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Home My WebLink About0193 PITCHER'S WAY 9,3ACTIVE r gy �: , . Assessor's map and lot number ...........�.. � .:........... THE c t Sewage Permit number // � + lt B9H39TABLE, i House number �. ` t 90O M6 9 - �FOMPy��9 TOWN OF BARNSTABLE BUILDING INSPECTOR 1 APPLICATION FOR PERMIT TO .....::..................................................................... .................................................. 2� . TYPE OF CONSTRUCTION ........................... ..............:..............................:........................................�0... ........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............,/„ ..... �,�,..-1-16, ........ T/ 77 , / /v .f.................................... Proposed Use ...... !U..... �!7 t ... �•.,/..p.t�... ...��i tf .................... ...... ........... . � /tl Zoning District .........................................................................Fire District .....................• ..................': Name of Owner ........................ .........................!..............Address ... ..................................: .,; Name of Builder' .......h��f .........(..T.. t�r/n/. .........Address ............... ' T ' ST....C.�...............L..M.....q...I....-�...../ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms � +! . ... `. ..........Foundation ....�+ ! �` � C ......2. ZL /M7o'6 Exterior s ,'° f ......... ...Roofing ..r...., f fs L f`l�,E/�t=,,,!�' '. ........... Floors ,. Interior ........... ............. .................................... Heating Es_ r�.......t, r" . ls....:......:...........Plumbing .....:.. ..:.....�" !f `............. ..... 00. Fireplace ................... ........................Approximate Cost -4.,1�................ .................................. .... Definitive Plan Approved by Planning Board -------------------------- / ?. ? !..r '; - 9 - - Area ..... Diagram of Lot and Building with Dimensions Fee ?F.:`��..............j: "/ SUBJECT TO APPROVAL OF BOARD OF HEALTH U L ��.__� /r�; t4 v 7 r. %h OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i hereby agree to conform to all the Rules and Regulations-of the Town of Barnstable regarding the above construction. Na m / !fix. ................ WALSH, WILLIAM A=289-24 No ... Permit for Single Family Dwelling,,,,,,... ... . ....................................... D s ech 193 Pit Location ............................. Way,,,,,,,,,,,,, , Hyannis ......................................................... ....... ............. Owner ..William Walsh ............................................ .................. Type of Construction ....jKAMe......................... ................................................................................ Plot ............................ Lot ................................ ................ Permit Granted ..April 6, 19 82...................... Date of Inspection ...... .............................19 Date Completed ......................................19 47 0 Assessors.ma and lot number P:�9 �Y • r P; ��: . ......... r THE Tp� Sewage Permit number .. U.. .. ...... ...... .. ... House number ......J� ./ ............... :. rB AflH9TODLE, MABB p 1639. \00 0 YPY a, TORN, OF � BARNSTA13 BUILDING : eS�PECTOR APPLICATION FOR'PERMIT TO ... ..& zI 77/7/9 ....... ....Y.................... TYPE OF CONSTRUCTION` ..... ...:)4,�c� ..................................................................................... �C�� s ,• ...................... ....19.. TO THE INSPECTOR OF BUILDINGS: ~ The undersigned hereby applies for a permit according.to the following information: Location .... .... f. ..... �7.Ca.�....�....... 1�.....'........1.r. F ....../....'