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HomeMy WebLinkAbout0045 NORRIS STREET !��E.'.ti'is ...� ,, i i i I Town ®f Barnstabl B uil dis n g e Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on job and this Card Must be Kept BAH\ ,A�L�) ;gl Posted Until Final Inspection Has Been Made. ® ' \�0 1 619 Permi Where.a Certificate of.Occupancy is Required, such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-4304 Applicant'Name: SWEET,ANDREW Approvals Date Issued: 12/14/2017 Current Use:' Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/14/2018. foundation: Location:: 45.NORRIS STREET, HYANNIS Map/Lot: 3067035 Zoning District: RB. Sheathing: ' Owner on Record;-PIERCE, DANA.W&CAROLYN C TRS' :.Contractor Name: -PAUL M,DOWNING Framing: < 1 Address: 45.NORRIS STREET_ Contractor License: CS-074247 2 HYANNIS, MA 02601 Est. Project Cost: $ 1,456.00 Chimney: Description: 1 door :30 u-value 'Permit fee: $35.00 Insulation: Project Review Req: Fee Paid: $ 35.00 Final: Date: 12/14/2017 Plumbing/Gas Rough Plumbing: Building'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 which his permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zoning by-laws and codes. . This permit shall be displayed in a location.clearly visible from access street or road and shall be maintained open for public inspection for the entire.duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy.will not be issued until all applicable signatures by the.Rbildingancl Fire Officials are provided,on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough:, 1. Foundation or Footing 2.Sheathing Inspection Final:. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed _ 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.final inspection before Occupancy Health Where applicable;-separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not.have access to'the guaranty fund".(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable "Permit# P- I�1 -4 oy Expires 6 mondis from issue date �T Regulatory Services Pee i 13►ttrisTn m v MASS Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner {'r`:_ 200 Main Street,Hyannis,MA 02601 �.r�-� 3 2017 www.town.bamstable.ma.us Office: 508-862-4038 (F c�l�5'OX8� 9 6230� fABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 301o035 '1. Property'Address AResidential Value of Work$ ./ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address - 'AM4 Sl--- otV4�9 #14 oZ60 l Contractor's Nam eT OT lU / Telephone Number 7V1-7�y`d.3IJ Home Improvement Contractor License#(if applicable)i j/..7 �01'7 `Email: Construction Supervisor's License#(if applicable) O 7 / 7—y 7 19Workman's Compensation Insurance `6 `W Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name lUA-TIPw- 11iVeoAJ Workman's Comp.Policy# fp S� 5 s Copy of Insurance Compliance Certificate must accompany each permit. p 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 Replacement Windows/doors/sliders.U Value J O (maximum 3)5)#of w' #of do s: ---- ❑ 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: Appewner must sign Property Owner Letter of Permission. the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: QAWPFILESWORMS\buildingpe fo s\E)TRE .d9c Revised 061313 ( 7 ',7[ SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 14 N.O. H2612-6 0862 Store 2612'HYANNIS Pholi3:.