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HomeMy WebLinkAbout0067 SAINT JOHN STREET �' 7 ��91 Atli..T��/�'�l S . � wr n S Y �> TOWN OF BARNSTABLE Permit No. ___ 7g7 _______________ Building`Inspector cash -----— +eia OCCUPANCY PERMIT Bond ---------X. Issued to Gil Raposo Address Lot 7, 67 St. John Street, Hyannis J Wiring Inspector Inspection date �:���y�-"� Plumbing Inspectors Inspection date Gas'Inspector� ���i i r��1't *t • R-f-' i�t .v t •-3�. Inspection date A x Engineering Department !� r . ,,f- r Inspection date Board of Health "�''"�tP ',. ,. .� s Inspection date ' 3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALLk-NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ...................................................... 19.. �.�� ..;:-G�'. ... ..............`��............ Building Inspector .. +i � „ ,5 : e"'.� { . ,r r� ^�-. .. Fir`j` .r . r.y - K, •a t, »;n, s Y.' e TOWN OF BARNSTABLE BUILDING 'DEPARTMENT [ I; DAHdlTAIM i TOWN OFFICE BUILDING ma q' i639' HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department r., DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #._....... s l„,.. � ................................................................................. ...»........»» issuedto .......................... ........ ............................ ......».»..»..»..»»..».....»»..».........».»»»....»»_ PIease release the performance bond. . J r h \ - LOC.gT/O.V .�EFE.ee.c/cE: 2 f,/EBE6y CE,eT/FY T.NgT Tf�E BCJ/LD/.c/F SAV40AV.c/ O.tJ T.N/S AN'4 0Q V /S LOCATED ON 7- Cr _ �E'O�/.Vfl AS SNO WN NEB60.V J _ OF M�C' I 9 •o ARN .- I wry cam en9irreerir�9 g fds �fCISTEAEC4,� ' C/V/L E.VG/t/EBcs /-/C/Gs L<ic/O Sc/�V6YOB3 (Q J Q ,�OG/TE 6A^- .Y�'�.E'MOG/TH, �NASS, a.�iTC- .eel. Diva s�,eVtyoe Assessor's map and lot number _...... F THE ^ �♦ Sewage Permit number ....... .`...�.��.�. S_.PTAC'Sy Z ABHS E. i �,i ^� pp 3 �p y(���9 ,fie �tl�g� g� Be,p B TAl1L House number ... ®.7........... '.' $ .l.irld lll9 w�(if6PFrIA6� 9� t,6 e0� WITH TITLESO'EO MPy d\ TOWN. ®F BA ; " rABI BUILDI G IN CT0 ,. . APPLICATION FOR PERMIT TO ... ........... .. .......... ........ .. ... ..... ... ... ... ....... . ... . . ....................... TYPE OF. CONSTRUCTION r.............. ... .... .. .. ... . ....... . ..... .. ............. ........ ... .................... ............... ............. ......19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to'the foil wing information- Location .�.G. .7... .. ..J Af................................................ ; � ProposedUse ....�,.l.l. ... .< ... ........ �t�........ ��..0..!�.r...... ............................... ZoningDistrict .................. .1.'......................`............................Fire District. ............................................................... Name of Owner ... C..l......(... .... ....... ...........................Address ....... ...... . ... ..!}.lel�.(✓ fr Name of Builder .. !./.....t/. ? ..6� ...........................Address ....................... .l�y1 ,..................................... Name of Architect ..................................................................Address ......... .....: Number of Rooms3. .4"n'?..... ...!,L,''1.... .. .c -...........Foundation ........... ............ :... ........................ e Exierior ...` - .1.!2. <...�-' '' .........................................................Roofing, .......�,1... ... ...9:. ........................................... Floors ... `,��1../ './...�..A✓..`J...................................................Interior ............. ..Y.:... ...�..(J�'.`. V 1 ...... ........................................Plumbin .......... .....4..�?� ......... ..................... rieatingR. .1............ g / �..... Fireplace .............. .........................................................Approximate Cost .�.S....6..0..0.1. 0 ........... .... .......................... Definitive Plan Approved by-Planning Board _____`_________________________19________. Area ...../o ^. .;.............. and Building with Dimensions J Diagram of Lot a g Fee ........... ........,...+.................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 t 40- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....0 .:........................................ Construction Supervisor's License ...� RAP 0 S 0 G1 L Na ...2 924. Permit for ...One...Story......... -Family Dw 11ing........... . ......... .......................... ........... Location .....Lqt...7. .........6.7....S.t......J.ohn...S.t.reet .................. S........................................... W Owner ..Qil...a4p.qAo..................................... Type of Construction .......�FX14MP�..................... ...........................................................*................... Plot ............................ Lot ................................. June 6,_ Permit Granted .....................................19 85 'Date of Inspection. ......................................19 Date Completed .. ...... ...................19 Is q Y A" Jk 7 Assessor's map and lot number -1 ....... ETO 4 Se.wage Permit number ......... .................. BABBSTADLE. House number, ... ..... MAG& ...... ...... . .039- TOWN OF BXRNSTABLE BUILDING I N a.P/E,C T OR APPLICATION FOR PERMIT TO Z, ......... 