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Home My WebLink About0125 PLEASANT STREET --` _ .�'� �� . --� - - 'y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION d a��3 6 Map Parcel' `: - � Application /3 Health Division v ; Date Issued b U -0 Conservation Division Application F �G � Planning Dept. c - Permit Fee 5� s Date Definitive Plan Approved by Planning Board ►� Historic - OKH Preservation/Hyannis Project Street,Address Village ` wner Ol�� l.l. N Addre3 Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed _Total new Zoning District Flood Plain Groundwater Overlay ; Project Valuation �� Construction Type ca I Lot Size Grandfathered: 0 Yes ❑ No If yes, attach subrting coo umentation. a Dwelling Type: Single Family ❑ Two Family Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's ighway`-❑Yes ❑ No -c- co 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 0 new size—Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑'No If yes, site,plan review Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name IBA- L— Telephone Number Address License # `"� �t )C Home Improvement Contractor# <C� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE — a . :r ,s �Ot 3 FOR OFFICIAL USE'ONLY APPLICATION# i DATE ISSUED f I MAP/PARCEL NO. rw r I I ADDRESS VILLAGE OWNER , DATE OF INSPECTION: y t , FOUNDATION I I FRAME INSULATION i FIREPLACE R ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y ,z DATE CLOSED OUT ASSOCIATION PLAN NO. I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance AfSdavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Le 'bl Name(Business/Otmization/Individual): Address: City/State/Zip: 4 Phone.#: - ��—`4 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I mployees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2. I am a-sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. (]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.-insurance comp•insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I qu a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions am 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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirial penalties of a fine tip 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 mi stuance coverage verification.. _ I do hereby certify under the p ' s•an ' s of perjury that the information provided above is true/(an�d(�c/orrect ti V p Signature: r Date: _ Phone Official use only. Do not write in this area, tb 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 Ins' tr,ucti®ns 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 o a dwelling house having not more than three apartments and who resides therein,or the occupant of the owner f P g , g dwelling house of another who employs persons Ito 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." "eve state or local licensing agency shall withhold the issuance or 25 also states that g Y MGL cha ter 152 "every g p , § �� 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 tor•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 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 ed to the city or town that the application for the permit or license is being requested,not the Department of be return pp ty Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a.valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.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 C6mmonwt~alth of Massachusetts Depart=nt of Industrial Accidents Office of Investigations + 600 Washington Street Boston, MA 02111 TO. # 617-,727-490.0 ext 406 or 1-M-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www-.mass.gov/dia oZVEr , Town of Barnstable Regulatory Services �B RNSTABLE, Thomas F. Geiler,Director ijA s63q. �Qr - , rFOMa�a Building Division Tom Perry, Building Commissioner 200 Main Street,-Hyannis, MA 0260i 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 GcO o CS ei , as Owner of the,subject property � r hereby authorize 4A �"'�°'(l to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) t )6� —7-OF i n Jtu re f wner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. hC/lu 1AC•ll�VAfFR PFR MiRCI(1N �I i Town of Barnstable �pfSHE tti Regulatory Services w aaxxszAst z Thomas F. Geiler,Director MASS. 039. Building Division lF0 MA't Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 wwiy.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 un.dersigned"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 he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify P P several towns. You may care t amend and adopt such a form/certification for use in your communitN. d for vi :»prds.. i License or registration date' If found return to: Board of Builc 4,"-ierui t o»_ I before the exp Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR One Ashburton Place Rm 1301 Registration ,105530 $oston,Ma•02108. 1 Exp�eation 7G17/2008 Il T.Ype DBA,,. NiICYIA€L"A.81NNALL ADDITION S;REMOCD 3F` a3 �I Michael Binnall - Not valid re tiz e i. 25 Geneva Road rr f dm►nistr�4or w� out sign to \q: Deputy A, South Yarmouth,MA 02664-"' Bgard of Bmldmg'Regulatio sand Standards ConstFuction Supervisor License License .CS .4.54,08 a Expiration 4l22/2009 Tr# 11750 �,� tea* Rest•,ict�on�1G#S€�, � r - K,� ' � { I I MICHAEL iA BINNAL 4 j. 25 GENEVA FtD �..- $YARMOUTM MA 0266�4 Cominissonei Shea,, Sally From:, Lt. Don Chase [dchase@hyannisfire.org] Sent: Thursday, July 17, 2008 4:39 PM To: Shea, Sally Subject: 125 Pleasant St OK for the stairs rebuild per submitted plans. Don 508 4� 8695 P,asi�tti JUL-16-2009 16 1S H S & 7 GROUP F AAC?RTGAGS 1NSPFECTION PLAN Y. m ,TI tz tz REGISTERED LAND. SURVEYORS NAA�IZ NANTU � hi®USE ASSQCIA E 41% .75 HAMiM1014D STREET FLOOR Z w�cE�R, MA c�6aa-17z.� LCC��A'd'lDN 125 A&B C—H PLEASANT S"l"f2EE-C�— � PtiomE: 508-752-8A8fi HYA FAX^ soe-752-8895 p" RMT@H5TGRQWP,NET °� DATE 07-•�$—Q$ A Dmason of H. S. & T. Oroup, Inc. SCE_ = 40 w � DCC. 263793-1 1ol REGISTRY BARNSTABLE PLAN 1711¢ D-1 0l WAS tug► ram, PUN eoac,rra marts aa+£tunri of Ate TI A .06 ,LL �HOF at:rEm+ry i►ur tatE tauw:wc�}mcwwmo Tw t!i PLIN.w to Pwo belP1P_L rt p"pWAft�elm Huo WP: I+iale w� tam swm PWA ow-mn. �� ';� 6 D o%07—02�-92 umotgnaty PL#A �' wr �D 4VA7 '� tam Kman zw mm tsa+wamNo&taml oto s my x lr Lam +IDOu�R Ukni DF1PIf a A�ws APE mm SL ot Is Agppt 6 -pi mm 40►+ pCl{tApNilEO,PMOM CAVAVNS CAMPO BE GM niE ABit °INS IIWC um'fl1E MStON 1w THE wFoawandra t vF& N RnAM T -%DTE: LOCATED IN FLOOD ZONE A9. P�ROP�R' Pf�LW� TEboY LAB N 8955'50" W SW32'40" W 151.11' 5.13' F- -------- �__ r®�- -•-^ i BLDG, i c,d Un #125 C-H ; BLDG. It d > L14 A.- Lerr~:-A JL O � w�2s•RIcsrrr OF wav f11 Sam, � �.�t' � N a5`37'50h W r 30.00' N 68*37*60' W o p LEWIS FAY UNE REARIhIG sTArdc� L N 01-2210"" V, 11.52 l 19d'13'04` !N 2.13' Dftwx Ibis.cap+ t�q u c>3:s�sws Spu.YNE. u� a w- M UNDA STONE TOTAL P.01 I s I I ! T-Tli I �1 QV 2 - �, 1 I � V' ! I� i I I ! I y 4 11 { I I f I� I i _ •! I I i i I !1�� r � I .