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0012 REDWOOD LANE
>r Town of BarnstableBuilding "_»�`w..` .;`."'"� Ps.,ice� ..Kr;.v �'»�""°--'*' � F� ,:��f .s;. st'This<Ca'r<d SoThat'•it is V�silile From the Street, ,A ,''roved Plans',Must beFRetamed on Job and this Card Mustl'be Kept s MAS& ;Posted UntilFinal nspection Has Been Made5, y ' tPermit 39.°' , Where a Certificate:of Occupancy is Required,such B mg shall Not beOccupied,until a Final�lnspection�has been made, Permit No. B-18-542 Applicant Name: Nathan. Tissot Approvals Date issued: 03/20/2018 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 09/20/2018 Foundation: Location: 12 REDWOOD LANE, HYANNIS Map/Lot: 288 195 k Zoning District: RB Sheathing: Owner on Record: GREGORY CHRISTOPHER&LANE JESSE Contractor Narne TESLA ENERGY OPERATIONS, INC. Framing: 1 Address: 12 REDWOOD LANE Y ;Con racttor License: 168572 2 HYANNIS, MA 02601 � � Est Project Cost: $9,000.00 Chimney: Description: Install solar electric panels on roof of existingho us'e'wii,6"ny Perm t Fee: $95.90 Insulation: upgrades,when applicable,specified by Design,To. e Fe'e Paid:` $95.90 interconnected with home electrical system Final: JB-0263822 5.795 KW 19 Panels Date 3/20/2018 ,�' Plumbing/Gas Project Review Req: a °" v Rough Plumbing: A w l -•Buildin Official g Final Plumbing: 1 Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. g All work authorized by this permit shall conform to the approved application and the,approved construction documents for�which this permit has been granted. All construction,alterations and changes of use of any building and structures shalFbe in compliance with the local zohiri by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. . Electrical z Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building,and;Fir6 Off cials are;;provided on this permit. Minimum of Five Call Inspections Required for All Construction Work f , �� y Rough: 1.foundation or Footing • '• 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT " rra Em 1xT1_ 5 C�-d T Town of Barnstable Building � �'.`'," ,✓i �''� ,.w' w,�, �.,;,, � , R �,: r„r �33,. �, """ fix:;z tr,� �,�;� a ^�» ', �s �. '� 4,y,::. �, .s-°r.� Pos This Card SosThat rtyisNi�szible;Fromthe Street :A roved-Plans-Must.beRetamed on Job and his Cartl"Must be Kery'�t ,. ELAUUMABLFY, s' z � y :.".`i z z ;- „" _'.( 5 pp `a '�� .'.,�'-� � sZ'�,.=,�^..t'' y., -; . �' �.F • t' t . 4 Posted Until Final Inspect�onHaseenMade / f y f c«` °� Where a Certificate of Occupancy s Requ`fired,such Building shall Not-'be Occupied until a Final Inspection has beenamade �, .... .a� �,,.ati «.., ,.., .,..,`�.� ,�.;ry w,&..,. .....,,. . ,..Cx'+ . -�« ws9w.... _ , .... �,.., .'.I ,.�.. . .....u,,, 'Z.., .. ....., ...c„nwr„> ...>e.,...,,. ,.w .. ,»>•.,.:,„ :�• Permit No. B-18-116 Applicant Name: RETROFIT INSULATION, INC. Approvals Date Issued: 01/12/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/12/2018 Foundation: Location: 12 REDWOOD LANE,HYANNIS Map/Lot 288-195 Zoning District: RB. Sheathing: Owner on Record: GREGORY,CHRISTOPHER&LANE,JESSErContractor<Name:- JOSEPH J REILLY Framing: 1 x Address: 12 REDWOOD LANE s Contractor License: CSSL-102771 2 HYANNIS, MA 02601 , Est Project Cost: $4,583.00 Chimney: Description: weatherization Y .Permit Fee: $85.00 Insulation: Project Review Req: V Fee Paid $85.00 �'. i Date 1/12/2018 Final: � ' - '- 4 rvr }r f y Plumbing/Gas _y _ �C V Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonz46` this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application aridt,.the,approved construction documents for which this permit has been granted. 11 All construction,alterations and changes of use of any building and structures-shall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will.not be issued until all applicable signatures bythe Bwldmg and Fire Officials are°provided on this permit. Service: Minimum of Five Call Inspections Required.for All Construction Work: - g Rou h: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Workshall not proceed until the Inspector has approved the various stages of construction. final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 188 Parcel 095- Application # �r Health Division Date Issued Z / Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �02- 1`�� wooA L o �y NNE S �ol-C�o Village Owner Address Telephone Lf 6 3 — ot/ Permit Request(1) lay�- .rL!'r 7;nVc C21 �ov� /C!� `.r�✓Qc� �?