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0500 OLD COLONY ROAD
D ��C-�`� �O �� U � f:� �' r: T.i � �f _ I ',r ��� '� 1 'j �� F iI 1 V v \� � , . (� � s� . �_ � �S �1 I I M i `� i s ____�_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel CO-? ApplicatioMap n 4: Health Division Date Issued g 30 Conservation Division JY Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/ Hyannis Project Street Address 500 op LD C®%--o m v Village H yap o ts M R "Owner AQNS t A 13LE kouS iAn /` Q i K , Address Telbphone 509 '7 7 it - ola� Permit Request —R EPAa S"T . Roe-K 00 PRom run,09 . A k-m&30 E'iQT 12-s- A rAT- REpaa .1iMT . RoraaG Cs. . "s -DPkinmaE.D I;y (AA-Lreg. Ru -1njsoLhT#oo� 0 W i--Rr C F Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 600 Construction Type - Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: O existing ❑Wnew size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use r rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name IL- T- PO A Telephone Number 508- ya8--6Gya o Aran q Q.Ty I Address q6 yE1ZmcePCavfCr License# CSFA- 064AL15 ®Si Er2�1 rLtE Home Improvement Contractor# 1792 17 Email "Worker's Compensation # TOPWi DO A . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKENITO SIGNATURE DATE ;I Y- A6 FOR OFFICIAL USE ONLY APPLICATION # j°. DATE ISSUED it s MAP/ PARCEL NO. ADDRESS VILLAGE i i OWNER DATE OF INSPECTION: FOUNDATION FRAME `/ )G INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING d 1/1 Ell? DATE CLOSED OUT ASSOCIATION PLAN NO. I y 17ze Comaomvedd:nfMarsadr=ett - Deprrfrnewt gfrmfirsttialAccrdergg " - _— Ge of. jTvTS i9,di&=. 2 , 600 Washfrrgton J eet =-r Boston,-VA- 02HI • tvfvxs>:nlc�ssg��r�in � t '"rurkers' Campensafrenlnsm-anceAffidavit Builder-JCuntraacto-rs/EleddcianslPhunbers -. 3PHcamdIufmmafrQg Please print f,e�ily 'Nat7le(()jncmRcc!1tsnFGnri' rta3 l/�� [rt_t�M ✓ . 1"/94 �l Qi 1r � Address: 46 V EF 2 M F iL 50 Are you an employer?Checkthe appropriate bay Type of project(required),: am a geeral conmcor anc€I, El I am a employ�. I n ❑ tt 6: Ell+Te�v consi=ucfiau employees(full amdlor part time * have lvreZ the sub-conb adorn 119 I am a sole prRpxiexar orpartaw listed on the attach d sheet. 'i_ ❑Remodeling ; s • and have no em 1 ees. Mho sch-canfractom have�P P 9_ Demolition wod-ing forme iaany capacity. employees andhave woAmre DII71 9. �II addition ❑ g t [NO srari~tW comp_insurance comp,ivsuraIIt7e$ r' rewired] 5. ❑ We are a corporation and its 1 Q❑ElectIdCal repairs or adds,Eious officers have-eseressed tlseir 3_❑ Famafiomeo�nerdaiggalI orHc 1L0Plumbingrepaimoradditions ' M lual€[No workefs'om2p- t of exempfiou per MGL L y_ c.152 jIM aadwo�have no ElI oafrepaiss f nerrrarire required-]I ` • employeecc.[15Ta wcaikess' '13_❑'4tlicr�E 4 A� S�o RAC , cong_ins=.=segi ired:j a a` cep �a m F,aoz `AMYWucsxtdfistc5edcsbasrlma elsaSIlontth�seetFoabciawsUuhingiheawo�c�'c®pcesafiaapoycyiafo�scio� i #M.nxvwae=who sabsdt fhi€d5dnif%dlrxlmg tbay sze dain�s1Fwo¢ic sad tbeabuE at[5idar'+++r srenrcTtn�sa7o-mitanewaffid st indiaiia�SLiCJ7- fCaatmctoEr*%tchecYshis baxmast attached saaddiGnasl sheet shnvrmgYheaxzu of the sub cis mmd st ewlsether nraottbase entitieshs�e MP3a3zes.Zfthesub cautracEn�sIuveemPIvfttfie}'�stgmsddeth5r wor�r�s'tomp.gaIicgamatrer E Ian[all.edip4er tliatis prax irtg nnrlrers"camperesatiur[i�tsnrancafvr nz}*emp&a-ees Helo[v is thePaiicy,and fain site ir�fvrraa[ion - - ' lns ceCompaIIy Nam- r •Policy�A,or H-im.Lio.:g: l xpiratiouDate Jab Tife tlddtes CifylStafel ,Sg s Attach a oapy afthe warltere campensatianpolic£declaration page(shopping the policy number and expiration date). Failmm to secure coverage as.required.uncler Section 25A of MGL a.M can lead to fhe imlpositioa of rdmisial perialti s of a fine up $1l, t}0:�0�asjd+or,atse earimpfisogmeuty as well as civnl penalties is fiie fazm of a STOP` DRIK ORDELR and a frae ° of up to$250_00 a day against the violator. fie adsdsed ffi-at a copy of this statement may,be faraeuarded to the Office of Inwestrgations ofthe DIA for fns=nce cow wage%verificahoa ; I:do hereby candft,ria i s ar[dPs s afPedkt ,fi[attJ[e bzfarrnaiam[•Prm *d abate is hue and c°arrect 7 �i�afure_ 'Date: Q al use only. Da not[wife in fh s area to be cmil ad b artan-[a. � t ' } P� }'city ,�frczn , City or Town: Permit uense;g ; Ewing nfh-ority(drde one): L Board of Health. 2.&-uffXmg Department 3.[may town Glens.4 Eledrical hmpector 5.Piu[nbmg bspector 6.Other _ Contact Person: Ph-one#: r �"E Town of Barnstable Regulatory Services i Richard V.Scab,Director s63q. � yea Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyammis,MA 02601 www.town°barnstable.ma°ns Office: 508-862-403 8 Fax: 508-79M230 Property.Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property - hereby authorize 1 , 69i)r to act on my behalf in all matters relative to work authorized by this building pertnit application for. . (Ad (e of J b) **Pool fences,and alarms. are the responsibility of the applicant Pools e not to be filled or utilized before fence is installed and all final pections are performed and accepted. e of Owner Signature of Applicant ' L�(L111 1�-cPTp Print Name Print Name �Pt� Date QTORM&OWNERPERMISSIONMIS Shea, Sally From: William Rex <wrex@hyannisfire.org> Sent: Friday, August 26, 201611:16 AM To: Shea, Sally; Franey, Patrick Cc: Deputy Dean Melanson; Lt.John Cosmo Subject: 500 Old Colony Road We are all set with the building permit to repair sheet rock damage from the water leak at 500 Old Colony Road. Captain Bill Rex Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 508-775-1300 . 1 Qo Id y /� FR TIER Frontier Adjusters JUSTERS, 95 \ J.Logan&Associates Administrative Offices: 2 Alexandra Circle,Suite 100 Southborough,MA 01772 41 1 ST HEAT ,' ; Date Taken:7/27/2016 Taken By:Robin Marszalek, y Frontier Adjusters 42 20160727_124939 k _ °t $t Date Taken:7/27/2016 1 `' Taken By:Robin Marszalek, q v Frontier Adjusters x j 7 r d \d�\d3 cn rs c 2616-07-21-1042 7/'8/2016 Page:45 rn d; FRpTIER Frontier Adjusters STERS- I4ti7 a - \ J.Logan&Associates Administrative Offices: 2 Alexandra Circle,Suite 100 Southborough,MA 01772 3 REINSPEC 2ND LR Date Taken: 7/27/2016 °1 Taken By:Robin Marszalek, Frontier Adjusters x 4 fi N 8 a •�w L tfi * n Y A - t r 4 REINSPEC 2ND LR Date Taken:7/27/2016 Taken By:Robin Marszalek, z Frontier Adjusters u c a a t 4 i } M C) 2016-07-21-1042 7/ /2016 �%ge:26 c" M ��iecvn�n2mncueal��a�P/�laraac�ccveCll } S�achUse4iS earit3 cplr�licafet Office of Consumer Affairs&Business Regulation l �dard o'f 1,Iding ReguWi6ns a_M Stan-4�1 HOME IMPROVEMENT CONTRACTORS :� Registration '_''179717 Type: T o2ctruction..T rvisar l&2 Family F" - license CSFA-064245 . Expiratiocn 9 2048 Individual r rt c, WILLIAM J.FOGARTY kIf i � 1' W]ULL AMJ f 46 VERMEER WILLIAM FOGARTYIIF - - OST$RVII:LE NSA 46 VERMEER CT OSTERVILLE,MA02655` Undersecretary 10/28/201,fi Commissioner , i d a Y I Shea, Sally From: William Rex <wrex@hyannisfire.org> Sent: Friday, August 26, 2016 11:16 AM To: Shea, Sally; Franey, Patrick Cc: Deputy Dean Melanson; Lt.John Cosmo Subject: 500 Old Colony Road We are all set with the building permit to repair sheet rock damage from the water leak at 500 Old Colony Road. Captain Bill Rex Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 508-775-1300 r 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map w 2 Parcel Application # Health Division Date Issued Z-z " /S.- Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic+fi OKH _ Preservation / Hyannis Project Street Address Village I� U QJ, Q IS Owner NNS 10. _ Rb os I" P UT� Address L4 S uT�, HIwj a f's Telephone S-0 2s r7 7 I - 9 as a Permit Request P�a&Q o J 0_* d C2 CZ � --}-© Cy Q_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation q Y 7 6-- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure D Historic House: ❑Yes a No On Old King's Highway: ❑Yes OIN-o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _news Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c6al stove��❑Y ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ ex ting Dgew size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: m Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use -- _ - _ - -Proposed Use— APPLICANT Sp 1 ) INFORMATION�ILDER OR HOMEOWNER) \\ m�au� Name �0.O 5 r�X'Ija P Telephone Number 50$ 9 9 S- I �g Address J q q Glt -[-C3.Q�.�� �G� License # C,S O© 6� 4 3 Home Improvement Contractor# 63 r]S 7 Email Sp R 1Y11 �_ CMmM1j_1 _ Q QT Worker's Compensation # R w C 400 r7 0 0 9 `� 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ow�rn o Lk F, I SIGNATURE DATE I I a(o I I J FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. I ADDRESS VILLAGE i OWNER ' DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 14 GAS: ROUGH FINAL FINAL BUILDING .Fr . S DATE CLOSED OUT ASSOCIATION PLAN NO. t ne a,umnwnweaun uj �nss��austs�esw Deparbnent of IndushialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mas&gov/dip Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbiv Name(Business/organization ndividual): Sprinkle Home Improvement Address: 199 Bamstable Road City/State/Zip: H annis, MA 02601 Phone#: 508 775-1778 Ext.10 Are you an employer?Check the appropriate box: 4 Type of project(required): L MI am a employer with 10-12 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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. required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L[D Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL p 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have :mployees. If the sub-contractors have employem they must provide their workers'comp.policy number. l am m employer that is providtrtg workers'compensadon busirance for pry employees. Below is the policy and Job site informadon. [nsurance Company Name: A.I.M Mutual Insurance Co. Policy#or Self:ins.Lic.#:—B W y 6 6 rl Q4 q- 3 Expiration Date: 1/01/2014 Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number ancrexpiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fme 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 )f 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. l do hereby cer +u Spaks and penal of perjury that the Information provided above u true and correct .i Date: lone#: 508 775-1778 Ext. 10 O,ftUr use only. Do not write In this area,to be completed by city or town official. City or Town: PermWLicense# Inning Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• SPRIN-1 OP ID:DI 14Ct?RE7►' DATE(MWOWYYYY) ...- CERTIFICATE OF LIABILITY INSURANCE 12/23114 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 WANED,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 endorsemen s. PRODUCER Phone:508-775.6060 MaMEaC Bryden&Sullivan Ins Agency -- -- '�F�1� 88 Falmouth Road Fax.508-790-1414 PRONE ;^ t{AIC.Not: Hyannis,MA 02801 AooRELss. Kelley A.Sullivan _....:.._....._ INSURERS)AFFORDING COVERAGE NAIC/ _ INSURER A:Associated Industries of MA INStaIED Sprinkle Home improvement Inc. INSURERB: ..�_.. 199 Barnstable Rd Hyannis,MA 02601 INSURER C: W µ , INSURER D INSURER E INSURER F: r ✓-' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR I ���. E Y EXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY Uh TO isg R ire aw nce_L man w= F�OCCUR MEO EXP(Any one neon)_ S PERSONAL&ADV INJURY $ w..... m M .... ..............._..... ..._._ GENERAL.AGGREGATE $ GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S POLICY PR0. LOC $ AUTOMOBILE LIABILITY COMM 3WERTImm Ea P11 ANYAUTO BODILY INJURY(Porpamn) S ALL AUTOS AUTOS OWNED 1EDUU01 BODILY INJURY(Per accident) $ HIRED AUTOS ._ AUTOS NON-OWNED a 'dent)DAMAGE $ j UMBRELLA LIAR OCCUR � EACH OCCURRENCE E EXCESS LUIB CLAIMS-MADE, AGGREGATE S DED RETENTION S j WORMERS COMPENSATION WC STATU OTH• AND EMPLOYER$'LIABILITY TOR A ANY X- ,PROPRIETORWAIMERACUTIVE YIN AWC400700943 01/01115 01/01116 E.L.EACH ACCIDENT S 500.01 OFFLOERMEMBER EXCLUDED? N I A (Mandl"In NN) E.L.DISEASE-EA EMPLOYEE S 500,01 If yea.dasaibo undnr OES PrION Of OPERATIONS b0ow E.L.DISEASE-POLICY LIMIT j 500,01 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 181.Additional Remarks Schedule,it more spec*Is required) CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home improvement,Inc ACCORDANCE WITH THE POLICY PROVISIONS. Fax#508.775-1350 Margo Mack AUTHORIZED REPRESENTATIVE 199 Samstable Rd. Kelley&Sullivan AH)ffinnis,MA 02601 019884010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Con%tructiun Supervimor License: CS.p0�g3 � :, I90 LOB W BAIMTAM - r� Expiration Commissioner 10/081�0'16 . QQk00ErAQalrf.dQ NOifRR�Ri��AttIOD COt�EIylAGTOR .� Prlvate Cotporetlo- SRRBIKl,E HOME INC.INI11rlFT; 1858rlun Ubb Rd 11y0nnls,MA GY8E17 Undawn" i Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 M )of enclosed space. Failure to possess a current-edition of the Massachusetts State Building Code is cause for revocation of this license. For DIPS licensing information visit: www.Mass.Gov/DPS Limme or r ebb 1 Yafiid fW an o* bind o momillm dtile. [iti>h=d rdw te; a< A ft gaitdes to loll Plan-scab 5178 Beftno NA 62116 Not valid widow dg&stwe RAMIWAEM ,� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstobie.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder roe t G(lion -�( (� as Owner of the subject l P p rtY hereby authorize p i:� 11V'K -2 �rile M kb� 04 o ac on my behalf, in all matters relative to work authorized by this building permit application for: oo Q& C�Qm,� d, (Address of Job) S' atur o er Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESTORMS\building permit fonns\EXPRESS.doc - Revised 061313 O I r ,50�, TOWN OF BARNSTABLEBuilding. } �1HE ti Application Ref: 200904574 BARNSTASLE, * Issue Date: 10/08/09 Permit 9 MASS. �ArFO,39-�Al Applicant: Permit Number: B 20091940 Proposed Use: TAX EXEMPT HOUSING AUTH Expiration Date: 04/07/10 Location 500 OLD COLONY ROAD Zoning District HD Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 326027 Permit Fee$ 59.15 Contractor VAREIKA CONST.CO. Village HYANNIS App Fee$ 100.00 License Num 076563 Est Construction Cost$ 6,500 Remarks APPROVE ST BE RET NED ON JOB AND DECK REPAIRS: REMOVE&REPLACE FRAMING,DECKING AND THIS M ST BE PT POST UNTIL FINAL SIDING AS NEEDED IN CTION BEE ADE. ERE A C T ICAT OF OCC NCY I QUIRED,SUCH Owner on Record: BARNSTABLE HOUSING AUTHOR'Y BUIL NG ALL N BE CC IED UNTIL A FINAL Address: 146 SOUTH ST INSPE T N HAS B N MADE HYANNIS, MA 02601 Application Entered by: PR wilding.Permit Is ed B THIS PERMIT CONVEYS NO RIGHT TO OCCUPY A STRE ALLY OR SIDEW 0 ANY P RT THEREO ;EITHER TEMPORARILY OR PERMANENTLY'. ENCROACHEMENTS,ON PUBLIC PROPERTY,NOT PECIFIC LLYP ITTED HE ILDING CODE;MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH', D LOCA ,ON'OF LIC'SEWE A E OBTAINED FROM'THE DEPARTMENT,OF.PUBLIC,WORKS."* THE ISSUANCE OF THIS PERMIT DOES NOT,RELE, E THE PPLICAN ROM,THE C IONS OF ANY APPLICABLE SUBDIVISION;RESTRICTIONS u. ,.,: :,:< a MINIMUM OF FOUR CALL INSPECTIONS REQUI F ALL CON TRUCTION ORK: t` 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPE ED AT THE OAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTION TO BE CO ED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL EMBERS(REA TO LATH). 5.INSULATION. 