� ; • ; i if j I, III , if !AA rQ UU I � I Tf TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map kM(a Parcel © IJ cat o �Rmzo% Health Division 79I11 'NOV 2'4 rye= I t)at6lssued /Z—q—/3 t0)= �! Conservation Division Application Fee 4(Z-2n Planning Dept. — - -- Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address IQ S P &A-, LI&;A Village S Owner Address Telephone SO2i 771 • aS`3 Permit Request W ki t,�cZ LO-S Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�,00 o 0 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 0 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 II APPLICANT INFORMATION 5 P iZ im K Le �hnQ� w_(,BUIILDER OR HOMEOWNER) )1111 Name 3y,P,o Q. N Ue Telephone Number 508 77 S- 1 7 7 Address � ? Q- A License # C S O o 6 W-18 f 14 LC ltD-3-S r7 Hy �n Pr b a e Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ZZ I FOR OFFICIAL USE ONLY r APPLICATION# i DATE ISSUED - MAP/PARCEL NO. y - ADDRESS VILLAGE - OWNER DATE OF INSPECTION: .s - FRAME t _• H INSULATION t FIREPLACE t ELECTRICAL: ROUGH FINAL p PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL ell FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. L I� , SPRIN-1 OP ID:DS ACORU" GATE(MMMDffM) CERTIFICATE OF LIABILITY INSURANCE 12121/12 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endonseme s. PRODUCER Phone:508-775-6060 TACT Bryden&Sullivan Ins Agency PHONE FAX 88 Falmouth Road Fax:6OS-790-1414 .No.Ett): Hyannis,MA 02601 E-MAIL - - Kelley A.Sullivan ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC 0 _ INSURER A:Associated Industries of MA INSURED Sprinkle Home Improvement Inc: INSURER e •199 Barnstable Rd Hyannis,MA 02601 INSURERC: INSURER D: INSURER E: - "--- -----'-- - INSURER F: 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. MSR TYPE OF INSURANCE POLPOLICY NUMBER MMID �F MWD� LIMITS GENERAL LIABILITY i EACH OCCURRENCE S I COMDAMAGE TO RTEI57 MERCIAL GENERAL LIABILITY -PREMISE FNooa b CLAIMS-MADE ❑OCCUR j y j MED EXP(Any one person) 8--------- { F ERSONAL&ADV INJURY $ ENERALAGGREGATE $ PRODUCTS-CAMPlOP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: JECT I POLICY i PRO LOC i $ AUTOMOBILE LIABILITY LIMITCO eiNgDSINGLE Ea a _-1$ ANY AUTO (. BODILY INJURY(Per person) is AIDE AUTOS SCHEDAUTOSULED i. BODILY INJURY(Per acddent) $ III --- NON-0YJNED I } t (per aocidDAMA E HIREDAUTOS AUTOS t11 i ) -7 — 1 UMBRELLALIAB OCCUR f" I EACH OCCURRENCE i$ — EXCESS UAB CLAIMS-MADE ( AGGREGATE $— — --- DED RETENTIONS I $ WORKERS COMPENSATION ) WC STALIMTU- I TH AND EMPLOYERS'LIABILITY YIN I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE �N I A AWC7004943012013 ( 01/01/13 01101I14 E.L.EACH ACODENT - $ 600,00 OFFICER/MEMBER EXCLUDED? El (Mandatory 1n NH) ) - E.L.DISEASE-.EA.EMPLOYEd ffi 500,000 If yes,describe under 1 DESCRIPTION OF OPERATIONS below ) L E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddMlonal Remarks Sehedule.If more apace Is required)" CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION,DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement,IncACCORDANCE WITH THE POLICY PROVISIONS. Margo Mack 199 Barnstable Rd. AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 Kelley A.Sullivan ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered,marks of ACORD I urt estricted -Buildings of anY use group which. contain less than 15.000 cubic feet (991m1)of vMEL Massachusetts-Department of Public Safety enclosed space, i3ciard of Buil'air:g Aegulations and Standards . , ' d. +{:un<truepnn �urcraie,a License: CS4KU43 Y ' IT, BRAD K SPREQ" 14A LOT11ROPS _ Failure to possess a current edition of the Massachusetts W BAItNSTABLE M State Building Code is cause for revocation of this license_ • ` . For DPS Licensing information visit www.Mass.Gov/ops Expiration Cormnisstoner 1010=015 t - Ofrce of Consumer Affairs&Business Regulation License or registration valid for individul use only :HOME IMPROVEMENT CONTRACTOR before the expiration`dnte. if iiund_return to � '! Istration: Office of Consumer Affairs Business Re ulation �w. ,09 103757 Type.:: 0 t� 'Exp rporatior 10 Park Plaza=Suite 5170 iration: 7/9/2014` Private Co Boston,MA'02116 �PRINKIE HOME IMPROVEMENT,INC E'rad Sprinkle 199 Barnstable Rd +iyannis.MA 02601 Undersecretary No valid witho signature A I , f �pTF{EYp Town of Baru-stable Regulatory Services s s seUzaiXst�, Thomas F.Geller,Director r -Building Divisiofi Tom ferry,Building Coma issioner 200 Main Skree� tfyannus,NLk 02601 rvwrvv:#o�+re.taarns�:ib84.ma:us � Office: 508-862-403S Fax: 508-790-62-30 P rope rLy Owner Must: C;oniplete and Sign ':I`hr.s ;section f• r_.,...rs ing ABuilder t I, �)� LDI,L� / ) , as Ov�q2er of the subject PiDperty her.•ebyautlsoiize Sprinkle Home,Imprdvement to act orimybeblf, in all matters relative to vvorlx ax tlzartr rl by this building permit applicatici for. //j"/J/� //p�fB /p.I/J' ./dam/ .• -(Addxess of job) Signature of Earner, . Date Pruit Nni If Proper Owner is applying for pei-nut please complete the Homeowners License Exemption Form on the reverse side. f AUTHORIZATION I, Matthew Spillane, Trustee of the CAPTAIN QUARTERS CONDOMINIUM 125 PLEASANT STREET HYANNIS, MA 02601 on behalf of the Condominium Association hereby approve of installation of new windows to be done by Sprinkle Home Improvement at UNIT F 125 Pleasant Street for owner Penelope Psomos. o� l November 22, 2013 MATTHEW S LLANE, TRUSTEE CAPTAIN'S QUARTERS CONDOMINIUMS 125 PLEASANT STREET HYANNIS, MA 02601 f ,per The Commonwealth of Massachusetts f Department o De art Industrial Accidents P �. Office of Investigations 600 Washington;Street' < Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers t Applicant Information Please Print Legibly Name (Business/Organization/individual): Sprinkle Home Improvement Address: 199 Barnstable Road City/state/zip: Hyannis, MA 02601 Phone #: 508 775-1778 Ext.10 Are you an employer?Check the appropriate box: Type of project(required): L[XI 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 g, ❑ Demolition workingfor me in an capacity. employees and have workers'; . Y P tY• ' � 9. ❑ Building addition [No workers' comp. insurance comp. insurance.• , required.] 5. ❑ We are a corporation and its ]0.❑ Electrical repairs or additions officers have exercised their 11.❑ Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work myself. [No workers' comp:- right of exemption per MGL' 12.❑ Roof re airs insurance required.]t ' c. 152, §1(4),and we have no employees. [No workers' 13Other comp. insurance required.]. ,- *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. . Homeowners who submit this affidavit indicating they are doing all work and thedhire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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: A.I.M. Mutual Insurance Co. Policy#or Self-ins.Lic.#: 7004943012013 Expiration Date: 1/01/2014 ' Job Site Address: I -le� a �3 . l�y�L� City/State/Zi wt � P 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 insu coverage verification.; I do hereby c nd t s'and penalties of perjury that the information provided above is true and correct. � j � • - �0 Si nature: Date: Phone#: 508 775-1778 Ext. 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'#: TOWN OF BADISTABLE . CAPECOD INSULATION 242 GEC 19 "1' 11. 116 NSSYY'S OUTTERS Mu l." 7YSVSHGSO M775 OYiifgi INSYMIIOH CNlW05 1-800-696-6611 Dlt TS 1 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, NSA 02601 Date: Ca—jI0/1 a• Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ) (Y) (7 ) Slopes ( ) ( ) ( } ( ) ( ) Floors ( ). ( ( 2 ) t4) ( ) Walls ( ) { ) ( ) ( ) ( ) Sincerely He y E C sidy J , President Cape Cod nsulation, Inc. o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3g;wMa ' Parcel Application Health Division Date Issueda- Conservation Division Application Fee Planning Dept. Permit Fee 3� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis q014 Project Street Address Z� 5 �►�1' tic v�( Village Owner d tiO4 0 Address Telephone ��v ' � `��, U Permit Re uest �� /��t�l Z �"l�� dZl 5 �1m �ld�L V5 C�II/` (�d? q e of eh- 64 k -k 6/6 © a rc A C ,5y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type �a 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 it Central Air: ❑Yes ❑ No Fireplaces. Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑misting LLnew&size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: I -� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ .:� C Commercial ❑Yes ❑ No If yes, site plan review# co Current Use Proposed Use " APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name� �� d /�/ 4,ge Telephone Number �� Address �,� ,�l�= l/� �61i /'/,� License # Home Improvement Contractor# /✓d�� Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1�4. 