� �O" 0Y Utir��{Ce—. r-1 her 4Fc liT1;:� f' A-rZ�f- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatioRg Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �-,r' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new .size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o Commercial ❑Yes ❑ No If yes, site plan review# � z Current Use Proposed Use w v APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �P. re (j Telephone Number Address _0 , 2)u License# /dd -2 l L' akc y�-�1 71 Home Improvement Contractor# I Email oCMLV ti 9 Q '2 0 Worker's Compensation # V1 w C,�-oJ_ / C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A jc &'/ncf/a l SIGNATURE DATE /� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,ALL 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansIPlumbers: TO BE FILED WITH THE PERMITTING AUTHORITY.:- Applicant Information Please Print Legibly Name (BusineWOrganization/Individual):RetroFit Insulation Address:PO Sox 105 City/State/Zip:Seekonk, MA 02771 Phone#:508-989-6436 Are you an employer?Check the appropriate box: Type of project(required): 1.[D 1 am a employer with 10 employees(full and/or part-time). 7. ❑New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in ❑ 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 0 Building addition 4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. . 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet., 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6-El we are a corporation and its officers have exercised their right of exemption per MGL c.' 14.❑✓ Other Weatherization 152,§1(4),and we have no employees.[No workers'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 hue outside.contract ors 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 ant tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ' Insurance Company Name:STAR Ins. Policy#or Self-ins.Lic.#:V9WC802160 Expiration Date:8-2-18 Job Site Address:12 Redwood Lane City/State/Zip:Hyannis, MA 02601 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance, coverage verification. I do hereby certify under the par nd penalties of perjury that the information provided above is true and correct Signature*. b Date:. 1/9118 Phone#:508-989-6436 Official use only. Do not rite in th area,to be completed by city or town official. City or Town: Permit/Ucense# 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#: DocuSign Envelope ID:706BCEB5-DD7346F2-A9B3-lA46B4BC336A `Town of Barnstable f, ,Regulatory Services Richard V.Scali,Director• - N Building.Division ,.•. Paul Roma Building Commissioner R' 200 Main Street,Hyannis,MA 02601 r www.town.barnstable.ma.us - - , Office: 508-8624038 Fax: 508490-6230 Property Owner Must _ a Complete and Sign This..Section : HER GREGORY . , as Owner of the'subject property I _ hereby,authorize = :,to act on m behalf, Ile wl� f-• ti J JG-fi y in all matters relative to work authorized by-,this building permit application for: - ` 12 Redwood Lane Hyannis, MA 02601 - (Address of Job) OocuSigned 6y:. - ' 11/6/2011 1 12:30 PM EST- . w . , ... - A616C G55EFt ' tgnature oOwner Date Christopher Gregory 'py' Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form C:\Users\deeollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/1 Z x r ' A. w w�«,� { �i , l Car� tratth afi I�Ischusetts owls of Pro ss�ran��t t ha�r� r Constructs. 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LIABILITY INSURANCE 07/27/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: "If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1780862 CONTACT Diane Carvalho NAME: HUB International New England PHONE FAX 222 Milliken Boulevard (A/C,No,Ext): (A/C;No): Fall River,MA 02721 aDORIEss:diane.carvalho@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B:National Liabih &Fire Insurance Company 20052 RetroFit Insulation,Inc: INSURER C: PO BOX 105 INSURER D: Seekonk,MA 02771 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. INSRLTR TYPE OF INSURANCE ADO JN DL SUBp POLICY NUMBER POLICY EFF POLICY EXP - LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR S 2187653 08/15/2017 08/15/2018 -DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 MOTHER: 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PEST LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ j ANY AUTO A 9100182 08/11/2017 08/11/2018 BODILY INJURY Perperson) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED NONWNED - PROPERTY DAMAGE AUTOS ONLY AUTO ONLY Per.accident $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000 EXCESSLIAB. CLAIMS-MADE S 2187653 08/15/2017 08/15/2018 •AGGREGATE $ 1,000,000 DED I RETENTION$ $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY - STATUTE I I ER - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN V9WC802160 J 08/02/2017 08/02/2018 1,000,000 OFFICER/M EMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Sylvan Road ACCORDANCE WITH THE POLICY PROVISIONS. , 02451 AUTHORIZED REPRESENTATIVE. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit# C 60 Expires 6 months fromi issue date Regulatory Services Fee Thomas F.Geiler,Director X-PRESS PERM, Building Division Tom�erry,CBO, Building Commissioner FEB 2. 1 2007 200 Main Street,Hyannis,MA.02601 3 www.town.barnstable.ma.us T-8V2-V �ARiVSTABLE Fax: 508-790-6230 Office: 508-862-40 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address La.,,7e— J I?A5 921esidential Value of Work <560 , Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address On 12 Contractor's Name' Telephone Number����I R� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor M-<am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) V�e-roof(stripping old shingles) All construction debris will be taken to r ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers � �ib t L i P Please Print el Applicant Information P Name(Business/Organization/Individual): /"' z� Address: Q / ef2 41 City/State/Zip: Atteol__Is f Phone.#: ?d Are you an employer. Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6• New construction .. employees(full and/or part-time). 7, Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ g ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 11.❑Plumbing repairs or additions 3.[ am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12:[ oof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers 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 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: 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 criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Oe / U Phone / U 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. Purr_uant 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 or tee of an individual,partnership,association or other le amity,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"alllocations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would 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. #f 17-727-4900 ext 446 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 w.mass.gov/dia Assessor's Office.Qst floor Map ,Lot Permit# 4 6 02 ce' bk_ agg-195 I N / Conservation Office(4th floor) Date Issued Board of Health Ord floor (8:30-9:30/1:00-100), r 1 Fees UST ISE Engineering Dept.(3rd floor) House#1 PZr �� � lY SEP'�'I�:SYSTEM �7 CE IALLED IN C Planning Dept.(1st floor/School Admin.Bldg.) WITH MIre �' Definitiv an r ved by Planning Board 19 a6 � TOWN OF BARNSTABLE Building Permit Application Project Stre ress �&2.4 Village /S Owner Address 4,cpn J7 ZA AAS Telephone 7g: /FrF Permit Request z Id-I/� C yl c cqe S C o-F -1h r / P3 Total 1 Story Area(include 1 story.garages&decks) _ square feet � a..,f�, Total 2 Story Area(total of 1st&2nd stories) / QQ square feet Estimated Project Cost $ a.0 000 , Zoning District Flood Plain Q Water Protection ,O Lot Size Grandfathered? U 25 Zoning Board of Appeals Authorization Recorded Current Use - Proposed Use Construction Type Ca e-, Commercial Residentials� Dwelling Type: Single Family6 Two Family Multi-Family Age of Existing Structure J_( /KS Basement Type: Finished Historic House ? Unfinished Old King's Highway !V Number of Baths No.of Bedrooms I Total Room Count(not including baths) First Floor Heat Type and Fuel ©/ Central Air kip Fireplaces Garage: Detached Other Detached Structures: Pool Attached A Barn None I/' Sheds ,V Other Ay0 Builder Information Name <1 C-41nrJ Telephone Numbe rCc Ig _L07 433 Address /� License# CC � Q[a.3 SQ�L(71� A� �/! Home Improvement Contractor# se n�p/�co/ Worker's Compensation# /i i i /0� (V1rKr-y1and &,Lxl 6 1� 01q- d9' NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT.ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6 F___-_ SIGNATURE t I/ V �( � DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) `FOR OFFICIAL USE ONLY R PERMIT NO. 4862 DATE ISSUED -June. 9, 1995�� r _ MAP/PARCEL NO. 288.195 ADDRESS` 12 Redwood Lane :~; VILLAGE Hyannis," , .02601 OWNER Lynn Ohrn DATE OF INSPECTION: FOUNDATION r r� FRAME INSULATION A FIREPLACE ` ELECTRICAL-,j ',ROUGH FINAL PLUMBING: . ROUGH J FINAL `~ _ GAS: ROUGH FINAL ! - FINAL BUILDING ` `.=.v +� f T - �• tom.. DATE CLOSED_ OUT - r ASSOCIATION PLAN NO. ,'' W .