7 .... TYPE OF CONSTRUCTION ......... ZO ........................ e. .. ............. .......... �� ........... .......... ........ .............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... ......7.............. �7/i to.... ......I'VI ................................................. Proposed Use 4-7 .... .... .. ............................ .................... ..... .................... Zoning District ............... Z'1 .... .........Fire DistrictName of Owner ... .... .......................Address .......7..4 64..kM... ...... 4 Nameof Builder .............................Address ...................... ........... ....................... Nameof Architect ..................................................................Address .................................................................................... . ................................. Number of Rooms l�. . ...........Foundation ....... Exterior .............................................................Roofing ......... 4 ............................................................ Floors ;4f it,A;7. ................................................Interior ............. ........ ............................................. Heating ........... ............................................................Plumbing ...................... ................................................. Fireplace .............kr .......................................................Approximate Cost ....... .....2........I............................................ Definitive Plan Approved by Planning Board --------------------------------19--------- Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 'J 'T OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS' I hereby agree to conform}to all the R6'les and Regulations of the Town of 'Barnstablie regarding the above construction. Name .................. ....................................... ef, !to struction Supervisor's License RAPOSO GIL A=291-270 No ... Permit for ..Qiae...Story........... .......... awa.11dng........... Location ...TAQ.t...7,......6.7...S.t....-John...Street ..................H-y-a niz............................................ Owner .....G11...RapQso................................... Type of Construction ....F-r-arne......................... ................................................................................ Plot ............................ Lot ................................ gune 6, 85 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L,-it does not give you permission to operate.) You must first obtain the nec.essaiY signatures on this format 200. Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA.02601 (Town Hall) and get the Business Certificate that is required by law. DATE: vi 2a Zola Fill in please: VA 111a 607MTk".1m� ', I APPLICANT'S YOUR NAME/S: AAc gf� BUSINESS YOUR HOME ADDRESS: 6'r SP.1NT �o�� Yp(NN�S- > Ma TELEPHONE # Home Telephone Number sue ' �85' 4g9.1 I� ' r�� ,���,:w ©camrJo��•�-�sm GAAA1 n r!.Y+{ a � Email Address: NAME,OF'CORPORATION:` s T.- IS�.l (Zp;gr�C TypE OF BUSINESS �/��2-uCT\QN NAME OF NEW'BUSINESS IS THIS A HOME OCCUPATION?. YES NO ADDRESS OF BUSINESS M hON\S-vim- MAP/PARCEL NUMBER �sessing) When starting a new business there are several-things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is"intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM IS 10 R'S OFFIC MUST COMPLY WITH HOME OCCUPATION This individu I ha e i fob d fQpeit equir me t�y�s that pertain to this type of business. AND R�OD��IO�1S. FAILURE TO �j COMPLY MAY RESULT IN FINES. o ize t rM NTSnAnAut� ti 2. BOARD J HEAL H e of business. at pertain to this that type it requirements This individual.has been informed of the permP Authorized Signature** COMMENTS: 3. CONS UMER AFFAIRS LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: town oI narnsiapie Building Department Services THE rq�, ti Brian Florence,CBO K " Building Commissioner -• • sAxNsxAara, • 200 Main Street,Hyannis,MA 02601 v hugs $ 1659.$ www.town.bastable.ma.us rn - Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: C �CI�J ��'c —� �\ Phone#: Address: ��— SAC/•nT 3Qu N Villager�N N S Name of Business: Q \ h��� CPS N Type of Business:��N�T�Cam\ ^� Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the.dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • -The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residentiaf buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing-the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included • No person shall bg employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have re and gree with the above restrictions for my home occupation I am registering. Applicant Date: Homeoe.doc Rev.06/20/16 Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 11/10/2014 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 ` RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 67 Saint John Street(#201400422) has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. ' Sincerely, William McCloskey , NQI IA1 -319VISOTAO WWI TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V ®a Application #c6a Health.Division Date Issued Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address w x Village /�'I OwnerZC:4, l?1 (4 rao 6 �L ddress Telephone 0 3.