6.FINAL INSPECTIO EFORE.00 Y. WHERE APPLICAB SEPA TE PERMI AR UIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL N PROCE UNTIL T SPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WI BEC E NUL AND OID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE P IT S ISSUE AS N ED ABOVE. PERSONS CONTRAC G WITH REGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). toR x rs ► p" ® ► o ® , a.; �x ,.s BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health ft �. S � C i 1 65 Z 1 71? r C UT i 5 U f 5 I S To P—.v1 I_A-))A)6-- t iJ rL TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,,, lvl "ap_99C�Qa? Parcel"" Applicatidh Health Division Date Issued la Conservation Division ------- Application Fee Planning:Dept. ,Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address 50 0 9>1 C-OLON Village tqo OA/1.5 Owner BAkO-SYA BL.0 Iq OLP.51 Al 6 ^U V+M V; 1914 S 3 T &(YAUM.5 11A 42(0/ Telephone O 2 3 a414A Je� a K e V PermitRequest llpck ItOPAlk__5 AS &)g-FA1t-6 . Square feet: 1 st floor: existing—proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay P(Plect Valuation Construction Type O'i Size Grandfathered: LJ Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family LJ Two Family Ll Multi-Family (# units) 11WAge of Existing Structure Historic House: Ll Yes LJ No On Old King's Highway: LJ Yes LJ No Basement Type: Ll Full LJ Crawl Q Walkout Ll Other Basement Finished Area (sq.ft.) Basement Unfinished AreAmft) E; ID- Number of Baths: Full: existing new Half: existing -:iqew >0 Number of Bedrooms: existing .new can Total Room Count (not including baths): existing new First Flo or R om Co110 lw 2Heat Type and Fuel: Ll Gas Ll Oil LJ Electric LJ Other Central Air: Ll Yes LJ No Fireplaces: Existing New Existing wood/co al stove: LJ Yes L1 No Detached garage: LJ existing U new size—Pool: LJ existing Ll new size Barn: Q existing LJ new size Attached garage: Q existing Ll new size —Shed: Ll existing Ll new size Other: Zoning Board of Appeals Authorization Ll Appeal # Recorded LJ Commercial L3 Yes LJ No If yes, site plan review# -C-urrent'Usd Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) geR_r VAkOk-A Nam�e VA (JkP) C-0AJ_S'T1t0<5TI&fJ /A/C-, Telephone Number Address Q_(!J WA L Addr 5T License #_C-!5 7 6 51 W. U-1 6 G9 WA)� . . NA &951�1 7 Home Improvement Contractor# Worker's Compensation # VtA 0) BALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A0, 5*VANTE WONAE 0 Ck"Tft/l t-7 A 0a 3 0 DATE SIGNATURE w 4 FOR OFFICIAL USE ONLY - APPLICATION# DATE ISSUED MAP/PARCEL NO. ; . ADDRESS VILLAGE :] r 'OWNER F a DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL i t 'GAS: ROUGH - FINAL t FINAL BUILDING DATE CLOSED OUT ', ASSOCIATION PLAN NO. r a The Commonwealth,of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston;MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Legibly Name(Business/Organiza6onandividual): t/A E f h-A C OA.r 46-t Address: a(q wAL v tT 51- 50 JTA -_ g City/State/Zip:W BRft ta)ATeR /yA P one.#: 5��'✓`8�j" ��� Are you an employer?Check the appropriate box: Type of project(required):. 1.�I am a employer with -1-5' 4. ❑ I am a general contractor and I - employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction ..2.❑ I am a sole proprietor or partner-' listed on the attached sheet. 7.. ❑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.$ 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.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other. comp.insurance required.] "Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: F i 2 1;M S 1VS /IV.SV R l9 AIC,E CD. Policy#or Self-ins. Lic.M 6('Gq 16 Expiration Date: �0-02©` 02©/O. Job Site Address:_SL90 010 COLC)Vy kb City/State/Zip: k1YANVlI7 17A. d>"0/ 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 certify under the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: / a3-C�I Phone#: 5 6 X` 9 8 3— 3272 ' [Other only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. + Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor.any of its political subdivisions shall . enter into any 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-contractors)name(s),-address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of,Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. hi addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone.and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigahons- 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia IKEr Town of Barnstablo Regulatory Services . K es � Thomas F.Geller,Director '°rEn 0, Building Division ' Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.m.q.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ,j{ , as Owner of the subject property hereby authorize �,Q,t �� �ij~ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of r ) Signature of r Date BARNSTABLE HOUSING AUTHORITY 146 SOUTH STREET HYANNIS,MA O26f1i Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable YH+e Regulatory Services tAxxsTAB . ; Thomas F.Geiler,Director 0.19. .•� Building Division Tom Perry,Building Commissioner 200 Mairi.Sireet,__Hyannis,MA.02601 vvww.to wn.b arnstabl e.ma.us Office: 509-962-403 8 Fax: 508-790-6230 . HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a.license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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_be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fu1ly 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 fom/certification for use in your community. Q:forms:homcexempt f � ; ���.y �'die -()omiawmusecz�i o�,/�aaaac`ivaetta ` ' K Board of Building Regulations and Standards Construction Supervisor License a{s License CS 76563 Expiration 1 211 812 0 0 Tr# 13006 S �k Restriction 0;0 ROBERT G VAREIKAr 86BEDFORDSTREET' LAKEVILLE,MA 02347 `- Commissioner ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE 20/20o PRODUCER (978)392-4S67 FAX (978)392-9696 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E. 1. Wells Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Regency Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 238 Littleton Road Westford, MA 01886 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Union Insurance (Acadia Group) Vareika Construction Co., Inc. INSURERB: Acadia Insurance 219 Walnut Street Suite B iNSURERc: Firemens Insurance Company W. Bridgewater, MA 02379 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR W01 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPA 0092 S64-16 06/20/2009 06/20/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITYDAMAGE TO RENTED $ 20,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ S,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFfl JET LOC AUTOMOBILE LIABILITY MAA 0092568-16 06/20/2009 06/20/2010 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 11000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ F1 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ S1000,000 X OCCUR CLAIMS MADE CUA0121032-IS 06/20/2009 06/20/2010 AGGREGATE $ S,000,000 B $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCA 0112029-16 06/20/2 9 06/20/2010 wCSTATU- FR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ S00,000 C ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ S00 000 N yes,describe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT 1$ 500 000 _DTHER CPA0092S64-16 06/20/2009 06/20/2010 $200,000 any one job site A tored Materials $200,000 temp off premises $200,000 property in transit DESCRIPTION OF OPERATIONS/LOCATIONS I VEHISLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 7202009 Barnstable tibusing Authority ins' listed as additional' insured with respect to General Liability here required by written contract. Except ,for 10 days for Non-Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL } 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Barnstable Housing Authority BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 146 South Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Paul Coffe /TMV ACORD 25(2001108) ©ACORD CORPORATION 1988, yvcac ) 5 )4 (� rzCi C U- b s —s ;c L � IST1z ry i � r` w � �Si S Tn 1-&)1A�)6— // ?Cr 5 tDrz p`A��_ r3TTU�.� (()DO 0 (27 u (L 1 �cJG j i)r r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 32� p2� �. f r Z Map Parcel ' t,: ;Application Health Division Date Issued Conservation Division :_.Application Fe ` Planning Dept. Permit Fee.I -00 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 50o COI b COLONY Village K)15 Owner" 121JS�'�Ll(31.� N�tS✓NG < IUTt�021Yy Address /y6 sOvY,y 5Y- ,�Yi4iyv� hq o.z60/ i Telephone S 0 g- 7 '7/' !Zia 3 Permit Request U-+t * AtSKWCiL p CiF C4AAt(3aARDS L D s'N0qdjI A J 91 Yki in, bEtkl Ne b Square-feet: 1st floor: � x�sting proposed 2nd floor: existing ; proposed Total new ZoningDistri - Flood Plain Groundwater Overlay Project-°Valuation i ©� Construction Type Lot Size } Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# - urrent-Use-- - — =-=_ - -- - - ProposedUse- -- - -- --�-- -- - -_ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 2. DART V Akt. lk)k Telephone Number �5�8' S8"3 3999 t/�F�2�II�/� Cc9Ns`r Vc�t� ice, Address V-11 W ALVc/r5- SY_ SOITC-A License 656 .3 • W 9 R_t b G rWAlre P t 1A 6a321 Home Improvement Contractor# Worker's Compensation # W CA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �ay C� DATE r ' FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL:. ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t 1 j ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): VACtOkACc9/V$�RVC�-ipn/ /N�i Address: 2(9 VAI ritl1 SI 0ullrt� 8 City/State/Zip: Wr;SY r1A Phone.#: 83" 3 71 01 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3_5 4. ❑ I am a general contractor and I employees(full and/or part-tim.e). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or parttter-' 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.$ 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.] t c. 152, §1(4),and we have no employees. [No workers' 13.©Other Qp 612 comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: V7 l 2 J tAj AJS /k)S tU 6?A N C C_0. Policy#or Self-ins.Lic.#: WCR ©� .�©�`? r/S� Expiration Date: Job Site Address: So(9 OID CBL &&.)q 2 D City/State/Zip: q'IANN!S . 76. ©a W 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: CIO Date: Phone#: 5-0 ti— .5 B 3-- -3 1 Official use.only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation'for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tiustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states`Neither the commonwealth nor any of its political subdivisions shall . enter into any 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-conti•actor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP doe's have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where'a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,tele.phone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigatlans. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ofVHME Town of Barnstable Regulatory Services . BARNSUB r e Thomas F.Geiler,Director En 9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstableana.us Office: 508-862-4038 'Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 4r as Owner of the subject property hereby authorize 1111miL to act on my behalf, in all matters relative to work authorized by this building pernut application for. D/ od (Address of J b) Si na of e Date BARNSTABLE HOUSING AUTH01M 146 SOUTH WEFT HYANNIS,MA 02601 Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:F0 RM S:O WNERPERM 1S S 10N Town of Barnstable oFIHE Regulatory Services RARNST.,RE : Thomas F.Geiler,Director HAIRS. � 059. . $ Building Division '°rfn�'I" • Tom Perry,Building Commissioner 200 Mairi.Street,_Hyannis,MA.02601 www.to wn.b arnstabl e.ma.us Office: 509-862-403 8 Fax: 508-790-6230 HO1tH;OWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A . person who constructs more than one home in a two-year period shall not be considered a homeowner. Such" "homeowner"shall submit to the Building.Official on a form acceptable to the Building Official,that he/she shall be t 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_be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. T Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or.larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section I09.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for him to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her nspormibilities,many communities require,as part of the permit application, that the homeowner certify that hclshe understands the iesponsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homcexempt Board of.Building Regulations and Standards Construction Supervisor License License':CS 76563 Expiration 12/18/2009 Tr# 13006 ` `Restriction 00 F.r ROBERT G VAREIKA 86 BEDFORD STREET 11Z w. e LAKEVILLE,-MA 02347 " ' Commissioner . - t 04/02/2009 15:52) 9783929696 EJ IWELLS INS PAGE 02/03 DATE(MWDDIYYYY) `A�CQMt CERTIFICATE OF LIABILITY INSURANCE 04/02/2009 PRODUCER (978)392-4S67 FAX (978)39Z-9596 THIS CERTIFICATE IS 193UED A5 A MATTER OF INFORMATION E. 7. Wells Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Regency Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 238 Littleton Road NAIC# Westford, MA 0188E IN5URER8 AFFORDING COVERAGE INSURED INSURERA: Union Insurance (Acadia Group) Vareika Construction Co., Inc. INSURERB.. Acadia Insurance 219 Walnut Street Suite B INSURERC. Firemens Insurance Company . W. Bridgewater, MA 02379 INSURER0: INSURER E: CQVERAGES R THE POLICY PERIOD INDICATED.NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FO 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERALLIADILIYY CPA 0092564-15 06/20/2008 06/20/2009 EACHOCCURRENCE $ 1,000 OO DAMAGE TO RENTED S 250,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED EXP(Any ona person) S S,OOO PERSONAL&ADV INJURY S 1 ODD,000 A 09NERALAGGREGATEE $ 2 000,000 PRODUCTS-COMPIOP AGG 1 2,OOO OO OEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JET LOC AUTOMOBILE LIABILITY MAA 0092568-15 06/20/2009 06/20/2009 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY S (Per person) A )( SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY g (Par accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ (Par eccldent) KGARAOX LIABILITY AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC S AUTO AUTO ONLY: AGG $ EACH OCCURRENCE $ 5,000,00 NMBRELLA LIABILITY S5000 000 CUR �cLAIMSMADE CUAo321032-14 06/20/2008 06/20/2009 AGGREGATE $ B $ DEDUCTIBLE $ RETENTION S WC STATU• OTH- WORKERS COMPENSATION AND WCA 0112029-15 06/20/2008 06/20/2009 X EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S SOD,000 C ANY PROPRIETORIPARTNERIEXECUTNE E.L.DISEASE•EA EMPLOYEE S 500,000 OFFICERMEMBER EXCLUDED') If yea,describe under. r E.L.DISEASE•POLICY LIMIT $ 500,000 SPECIAL PROVISIONS belowr OTHER CPA0092564-15 06/20/Z008 06/20/2009 $200,000 any one job site Stored Materials $200,000 temp off premises A $200,000 property in transit DESCRIPTION OF OPERATIONS!LOCA DNS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 40209 Colony House Kitchen Renovations. Except 10 days for non-payment of premium. CE811FICA-TE HOLDER CANC IN SHOULD ANY OF THE ABOVE 13MCRIGED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Barnstable Housing Authority BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 146 South Street OF ANY KIND UPON THR INSURER,ITS AGRNT9 OR REPRESENTATNEB• Hyannis , MA 02601 AUTHORIZED REPRESENTATIVE ,�—� Paul CoffeyNAM ®ACORD CORPORATION 1988 ACORD 26(2001103) I i CUT f x c 5 r-i; - Sb, s r5 TWISTS Tb �e-vtAA'iA)EA.)Z3-- s I I�YZ WALLS c{Z T 41— 51DYZ r2437-Tvz" L Ld 00 OIL) _ z. Hyannis Fire Department �Sjp8L1S"Fo 95 High School Road Extension rye .p Hyannis,Massachusetts 02601 Office of; Business : (508) 775-1300 1896 Deputy Chief Facsimile : (508) 778-6448 ' S Dean L. Melanson, Emergency : 911 May 24, 2007 Mr. David Hart Barnstable Housing Authority 500 Old Colony Road Hyannis, MA 02601 C'O'U, Re; Doors at 500 Old Colony Road �'' Dear Mr. Hart, �d Earlier this month we discussed your request to remove some of the doors in the common (Q� ._corridors at 500 Old Colony Road. The