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�� �,oZ��--- ���� �, a' ,` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ! Application Health Division Date Issued/Z-Z2-iL{ P+C.! Conservation Division_ Application Feet Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address N d YLTh l Village /Y�� Owner Z/Ri-1 (2 0cJN406N 7- T(fZF Address /00 (t-075 t4A11 , 5r t � A10 9-C"�1, " 1IZ0 1) ��1���:. 360A 14YAZsjlS r► r� C2� gaI Telephone Permit Request &1&4 W f'Yto',-r O wt'l o Fo y e-n tZ�od/-1 -- Tpt ok F' 71, 4 1ZffOtA •/,PP YO FT f F,9 TLS^rub 5##, 'nru!a 6 /z(5' ,QvA77r VP �TAilt-� 13kTu(L_)JM1 AVO jv(�u-, FLerCTAi4 PJa503oAN01Jirtf13 OM R�d�CCfs Square feet: 1 st floor: existing proposed v 2nd floor: existing propos.' 1 Total Jw Zoning District Flood Plain Groundwater Overlay Project Valuation 14b,O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach upportino'documentation. t4a Dwelling Type: Single Family AY Two Family ❑ Multi-Family (# units) , t.T Age of of Existing Structure- �v Historic House: ❑Yes YNo On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout &,*Other C A 49U GJ O Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) `(7 Number of Baths: Full: existing new Half: existing 1 new C7c 0 ('rare-V3 Number of Bedrooms: y existing _new Total Room Count (not including baths): existing _new 'Wl V First Floor Room Count s Heat Type and Fuel: gGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes C&No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L /IQ /�. �`'YN-6 41 Telephone Number Address 9 G kG5"Y `csr^' Aq License# C (r�,TMy (( Ut 14 A Home Improvement Contractor# Email Lv Worker's Compensation # 1-1Y c f.27 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ti TM V 7-nAtosfe�t SIGNATURE DATE / �/�8/L/ FOR OFFICIAL USE ONLY ` APPLICATION# DATE ISSUED MAP/PARCEL NO. R ADDRESS VILLAGE OWNER f DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING E DATECLQSED OUT AS 0CIATION PLAN NO. I a 4 r dY ' Hie Cammomt th of-Vassachuseffs Deparftneza offiddrrstrurlAccidents 600 ffia TFirigloa Street Boston,MA 0211I Wniv na-mgavIdiax Workers' Compensafi6nInsaranceAffidavit-BuEders/ContractarsMecEriciansMumhers Applicant Information Please Print Iej�ihly Name(13ttssnessl6Fganizdtion(ln>�vidnalJ: ���� 7141� Address: / i 0 iv,-r4 5 City/State/Zip: �5� Ir�1.iiS G"1 phonemec7Ud°- Am you an employer? Check the appropriate box: Type of "ect .r• 4. ❑ I=a dal contractor and I pTo l - L 0 I am a employer with cj 6- ❑Neu*won employees(full and/or part-me)* have hired the sub-con raciors 2_❑ I am a sole proprietor or partner- listed on the attached sheet 2- ❑Remodelmg r Thes-sub-contractors have S_ Demolition drip acid have no;employees ❑ employees working forme in any capacit�c �InSees and have wormers' 9_ ❑Building addition nr LN0"workers comp.iusu ae Gam-insuralFt�_1 5_❑ ale are a corporation and its 14.❑Electrical repairs or additions 3_❑ I am a homeowner doing all work ofEcers h;nm exercised their 1$-❑Plumbing repairs or additions Myself [No warkers'comp. right of ei m. fion per MGL 12❑%- of repairs inarranre required]1 c_152,§1(4),and webavoena employees-[No Workers, 13_❑Other comp-msarartm raquire-d-I *Any appT2t mT dust checks boa#1 nmst also fill out the section below shnwing rhea routes'compemsstnn PORU i fur:*+ztmiY T 13nmeowners who submit ffi.atfi v inmcatigg they ate doing alI rr& d then hae outside contractors mch- lautmcmrs dust check this box must attached an additional sheet shawirg then of the Pb-caaft3cb3n=d state whether oc not these en�have emplayees_ If toe nu camtmcturs base empIoyeps,they must provide their wars'comp.pahcy number I am an empJ.oyer that is proNidLug markers'congmrisa6on irm4rartca for eery ampioyees $eloty is the pa&cy au,dtob site Insurance Company Name: 1, (/)q Vk 0 Policy ff cr Self-ins-Lil-4k L �6 y Expiration.Date= ZL l`l f Job Site Address: k, V ILA " 5T , Cityr'5tawzip: A##ach a copy of the workers'compensation policy dediration page(sfmNring the policy number and expiration date). Failure to secure coverage as requiredunder SeL-ti0ai 25 A of MGL c- 152 can lead to the imposition of rriminal pm lties of a fine up to S1,500.00 and/or one yearimpd as well as civil penalties in the four of a STOP WORK ORDER-and a fine of up to S250.00 a day against the violator_ Be advised that a copy of this statement may be finwarded to the Office of Imrestigations of the DIA far insurance,coverage vrzrfication- I do hereby cetlt&under ilte}edxis andpenaTiies ofp�ury t3trrtfhe artjormafurn prat�riRd abode is true Land correct Sit3rature !