• jy f To ` Date �� L� e _ WHIlrE YOU W= OUT M of Phone Area Code Numb Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOU ALL IF Message y( / G ' xv Operator AMPAD 23-021-200 SETS �t] EFFICIENCY® 23-421-400SETS CARBONI_ESS 11%02'9d 17:02 V6177277122 DEPT IND ACCID Q00: y =J� Corn. ,-wn[ueatdl o/ MalJaclzu�ettj 2apartment 01 J-.cLEria —A iLi 600 Wu�lon Stmet UostoJames J.Campbell n., /// m—L"&d 02 f>>; Commissioner Workers' Compensation Insurance Affidavit eaoensedpermarft) with a principal place of business at: I'S-on Sq4 w cj�\ (Gcyistmezia) do hereby certify under the pains and penalties of perjury, that: () I am an employer provid'mg workers' compensation coverage for my employees working on this job. insurance Company Policy Number I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number {) I am a homeowner performing all the work myself. I understand that a copy of&,is statement will be fo'v;arded to the Office of invesd7.2rions of the 01A for co-%rerage verification and that faiiure to secure covt,age:s rec:i,,-ed under Section 25A of MGL 152 can lead to the imposition of criminal penatties eonsisdn¢of a fine of up to s 1,s00.00 and/or cr. years' impriscrr.,ent as well as civil penalties in the foum cf a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this day of _6 19 e,ij M � 1 — Licensee/Permittee Building Department Licensing Board Selectmens Ofice Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 __ _ mnT— — n A T11T70TA IT T` ITITT IT III IVDMTT 11 - 1lSlG tlN 'KJI�ONtl� 3 80 NOSIOtlN 8I � N30R 3 03VN3I6 a 91 .01 papljjsly :Saltdz3 i 3SN33I1 BGSIA83dU N01.13081SNOG j ni33tlS OI18(Id 30 IN3NIM30 Nu -1 �._ The Town of Barnstable • sAexsr�sr.e. - KAS& peg Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office:'508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. TypeofWork: Re (aCfb)d)y% Slob Est.Cost Address of Work: ( Q e-e �,J�6 `n I�� Q i (_z, (�D A . Owner Name: n n R r1 Date of Permit Application: �1 S I hereby certifv that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: O Vh TA Y ► �R 1 I � 2 Date . Contractor name Registration No. 0//b OR ' V Date Owner's name !n>rALTH OF MASSACHUSETTS Board of Building Regulations and Standards Transaction No. - One Ashburton Place - Room 1301 Boston, Massachusetts 02108 s ° Application for Registration as a Registration No. Home Improvement Contractor or Subcontractor Effective Date MGL Chapter 142A, CMR 780-6 Expiration Date FOR OFFICE USE ONLY Date 1. Name — C,k Q'(Z VY)01i'n Print the name of theindividual or business applying for the registration(not both) 2. Mailing Address I Yl ro Q ice{,( C,0 f V�_, (SO L•p 1 STY S 1/33 Area Code dt Telephone Number 3. City �9`�l �n t� w I C/`� State � � 7�p 0J 4. Street Address(if different) Print street and Number(P.O.Box not acceptable) City State Zip S. Applicant type: 0 Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation (See instructions on back regarding enclosing a city/or town registration under the DBA or"fictitious name"law-MGL c 110,ss 5 8t 6) (see instructions) 7. Number of Employees / � 8. Individual responsible for Home Improvement Contracts ► ' 16 rr) R I e h k rz,4 C ? Last First Mi 9. Title of individual responsible for Home Improvement Contracts 6 tJ h-(.V/. 10. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? ❑ If yes,complete the table below. Use additional paper if necessary. Yes No Type license or registration Issued By License or Expiration Name of License Holder registration number Date Con -4zL,C V,11$ No 13. o Guaranty Fund fee enclosed:$ Include two separate certified checks or money orders-one marked"Registration Fee, one marked"Guaranty Fund". ALL APPLICANTS MUST INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE See instructions on back for amount of fees. Make all certified-checks or money orders payable to"Commonwealth of Massachusetts" Pursuant to Massachusetts General Laws Chapter 62C section 49A,I cert*under the penalties of perjury that I, to my t knowledge and belief,have filed all state tax returns and paid all state taxes required under law. Signature of.applicant or applicant's representative Title held with applicant A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration. APPLICATION FOR PERMIT TO INSTALL AND REQUEST f 1 FOR ELECTRICAL SERVICE . Inspectorkof Wires r Wiring Permit# 4 COM/Electric # 310 5 3 9 Town.of /1 NSA Massachusetts Building Permit# r B Date Customer: L (�/V/V a�/ on (Street #) C �1-'D GL/O17"13 Z�, Lot # in the village of _ 1 11 utility pole number or underground number Y s j Customer's billing address Temporary New installation - Chinge of service Starting date Job description l�!`)�Lf�L(� �7df 1/ �F7� Sew t//C, Service entrance voltage /a'.0 "/ Amperage f�O Phase Wire size(cu.or al.) Conductor per phase Number of meters 1 Water heater - Off peak: YesNo— Estimated load:Electric heat kw,lights kw, Range dryer Motors, H.P. &Phase Ready for first inspection Ready for final inspection Electrical Contractor%/i 71I e O J/-lp" A7 4 C_/7�te (&f ic.