(508)778-8948 VALIDATION 65 INDEPENDENCE DRIVE Salesperson:RHP4LE Date pz� '` HYANNIS,MA 02601: Reviewer,SV,995. Transaction: 2612 Name PhMsI b08 221-6073 Order Total:.:., $1,456:22`. PIERCE? DANA t ) Amount Rald'. $0.00 :naa e. 45_NORRIS ST (5U8):775-0565 co HYANNIS JoDOG `P"`" exterior door install 'slat NIA Z'° 0260:1 c"-Oy BARNSTABLE s { s { n , MERCHANDISE AND SERVICE sold to'tw omen REF#W09 SKU#..0000-51a-664. Customer Picku 4 WiII Call S.O.MERCHANDISE TO 8.E PICKED.UP. S10 FEATHER RIVER REF#'S08. ESTIMATED:ARRIVAL DATE: 12/2 'tom DOOR QTY UM DES.GRIPTlON E'1 CE EACH . ,.EXTENSION $0806 0000-8067449 1:06 EA NA/STANDARD ENTRY.DOORS'.ENTRY D.00R::3715 X 7:1 ENTRY D 5715:46 $7:15'.46 DOOR37.5-X.795STANDARD`ENTRY DOORS#1: SCHEDULED PICKUP DATE. WIII.be.scheduted:u on arrival of all SIO Merchandise • $.715 46 ND`0F.CUStOMER-PICKUP. .R F`#IN09 INSTALLER`t�4ELl1/ERY REF#'101 STOCK MERCHANDISE TO BE DELIVERED REF# SKU QTY UM. SCRIPTION. Pi TAX RR10E EACH EXTENSION R03 0000-677A37 3.00 FA 3/4"X5-1/2"X8: A Y �30 57 $91 71' R04 0000-324-327 18.00 LF 3/4 X3-7 FFORD.CASING.I A Y $1,94.. $34.92 �4]00.[IB?2=204 _v 100.. 6L fi ldt OtNl2DOR.&EALIG�I.. M7. M- �. R06. 00.0:0-715-499. 1.00 G PURP'16"X48 ROLL.INSUL5.3SFa A Y S5A 5.48 . r • 149.68 ""CONTINUEO.`ON: EXT.PACiE'*" FOR WILL CALL MERCHANDISE�PICK=;UP PROCEEI�:TO WLLL CAL�.OR: [J (Pro Customers; Praceecl;To The:Pro Desk) J. Pine 9 of 1d No- H2612-60862 'Customer-Cony SPECIAL SERVICES CUSTOMER INVOICE-Continued Name: PIERCE Page 5 of 14 No. H2612-60862 TOTAL CHARGES OF ALL MERCHANDISE & SERVICE . aa2.15 Policy ld (PI): SALES TAX � , $54:07 A:90 DAYS DEFAULT POLICY; � AL 1-456.22 BALANCE DUE 1 456.22 'The Home Depot reserves the'right to limit/deny returns.Please see the m1um policy sign in stores for detaits.' END OF 0RDER No.H26124*! Customer's Signature y c V Date! T� Pane 5 of 14 No. H2612-60862 Customer Coov r PAO�4, 00i N G. oo :. . 4.Z{ r � � r tom' c. r i .'`�. The Commonwealth of Massachusetts Department of IndustrialAccidents — -tJ Office of Investigations -=, V-,; �--•: I Congress Street,Suite 100 Boston MA 02114 2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: l$uilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ .L .. � ` � :101 k)C Address:_1ir;t 't✓Y-- c- City/State/Zip: [j . Phone �-- Are you an employer?Check the appropriate box: Type of project(required): I.❑ lain a employer with 4. ❑ I am a general contractor and I employees(full and/or part-tir.Ze).* 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 8. ❑Demolition Working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.t 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 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]1 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 till 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. . �Contractnrs 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 ain an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: . Policy#or Self-ins.Lic4: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Gertz y under the pains and penalties of perjury that the information provided above is true and correct S1 afore: l ,- :,u z ___.. 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: - Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 }.. F Boston, 111.4 02114-2017 www.mass.gov/dig umbers Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleptri jease Print_Le gib A licant Information The Home Depot At-Home Services Name (Business/Oreanization/lndividual): Address: 908 BOSTON TPK City/State/Zip: SHREWSBURY: MA 01545 Phone#: (508) 942-6942 Are you an employer? Check the appropriat box: Type of project(required): employer with 2001 4. 