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HomeMy WebLinkAbout0468 SCUDDER AVENUE �//vg <Sc�ddeo �✓e / - - - `- 'TOWN►OF BARNSTABLE BUILDING PERMIT APPLICATION Map < f PT Parcel Irv' Application # Health Division l�,Q� Date Issued 7A'?tl L Conservation Division ��C? r�cp Application Fee Plannin g p 5 De t. � ��O 'Cp�� Permit Fee Date Definitive Plan Approved by Planning Board0\' ,Q,p� O Historic - OKH _ Preservation /�l1inis � (� T7_ S Project Street Address �.l C�C.l Q P� t A Village ��-/J- dtqOwner Address Telephone o"A7 7'q 7 Permit Re uest C 8�P i �iI ICJ` t Square feet: 1 st floor: existing -proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation <3 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family /_,C�L� Two Family ❑ Multi-Family(# units) Age of Existing Structure ! ! l 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 iA�?LJOil_ -baths): existing S� new First Floor Room Count Heat Type and Fuel: w ❑ 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 ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use- APPLICANT INFORMATION -- — (BUILDER OR HOMEOWNER) Name ✓ )�C � e4--- Telephone Number�� �� �D l / - � rQ �s A/d�d�ress n � License # v l� �4D Home Improvement Contractor# 7 � Email (�"���� /� f'�'\ r CrC�/ Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ems SIGNATURE C DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE R OWNER DATE OF INSPECTION: FOUNDATION FRAME r INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. k HOME OWNER WEATHERIZATION WORK PERMIT: i PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. /J. art C CH 3� hereby consent to and agree that weatherization work ; may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: / ! �.'�'s(•lRsrJr/'�C.`i.'_',� f'�'�F't C.�� `fy�i � The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: - Weather stripping; air sealing; attic & basement insulation; exterior wall insulation; ventilation r measures Inconsideration of the weatherization work to be done at my home I ag ee to the following: 1. 1 give permission to Housing Assistance Corporation the property with such equipment, and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. - I have read the provisions of this agreement and give my consent. Home Owner(signature) f Home Owner email: a L-Ai2r Cc�:� Date: A ent: Signature M1 `" �. ,; Date: ( g ) � Weatherization Contractors: Adam T Inc Cape Save All Cape Energy' Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction. Resolution Energy Cape Cod Insulation Tupper Construction - r The Commonwealth of Massachusetts Department of Industrial Accidents Offke of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(lousiness/0rganizationllndi-,idealy. TUPPER CONSTRUCTION Address:546A HIGGINS CROWELL RE) City/Statel7ip:WEST YARMOUTH MA 02673 Phone#:b08-778-01'11 Are you an employer?Cheep the appropriate box: Type of project(required) I.10 1 am a employer with 10 4. I am a general contractor and 1 - employees(full and/or part-time).* have hifed the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. C]Remodeling ship and have no employees These sub-contractors have 8, C]Demolition working .For me in any capacity. employees and have workers' 9 E]Building addition [No workers' comp. insurance comp.insurznce required.) 5.C] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I-El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12❑hoof repairs insurance required.] t c.152,§1(4),and we have no WEATHERIZATION employees.(No workers' 13.1K Other comp.insurance required.] 4Any applicant that checks bux#1 must also fill out the section below showing their%wrkcrs'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work a ndthen him 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 cinploy'ees,thev mt4st provide thou workers comp..polity number. I am an employer that is providing workers'compensatlon bmrance for►qv employees. Below is the policy and job site information. Insurance Company Name:AEIC Policy#or Self-ins.Lic.#:WCC5005593012015A Fxpiration Date.1013/16 Job Site Address: 468 Scudder Ave City/State/Zip. yannisport MA 02647 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(late). 