.. ............................:...... Proposed Use ........................................................Fire District ...........Zoning District ..... . l.v./.l!.( Name of Owner .............. .........................`.................Address ...�d. ,...11.l... �c "� :... Name of. Builder- .... ... ..........Address Name of Architect ...................................................................Address Number of Rooms ......... .....Foundation .... Q/l0 1 G1f� n T.. . ... .�...... .. ........ ... .. ..ff... Exterior .......`... C%6�i �5�..... ..:... Roofing . ..� !"/. 7; .f:fllt6 ........., Floors ...........1-Lj! ..................................Interior ....... ...(sv ....... ................:........ Heating ...........(1, ...... ..................Plumbing ......... ....... .l l ............. 'J Fireplace .............:......................:..................................:..........Approximate Cost .....:..:... ®6 a. .: ................:...............,. Definitive Plan Approved by Planning Board ----------------------_---------19________. Area :Ay.�/.. ... Diagram of Lot. and Building with .Dimensions Fee ..7/.— ...................... ...I. SUBJECT TO APPROVAL OF BOARD OF HEALTH d �rvh l� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree .to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ..... . .... .. .. .. .. ............................. WALSH,, WILLIAM BUILD DORMER 23 No . 940................ Permit for ....... Single Fami1X _q............. rr Location ...193 Pitqh�rs .y-4 ................................. .. y.I [..s........... Hyannis .................................................... ........ :�........ ..... William Owner ...........I...... .... . i .................... A Type of Construction .....came .................... ................................................. Plot .......................... Lot .............�! ................ Permit Granted Agri 1...6.t.............19 82 Date of Inspection ...........I.... .19 Date Completed .................... ...........19 PARCEL ID 280 024 ��Et B�1S s ADDRESS ?I TCHER'S WAY P11ONE ` L r 5 k r BLOCK LOT 9ME. r DBA DhVr� LOPMFNT Di RICT HY �{ <. }, u . :PERMIT- �� 64573. DES��RIATI�7N 24 X �2 DECK PERMIT .T` B BA TITLE P,JIL,DI AI:RMt°I' DI fl ;t;Y; CONTRACTORS 'FPv ERTY OWNER M '' Department of ARCHITECTS; Regulatory Services TOTAL FEES:: $30.00 ' BOND 'r ` $:-00 CONSTRUCT?�4STS $3 a 500.00 34 D AD,)/ALT/CONV- L FIR t��TR "` , • sARMNSrABLc, • . MASS. 059. BUILDING,DIVISION BY x f' DATE . D.L. 08/0 ,/2OC1 EXVII RAT ON I ATE �' � y i' r..'^ r ,.— i--yy,,,, ht' k �C-• -�Ih�,nr -_�, s..- ____-. __ 4 , BTOWN .lFA TA.E 1 LD IG �,ARMFy +;+ v.' t..." •.s .�;�,.rr, ;lp '7R1A tt��vvy��e�•; Tpg'i�'11,, �y -� ry �+ T yy, - I . .C?:R33.�il�,CrLt(lb. -L8 rQ'24 'r Vr A SS I�.. # 69+ ATZRESS. .F 1.93. PITCHER'S VAYHYANNIS ,• c�,�'H Y (�,'� LOT •,��,1+�j f_7'[� ^ .LIiJT \ t ¢131-OCK• .I,pT 4�t.L1L' DHA DE EL4P TENT V', - DISTRICT HY r� r i r f.t, Px�MIT. 57 + nESIQTICH° 24 s E bR*$ C PERMIT TYPE BA D ;: : TIT ,�t �' HC7i DINS ;PRRMIT,.,A.DD DECK *x C IN KIGTQRS 'PROPnT# -t D r ARCxEcTS - ;.> epa tment of _ Regulatory Services. s TOTA-1'4?" ORES y ,' 0,00 i' CON$rRUGTIC�i z 'QSTS $3,500,Q4 �D' ADP ALL/`CONV 1 PRIVA�H I ' P • 4 � ,t. BUILDING.DIVISION BY DATE{W ISS�D 0B 0920 z , ExPiRA,TIbN 6 Trs - _ THIS-PERMIT CONVEYS NO RIGHT TO OCCURY'ANYaSTREET ALLEY OR SIDEWALK OR:-ANY"PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICAUY.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 FOUfCALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED,ON JOB AND WHERE APPLICABLE, SEPARATE t.FOUNDATIONS^OR`FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTIO�1 PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMjBERS HAS BEEN MADE.WHERE A CERTIFICATE OF'OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). r PANCY IS REQUIRED,SUCH BUILDING SHALL-NOT BE {" 3.INSULATION: .� OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPR .VAILS _ PLUMBING INSPECTION APPROVALS- ELECTRICAL INSPECTION APPROVALS 2 Al 2 2 9r 0 � 3. 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2`j BOARD OF HEALTH I '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. 14 nz BUILD G PERMIT j�i,¢��, e - d a 'pr a,, r"�", yrr' €,' �' •, - .III . �_ ,� � s . � f �f _ � Gin• � � a a /l-17 �s Town of Barnstable Permit# �� * Regulatory Services �Fe es 6 mo o" e g rY • sntuvsrns[.e, • MASS, Richard V.Scali,Director _._ .._. Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRE S PERMT APPLICATION - RESIDENTIAL ONLY Map/parcel Numbcin Not Valid without Red X--Press Imprint ,, Property Address �� (tel''as Q%� 4.t y&n ni�. "PRResidential Value of Work$ �t boo 04 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address K. y l v% C 1 Contractor's Name LmtwvtczA Telephone Number W`c360. 4�,7 Y 7. Home Improvement Contractor License#(if applicable) 110197 Email: fto<� Co w� C7Workman's tion Supervisor's License#(if applicable) 0 44ftpe Compensation Insurance ' Check one: ❑ I am a sole proprietor Nov ❑ I am the Homeowner 'ajl ''®�n� S7 Q, El I.have Worker's Compensation Insurance � � rN OF A p/�, Insurance Company Name �� i te/ tcL_emo CA ,7/uSMatte Workman's Comp:Policy# L.W C ,q 7r'Tr 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E SS.doc Revised 040215 O„ BARNSrABLS, ,m Town of Barnstable ArFD MA't ____---------_-------__..___ --------- Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I, 1K�'-(Jl I v 61 Lc O O K E , as Owner of the subject property hereby authorize 0�A4I' P Y G,4gluOUd g�1 to act on my behalf, in all matters relative to work authorized by this building permit application for: F NCP� w4y, I OINI S, LOO/ (Address of Job) I Ak - Signa of Owner Date Vl� 61 oe.'E Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doe Revised 040215 Town of Barnstable Regulatory Services soft Tqy� Richard V.Scali,Director Building Division * snaivsTasr 8 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ATEoA www.town.barnstable.ma.us Office: 508-862-4038 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 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 proce es requirements and that he/she will comply with said procedures and requirements. Sign o meo er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 t 1 i .� 27ie ComrnoinveaItli of Massachusetts Dep -rhmevrt of Industrial A.cciderrts - Office of Investigadons 600 Waslhington Street - — — - ti -- --- -- Boston;-? A 02111 -- frvinv.masmgmMia Workers' Campensation Insurance Affidavit: BmldersiContracturslElecfricianslPlumbers Applicant Infar ation OP Please,Print lmbIy Name(Blasiaessorg �zfion&&i&fl): G bl NC b� � CO p GLC Address: 68 Wt N s Co w �� f to _ IJ�• oWr� /M40267tPhone SU:3C0. 2 7 V T Are an employer?Check the approp ' to box. Type of project(regniretl)c I am a general contractor and I 6. ❑New construction 1. I am a employer urith 4. ❑ employees(full andfor part-time)-* have hired th sub-cmmtractocs 2.❑ I am a sole proprietor orpartaw- Tilted on the attached sheet. y- ❑Remodeling slurp and have no employees . These sub-contractors have 8. ❑Demolition worth for me in any capacity. employees and lm a wodaws' [No n;orlmrs' comp.insurance comp-imurance 1 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeoumer doing all work officers have exercised their 11.❑Plumbingrepairs or'additioms set€ o workers' t of exemption per MGL �` � - 12.❑Roafrepairs insurance required]F c.152,§1(4X andwe have no employees.[No vmd=s' 13.