1 am a general contractor and 1 5 New construction 1 1 ] am a em have hired the sub-contractors employees (full and/or part-time).* 7. ❑ Remodeling listed on the attached sheet. 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' 9 Building addition working for me in anti' capacity. comp. insurance.- [No workers' comp. insurance 5 We are a corporation and its 10•❑Electrical repairs or additions required.] officers have exercised their 11.❑Plumbing repairs or additions = ❑ 1 ys a homeowner doing all work right of exemption per MGL 12.� Roof rep irs myself. e r workers` comp. c. 152, §1(4).and we have no 1 Other - �r insurance required.]t employees. [No workers' comp. insurance required.] *Any applicam that checks box#1 must also fill out the section below showing their workers'compensation police information. dict HomeOMMM who submit this affidavit attached ar additional ing the):are sheet showing the name of the sub-contractors and state whether oing all work-and then hire outside contractors must submit a new note those�entiti s havesuch. Contractors that check this box olicy number. employees. if the sub-contractors have employees.they must provide their workers comp.p I am an employer that is providing workers'compensation insurance for my employees. Below is the polic►7 and job site information. Insurance Company Name:NATIONAL UNION FIRE INSURANCE COMPANY XWC 65831 45 (QSI) Expiration Date: 03/01/2018 Police#or Self-ins. Lic. (� Orris City/State/Zip: Job Site Address: er and expiration Attach a copy of the workers' compensation policy deAcof MGL laration rac. g 2 can lead to the(showing the oimpos t o of nm nal penalti e of a er an"dexpira Failure to secure coverage as required under Section 2 fine up to$1,500.00 and/or one-year imprisonment; as wtheat a co as py of this statement m be forwarded es in the form of a STOP Otothe Rffic eOf and a fine of up to$250.00 a day aga r m e violator. coveBe advised rage verification. p Investigations of the D h f perjury that the information provided abov is tr a and correct I do hereby certify an e aims a d Date- Si atuTe: ` Phone#: if [E6. Other only. Do not write in this area,to be completed by city or town official. Permit/License# n: hority(circle one): Health Z. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Phone#: rson: i , P. —_- lie Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04(22-12019 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Update Address and return card. Mark reason for change. == ❑ Address ❑ Renewal ❑ Employment ❑ Lost Card _ Office of Consumer Affairs&Business Regulation Get; HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDDlement Card before the expiration date. If found return to: i, '= Registration Expiration , Office of Consumer Affairs and Business Regulation 112785 04,12212019 10 Park Plaza-Suite 5170 '-T ME DEPOT USA INC Boston;MA 02116 ANDREW SWEET C� -- 2455 PACES FERRY RD C-11 HSC d Rt -Ouk signature ATLANTA,GA 30339 Undersecretary A� CERTIFICATE OF LIABILITY INSURANCE Dozl n'iM� 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). CONTACT PROOU MA MARSH USA,INC. PHONE FAX AI TWO ALLIANCE CENTER IAQ No-Ryft ( Not 3550 LENOX ROAD,SUITE 2400 ODD L ATLANTA,GA 30328 I51 { INSURER AFFOW ROG COVERAGE I NAIL L 