reason for the request relates to difficulties some of the occupants, specifically those in motorized wheel chairs, are having going through the doors, along with the damage they are causing. I have visited the site, reviewed the available codes from the time of building construction, and reviewed the available documentation in our property files. After review, I find that all common corridor doors are required by code. There is a change that could be made to improve the situation. The first floor atrium door closest to the trash room could be changed so that the hinge side is on the opposite wall. There is room to also widen this opening. These efforts could reduce the damage in this area. If this work is undertaken remember that The door will still have to open into the atrium, and the assembly will have to be constructed so that the corridor is still separated from the atrium. The building Commissioner would have to approve any changes before they are made. My site visit found many of the common area doors to be in a state of disrepair. Below I have outlined the specific common area door requirements. -All stairwell doors are required to be self closing and positive latching. r, -The trash chute room doors are also required to be self closing and positive latching, - The glass atrium smoke doors are required to be self closing. - The stairwell and atrium doors cannot be put on fire alarm activated hold open devices. TFey must always self close. ' Attached is a fist of doors and-their problems. I have identified the doors by the closesTocct ant room to assist YOU: m snn nlrl r;nlnnv Rrl_ nnor IRRIIP_.S P4-MAY-n7 Pane 1 of P:' Rm. 324, Stairwell Door sticks on the carpet and cannot be fully closed. Rm. 312, Trash Room, door drags on the floor and cannot be fully closed. ,Rm. 312, Atrium smoke door, The self closing hardware on this door has been over extended and now holds the door open. This door shall be self-closing. Rm. 312, Stairwell door in elevator atrium. This door has no self closing hardware. Rm. 300, Stairwell door does not self close and latch. Rm. 200, Stairwell door does not self close and latch. Rm. 212, Trash Room door does not self close. Door drags on the floor and can only be closed with difficulty. Rm. 212, Atrium smoke door, The self closing hardware on this doorhas been over extended and now holds the door open. This door shall be self-closing. Rm. 212 Stairwell door in elevator atrium. This door is difficult to open and does not swing fully open as the door sticks on the carpet in the stairwell. Rm. 225 Stairwell. The exit sign above the door is broken and has exposed electrical wires. This door does not self close fully and does not latch in the closed position. Rm. 117 Stairwell door has the self closing hardware removed, door does not fully close or latch. Remove the storage from under the stairs in this location. Rm. 100 Stairwell door does not self close or latch. Additionally, I found a 25 lb propane cylinder stored in the maintenance area while checking the status of the fire alarm and sprinkler systems. These cylinders cannot be stored in this building in any area, for any reason. During our phone conversation the following day you stated it would be removed to the exterior storage shed. As we discussed, I fully understand the cost issues involved in maintaining the doors in this building. I also understand that the building has settled causing many of the floor and door problems. The requirements listed above are the minimum life safety standards set for your building. Please contact the Fire Prevention office when corrections have been made so that we can perform a follow up inspection. Sincerely Dean L. Melanson, Deputy Fire Chief Hyannis Fire Department CC. T. Perry - Building Commissioner T. Lynch - BHA Fnn Old r.nlnnv RN. nnnr Issues,04-MAY-n7 Pane.P of.P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- P=4 Application # 13 Health:bivisio' n Date Issued Conservation Division "Appribati6h Fee Planning Dept. :Permit Fee 1 Date Definitive Plan Approved by Planning Board Historic OKH Preservation Hyannis Project Street Address Z)Lb C'01'o0y Village VA A)All .5 Owner SARV.,ftAgUi IMWW, AVIVORITY Address-/(/9 Souipj ST HYAMPAS f1A Telephone '7 Permit Request g tws igm-c.# 0,766 070g, A6,90 :Zlk) At al/ 02 1.2- �2ht:te:�e Square feet: 1 st floor: existing proposed 2nd floor: existing —proposed Total new Z6ning District Flood Plain Groundwater Overlay P Valuation s. -DE) Construction Type Lot Size Grandfathered: LJ Yes L3 No If yes, attach supporting documentation. Dwelling Type: Single Family .L] Two Family Ll Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes Ll No On Old King's Highway: Ll Yes U No I Basement Type: 0 Full LJ Crawl Ll Walkout LI Other Basement Finished Area(sq.ft.)- Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Iotal Room Count (not including baths): existing new First Floor Rolm Coug ,Heat Type and Fuel: Ll Gas LJ Oil Ll Electric Ll Other Central Air: Ll Yes L] No Fireplaces: Existing New Existing woo coal stove: U-,Yes Ll No Detached garage: Ll existing LJ new size—Pool: LJ existing U new size Barn: L3 xistinq,.Li new) size Attached garage: LJ existing Ll new size —Shed: LJ existing U new size Other: Zoning Board of Appeals Authorization U Appeal # Recorded L3 Commercial Ll Yes LJ No If yes, site plan review Current Use Proposed Use APPLICANT INFORMATION o,ot-t if 8 (BUILDER OR HOMEOWNER) Name VAR TAKA C00-S V (TWJ MO. Telephone Number Address 215 W&LOul- ST- _ License # 26-5'6 - Home Improvement Contractor# Worker's Compensation # WCA Of/a0al-/,5' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AL,L_ W1\f.*r6_ - Bk(!)( - 'K 0 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. s _. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT IIz ASSOCIATION PLAN NO. t } The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations' ' 600 Washington Street h Boston, MA 02111 •� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A 4 Please Print Legibly Name(Business/Organizationdlndividual): yAR j I KA. M0STIC,U (B'TJ 1 UC/ Address: 15 WALn/UY S 7 City/State/Zip:WEST- RI 2 Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.KI am a employer with 35- 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-tim.e).* have hired the sub-contractors .2.0 I am a sole proprietor or partner-' listed on the attached sheet. 7.. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me m any capacity. employees and have workers' 9. Building addition [No workers'-comp.insurance comp. insuraace.t required.) 5. We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t _ c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Icontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: YA2I M FA)S r A)$0 RANG 6 Cbkl PAU Policy#or Self-ins.Lic.#:QCA Expiration Date: ( -oUO-9 . Job Site Address: 9"UO ®L.b C6t.0/V y City/State/zip: 14yA IS5,r1A • .026ol 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 certify under the pains and p-e—nQalties of perjury that the information provided above is true and correct. Signature: (,-0, Date: g" ' i Phone#: Official use only. Do not write in this area,to he 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#: � K Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation'for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any 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-con6actor(s)name(s),-address(es)andphone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is completeand printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: _The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigatlans, 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617427-7749 Revised 11-22-06 www.rnass.gov/dia INE Town of Barnstable ' Regulatory Services . BA" rAMM KAS& $, Thomas F.Geiler,Director 'i°rEu &A 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 14A&k,�L "Q M` to act on my behalf, in all matters relative to work authorized by this building permit application for- Soo (Address of Job) Ckzj D ignature o er� Date BARNSTABLE HOUSING AUTHORITY 146 SOUTH STREET HYANNIS,MA 02601 SRA7 ARiR ��R�Y Print Name If Properly Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERFERMISSION . a Town of Barnstable �pF THE Tp�y Regulatory Services BARNST"LF- : Thomas F.Geiler,Director MAss � �65s� ,•� Building Division PrfD �s Tom Perry,Building Commissioner 200 Mairi.Street,__Hy s,MA_0.2601 www.town.barnstable.ma.us Office: 509-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units orless and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINTITON OF HOMEOWNTR 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 Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. Q:forms:homcexempt .-o"000"000,-l-----lll---� /� �3 �r Gffie "C�aninxo�uaed�o�� ai�ude� .i Board of Braiding Regulation§aqd Standards i i r Construction Supervisor License License:CS. 76563 Expiration 12/18/200§ Tr# 13006` _ ftestrictionfi Uw. r ROBERT.G VAREIKA s J 86 BEDFORD STR�ET� LAKEVILLE,MA 02347 Commissioner �' 04/02/2009 15:52 9783929696 EJ WELLS INS PAGE 02/03 ' DATE(MMIDD/YYYY) AC=. CERTIFICATE OF LIABILITY INSURANCE 04/02/2009 PRODUCER (978)392-4567 FAX (978)392-9596 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E. 7. Wells Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Regency Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 238 Littleton Road NAIC# Westford, MA 01886 INSURERS AFFORDING COVERAGE INSURED INSURERA: Union Insurance (Acadia Group) Vareika Construction Co., Inc. INSURERS: Acadia Insurance 2I9 Walnut Street Suite B INSURERC. Firemens Insurance Company W. Bridgewater, MA 02379 INSURER0: INSURER E: COVERAGES 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.AGGREGATE INSURANCE SHOWN MAY HAVE BEEN REDUCEDIDESCRIBED HEREIN IS BY PAID CLAIMS.SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH P INSR OD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY CPA 0092564-15 06/20/2008 06/20/2009 EACH OCCURRENCE 1.250,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MEO EXP(Any ona person) $ 5,000 PERSONAL&ADV INJURY $ 1 000,000 A GENERAL AGGREGATE S 2 000,000 PRODUCTS-COMPIOP AGG E 2,0001000 OEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JEC El LOC AUTOMOBILE LIABILITY MAA 0092568-15 06/20/2008 06/20/2009 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,00 ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) A X SCHEDULED AUTOS BODILY INJURY X HIRED AUTOS S (Par accident) VARA ON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GELIABILITY EA ACC S NY AUTO OTHER THAN AUTO ONLY: AGG $ EACH OCCURRENCE S 5,000,O0 SSIUMBRELLA LIABILITY s 5 000 CCUR �cLAtMstuwDE CUA012103Z-14 06/20/2008 06/20/2009 AGGREGATE S EDUCTIBLE S . ETENTION S TH- COMPENSATION AND WCA 0112029-15 06/20/2008 06/20/2009S'LIABILITYE.L.EACH ACCIDENT a 500,000 IETOR/PARTNER/EXECUTNE E.L.OISEASE•EA EMPLOYEE S 500,000 EMBER EXCLUDED?. ibe under E.L.DISEASE-POLICY LIMIT >I 500,000 SPECIAL PROVISIONS below OTHER CPA0092564-15 06/20/2008 06/20/z009 $200,000 any one job site Stored Materials $200,000 temp off premises A $200,000 property in .transit DESCRIPTION OF OPERATIONS/LOCATIDNS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 40209 Colony House Kitchen Renovations. `'Except 10 days for non-payment of premium. 0811FICATE HgLDER CANC LATION SHOULD ANY OF 714E A90VE OESCRIOED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Barnstable Housing Authority BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AOENT9 OR REPRESENTATIVES. 146 South Street Hyannis MA 02601 AUTHORIZED REPRESENTATIVE Paul Coffe NAM (� @ACORD CORPORATION 1988 ACORD 25(2001108) ' E TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION Map �- 2 Parcel �� Application# Q� Health Division +vi§"'' `�# lbi`RHSTA KE Conservation Division .w f Permit# Tax Collector Date Issued Zll02107 Treasurer '__._.."�_ ' ;4 , - Application Fee d 00 Planning Dept. Permit Fee `� �� to Date Definitive Plan Approved by Planning Board �Z— Historic-OKH Preservation/Hyannis Project Street Address S O D ©tb CO L OA-) N Village H YArOM S' Owner 23ARL)S'rAr6L,1 1'l001--/AI-6 Avl-M ok(Ty Address 146 6 5o()ri H tr OYAMAII s r/A 0,,z66l Telephone .SO 9- ')7/ - ? 2 ;L 3 Permit Request Re-1 1 c�o t Pl i' C:f TRH�►y -' l?r w�VT_5 S1� r✓`L L�i RIC�1L .l✓ PCP*Acg K 1 Tc.N610 F L ou R. "It 11- P�\J W'z 1 1 VC. 1A EN (�1 5. '100. a 1 , 10 203 . �lb 1`ctiGN t)y Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation !/ Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) 3f ti Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total'Room Count(not including baths):existing new First Floor Room Count s' Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name R ORE f 1,— VA2i?Ili to Telephone Number ���-5`�3- 3 9Tg Address 'z i, ZEhV6eh ST License# 176 5 6 3 -twe Ut i,1.E MA ©a-3 Y Home Improvement Contractor# Worker's Compensation# I VVC-A O 11 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AL,(, 5 AT C tVALTC SIGNATURE &t A DATE ( - 10 a R f FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED , { MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION x FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts. Department of Industrial Accidents - Office of Investigations b 600 Wkshington Street Boston,MA 02111• wl dOmmass.gov/dia ' Workers'-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Legibly Name(Business/Organizationadividual): Address: a 15 W A L, PJ uN- 's 5 U 16 Z✓ g City/State/Zip:Lei �Ri�r,N�Yl�:� M A. �399 Phone:#;_ �h`O$�g3-3 ��� • Are you an employer? Check the appropriate box: :Type of pioiect(required):, 1,ER I am a employer with 3 Q 4• ❑ I am a general contractor and I , have hired the sub-contractors 6. ❑New construction . 'employees(full and./or part-time).* • 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,$' required.] 5. ❑ We area corporation and its 10.❑•Blectrical repairs or additions '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.El Plumbing repairs or additions ' myself.[No workers'comp, right of exemption per MGL 12.❑Roof repairs . . insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer.that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: �:71P hAVS >ol/� CC) G V LJA-Sf-/- Policy#or Self-ins.Lic,#:\4 )C#C� 01 1 a d 21- Expiration Date: Job Site Address: °S6U ©Lb C.0L&70 y City/State/Zip: N'/AIViv/S '/'74 0,U6 Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as,required tinder 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 t1ie Office of Investigations of the IRA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. I ' Sienature: .V a.r. Date: 1 I 0 Phone.#: 5 U E.- u�-3- 3 S C/5 Official use only. Do not write in this area, to be completed by,city or town official City or Town: ' . Rermit/License# Issuing Authority(circle one): A.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not pro.duced,aeceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL ohapter.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 0f•co4ilaiice v�rithtkie 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-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law-or if you are required to obtain a workers,' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Towr<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 permiVUcense 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 fo any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Mmach=ds Bepartmeat of Mustrial Accidents • ' Offtce of Invesagotoiks 600 Washingtoli,Stmet BQstan1x MA 0.2111 - . TO, 617-727-490.0 ext 406 or 1477-M.ASSA.FE Fax 4 617-727-77-49 Revised 11-22-06 www.mass.gov/dia Town'of Barnstable R.egu.Iatory Services _ 8 Thomas F.Geller,Directorbum . Building Division Tom Farrp, Building CommUsiorter 200 Main Sheet. Hyannis,NIA 02601 ° ?fficb: 508-8b�4438 Pax: SOS 796-6230 4 Property Ownor Must Complete acid'Sign This Section If Using A Builder. y . ' t U Ononet orthe subjectpxopesty } to act on my a iu ail matters relative to work zutbatized by-this big p=it application for: kF L j�s/tf f�l• �lrJ ti C=. .