� Date: Oil/ / Phone : ov OJEciat use only. Da not write in th&urea;fa bs co"mpieted by city or town of C&L City or'Fown-. PermitlT_iceme At Isiding Antlaority(circle one): 1.:Board of Ilealtfx 2.Buffd ng I?epartnieut Cityfl aRrr Clerk 4.Electrical Inspector,{.l'iumbmg Inspe for . 6:Other Contact Person: Phone-#: 6 r" 1 Informafion and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"___every person in the service of another under any contract of hire, express or implied, oral or written." An embfoyer is defined as"an individual,partnership,association,corporation or other Iegal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.'' MGL chapter 152, §25C(6)also states that."every state or IocaI licensing agency shaII 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 peiormance of public work until acceptable evidence of compliance Yith the insurance requirements of this chapter have been presented to the contracting authority.- Applicants Please fill out the workers' compensation a$davit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their ceniificaie(s)of insurance. Limited Liability Companies(1-LC)or Limited Liability Partnerships(LLP)with no ernaployees other than the members or pa-fners, are not required to carry workers' compensation insurance- Tr an LLC or LLP does have employees, a policy is required- Be advised that this affidavit may be submitted to the Deparu meat of Indusirial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit Zane affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Departnent of Industrial Accidents. Should you have any questions regarding the law or if you are required to oLtain a workers' compensation policy,please call the Department at the number listed below. Self=inured companies should enter their self-insurance license number on the appropriate line. City or Town Otftcia.Is 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 n11 out in the event the Office of Investgafions 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 add-acn,an applicant that must submit multiple pemd`Jlicense applications in any given year,need only submit one a-davit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write"all locations i1Z (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 mist be tilled 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 aThdavit 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` I?epaitaent of Ind al Aod&., is Office of kvestigatlGas 600 Washington Stet Boston,IAA 02111 Tel 9 617--727-4900 W 4-06 or 1-&77-1,L&S E Fax#617-727-7749 Revised 4-24-07 www-mass-govf&ia die Cfrn ompad*gfHasy*ehme#r 6 #Waste ©ir Street 7. stars,.MA 02 wecns.r ss:go r#-a WGrkers' Clt mpensafian Inset ante avit Builders/ h-acturs/Elec-t icianslPllunibers Aytplicmt Irifurmaticm Fleas&Frint Le.,-iW N G P, 7 i w A 1�x1 N Address. �' � � A k(s ,ityfstatxs, - Phons Amyan an employer?Check thcapprapriaf35bo= T o'ecE�r 1_El �Pto I am a employer with 4 [�I ain a gc� ❑New contractor and I TT Pe .of e d ���_ .� u�trincfrr_u� er slayees{full azrdforgatt#ime�* hav6hireatbe sub-eautmc rr= - ❑ I am a sole gropzir tar orparfner- listed on the attached shy �g ship and hate no employees These mb-contractors have S. ❑Demolition. Wodzng forme in any capadr r_ employees azld have wofkers' Q_ Building addition �rr o.ttrarl s'.camp_ ance comP "„,•"' $ El m7F I .. 5�•❑ We a a corporati�and its I0.❑Electrical repa= re or addiiians 3_❑ I am a homer doing aU work officers have e5rised th`W- I I.❑Piumbmg rep, =or additions tioa per MG myself [No warlrr:ca'� �of P_ • F F Imo❑Roof repairs msttrance required-]F c_15Z§1(4),and wehff.IenD employees [Noworkem' 13-0 4tiier comp_ins arante-raq=e& _. 'Any m,)pbRxzt that checks box Cum staLw fDI out the section,below showing iheirwa3cess' inffinnatian- Hlmeowne:N vcho smbmit his cai&-711 M =dzE ffiL�y ZM doing_II rah Mi tb—h_r-e ortside cantactarsmnst saIMit a sn-s�darit sndL -Cant�ena that rl�lr this b=nr=stlarhe3 m add r;anal shed showing the name of dm sub-mufrKiDa andstse uhetixr nrnat$msa Mrt6es have erngloyegs. Ifthe sntr{oidmdushave eniplgyeps�they Tti 7 pmuide teir wa kers'comp.p DUCT Il mber_ Lam as emj7kJy `thous prtrtfidiag irr mancs for trzy amploygcs. HeZcw is fha praFicy and,job sits irtfvrrrtQlian. Insl=mce CompmyName: Paficy 9 or Self-ias_Uc- Expiratiort.T]ate= job Site Address- V 'ki U r,TA 5 City1"5tatelTp: L� ry�✓15 A-, 14. Of 661 Attach a copy of the=vmrkers'compeusafion policy declaration page(showing the policy number xnd erpimtion date): _ Failure to sec:=-coverage as required under Section.25A ofMGL c- 152 can lead to the imposition ofrriminal penalties of a fine up to S1.5010D andfor one yearimpH-S ,as well