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HomeMy WebLinkAbout0162 SCUDDER AVENUE %do? Sc sevG7�'e.� - - - - - - Town of Barnstable R _ s _ Building t Post This=Card So That it is Visible From th'e Sheet-Approved Plans Must'be Retained on Job and this Card Must;be Kept r SAM Posted Until Final nspecton Has Been:Made 3, Permit s Where a Cert�ficate.of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit No. B-19-3029 Applicant Name: HOMEOWNER IS APPLICANT Approvals Date Issued: 05/13/2019 Current Use: Structure Permit Type: Building-Shed-Residential 200 sf and under Expiration Date: 03/13/2020 Foundation: Location: 162 SCUDDER AVENUE, HYANNIS Map/Lot: 289-073 Zoning District: RB Sheathing: Owner on Record: FEDERICO,ANGELO A& PATRICIA Contractor Name:.` HOMEOWNER IS APPLICANT Framing: 1 Address: 278 BEECH STREET - Contractor License: EXEMPT 2 N ROSLINDALE, MA 02131 E„ Est. Project Cost:. $0.00 Chimney: Description: 6x6 Shed Permit Fee: $35.00 Insulation: Project Review Req: 6'x6'shed located as shown on submied plot plan > _ Fee Paid:. $35.00 m Date 9/13/2019 Final: + � Plumbing/Gas Rough Plumbing: -- �-- \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by thiFs permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the.approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. � r Final Gas- This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fopublic 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 by the Building and Fire Officials are provided on this.-permit. Service: Minimum of Five Call Inspections Required for All Construction Work: , 1.Foundation or Footing ,a Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health '. 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 y Town of Barnstable THE r Banding Department Services Brian Florence,CBO • A•+ �*•^R Building Commissioner 2659. ���� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fag: 508-790-6230 PFRMTT ' FEE: $35.00. --� SE=REGISTRATION =o 0 RESIDENTIAL ONLY =" 200 square feet or less d de ar, f9f S W Location of shed(address) Village - ,� � �, Z/ a Property ees name 'Telephone number Size of Shed Map/Parcel# al � J� e g e Date Hyannis Main Street Waterfront H1StDric District? AL Old King's Highway Historic District Commission jurisdiction? You must file with Old Kin.g's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3-304:30 PLEASE NOTE: IF You ARE WTTIDN THE JURISDICTION OF ANY OF THE ABOVE" COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST U ACCON PANED BY A PLOT'PLAN . r Q-forms-shedreg REV:08/6/17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel r 1 Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 2 �� �+�e�n Ave - I t�a n n tS ®Z(o 0/ Village Owner e,L� eelPi2,c..�� Address73 s� �°�s�hd�;c;�. /�t.c� C�`Lf3 Telephone d2.- (oY,3 6 Permit Request A'ep/a ce 6,a6 1Le-L , ., A'.(-,(- i . tzeale.e oe�Zvc . f aem ale- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationl�Uo© Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family tr" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 2 No On Old King's Highway: ❑Yes LXNo Basement Type: ❑ Full ❑ Crawl O'Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing 0 new � Number of Bedrooms: A- existing n w Total Room Count (not including baths): existing 41 new Q First Floor Room Count Heat Type and Fuel: d'G"as ❑ Oil ❑ Electric ❑ Other v w a Central Air: ❑Yes C36o Fireplaces: Existing New ID, Existing wooct al stove"-b Yf Wlo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ex(sting Q;tew ze_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ + Commercial ❑Yes 0 N-o If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER O OMEOWNER Name el Telephone Number 33q Y F, Address' 0:1PJ ,J Zej, I(t�Uti��QP License # o Home Improvement Contractor# cevv`- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .� FOR OFFICIAL USE ONLY . ., APPLICA.tTION# DATE.ISSUED_ MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: �, w f � ,]AFOUNDATION�, ,.�kW'.'aJi3�`t,�_"��I✓�ia:,.._ FRAME r ` INSULATIONLik FIREPLACE , 4. ELECTRICAL: .._ ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ..ROUGH FINAL it - r, FINAL BUILDING=- a c DATE CLOSED OUT ,i ASSOCIATION PLAN NO. i -i ' The Commonwealth of Massachusetts Departrnent of InduytriatAccidenfs Office of Investigations ' 600 Washington Street Boston,MA 02111 www tass.gov/dia Workers' Compensation Insurance Affidavit:Bulderi/Contractors/Electricians/Plumbers _ Applicant Information y• ,` Please Print Legibly iorgauization4ndfviduaD: rName(Business' Address: City/State/Zip: l2e s rt '�Phone#:• 3 J 2 Z �p �P Are you an employer?Check the appropriate boa: ' Type of project(required): 1.