�Z�L� e!/l61 C?i�d•Y.' 7�T ��/ti'�%'Y� i 01 s (Address of ob) A Signature of Owuez Date Q;�ORM6'dWN'f.RPER2vi5S5I0N BOARD OF BUILDING REGULATIONS , f License CONSTRUCTION SUPERVISOR . r Num ber CS g78583 �Expires 12/18/200'7 Tr no A 18411. CenQn#j tlo% p RestrictedAU00 w' ROBERT 66;BED0ORD t LAKEUILLE MA 023d7 `. Commissioner:.., �, F > L r Ff A DATE(WAVD(YYTT) ® CERTIFICATE OF LIABILITY INSURANCE 08/15/2006 PROOUCER (978)392-4567 FAX (978)39Z-9696 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E. 7. 'wells Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR t Regency Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 238 Littleton Road Westford, MA 01886 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Firemen's Insurance Co. of Wash. Vareika Construction - _ INSURERe: Acadia Insurance 219 Walnut Street INSURERC: W. Bridgewater, MA OZ379 INSUPMD: INSURER E; OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURO)NAMED ABOVE FOR THE POUCY PERIOD INDICATED.NOTWITHSTANDIN 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD*1 TYPE OF INSURANCE POLICY NUMBER POLICY eFP!(:T'iVE POUCY EXPIRATION LIMITS DATE(MMODMO GENERALLIAeruTT CPA 0092564 06/20/2006 06/20/ZO07 EACHOCCuRRENCE $ 1 000,0 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300.00 CLAIMS MADE D OCCUR MED EXP(Any one person) S 15 00 } A - _ PERSONAL A ADV INJURY $ 1,000 ; GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UAIrr APPLIES PER: PRODUCTS.COUP/OP AGG $ 2,000,000 POLICY X JJC-CT p LOC AUTOMOBILE LIABILITY MAA 009Z56810 06/20/2006 06/20/2007 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY S A X SCHEDULED AUTOS (Perperabn) X HIREDAUTOS BODILY INJURY 9 X NON-OWNED AUTOS (Pc 2t bdent) PROPEFITY DAMAGE $ (Per wdderd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY - _ EACH OCCURRENCE $ S,000,005 X OCCUR CLAIMS MADE CUA0121032 06/2Q/2006 06/20/2007 A=RROATS t 5,000,00 B $ DEDUCTIBLE _ $ RETENTION $ $ woRKF�scoMPENSAnoNAND WCA 0112029 06/20/20 06/20/2007 wCsLATU- OTH. ER EMPLOYERS•LIABILITY E.L.EACH ACCIDENT .S 500,00C A ANY PROPRIETOR/PARTNER/F ECUTIVE OFFICER/MEuBER EXCLUDED? E.L.DISEASE-EA EMPLOYEd$ 500,00( WAL PROVISIONS below deaWbe under EL.DISEASE-POLICY LIMIT $ 500 0 SPECI tored Materials CPA 009Z564 06/20/2006 06/20/2007 $200,000 any one job site A $200,000 temp off premises # $200,000 property in transit DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project: Ten kitchens renovations at 146 5outh.. 5t.- in Hyannis. CERTIFICATE HOLDER CANCELLAnON SHOULD ANY OF THE AeOVP OPSCRIBPD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY Barnstable Housing Authority 146 South Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Paul Coffey ACORD 25(2001/08) &ACORD CORPORATION 1988 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � VParcel Application# V v "SS Health Division Conservation Division Permit.# Tax Collector Date Issued Treasurer _Application Fee Planning Dept. ` ' Permit Fee �" 9 Date Definitive Plan Approved by Planning Board �L Historic-OKH Preservation/Hyannis Project Street Address 5 C>0 ©L b C-O LO N`' R t? Village H yAum s Owner RNR;*WLE i/omw 6 AUT /On I T y Address _ /4 G 500TH -5T Telephone 50'b 9/- 1.22.3 Permit Request Cl-K I T CU&IDS - R-EMVe7 f k67PLAcCC CA81 NE%rSt i=IOoizIV& PPOUT Cel[Luv6 + WALLS R-MLAc� '5nvK+F!6V(-87' , OL&G*rtzleA,I. 1-KI iC W R FLOM06 PAlor 6Ar-,kSP,,&5H EGeakICA ,. Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District n Flood Plain Groundwater Overlay Project Valuation ►g / Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths)�existing new first Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size t_ Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning 13oard-of Appeals-Authorization O=Appeal`#` Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name l/ IM -0 t W —T- N C• - Telephone Number �Ot3ER'L- AIt,�IK/a , , r Address License# C S 0176 S6 3 a 19 VALAAIT S 501Te B Home Improvement Contractor# 3LG IGl �4 C6 e �JUA DAM Worker's Compensation# VJC-A 0112.0..9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AtLL�- ST&u" fll STr QkocKm�? H 14 SIGNATURE e,- DATE r } FOR OFFICIAL USE ONLY' . P�RMIT NO. p DATE ISSUED 6` MAP/PARCEL NO. ADDRESS, VILLAGE s OWNER ga _ t DATE OF INSPECTION: FOUNDATION ; FRAME 'r. INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f r € 'GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r, 1 r y f `y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit., Builders/Contractors/Elects icians/Plulnbers Applicant Information Please Print Legibly V Naive (Business/organization/Individual): yAZZ.E-1 f(A CQU 51TW CYlDly )I)C, Address: Z19 AL A)UT SY Go 1 TO. R, City/State/Zip: B l b&FWAT-ER.HA 03397Phone#: S 0$�583- 3999 Are you an employer? Check the-appropriate box: Type of project(required): to er with 3 4. ❑ I am a genera contractor and I 1� a© I am � Y —� l 6. New construction employees(full and/or part-time).T have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.'$ ® Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working,for me in any capacity: workers' comp. insurance. 9, ❑ Budding addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LF❑ Plumbing repairs or, additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13:❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that cbeck this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. p,n/ Insurance Company Name: F 1 T a t 1 cN S my&y1nPCc c � W P�H.. Policy#or Self-ins.Lie. #: W C A ©11 a 0 2 9 Expiration Date: Job Site Address: 500 ftD COLOR y 2Oaa City/State/Zip: ALAll So M A. 09-60 J 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 tine 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 certify per under the pains andpenaldes ofperjury that the information provided above is true and correct • Sienature: R �0 V Date: - 2 t— d2006 { Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: P ermit/L!cense# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector I 6. Other Contact Iverson: Phone#: 3 i Town of Barnstable Regulatory Services + BARNSTABLE, v MASS. g Thomas F.Geller,Director i6;y. ♦0 639. ' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Ja n di-a- T Peyr Lf 6ff' rsi floc b(«ecJl°,as Owner of the property subject J hereby authorize ad2yzC6ak1 to act on my behalf, in all matters relative to work authorized by this building permit application for: 5-J 01d CaIm (Address of Job) ignature o Owner Date A.. M HOUSING AUTHORITY Print Name 14 SOUTH STREET ��� Ai�VIS,.Ndl102601 Q TORMS:O WNERPERMISSION i ACORt�, CERTIFICATE OF LIABILITY INSURANCE osi io6 PRODUCER (978)392-4567 FAX (978)392-9696 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E. ]. Wells Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Regency Park HOLDER.THIS CERTIFICATE DOES-NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 238 Littleton Road Westford, MA 01886 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Firemen's Insurance Co. of Wash. Vareika Construction INSURERS: Acadia Insurance 219 Walnut Street INSURER C: W. Bridgewater, MA 02379 INSURERD: INSURER E: ES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR5D NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR D TYPE OF INSURANCE POLICY NUMBER �►��'ePPeCTIVE POLICY EXPIRATION UNITS GENERAL LIABILITY CPA 0092 S64 06/20/2006 06/20/2007 EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILPIY DAMAGE TO RENTED $ 300.000 CLAIMS MADE D OCCUR MED EXP(Any one person) S 15 000 A PERSONAL&ADV INJURY $ 1,000 00 GENERAL AGGREGATE $ 2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG S 2,000,000 POLICY X PR LOC AUTOMOBILE uaealTY MAA 009256810 06/20/2006 06/20/2007 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY A X SCHEDULEDAUTOS (Per person) X HIREDAUTOS BODILY INJURY X $NON-OWNEDAUTOS (Per BCOdeAt) ----�� PROPERTY DAMAGE $ (Peracadent) OARAar LIA9I1-ITY AUTO ONLY-EA ACCIDENT $ ANY AUTO S OTH ACC ER THAN EA AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ S 00O OOO B ]( OCCUR FI CLAIMS MADE CUA0121032 06/240/2006 06/20/2007 AG4RECAT6 $ 5,000,000 $ DEDUCTIBLE RETENTION $ $ LA WORKERS COMPENSATION AND WCA 0112029 06/20/2006 06/20/2007 X WG STATU- oTH EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER%nCUTIVE E U EACH ACCIDENT S S00,000 OFFICEWM EXCLUDED? IryeS describe EL.DISEASE-EA EMPLOYE S 500,00( be under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ SOO,0O OTHCored Materials CPA 0092564 06/20/2006 06/20/2007 $2001,000 any one job site A $200,000 temp off premises $200,000 property in transit DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS rojett: Ten kitchens renovations at 146 South St. in Hyannis. ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A86W DFACRIEEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LER Barnstable Housing Authority BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY 146 South Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Paul Coffey ACORD 26(2001108) ©ACORD CORPORATION 1988 I , i ✓/ze V�oonnao?uuea` o�✓�czaaaclziide/�d '` " - BOARD OF BUILDING REGULATIONS # I License CONSTRUCTION SUPERVISOR CS 076563 a i I Expires �12/18/2007 Tr no 1.1841 stricted 00h, i � 4 ROBERT G VARE #I j 86 BEDFORD STREETG— LAKEVILLE, MA 02347 'Commissioner � Y s . i i'; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# B58G Health Division w po AD to Issued Conservation Division QF 7V10 Tax Collector ,�] I °�� � �� �t" 00 - Treasurer I Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address d n Village Owner FAKk6 6 A B1 E �Pu5/rt16 Aurno Address ,5_00 QL b COLCW Telephone Permit Request e5 1 LE dquaLr�re feggt: 1st floor: existing proposed 2nd floor: existing proposed Total new T C C&+ mien �T bn Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O 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) r" Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing. new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Cl Yes ❑ No- E�etached garage:Cl existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ _ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name L � � �V Telephone Number OFS 6$3 3J5 ? Address License# ©(9. D P_ SOL)TH A s'KflrV r7 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJECT WILL BETAKEN TO ktJ, RVAIEZ WAS�� SIGNATURE - DATE g 'S 0 FOR OFFICIAL USE ONLY i t 1 PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER k DATE OF INSPECTION:, FOUNDATION FRAME INSULATION 00, FIREF�L ACE ELECTRI AL: ROUGH FINAL PLUMBING: ROUGH : FINAL GAS: ROUGH FINAL r FINAL BUILDING DATEaCLOSED OUT-y+-_ ASSOCIATION PLAN NO. .. 11, 1'rcH e7tiS 9. o Sq 'Feer Y E r i COMMERCIAL.BUILDING PERNIIT FEES APPLICATION FEE New Buildings,Additions $150.00 Alterations/Renovations $100.00 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0081= ALTERATIONS%RENOVATIONS OF EXISTING SPACE square feet X$96/sq.foot= X.0081= STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0081 Commprojcost Rev:063004 Town of Barnstable �- �� Regulatory Services R t sn�tsrt►st�, ; T.homas F.Geiler,Direetor1 4 Building Division TomPerry, Building Commissioner 200 Maier Street, IiYmais,MA 02601 , www.iown barustable;ma.us Office: 508-862-4038 Fax: 508 790-6230. Property Owner Must Complete and Sign This Section If Using A Builder I o as Owner of the subject property 'hereby authorize to-act on my behalf, in all rr[Atters relative to work authorized bytU building permit application for DD Rd 6l a� -a,")rl, CAcl*di of Job} . 4s, ur er Date / if c V kOUSINQ AUTHORITY Print Name M SOUTH STREET WANNIS, MA 02601 o�j 77 r/aaa_ a // o } Y�ft� CJOryIt/h249tU/ � '"^"LiIGP. t „' BOARD OF BUILDING REGULATIONS �F x License: CONSTRUCTION SUPERVISOR n Number CS 065021 ' x r z 08/14/ Tr.no 36`:0 Expires, Restricted 00 MICHAEL J 12 BEATTY S1.EASTON tMA 02375 •Comnilssioner AKRO ASSOCIATES ARCHITECTS V 10 Barnstable Road, Suite 102, Hyannis, Massachusetts 02601 : 508-778-6060 FAX: 508-778-2558 3 August, 2005 TO: BARNSTABLE BUILDING DEPARTMENT PROJECT: RENOVATIONS AND ALTERATIONS TO COLONY HOUSE OFFICE AREAS AND ACCESSIBLE KITCHENS PROJECT LOCATION: 146 South Street, Hyannis, MA 02601 OWNER: THE BARNSTABLE HOUSING AUTHORITY CONSTRUCTION CONTROL AFFIDAVIT In accordance with Section 116.0 of the Massachusetts State Building Code, I, Alice L. Oberdorf, Registration Number 5732, being a registered Architect in the Commonwealth of Massachusetts, hereby certify that I have prepared the plans and specifications for the above referenced project, and that to the best of my knowledge such plans and specifications meet the applicable provisions of the Massachusetts State Building Code. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that, generally, the work is proceeding in accordance with the documents approved for the building permit. Very truly yours, AKRO ASSOCIATES ARCHITECTS C4 Alice L. Oberdorf, RA � Q wo sra HVANaps, v I � 77 e HYANIVIS FIRE DEPARTMENT � rs 9.5.HIGH-SCHOOL RD. EXT. HYANNIS, MA.02601 StEv HAROLD S. BRUNELLE, CHIEF �"E,pF"pntEr� . - fTUUEMT AWApENEff OFTIRE EOVGT/0N 19IRE PREVENTION BUREAU BUSINESS PHONE:(508)775-1300 FACSIMILE PHONE: (508)778-6448 LT.!)ON-ALD I-1. CHASE,JR., CFl LT. ERIC F.MJBLER, CFI FIRE PREVFNTION.OFFICER. FIRE PIZEVEN'I'ION OFFICER BUILDING . CODE COMPLIANCE FORM THIS FIRE PREVENTION BUREAU.HAS REVIEWED THE PLANS DATED, 4 FOR THE PROPERTY. LOCATED AT _ ALSO.KNOWN AS: D — THE .CHART BELOW INDICATES: THE STATUS OF OUR REVIEW: TYPE OF CbNSTRUCTION DZ7CUMENT NJA RECEIVEDREVIEWED COMPLIES, 14gRRATIVE:DEPORT 2.FtRELGHTING!IESCUE_ACCESS: . : 3 NYDRAN? O.CATION/WATER SUPPLY 4_SPRINKLER'SYS_TE1S S.;SPRINKLER.CONTROL EQUIPMENT 6 STANDFIIPE SYSTEMS T STANI3PIPE;VAt�VE LOCATIbNS 8 FIRE DEPARTMENT..CONNEGTION :9=FIRE PROTECTIVE 3lCNALiNG SYST 10=F P. .$ &ANNUNCIATOR LOCATION 11=SMOKE CONTROL./EXHAUST- 1 2-SMOKE CONTROL.ECaUIP LOCATION 13=LIFE SAFETY SYSTEM FEATURES 14;FIRE.EXTINGUISHING SYSTEMS 15- F E S.CONTROL.EQUIP LOCATION 16-FIRE PROTECTION ROOPhS 17 FIRE PROTECTION EQUIP 51GNAGE ---' - 1£3.-ALARM TRANSMI5SIN METHOD' 1.9=SEQUENCE CIF OPERATION REPORT'. 20-ACCEPTANCE TESTING CRITERIA WE BE EVE T DOCUMENTS T T AND.COMPLIANT FOR THE ISSUANCE OF A BUILDING PERMIT. WE HAVE COMPLETED THE: CEP CE ES ING FOR THE OCCUPANCY PERMIT AND BELIEVE THAT WITHIN THE SCOPE OF THE BUILDING PERMIT,THE AB E ISS ARE IN COMPLIANCE. j C { .P �A te :*.�,+.A,�-xl-�'s.sti . P -s,. r t `• -, �3Trr t-{�aa w��'�y'k�n'E i,.�s�+, m_. . E, _:. g,..,....,-.,:s»_1 .:.>...azsu -#»..i�`.3& - ` .:�i�r.�.rn`:,�..c�',3�4r,n.�a,� , c ,y t ^:'.- - •' ..' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a{ r` Map n t!� Parcel t Permit# � Health Division Date Issued Conservation Division Application Fee :��-00 Tax Collector ��/ Permit Fee f 00 Treasurer A ,1� Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address S OO 0 L.J 6G1 ® /d/l!�. 12- Village Y/$A,,/V i .S r Owner Bd1UV JT14ALG Hoy,,-/ry,' jgU79 VTfy4ddress lqi� 45'aCsI'P rS r Telephone Le SC 7 '71 - r Permit Request u1 !/Z_<, ® ot- Svc `apt., 57 L f,C-7-4 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �'�Q,000 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: V Full D-Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# ` Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name _5 ioA T/o w Telephone Number _ o 74 a Address,2. )9^19( 1 C>. 