71 U(7/ ' FOR OFFICIAL USE ONLY 41 � APPLICATION# DATE ISSUED ? MAP/PARCEL NO. .y i f ADDRESS VILLAGE i OWNER s 'DATE OF INSPECTION: F FOUNDATION FRAME INSULATION :4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING y DATE CLOSED OUT ASSOCIATION PLAN NO. Spillane&Spillane LLP 508 418 5049 p.2 AUTHORIZATION- I, Matthew Spillane,Trustee of the CARTAW'QUARTERS CONDOMINIUM 125 PLEASANT STREET HYANNIS, MA 02601-on behalf of the Condominium Association hereby approve of work to be done by Cape Cod Insulation at UNIT F 125 Pleasant Street for owner Pen lope Psomos. MATTHEW SPILLANE, TRUSTEE CAPTAIN'S QUARTERS CONDOMINIUMS 125 PLEASANT STREET HYANNIS, MA 02601 'Az Oct 1,9 2012 12: 56PM ATTORNEY PENELOPE PSOMOS 5083620188 P. 2 ARM �34 qto OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at S Gt (Property Address) NY n2 (Property Address) �V4� v �o� ' hereby authorize i0 y) , .(Subco t ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Z,— Date �'1�R11.C � 121�i'� d 2r � d'GS 10 Park Plaza - Suite/5170 l Boston, Massachusetts 02110 Home Improvement Cont.ractor Registration Reqistration: 153567 Type: Private Corporation Expiration. 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC ............._. HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 ..Update Address and return curd. Mark reason for change. I. I Address L 16enewal I I Employment Lost Card >'l:•�I iJ 7l1(vi'U•I:UI I.i llll�lb 1 (Illlic t1(��111 A,Il11lL'r.�ttal ' n nus�uc_/,.Regul�•it;ou License or registration valid for individu! �/ � - � 7 cd44;Wea llefore the expiration date. If found return to: HOME IMP tSVt•`I�I'f` 1`�A b i Registration: 153567 Type: Office of Consumer Affairs and business Regulation -�"�,' Expiration: 12/15/2012 Private Corporation t0 Park Plaza-Suite 5170 - �-:j-, Boston,MA 02116 OOD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS,MA 02601 I.Judersecretary t aIid ith t si tune '- 0 'llcfiusctts A)Cpal-mlent of Pul lic tiafch Bu;lyd of Building Rc-ulatiuns antl stantlurtls` - instruction Supervisor License Licerl> Cs� 100988 tt , L.. HENRY CASSIDY 8 SHED ROW WEST�ARMOUTH, MA 02673 Expiration: 11/11/2013 t IIIII i..1,.:1,•I Trtt: 7620 •- .v I L � I i I lvl No, 1605 v Client#:4597 CCINSUL ACORD,, CERTIFICATE OF UABILITY INSURANCE F DA'rE(MMIDDrYYYY) O71a21z012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMATIUN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.12 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY TtIE POLICIES skI_OW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE I$SUING INSURFR(S),AUTHQRIZLD REPRESIENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:I� f the carljficate hDlder ib an ADDITIONAL 1NSURF:U,the Iaollcy(les)must be endorsed.If SUBROGATION 13 WAIVCD,s,bj,u.:t to the terms and conditions of the policy,cnrtaln policies may ruquha an andomarnent.A statement On this certificate does nOt confer rights lu(he C6rHficate hglder in IieU of Such dlldpr'90men((S). NRDuucEu Rogers&Gray Ins. -So. Dennis NAME: Mar paret Young ---- P" Ex :50e-760-0G02434 Route 134 _ FAArXc N.17 E-MAIL 817-816.2'156 -------_..�_ South 01 mlis, MA 02660-1601 506 398-7900 _ INOURERIO)AFFORDING COVERAGE I NAIL H — - WSURI;RA I Peerless Insurance 10333 INSURED ------- Cape Cod Insulation Inc INSURER B:Evanston Insurance Company 455 Yarmouth Road INSURERC:Atlantic Charter Insurance Hyannis, MA 0260.1 x INJURER 1):Commerce Insurance Company 347�t _ INWRER E: _ INSiJHER F; --- COVERAGES CERTIFICATE NUMBER: - _ REVISION NUMBER: TFII8 IS TO CERTIFY THAT' THE POLICIES OF INSURANCE LISTED I'LLOW 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 HAWS BEEN REDUCED BY PAID CLAIMS. IA'R ADDL SUER All TYPF;OF INSURANCE POLIcr NUO1" S POLICY Em MMJQDIYYYY LIMITS A GENERALLIAdILITY CBP8263063 041011201 EACH OCCURRENCE $1 UUUUOU X_ COMMERCIAL GENERAL LIABILITY pp ��qq TT Erlreo � PaL-M-19 a occurrence q 1 D0 DDD CLAIMS-MADE L_^I OCCUR MED EXP IAnY one pomu) S 5 000 KR80NA4&ADV INJURY 11,000,000 GENERAL AGGREGATE $2.000,0_00 GEN'L AGGHCGA16 LIMITAPPLIE8 PCR: PRODUCTS•GOMPlOP AGG tiZ DUU ODU _ POLICY PRO- LOC fl AUTOMOHILELIABILII'Y 12MMBCKvmK p4/Q1�2p1' COMBINED SINGLE LIMIT Eaaccidernn1,0UU,000 AIJY AUTO BODILY INJURY(Per V.,.) $ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per soeiecnl) 4; X HIRED AUTOS X NON-OWNED PROPERrY5AKI p'k --- "� AUTOS $ (Fdf nccldeDll H X uMeHkLLAunl3' OCCUR XONJ453512— 4101/2012 04/01/201 EACH OCCURRENCE $1 000 000 E1lC1=tib Llge LCLAIMS-MADE AGGREGATE �611000,UUO oeo X RErENT10N 10000 WOHKEtO COMVtNOATION $ C AND EMPLOYERS' LIABILITY WCAOp5259U2 6/3012012 U6/3 11201, X WC STATU, OTH.ANY PROP E.(Ci dp IKvTIvEI'Y�I"N�I r ,•i NIA FL,EACH ACCIOIkNT . l 000 000 I yod,(Rory in NH) E.L.DISEASE-CA EMPLOYEE u ynn,Uew;nOn under _ DESCRIPTION OF OPERATIONS unluw _ ._ E.L.DISEASE.POLICY LIMIT a1 ODU UUU UESCHIP noN OF OPERA."rIONS I LOCATIONS 1 VCNICLES(AUach ACORU 101,Addlilm,nl Runmrks s�h4aw�,II P1VP9 9pgCB I@ fBpgll'9p) "Workers Comp Information Included Officers or Proprietors C.erilticate Holder is Included as an additional insured unctur General Liability when required by written Contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIF$13E CANCkI,LF.A 13EFoRL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROV131ONS. AUMORIZED REPRESENT ATIVE ^� �r ^� t 18B -2010 ACORD CORPORATION,All rights rouvrved. #Sd3049/ Al o11u zb 49/ U5) 1 of 1 The ACOftD name and logo aru rogls(wed marks of ACORD M8384p EY The Common 11 r!1h of Massachusetts Department t,/ inthistrial Accidents Office if,hi vestigations --- 600 ll iN'/1iI1 ton Street Boat,.,:. IA 02111 WWI .r: 1-ti'.y'.9012fillil Wol•licr's court CIlsation Insurance Aftid ,:,t: Builders/Contractors/Electricians/Plutt.1bers �ltllliiuttt l.ufortuilGO I) r I'le kse faint I..egibly :ultt: (liftwu.tis/(hgani.ztuiiul%l.ndividual): r _L UQ t'11)611tcV'Zip:__�1�Y r4 Y? ��a7l%1�6� -Phone#: C `J 15 ` 31c}ou all cutployerY Check tlie appropriate box; _ �Type of of p►olecl (required): I,lot a r.utploycr with ..... tl ❑ 1 ant „ :I contractor and I have 6. ❑ New epnsn'uctitin cwploycrS (full aril/irr hcU'C-fl[IlC).'I`' hired th< ~lit+ .',lmraclors listed on 7. ❑ Remodeling F rr • the a[ta.11:.l Jr,:c[.C1.1[ , I_-1 I tni sole pmprietol: or partnership These sal, .',utt have 81 ❑ 1�ernolitiort iuid Ila- no ctrtployees working tor, entployl:.,,a J have workers' comp. 9. ❑ Btid ling addition [tic in any capacity. [No worlm-S' insulaut ,� 10, ❑ Electrical repairs ur ddditiulls c nnp muttancc rrcluired.J 5: ❑ We arc I t,�i,,,'timion and its 11. ❑ hlurn 6 but t�1:ours or additions ii olht.er,lia't,. ,xtrcised their right of - holtleuwncr doing all work: exemput,n 1 1 MGL c. 152§(4),and 12. Root`repairs MV: elf [Nt, workers' comp, we have• it, , mployees. [No workers' 13. 011tcr��CCtr�1f'I`jr1CT�1Gl nt5urautCc W(tuilcCl.I 'I- C0111p. Insu(`:ur,.'c required.) s _ ,ns,g)pllrant that checks tzox #I must also fill out the section Wow shown,•IIr Ir workers'compensation policy information. 11,11cuwiWlu•.chic subtrlit this affidavit indicating the-y are doing all won[,.,,„i h'a hire outside Colltlactols must Submit it new affidavit irulieatiug such. it ollimctol that cheek this box must attach an additional sheet showing II,.•n:,;l:oFthe sub-contractors and state whelher or not those entities have:empluyaes 11 li,<cutl autIJctor6 have wnployccs, talcy roust ptvvide their workers'coo 1, 4n number. , i tint an employer that is pro viding workers'compensation m nntnce for my employees:Below,is the policy and fob site tit/urnuttion. ^ (Iy, '�/�`'/�/� /� I111tlltl1lrC l.'onipany Nat : A �ry( I 1�! ��t , _1^ j 0nl l yte—e `- 6t -- — I' hay it tit .dell-ins. L.ic. #: � � �._.. .._. Expiration llate: city/State/Zip: "��7 ----- Attach a copy of the workers' compensation policy declaration page i.hocring the policy number and expir•atio i date:). I�litu.to,ccnlc ruvcraoc as rccluircd under Section 25A of MGL c. I 5m Icad to file imposition of.criminal Pcnaltics of a fiuc uP to$1,500.U1 au<Uul nt -year Inlprlsuntnrnt, as well as civil penalties in the form of a STOP\hi IRI:ORDER and a fine of up to$250.00 a flay against-rite viulatut. Be advised „py uF this>tutcmcut tnzt e forwarded to the Office of Investi,..n.,,,;„i thz DIA for insurance coverage verification. l du here c if uruler the ins and penalties of tArIuty that the information`pr vided above is true and correct. i J aCIM —7 i 20(—ul Ujlicitl eta,illy. 1:)u riot write in this tires, to be complett:d oi- :tr or totvrl official Pity of.'Cuwn: I'trnlit/License# Issuing Authority (circle one): I.Board otAlealth - 2. Building Department . 