as vital penalfies in the ftrTm-of a STOP WORK ORDER-and a fizzy of up to$250.OG a day against the.violator_ Be advised that a campy of this statement maybe forwarded to the Office of Investigations of the DIA fhr Tnvtrvsncz�coverage v=EEt.dtion- I da h er-ebl,certz,ff under-thepains penahges t fpeow '.tfiatfhrg b7m and correct Sisnature: �� Bate l'9 / Phone 'cW um anly. Do-n©t writes in fkis are2,fa ba completed by cif urtawvn afficiaL QEty or Tom PermtUcense# /smugA-ufhcri'ty(code One L Bam d of Health 2.Building D-Taxim.itut I CitpTawn O=k 4.Electrical Fnsgector S.Plumbbag Inspector - Coroi�ct>:_'ersaa: FlEo-nez� . • 6 JM arl 11 allU H3 Massachusc s G.eral Laws chapter 152 requires all employers to provide workers'compensation for their e�iiploye;m Purmautto this statute,an errp£oyee is defined as"._every person in the service of another under any contract ofhire, express or implied, oral or written.." . An anpLgyer is defined as ran individual,parinershig,associafim,corporation or other legal ratify, or any two or more of the foregoing engaged in a joint enterprise;and in udiugthe legal represent6ves of a deceased employer,-or the receiver or trustee of an individual,parmershig,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 eniploys persons to do maitrtenanm,construotion or repair work on such dwelling house or on the grounds or building appurtenant f e-reto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6 also stales that"every*state or local&tenting agency shall withhold fine issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwwcalth for any applicantwho has not produced acceptable evidence of compliance with the insurance.coverage required.r' Additionally, MGL chapter 152, §25C(7)states`Weither 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 in sr7rance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensafion affidavit completely,by checking the boxes that apply to)'GUT sifurtion and,if necessary,supply sub-CDntractbr(s)name(s), addresses)and phone number(s)along with their ceri_ficate(s) of insurance. Limn Liability Companies(LLC)or Limited Liability Partnerships(LLP)vrithno employees other than the members or partners,are not required to carry workers' compensation insurance. If as LLC or LLP does have employees;a policy is require;]_ Be,advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofias nce 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 Deponent of Industrial Accidents. Should you have any questions reg=diug the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured compani es should enter their self in.crnance license number on the appropriate line, City or Town Q," z. Plmse.be sure that the affidavit is complete:and printed legibly: The Deepartment 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 pemhit/lic(-,nse number which will be used as a reference number. In adds on,an applicant that must submit multiple pcunit/Emnse applications in.any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should writf,- ,'all locations in (city or town)."A copy of the affidavit that has been officially stomped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oa file for hither permits or.licenses. A new affidavit must be led out each year.Where a home owner or citzen is obtaining a license or permit not related to,any business or commercial Venture (Lt. a dog license or permit.;burin leaves etx.)said person is NOT rff_r to complete this ainda-yit The Office of Investigations would bite to thank you in advance for your cooperafion and should you have any questions, please do not hesitate to give tis a call. The Department's address,telephone and faxnunmber ; lh.�CommcL L� th of Massachu,&, t, D pajtmcmt GfIndustial.f oDid-eats - Q Wasbingtan S BagtonsMA 02111 TeI-A 61.7 727-4,90El i�z±4-0 C Qr,I-977-hEkSSAFE . Revised 4-24-07 FM A 6l?-` 27- 49 - i Town of Barnstable Regulatory Services I-RE rQty� Richard V.Scali,Director Building Division sAxxsTasLE Tom Perry,Building Commissioner �Q? . 200 Main Street, Hyannis,MA 02601 0. www.town.barnstable.ma.us Office: 508-862-4038 Fax_ 5087790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �'i JOB LOCATION: U tz/ n 15 T /Y f-A Y"N i S number street village L I A P-1 ti cl WYa 6 1,14 P s name home phone Y work phone— CURRENT MAILING ADDRFS S: -6 lot city/town state zip Cade 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. DEKNITION OFHOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner' shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 Deparbneut--inrmum inspection procedures rtquirementsand that he/she will comply with said procedures and requirements. Signatur of Homeown 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 repaired 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,RuIes &Regulations for Licensing Construction Supervisors,Section 2.1S) 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. QAWPFILES\FORNS\building permit forms\EXPRBSS.doc Revised 061313 �1HE Tpy Town of Barnstable Regulatory Services t - 9 ss iE r� � Richard V.Scali,Director 163;9.