❑Other camp-insurance regi iced-] 'Any W5cautthatchedcsbox F1=xLst also faoutthe sectionbeIawshaning iheirWaskere compensaflonpolicyin5rmadoa #Homeowners who submit¢his affidaeu mdkxtmg they are doing all wank and then hire autside contractors mast submit a new affidseit indicating sir h =Contractors tbat cbeck this boar must attached an additional sheet showing the mme of the snit-connzctors mad stare whether or nit those entities have employees. If the sub-cant xctorshace emmpIoyee%thep must pm ride their worken'comp.policy number. I arrt art eraplo}�er that is pro�zilirrg yvorkers cotrrperrsaltcrrt i�srerarrce f or mp*enrptnj es Below is f to policy aril jobs site tnfotnnation. Insurance Company Name: QwM?'A Policy#or S&_ins..Lic.* 1 SZ �'�'T I F-kpiration Date: �. L Job Site Address (`I J � W City/State/Zip: n� �� Attach a�rpy of the workers'compensation.policy declaration page(showing the policy number and expiration date). Fair to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalfi s of a fine up to$1,500.00 andFor one-year imprisonment,as we11 as d%ril penalties.in the form of a STOP WORIK ORDER and a fine of up to MO-00 a day against the violator. Be ad Ased that a copy of this statement may be hnvarded to the Office of Investigations ofthe DIA for insurance coverage verifcation- I do hereby csrlffl,a t e parrs and perlahYes ofpet jruty that the informadon pt m ided abpe is bare curd correct Simature. Date: H r l Phone 0: Official use only. Do not write in this area,fa be camplete.+d by city or totrn official, City or Town: PermitUcense 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrmwn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' Massachusetts Geamd Laws chapter 152 rmpfirs all employers to provide workers'compensation for their employees- P ee is defined as."_. n in the service of another under any contract of hire, Prasaantto this statute,an.�nplay e�9Parso express or itaplied,oral or writ" An wT&yu-is defined as"an individnaI,part a bip,association,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint entErpnse,and including the legal represeniziives of a deceased employer,ar the receiver or txnstee of an individag partnMMhjp,association or other Iegal 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 mafitmi n ce,comtaction or repair work on such dwelling house or on the grounds or bufidmg appurtenant thereto shall not because of such employment be deemed to be an employer." . k MGL chapter 152 §25C(6)a]so states that"every state or,Iocal 3icensing ageizcy shall withhold the issuance or rene*al of aEcense or permit to operate a buiskess or to`consfrixct btuZdings iu the commonwealth far any applicant who has not produced acceptable evidence of coatpliancewith the•hismance.coverage required-" Additionally,MGL chapter 152, §25C(7)states'Neither the commanwealthnor aay ofits political subdivisions shall enter into any contract for the performance ofpublic WMIC acceptable evidence of compliancewitll ijae;ns ce. require�of this chapter'ha em ve beta presented to the conhwth*" nhozity" AppIicar�ts - Please fill out the workers'compensation affidavit completely,by cherl &e boxes that apply to your sitnation and,if i . d umb j-- a ( n cessaryY, Pl sub-contactor(s)nam (s) addre (es anPhone ner(s) es)of T,,�r,�„ce. Limitrd Liability Companies(LLC)or LimitedLiabl7ity Partaersbips(LLP)withno employees other than the members or pmtaers,ale not requited to carry workers' compensation ins=ce. 