❑ I an a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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.incnran=$ ,mquired.] 5. We are a corporation and its 10.El Electrical repairs or additions 3.5.I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repass insurance required.]t c.152, §1(4),and we have no employees.[No workers' 13.❑offer comp.insurance required.] *Any applicant that checks box#1 must also 01 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 cbmk 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 rmW provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee,. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/StatelZip Attach a copy of the Workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required imder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50-0.00 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 upDr th 'pains and penalties ofperjury that the information provided above '/true correct rsi ature: Date: [ ' Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permi�tUcense# 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. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract ofhire, 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(ILLP)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 lusted 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 wr11 be used as a reference number. In addition,an applicant that must submit multiple permit/licease 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 futrae 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 venue (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 lice 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 Comm aawealth of Massachusetts Department of Indust dal Accidents Office of Investigatlans 600 Wasl z oa Street Boston=IAA 02111 Tel.#617 727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mu&gov/dia Town of Barnstable Regulatory Services e RIANCPAB Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXI+'IYnMON DATE: f/ r,I l /ZO l Please Print JOB LOCATION: number sleet village ..xoMEowxEx 07-2: . ram Q home-pnho�ne# ` work phone# CURRENT MAnJ NG ADDRESS: ��/ &/� e- l j/l f AAA--. 0213 city/town smote up 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 P ersoa(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,thathe/she shall be responsible for all such work performed under the building permit (Section '. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations,. The and i d`homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr a requirements and that he/she will comply with said procedures and requirements. Sign a blff 5 ofHomcowner Approval of Bwlding Official r ' Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION _ The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last gage of this issue is a form currently used by several towns. You may rare t amend and adopt such a form/certification for use in your community. C:\Usms\der nWAppDmkLocallMcrosoMYrmdowslTcmporary Internet Frlcs\Contmtoutlook\QRE6LUBN\E)2RESS.doc Revised 053012 Town of Barnstable Regulatory Services r �g Thomas F.Geiler,Director i63q. 1$ 1,W616 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must ' - Complete and Sign This Section If Usi.,sg A Builder L ,2- es of the subject property hereby authorize to act on nay behalf, is all mattes Bela a to work authorized by this b pet=t (Address of Jo Pool fences and alarms e responsibility of the applicant:-Tools are not to be filled or utilized b ore fence is installed and all final inspections are pefformed an acc ted. Signature of Ownet ' Signature of Ap cant I Print Name Print Name Date QTME-OWNERPERMMONTOOLS 6=12 .......................... sit Cab,+ift n Qt v v D ---z Coll rn 1 060 X-PRESS PERMIT Ft r ` 'own of Barnstable *Permit# { 08 Expires 6 iorfthsfrom issue date Regulatory Services Fee TO TABLE Thomas F. Geiler, Director Y 1659• Building Division prEo Ma a . Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to\vn.bamstablc.rna.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY (' Not Valid without Red X-Press lmprint Map/parcel Number v Property Address 1612 S.CtI G(�/' /7 ✓P l���Ce(�( yt(S ( �� (Residential Value of Work of 0 Minimum fee of$25.00 for work under $6000.00 Owner's Name & Address 7Lu "4PWPf /�6-0 Contractor's Name /� S ���/l/�� /Lj S Telephone Number 7d'/' r?6,�_/,7 , � Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner *Sri have Worker's Compensation Insurance Insurance Company Name /,i'/��� 6-1a 4-1 � `L u v'�'l h ��r��� ce- c� Workman's Comp.Policy# P/✓C `I 2411 C Copy of insurance Compliance Certificate must be on file. Permit 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 ❑ .Replacement Windows/doors/sliders. U-Value (maxi.mum..