� _®CAA) Permit Request j`� .Sfa Lv CtC a� c`1 f L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family UK 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 r, 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: ZIE Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , Commercial ❑Yes ❑ No If yes, site plan review# )i Current Use Proposed Use w' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ` Name /"t, (Itakeyl(I—qvL!�A-Telephone NumberL WO_?�8 02 D Address .c ' �'�'�` J`� License # ! N , Home Improvement,Contractor# A 6 J V 0 Worker's Compensation #/ t/C33� 3 X61, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� SIGNATURE DATE XO — N\ 73P_ Ij FOR OFFICIAL USE ONLY d APPLICATION# . DATE ISSUED MAP/PARCEL NO. 7t ADDRESS VILLAGE F ' OWNER �r DATE OF INSPECTION: } w . 'E _f`:FOUNDATIONs;�r,�-,,s!)ii!,-.4 �itt�.=--. " FRAME k :INSULATION!,,.� . FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL FINAL BUILDING' s l DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts I Nnnt t-orm J Department of Industrial Accidents Office of Investigations =i I Congress Street, Suite 100 Boston, MA 02114-2017 r � J - - ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save,Inc. • Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 17 4. ❑ 1 am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired,the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. ❑ DemolMon • ship and have no employees employees and have workers' working forme in any capacity. 9, ❑Building addition insurance.- [No workers' comp. insurance comp. 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation.and its officers have exercised their 1 l.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp.' right of exemption per MGL 12.❑ Roof repairs c. 152, §1(4), and we have no Insulation insurance required.]' 13.0 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Technology Insurance Company Insurance Company Name: TWC 3353968 Expiration Date: 04/09/2014 Policy#or Self-ins.Lic.#:Job Site Address: l� `� (_ (' /'Q p� ,Ca`vp f T c�a'1q City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure covers as coverage required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 of Up t0$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 tl at tlae information provided above is true and correct. Date -- Siattature: - Phone#: 508-398-0398 Official use only. Do not write in this area,to be completed by city or town official, Cityor Town: Permit/License# L6. ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other.ontact Person: Phone#• '4 CERTIFICATE OF LIABILITY INSURANCE DlD 10/22/22/201313 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 pol)cy(ies) 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 endorsement(s). PRODUCER NAMNEACT Colleen Crowley Risk Strategies Company HUM.IAIC.No.Ext (781)986-4400 FAC No:t7ei)963-4920 15 Pacella Park Drive E-MAIL ADnRFSq- Suite 240 INSURER(S)AFFORDING COVERAGE NAIL Randolph MR 02368 INSURER A:Selective Ins. , OF America INSURED INSURERB:SafetY Insurance company 3618 Cape Save, Inc INSURER C:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURER E South Yarmouth I A 02664 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13102268490 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. 7 SI TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER MIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESO a occurrence $ 100,000 A CLAIMS-MADE rX OCCUR S1994480 0/16/2013 0/16/2019 MED EXP(My one person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 M'POLICYFx— L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 %0 XLOC $ AUTOMOBILE LIABILITY Ee accident SINGLE L 1T 1,000,600 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED` 6208200 1/6/2013 1/6/2014 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED - PROPERTY AMAGE AUTOS Peraccident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 . A EXCESS UA8 CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ U11 1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION officers Included for W�CSTATU- OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ANY PROPRIETORIPARTNERID(ECUTiVE overage E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ® NIA __ 500,000 (Mandatory in NH) rWC3353968 /9/2013 /9/2014 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,.Additional Remarks Schedule,if more space Is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Pro j Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ chael Christian/CLG ACORD 25(2010105) 0 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD , i Cunsi-urtifin 5upenn isur specially _ic nsa: CSSI-402776 J WI LLIAI► J MC CLUSIKE5[., , 37 NAUSE'T ROAD West Yarmouth 121A 0Z673 06/28/2015 MS• ! ygg�,/�f/%•y�yl), (� /'���/��Jf��//g}> f/J/f`{/f,/��/dam ' `_ � �y ���L% I.r'���/C/i/VC/L V'./4 V ���1/ e�O�/Y/if/C/V�1�/��4J`✓YY. C/1%4Y t Office of consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration` 3/14/2014 Tr# 222184 CAPE SAVE INC. - WILLIAM MCCLUSKEY. 