4Z fly License# .Sa. O f'w/V/S "a 0,�2,eolO Home Improvement Contractor# 1.2 �a- Worker's Compensation# C/o71,3),o Zf ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Yft-Mor,)z;y SIGNATURE �� ?���✓j` DATE i FOR OFFICIAL USE ONLY 1 PERMIT NO. DxrE ISSUED " F MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION ; FRAME /'�f/�'il'! /t ��? �s/a SIG Y INSULATION 61,v-c v D fc Z�,� 1� r FIREPLACE I ELECTRICAL: ROUGH FINAL` 3 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING iT - • - DATE CLOSED OUT ASSOCIATION•PLAN NO. - The Commonwealth of Massachusetts F5 -- Department of Industrial Accidents _� Ise Bl�r�sd®ad�a 600 Washington Street Boston,Mass. 02111 Workers'.ComiDensation.,Insurance Affidavit-General Businesses - Sim e. address �2 •��'/�l u�� �1� V✓ �' � state ziv !� �L� yhone# work site location(full addressl' • ❑ I am'a sole proprietor and have no one Business Type: ❑ ❑Retail RestaurantBar/Eatmg Establishment working in any capacity. ❑ Office 0 Sales(including Real Estate,Autos etc.)' ❑I am an employer with em to ees(full& art time) ElOther %%//%%%%%sr,�,P, p/ � am an employer providing workers' compensation for my employees working on this job.: . . coniUhnVname:IT7 �'� Z:•' �.�1f41_�.J�•Gi�✓ c� 1,,;:(b• .. ..^ AA sdiires �'f i/-® .;:: :'•:tip::;'• . 'LJ t; • fit•' . / " IT I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: : con an name• "' `' address:. tifion e;: city 'Ul con anY name _ is address:. . :: :.' .•. ; .: .. ' :phone# - - Clty yt f a.' G:P J:.,.. '., ]nsuranc. _o. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a ilne up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that g copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains andponnalties ofperjury that the information provided above is true and correct Signature Date ^0.3 Print name Phone v official use only do not write in this area to be completed by city or town official city or town: permitllicense# 7C71tment •. dcheck if immediate response is required icement ,contact person: phone#; (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. employees. 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 ajoint enferprise, 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 i52 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 untie acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address and phone numbers along with a certificate of insurance 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 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 regardin'ft"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 perrrioicense number which will b�e used as a reference number. The.affidavits maybe 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 011n of Imsnuatlens 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $100.00 Alterations/Renovations $50.00 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq. foot= x.0061= ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet X$96/sq.foot= S Q• D O e X.0061= l S• O STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X .0061 Commprojeost °F�x�ro�ti Town of Barnstable Regulatory Services 's sa MSS Thomas F.Geiler,Director 9�P 165 Building Division - TfD h� . Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder the Subject to e hereby authorize, ���< ��� �`�- '°`—b to°act bn my..behalf,. is ali mattets xdzdve to work authorize—by-this building.pe=-A-application=for. (Addtess of ob) #=:!� Signatate of ovine Date print Name F - n V MLR-03-2004 12137 ROGERS & GRAYICOMM LINES 15003980246 P.01/02 1 n •32193 FfALi2E t FAAL'���� CERTIFICATE CIF LIABILITY INSURA VCE PATEIMMIDDfYYYY) CER03103lO4 are do Gray Ins.Agency,Ina THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 434 Route 134 HOLDER T HIS CE TIIPI ATE DRS NO RIG OES NOT AMEND UPON THE TIFICATE EXTEND OR P.0.Box 1601 ALTER T146 COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02880.1001 INBURED INSURERS AFFORDING COVERAGE WC# Whalen Rsstoratlen Services Inc INSURERA., Arbella proteclion Cc 22 American Way INSURER e: Arb; a Mutual Insurance Company South Dennis,MA 02860 INSURERO: INSURER D: GOVERAGES INSURER E; THS POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISBUED TO THE INSURED NAMED AE1QVE FOR TH9 POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTWER DOCUMENT WITH RSSPJCT TO WHICH THIS=RTIFICAT7a MAYBE ISSLEC OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES OESCRIDED HEREIN N5 SUBJECT To ALL THE TERMS,EXCLUSIONS AND CONDITION$OF SUCH POLICIES,AGGREQATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER OLICY EFF2 E FOLIC XP A N A GENERAL LIABILITY X COMMERCIAL CiENERpI LIABILITY 8500024585 LNAT$ 04/01/03 04101104 EACH OCCURRENCE $1 000 000 AUG TO CLAIMS MADG ® DENT OCCUR R5NJI ED $10C 000 MED EXP(Any tlrm paraan) $$,COO __ PERSONAL,d ADV INJURY $1,000,0110 GEN'LAGGRE GATE UMITAPPUESPER; GENERALAGGREGAye $2000000 PC LOC PROOUCTe.COMPfOPAGG S2 O00 QQO A AUTOMOBILE LIABILITY 74017400001 09/25/03 09126/04 ANYAUTO lE COMBINED IN9ont) LELIMIT t1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY eINJURY 6 X HIRIO AUTOS NON.OWNED AUTOS BODILY INJURY ' (Puf BCCItl9rtt) � PROPERTYDAM.43E S ' (Pm+ucW�rrtl GE LIABILITY ANY AUTO AUTO ONLY-PARCCIOENT OTMEg7MAN EA ACC $ AUTO NLY; pGG A l7iCESB1UMBRELLA LABILITY 4fi000215r38 $ 04J01/08 04/01/04 6AOFIOCCURRENCE $1 00 X OCCUR E CLAIMS MADE ' REBATE $1.000 000 DEDUCTIBLE $ X R ION 10000 $ . B WORKORB COMPEN15ATION AND 90913ZD403 04/01103 0 9 -- eMPLOTEW LABILITY 4101/04 We ATU- OTN- ANYCER)Z IETORIPARTNERIEXECUTIVE OPAFICERa1pAMdEEMBER EXCLUDED? ESL.EACH IDENT 3500000 S EedIAL PtlLBJISIONS law G.L.DISEASE•EA EMPLOYEE $600 Q OTHER E.L.DISEASE-PCLICY LIMIT 9500 000 PE$CRIPTiON OR DPEAATIDN$I L4CATION$1VEHICLS$I EXCLUSIONS ADDED BY ENDORSEMENT ISPECIAL PROMMON8 CENT E HGLOER CANCELLATION THE Y OF THE ABOVE DBSCRIBEC POLICIES B2 CANCELLED 6EFORC THEFJLPIRATION Barnstable Housing Authority OF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3DO Old Colony Road �_ DAYS WRITTEN OCATIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO p0 SO SHALL Hyannle,MA 02001 oeuc�j aa^^ ITS AOCNTS ORATIVSg. , AUTHORIi60 REPRE$LNT IV ACORD 25(s001J8Bj 1 of 2 #8640 ey. CAR . ©ACORI7 CORPORAT1QId 1988 f i 1 Oro, x, soARDoF�fBuiLDINGRGULAnoNs c�n�� ClJNSTRUGTION,SUPERVISOR �Nuym sber C����•'fj�0 ki; ' fmgplre�s Tr no ; d key r a x* WIL IAM�WHAUE ' G } 122 PONDrdS TREE7 �BREWSTER, AilA02631 3,. R` � in m, Administrators' ��� �� 97 , .4 1 .. .`zI -4�.. f ,. .rx s,(/�/ `. L4%d(I/EISUIL O�✓# GLI.I4ff.� *.� . BoardotBJuildiogFl�g'ua�latloss udkStasdards_, � 5 = .� k`n +'Mn�j'M FF'y { ✓Y;yY [ �v�"�{ ti.,r J. '�. _ v ' S HOME,RROVEME:NT+CONTRACTOR q`"fFS.,`.'"d' aAr .Na°`a*. �j.Regisk traA tibn. 129244 Ex tion 7%' 072005+ E Vats Corporation` Whalen ResiO'rabon s inch' � WilliamWhalen Ti #'22 Ameca nyvay � •� ` � .South Dennis�Mgr02660 W ety� "t xr - • .i,l F" ! -Y+•. ..'AL.�»'[E'S�! l'.I .". L�3a-.R M � \" ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 6 e Map Parcel Permit# 7 y ` �sd a �t a �i TABLE Health Division 5 ?a��G/1,7l Date Issued Conservation Division (® 6 `�. ?I N Ap ilic t¢n)=�e Tax Collector i Permit Fe �� 6 Treasurer Uq UV Planning Dept. APPLICANT MUST OBTAIN ASEWER CONNECTION PERMIT FROM THE Date Definitive Plan Approved by Planning Board ENGINEERING DIVISION PRIOR TO CONSTRUCTION. Historic-OKH Preservation/Hyannis Project Street Address , 5 0 Village Owner 77 Address Telephone Permit Request'-S2 y ZS 1C 1-7 - Z - S S 6\f� Sv.�t � 6� GJ\ Square feet: 1st floor: existing proposed �3`�2nd floor: existing proposed Total new , Zoning District Flood Plain Groundwater Overlay Project Valuation - 1-7 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing. new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other � N Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION - - Name 1CATelephone Number Address D. 'K y.t-gyp\ License# (�)h 0) Home Improvement Contractor# q Worker's Compensation# 5 < Qy3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO os � S SIGNATURE - DATE 716 i FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. _ f _ ADDRESS. VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ( N. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL FINAL BUILDING- DATE CLOSED-OUT ' ASSOCIATIONIPLAN NO. _ �s /? j E, i °FIME T Town of Barnstable Regulatory Services } saxNsz ss. Thomas F.Geiler,Director y Mn g' 1 39.t aim Building Division 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 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. e Type of Work: � � 1��' Estimated Cost Address of Work: Owner's Name: CS`( -5 Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a pe 't as the agent of the owner: _ _%T9T7 I D CAx�1�� ly%o Contractor Name ,:�, Registration No. OR Date Owner's Name Q:forms:homeaffidav - - 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office afln�estigadoes . 600 Washington Street -- �' Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location: lohone# city �— ❑ 'I am a homeowner performing all work myself ❑ I am a sole proprietor and have no one working in ca achy //% %G%%/G/G%%%%%%%%//%%%%%O//%///%%/%/%%%%//G%%//%%%%%%/%%%////%%%%%%//G%///G/G, ding workers' com ensation for my emplogees working on this job. :r-::::::•.:.::...::..r:;;::;,;;?}.:;?:>;.:.:;?.;.:;,;::;:.;:..::.: ��} ............ .-........ r. ..r.. -.. .. ..... .L. :.....: •..:::...........�::•.::::::.:::.:.:... :.... sn .Warn .:.�.. ....:::::::.:.... ..... ..... .....:::::::::::::::{...:::::::tG:{?•}?:^'?4:;i{'G�}:}:{;•}:•:�:•}}:{. v.•'fi•'+''•i:?;?v:•:w:f:^:{.;.}}w:.:•i}:•}}::.v:;}k}$,•.\+} ...... .....:. ...:...... ......... .r...... ...........:m:.,•,.. ............:.:.:v:v:wnv::.:• ,::w:v:::::'v:•:;S•}}:�i::;:;}isi::ti:;:;}F.}:•}}:;:}:;+.}}::.:w:.v::•:r}. .:{•..v ?.:.:..r.{:-?. •........:.... .r.....:-.....n......t.........• ..J .m .:::....... .::w•::r.v{.}}:•:i.}x...:.:.::....:'vv. wrr:•:- ..{ ....................t.......-. - ..:.:..... ......... ... .................. .....:.••• r::..............r:?•.}:;:•:.::.........-....... .•:.:.:.,:.}a:;...•::v::.:t.::s•:;^::r"ii >::: r:;:{}a;rf:•:t,;it{n.-r::::}_: ..}:.. ..c L. ..............................:::::::::::::::::::::.r.�..:i'^}:•}:::.v}}}}}i'•}}}:}:vii,i':i':7}:?{ti}:?'ry}}:}':{{?•:J\G:i{^Y:;':.7!�y:;;i}};:,i;:;•:i::i: ... .. .... ...... ........ ........... ..}:-:-. :•:;;,; of ❑ I.am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have ensain olices: ....i..........::•:::::::::?:..:......... ? imK;the following v.} ::......::..:.:.:..:.,....�..::... .addFess ........:.�:::.�::::.�;{:.}::::.?.:f.::•.?..::::....•::•:}:a•::.,•.+:a:::::::f•.�?•::.,.::r....�:::L..{..-f:y.::J.J.t:.:r...:::.:.�::.t•::•:::•:•:::.•::.,-::.•x•:<.. ::. �t..,.X.,,.t:,.j. .. .. ...:..............v::::::::::::::::::'•:::i:?•?:4i}i}:•i:;•::;v.::..........v:.........-...vv?....vr.}.•.....vt-..:::...,.........,.n..•x:::•..,.., r...r...,+.r:•v::.:.. t.:..} 4.,.. ...............v.,..........•;•u:}:............,.....?w....,,.........:•........�.:..v:n.........•n:ft3...t,.........<.:.:.n:., n:.. ... ,}f...t:.v;{:.. .. 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Failure to secure coverage u required ender Section 25A of MGL 152 can lead to the imposition of criminal.penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civ�1 penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I undersfamd that a. copy of this statement maybe forwarded to the Office of Investigations of the D]A for coverage verification I&hereby-certifyunderihepains-and-pen •of-perjury-that-the-information-pros�ided-above_islr correct Sgnur Date �7 0 iat e 'Phone Print name c Y\ ofncial use only do not write in this area to be completed by city or town official city or town: permit/license# OBuilding Department ❑Licensing Board OSelechnen's Office checkif immediate response is required OHealthDepartment contact person: r phone#; ❑Other (mvised 9/95 P7[) Informat ion and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. 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, neitherthe' 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and: supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may b' submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The.affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the' or ifygu are required,to'btain.a workers' compensation policy,pleaie 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 oilhe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. .Plei�e� be Buie to fill in the.permitlhcense number which will.be used as a reference number..The affidavits may.lie'r _.tq the Departmeiitby mail:or FAX unless other arrangements have been iriade: The Office of Investigations would like to thank you in advance foryou cooperation and should you have�esttons, . 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 _ 0111ce of Invesilgadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727.7749 phone #: (617) 727-4900 ext. 406, 409 or 375 . COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE / New Buildings,Additions $100.00 l (f O^ 00 Alterations/Renovations $50.00 Building Permit Amendment $50.00 'I FEE VALUE WORKSHEET NEW BUILDINGS —�--v square feet x$140.00/sq.foot= ! C/a 0 x.0061= l Q• ALTERATIONS/RENOVATIONS OF EXISTING SPACE. square feet X$96/sq.foot= X.0061= STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0061 Commprojeost FXI5TIN6 6'POOR FROM HOH a m FXI5TIN6 FOUNt9ATION 9'XIT(APPROX) A a 9' 2" 5LV&FOUNDATION WALL UNPMTMRMINMP PROP05MD 5 5MA50N PORCH 9'X 12'(APMOX) AFRAMF 5TYLF *. 3"MP5+ N ROOF 5Y51W (8'-9"5PAN) III—I1ElIGIMIMIIl11=11M1M II�Il II—I=1II�I1�1- I� I� I�II�II�II� I�II�II�II�IImo' 1II—IIHIE�IMI1aII—MIMIIz�II=—lIIaLI�11-11=1IHIM I I1= iEiII=IMIII-1II�IMI1=1IMII1�I1=1II�I1�I1=J 11=11�1 �=I IlJ�- -III l�l I ICU=JJ� I�11=1 11=1I I I— �— — �IHIHTi- . Project; Scale;1/8''-1'-0" Drawinq, wi n g PAFMTAf31,� HOU5IN6 AU1'HOFITY B,su MS 146 5OUTH 5TRMMT �—L 78 Turnppi H Westboro,MA 01581 HYANNI5,MA02601 Phone(5 J ;0 1900 Fax(508)8701838 Date;5/24/04 Sheet 1 of I <> >x "QSO > - Z G O > 7v m r n -' C1 Q m`G O r O r>- N D r'O➢ N m m m 71 Z R v m m N r n'X m to W X L� Z N -; O Q m ➢ r... 1= z - W 1 Q) 7a ( D Q.y 6 C� m G 00 r= CmJ� O N > N O Ulu!N T up "Qc �Z 713 71 e cJ� -o 7a 70 :,�. m > 711 r G M Q m x'C31 j c (74) v Z) Q n = m w s T 4 WM WM pm e O z a O � O m O z pz R Ne.09x,.69 AMO�Jx.,o9 MA9•„E9'd m O O�O N Z cNZg�� y7mZ000 � m = oz IINM Nm aD>`O ` mivp > p (7 N O Calir ma NO< KD m mmT < N xNO T T � CO O �,00 j> ➢ DZG II xN Z 3� _ > 'I 7a z {O Q O O O 2 X�_._ X Q, Orm Go -- mmj m Q 0 NBC) I r Q000 ➢ a - Ea Z �n a� z N m m Ell Cl_ cVcn0 � D r* m O x m c G G➢ CJ� N -� m T= m j u u D=1 n 1 c u _I] pD m Z p D u z�Ocm aOc)gz O< Z m r p Cn r 00 n�. .0 Z z C1i -n Q m Q G x k� m 73 n>m o z Z_• r W I. y m N nv,T O �II�✓vv- IR, ij Lim I 0-6 *,�, i- -o i n zt 1�cCf r,�:�E It m �- Gl OC1G S OC D> n L I 706 o Z m 7a � N m� ' ? _ � m �� � Q > Z-i0 Cl ZZ 3 O rOZ Cf1 O70o, > N m OZ 71 � T Q ({� (D x > I > >,m, \�J m Qm o v o I m➢ 1 I 1 1 V o- 7 >Q➢ ,tie 4 � G,➢" Zpy �-� NOD --� ✓.. � V/ s< r- 0 -1 G1 J m D Nmw rm y . 1 r r !'ir a I This section to be filled out in home and signed by customer Property Owner Must Complete and Sign This Section If Using A Builder 1V C; - , as Owner of the subject property hereby authorize Betterliving Vatio Rooms (d.b.a. —Patio Rooms of America) to act on my behalf, in all matters relative to work authorized by this building permit application for (address of job) Signature of Owner Date This section to be completed by Betterlivin.g Office Staff Owner or Builder (as Agent of Owner) Must Complete and Sign This Section as Owner/Authorized Agent hereby declare that the staten ei s and information on the foregoing application for (address of job) l� are true and accurate, to the best of my knowledge and belief. Signed under the pains,and penalties of perjury. 