3.Cih;v't l„rn Clerk 4.Electricallnspector S.Pluiubulg 111spector o. (.)the,- Contact 1'crsurr: Phone#: __ a TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION- Map_ Parcel Application:# W7N37 Health Division Date Issued ^l Conservation Division Application Fee Tax Collector Permit Fee Treasurer f Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address a c5 Village�,4"A11.S Owner ��/ve- Address e-, Telephone O -- Permit Request Kcr Vo Glwr� Addd DAli�ats, - Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new. Zoning District Flood Plain Groundwater Overlay *Project Valuation 5� a b 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 Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor RoQM-i ount ` o Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/co I stove:X7 YeF ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑e isting ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U No- -1f yes,-site-plan-review# Current Use Proposed Use BUILDER INFORMATION Name�i» ��Ga,�c/ Telephone Number .5— -9Ol Address i 7 icif ��,�a �9i�f License# Teo�9 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU E DATE f FOR OFFICIAL USE ONLY ;APPLICATION# DATE ISSUED Mk-P/PARCEL NO. ADDRESS VILLAGE OWNER '. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH ` FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 'k ASSOCIATION PLAN NO. �; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govldia Workers" Compensation Iusurance.A>fidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . Address: /e &Af& 6&'Ven .sae City/State/Zip:A&MV Phone.#: <5 0 Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I �,. employees(full and/or part-time).* have hired the stab-contractors 6. ❑New construction . 2.L7 I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' $• 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myselL [No workers' comp. right of exemption per MGL 12.❑ oof repairs insurance required.]t c. 152, §1(4),and we have now �GO employees. [No workers' 13. Other comp.insurance required.] . 'Any applicant that checks box#1 must also fin 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is.the policy and job site information. Insurance Company Name:&Cj Policy#or Self-ins.Lic.#: Expiration Date: / 1 D —D g Job Site Address: IQ<-" City/State/Zip: A 0�6a Attach a copy of the workers' compensation policy declaration page(showing the policy n tuber 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 MA for insurance coverage verification. I do hereby certify er t ..a d r Ities of perjury that the information provided above is true and correct: Si e: Date: Phone#.<S'O 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 CIerk 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, assodiation,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,assogiation or other legal entity,employing employees. However the owner of a dwelling house having not more tliah+.three'apaUinents and wo.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 eiaploy%ii be domed#o,.be an'"employer." MGL chapter.i 52,§25C(6)Falso.-states that".every state or local licensing ag }cy shall wlthho'�e�, to 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 fm 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, 1 sub-contractors names ,address es and phone number(s)along with their certificate(s)of �Y,supply insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the m&rii iers:or*Aaytnersy,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;.�oreplete and punted legfbly.,'Tlie0,epartment has provided+a space at the bottom of the•afiidavit fpr.you to fill out in the event the Office of Investigations,ps to,contact ypu regarding the applicant. Please be`sure.to fill'in thepermit/license number which will be used as-a-reference number: In addition,an applicant that must submit multiple pernit/license applications in any given year need,only submit ene affidavit indicating current -= pdlic}� orination(jf'neeessari�)and under"Job Site Address"the applican�should'l;iiii"all-locatioi s 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 homeowner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and.should you liave any questions, please do not hesitate to give us a call. a The Department's-address,telephone and fax number:. ,-'• ''�!h, .\ -+ The Commonwealth of Massachusetts _ Department of Industrial Accid6nts Qffiee of Investigations 600 Weshingtori Street Boston,MA 02111 Tel. #617-727-49QG ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 www.mass.gov/dia tioF,�� y Town of Barnstable; Regulatory Services '�BARWABLZ.$ Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b unstabie.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder kQ . , as Owner of the subject property hereby authorize 1c �L1 0'r, to act on mY behalf, in all matters relative to work authorized by this bi ilding permit application for; , (Address of Job) Signature f Owner Date - y Print Name Q FO RM S:0"W NF RPERMIS S ION '" fi w. i«r A//�14M' 'i!° � ,«,.ey g�tilt'.. g •dr.,,qd ,r _ _ o * .°. .,«gyp .¢.;. •= a ;p . >bRw.. .. a� r a t i W-7Z, �IaIS 41, ,.eM ara�r# pE�' 1r 'aEJ4 � S.,q° '1�,"lh...z A %i.. .M,. *' 'a..a.rea"MW"rr '"�"1' ;.+++ r ^., i i k+�i+►3> Xl ai+IF L' (iiu� A, t a & ,::' M -..,a* ,i... a ., w e .rr� w �; :•�•+�"w'a w«r�a�w,a,,,,a � .x'}#+"YM� 'ia d€�'a � .�, .:�' �� Ma+ _ ..,... oSx�..r�ri+� 'i,�Nlr � tAaX#A�3s,i i' •-��if ��Y, �% �� r «iIt �y}tf ,x.wiA�# . ' 1 JU LT, r r r C C1r� y_. t#�i6 ..°.� d r„«4au JW]I�a 4 + +iMy- +w ppJ1 .r:..,"':_4,„ " '��, rim � � � i a a«,.L„2gy , �4�•�sre� .pm,,..ab+�wu�.�hcar�IWawa`aia$ot�,u � d �• I .. .. w #,xaw«asiev.ww+ JA,k- w. a+w.. wwr umrwi � .n. Pd&*i�+�+`�a+i� kFa w « ' r f _e ,. Kwr'_ .. w. ""*. -. ', :' �.a' a x €r4L* :#.*�e++Ml�►^.w�a� 9t,.�EaY,�« +rnt a ,iA 'as a r :' „.-aq+t'' .'«. g a@, k ,tri•�w1y^«�'. Y r1 y,,,,,. , .x x Fr 1 Y i x K e L . t ~M r ;a f a� r a . v n n 1� 'nvwnyy�: ~ l z , r• _ a i 5 s � �a Frns< a n . r e i a � 4 s. F SZ .�, .... ,.� e � ,. ".�.`,r.s wax.:- d a- y•__.: w ... �� - a , 5 a 125 Pleasant St. , Hyannis 8/23/0 6 r g TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map 3A. Parcel Application# dO 4 706 Health Division Conservation Division Permit# Tax Collector Date Issued /07 Treasurer Application Fee lee, Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address .42 C Village �l�tG/.S T Owner �!/,�L —%7 Address Telephone Permit Request G��ICU O�L1l C5,1 z,IXIG! 1"VW Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District 1:1-> Flood Plain Groundwater Overlay Project Valuation G ; eo 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 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: t Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# CD Current Use Proposed Use BUILDER INFORMATION Name-. t��>Cl Telephone Number Address f2Z2 t-6 JZ V C- License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ujaq IDO DATE SIGNATUR � t c, FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS' VILLAGE r t OWNER 3 1 ' . '! DATE OF INSPECTION: a FOUNDATION k FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL P I FINAL BUILDING t DATE CLOSED OUT I ASSOCIATION PLAN NO. M ':z ,J•:l,. The Commonwealth of Massachusetts Department of Industrial Accidents 1 1• 1 Office of Investigations err 1 600 Washington Street \V'e a Boston, MA 02111 t �y www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): &),) p Address: �'6 City/State/Zip: / one#:c5W 7 C) Are you an employer?Check the appropriate box: _ Type of project(required): - 1.