. Failure to secure coverage as required uNNNW� nder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'1mprGonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that = t beforwarded to the Office of investigations of the DIA.for coverage verification. • copy of this statem.en ma Y I do hereby certi 'es o er' at the infar ation provided above is itue and correctoC = ' Date Q Signature Phone# print name J official use only do not write in this area to be completed by city or torn ofii cfal permitflicense# ❑Building Department , city or town: ❑Licensing Board •checkif immediate response is required ❑❑Selectmen's Bice Health Deparr tment contact person• phone#; ❑Other r (rev5ed Sept$?43) c _ Information and Instructions. con ensatidhfor'their. ...;.1. vlassachusetts General Laws ch4 pter�152 section 25 requires all emFlOYers ersonin the ;mployees: to providq Workers' pp service of anoth under arty o tract As quoted from the law', an employee is.defined as every p �f hire, expr--ess 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 P the foregoing engaged in a•]omt enterprise, and including the Legal representatives of a deeeased,employer, or the receiver or trustee of an individual, -partnership,association or other legal entity, employing employees. 'However the owner of a dwelling house '?mg n )onore than three apartments and-who resides therein, or the.occupant of the dwelling house bf another who employs persbris to do.maintenance, construction or repair work on such dwelling house 6r on the grounds or building appujtenant thereto shall not because of such.employment.bedeemed to be an employer. MGL chapter 152 section 25 also'states that'every state'or local licensing agency shall withhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced accephei the table evidence of compliance with the enter into any contract for the performance of publictwork until commonwealth nor.any.of its political subdivisions shall e y acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. ME Applicants Please fill in .the workers''compensation affidavit completely,by checking the box that applies to your situation :Please supply con�any narrie, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the D apany •of In Accidents-for confzmation.of insurance coverage. -Also'be sure to ig�endbde to the eP 't or h is P, error lication for th affidavit. The affidavit should be returned to the city or town that the.app p m$ the D aztnnent of Iudustrial Accidents. Should you have any questions regarding the"law" or if you are. requested, not eP re aired to obtain a workers.'•cornpensationpolicy,please call the Department at the niunber liste�dbelow. q P . 1011 City or Towns . ?l ease be sure that the affidavit is complete andprinted 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 a e pphcant. Please be sure to fM.in the permitlhc ens e number.which will be used as a reference number. The.affidavits may.b e:retumed to the Departrne►itbY orFAX•unless other:ariangements have been.made. thank you in advance for you cooperation and should you have any questions The Office of Investigations would hke to ; 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 6iflce o[[eifesfi�tlens • 600 Washington Street Boston,Ma. 02111 fag#: (617)727-7749 phone#: (617) 727-4900 ext:406 r rs RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00. >500 sf-750 sf 50.00 >750 sf- 1000 sf - 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck' x$30.00= (number). Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.0 1 (plus above if applicable) Permit Fee Proicost 10/20/2004 WED 10:05 FAX NSTAR One t4STAR WaY.WeStWOW-A113s-=hWd'6 02090.1 EL EC rR/C GAS October 20,2004 Dear Willis Bye:This letter will serve as confirmation ha the el IhC ectric Utility e at-jMan t a u Hyannisport, Ma has been removed Based on this u►formation,there 13/04 is no electric power t0 thi buildingj �78�44I-3640.0 may ceed with the demolition.. If you have any questions,please contact .1- Sincerely yours, ,Susan(A. Skru an Customer Service Clerk ... .... ...... -.- JE i .. f n • __ �' .., • ,' n _ • .. _ Hh EIZ- 6191s"� 20.4. M,. _— ,`— t r , I. Prehmi nary plans and layouts by DCD.are for the use of their customers only.Any other use is stnc ly pohi hrte t t ——----- — ---- �.—. -- — -- a I ' , 12r I Q - *r I _ ice ;I .O' _ • i ' 508.428.6191 [served evlin Ustom yJ esignpyright 0�Rights I - I a 5 Preliminary plans and layouts by DC.D.are for the use of their customers only Any other use is strictly Prohlbite ... .. �I f , ,.. � � - •. lL\�v/.u.S=B'.�H1;:.ti�i 1'�4'n0'=Cti cr,-F.c�cE1TKl>ti.`546'_'NCTcf7sFID\rERfYr.,i lTyNh17f:- .. • "'c - �t_4ts_r.�'s4AA_tXL�T@�ft-1331?-rutil--,--- '— -- �SlrvcE,a5iUn5 .__,__ . • -2 c¢-o-�oa�— ' Cy-:/:FCr3.X0C_5=tu:C'a8-P_T-flt��REt' _.._. --:7 vIR>j:.Fitax S ' USE Y✓tfst$7 L .l"r r .. � I I � _-.-r�P_6"_�EFLtiK-.LA-l3LLtt-_9�E--__�_ .... • I - .. _. �. I I d \ / N I v \ m ;I � ll r I ! e �.6•.• ... �.�., - 6.4., L.2.: c•b z.b Z.o.. ... 6.0` CA DATE I jl -_-- — — ._..- - _ CD508.428.6191 �._— evlin hl; �xrsrcmti_F:r, = j r'. Custom r I designs", i vJ _—LI I copyright®2004 » i 1 JAI]Rights Reserved C6) f � I j �ff Prelrminary plans and layouts by DC.D.are for the use of their customers only.Any other use is st r,crly prohibite - J. j ul - t ':$06?1Fr4M_EL•t&ttdHEQ�_s�9•_'.:... � ."i� rM t -- •3QTJIKN t)tJ.51T!(1H'.ut.'•s4� 4 'V _ - . ..^ � - PzurE-n,•VEl7f UR..F1auAl. __ cF=F1EiGi7L�CUCr3�S�fkSFC�-__ . r../_tatTSTG.t�— . i L)(77 -'=ivw L-�Ko i— • I SRGK __ _ it ' t I I 1 • ... - �CALE DATE 508.428.6191 7. GI - -- (flevl i n - - �• - - - Custom . (Res igns • - copyright®2004 111 - All Rights JA Reserved — -- 1 F IRS}- PIDGF�j — a _ u _HH1 I b - - - - 4�. Preliminary plans and layouts by DC-D.are for the use or their customers only-Any other use is strictly prohibrte ZONWG M32EV2m RF-1 i ! BUILDING SETBACAY- % FRONT - 30' SIDE - 15' REAR - 15' ! % OVERLAY DISTRICT` ! / UP" DEED REFERENCE' ! % C7F -116947 ASSAYSO! % DAM MAP 287 PARCEL 127 i j �•�Q. ! ! i i •` 63 6' W j Stone Driveway lI Emsti :T j % • Gamge 61' E�ostang.. Cottage i • ::: ry0 rod' / / :• :::: i 4 77 ! 122.2Ap Ro 901 i 97' '0 27.8' " .. ;_: ! Septic System .. lPer Owner As-Built Data . N8921'54 T 90.26 .Plot .Pl a is O-f .L ,-i n. d Prepared For.- The -Bye .residence �y In .H annis ort, Massa ch use t is .Y .P ✓"®,. Scale: 1" = 20' Date: August 23, 2004 a���� T RFo tis Prepared By.• GRAPHIC SCALE Stephen J. Doyle and Associates s sTcrNEti jDo' N 42 Canterbury Lane, E. Falmouth, MA 02536 20 0 10 20 40 80 .4 p #37559 Telephone.• 5081540-2534 -E3.Zc� ck S ( IN FEET ) 1 inch = 20 ft. 1 c9g, 7C,-D� 1Z�.J Ar��ti-rt o'b•-� � r NO. DATE DESCRIPTION BY