100492-HaneD-GAW-17-18 INSURER A:0`9 ftubNC InSucanCe GO 124147 INSURED INsuRER a:Agd General lnsurarim Company 142757 THE HOME DEPOT,INC. HOME DEPOT U.SA,INC. INSURER C:New Hampshire Ins Co 123841 2455 PACES FERRY ROAD INSURER D: I BUILDING C-20 ATLANTA,GA 30339 INSURER E INSURER F: I COVERAGES CERTIFICATE NUMBER: ATL-M374MB7-14 REVISION NUMBER 2 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. IL7R I A B ( POLICY EFF POLICY EXPO TYPE OF INSURANCE POLICY NUMBER M wrov A X I COMMERCIAL GENERAL LIABn rrY IUMITS MWZY 310022 0310112017 03ID112010 FACT{OCCURRENCE S 9,OO UM DAMAGE TO RENTED CLAIMS-MADE `r OCCUR PREMISES Ea me OF POLICY XS MED EXP(Any ww ) 5 EXCLUDED OF Slit$1 M PER OCC PERSONAL s ADV INJURY s 9=00B GENL AGGREGATE UMT APPUES PER: GENERAL AGGREGATE S 9•0•DW X POLICY J� LOC PRODUCTS-COMPIOPAGG S 9•0wA00 OTHER: I 15 A AUroMOBILELIAe1LITY MWTB3iQ021 0310112017 0310112D18 COMMe 6BIN4EeDD NGLE LIMIT S 1OOO,DDO X ANY AUTO BODILY INJURY(Pepe 5 ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accidell)I s AUTOS AUTOS NON-OWNED PROPERTY DAMAGE 5 HIRED AUTOS AUTOS Wff 2cdderd S i UMBRELLA UAB OCCUR I EACH OCCURRENCE S i EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETETJTIONS Is B WORKERS COMPENSATION WLR C4911230D(TN) j031=17 031D712018 X P� o�H C AND EMPLOYERS LIABILITY Y/N 4YC 023102423(AK NH NJ,Vn 03N112017 031D112D18 1,000,000 ANY PR OPRIETGAIPARTNEROMCU IVE a N/A EL EACHACCID3QT S C OFRCERIMEMBET EXCLUDED? WC t713i02424 I0310112017 D3MI12018 1,0Di1,000 (Mandatory In NH) � E L DISEASE-EA EMPLO S If yes,dr trine-OW Continued on Additional Page E L DISEASE-POLICY LIMIT S 1• •�0 DESCRIPTION OF OPERATIONS blow DESCRiPT10N OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AddWvnal Remarks Schedule,may be attached it mare apace is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE of Marsh USA Inc Masashi Mukhmiee _MaL.xaew: I O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25-(2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100492 LoC#: Atlanta AC40RE) ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. HOME DEPOT U.SA,INC. DIWA THE HOME DEPOT POUCY NUMBER 2455 PACES FERRY ROAD BUILDING C•20 ATLANTA.GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE Certificate of Liability Insurance Wards Cornpersalion Continued: Carrier.Indamolty Insurance Company of Nohh America Pony Nlmlber.WLR C49112294(AL AR,FI ID,IA KS.KY,LA,MS,NO.NE NKND,OK,SC.SD,WN,WY) Effective Date:MIM12M7 Expiration Date:03V2018 (EL)Limit Si,000,0W Cartier.New Hampshire Insurance Company Policy Number.WC 023702422(DC,DE H1,IN,MD.MN,MT NY,RI) Effective Date:0370112M7 Expiration DaW-091D1018 (EL)Limit-S1,000,00D Carrier.ACE American Irrsurance Company Policy Number.WCU C491122B2(OSIXAZ,CA.11.NC,OR,VA WA) Effective Date:03101✓3017 Expiration Date 01012018 (Eu Urnt S1,000,13M SIFL 51,00D,0W SIR for tre states of AZ,CA II.NC,OR,VA,WA Cartier.Nationa!Union Fee Iraura m Company Poky Number.XWC 0583144(DSQ(CO,CT,GAAE,MI,NN,OH PA,UT) Effective Date 11 10'f2017 Expiration Date:030IDMS (EL)Link 51,00D,000 s1,000,001)SIR for the slates oI CO,ME,NV,tA,OH,PA,UT S750,11M 61R for lheslate at GA I S350,0W SIR for Ore state d C r Carries N n"U- Ere Insurance Company Policy Nlsntx'r XYVC 8583145(OSq(MA) Effective D. 0310V2Dt7 / ►( Q Ci/L ` t O Exp ration Dale 03012618 (EL)Limit 51,0DQ0D0 SIR:S54D.0m TX Employers XS Indemnity Camerigh s Union h-sum ce Company Po'ay Number TNS C48613202(TX) Effective Date 03/012017 Expiration Date:03/0112018 (EL)Limit S10.000,000 SIR S1,00D,000 ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 30�.f ' Parcel 0 r C F.. Permit# j " 0 Health Division ) _ C�a .0 . Sc, e,�n,; ° �bJ.27 • Date Issued �� !