❑ I am a employer with 4. ❑ I am a general contractor and I einployees(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. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp:insurance, g, ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.ElElectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' romp. c: 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13,❑ Other � . S/ 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. #Contractors that check 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 and job site information. Insurance Company Name: �� C"7 /v l Policy#or Self-ins.Lic.#:__� Pa `- o� 17e� Expiration Date: 1 Job Site Address:f�� 5 R�7" City/State/Zip: ,/J/�/J 5S 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 herebycertify er e s a nalti of perjury that the information provided above is true and correct. Si a Date: / G Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: -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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self.insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy-information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-8.77-MASW- E Fax##617-727-7749 Revised 5-26-OS w.mass.gov/dia FIKE r, Town of Barnstable Regulatory Services �a►aMASS.Bie$+ Thomas F.Geiler,Director Building Division 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 as Owner of the subject property hereby authorize �c>dd too 4 to act on my behalf, in all matters relative to work authorized by this building permit application for: t (Address of Jot) 17LI 7 Signature o Owner Date f Print Name Q:FORM&OWNERPERMISSION r - Town of Barnstable *Pero? ��y7 Or - I * Expires r6onthsfirom issue date Regulatory Services Fee =)5' , Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �7 Not Valid without Red X-Press Imprint [ap/parcel Number �0(c ropertyAddress 05 P)eaSont 02toO1 Residential Value of Work . ( Minimum fee of$25.00 for work under$6000.00 1wner's Name&Address .ontractor's Name Telephone Number [ome Improvement Contractor License#(if applicable) — -- s hicense4"ff—applicable) ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance tsurance Company an Name v Vorkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. ern-it Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side Q [2""Replacement Windows/ oors liders. U-Valu (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: P operty Owner must sign Property Owner Letter of Permission, A copy of the Home Improven Contractors License is required. GNATURE: !:Forms:expmtrg .evise061306 ems_ The Commonwealth-ofMassach usetts or ADepartment of Industrial Accidents' Office of Investigations t[I*�a shin 600 Wa ton Street g Boston, MA 02111 t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required); 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hiredthe*sub-contractors 5. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp;insurance. g, ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required j officers have exercised their 10.❑Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑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, r ork and then hire outside contractors must submit a new affidavit indicating such. Homeowners who submit this affidavit indicating they are doing all w kContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. [am an employer that is providing workers'compensation insurance for my.employees. Below is thepolicy and job site information. insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: fob Site Address: City/State/Zip: Uttach 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 :me 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. f do hereby certify under the pains and penalties of perjury that the information provided above is true and correct 3i ature: ?hone n2Q — 033 Of 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 1. Other Contact Person: Phone#: -Information and Instructions j 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 pf 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(,$)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 Deparhment.of Industrial Accidents. Should you have.any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Mmachusetts Depmtnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-8.77-11 AS—SAFE Fax##617-727-7749 Revised 5-26-OS tw.mass-govvldia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (�� ( (� -�" Permit# 55 -45 Health Division Date Issued 10-14-057 _ Conservation Division Fee �' Tax Collector Application Fee /01 oe UV Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address boly k s b A— 7'" '] � yN i T`� Village f{Yt "t+ t S Owner O_pL ✓ -fe S llyST Address Telephone !" z1— SA g5tO r. Permit Request S' 63 a S�: �C L° tse C.ts, „c, �� >hip 1✓ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 2��S�y , — 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: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: Cl Full Cl 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 ❑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 Telephone Number- Address l — License# he��.1�/f � �e.� Home Improvement Contractor# Worker's Compensation# %*2P3'2 751�l AA`7 5' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE o? FOR OFFICIAL USE ONLY PERMUT NO. DAE ISSUED MAP/PARCEL NO. - �I ADDRESS VILLAGE OWNER f DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL= FINAL BUILDING DATE CLOSED-OUT a ASSOCIATION PLAN NO. ' 1 ne "mmonweatrn of massachusens Department of Industrial Accidents ' A Office.of Investigations A r ' 600 Washington Street Boston,MA 02111' Y' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Alyplicant Information Please Print Legibly Name (Business/orga=ationandividual): 2 Address: City/State/Zip: — "Ao'j'f 1L`LP Phone#: Are you an employer? Check the-appropriate bo A Type of project(required): 1.❑.I am a employer with 4. T agenerali 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. 0 Demolition working for me in any'capacity. workers' comp. insurance. 9, El Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10. required.] officers have exercised their ❑.Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL ll.❑ Plumbing repairs or additions myself.,[No workers' comp. c. 152,§1(4),and we have no 12. oof repairs insurance required.] t employees. [No workers' ' camp.insurance required.] 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: r Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such GContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policey information. _ i am an employer that is providing workers'compensation insurance for my employees.:Below is the policy and job site information. Insurance Company Name: $ Policy#or Self-ins.Lic.#: nl A 7T Expiration Date: _T Job Site Address: /�S Wo K a, t S City/State/Zip:_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a.fine of ii.p to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. [do hereby certify the and penalties of perjury that the information provided above is true and correct: Si afore: � Date:'. Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4..Electrical Ins 6.Other pector 5.Plumbing Inspector 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 o€hire, express or implied,oral or written." An employer is defined as:"an individ al,..p�Mlii:associatign, Forporation*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 woikbn 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 ofpublic 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, upply sub-contractors)name(s), address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the s members orpartners; 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 comparrimshouid enter their self-insurance license number on the appropriate line. City or Town Officials �. e 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 appl icant 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 permit4icense 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 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 proofthat-a valid affidavit is-on file for:future permits.or licenses..Anew 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 Departnent's address;telephone and.fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents ..Office of,Investigations . ,. 