# ,+ Telephone # L/ 7 7 51) Address 7, //196W S 77V /*/G L S r Additional Remarks: , Do Not Write Below This Line / ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS DATE FEE CHARGE Temporary Service Roughing in Service and Meter Off Peak Meter Final Approval /2���'. ✓�✓� Disapproved' ,For the following reasons zr, CERTIFICATE OF INSPECTION Date To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been.completed and has this day been inspected and approval granted for connection to your service. Inspector of Wires t WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION E Permit Good For One Year From Date Of Issue CA 46 a INSPECTOR'S NOTICE Deporrr cn( of Public Sofcryr oeeopax�tr..Cbeetaa__ j` BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3190 Oemblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK M aork to be pst{orened to accordance v"the Haaeacbvaatts Electrical Code.S27 CMR 12:00 (PLEASE PRIHT u nm OR '3TPE ALL THFOIiK=OH) Date f.-- TOWN OF BARLISTA.M.E. :o the Inspector of Aires: The undersigned applies for a petmic-to rerfora the eleccricsl wank :escrlbcd below. Location (Street 6 Number), / / 2- -2 ZI Owner or Tenant L Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building LCAI&26L4/Z Utility Authorization 90. Existing Service Amps ZC1 / Z d r Volts Overhead o'-Undgrd❑ No. of Meters_ New Service Idd Amps /7 d / 2 0'd volts Overhead Q Undgrd❑ No. of lleters_�_ Number of Feeders and Ampacity F&WA /Oze-- -, Location and Nature of Proposed Electrical Work 11-4 (l/Cl'% Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers XVA x1lA No. of Lighting Fixtures Swimming Pool Above In- grnd.❑grnd. ❑ Generators VA No. of Receptacle Outlets No. of Oil Burners No. of Faergeacy Lighting 8atte Units No. of-Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Itons No. of Detection and Initiating Devices No. of Disposals No. of Rea TocalTons Total No. of Sounding Devices No. of Dishwashers Space/Area HeacinR RW NDeteetion/SoundingeDevices icial No. of Dryers Heating Devices' XW Local❑ CConnection❑Other No. of Water Heaters KW No, of No. of Low Voltage Sirns Ballasts Wtrinit No. Hydro Massage Tubs No. of motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Lia lit Insurance Policy including Completed Operations Coverage or it equivalent. YES�NO U I have submitted valid proof of same to this office. Y0 6 No ❑ If you have checked YES, please indicate the type of coverage by cnecking the appropriate box. INSURANCE LLJ BOND ❑ OZNER ❑ (Please Specify) xpiration ate Estimated Value of Electrical Work S Work to Start 7 S Inspection Dace Requested: Rough Finn C� P�v�� ��1 Signed under the penalties of perjury: FIR!! LIC.•.t0._ /� Licensee ✓1.7Z/ e- Signature LIC. NO. Address ZChOAPIA&/N1 /f7 W-11h �l/er�✓I�/Z� � Alt. 2e1. No. �-- OWNER`S INSURANCE WAIVER: I an aware that the Licensee does noc have the insurance coverage or its su stancial equivalent as, required by Massachusetts General ws, and tbac my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent L Assessor's map and- lot numbir .. ..:.... �I� 4 ell Assessor's Y Sewa �ge Permit number .....S.l.......L, / GUtt.�oia 'T"ET°��, TOWN OF BARNSTABLE Of ro w fw �y t BABH9TSBLE, i a�a N GURDIAG INSPECTOR9�p 03q. APPLICATION FOR PERMIT TO .... (.... .................................................................. TYPE OF CONSTRUCTION ..... ... .. t .............................. ' t I r TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby, applies for a permit according to�t(hee following inform tion X Location .... K.GIl. ��...... ... A,,/ � .......... ................................... ProposedUse . . ................................................................................................................................... ZoningDistrict ........................................................................Fire District .......... .. .................................... ... Name of Owner ..................Address .. .. ... . .. . . 4A........ A Name of Builder ... .. . .... Address .� .. .... .. . /1�....... . ..... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ... ... .. a . ...... .................... Exterior .... .GG� ...................................................Roofing ... ... ... ................. ....................................... Floors ................... .................................................Interior .... ... ...... .. .. ..... .... ........................................... ....Heating ...�%?� .... .................................................Plumbing ... ...... .. .. Fireplace ...Z ............................................................Approximate Cost ......".._ Definitive Plan Approved by Planning Board ------------_------____ - -------19--------. Area ................�....... ........... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f� 7 Ir�Js-'�sr.,Y:!'"rYJ�". � -`°�.'t'.►=r'�'- ex�^�' '4r = '�' s {. •�' v.-,-- ^..i�,• i. - ""i".�,.,�,,,,., -.u„n..;....�;.-.-� .�;'- ni.: n: '•,,..+:-.-'..r-'.