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 retumed to the city or town that the application for the permit or license is being requested,not the Department of hjdL efrial Accidents. Should you have any questions regarding the law or ifyon are required to obtain a workers' compensation policy,please call the Department at the mnnber Iisind below. Self-insured companies should enter their self-msmance license number an the appropriate line. City or Town Offl ills. . f _ Please be sure that the affidavit is complete and pried IegIly. The Deparfrnent has provided a space at the bottom of t$e affidavit for you to fill out is the event file Office of Investigations has to conEact you regarding the applicant Please be sure to fill in the peffiit/license number which will be used as a reference num aber. In addition, a applicant that must submit multiple pen itllicense applications in any given year,need only submit one affidavit indicating cmrrmt policy infbation(if necessary)and under"Job Site Ad&ess"the applicant,shoLid-z ni _all locations in (cry or m ton)-"A copy of the-affidavit4hat bas been officially stamped or marked by the city,or town maybe provided to the applicant as proof that a valid affidavit is on file for futare pm an#s or licenses A new affidavit must be filled out each year.Where`'a home owaer or 6idLa is obtaining a license or permit not related tQ any business or commercial vent= ( i_e. a dog license or permit to bum leaves etc.)said person is NOT regoi red to complete this affidavit The Office of Investigations would hke to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give as a call. The Departments address,telephone and fax mmulber: _The C<GMDjanve�alt3r of Mass-achnsetls ' 'Ilagartmmt cif Eidnstzal Ao�ents C�Mce of jnVeYdgatio B tm,MA G�111 `Ff,-L 4 617 727-4900 Q�d 4-06 or 1--977-MASSAFE Fax 4 617-727 7M Revised 4-24-07 mass-gov/dia 12.02.2015 16:07:38 Guard Insurance Guard Insurance Croup 1/1 AR Q00JUDI ACO CERTIFICATE OF LIABILITY INSURANCE02/02/2015 MY) `.�'. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA71ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TILE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.!s!iulNa IN-SU ER(S),ALITI(ORITER REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions or the policy,certain policies may require on endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). _ PRODUCER CONTACT fuL,ME• HUB INTERNATIONAL NEW ENGLAND LLC a( o°NI Exllc FAX 4 West Mill Street E•NA1L P.O.BOX 250 ADDRESS: Medfield,MA 02052 It$tlRErldejAFFOaQIhGC IIERA NAMit i INSURERA: INSURED INSURER a: Am GUARD Insurance Company 42390 Roofing 8 Siding Of Cape Cod LLC INSURERC: 68 Winslow Gray Road INSURERO: VlestYarmuuth,MA 02673 INSURERE: IN9URERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TW 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 TER\IS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tTH TYPE OF INSURACCE AysAlywu� POU CY BLINDER V%DDTYYY)�POLICY Eff PVmOTOLICY YYY LIMITS GENERAL LIABRIV - EACHOCCURRENCE 0 DAMAGE TO RENTED 0 CgVkIERCIALGEKERAL LUL"JLFrY PREh+!S=5_IEa o:currenc> _-. -_ CtA'SGdL40E OCCUR VEOEXP(AeyormFEts'.0 $ 0 FERSONAL8AOVINJUfiV S 0 _ GENERAL AGGREGATE S 0 G£NL AGGREGATE WAT APPLIES PER _ PRODUCTS-COMKOPAGG $ 0 POLICY !ECT LCC $ AUTOMOBILE LIABILITY (Ea e" er SINGLE LIMIT Ea 8ctilenl ANYAUTO BODILY DULRY(Per Pvtu!) $ ALLOWNED SCHEDULED BODILY INJ49V IPeraccirfent) S AUTOS -_AUTOS NON-UNNED PROPERTY DAMAGE S HIRED AUTOS AUTOS iPs�xc3-N) S UVBRELLALNB OCCUR EACH OC.CURF:ENCE S EXCESS LIAR CLAVAS MAOE AGGREGATE S C£D R=TENnfON$ $ I-I.I.A.ERSCOMPENSAXION X Y:C STATU- OTH- AND ENPLOYERS'LIABILITY T RY "'S R ANY PROPPoETO:WARTNEWU(ECUTVE YIN E.L.EACH ACCIDENT $ 100,000 B OFFICEf1.'Er.1BEREXCLUDED? �Y NJA R2WC519541 12/20/2014 12120/2015 IMandMory in NN) El DISEASE-EAEMPtO1E:J S 100,000 'f ts.dKnbe under LASCF:IPTON OF OPEPANON9helox E[.CISFAE-POUCYUSi`T S 500,000 DESCRIPTION OF CPERAP!ONS I LOCATIONS I VEHICLES(Attach ACORD 101,Adddional Rtwils S.hedufe.rmorespate)stecIOmd) Exclusions: DimiLri Labko2ich; CERTIFICATE IIOLRER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Johnn Banks Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 26 CDlonia Way Falmouth, MA 02540 AUTHORIZED REPRE/SENTTAATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation License or registration vajid•for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I,Up' . gistration 170787 Type: Office of Consumer Affairs and Business Regulation piration 12r19/2015 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 ROOFING AND SIDING_OFCAPE COD, LLC. . DZMITRY LABKOVICH ?tr__= I 68 WINSLOW GRAY W.YARMOUTH MA Undersecretary f Not valid withou si ature: Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-102600 DZNHTRY LABK *1 68 Winslow Grayltd West Yarmouth 1%A � x Expiration Commissioner 03/27/2017 Town of Barnstable , Regulatory Services " Thomas F.Geiler,Director annrtsrABt�; MASS. Building Division 39- Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 07o1��J �s r PERMIT# D FEE: $ SHED REGISTRATION 120 square feet or less Location of shed.(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# ��67 Si ture Date Hyannis Main Street Waterfront Historic District? t= C-3 a� Old King's Highway Historic District Commission jurisdiction? Q Conservation Commission(signature is required) �� co PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE " r3 ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. �,- THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 to -AppLicanct, G-/ dor lo � Cf-property: 3l annl s I ��.�� =3S _ -off. l � I a 2 suN { Q) � awetrl�� o� � i 9 P I r d eck I I t� i ref 2° 3 flood,pa tuX.- 2 5000! Q20E.D looGL Zone: G ,ZM of jlf,s i + s, J here cent �ttat PAUL I fy this mortgage uis�tl"ort was-prtPar ea 4q-r o T. _.c l x�c yna� Bennett'an 4�-R- -lock Vort-4 e Cor�7. � GROVER LAY Mo Still 910wtv hereatt, does not Pfau. in a spedca {�ooc� ,S at�a wt.tft,aM e{fectLVe daze o f 7 - 2 52 and, ate Location, o� o T y0 the dweturtg a'oeS conFOT-mn rro �e beat . Or d - wt the tune 6FOMStYuctwn with, respect to horiMaws uti e ct' Setbatck or is emr pr-FMt'rt- Vt'Latton, merles ortrz� Scale: 1" = 3o ` =twt-L under Aiass. Genera j aws er1 Or�CerYter2z-' Date: 40 A,-sectton,.7_ File No. Q 7detcrmination TE: The structures as shown on this plot -plan are approximate only. An actual survey Is necessary for a precise of the building location and encroachments, if any exist. either.wav across property lines. This plan must not be cording purposes or for use in preparing deed descriptions and must not be used for variance or building plan his plan must not he used ut locate:propertylines. Verification of. building locations, property line dimensions, fences uration can only be accomplished by an accurate instrument survey which may reflect diffcr;nt information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY- and is 'FOR MORTGAGE PURPOSES ONLY COLONIAL LAND SURVEYING COMPANY INC. 269 Hanover Street - Hanover. Mace. 02';to pNn"— 79, ",c „o-c __ _ . . .. _ _. . . . _ _ _ � _� .___".'/. 1. WrOQF BARNSTABLE BUILDING PERMIT APPLICATION . 'Map � 1� Parcel Permit# 73 Health Division Date Issued � . ®2 Conservation Division %DZA;t_ Application Fee Tax Collector �- .