600.Washington Street� . BOAM31 MA 0211 L 'Tel.#617-727-4900 ext 406 or-1,877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www,mass.gov/dia • 5 COREY f COREY ""The R- oolers" % %%tag Calpt C % 4 0; % att J % 7,1 % 1694 FALMOUTH RD., CENTERVILLE, MA 02632 pule t I-Sep - -414% CERTAINTEED LANDMARK '% .-, - RE -LROOFING PROPOSAL August 22, 2005 CAPTAIN QUARTERS CONDOMINIUM TRUST 125 PLEASANT STREET-- UNITS C-H HYANNIS,MA COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles. Remove and Haul Away the Existing Metal Roof Vents and Fill in the Openings with Plywood. Supply and Install CERTAINTEED LANDMARK TL AR LIFETIME: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, 340 POUND ULTRA HEAVY WEIGHT, TRIPLE LAYERED, SELF-SEALING, 110 MPH WIND WARRANTY, CATEGORY II HURRICANE, STORM/HURRICANE NAILED (6 NAILS PER SHINGLE), LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive COPPER/CERAMIC STONES with a FULL 1.5 YEAR WARRANTY AGAINSX ALG E CONTAMINENT COLOR: We l� Supply and Install SMART SOFFIT VENT SYSTEM on the Upper and Front Eaves. Supply and Install SMART VENT OFF RIDGE VENT SYSTEM on the Roof Area Near the Ridges. Supply and Install CERTAINTEED WINTER-GUARD (lee & Water Shield) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves,the Front Dormers, & Under the Step Flashing on the Gable Walls . Supply and Install ALPHAPROTECTOR-SUL SYNTHETIC UNDERLAYMENT MEMBRANE Supply and Install S" WHITE ALUMINUM DRIP & RAKE EDGE on All Eaves &Rakes. Supply and Install —ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. f TOTAL INVESTMENT $ 29,950.00 Payable immediately upon completion. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated'Prim Boards, Plywood Sheathing, Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus 20% and Labor at the Rate of$ 50.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Third is due at the Signing of this Roof Proposal, the Second Payment is due 30 days Later and the Final Payment for the Balance is Due 30 days Later or Immediately Upon Completion whichever is the Longest.. WORK SCHEDULE: All Roof Work is Scheduled for Start & Completion Within 30-60 Days of the Second Payment. Please make checks payable to CHARLES COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and then for 50 Years Total on Group Owned Properties if the shingles are defective. CERTAINTEED Warrants the Shingles up to a 110 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 15 Years. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra charge,over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance upon the above work.. This proposal may be withdrawn by us if not accepted within thirty days. COREY & COREY kcarries Workman's ompe�sation d Public Liability liisurance on the above work � I✓� �,ae%��rx tlAtT 11 1 td��fo�r Ce.rfi�cQ�� o b /�ilv�d-+ee ie��r•4� DATE OF ACCEPTANCE: x;/7w I ACCEPTED BY: SUBMITTED BY: -V\ r�s � Q�4-- 9s), A T RIZED S GNATURE. CHARLES COREY O EOWNER COREY & COREY 05/09/05 10:02 F_,15"5087900249 OLDHAN ASSUC wiVL " •r' Jt�'{C-08f- CERTII+ICA 'E OF LIABILITY INSURANCE cotes 5o DAoS o a PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOLDMAN &'ASSOCIATES INBVRAt4CB ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINANCIAL SERVICES TVC_ HOLDER.THIS CERTIFICATE DOES HOT AMEND,EXTEND OR 933 FALMOUTH RD. ALTER THE COVERAGE McFORDEO BY THE POLICKS SELOW I HYANNIS MA 02602 ; Phme. 508-7?5-6010 Fax:508-790-0249 INSURERS AFMRDINGCLIVERAGE iNm# ago aal fiA NESRF.E>t2+T WORLD i dVStlREfT 8. i . ' . CHARIES COREY C. - -- 1684 FALMOUTH POD 1115 _.._....- CENTERVILT.E DID► 0263 I. _..._..:...._.____. _;__...,.... ._. 1 tn'URER e: COVERAGES i ThEFCLICESTVf:S;)RA:: TE�C�.,^CJt'A 9EfTi:s t:♦:OTOTrcIN$u:tEc:UMEDAEOVEfORTftEPflLtCTP�-RIO'JRtDtCATED NGngfTH3TAt:DRJ3 AMY REQCtE t' ^:i.TEW o'R."OniJ tM GF ANY rC.I1ftA,,:�T oft OTkCR D0CilhF—Vr Wr;H RE3FEC'T:O WNCH TH+S CERTIFICATE MAYBE tsmm OR IAAY PEKTATN,,f IN'jURAl FAFf ORVED BY THE?O.i.ms DESCRIser;tic RER41SSJOjECT TO ALL THE TEFA1S.ExeLUSIONsi;VDCO.fOfTIONS Or SUCH t pot iows A%QREiA-7E LWTS£HMM MFf HAV"c SEEN P---WCr-O DY PAiD CLAIMS. ... 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PAOPERVCALME $ f 1 WcramdmW) GARAGBLmsp.17Y ( Y:FRACCIOTRi !Z 1 #XyAVT.D ` f ;CTtttxRTiuW EA_ACC.I 5 . l AUTO ONLY' AGG'9 FXCESSAlMEVELSALWOKIYY ,I EACH v - _ I OCCURRENCE 'Z Brc:ia •CLA7'..AS MADE ; I A,t3pRF(;ATF S r---- _, .-- tLETENTIot4 WORKE"c016PE.M5ATmMAM � ` T EMPLOYEW LIABRLTY i E L EAC4 ACCIDENT 9 ANY CFAIMiIEYOR'I'APTNERfE%EC'lTM .. ANY FR0MlFl0Tt PAl%T ERfE l Fes.015EAS@-GJa F2iPLOYCCf 3 - t U y68.aesaroc E L OISEAW..POLICY LJMR!D s?ECSAL PROfIL;F(LVS r OTHER i DESCMTIM OF orWATONS.`L13CATIOHS I VEHMUS I Z=I S OAIS AOOED BY END.7RSTu Ron $PmAk PROtJIS1010 COVMN= FOR ROOFING IS =C=ED RUDER TM GLL74BRA: LIABILITY POLICY CERTIFICATE HOLDER CANCEUATION CARTINSA SHOULD ANY OF THE ARDUE DESC1OSED POUCWS 6E ULNCEUM BEFORE THE F.7><pf 7*N OATSTLiFWVF,TNSIWV,14G;SURERWiLI.ENDEAVORTO&mL 10 DAYSWRITn!N kOTICE TO TLi-CERTiricATE WILDER NA6TED TO THE LEFT.BDT FALURE TO DO SO SKA" G'P.RYN SAMUEL WFOSE M,b OaLL6AMN OR LJA3MM OF ANY WID.UPON THE Uf5UROL US P.GEMTS OR FAX 508-362-0175 RFC rATIVEs• PO BOX 441 CMMMAQUID MR 02637 A . ANDi x AC.ORO 23(2001/0e) O ACORP CORPORAnoN im i 4CORD CERTIFICATE OF LIABILITY INSURANCE 05/11/2005 THIS CERTIFICATE IS ISSUED A"'MA F INFO Due= ONLY AND CONFERS NO RWM UPON THE � it7som 2NSI?RANCS HOLDER, TM ATE ODESWrAte, WM OR ALTER THE i0OVERAGE AFFORDED BY THE PDLCIES SOW' lBiTN 8'Y MIGURIERS AFFOW)WG COVERAGE NAIL IY ST YAneDuTS, MA 02673 Im rsuRelA 2�RTffi.111�D INSI4IRANCE al DucknMes, Dba Suckmi T le= ROo£iaq awe: TRAVELUS 5 PitdWws Way .mI1Ra�c tea. !atoms► mh 02"1 )VERAGES BOWpE ►FVICATED. NDTVNTFETANOM FFE f W t[LES INSUAAtaCE USTED BELOW HAVE BEEN ISSUED TOE 1AATH MW AREVEOT T CBMFICATE MAY BE OR ANY RE XXREMENT. TERM OR COF�I M ?ANY OONMM OR R' OO IS SUBJECT TO ALL' THE TERMS EXCLUSIONS AND CAH�fT10N3 OF SLKLi MAY PSiTAW. THE WSU RANC E AFC By POLIM AGGREDATE Ulu rS SHIOM MAY HAVE SEEN FMXLBI BY PAID CLAIMS.IF aw POt1GY DATE TYPEOFt a0uevaRROER ° EwHocomm"m $500,000 ormouILLummm 5/15/2005 5/15/2006 FAQ $50,000 g t;o.Lnaun CP46$95 ; elEo Fxv WrY'�aewart CIA24MWE Flocom pB s 500,A00 i90NALa ADY w�1Y $1,000,000 AWOWM.Coe�AGG $1,000,000 ae/s UMAPFUESP : FOIIGY LOC � OOueN�$tImLELaor s ANYAUIO . eDDLYWARY $. ALLOVMWAu)OS Iw1+omm) SOODULEDAUTOS 90DA-Y6UURY s HNED AUTO$ (her Wdito RpµOWMEDAU[OS FROPERWDAMAGE $ (Pe,aodde�t - AUIOONLY•EAAOCOIT $ IFARWUABLEFY - OTHERTHAN EAACC $ ANYAUIO AUMONLY. AGG $ EACH OCCURR04= $ AG RIEDATE r~ $ OCCUR r—1 CLAVASVADE - b $ DEDUCTMLE is —- tEf9aTMN D AM_ 7PJUB-7430A75 04/11/200S 04/11/2006 X TORYLR®Is ER E.L e�AC COW $1Q0,000 A � E.L UNWA E-MEMKOYEE $100,000 Oe 500,000 � Faot�ueeo,.�s ym E.L0�13E-FDLtGYLAvi $ OTHM o�vtloreoFoverAno�sttocat�s►veaaesteoa )mD�areno��) PWL Ducmulam IS =C=ZD 1?ROM T=3 i ow= aommosm(m POLICY CANCELLATION CERIW"TE HOLDER RiIOW.D AM 111f OOF Tiff BE eEFORE THE EAPJRIITMR Sys Cogy VAL w&21 DAYS wmTm ... - >bITE TIR3lE0F. TM16tNM1D 1648 8AI2OUTS RD_ NW" ro na CERHRrATE mv= TO in BUT FALM TO DO 60 SH" CZWgSRVnm, Mh 02632 1IAPOSE q0 OBUDATMN OR OF ANY UPON THE t 4LM3k 11S AGO= OR BiTA'l1YES. FAH SOO-362-ISSI AlrnwaaEo A � gsACORD CORPORATION t988 Assessor's ma and lot number � � P ................................ ......... SEPTIC SYSTEM MUST BE Sewage Permit number�j�,s/tAli.hf4-1...�C�...t��t Se w�F �• I` :'TALLER IN COMPLIANCE t'."I e H AITICLE II STATE �J 4"T R n D TOWN t y0F7HE T�� TOWN N OF A R NF '- �. rf SS t i BARB9TOBLL i r t� "b q .e�� t BUILDING INSPECTOR YpY 0a ' „ APPLICATION FOR PERMIT TO ... . . ..:!v ©..1, .....