� Conservation Division • �s �' 2H31 `4O11 "`j 10' 13®� 'Application Fee .Tax Collector. s Permit Fee' Treasurer ® � Planning Dept. .J1/� •: __ F .Ate'I,1Cl4�iThItTST08TAt�ASEVPEF CONNECTION PERMIT FROM THE Date Definitive Plan Approved by Planning Board h/ CONSTRUCTION,ENGIlQEERW(I DIVISION PRIOR TO Historic-OKH Preservation/Hyannis Project Street Address AS \A e�1 (A. 1Dta t Village ,�6 ' Owner _louhix uA Cwfo� ><PCCe. Address Telephone TS 0% ELF) Permit Request t h UAW fQQ, �� . a Square feet: 1 st floor: existing proposed IW 2nd floor: existing proposed Total new�lc(� Zoning District Flood Plain 1mixe. G Groundwater Overlay Project ValuatioA o'is'00t) Construction Type i Lot Size ��® Grandfathered: ❑Yes ❑No . If yes, attach supporting documentation. Dwelling Type: Single Family C✓1 Two Family ❑ Multi-Family(#units) Age of Existing Structure o Aeav5 Historic House: ❑Yes dNo On Old King's Highway: ❑Yes d No Basement Type: dFull hl Crawl ❑Walkout ❑Other C04\Yee Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft,) `� 0 Number of Baths: Full: existing new 1 Half: existing new >� Number of Bedrooms: existing 'Z new Total Room Count(not including baths): existing new First Floor Room Count 4 Heat Type and Fuel: YGas ❑Oil ❑ Electric ❑Other Central Air: 5(Yes ❑ No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes ®No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:dexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 6o If yes, site plan review* Current Use, - Proposed Use. \\ BUILDER INFORMATION Name �UhV� ��V�Q� j� Telephone Number Address_ 155 �,�v,er� ��. License# wMaix"lMtUs► \ - YAk_ Home Improvement Contractor# lVVS A 01\1ADA Worker's Compensation`# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �c�`c�p NATURE DATE I ' i t i FOR"OFFICIAL USE ONLY � r - t PERM�T NO. j DA ISSUED f I MAP/PARCEL NO. ADDRESS VILLAGE ' 1 OWNER .01 DATE OF INSPECTION: FOUNDATION 4 / Q a '_ 0'SJr l� FRAME e,< D 5 z_1-sz � � /T /!z" ! n .s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t t PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING �i h/ �h ,( /�< 4 DATE CLOSED OUT• , `= ASSOCIATION,PLAN NO. E r , t t } The Commonwealth of Massachusetts Department of Industrial Accidents Office 9110YestfIfif/00s ' 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit iMUM \u name• 1 �1\� I�PW� �CS(1� A\ location city C-.>y\A\-\ "\U'i ftMk \ phone# 15A 1,71 ❑ I am a homeowner performing all work myself. [�I am a sole etor and have no one w I Idn in ca iclty %%/ %//G�%%//%%%%% %/%/G/�%///////////%////%/////%%%%% ❑ I am an em layer raviding workers' compensation for my employees worlang on this job. �CO�pX.INN ;...: x{4..t.. ...: ...:..,........ .: ....... }:: .Y. :::r}.r.:? •.. •r:Y:Y}:.............,...r........,:..,..:....... ;...:.:Y:r:.::Y::::::.Y.Y.Y::::::.:•,}..:....,...,•.Y:,::-:•T••?}:;•}:•}}:;;•'..-.,r.•::::•::•:::::•:::;•::-:: ..h•}}:.}:�:Y:•}}:;v:;4:':;;::.:.::}}}::::::;v:.Y%i-}}iT}}:•:}}}}}};:i.4.;:}i�i:•?}::ii::::}:{i:iii::::v?:Y'}Y4:}•:i•'r? .............................. .. ....:...........n..r................ ........v......:n..................