�6�yp 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by dais building permit application for: (Address of Job) ""'Pool fences and alanzls are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPERMIS SIOI\TP OOLS • \1 I eoassachUsetts r ,o;Bttiicti/7 Partment of P livenstrscti„p,, gtdations an. Ubiic Safety L e; cs-07 Aso, Stanga qs 29�PMO ,, 07g3 Cent,,,,, N _ 0-4632 yy SS Commis --W . 11 is 11% Sioner 1,61Zp�s � 7/air 4 a ..... _., see rs _,�"' n - 'z yn; f. .«.r',a, u' � `� .vws"Y a�•>..o. `, ` BER (�iIR� T�J4 iid1YWo +m v i nd. i ft Policy INSURANCE ` 1VorGUARD Insurance Corinpany-:A Stock Company ; 0 CtDt+9P>�,NYI:S. Policy tN ey Number. �Gu ;Renewal of HYWC427464 NCC1 No.[25844] Policy Infbemaition'Paige . ![I]Named Insured end•Mailing Address -Agency, Hyannis Travel Inn Limited Partnerih,ip p THiw.FAIRWAYACENC.Y . 16 North Street.._. . 63 Main St.5uite 5'r w Hyannis, MA•026:01 Bridge,w.ater, MA '02324 Agency erode: MAFAWA10 Federal Employer's ID q41 3258880 Insured is Limited Partner Risk ID Number 0000i5369 v 3 [2] Policy Period. , h _ ri5tfl Aprit'T_201"4`to Apri1.1, 2'015, 12:01AM,sta+idar `time i.tthe insureif;'s niailin address: 9 131 Coverage A. Workers'Compensation.Insurance -:Part One of this policy applies.to the Workers'.Cormpensation i. Law of the follow ing,states:,Massichusetts B. Employers Liability Insurance -Part Tvwo of this policy applies to'.w,ork in each-of the states listed ire ite ,[3]A.. The limits ofour'liability'uriderPartTwo are; Bodily Injury by:Accident,-each accident $500,000 1 Bodily Injury°by Disease -,each employee $500,000 i Bodily Injury by Disease -policy limi . $500,000 � r _ C. Other States Insurance -Part,Three of this policy applies to all states,except any state.listed in item [3)A. and the stags of North Dakota,Ohio,Washington,_andrNlyoming.. i _ i D. This policy includes these endorseroentseand schedules, I See Extension of Information Page -Schedule,of Forms [4] Premium. h The Premium Basis:and,,therefore,the premium will.be determined by our Manual''of_Rules, Classifications, Rates;-,and Rating Plans.. All required,information is subject to verification and change by audit. (Continued on,another page): MU Ph .* APR z Total Estimated Polllcy:Premium Total Surcharges/Assessments' $ Total Estimated Cost $ INTERNAL USE xx Page -1 - Information Page MGA :HYWC533438 WC 000001A Date :04/04/2014 MANOTE -16 South Alver Street=P.O. Box A-H•Wilkes-Barre, PA;18703-0020.www,guard.corn Application number. �7 Fee.............................................................................. Mae ` .,a� r� Building Inspectors Initials...................... II ��\ Date Issued......��...�...3.!..��...................................... Map/Parcel... . ................ ................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: / ter &?L ON, 6 0 NUMBER STRE T VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number Project cost$ �tf c . 00 Check one Residential Commercial 01 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: G � Date: '-°t'' TYPE OF WORK © Siding E-1 Windows (no header change)# 0 Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review IM Roof(not applying more than 1 layer of shingles) , Construction Debris will be going to C,�U lwS Pe" CONTRACTOR'S INFORMATION Contractor's name�!' 6/w P 5" -Home Improvement Contractors Registration(if applicable)# 9dr�0 4("2, (attach copy) Construction'Supervisor's License# 106 0 y 0 (attach copy) Email of Contractor • We COd(/)9 s�PIn L AD Sri Phone number 6T&116 9C 2. ALL PROPERTIES THAT HAVE STRUCTURES O1WR 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER..............................................:............s *For Tents'Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. 