1 Print Name LP b Uv gnature. of 0 ner%Ag t Date ' � `�`kCOIdSIT11�iER�INFOR�7EA�'IOI�w,�'ORl'�T � "SIINROONIS"N �s,� � �� ' � ' r s Stts ate Buildup Cede '18Q C The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). This. FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom" addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the :Hain house. In the selection'and construction/installation of"sunrooms", includ.ed below is a non-required,-open-ended list of product and design considerations that a homeowner may wish to consider before actually rnnctntrfin10--------- a "ennrnnm" Tr i� rernmmenny`ed to-� Co nsl1me"Sc, Careful y rev—j L_ vptivnS with -_�.. -.J _ ,... _ their designer, builder, or contractor, in order to minimize potential energy consumption and/or house d: .T f t ;c: e T lditiCn, the �� _.. :cF o J: ut� company o. individuals to be h d Sscot _1Vll -u s. Tn all ,i_ _d .C.-L Y r c f=e tt are important considerations. ERO DUCT DZSIGN C1GNSHMERtATIOi`�S �. LAT1E-D :,Q °SUl�ROO�iS`, Uvtu VrtCul%i lava a12U i\c4ili4 i1:ail R1E� - F Jf SAQLL E� insuiating value Solar heat gain Frame materials . ,�Yiaiiub iC1 irsLluc sealing ciit`Y „ga3rccx.c7 :i.Qie;rYciSi Star ti€irnUiii=J'dnCi/uY° , weather tightness of the sunroom C-l2 C(.i IiG GC VC12 Ll1eE tY El(1 - u - Li `T'i.iuurits ,.-:£2 ans _ apr_ied Shading Sy stem$ Insulation level in floors,walls, and ceHin;s ® Possible Sunroom isolation from the main house via a wall and/or door or slider Denting and Cooling Methods: Efficiency, Zoning and Controls , =cmeowner AcI-.:awle:I^meuf ne Massachusetts State Building Code, Section Jl.i.2.3.1, requires-that the actual property owner (not the owner's agent or representative) acknowledbe receipt of this CONSUMER 1I-�FORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building.. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. j 3 o Signature of Actual B i tng Owner Date Print.Name V Address of Permitted Project Osier Address (if different than.project location) Owner's t. lephone number ;J 1�I 7 / y , y x� / f I � , so .� (;TO ' is TPY` r 1^ ��>✓ PET i $ 01 (G) /f � 1. •it J r S � - - '�/,._: Y:, t.7, �3 � 'fir`!.i W �• r- EX151wcl 6'170OF ' FPOM HOUSE EX1511Z FOUIVA11ON 9'XIT(APROX) 9'2" 5LV&FOUN17Afi0N WALL UNbEtEPMMP a PPOP05E0 5 5EA50N POPCN 9'X 17'(APPPDX) A MIME 5fU \ 3"EP5+ N POOF 5Y5tM 5PM) \ 4 v I I-III-1 I I-1 11=1 I I=1 11=1I 1=I I I-1 I M 11=1I I-I I=1 I1=1 =I I El 1 I-1 I M 11-1lu=1 11=1nnt I In 1511 I-11 Itl' I-1 11a 11=1 I i:-7 I I=III=1 I I-1 1=1I I—III-1 I h =1 1=1 I I—III- III—III—III—III—III—I I is 11=11 E I EI I I 11=I I E I EI I Ia 11=111=111=111- III-III—'n�11=111i Illlilllll ll=III-III=111 1L�III11-11-111 _ 11 1jl�lllliiill ill„III-ILI hII i-=llli�lII \ _% Project: 5cale:1/8"=1'-0" brawinq: ea , :: mi �/ i n PApN5fA13LF NOLISING PSI NO�IT A-1 I I C 146 50UiN SfPEEfBSU �''i4 MJ � NYANNIS,MA 02601 78 TurnppI e "b Westboro,MA 01581 Phone(508)$:0 1900 Fax(508)870 1838 Pate:5/24/04 :Sheet I of I --- L, ---I n71 I C r C N >C p I 177. _ �» ccNZ v10 a ZC3I ICiN � I ri 0 mW O� V� �' wecc n z ? Q I Ia > Q1) Z :� . Fi' iv LD o-snN ? > � �o ,d rnc.=!oZ iyM _z� m os 71r O C O O v v ��;� ,-arc,= _s> � cn �4, • cv c„I��` i �v� I I cij 7. o _ I! 1II-1mj `Il,r � !! 0 n _fi—ocm �o 5 dal ' - I. �_�•�cr` prCmD.."O�` Ic,v C_ `ri Zsl I. ! I. I Ul T T T z= _ O n n Z > N � y � I yfci�n � `'hs `ov= _•oc u^iq'�ji�J I I —1 1, o ��ll CV31 L I C = _21 r SI I I!I I C pc >> p I I I� *,;7,3 G ><p G `_CG C nF11L I Ii II Zoo. n az o�c) n o Im'J T OZ 1 L pN N I C9 X C �I i- I > / ° N OC 9 n — _ Board of Buildina Regulations and Standards License or registration valid for individul use only r.==-r��-- b -', HOME IM_Pr20VEMENT CONTRACTOR before the etpiration date. If found return to: _=-_;; =E ;;J Board of Building Regulations and Standards s Registration`._1:38974 One Ashburton Place Rm 1301 =�' txpiratlon=6/9/_2005 Boston,'1fa.03108 element Card PATIO ROOMS QF`AM;= JAMES RINGER`= --_--- /' 78 TURNPIKE RD. v' �!—� —•_ .,i r��.'1,1 � /C�✓LL�J' ----- JJEST30ROUGri,MA 01531 Administrator Not valid with signature BOARD O U.—DINYG R=^I'I _. s. 1 icense: C ,�il(:iION.S` . V�=t:Vi�OR ....;; .�.,,, vQ S { Restricted Toc'.:'=0v:_. JAMES F RING=:�`.. 4 CANDICE STR= CLINTON, MA' 0151,0 AcciNstraior TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 326 027 GEOBASE ID 23993 , ADDRESS 500 OLD COLONY ROAD PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 64790 DESCRIPTION HOUSE FROM 146 LEWIS BAY TO 89 PLEASANT ST PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: BOND $.00 Ox CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE * sA STABLE, MASS. i639. A, FD MP'� BUILDING.DIVISION BY DATE ISSUED 10/24/2002 EXPIRATION DATE -_, TOWN OF BARNSTABLE 'aAf - BUILDING PERMIT PARCEL ID 326 027 GEOBASE '10 23993 . ADDRESS 500 OLD COLONY ROAD .; PHONE HYANNIS ZIP — LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 40748 DESCRIPTION HOUSE FROM 146 LEWIS BAY RD TO 89 PLEASANT S1 PERMIT TYPE BMOV TITLE BUILDING MOVING PERMIT CONTRACTORS: ST GEORGE, KEVIN R Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $263.50 IMEf�._ BOND �f► CONSTRUCTION CASTS $85,000.00' 753 MISC. NOT CODED ELSEWHERE 2 PRIVATE Pa' : MA83. �i6g9. Ep�MpCt BUILD `�- BY DATE ISSUED 08/30/1999 EXPIRATION DATE ' TOWN CI+ BARN S"IAS. E r� B-LJILtDTNG PERMIT J.�yARCiE ID 326 027 GECBASR .10� . 2599� #?. �,At 0R,ESS 600 OLD COLONY EQAD, ;. PHONE HYANN,IS �; ; '' alP Y�yyy�A'1Rlri tY 7 �y.np { .yrs :4••� "�STlh�rrel�Scr��] r� Tilt , tDAA. 7.••. • ',,t D V s1.aX,dL`i.i.4:.lq'.3� - .EJ`l C9...t.J['4 it 1Cn.Z F PERMIT, ' 40748 DIESCRIPTTON,.HOUSE FROM, 146 LEWIS BAY RD,TO 89 PLEASANT S PERMIT `1'YPE POW '- TITLE P,UILDING MOVING PERMIT CON TR CTORS. �"ST GEORGB; ,_KEVIN R � Department of Health, Safety x ARCHITECTS >R y And Environmental Services ' TOTAL FEES: rr $263 50� � plfrtHE BOND Y � _ $.00 1 3• CONS`I'RUd ION CC Tad y'UQ£� OC3 - r 753- M-V<,C .NOT C0bHD ELSEWHERE .2 PRIVATE; Pik i s, MA & s639. 0� 1 Al BUILDI BY y y j 4 DATE ISSUED 08,✓50� ; 99 j EPTRATICN,`DATE A �5���d�.`�v.+aq�- ;�.,�.ri t.,,e Y ".,�.:i,, r, w• '4+k£ ' .3v�y.�,r,t'o ch'Y*,aS,?.,c..;. ���k ;;'.:r`� ti!9i..'nara:°�,.etxF..4 e x� }}7,� ' 'ew:. 3 .� 'r` ..-. :. " „::$.�. «vo•u ,.. ,i.; f a.. .,._�a.a,U.w..es ..n,.a:.- w.y,..-..e+..t....� -i PHIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS- HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN'MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. .j1"" M i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS.INDICATED.ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE,ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. {{.. 8 19 � l I Assessor's map- and lot number ... . ..:I�? .�.A/ -/1 it - 77_ i� �!���W, Sewage Permit number ........................... .......... °f7"ET°�; TOWN OF BARNSTABLE t BAWSTADLE, i "b q a BUILDING INSPECTOR QED MPY APPLICATION FOR PERMIT TO Build addition to , 1 Pitch .......................................................................................................... TYPE OF CONSTRUCTION .... St.�el Dec amber...1.�.........19.' .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lot 129 , OldColony -,oa.d Location ............................................................................................................................................................................:........... ProposedUse ........9.torsi.€"e................................................. ....... ................................................. ......I............... ...... Zoning District J2....................................................Fire District Hyannl S Name of Owner .R.:.F�....a:�?�...�...M:... �r,arlr7�?'.............Address 3 . Ocean St . . Hyannis . Mass Name of Builder Space .Metal B1dE;s .Address z�0 Cape Hii�hwaV , E. '_^aunton . MA ............................................................. .. Name of Architect TJaCe Metal Bld�s ....Address 250 Cape Highway . F. Taun�;c?.�a..;. MA ..................................... ......................................... .... . . Number of Rooms ................O...n..e................................... Foundation C.onc.rete ........................................................... ....... .... .. Exierior .....Steel Roofing Steel ..........:............................................... .................................................................................... Floors ..VA. .Interior Con(,retQ ..................................................................... ............................................................................. Heating ........:.j�..............................................................:......Plumbing ...........JO................................................................... Fireplace ........:��.....................................................................Approximate Cost .... ......................................... Definitive Plan Approved by Planning Board ________________________________19________. Area )i q0 0 Diagram of Lot and Building with Dimensions Fee .! SUBJECT TO APPROVAL OF BOARD OF HEALTH I. Plot Plan attached. 2 . Variance heating;, October 29 , 1975 . Anoroved , govember 26 , 1075 . - Zo r J I hereby agree to conform to all the Rules and Regulations ofgtheown of Barnstable regarding the above construction: Name fl,!. 111�Al1pi r # r................. / Scudder, R. F. f� R. M. A=32�-l29 v ' 18104 = add to conmuerolal No ---.--. Parmit for ..................................... ' ' building ----.-- -------. /) ' ld Cmlooy Rmad Location'--'------------.------. Hyannis . � --------_-----.----------- ' R. F. & R. M. Scudder . Owner ---.�—..�---'�--�-'--------' - ' a�eel ' ' Type of Construction -------------- ----~----^----------------'' Plot ............................ Lot ................................ - ' ^ ' ' December 12 75 � Permit Granted ........................................ � , Date of Inspection ....................................lg � . � Date Completed ...................................... ( ^ � ` , PERMIT REFUSED . ----._.---.----------- 19 , ' --- ' n,�' —.--------.. ` --. ~�----~------.. . �r ei , � ' , .............. ............................................ - � < Approved ---------------.. lA ' ' ` -------.-------------~.~.--.. . ' -------'-----------------..~ . ` . . ' Assessor's m4 and lot number ?.7 plot 326, 117 ;.?lot .,UHF r->;p y 7� Sewage Permit number r '1 ,.-i_ ,e .- /; .�� ,.�•- �•~i, �l Z 33AHB9TABLE, i lJ r 1, House number_ ....:...::. Y.......:..:.. .......:.'.:..:..:'. ......::.. ro rose TOWN OF BARNSTABLE BUILDING INSPECTOR Lewis ?,a)T Housing APPLICATION FOR PERMIT TO ...........................:................................................................................................. T776 OF CONSTRUCTION .... .. .. .r''r -.. J nn6, 7'rrr m Cnr t lrra.ran .. .... ... .. .... ... .................................................... lc)...............19........ TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according to the following information: Location ............Carl Cc�lean�r..Avenue .............................................................................................. ............................ ... -Proposed Use ......... >r� tart exa.t~ Unj is for Fl&,Kn Iy......................................................................................... .............. ................................................. Fire District ......... „van.nis Zoning District ........... ' ` ...................:.. ..................................................... Name of Owner >~rnrFtt,.. zx�..... .........................Address ..A.. .t sat c+-.rP.et' T3 ........................... e._ Name of Builder ..Qpc>rqe ? T? Rtarr7mt�r r 'r?'"' an. ?.Address ..t3 ,.p, ,crh ` .�........... Name of Architect m ............. . no*�h�m..�...r�,?a��rz ...Address : ... ................ Number of Rooms .69..an .;,:/ r,�,,,n,a=�/PTTt)1?.r...A,r. %Foundation .......f1lah...on... ............. Exierior ..... vitc,n,� C 1 -,.,hnarr?.............................................Roofing .........290 •t; c'hi.,,r 1 aq Floors .....Interior Pm,rrer,-#3 T Heating A. r,� ..,:, , ........................................Plumbing Sea nn-$ Fireplace �,=q .........................................Approximate Cost $1•20g Cgg ..:...................................... .................................................................... Definitive Plan. Approved by Planning Board ______f41a --------19________. Area ....... ::�".,snr?...................... Diagram of Lot and Building with Dimensions 1 5 S Fee ........ ... 6 See Drawings . . . . .'.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Curb P'ertnit:: 1,000 TOTAL 2,560. *Note - Zoning Variance Decision June E,, 1.°79 Pecorc,ed Juze 19, 1979 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. PROCESSORS, IAIC.; Name . ... ................... JProcessor, Inc, ' 4=,a267 4 No ,,,21678... Permit for 69 unit *art- ment buildin (L,_derly Hov, ng) ....................................y............................ ........ '' Old Colony Blvd. �`�cation . Hyannis ............................................................................... Owner Processor, Inc. ...................................................... Type of Construction ..........r@ frame ........................... ................................................................................ Plot ............................ Lot .. ............................ Septeler 24 79 Permit Granted 0....................19 ..................... Date of Inspection .............. ....................19 Date Completed ...............I ..1.....:....19 PERMIT REFUSED .................................................... ....... 19 ............................................................................... ........................... .�. ................. .................................... ... . .�....... � l Approvd .. . ........ ... ............ .... ............ 19 ................................................` ............................ ............................................................................... Assessor's :map and•lot "number 2 .Lot 12 i ..........................................................;.. ` dL eG 6 , r Sewage Permit number �Y � �. � ���� �7'�.t� :r • p�l� J' °`T"�� � s � ; TOWN OF BARNSTABLE B8HBSTA 3L �+. 9 NABS, pp i67q. '' ' D' ILDIH I T R U G .. N S P E C 0 'FO MPY�'' �Tv � {.� na• c APPLICATIONFORPERMIT TO Build` addition+to , 1 pitch ............ .... .... TYPE OF CONSTRUCTION ......Steel I ............................................................ . ...........De c e mb e.r....1.2.......... 19. .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot 129, Old Colony Road. , .. .................................................................. Storae .....................:............................................................................ Proposed Use ......................�.........:......................................... ..'+�• T Zoning District ........ ... Fire District ......rIyannlS..................................................... Name of Owner JIJ,....aXld...1L.K.....S.c luddex............Address .6...Ocean St,;,,, Hyannis, Mass ...... ........... Name of Builder Space Metal Bldgs ...Address 2 O .Cage Highway, E. Tau to ,,,,,1 Name of Architect Space Metal Bldgs address 2.