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address i_; Renewal J Employment i_I host Card OPS-CAI-0 50is1-04..104-G10121e ,v, ✓fie .r{�sa�n»zcozusealf� c�;.llayrcc�usel� • - Office of Consumer Affairs&Ildsiness Regulation License or registration valid for individul use only _',,•„ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: - 171380 Type: Office of Consumer Affairs and Business Regulation e - 7EZ— Expiration: 3/14/2014 Corporation 10 Park Plaza-Suite 5170 f ` ` Boston,MA 02116 CApE SAVE INC. WILLIAM McCLUSKEY \ F 7-D HUNTINGTON AVENUE-,',.` SOUTH YARMOUTH M-A-- fi4_ Undersecretary Not valid 't o siLyn a Building Permit Authorization I, Raissa Barroso f ` „ , as owner hereby give my permissionto Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to' perform work at my property located at 67 Saint John St Hyannis, MA 02601 R Signed Date 3 d f Town of Barnstable *Permit# Expires 6 months from issuedae Regulatory Services Fee * saaxsr,014 + 9� 3s.1639. Richard V.Scali,Interim Director, Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tow.n.barristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY V O j� alid without Red X-Press Imprint • Map/parcel Number �j`� V ( //--� ,l Property Address o �z r �i�'w n SA_ Y�J Gi"l,v_V1 k j Yfl A nu (Ll K Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 %a Owner's Name&Address R bra, \0� Contractor's Name Telephone Number Home Improvement Contractor License#,(if applicable) Email: Construction Supervisor's License#(if applicable) MR Ink- nm: %rn ❑Workman's Compensation Insurance Check one: MAY —.5 Zo14 &I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance T® WN,. ®E BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ' Replacement Windows/doors/sliders.U-Value .. (maximum.35)#of windows #of doors: • ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the home provement Contractors License&Construction Supervisors License is required. SIGNATURE: i Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 l The.Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations �~ 600 Washington Street V Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Legibly N�e,(Busines_ s�/Organizafionllndividual): Address'" � City_/_State/Zp ,„ ✓�,( Qhone Are you an employer?dheck 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 hued 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 mein any capacity. employees and have workers' 9. El Building addition [No workers' comp, insurance comp.insuranceJ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions AI am a homeowner doing all work ❑ g myself. [No workers'comp: right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no ,.�--ESA employees.[No workers' 13-0-0w,,er 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 contractors must submit a new affidavit indicating such. tContractms 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 suh-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.#: t Expiration Date: Job_Sit i 9 ess:`�Q �� 1I1wr]—� City/State/Zip: - '✓lryl ,�Z t�11 d'� 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 K 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 DU for insurance coverage verification. I do hereby c Under the and penalties of perjury that the information provided above is true and correct Si ate: --Date Phone 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 CIerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions a° 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 stale 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 PIease fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)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-ir=ed 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 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 westigatian 600 washivou met. Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-S77-MAS9AFE Revised 4-24-07 Fax#f 17-727,7749. www.mass.gov/dia i Town of Barnstable Regulatory Services r - oFtt Richard V.Scan,Interim Director Building Division 3 IIearvsrl+sri,. _ Tom Perry,Building Commissioner - 9� ..0 �� 200 Main Street, Hyannis,MA 02601 www.town.birnstable.ma.us f • Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION j Please Print JOB.LOCATIOM'(6 - ,��/0 ►(L `' numb street Ce street -village G n cao sm - "HOMEOWNER" name homephdhe# work phone# CURRENT MAILING ADDRESS: NAB ► PVl 6 e(6-a� — I c ty/town state zip code The current exemption foi•"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form. acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.,(Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The•undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr_edures and requir ments and that he/she will comply with said procedures and requirements. ignature of Homeowner Appioval of Building Official ` K 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 t Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities'of a supervisor . (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness-often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. EVE roh� Town of Barnstable Regulatory Services ., i AARN.GTAR� 1 M, $, Richard V.Scali,Interim Director fl � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete.and Sign.This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms ate the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date