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/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a buildi g official's approval prior to issuance. Ilk The Commonwealth of Massachusetts : 4 Department of IndustrialAccidents — Office of Investigations ' 600 Washington Street , - Boston,MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): Address: 0�7� �l� A0117 City/State/Zip: Phone#: Are u an employer?Check the appropriate box: � 4. I am a. eneral contractor and I Type of project(required): 1.L� 1 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' $ 9. ❑Building addition [No workers'comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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. of repairs insurance required]t C. 152, §1(4),and we have no LL employees. [No workers' 13. Other DD�J 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 contactors 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 sife information. �C��� ` . Insurance Company Name: 22 of Policy_ #or Self-ins.Lic.#: ��012/ Expiration Date: 06 L0 3 Ll Job Site Address: City/State/Zip: G' ' 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$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerdJy under the pains and penalties o perjury that the information provided above is true and correct Signature: Date: Phone#: .513 tS tC 6 9 0/0 Z Official use only. Do not write in this area,to be completed by city or town official~ City or Town: Permit/License# Issuing Authority (circle one): 1`.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions U Massachusetts General!-Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statut4'm employee is defined as"...every person in the service of another under any contract of hire, express or implied, ora4r wraeti.." a) N entity,or an two or more d$s an' dividual partnership,association,corporation or other legal ty, y An employer is defiu� �P P of the foregoing eng�e*a' t enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of'0 194dnal,partnership,association or other legal entity,employing employees. However the owner of a dwelling h h not more than three apartments and who resides therein,or the occupant of the dwelling house of anofbe,¢wls employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or b�riild&9�p�""ant thereto shall not because of such employment be deemed to be an employer." o MGL chapter 152, §25t( 'aso N tes that"every state or local licensing agency shall withhold the issuance or renewal of a license oyVdi 4 t t6operate 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 numbers)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 cant'workers'compensation insurmce. If an LLC or LLP does have a be submitted to the Department of Industrial Be advised that this affidavit may P policy is required. employees,a po y 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 AcCddents. c"Ioi 14 you li2:'e any iTuccst=rega-rdimg tl,e laxxr nr if vmi are rflauired to obtain a wor erS 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice 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 Depmtmment,of Industrial Aeidents Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel.#617-7274900 ext 406 or 1-877-MASSAFF, Fax##6.17-727-7749 Revised 4-24-07 Wr.Mass,gov#d1a Val CAPE COD r Home lmprnvcment CAPE COD HOME IMPROVEMENT'T'" 27 MILL POND ROAD, WEST'YARMOUTH MA 02673 (617) 710.1001 ,(508) 469-0102 O'APECODINC@GMAIL.COM, WWW.RoOFCAPECOD.COM, www.FACEBo6K.COM/CAPECODHoME --- -- ---------------------------- -------------------------------------- ' PROPOSAL 01 .25.2019 To LIAM MONAGHAM LOCATION: 8 NORTH STR, HYANNIS WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION(APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 18 INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERT� AI_ NTEED SHINGLES.SHINGLES WILL 13E INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED. HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. 0 1- ftj CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS Y p - CAPE COD �A r �g �+pA Homc Improvement ^ j� ®� O® Lj O lYd 1 g r R®�G,lrl Nr'• ''M 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001 , (508) 469.0102 CAPECODINC@GMAIL.COM, WWW:RoOFCAPECOD.COM, WWW.FACEBOOK.COM/CAP_CODHOME - - ------------ -----��---=-----------------------------—--------------- CERTAINTEED LANDMARK SHINGLES 50 YEARS NON-PRORATED TRANSFERABLE WARRANTY LABOR AND MATERIALS: $4,350.00 DUMPSTER: $450.00 GRAND TOTAL: $4,800.00 CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY. THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION PAYMENT TERMS: +30%AT DEPOSIT; �1�I�Io-mod 300/b AT START; 40%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY i TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS,MOVING ALL PERSONAL OBJECTS, FURNITURE,ETC.FROM WORK AREA,WILL BE SUBJECT TO EXTRA CHARGE.IN THE EVENT OF ROT REPAIRS,ROOF REPAIRS OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION,WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. CAPE COD HOME IMPROVEMENT'rm WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE (PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME.IMPROVEMENTTm WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE;,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD 3E CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE.IN THE CASE OF ANY CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS CAPE COD Hon cImprovement GAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001 , (508) 469.0102 CAPECODINC@GMAIL.COM, WWW.RoOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENTTM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY,ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES, ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENT TM 'THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI"TONY"SIVITSKI A I'l n hot,� ACCEPTED BY SIGN- DATE _V 36 ACCEPTED BY Vi c", S N DATE 0 ` ''C) CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS Jl e Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M ssachusetts 02118 Home Improve tractorRegistration Type: Corporation CAPE COD HOME IMPROVEMENT,INC. V ' w Registration: 168043 27 MILL POND RD ^' Expiration: 12/06/2020 WEST YARMOUTH,MA 02673 W Update Address and Return Card. SCA 1 0 20M-05/17 .�'�',e �irrnzoirurc¢�1��✓//�a�sod�t'��cddv _ _... _..__ �-_ __._ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYFRE.1Corooration before the expiration date. If found return to: Rea*s�ti4J ., Expiration Office of Consumer Affairs and Business Regulation {��'¢_Bo-/7�12/06/2020 1000 Washington Street•Suite 710 ., CAPE COD H M =1M r€OVEMENT,INC. Boston,MA 02118 ANATOLI SIVIT�K "' -- 27 MILL POND \�_... WEST YARMOUTH,MA 02673 Not V�f9 without signature - Undersecretary - r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulat ons and standards t Constructionn� dperms r Specialty CSSL-106040 E. ire : 01400 ., ..} ANATOLI SIVITSKI ► ` -= . . - A. 27 MILL POND=RD R WEST YARMOUTH MA 02673 -4 , Commissioner �� TAkT5 rBaS7�YYYY4l, CERTIFICATE OF ILIA BILITY INSURANCE 1@91iy C@i!#T9FIGATTE tl�5 U 6V AS,� 88E5751l1R F It�F lt�+,Tlti ONL1d AN!O k OMRS �At'Y P�SHTS U'PID N THE CERTIIFI `M INCLOE I,THIS CE-RTIFI"TE @dam;$ NO*t AFiPi>lA1raATIVELY OA NIEGATWELY'AFAFNI), EXTERO ALTER{ " IaF CME E 0FOROEEG By THE F CIF, k�ELrl W, TIHIS GERTiFiCATE IZP O Ud UFBhNd<E 6] E NOT CONS"- -E d CONTIR OT' BEnVEEN THE t93LfANQ[NWI�BR�N- AAtYHOR—0 REp€tESLNTATNE OR PMMUCER.AN THE f ERnFII-AT€HOLDER, _ _ IwRO�. la Itle cblimu Is 1101der Is an ADOMONAL A-SURED.-me®ulli:7 L88)nwist be mddclrsgdy M SU13Rt AATI is WANED,elgp�efl 4®. krAr JaMw pro 6willUms of the 001kV.mitaln 9ipIkIft maV re+oaulrm an emdo eemird..19 statemimni On INS celillilgift dbeg Il4ttl COMW- Dams tO thu `uI ttft8be IsAW In Ueau ad such�odurBramr9nEW._ - - _ __ a. L,rnr,�SL�inff]Il� -- 4OWLIN &CIM-lt INSURANCE AGENCY °Mtge 36�Te1.7'5 itu"!G 1 �c 972, YF,tiNOL.."Rir _ _E; lar'b�tArrRr�pnRO; v RAre tA�S Crcbl9 fH6'IR�+r: 7k�,9GLde.R SNfijRANU,00 42397` HYPONNIS _ - Ip�UREU 1 IIhCA@. CAPE,OE)HOME WROVEMENT INC IFi9llRlA.rr__. _ � 27 MILL Polo MAC, fn�sr F COVERAGESIMSyR 2 � REVISION F �&B09 41D7 H �� M s To t TtP'Y THAT'THE POLICIES OFfU NG9 L E ®EOM h4vE BEEN S :Gp 3A TA-POLICY PS-uoCa IMCICFiTE+7 ajTlldllMs7 �"+ 3:ANY'fx ':i3R'stdEhlT.`TEq :?k 44 DTTls F:�1F ��1 r NTAaCT OR GTHEIk DC0UME JT VllH RESPF;rT ToMICH rc35_ G._=RT[P TE tAA'Y's€ ISSUF.0 OR MAY AERTIONj THE IIVSUA;6NCE AFF�CRIjt=7 Bl"r THE FOLICIQ,S pE9CEIT(3ED wee' )E{N t5:9u9.sCT-TO THE 'IERM7i`s. 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T v , r 4 ki - F gg r r 333 r _ r f ,-- ..- P t t- - g a A^ 8 North St, Hyan r 3a. 14 8 North St, Hyannis 12/10/14 I R EN OPPROM p Rl ' _ b t`� t o � _Jki A"N t RPE Tv r Ca� *oeo ,%cO M 4 _ -.. _. �- i { ji1 l r , C a J �l a' r s . a �f � n 4+gg a kF -' s, rth Sty n is 8 N� � _ 8- North St, Hyannis 12/10/14 4 n Ii u Northf14 Town of Barnstable Regulatory Services �FTHE Tp� f (a � -��,Itl;} P. o Thomas F.Geiler,Director f I sAxxSTABLE, )Building Division . f�`l t "� ®# Al'? lll; ,J y MASS. $ Tom Perry,Building Commissionera� � tb;q. ��'ATFo 39. 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us � J e Office: 508-862-4038 f Fax: 508-790-6230 Approved. Fee: — ]Permit#: HOME OCCUPATION REGISTRATION Date: Nacre: 1)1_74 , s-7 0 Phone#: 50OC " 9000 Address: O �D/4�h �{ // ��I!'I Village: Name of Business:---,UE' '� Gef� --- "f ype of Business: j��s'C/q�Di�l� Map/Lot(��� ..�. ------------ ------- INTENT: It is the intent of this section to allo,,v the residents of the Town of Barnstable to operate a hcinre occupation «2thin single Family chvellings,subject to the provisions of Section 44.