�?D...Cape...Highway.,,,,E,;,,,.T,� .ir,Q,�,,,,,p!IQ� ...................... Number of Rooms .................O..n...e............................................Foundation ..C..o...n...c..r...e. te.. ......................................................... Exterior .....Ste.el. .................... ......... .............:.....................Roofing .......... .��.................::.......................................... .. .. .. . . Floors N/A interior .......... 011�X�.te........:.:..:. ..................................................................... ...................................... No 1 Heating .....................................:...........................:.................Plumbing ..........No..:................................................................ Approximate Cost ..... 8 0 0 0 0 Fireplace ........N. ...............................................................:.... PP �.........r........... Definitive Plan Approved by Planning Board _--------_---------------------19________ • Area A. ®0....7••.................... Diagram of Lot and Building .with Dimensions Fee . .... ..s��........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 1. Plot Plan attached. 2 . Variance hearing, October 29, 1975 . Approved, November 26 , 1975 . I hereby agree to conform to all the Rules and Regulations of tL' Vble regarding t above construction. - P Name ................ 18104 "=� ` add to sommercial y No ............... Permit for:.................................... ................building. ......................................... ' Location Old Colon.v Road................................ :..........Hyannis............................................... - 4 f. Owner RF. & R.M. Scudder ............................ z w Type of Construction steel �. + ........................... Plot ............................ Lot ................................ zDecemberU 75 Permit Granted .......... ............................19 Date of Inspection ` :...............:.......19 Date CompletedX/ = �f .�. 19i R .: PERMIT REFUSED s :..........:..'' �4 ........... ' .. 19.............. f _ .. .. ... ....... ........ ... ........... * ........... ............................................................... 1f .............. ....................... } ............................................................................... Approved ............................................. 19 _J> ............................................. 4 Th"e�YTown} �f Barnstable'. . o a nstable ''ASS g z619. Office of Town Manager �e rEG MA'S► 367 Main Street,Hyannis MA 02601 Office: 508-790-6205 Warren J.Rutherford Fax: 508-790-6226 Town Manager April 6, 1995 Mr. Thomas K. Lynch Barnstable Housing Authority 146 South Street Hyannis, MA 02601 Re: Elevator Certificate-500 Old Colony Road, Hyannis Dear Mr. Lynch: In reference to the enclosed correspondence,would you please ensure that your staff will promptly post the current certificate. Sincerely yours, Warren J. Rutherford Town Manager WR/tr �nclosure _ C: Ralph Crossen,Building Inspector TOWN OF BARNS 1ABLE BUILDING DEPT T p PEt 3 0 '11995, WILLWM F.WELD W 4Onii Ol�O�'-�6d -5. Govemor KATHLEEN M.OTOOLE , Secretmy 'April 3, 1995 Mr. Warren . Rutherford, Town Manager ` Town of Barnstable 367 Main Street Hyannis MA 02601 f. y-Subject: 500 Old Colony Road,Hyannis w Dear Mr. Rutherford: - c Your memo and enclosures from Ralph M. Crossen as well as handwritten note from a (concerned Barnstable Taxpayer) with'a copy of the 1993 certificate.covering the ' f , annual test o the elevator at the above address have been received In checking our records we find this unit#21-P-118 was tested on, 5-17-94, and the certificate issued by our inspector Mr. Richard Penney on that date. He can be contacted at 1-508-821-9375 ijyou have any questions. We suggest this may be a case of the owner not posting the current certificate. , y Very truly yours,. r 1: " • n Charles H. Murphy State.Elevator Inspector ' r (617) 727--3200 X633 _ w . l TOWN OF BARNSTABLE BUILDING DEPT I MAR 2 8 a TO 1fe (9v1vUn0t6rajth of�AKttss2tct� t� s DEPAW,,�i;.'%OF PUBLIC SAFETY ELEVATOR DIVISION �t'e ONE ASHBURTON PLACE,BOSTON 02108 .,, Located at y Cl) 1 �S CERTIFICATE FOR'USE OF ELEVATOR , Chapter 143,General Laws, as amended. Capacity Pounds Saeec� Per M1. .tr R Date issued �� Y• �... a' Inspector � — coiuitsstoRCR r 4 Exp' 1 year frog above date " , 'J8 to in Case of Accident Notify the Chief of Inspections at Once v�' 7z� Y' y,. qq i i _ k � `2 r Whalen Restoration j Services, Inc. Insurance Claim Specialists Fire,Smoke,Soot&Water Damage Cleaning • Deodorization •Reconstruction (508)790-1187 Thomas S.Cohen (800)244-2598 Construction Supervisor FAX 790-1793 110 Breeds Hill Road,Unit 4 Falmouth 540-2234 Hyannis, MA 02601 Chatham 945-7400 6_7 Parcel Wermit# / 7 R tG .C � Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45)' Fee 60" Engineering Dept.',(3rd floor) House# n. CA0 THE T ` ENG FROM - 19 CONS PSIA 0 T f T�WN BARNSTABLE r Building-Permit Application treet Address 500 Old Colony Road;';-Unit 220 4age . Hyannis Owner Barnstable Housing Authority Address 146 South Street: Hyannis, MA 02601 Telephone 508 771-7222 Executive - Permit Request Reconstruction of unit damaged by fire S V'u C4-,J I' First Floor 700 sq ft square feet Second Floor square feet Estimated Project Cost $ $ 35,000 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Residential Apartment Proposed Use Same Construction Type Wood Frame Commercial Residential X Dwelling Type: Single Family Two Family Multi-Family x Age of Existing Structure Basement Type: Finished NONE Historic House Unfinished NONE Old King's Highway Number of Baths n„P No.of Bedrooms Onp Total Room Count(not including baths) Four First Floor Heat Type and Fuel FHW Gas Central Air Fireplaces NOW Garage: Detached Other Detached Structures: Pool Attached Barn None X Sheds Other Builder Information Name Thomas S. Cohen Telephone Number (5og) 790-1187 Address Whalen Restoration Services. Inc. License# CS 057122 110 B e ds Hill Road, Unit 4 Home Improvement Contractor# 110363 Hyannis, MA 02601 Worker's Compensation# See Attached NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z'A& 'i BUILDING PERMIT DENIED FOR THE FOLLOWI ASON(S) FOR OFFICIAL USE ONLY P MIT NO. — D EI E ISSUED M . /:PARCEL NO gg } RESS r { VILLAGE OWNER , DATE OF INSPECTION: r FOUNDATION FRAME, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL +. GAS: �ROU�GH FINAL • s FINAL BUILDINGS .: ; y DATE CLOSED O ; . r , ASSOCIATION PL ' ✓fie �anvnraouuea o�✓��aaaaduaecZ Restricted To: 00 DEPARINENI OF PUBLIC SAFETY . _ CONSTRUCIION .SUPERVISOR LICENSE 00 - None Numbers Expires 1G - 1 6 2 Family Homes - - Rest ted to:, 00 j, c;: < Fel/nryrnr���wsaannnrrcof tp Rtrte tDellltflog 4, INONAS S COHEN ��^a la a wAt for royocetloll Il CAPES FRAIL """"Rs• r Y BARNSIABLE, MA 02668 •• r..L:r rY.Ar:A•rlMa..+.t r � .. • I t , HOME IMPROVEMENT CONTRACTOR Registration 110363 • 9 s Type - INDIVIDUAL Expiration • 10/20/96 THOMAS S COHEN { �t�tAS L� S. COHEN toM•o�', 5 Hadrada Lane ADMINISTRATOR { 1 Centerville MA 02632 1 I . r, i - . _r : .. .. .1�.. .. ... .....ilk 71•:.'.' / 1 v Tile Commonwealth of Massachusetts Department of Industrial Accidents • _:1 OJ//ceOftWstlgalloas askingyon Street Boston.Mass. 02111 `-- Workers' Compensation Insurance.ARdavit A Wleant in`tormatio`n= i'le se PRiNTI v 'R -� name! Barnstable Housing Authority Iomition• 500 Old Colony Road, Unit 220 _ d Hyannis, MA 02601 phone# (508)771-7222 1 am a homeowner performing all wort:myself. 1 am a sole proprietor and have no one working in any capacity ® 1 am an employer providing workers' compensation for my employees working on this job. comp•rny nnme• Whalen Restoration Services, Inc_. _ address: 110 Breeds Hill Road, Unit 4 coty: Hyannis, MA 02601 . . phone#: (508) 790-1187 . instinince, Granite State Insurance Co. nnIia# 6152458 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: comp•my name• address: city phone#r incurnnce c� Boller# l`:..«.-- '.N. �. — '... IT/f!7 Q.••.iR�R?'?`l�7!1!Rt/If77 C7L�. TJVF�_7'SC�!�e7 ? '�'!!•"�19�43* 7!��'r�l crimpam•name• address: city: #s incuranee en nolicv# _ .Atiach additional'sheet if aeeess_ "'^'+"r'°"t` '"`►`"�� Failure to secure coverage as required under Section 25A of Ii1GL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as w•c11 as civil penalties in the form of a STOP WORK ORDER and a One of SI00.00 a day against me. I understand that s copy of this statement may be forwarded to the OMce of Investigations of the DIA for cow.. ge YMOcadom t do hereby certify under th randpenaft, f pedurr• at the information pro►ided above is true and correct Signaturt: rue August 8, 1996 Print name Lisa A. ,Whalen Vice- one# (508) 790-1187 ofcial use only do not write in this area to be completed by city or town official city or to., permitnieense# rtBuiiding Department OLicensing Board check if immediate response is required Wcleetmea's Office Otieallh Department contact person• phone#; MOther . •• y J Information and Instructions Massachusetts Gencral Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an emplgvee is defined as every person in the service of another under any contract of hire, express or implied oral or written. o ver is defined as an individual, partnership.association.corporation or other ;-gal entity, or any two or more of An crop/ t 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 1.52 section 25 also states that ever}•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 in 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. .....�...+.� i.ra. a:: i_... y.: per•!»�...: CAr:nn! (` .. �!•s:i.'.1:i 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 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. • 77 '61 LL 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 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) 7274900 eat. 406, 409 or 375 ppi f:r .S + yp r} • qr j,VM ^7,y r }�,'y)y r.A �I f. s , F •c t f iJIWII DATIF isr t•am . ,���A'fi`e�Ib#k 90�Tr �r�,t��.� Xf�� �b yy))41��'��n y���� �1,J,`"Y3�1��7'6l�•y,►�'+^r ' ss:� rat�'(r � r,r'Sx I�} w, •(�L 1^,yfTf.(� .}.;r.,i.:.,r:.,;j if,� n7l..r•.ii'rel�i .:.Ynx?: .A4.�.. .: > s 111';;.l•5, ��r 1, Qs { .13+'!i Yri1 4/16/1996 YCLt'CfI1 s r ...1................ ........................ 11{I9 CE'i11FICAIE" IS INSUED AS A P1tymn or IFIrOnr.iAvoiI WILY A►1D Itagern r GrT+y - IfXann�.13 CONFERS HO n!!iIFTS UrON TIIG CE(T11nCAlE i!CLOF'i. 11113 GrnT1rICAlE Rvq I tt)>tor.tr��t itnld/RoTTtD 132 i vors noT A?IEHD. ExTENa on ALTEn TINE COYEn.AGF ArronDED nY THE �' . , rOLICIES DCLOVY. ............................................................................................................................................ I;yrezaTaxa, Nil'! 02601-1459 comrANIES AvronDING covc-n 1GE (500) 175-0011 FAX 775-0966 �. rnlnulY A Commercial Union Ina. Co. LETIM ....� coIIPA�rr B GRANXTE ST7ATE INS. CO. alavnro , LETTBI Whalen Restoration Inc. ! � LE1TU1 yiilliam and Liss A. Whalen C I........:.........................................................................................................................................•.................. 110 Breeds Hill ad, Unit 14 1 coMPIwY LETS D U annie NA 02601 11ETIvn ! ''( x i �; ^.(::^: •;•Z; R. •Sx_: . r: r'T 9rY'1 l' 'ir:ranritn :},.• S ') .1/3 •� § .�'iV s:,,'•: ':,"E:; 'r:i1n i.rx�:aiirf7 •'ri7' c7.. }....ai.. 'i,F:` 4 <. i.OrI!: ::f:y..r;•.%7 .Z.•n7..^t:,:� L .+. .t e.z.w.. s. ...• x,:tr ,. •3 �.,c};1. ..Z!f...,!l,,r.,r.,.;:.;.4fa.,...•;y. a .,,; ,;..•s•..a ;!T!:�, :!;,, ..s,r..,:; r•.r:..:,.+,., %`.* .:,... ,t,:�xga: : :x:.. .. .. 1Y...]_.,... ......f....::••::..•.:..•s.: 7.1:. ..:..�;�. .r j, .. THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PURIOD INDICATED,NOTWITHSTANDINQ 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 NEnEIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COPI0ITTONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................................................................................................................................................................................,.,.............,....,.,................................................................................... TYPE OF PSURAMCK r POLICY MVIMNtR ;POLICY fiTicC TiYE POLICY EWrIMAT IN LIMrT9 lam; 1 VATE (MIMom) i DATR(PDArOD" i A rrol�BAl wNenm000000 B AUOitEOAtE I ,....t7I[jiN. .....................................................r. ► ! x coAalF�IraAt at71ENs'L LNBLrTY I PRODUCTI-LroMPIDr'Am. 1I 000 00 (..••.... or3+saIAL ADV.I"JJRY 'S L....000 OO :•..<. i CIlIeN6 MADH OCCUR.; ;04/01/96 ! 04/O1/97�. ............ i awNEgs a cDHTgncrogs FITOT, ; EACH OCCURREp4m is1,000,000 ............. ............................. ........................ ............ ! i i ! FIRE DAMAGE(My OM Re) !1t 5 0 �0 - .......... .................... . , .................. M.OTENSE Ih'Y am pamnlii 5,000 .. t........ I.......................................................................•.,......:.,................................ ... I AlrMUORRE UAOWTT I ,........ , i COMBINED SIMME. ANY Aurb - ; ;LMrr ALL OWNED AUPOS i i...... ' ........ i ;BODILY RULPRY , TED . I I eamo AVT'OS i ' ;(Pet Person) I: { HIRED AVTOS �.,. WMLY M,AMTY........' i '(Par ece"04 !S NON•owNED AUTOS ;. � , GARAGE LIABILITY !.,......{ ; ; PIImm, DAMAGE is i ETICE88 woMY EACH OCCUMENCE f ,........i 1 ................................ .................:.............:.............. ? I umme"FOMI + I AON3fEtL1TE !t ! ; oil 01 THAN UMBRELLA FORM ! t: ......�....:..1...................................................e........................... ..... ......................... !...... ... ,........................... ... ji: ti s .. 9TATUTORYLMITS 1TOgKfA'<f COEIPS13ATg1T ; ; , r. ..}........................:.............. . ...,.r...........:.............: ... Bi AMBii3A5A 44/oi/96 ' 04/01/97 ""��" ;+ 100 000 nwLOYEN9'uAgw Y I { ;0 500 000! , , 1SEASE.POLICY LFnrr............:�.............,..,..... ►............. ' ! o15F 00 I .....�.t.0...... . ............ t , ......I.. ............................. .............................. ......i.............................r .................................... .................................. ...................... I)T=nTW?4 OF 0PMTTONWCA1IDBB/Y011p,E91S1=A1.ROB FIRE,SMORE,SOOT,HATER,CLEANININO AND RECONSTRUCTION '..%:,,;.:•:•:.......:........:,. :ar.:av:..:.�c„.,,...r r�:•y:::..:... .... ......:...: ;;.;.......:sw•:r:[,.;:'..-•m;�x.u...v:•r.v::rf::y n.,:;�... ,..assss::.::`:::: e.q::xar.y.:. ..k. Y 7 ik Fi��:f':n :�'1:r:••;.,..f.�.� �«3.i:..r{s: , x� ?s,. a �o..oG K.v+... 3 )'r r 1...Y.. ,.It. '.dx r.T•.. - 'y'I l:crSi.'�%�'�k,x..r:,:;:�,,.< ,.y ,,.,»:�.io:..5..�,�. v•k�!,:�'},..E,..fn v..,tx �n.Z.�;.,,....i.. �.,.}.�..�. :.<... ti n: :3... .,,.,, f. ,i: ,,,�f;f�gt.,:;:(Fac.:.:T. ?,���*:.r.�.<-!N::...:,�::.::,�!.;;.•.,.:ra:>ar�::. :.... :n�:wn�•r.::. •.^.:.•:�•r.:v.::l�I(;�.... �.._.i...:S.L:`i......flfili t .�...��: �,'+,. .......:...:vyx;;... 4 .... ...a t:f•ln ni � :�.......v�.x r: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ?g S(PIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO f MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE F, LEFT.BUT FAILURE TO MAiL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ' I% LIABILITY OF ANY KIND UPON THE COMPANY, ITS AOENT9 OR REPRESENTATIVES. Aumona>� "jay INSU RMUN A433HU It MIIJ9 - .; 'ye"•e.t•,anY'S1I'�' •Mv JY i` A� ! F�YIT: }:#.}.:($�, 'f:' •"!I. r.• r :ssF3 t , !fs „ :ae.e.,:v• ��} .�iQ l r •}Rr�i: .