� Da� Permit Fee Treasurer SEPTIC S'c S T UA IIJUST BE INSTALLED IN COMPLIANCE F /� Z Planning Dept. VIIITH TITLE$ Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANG Historic-OKH Preservation/Hyannis TOMB REGIULATIONS Project Street Address Village q\Jrlani`--> Owner Ktu 10 W Laura Q Address AJ Telephon� Permit Request x-i's Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuationQ(� Construction Type -' Lot Size ,o�� A��[/ Grandfathered: ❑Yes 6 No If yes, attach supporting doc smentations s Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) " Y Age of Existing Structure 425' Historic House: ❑Yes )d No On Old King's High ay: ❑is RNo Basement Type: k Full . ❑Crawl ❑Walkout ❑Other ` M Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new d Half: existing_ new d Number of Bedrooms: existing new c-� Total Room Count(not including baths):existing 'IT new First Floor Room Count Heat Type and Fuel: �Gas 0 Oil ❑ Electric ❑Other Central Air: ❑Yes �No Fireplaces: Existing I New O Existing wood/coal stove: ❑Yes �No Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing 0 new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 4 No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name , yl� �� CS� 1 Telephone Number Address 46Y22 .� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM T S PROJECT WILL BE TAKEN TO a i SIGNATUR ,-DATE D 6 � FOR OFFICIAL USE ONLY ;`PERMIT NO. DAT&AISSUED MAP/PARCEL NO. 0,,,ADDRESS y VILLAGE OWNER DATE OF INSPECTION 1 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH • FINAL PLUMBING: ROUGH i s 1 FINAL GAS: ROUGH, = .ys t FINAL ; / 4 FINAL BUILDING DATE CLOSED OUT'. ASSOCIATION PLANNO.- • ate' °FTME r Town of Barnstable ti Regulatory Services rMASS. Thomas F.Geiler,Director 039. 0 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. (� Type of Work: \��(1 �p�( Estimated Cost`K Address of Work: Owner's Name: Liulyr-,A V 1 SCt X _ Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job under s1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor.Name Registration No. O Date Owner's Name t _ --=__ The Commonwealth of Massachusetts - Department of Industrial Accidents =- = Office Of/nrestigalions . 600 Washington Street ; cs' Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit n �OE�O �� O/�0��/, name: I.O n C5`k' (6 � ` location 1"l3�A7Cl 0 r--N Qh Ir T hone# ci I am a homeowner performing all work myself ❑ lamas le r rietor and have no one worker in ca ac�ty I am an em 1 er_ ravidin workers' compensation for my employees working on this job.:::r{::.>:.::;;<;:••:•:,:,::::.r:::::::::..:•,,., :,:,,,•,...•:,•„:: ..:......:.:.: r'; - j>i # ;� %;'i`Sii`i` iii?>` >?fiiY' iiii_;i;isE:''•1{':'i:;:?s:i>ii`ii;>ii:i ::::ii32::''i:?:'::is: i:i::i: ii:i:<ii::: < isii: !;iiip ::i:::Si22:asiY :i:::i:::::isi:i:::i:;:;<:5i:i< isi:::};:i;>; :::<%'+.::•`::'?:i:>i?i:?s:?::i: sn II ' +,••�ss ;.y :':.::":'. ........r;::;+'r•::.:'.} y.;.?;i` ': r:v.::::':'.,i: :; .:'?:;.;i:.:}:;:?}.:4;' ii:::^`i:;i sf;:�S,.:`:':;:;{Ji+i?ii'•'1 ji:;$:>.?;.?:'rr:::>:}::i:>::>.>.':ii`-'.;:j':4:;i:;:;:2;':::i:i-`._':`:C::?isi :.. v.<v. fl%t '':"h n .> >P .... ............:.. ❑ I.am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listedbelow who,._. have ,. . ..::.i:.:.'.:. 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I understand Qiat a' copy of this statement may be forwarded to the Ofdce of Investigations of the DIA for coverage verification -' I Jo herebyzertifyunder the ai and p -of-perjury-that-the-information-pro-ovided-above�slrux and_cair ea _... Date �� Signature - •-�-- rn�/ •.. -- Print name' !�: ..: /_ ;Phone# ' �' /!S 07� official use only do not write in this area to be completed by city or town oMdal city or town: permit/license If OBuilding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's OMce ❑HealthDepartment contact person: phone##; _❑Other (fevised 9/95 PJ4 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 in engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or the foregoing gag J trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a .. . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the' commonwealth•nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. _ PP A licants . the workers' compensation affidavit completely,by checking the box that applies to your situation and Please fill in � • supplying company names, 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 regarding the"law".. 