�........................................................................... TYPE OF CONSTRUCTION ap `�+ � ..!:1.� L 1 .19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... .. . :.r....... . .. -. .. 5. ta........... .`............ .. .............................................. ProposedUse Z......... . ..................................................................................................................................................... ZoningDistrict .................................. .. .................................Fire District .............................................................................. Name of Owner ! 11LI... .. ......... EA . .. ..................Address ................................... iu7 1 � �e� �S Address a ........................................ ...... i S Name of Builder ....... . ... ............................ Name of Architect ° �I E c...�.. C?t7 .. ..l. Y.]........Address ..�!a 'R ��.C-S.. ... ��..................................... .................... ............................................Foundation .S+.. Number of Rooms .......... ....�- .....- Exieriorw C.. . 1 Y1 �. .............................Roofing I ... ...5.......�1c��.`. ................................................1 ...........................Interior .............. Floors .............. ..... .�................................................ Heating ... ................................................................Plumbing �4 ......................................:........................ Fireplace ..................................................................................Approximate Cost ..../0 r ; ........ ........................... Definitive Plan Approved by Planning Board ________________________________19_______. Area .............. ..... !.!.. Diagram of Lot and Building with Dimensions Fee aG SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ��r- Name . . . ....� ............................... ............ 6y-a-CC J , T__--- Realty . - � . ,16620 raonzdeI J No .............. Permit for .......................... dwelling (2 -----.--'..��--��..��..-------. Location ]�� Pleasant Street ---'---'--------------'' ----- . .................. ............................... Owner .........�f��.��-_------- '~ ` ~�~ .. � - � Type of Cons,rucion ._---.franaa-----.. .~ ` ! ----'----------------------' ^ ( Plot ............................ Lot ................................ � ' ~ Omtx��v� ]L �� h Perm ------_----.--]g '~ � ' ' Date of Inspection .....-----.lV ` Date Completed ...................................... / � ~ / ' � ~ � ��&�� '- , � ----.,-----.----------.. lQ ----------------..---------' ' -----.----'-----.---------..— , ..~---------.—~-------~—..~-- . . . ' . ........................................................... ^ ~ � � Approved .... lQ ' ' ---------------'--^'-------- � 6 - ---------------------.......,, ` \ , Assessor's map and lot 'number ..:....::...... 3 Sewage Permit number I'm y0F7NET0 = TOWN OF BARNSTABLE BABISTSDLE; 9°� "6 9 .e BFUILDING INSPECTOR i , ray s APPLICATION FOR PERMIT TO 'r7 r /�L / T /r�+7 f(Z l C f ! ST//vyl- LJw •/• �.. ............ ....... .............................................................. ....... TYPE OF CONSTRUCTION ....(Jf1[7.a�......./`lJ::?:r�.:............... ................................................................. ,A - / \ Y TO THE INSPECTOR OF BUILDINGS: 7 The undersigned hereby applies for a permit according to the following information: Location �- ..... Proposed Use fir• ^ 1 f do ..... ' ZoningDistrict .........................................................................Fire District .............................................................................. N6me of Owner .:.........:. ,- r ,,:.,�. i�u.r,rc..::.'...'..:...Address ,/7/>.....ir�lF/SG/.w••r...............................................ns `.. � �, ri .:.�:............................. ....... .. .... .. Name of Builder . �• /r.ra.. i C .0 OX./ ? �. �,•,_•SF,� Address .. :? 1._... Nameof Architect ..................................................................Address .................................................................................... ......Foundation ....:�A.�L/L Number of Rooms ............................................................ ............................................................... Exterior .. r..l.4.O c r r/r��1. t f' ...Roofing ./� 1 Floors . ... .............. .Interior .................... Heating �r n x.> >� ................................................Plumbing I�! - t .(Jf 10f r .... ....... .......................................... Fireplace l�il.` !.- �tC . c i/^/F-:..................Approximate Cost �r�.j�:G 67G............................................. ............................................................... .`. .. ! J. Definitive Plan Approved by Planning Board _____________________________--t 9-------- . Area ........4. . ........... Diagram of Lot and Building with Dimensions Fee / �i:�-'.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r r+ J� l: 1 r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding,the above construction. Name , ....✓.r? � `... '/ ..................... A-326-57 Nantucket ,HouSe ASSociates 06 No ..2198.9.. Permit for ...Remodel............. ....Remodel PIP ................ .......................... Location .1.2.5...P.le.a.sa.n.t...S.tr.eet............. .. .... .. .... .. .. .. .... ....... Hyannis . ..................... ...................... ..................... NantucketlHoqSe Assqciates Owner ......... .............. .......................... .......... Type of Construction, ............. ....................... ..................................... .................. Plot .......... I............ Lot .................... Febrjary 12, 80 Permit Granted ................................... ....19 Date of Inspection ................................ ...19 Date Completed ......................................19 PERMIT REFUSED ............. ........... ........... ......... ................. 19 ....................... ......................... .................................................... ................................................................................. ........................... .................................................. Approved .............4................................... 19 ............................................................................... ....................... 4 rAssessor s map and lot number . .... . . -:f j ` $ MM :t Sew6ge Permit numbed/5 .�{�.... ./111��e�/•r•�...• ••• CO. ( �C2`a'- . Via,.. .-usT'sE -� -; COMPLIANCE TITLE 6 TO ♦1 N�' OF` BARNS CODE AL+ AND uo� ?:; Ft N RE ULAT IONS BAHH9�SDL ,i ? 1 0 BrUIDING INSPECTOR (? O 163q. �. Cv OMPYa` .rg 0 (i7 ' r 1i !li .'x APPLICATION;FOR PERMIT TO �—.....IlYCr�:�ld. ..... r: ~' TYPE OF CONSTRUCTION .... .......r:7-14 ..-1,44..................................z........;................:......... 0 � r � .�. :. �r> .....................19. 2?; TO THE INSPECTOR OF iBUILDINGS: x d The undersigned hereby applies for a permit according to the following information: Location �a s �LC 5 -7— S� .......:................. ........................................................................................................................................................... ProposedUse ...4kp.& X....... ...................................................................................I......................... ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner ��14 P? c . .Q.�....Address /G ...... ............ Name of Builder .. :. :.A(U.L'lf - . .. ..............Address ...4'3. C ...gj.j ....�. ... ....................................... Nameof Architect ..................................................................Address ................................::.................................................. Numberof Rooms ...... ........................................................Foundation ....,R! 1."K....................................................... Exierior ..41441.1.0 �................................Roofing ....... ................................................ Floors - -.. .....Ofil�L,r[......................................Interior (� /! E.f,.r �Z i -s5,7'1✓. .. . ..........: ... ..... ... .......... ....................... Heating ..................................................Plumbing ... t.. 0/0. �.............................. Fireplace .... ...................Approximate Cost Y��.�c�r®. ��........ . ... Definitive Plan Approved by Planning Board ________________________________19________. Area //.:..C/ V 7_1�.......... Diagram of Lot and Building with Dimensions Fee 1.CY.................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .. . ............. ...................... Nantucket House Associates 21989 Remodel No Permit for. .................................... Duplex ............... .........................e...................... 125 Pleasant Street Location ........................................... Hyannis ..................................................................:............. Owner Nantucket House Associates, ............................................................... Frame Type of Construction .......................................... ............................................................. ................... Plot ........................ Lot ................................. Permit Granted. ...14t....19 80 Date of Inspection .................................:::19 Date Completed ........................................19 PERMIT REFUSED . ................................................................ 19 . ............................................................................... tool Im hs--01............................................ ................................ Appro .-7................................. 19 M 0 Lids. 15.• ............................ ...VC rn 1J.. ........................... ............ ..... ........ TOWN OF BARNSTABLE 21989 Permit No. _____ _ l susrr..r r Building Inspector Cash ,ew• N/A oral- 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 Nantucket House Assoc. Address 176 Winslow Grey Rd. , W.Yarmout 125 Pleasant Street H annis Wiring Inspector Inspection date . Plumbing r Inspection date Gas Inspector Inspection date Engineering Department NSA 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. ........................................._._, 19— ................. .... ...... . ... .............._. Building Inspector J TOWN OF BARNSTABLE Permit No. suurur, Building Inspector cash Oval► Nf q 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 Nantucket House Assoc. Address 176 kjinsim, Grey Rd., W.Yarmout 125 Pl_e;knant- .9trPat- Hyarm:ic a Wiring Inspector Inspection date ,-�j Plumbing Inspector' - �' f\ /} Inspection date Gas Inspector Inspection date Engineering Department H/A 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. ................................................».», 1^».».»»» ............................................. ................»..........»...».»»» Building Inspector ``�„�•;` �e TOWN OF BARNSTABLE Permit No. _-______- Building Inspector .�� Cash _---____-- 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 ��• '•�'- 1-:xue r,:3sct► Address 175 `!1n-,1Ci Cam ';, rri Wiring Inspector ,, Inspection date Plumbing Inspector 1 Inspection date Gas Inspector Inspection date Engineering Department l; 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. _.........................«.....................-1 19......_ ......................................................_..........._.«......... Building Inspector 1Q1, b�PyOFTHE TOWN OF . BARNSTABLE BARNSTA33LL 0: M639 BUILDIA AO& 'G" INSPECTOR 1 APPLICATION FOR PERMIT TO .........4........cyt......7o-�.. ......?� re.s....... TYPE OF 'CONSTRUCTION :..............IV. ...................................................................... ..........i 97!-.... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned herbby ap�lies for a permit according to the following information: p Location ......./42,6 ........... ...................... 5 , ................... ........................................... ProposedUse ...........7�.q.N....... ............Aer.5........................................................................................ Zoning District .......... .... ........Fire District ....... ................................................ Azamg zf-'y Name of Owner El-l* ... .... .. .. ....... .. Addret .... ... Nameof Builder ..... . .... . . .. .. . ........ es ............................. ......... ................................. Name of Architect ... .. .............. ......... .. ......... .................Address.............Address ...........M.M=F........A069.......... Number of Rooms ............�........ ...........................Foundation & Exterior .............. 4 (e 412 !?e.,.?....Roofing .................�.��X/ ......je .......................................... . Floors ................ t`n..... ...................Interior ................4.5.7%.... ................................................... Heating ............qi As......... ...............................Plumbing ........ ...... . ................... ................................ Fireplace ..................1Xe I-A UA� .6 ................................. .............................Approximate Cost .........7-4--teR....... ........... Definitive Plan Approved by Planning Board ------------------------------ Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH cL IL e c/ ��A/'/5' .4W THE PROPOSED METHOD OF PROVIDING FOR SANITARY WATER SUPPLY, SEWAGE DISPOSAL AND DRAINAGE IS HERE Y AP' R fl-d"VIED 6 tu/*t 04 TOWN OF BARNSTAKE. —--- -- BOAR-D-OF HEALTH EWAGE S A LICENstb—I-NSTA'Lllk bB- 'TAI1q PERMIT, AND IDtSTALL- SYSTEM. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -Fj I/e e— Y 7 RZ1,6e Name ................... T 94tJ-'v Tiller Realty Trust 15430 two story No ................. Permit for .................................... apartment building ,f ............................................................................... Location 125 Pleasant Street ........................H�.anni s........................................ Owner ....... Tiller Realty Trust Type of Construction frame ................................................................................ Plot ............................ Lot ................................ F Permit Granted .........�ugust.2..... ....'1�9 72 - ��I � Date of Inspection ........ .....` /Qj7�• �_ �b2ate Completed .��' � ................. k� . .&fi PERMIT REFUSED ................................................................ 19 ► { 1 ............................................................................... ................................................... .................... 4 _ - ............................................................................... ............................................................................... . j Approved ................................................ 19 .............................................................................. f .................... ......................................................... I C� ON 326 057 n ondommium Assoc. Mq 125 Pleasant Street Ca is ,rs Condos) Umt H, 125 Pleasant St., Hyannis 07 ggqAE nv Captain's Quarters Condominiums. Dock, unsafe. Condo Assoc.won't fix it until after the dry harbor is dredged in the fall. Mr. Clark feels it is dangerous and should be either repaired or removed now. IN' �.*-. ...x-�J.�. ""_ � � � i ' ,^ �: � � �6�� i �� ' -� �� . � � • . '- � , . . a .' . � � - rk ,� ��:� .l � \ 4 `�� y�e: �.. �.. a ` _ ' � ' � Y. e a- �r J "I- f i � Y y 1` y f� �'� •- •�eY.b r+! i .!L l a^ ----�-'� � ` �� I ,� � f ` �� _- - - __ - I