• .................n:..t..:.::............. t.....:..t.......:.....:..n.t,,:�%}v:::}:ti::•:v:.v:::}}:':•...................... ::.:....... .:....nYnv::..,,:.v:::. ::::. i'•}:;::4}}:4:4;i:}}::i:::i;:;.}r.,:. � iv:}::.t;.'� rice pf`:`��>� � X •. ::%:• �ristira ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: Comb V' .}:•}:•}}:?:::::::::•:.t•?}•<<�:�::}::;a:..:•-�::::;•:to-•,.•}:::•:::::•}:%.;:. ....::.Y::. 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As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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. PP A licants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and Asa, supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe :€ ,gyp submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an +:. date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents- Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be retarhR*b the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. 'lye Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Offlce of lmlesugauOns 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . °FTHET°� Town of Barnstable Regulatory Services ■WSTABLE ' Thomas F.Geiler,Director v MASS. $' `bp f639;�a Building Division D MP Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW LL SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.Type of Work: �,p(,ky Cost V115,000 Address of Work: �,l\C�, SA Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 03 Da a Contractor Name Registration No. OR Date Owner's Name QIorms:homeaf day 1 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE V New Buildings,Additions $50.00 �G� O 6 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= 2-!� D a O x.0031= ?' ` plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031 plus from below(if applicable) GARAGES(attached&detached) - - square feet x$32/sq.ft.= x.0031= 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.0031= STAND ALONE PERMITS Open Porch x$30.00= (number). Deck A x$30.00= (number) Fireplace/Chimney x$25.00 r (number) Inground Swimming Pool $60.00 J Above Ground Swimming - r Ab g Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 7 �� Town of Barnstable Regulatory Services RAMSrABIMASM '$ Thomas F.Geiler,Director �ArFD MA'S� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, C-00..VCL4 x e--('c.e, ,as Owner of the subject property hereby authorize CkA`\ W Q-YA9—rqO Y\ to act on my behalf, in all matters relative to work authorized by this building permit application for: Lis- ' A rL o. pis (Address of Job) Signature of Owner Date Print Name A.WADL AC.r%n7ATDD DRD T ATCQTAWT .�fze �o�nv�rumcuecz�i a�...��a:s�ac�suaef,� � Board of Building Regulations and Standards �. HOME IMPROVEMENT CONTRACTOR d Registration: 140154 . Expiration 9%19/2005 I' . Type In . vidual RANDALL E HENDERSON RANDALL HENDE`RSOW = 55 BLUEROCK ROAD SO YARMOUTH, MA 02664 Administrator � � fie -Vanvrrca�ruuea.� ��✓ BOARD OF BUILDING. 0 License: CONSTRUCTION SUPERVISOR 3 Number "'CS 085255 Birthdate 'A,4130/1964 ` Expires.s 11/30120,06 Tr. no: 85255 Restricted 00 - RANDALL E HENDERSON _ 55 BLUEROCK RD; ( e I SOYARMOUTH, MA 02664,. Administrator Ixev f AAsa IA9Kg '��IyT�►��r -• New � � . . ._. . is%�- _ � 4 1- 7-4 Pt tzy► t�Nd�lx7-N Doi . . T P-w ---k-t,t S i. iS11 o cl U - etiw W i CA t'L T - % -Div raJ � �v��`j'Iq. i JCt�-fin i►i�`t-p _ . a„ !1 p �. +�.