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.peraumeense number winch Vabe used as a reference number..Tlie affidavits may l?e ie tq i ta. .. . . .r. •-. .r .. the Departmen by mail or FAX.unless other arrangements have been oracle: The Office of Investigations would like to thank you in advance for you cooperation and should you have any_q a ons. . Please do not hesitate to give us a call. • , The D artment'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 n7749 phone#: (617) 727-4900 ext. 406, 409 or 375 S(o r 3^r� XWPO 51 --- << DtA r � i - ay la' 0 la5 oc oc o- oc- o- 1 �da)lolzcc7c Cie Inspecct� PIN� Ali cax Cry dor 1�x;at om of-property: Stef .6 . T ' ' ,I I C e 3� >s a Q dvud(143 Pow 193 _ f f, �I 25000I 0008.D ��.114 OF PAUL G J hereby cerri j Tact ttus mortgaga tns�¢ction wczs�r epareAA-For o T. Bennetuhd 1-l�-,e Olook, Vortg e Corp GROVER H cJl � &e 1m s m [ r ,,/ ��1 No 31311 Q -J 1!G LLU f i1Lii e��. !��PiJ��'i ww to Qi s�eCi�.� T /► k�4 /ST Ihamand, cna witK an ejTecttve date Of 7 - 2-92 and, Idte locatibm, ojC� h dweWng Clues canfcmn rto t,e loca.l Eonirig 6y-taws tm ct' fie tune oFCM fi coon wit�t, respect horiuntmL dimert sionrz� Set bG�Gt2 2'+eG�U,�l'e?1 to 1 LtS or is Q,reJ1 l tri V 10 jAt'i oYL mr o-reemura--' Scale: 1" = 3 O dctwry under' A(ass. Ge:�erd laws 4a X.SeCtLom 7. date: �'".�`Y�u File No. D1-()<Q26.. PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments. if any exist. either way across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not he used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". . a COLONIAL LAND SURVEYING COMPANY INC. 7 269 Hanover Street - Hanover, Mass. 02339 - Phone: 781-826-7186 - Fax: 781-8264823 F The Town of Barnstable Regulatory Services g Y Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:I"1� I C1 I rAv ern nn num pbe �r � streetrn (� -7�vi village r�/ l (� "<HOMEOWNER':—L1�I, l T1`� d�� Mx)S'_(1_ZQj' 11( X�-a 1`-t_�O`f�r00 name home phone# work phone# CURRENT MAILING ADDRESS: ��h city town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the 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 p cedures and requirements and that he/she will comply with said procedures and q en Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often.results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN v Q ! I ICA i i o ,E 1pw o ;Town-or arns a� Expires 6 months from issue aair N 'it �\ Fee • `� ' Regulatory Services 9 MA-S& 4b Thomas F.Geiler,Director Cv 3 l i679• � pTF0"10'y JbV Building Division Peter F.DiMatteo, Building CO PRESS PERMIT 367 Plain Street. Hyannis,MA 02601w 9�� Office: 508-862=038 OCT 1 2 2001 Fax: 508-7 90-62:0 NSTABLE EXPRESS PERAUT APPLICATION - RESID Nor Valid without Rsd X-Press Inrpnnt � Vlap.,parcel Number�� ( /L Property Address / 3 �� %Gl l� S �/ //-*/Vlf �'I Q,d d Q _ d Residential Value of Work Q�b i Owner's Name&:Address �7' �, i tea?S G `� /�/�9nfi✓�f /'��4 D�6 Ci Contractor's:Fame Telephone Number `2 s �� itr Home Improvement Contractor License it(if applicable) r } Construction Supervisor's License_(if applicable) l ' ❑Workman's Compensation Insurance Check one: []/4am a sole proprietor U I am the Homeonner I have Worker's Compensation Insurance Insurance Company Name 1 Work man's Comp.Policy Permit Request(check box.) ( ( Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) dRe-side J Replacement«'indons. U-Value ( 44) [� Other(specify) n7G>2 *Where required: Issuance of this permit does not exempt compliance with other town deparcrtent regulations.i.e.Historic.Conservation.:::. Signature 4�L Zvi- Q:Forrris:e.xomrr-r:r.,v-tl70601