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 Nome improvement Contractors License is required. SIGNATURE: QAWPF[LES\FORJvfS\building permit forms\EXPRESS.doc Contract# 340 CUSTOMER INFO: JOB LOCATION: Tony Federico 278 Beech Rd. 162 Scudder Av. Roslindale,MA 02131 Hyannis,MA 617-327-1307 AGREEMENT BETWEEN: Tony Federico(owner of property) AND Linas Revinskas, Date 09/02/2008 DBA Baltic Company (owner/carpenter) Linas Revinskas, DBA Baltic Company, hereinafter referred to as General Contractor(GC), on the one hand and Tony Federico owner of property (162 Scudder Av, Hyannis,MA),hereinafter referred to as Customer,on the other hand, have concluded the present contract as follows: 1. THE SUBJECT OF THE CONTRACT 1.1 GC undertakes hereby to supply all labor and materials necessary to complete the remodeling services as proposed in estimate#36(Removing gutters, fascia,soffit in the back and in the front of the house, installing fascia and soffit with aluminum vents,residing with PVC shingles, louver windows (2 units) installation, vinyl shutters (front of the house only) installation, seamless gutters installation), said proposal being an integral part of the contract. 1.2 Customer undertakes to pay in the order and terms established by sides in the present contract, 1.3 All work is to be performed according to the specifications submitted, in a substantial workmanlike manner, per standard practices. Any alteration of or deviation from the submitted specifications involving extra cost will become an extra charge over the estimate,-but any extras must be approved by Customer. 2. THE PRICE AND THE TOTAL SUM OF THE CONTRACT 2.1 Estimated price $8,485.00. This price includes the cost of materials, labor, required permits and construction debris removing. 2.2 In the estimate #36 not mentioned but verbally submitted by .Customer and GC $350.00 allowance for corner boards installation. Used amount from this allowance will be added to the final invoice. 2.3 Cost for the freeze board installation in the front elevation of the house will be added to the final invoice. 3. TERMS OF PAYMENT. 3.1 Deposit equal to 12% ($1,000,00) of estimated amount($8,485.00) is required after GC and Customer will schedule the date of the project beginning. 3.2 The remaining amount $7,485.00 (plus above mentioned additional charges) is due after project will be completed. 4. OTHER CONDITIONS additionsunder the given Contract are valid if the are accomplished in 4.1 All changes and gY y P writing and signed by both parties of the Contract. The present Contract is made in duplicate of one for each of the sides. All copies have an equal validity. The contract inures from the date of its signing. After signing the Contract all previous negotiations and correspondence on it lose force. 4.2 GC may at its discretion engage subcontractors to perform work hereunder, provided GC shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Contract. 4.3 GC agrees to remove all debris and leave the premises in broom clean condition. 4.4 Customer agrees that equipment and building materials moving in the area around the house can cause light damage(smashed grass,broken flowers or bush branches). 4.5 GC shall not be liable for any due to circumstances beyond its control including strikes, casualty,weather conditions or general unavailability of building materials. Contractor Customer Signatures: Linas Revinskas Signatures: Date: 9/02/2008 Date: The ComrnonweaXth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mgt 02111 www.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridan.s/Plumberg Applicant Information G//V/f-s ��(///j�S K S v Please print Legit Name (Busint:gdoTganization!Individual): AA&tss 26�-/73`7 City/State/Zip: - i� �GCI Phone.#: Are you an employer? Check the appropriate bwc: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor�ajudl 6 ❑New constructionemployeeseve hired theshb-contra2. 1 am asole proprietor or partner- listed on the attached sha7. ❑R-emodeling ship andhavcDo employees These suib-contractors have g, ❑Deunolition employees and have workers' working far mein any capacity. 9. ❑$uuldmg additioncom . [No workers'comgj.