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase iu noise or odor;no Visual alteration to the premises�vlrich Fvould suggest arrything other tli ui a residential use;no increase ii traffic above normal resicleutial volumes; and no increase iu air or groundwater pollution. After registration�Vitlr the Building Inspector,a customary lionie occupation sliall be permitted as of rightsci1iject to tine following conditions: • The actiNr4 is carried on by the permanent,resideit of a single family residential chvelliug Unit,located Nvithin - that dwelling unit.; Such use occupies no more than 400 squ<u-e feet of space. • There are no external alterations to'the chvelliug�vlricli are not customary iu residential buildings,and there is no outside evidence of such use. • No traffic 4vlll be generated in excess of normal residential volumes. • The use does not involve the production of oflensive noise,6bration,smoke, dust or either"particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of tonic or hazardous materials,,or flartimable or explosive materials, in excess-of normal household quantities.• • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation;and not«2thin the required front yard. • There is no exterior storage of display of_niaterials or equir>merit. • ,Tlrere are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton rapacity,and one hailer riot to exceed 20 feet iu length and not to exceed it tires,parked on the same lot containing the Customary Home Occupation. • No sigh shall be displayed indicating the Customary Honre Occupation. If the Customary Home Occupation is listed or.advertised as a business,the street address,shall not be included. • No person shall be employed in the Customary Home Occupation Who is'not a permanent resident of the chvelliug unit. I, the undersigned, I •ve read and agree mth the above restrictions for Illy home occupation I am registering. Applicant; Date: t tunieoc.doc Rev.01/3'Im YOU WISH TO OPEN A BUSINESS? For Your.information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are-available at the Town Clerk's Office, I"FL, 367 Main•Street, Hyannis, MA 02601 (Town Hall) _ } x � DATE: Fill in please: at APPLICANT'S YOUR NAME/S: ��c� SUO-Z 0 BUSINESS" YOUR HOME ADDRESS: S 220 6Z r S-F 1��l�nni.5 _ ¢3� g SDI 7 p� TELEPHONE # Home Telephone Number - NAME OF CORPORATION: ---� NAME OF NEW BUSINESS ��L �� lQ/�1 TYPE OF BUSINESS 5'C!4 ' IS THIS A HOME OCCUPATION? Q,.__YE NO ADDRESS OF BUSINESS fLi t,. /'Ii/inS MAP/PLIRCEL NUMBER 32- -(Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town.of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO.200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to-legally operate your business m , as own. 1. BUILDINGCOMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual ha5_be�e�?irrforme of/any permit requirements that pertain to this type`of businessRULES.AND F�EGULATIONS. FAILURE TO - kL�t/'vL t i i L1ZA4 Y'V�. ..- COMPLY MAY RESULT IN FINES."-..+ if Authorized Signature• COMMENTS: c, I c Iel iJ 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: - IMPORTANT MESSAGE For A.M. Day � Time P.M. M Of Phone' A--,O U 0 Z- FAQ( Area Code Number. Extension MOBILE Area Code Number Extension Telephoned. Returned your call 'RUSH Came to see you Please call - Special attention Wants to see you Will call again Caller on hold Message Signed UniversW`48023 �� �lai&o IN U.S.A. NOTES � Engineering Dept. (3rd floor) Map Parcel ®/ Permit# House# Date Issued 7: 1 �✓9 Bibb Fee 19 , BARNSTABLE• TOWN Off' BARNSTABLE �'E°�'�'�� Building Permit Application , PrFStreetress E /X�� Village y _VL ;g Owner 5 A" Address A O D Telephone '7 '71 Permit Request - -a i L i First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ O? e/0& Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) "! Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing lfNew--_ Half: Existing New No.of Bedrooms: Existing I�lew� Total Room Count(not includingbaths): Existing New First Floor Room Count Heat Type and Fuel: ❑,Gas ❑Oil ❑Electric ❑Other Central Air Yes-"-, No Fireplaces: Existing New � ❑ �e ❑ p g N Existing wood/coal stove ❑Yes ❑No JGarage: Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information j� Name 400cl2r 1�/ C7��—�- Telephone Number Address 27 64,P14 tfAfC H /1-0. License# OSTC, go Home Improvement Contractor# j f(o b fo Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y1_1 SIGNATURE DATE 7— /S' BUILDING PERMIT DENIED FO THE FOLLOWING REASON(S) oFTMe The Town of Barnstable • e�arernsc�l • - ��� Department of Health Safety and Environmental Services r�1"9. Building Division 