� — -- � td�F-FZTL� TT�P� tt W 2r%�I f-1115N1�G lo 2t . [% . . I . . .. . , oN nl.6l_L. 4 149 -L a 3- �l I✓i4 Z �� I q. z O Q D O ¢ - ic�u�l� (�� w Z LLJ ~ B n- ''a v MV — f I 32" ✓` ( I b. y^�3 z �— �r r O Q Z n ��,> — � � pr = �- w S I Y�tint� ��' �. - Iv INt1 chi A. 2 C1p � Wp ¢ � m 3 � w o o A ZI „ n W Q W � W {. C3)VRt)X CC WJQpQ !_— ¢u zut1aN t 11 .� ��o{ LLJ 44 Svil.f `1i.NlrlG �' \ }'- Z ?,� (� U W C'3 O W r 1 — NILu w w W W Ll1 �14-A t�tm yJ ..._ W z vs fi _ e 1 2V�L 3 (� `H ula}q-�/, , t� .6t1:1Ac,-"el y 5 S W C] O LL 2 CZ I— �.. . 2d Y --� C) W I U ii 2� 7. , q I Z y66 1 ��y �I gig q u rE r�k yid acU nL* DorrL__ . IJ 41 pco _ ¢ _ e� o� ram. s uT �Q1�_t�..�; NJ �y /y/ Y" r 'I I �,. Lll.. , vu(.-� 6CnLE: .:F4�-C7 APPROVED IT: DRAWN BY 00, G 2S-oEjjiNC y W a1 DATE: II Lien ,Yevr PIP IN 60 \ I I II UX(�1.I INGj �� --- G oFs�. 2 i o4c. •,ipJ �\ 2k10 I p � 20oF lµdL CtA I � � � `n� +�+, � � ¢�i Gin �OSH,�'-�•: v�'rcu�sr rL 13,rL i 13 2x 1 O BQ � ( I � • vp r(' ('ll'N/1DIImhMwI - 1 it4 4&?R- >L. Mpq�t� iv). , =Y2 ��Yv�px)���ING 4 pts_.,g0- CIsPr61 +�ov� ��'� •: >oi�ClOe4(��D G• ��DG� v�f 1.)k �o�>:s5'� . ' � r -rv,,rn`.� � •-�n�+F.�c�� - C-�A��(•o � oft G�'� �py��p ,, — vallN00o : k l)U4 07 —t Fok -- ?+Xds1b��o' c.•o . 2�c I o s eS i 411<o•o _ ';- - - — 7jtePf-sILL 12care- _.. G"�13ius �t -►9 W,ALr,-oVr I wAJ Z)KIP LA4r I I Nct+orLJ3 i �I - �r�ntia� '- I - vllmle— _ , ! ���p-�►��J�� Mt, t j� -�a , �` �; �r ► Ttc �n �c cz��Y�t l� �C�-c r -1 j 1ul -- �- 11 ►`1"' 'r l i ` scsE: s .(f ROVED BY: DRAWN BY. A►i 3 DATE: —ems_.+. .. � �• NUMeal vRN 4 x. c 'U. . REVISIONS: SOV� 5� NO. DATE DESC. o N — rn i — D Z N LOCUS INFORMATION j GO`'N0� CURRENT OWNER: DANA W. PIERCE — JORR�S 5 TITLE REFERENCE: BOOK 1440, PAGE 468 LOCUS PLAN REFERENCE: BOOK 56, PAGE 95 ASSESSORS MAP: 306 HYANNIS HARBOR PARCEL: 35 LOCUS MAP ZONING DISTRICT: RB I CERTIFY TO THE BEST OF MY NOT TO SCALE SETBACKS: FRONT 20' PROFESSIONAL KNOWLEDGE, INFORMATION SIDE 10' AND BELIEF THAT THE LOT CORNERS, REAR 10' DIMENSIONS AND SETBACKS TO THE MINIMUM LOT SIZE: 43,560 S.F. STRUCTURE AS DETERMINED BYINSTRUMENT SURVEY AND AS SHOWN ON OVERLAY DISTRICT: NOT IN A ZONE II THIS PLAN ARE CORRECT. C FEMA FLOOD ZONE "C" AS SHOWN ON COMMUNITY PANEL W ZONE DISTRICT: 250001 0006 D DATED 7/2/92 Q. 1 NOTE: BSC WAS UNABLE TO DETERMINE THE LOCATION OF THE SEWER LINE FROM THE HOUSE TO: THE SEWER LINE IN THE ROAD. 0 om PROFESSIONAL LAND SURVEYOR DATE LP CERTIFIED PLOT PLAN °sz- NORRIS STREET (2 ' WIDE) AT SMH °s #45 - - - - - - - - 90.00 _S79'1345"E-- - - - - - - - ---_. - - GG -�.-- NORRIS STREET O POST AND RAIL ti y4 FENCE IN EHH 3 N/F HYANNIS °y F DANA & CAROLYN PIERCE 00 MASSAC H U S ETTS ASSESSORS MAP 306 N w W M PARCEL 35 ►� (BARNSTABLE COUNTY) c� 6,119f S.F. r. cn `` _0 z'`� 3 w 3 Z o J (L �. STOOP o `� Oti OCTOBER 27. 2003 = Nw ; ZCLW o 4 37 rn 0 o Q N 32.6' �° N/F c~n cn a F 28.3' 3 OSCAR KWASNEK i Cl ASSESSORS MAP 306 v Q PARCEL 34, � EXISTING 5.0' oM' HOUSE ao N #45 5.0' ,. ' N 16.0' 9.5' EXISTING O PREPARED FOR: GqS b b GARAGE � RANDALL HENDERSON BULKHEAD �i 55 BLUE ROCK RD. GAS GAS S. YARMOUTH, MA 1 '�� 11.0' 02664 35.9' STOCKADE FENCE 90.03' N77-03-54"W 657 Main Street, Route 28 West Yarmouth, Massachusetts N/F 02673 SCOTT CARTWRIGHT 5W 778 8919 ASSESSORS MAP 306 PARCEL 30 © 2003 The BSC Group, Inc. SCALE: 1" =10' 0 1.25 2.5 5 MUM iiia 0 5 10 20 Fm PROJ. MGR.: CRAIG FIELD FIELD: D. GAZZOLO / J. MCCARTIN CALC./DESIGN: P. HAGIST DRAWN: P. HAGIST CHECK: CRAIG FIELD FILE: 8619-CPP.DWG DWG. NO: 5481-01 SHEET 1 OF 1 JOB. NO: 4-8619.00