-..t- �i`- ^s-'- ram••- S` 4t hereby-agree' to conform to all the Rules ands Regulations of the Town of Barnstable regarding fh;.;,above construction. `° - - ----Tr - -~-'t - -- — _- --- -=- � --�--- ' Calm�zm° Wilfred ' ` 20244 ' ��d to dwelling ' ' No -----.. Punn� for ------------� . . .-------------------.-.---.-- pJ-Re�-n�� �a �ocLocation �--- .--p�--�m-------..r---. _ ............... .................................... . Owner .---..Wi .Calouzs__.__,.__ . . ^ pe of Construction .......................................... . - � --'---'--''-'~'~^'-'--^`-~'r---' � -----.�_—_. �a .---------- v . �ronx*6 --.-y�m/-�� ' --�.]g 78 -' --' '7-'�' ' ' r \ ' of | -' lg � ' � 0 � ' PERMIT REFUSED ~ ` l�~'~'r-~^~—~'~-`-~---'~~'~^^^'- -.-----.._..-.--...~.---------. / ^ . . ! ^ - ' ' ` ` ^ | | ~ Assessor's map and lot numbe .................. N , f i � 1 Sewage Permit number ...................................r. ..:.........:..... i - Q�o�TNEro�° TOWN OF BARNSTABLE • � r l M"STADLE, i M6 9 BUILDING INSPECTOR ... 'E'p yPY�'• ` APPLICATION FOR. PERMIT TO ..........,....6....... �! C.. f.�.....L...................................................................... I ��/ ? %7 l/..[:fit L� TYPE OF CONSTRUCTION ..................................................................................................................................... .......... /4'...............................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........................................:............:......:...........................'.............. :..........:.............................................................. ' Proposed Use ....:........,. ................................................................................................................................................................ .........Fire District .............:....Zoning District ................................... -............................................................ Nameof Owner ........ ......:..f............. ....... �f........................Address ...................`................................................................. Nameof Builder `..............................c.....1.:.l....:.....:..:•.............Address .................................................................................... Nameof Architect r:.... .............................................Address .....................r.............................................................. r � , Numberof Rooms ......................................Foundation ....... .. `.............................. ............:....................................................... Exterior ..................:...:....j:......................................................Roofing ....... .....................................: Floors .................................................Interior - f s Heating '........................:..........:.:...........Plumbing ................ : - - Fireplace ...........„.....................................................................Approximate Cost .................................................................... ... Definitive Plan Approved by Planning Board -----------____=______ ^~ 'f 19________ . Area l=' r �. Diagram of Lot and Building with Dimensions Fee ........!.................................. 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. Name .................................................................................. I ' Calmus, Wilfred A=288-195 20244 add to dw 1 ng No ................. Permit for ........................ .... � .............................................................................. Location ... .J�3edwood Lane .......................................:.:................. . + Hyannisport ................. .........................................................Owner - Wilfred Calmus _ frame Type of Constructio .......................................... F .................................. ........................................... Plot ......................... Lot ................................ • ilk May 26 78 Permit Granted .............................19 I ` Date of Inspection ...:................................19 Jt. r Date Completed ......................................19 PERMIT REFUSED I ..................... ......:........... ........................ 19 " f .......... .. .. ............. .................................�...... .. ......... .............. - y ................................. ............................................ Approved ................... ........................ 19 ...................................... .................. ....... a ... .t.�:.i.. ......................................... ' �- n