367 Main Street,Hyannis MA 02601 ' Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: P—0 ,0 t' - Est.Cost Address of Work: X 1J vA 7+ 5T, #We IU A)/5 Owner's Name tJ,C,'1--4 4 A) / Date of Permit 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. g& Date Contractor Name Registration No. OR Date Owner's Name OME. IMPROVEMENT::'.CONTRACT0 S,� REGISTRATION oard of .Building ReguI tions `and Standards <" {' ` R One Ashburton!Place�... '+Roo.m a' r a Boston, Massachusetts :02108 ._of E HOME IMPROVEMENT-CONTRACTOR F Registration 116064r i � Expi,ration05/15/98Y e ,;�5 y `� ` 4� NONE'IMPROVEMENT CONTRACTOR TYR e k DBA ' F t ,Y "} Registration jjk%4 ;Type°" DBA. TYNDALL ROOFING' s Ezpirati0h O5/I5/98 ; ROBERT F : TYNDALL+ri 11//r 37 BRIAR � PATCH RD ' ':TYNDALL ROOFING OSTERVILLE " MA 026�5 ' !! ROBERT F. TYNDALL IAR PATCH RD JTMINiSTRnroR 'OSTERVILIE NA 02655 The Contntonivealth of?Massachusetts ;:.:- Department of Industrial Accidews l y 1 Office Of1,7Y9SUgaUons 6110 11 a.diington Street Boston.Afars. 02111 Workers' Compensation Insurance Affidavit Plc. �pplican reformation• _ .__^_ . �- 'tse PRINi'Igbi1v name' - locition- citv phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in-any capacity _ RE9�'TA�e"rr-'r*�1F7'.K7�.'!TRw�lC1i *+'""....i^."* ...�w!+l�*++""^,.,'�qT""'^' !n+r"�^'e!'.�'-e'."�{'e��_..r,.s•.� .. .�...+f w.r.. --:i .0 -_i=Lams.=.r:.�3�.•a�� - — c.:.��..�.. I am an emplover providing workers' compensation for my employees working on this job. company name: 'TyaJ ALL DDT /� G address: it U✓` 1 f�C L ft//-�. t� CP on '�'� insurnnee o. 7 � 'e-' lic •# WC f 31a2--?c 0 V3 7 Ol 5 .. I am a sole proprietor, era contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comp•tnv name: address: city phone#• insurance co poiiev# � +�e:.n.:: -:+yvr,_ _ '"ar^�- - - - -... .ti�!,rr:+.,....• .,s.:• �....;;?T4q:.e:.._,r .. _ .-�-rr----�- _..___..�.s=. ..__...:tea-.__ .�. - — - '�iia -� • - a.ar:a�a comimov n•tme• address- city phone#• insur-ince co rolicv# Attach additional sheet if necessa +�` �^t r'f'�' {•.= ��•.''."'"'" ""' s�"`�^"""»»�� _ .��:�ii.:.aa:as, r+�sAm51a•, -,.'e"...t`.yiSr�rt,..,�: :-•..we�..,a. Failure to secure coverage as required under Section 25A of A1GL 1.52 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andior one years'imprisonment as well as civil penalties in the form of a STOP NYORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the OMce of Investigations of the D1A for coverage verification. I do liereht certift•under the pains attd penalties of perjure•that the information provided above is true and correct. 00, Signature Date '7` /5' /4 Print name ,r !��i� � Phone# VV4 60 official use oniv do not write in this area to be completed by city or town official city or town: permit/license# rlBuilding Department Licensing Board 1]check if immediate response is required �Scicctmen•s Office []licalth Department contact person: phone#: r'IOthcr .e.o (revised 3,15 Pt.v Information and Instructions b� Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an einplovee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An etnph vcr is defined as an individual, partnership, association, corporation or other legal entity. or any two or m6rc the foregoing, engaged in a joint enterprise, and including the le-al 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 dwellino house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or on the urounds 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 ivho 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 j ublic wort: until acceptable evidence of compliance with the insurance requirements of this chapter ha. been presented to the contracting authority. , Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 cite 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 roivns 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. Pleas: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. • The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 The Town of-Barnstable - �' Department of Health, Safety and Environmental Services t�sxsraetx. ; Building Division &659. 367 Main Street,Hyannis MAY02601 Eb M(•'t�' l Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date. Name• 1, J t, /U A' C' S 1"6 Phone#• Address L�� cp Map/I,ot: Type of Business: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traf ik will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup track not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit, 1,the undersigned,have read and agree-with the above restrictions for my home occupation I am registering Applir�n • Date:-3/3/?;r 9 Hemeoc.doe I 0'