•L: 9'' r.9:::'Vi4�i.: :sts. ,y�:I�A!s TOTAL P.01 The Town of Barnstable S Department of Health Safety and Environmental Services 6�19. Building Division 367 Main Strut,Hyannis MA 02 I Office: 508790-6227 Ralph Cross Building Commissio: Fax± 508 775-3344 For office use only Permit no. Date AFFIDAVIT HOME WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the-reronstruction,alterations,'renovation,repair,modernization.,conversion, imprvveraar&t,.remo%al, demolition. or construction of an addition to any PICCadsting awns OecePied building containing at least one but not more than four dwelling units or to stl r2 r h zes which am adjacent to such residence or building be done by registered contractors,with certain exceptions. along with other requirements- Type of Work: Reconstruction of fire damage Est.COS[ $ 15-00Q Address of Work: 500 Old Colony Road Unit 220 OR'ner.Name: Barnstable Housing Authority Data of Permit Application: August 89 1996 I hereby certify that: Registration is not required for the following reason(s): Work cmduded by law Job under S1,000 Building not owner-0ocmpied pulling own permit Notice is hereby green that: CONTRACTORS OWNERS PULLING 7HEIR OWN PERMIT OR DEALING WITHUNIZEG 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 0%-ner. August 8. 1996 Thomas S. Cohen for Whalen Restoration Service 110363 Date Coma Registration No. -,7 OR ' rim _ _ P 1 Y1111►i 1 �I n ll 1 L Y lY►7 l a Y�1i U6Departmentof Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: E)8-90-6230 Building Commissioner DATE: March 29, 1995 TO: Warren J. Rutherford, Town Manager FROM: Ralph M. Crossen, Building Commissioner RE: Elevator inspection,500 Old Colony Roacgzlm-_,an us� These inspections are supposed to be done by the State. We will send them a letter. r f t ��. : The TcP V� Y� of ��a �Istable 1659. � Department of Health Safety and Environmental Services +" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 368-7'90-6230 Building Commissioner March 29, 1995 State Board of Building Regulations and Standards Attention: Elevator Board Room 1301 One Ashburton Place Boston,MA 02108 Re: Elevator inspection To Whom It May Concern: I am forwarding the enclosed correspondence for your action. Please contact me with any questions. J Sincerely, Ralph M. Crossen Building Commissioner RMC/km enclosures(2) TOM OF BARNSTABLE BUILDING DEPT. p I AR 2 1►;'I vim Zile KLIIIItIT onli falth of f ttsszac�it to DEPARTMEN 6 OF PUBLIC SAFETY ELEVATOR DIVISION MkR, 27 A'� +- a" ONE ASHBURTON PLACE,BOSTON 02108 + Elevator No. Located at VA �y CERTIFICATE FOR USE OF ELEVATOR 7 Chapter 143, General Laws, tas amended. Capacity C OC! Pounds pees'J. i Dote issued Inspector COMMISSIONER ExpireYlyeariio above date In Case of Accident Notify the Chief of inspections at Once. _ /f fam:R a Af : . The Town of Barnstable • MtuvseeBU& • 0 Office of Town Manager rEo MA't 367 Main Street,Hyannis MA 02601 Office: 508-790-6205 Warren J. Rutherford Fax: 508-790-6226 Town Manager April 6, 1995 Mr. Thomas K.Lynch Barnstable Housing Authority 146 South Street Hyannis,MA 02601 Re ElevatorrCertificat 011 D1d-C Qt ad�Iyan�iis Dear Mr. Lynch. In reference to the enclosed correspondence, would you please ensure that your staff will promptly post the current certificate. Sincerely yours, Warren J. Rutherford Town Manager WR/tr Enclosure JC: Ralph Crossen,Building Inspector P g P TOWN OF BARNSTABLE BUILDING DEPT D An 3 0 41 Eton 0. ✓ �6a LLIAM F.WELD -5 •._ •`. Govemor KATHLEEN M.OTOOLE Secretary PXY April 3, 1995 Mr. Warren J. Rutherford, Town Manager Town of Barnstable 367Main Street Hyannis MA 02601 Subject: 500 Old Colony Road,Hyannis Dear Mr. Rutherford: Your memo and enclosures from Ralph M. Crossen-as well as hand written note from a (concerned Barnstable Taxpayer) with a copy of the 1993 certificate covering the annual test of the elevator at the above address have been received In checking our records we find this unit#21-P-118 was tested on, 5-17-94, and the certificate issued by our inspector Mr. Richard Penney on that date. He can be contacted at 1-508-821-9375 if you have`any questions. We suggest this may be a case of the owner not posting the current certificate. Very truly yours, Charles H. Murphy State Elevator Inspector, (617) 727-3200 X633 FROM ' TOWN OF EARNSTAELE \2 BUILDING DEPARTMENT 367 MAIN STREET �• I HYANNIS, MA 02601 Engineering I Phone: 775-1120 SUBJECT: Processo f Inc. (Elderly.H 7US ) Old Colony Blvd., Hyannis FOLD HERE DATE - Novwber 13 1980 MESSAGE P ease make an impectivn for an Occupancy Permit, f SIG ED . ..DATE REPLY E h - SIGNED i Ii N87-RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY t i PRINTED IN U.S.A. SENDER: SNA' OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. ,TO TOWN OF BA STABLE. BUILDING DEPARTMENT 357 MAIN STREET D• P. We, � � - � HYANNIS, AAA 02501 Eee Phone: 775-1120 L SUBJECT: gesso , Inc.' (Elderly Ho wing) Old Colony Blvd.., 11�im15 FOLD HEREt DATE November MESSAGE Ply ice an impection f an Occupanidy Pe m.t. i SIGNED i s DATE Alo 14) 19,go REPLY �I SIGNED N87•RMI ? RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. r V. rj 3 TOWN OF BARNSTABLE ------_- j78 Permit No. »n Building Inspector Cash � GOO.011; ►C OCCUPANCY PERMIT --Bond --- "No building nor structure shall be erected, and No land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Processor, ImC. Address fll A Cnl rmy R��7 orcra rr1 '�.sa-n±-.i Q Wiring Inspector �� ` .!, Inspection date !? _r % -- Plumbing Inspector f ' t r y ;\,� Inspection date Gas Inspector - Inspection date prEngineering Department-"�� y� r� / 4 Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. e ! J.... ._.........», 19 �� Building Inspecto � y 7 , !'saws 's map and lot number -Lots...129...lot...32.7..,...?7 plot 326, 117 plot -&W 3-21,2 i �TNET yDk sfuf> �o oaf Sewage Permit number A/ ff/�ll -�----- House numberj/ !k./"*4y.......G.U. . .CL /a - -/� v............... 3�`3/IT/9/�L �CO9GT� C/vlTLOeep 6 9, EM"ONMENTO , TO( OF WiANSTA.RL'F��" fe�- BUILDING INSPECTOR 3 (� 2 7 Lewis Ba Housing JYPLICATION•FOR PERMIT TO ..........................y................................................................................................ TYPE CONSTRUCTION ............Type..4.,..W44d..Fr'ame•,Construction SYP t1T1?e.r. .............. .. ,,, ,.T0- THE.INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........Old Colpny• Avenue ... ................................................................. Proposed Use ........69..AP.?rtment„Units for.,the E1de,TlY.......................................................................................... Zoning District 51dgn.re..$'.l................................Fire District Name of Owner P.KQGS.S:SQ ..InG.;..........................Address A.4-5.1 at.q... ................. Homar-Worthington 111 Name of Builder ..fG,B/A / /.,$l./. /,,l. Ey�y.A)Vyr/.,CW.AXW/Address .......... .Name of Architect ..........ARnham.&...$xeeney$xemey..................... ................. Number of Rooms 69..its../..a..L.Q.wgQs,/.Piib.lic..Axe#oundation .......Slab..oa..Qrade.........................:.....:........... Exterior .......[ Rod..Clc3pkaoaX'.d........................................... .. ......... ....................... Floors Carp.et..&...Vinyl..on...Wood..Deck,/.Conn-reta.....Interior ...............Dry.wall..................................................... Heating ..............S.ee..Dxawiags............................:............Plumbing .........5PQ... i; wings................................................ Fireplace .....................None........................................ .......ApproximateCost ........$2t20'0,000:.............................. ..... L Definitive Plan Approved by Planning Board ______N/A -----------19________. Area .......19.5QQ...................... Diagram of Lot and Building with 'Dimensions Fee $ 1,560. See Drawings ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Curb Permit 1,000 TOTAL 2,560. *Note- Zoning Variance Decision June 6, 1979 Recorded June 19, 1979 I hereby agree to conform to all the Rules and Regulations of the Town qf Barnstable regarding the above construction. PROCESSORS, -I C. Name ... L ` Inc.Processor, 't r �a ... Permit for .......69 unit apart. i r :.mant..bu7.a..d�,ng...(.F1,derly,,,Housin ) i Location- 0.07.d... RIQDV.. v.d r.......... t. ........................ ....................................... { ` Owner ..............P.)?.QQ ..Inc.................... Type of Construction fr=q................... ........................................................................... , Plot ............................ Lot ................................ ` Permit Granted September. 24 19 7 a Date of Inspection 19 Date Completed 19 • s � Y PERMIT REFUSED ' :............... .....th. ................................... . 19 .. .. . ................................................... . .s. ................................................. + i ................................................ ' R) 0 Appr ................................................ 19 ` n ' >r 'D00R SGHE0ULE .'DR L ON .SIZE `KEG 'MIATERULLa HARDWARE STOP 'CLO FRAMES NO w A.. t Y. SER t f f 1; 1 N611:Oq Eldat '-W '.e'=e' 1-W A Wood:Sdkf Sehlage Enhance/ well no New red oak frame with Ofl o._: .Rush wood,red office lock,050PD, ?'.red oak casings,dtN .. 1. 31 '0"oe l oak veneer,wood >keyed hail side, rabetted,not finger-jointed. Offioe 2 lowers. thumbty r.in office, Note new, rough opening. match eAsting finish. - 4; all Cbeet 2'-0' :8•-B- 1-314'. B Wood,Solid Core Schlage Passage none no New pine frame w!'A'x 2' - - 'Rush:birch Latch D10S•lever pine colonial casings;dbl - veneer. handles match finish .rabetted.Door, frame;trim, .. to axlatin . - to be 'lnted.,:Nota nevrR:2 6: Mpibm 8'-0' 8 8' 1,l4' -A Wood gold Core SCMego. wall _ no _ New red oak me with•,'S'it. . . p4lating gush wood,red "Entrancet.ORire lock, '.2'red oak casings.dbl �• � " - ' ' : _ !jOGectoes oak venear,wood s D50PD,keyed hall rabetted,.not finger-jointed. - ,'Of]ioe _ ' : :lolvera ..aide,t iumbtum'.in: :Note eidsting rough opening. bffice,.tnaOcti ex 8, Closet' 1'-0' 6=8 1314 A . Wood Solid Core Soilage-Passage' hinge, no *Now pine frame with 34 x'2' ..t w+4£_�tMrtM Extln0&)- - - .-1kish birch... latch` 10S:sever` _ � •: ...P .. `': pine'cobnial-casm e,dbl,. 3iT sl><t�ahre 1Pwc.. . veneer. 'hindies;irabh finish rabettad>Door;frame,and 1. MYcl . _ to:exleting: 'trim to'bepainted.Note new. - t3 a In. _GLAS-1 - ': R.O. '..; ..•NS? 16HEORAWI.GS FOR HANDEDNESSOF. RS .. 3'•0. ..',: 2r-0` P M. REsaWE� �. ZK Jo rx,t"r—,skme IEYEI. PSY .=._ >ry �i_^.c+M_l�A �t'yS. •�YLY-e'7CYti ,'- sa I `+�` t .. .- _ ^ - x 3 ■# C �_--__larm.e srarcKc?a 11 -. �.t�CSA[�=al3sl"tHIaSArYIt{S .�Lra6i__.._ 1. - r Q6MOLITI©N NOff$: `Kitchen.Rent)VAioOR• ]: Rensove all-krich n'ciibineli.and.countertops _ .. .. 1 1. 2. Remote_apPIiM wand drseard:ori>taceas otherwise directed byowner: I . J: `Jtemove:plumb g'fidings add fizhries - J IO 5 `.' 4'.. ,Remov6.extraneous electriol finings and 1146i ..;Remove ekctrrcal tlerices .. -- _ .. _ :µfitd'povet plates;wblch are fn:locaidns.to remain,.Devices arts wver:plates - NY .xobereplaced lxistiagcetlipill.KSMfixtures.ko`reRtain. _ 5. 'Remote_sheet v11 1 Hngring 6. f—move,backspY, matenals:,whe"r formicaon wall orcaWructed:.. .. _ r-...._. ... { ,plashes.- - i 7: 'Remoyesheetrodk as required to rnoi:14 range:hood ductwork or-Io.Pam.ie .newwliing .. �YnP.Ffl _.i 8.•. :Remove any other materials 6oceI4W,t0"!'e`1r d to:complete the work. - : ' .ol f:dernbi,wn1olrts cithe.onditions. . _- co edon d pe . . .. • 14'. All min a .1Mt,p� 'OP _. .NSW.- - .. � �s O ., lQ'.� All mateelats w'.�e�immedlately,d'isyosed bf ujgn nrnoyal;ln a legal manner :.- :: --tX ... uxrcr . crac►er,� c1,arcrt rtr:r�Y4-4rrcY for Ibcwterrt QfAumpster. . 1,L..i a CoordinatewlthikiousingA'uthoritp p .. :! 1,3:1 Ledyesrte:toasak condrtton daily)rJue:to._conansed occupancy ofynit:- -_,t:iG .I .. - - -,: -. .:... _ _ . . _ - 1.. - z' 1. :.� tcx c4a Drat•. 1 s� TION NUTE6:''Offtct Renovattoas - - — -- rvtsc CA u1 l 22 k 1: ,.Remove al6kitSlien cabtnety and.countedgpa. :.... . ..,.. ....... ... ::'' .'�+ _°. ,.�.. —r-R ti ._. ntl'discaliJor•lace.asotherNgtse duetted by, S,' - -h' e a ianees a .P. ....3:: Re. ... ...:.. m . n Dist pp :: .. 37°: Remove Piumbi}ig rittiagaand.;Flxtvres aid Rh where,regilrred.�Review�,wNh • � :: rehitecsJ cleanouts--are ibgtnred-toremain; .:. .''_ ..P.. ... .. ,....:Eklui Rerneve el taf devices: ---PE'M.l.f{ -10E - .•J -iF-2• -CSC.c2.t?l _ T- ,,.i..: '4.. Remdve.ext;angous elechtbgl,fiamgs sad es._ eclra. . ,.:. 4 Qr ` 11 . : er lateswhtih ar tw'aocatiore toteinaiii.:)i)evitesantl enger'.plzles r:. .y. ,and cop p:... .S ._ ..o.be-re laced... . " n:and ca � . 5t!txl:e?P�l..g_..--^�-_� --•`� ---=�� - - t r ae.T i, ;• ':replaced.. .i<Rcnsove 7 - :;Remove sh .ck as':regwreil to adcotnrandate:aeaa.plani to morlity -. .. .._ 1 R.1 GL"A95 klll•1�N4 j p,.FMt.• - 7f1�S4 Ersf 4:uA5S`Mf:aDo!rr.. l -.: :: 'ductwork ato tait;naw waking - e -g. Ef _ ._ - r• : .. ;. 7•o'.cnFJttoy?K`xy�s _ -r isL n6yxoxe es,rte 'n.- bke-emored to s4ork ;- : '✓ALA--l°VAt'1'.... - 2�SS"4b Y .. EiE,Fi YE �hsXa, -: 6r. dtt7noYearsy _ - - 9 r m. Contali am,Mlt t upon ...6H dernow .ID tmpt`Gt+he cadiclons : — _ _ _ Aso er{ a6 16. ;,�I materials sate imrnediatefy;disnoIW O'tlppasimoval in a Igiw: antler pu .ti;'3•Gooidhtatcwft6HouiiAuthodty!fQe''P10eernenPofdurhjister ,.,: :. . .�...- . 1Tq`ILeave the,in.a sah cbndiuon daily due lo.ratitsnued.oceUpaf+cy of oftices.. . tfta'>a�io-ee-ar�� "Lli�J s�rDuNrag exec{itr�n�of,lbe tvotk-provide d.. _ .. . 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CfC?RLlL�11WorC719REPtXEv044S. c�1-rrtvr�r[0c-*sRr rcz1bu t�9:li GNat biyto:�t�a�a>rR lfcsar3I i���7t[S,�M:-�u—XE-na�;f-tro a Wtc.a4x_A�'.+;yKFt'Etb.Nc>.-�teLGOtr>cS=�"fPE.��.b.Y�-r Ct`a_:x�wv�v�:t,t►,R�as GIwara�.TFlcaasYlt�wr i s.sitT-�ra.TS 7-elrA>�tbyC=ab r (j�_\:-_—•`---�a-- --'VP-- >� nas'vTwI- rHtc-F:c4-Cali•s?-'�oh-'A-amS'!-�►ar-6*�j]b��ll a:�._.. - - ..:..... . .- - D'twswaR-RNA... I. COLONY HOUSE KITCHEN RENOVATIONS _ L.,n�►�-pitya�a_�a,�s _ �.eve�l�s. . w►► d . �� �.I�.. For Bamstable Housing Authollty - AKRO ASSOCIATES ARCHITECTS i46 South Street, Hyannis, MA 02601 310 Barnstable Road, Hyannis, MA. 02601 te1 . 508-77B-6060 fax 508-778-2558 Steven M.Shuman,RA Alice L.O RA ' I I . .. .•�.. J I I I I Q'(� I it 'I ', .•�^ I � i i� � �t � I � � � I�I is 9� I i w - 1 + +• W � i it NO TO U�$m � Y C^N �• 21f two ��Y I:. a 34 cn t O. t I V, asP uj p Z0 LU -.� 5e I. 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( HOOP Ll -g©D 10 2,, _ UAN T5 2QC,, 2-0� to vC'T" ✓ � AV COLONY HOUSE KITCHEN RENOVATIONS SCALE: APPROVED BY: DRAWN BY 41 For: Barnstable Housing Authority D ATE. , .-_ , REVISED ` ; ! '.. ry�r ,! MA 2 1 AKRO ASSOCIATES ARCHITECTS 146 South Street, Hyannis, 0 60 ! 310 Barnstable Road Hyannis, MA 02601 r f Y pp p C C Q r ffE L ,' ° tel. 508-778-6060 fax 500-778-2558 <! DRAWING NUMBER o • t 10, n Ol w (n O O 1• r•'rr z .-') O .� 1 5 cnm lu Cw N � Q C i 1 coo lo•.a' a ' __ - ' (� l Q fL O O F- ul �_ I - - - - 1 ►c[ f4 y/� ,4j"CO +�.,0" l - o'e�,G -_ _ ` d �� CO CO Apt, RFFLrGT�!iD 6EIL-IN3- PLAt1 0 rVISITION CtLNUR 1 I Q C N • I 1 '-' � Y'1-1� r 1 1- 6- 1 11.5 � - 1 s � 1'1 IA t• � • • r Ip-2' rf4: '11•-l0 10•ti IP•!• ti-10♦ 11•-V♦ ldY• l0'-1' U'-,O" 1 _ # I, �2 -. 111 —_�•._ •`__--_. _—_ t ,_.— T._ — -{ -.__.•�- � .—__.. ,!G'�1'®s-D -- 0 1 11 V t "` �_-, a •...` `` � c _� _. • --- -- - _.__- �----- r ---- . _ -.1 , `1 1, .,r,C _J ,raj^ " � ` � � __'Lr.—1—y� b r4_7�16�__ — __.—__�L Q�TI•>r _.__�;�' �-n-� -� ��cb I f . _� I D -L . _. �__t_=�}.: � � � G- t1 ,+K •r•r -. w r; � Apt IN r - ae•<H tt 1�-- S,� r3 111P �., E L l bIC. 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