-i„s<Wince Wr, i a cr orpGra 10. -Electrical repairs or additions required_] 5. [] VJe arc a corporation and its ❑ p 3,❑ I am a homeowner doing all work office ve rs ha exercised their I l.[]Plumbing repairs or additions myself [No workers' comp. right bf exemption per MGL 12 ❑Roof repairs insurance r t c. 152, §1(4), and we have no �) employees. [No workers' 13- Other u comp,insurance required"] "Any applicant tfuet chmla box#1 must also fill out the section below sbowing their workers'corNxnsation policy informatim-, t HwT=ownera who submit this affidzvitindiicating they are doinggm worlcand thcu hire outside cont-actors mustsubrnit anew affi&avitindicating such. cContractors that ahmk this box nnist attached an additional sheet showing the name of the sub-contraaturs and state whttha or not thost cotitia bave employees. If the sub-contn+chors have eniployccs,.they must pravi&their workers'mnv.poBcy number. I am an employer thaf is providing workers'compensation insurance for my emproyees Selaw is the policy and job site information. �T -rn Gc..:f a.K.C_ Insurance Company Nam �/ �{. �/�-�i�'l �"c 4�T Policy#or Self-ins.Lic.#: 7 as Expiation Date. Job Site Address: 11 2 CitylSb&zip: e2vt ti of Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to scevre coverage as required under Section 25A of MGL c. 152 can lean to the imposition of crina g penalties of a firer tip to S 1,500.00 and/or one-year imprisonment, as well as civt-1 penaltin 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 statm=jit may be forwarded to the Office of Invmti tions of the DIA for insurance rage vczification_ I do hereby certzf under_the pains-and penalties of perjury that the information provided above is true and correct Si>nahac �� // Dart Phone# ! _ G G 7� O f dal use only. Do.not write in this area, tb be completed by city or town offcciaL City or Town: Permit/License# IssuriagAuthority(circle one): 1.Board of Health 2.Building Department 3. City/Tovim Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other r� a no Phone#: hJ7 �op'(HE fps Town of Barnstable Regulatory Services a"R''` "B' HASy �'�; Thomas F. Geiler,Director Fo g Buildin Division �• Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 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 application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Regulatory, Services H x S Thomas F. Geiler, Director t sasxsrwsr t, MASS. �b 1619. Building Division PIFD �a Tom Perry,.Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsiable.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 ON 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 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 109.13-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 Hith 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 partof 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 forrr✓certification for use in your community. MONEYGRAM PAYMENT SYSTEMS,INC.DRAWER P.O.BOX 9476 ->- - N PLEASE READ REVERS M w O E SIDE ww moneyg MN 80 ram.com DATE/AMOUNT ��> • F '` SJ I�v.E �.t L.I.C.I C-1 E .�.�� a00 Cz o'ou� "ae R 1015 8 2 6 4 8 0 3® 01. 715 ;00/14000 ♦. ♦DETACH HERE V M 92579-P 1 License or registration valid for individul use only Board of Building Regulations and Standards ulations and Standards before the expiration date. If found return to: Board of Building Reg HOME IMPROVEMENT CONTRACTOR one Ashburton Place Rm 1301 lug Registration 152372 Boston,Ma.02108 Expirat►on 8/23/2008 7i,DBA TYp t BALTIC COMPANY r Pry t 7F �c LINAS REVINSKA, Not valid without signature 166 UPPER COUNTY,RD..9_,11 Deputy Administrator DENNISPORT,MA 02639 CD C Town of Barnstable. *Permit# `7 o° F oo Farpires 6 tnonths�issue dat Regulatory Services Fee 1:�S 26� �� Thomas F.Geiler,Director rr�s Building Division Tom Perry, Building Commissioner ��®® PERMITESS 200 Main Street, Hyaimis,MA 02601 P R Office: 508-862-4038 $EP 7 2�D4 Fax: 508-790-6230 EXPRESS PERMU APPLICATION - RESIDENTLAU 1*r►W)bF BARNSTA iQ Not Vaud without Red X-Press Imprint vlap/parcel Number O d 2 ?roperty Address OZ Sd fIV4 Ale i t;sidential Value of Work 00 Minimum fee of$25.00'for work under$ 000.00 owner's Name&Address Tuna f tf Ina contractor's Name �Q(A) Telephone Number Some Improvement Contractor License# if applicable) :onstruction Supervisor's License#(if applicable) ' rkman's Compensation Insurance Check one: ❑❑ I am a sole proprietor am the Homeowner --t have Worker's Compensation Insurance osurance Company Name , (/ z Workman's Comp.Policy# N&.. U' ;opy of Insurance Compliance Certificate'must be 69 file. o 'ermit Request(check box) �= r CD M e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. 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. Home Impr ement Contractors'License is required. ignature all" :Forms:expmtq w;,.nA-AAnd David Sawyer Construction 118 Meiggs Backus Road Sandwich, MA 02563 508 -539-1992 IG(��. Proposal Submitted To: Work Place: ate v Q2J31 - Strip, Remove, and Haul Away all old roof shingles. 2 �� S SUPPLY&INSTALL: �✓y�2 �- UWU fax cl eL. 0A ate. - LIAO CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER �r� ( � JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. /-/�VD.Ob V` TOTAL INVESTMENT FOR MATERIAL&LABOR$ O All material is guaranteed to be as specified,and the above work to be p ormed in accordance with the specifications submitted for the above work and completed in a substantial workmanlike manner. Payments to be made as follows Paudi��i',t�� g? CA 101 � Any alteration or deviation from the work specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. 10YEAR LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. NOTE-This proposal may be withdrawn by us if not accepted wit4 30 days. Respectfully submitted ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above. Date /1 d Signature 142 i6-4e �2 oY��e COP �wdv�t.�.c 6�'ti—P s r ✓a �U to Q Q �v 6/1 d'vrG 'ZGe 4-k/a�"� ,J�c/'rc�G/ /J v.s c'?� f}��'�1) �i �,+i►, �9 S G✓ Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2005 DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address Renewal Employment I] Lost Card ------ - - lie.�anvncn�uaea// o�./�aoar,/crcaelld Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 134313 One Ashburton Place Rm 1301 Expiration: 10/24/2o05 Boston,Ma.02108 Type: DBA DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. — , SANDWICH,MA 02563 Administrator Not v(dift wi out signature CERTIFICATE OF INSURANCE Commercial Lines Common Declarations No.LGL033832 Previous No.New Effected with Underwriters at Lloyd's,London,England(Not Incorporated) In accordance with limited authorization granted to Insurance Innovators Agency of New England,Inc.by Certain Underwriters at Lloyd's, London. Under contract no. NACO259/03 (Such underwriters being hereinafter called the'"Underwriters"), the Underwriters do hereby bind themselves in the proportions underwritten by them,each for his own part,and not for another,their heirs, executors and administrators,in favor of David Sawyer dba Sawyer Construction 318 Meiggs Backus Rd. South Sandwich,MA 02563 09-17-03 09-17-04 One Inception and expiration Inception(Mo.Day Yr.) Expiration(Mo.Day Yr.) Year (at 12:01 AM Standard time at Location of described property In case of loss,notify Insurance Innovators Agency of New England,Inc.at once in writing Business Description:Residential Roofing&Siding Installation In return for the pWnent of the premium and subject to all the terms of this certificate we agree with you to in this certificate. rovide the insurance as stated This certificate consists of the following cove a arts for which a projurn,is indicated.This premium maybe subject to adustment. Premium Commercial Property Coverage Part $ Commercial General Liability Coverage Part $3.750.00* Commercial Crime Coverage Part $ Total advance premium payable at inception *Minimum&Deposit Forms and endorsements applicable to all coverage parts and made a part of this certificate at time of issue:Certificate Provisions, 11,0017(11/98),LIA102(5/77),NMA2341(24/11/88),NMA2342(24/11/88),NMA2920(08/10)2001),NMA2962(06/02/03), LSW1001(Insurance)08/94,Total"Mold"Exclusion,NMA2970(30/05/03), CL150(11/85) Application dated 08/13/03.attaches to and forms an integral part of this policy and is made the basis upon which this policy is issued. 25%Minimum and fully earned premium in the event of cancellation by the insured. This certificate of insurance is made and acc ted subject to the fore pin sti ulations and nditions and to conditions attached hereto.which are specifically referred to and made a Part of the Certificate of Insurance.together with such other provisions agreements or conditions as may be endorsed or added hereto Dated at West Springfield, MA 11105103(ss) Insuran ovators Agency ofNew Engi Inc. By: ^ TOW OF BA MTABLE l 13 PM 3 57 . • -4-c. .¢o c�,cT.rBrfa L� k JIFF"=rw-40"6- /8 i �2,oio r � O 1 - z7�- �1 3I �•. ANiJVA C-- '/YJO.@ ORDE D `• - : .y .�,e o.•. - � N AM N Aof -0 Jfa ,. 3 coat / .v' 40 r Octfro Af C, ,�,' 'vr Y"QF BAFOfSTA$Z Bpi®.eiivGs.o vo is�a�vice ,.E�xcrP� AFC. /6 j 1'1S / r "-UC LsT JrA0l 19 y i