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 S 1,500.00 and/or one year imprisooment,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 f • e coverage verification. I do hereby certify der th pants an penalties of perjury that the information provided above is true and correct. Si nature �. - 5/27/16 Date: Phone#: 508-778-01 Official use only. Do not write in thin area,to be completed by city or town offrcial. City or Town: Permit/Licensc 1# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t 9 ACQ® IYYMn CERTIFICATE OF LIABILITY INSURANCE 12 DATE(MMIDD(MMIDO 5 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 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 NAME:NTACT Lora FitzGerald Southeastern Insurance Agency, Inc. PHONE (508)997-6061 I FAX (5051990-2731 .tAdG,rL4-EMY-- 1�.�: 439 State Rd. Aplfita@southeasternins.com {{ P.O. Bolt 79396 INSURERIS)AT-FORCING COVERAGE 1 NAIC# North Dartmouth MA 02747 INNIRERAArbelia Protection Insu ranee 41360 INSURED - a maumR.B Boston InsuYance Brokerage Inc Tupper Construction Co LLC LNSURFJRC. 546A Higgins Crowell Road INSURFRo, !t INSURER E• i Hest Yarmouth MA 02673 INSURERF: COVERAGES CERTIFICATE NUMBER2015-2016-1 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 SEEN REDUCED BY PAID CLAIMS. IL TYPE OF INSURANCE IXODL P�A LO:F + POLICY EXP � UMW POLICY NUMBER M l MMIO % COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE S 1,000,000 A _ CLAIMS-MADE a OCCUR 5 100,000 l PREMISES(Eaocamenee z 9520045209 11/1/2015 11/1/2016 MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY i S 1,000,000 I GEN L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE I S 2,000,000 B POLICY PEGQT- Li LOG I PRODUCTS-COMP(OP AGG I S 2,000,000 OTHER: _ _. 5 -- i AUTOMOBILELIABILITV O BINBI)DiINGL LIMIT5 . 1,000,000 I ANY AUTO - BODILY INJURY(Per person) 1 S A '� ALL OWNED R 1 SCHEDULED 1020009389 12/1/2015 12/1/2016 i BODILY INJURY(Pereccident)�S L HIRED AUTOSX NON-OWNED PROPERTY(m+AIAGE 5 I.�.1 AUTOS Pet 0'aril - t i { insured motorist a it limit S 250,000 UMBRELLA uAa _OCCUR I EACH OCCURRENCE S A �.EXCESSLIAB _C_LAImS-►AADE AGGt REGATE - S. DED RETENTIONS 4600058368 '11/1/2C15 11/1/2016 tt �g I WORKERS COMPENSATION 1 STATUTE i ER AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ` ) E.L.EACH ACCIDENT t S 1,000,000 OFFICERM1NEMIIER EXCLUDED? NIA . - B ](Mandatory In NH) 'I �.WCC9005 5 8 3 012 0 151► F 10/3/2C15 10/3/2016"fL.DISEASE.EAEMPLOYE 5 „,,._l.,000,,_000, It yes.describe antler -- -- "- I DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT 8 1100010012 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional R.ma&s Schedule,maybe attached irmore syaco Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE, For informational purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN " Tupper Construction Co..,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 546A Higgins Crowell Road W Yarmouth, MA 02673 AUTHORIZED REPRESENTATIVE Lora EitzGerald/HEM 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered Tnarlls of ACORD INS02 5 1201401 1 �r lIlKr.j.;crdemj,e Al Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 178434 Type: LLC Expiration: 4116UO18 Trd 419291 TUPPER CONSTRUCTION CO, L.C. RICHARD TUPPER 546 A HIGGINS CROWALL RD W. YARMOUTH, MA 02673 Update Address and return card.Mark reason for change. scn, q zone osrn Address Renewal E( Employment Lw Lost Card �'%/. Y'rarrirr�rraan///a/`•/%re..;rrr�ydr�/.. Offiee or Consumer Affairs&Budaess Regulation License or registration valid for individual use only 3 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: s t v Registration: 178434 Type: Office ofConsuamer Affairs and Business Regulation r Expiration: 411812018 LLC to P -Suite 5170 PE oston, 1 TUPR CONSTRUCTION CO,I.I.C. RICHARD TUPPER W A HIGGINS CROWELL RD W.YARMOUTH,MA 02673 Undersemterq Not without signature BUILDING PERFORMANCE INSTITUTE, INC 107 Hermes Road,Sufte 210 MaIK NY 12020 (077)274-1274 www.bpi.org Richard Tupper BPII13e:6040a40 " W 11EVERSE SO..MR DESIONA.MK MO EXPUT10N DATES) Massachusetts ;,D apartment df Public Safety' Unrestricted-Buildings of any use group which 'Board of,Building Regulations and Standards contain less than 35,000 cubic feet(991m)of C,rnceriiCt[un Sups r,Norenclosed space. License:CS4169051111 Richard S Tupper`: '. [Z' j 506 A> os Cr+diveiil Wed Yarmouth KA f f y Failure to possess a current edition of the M usetts �''�; State Building Code is cause for revocation of this license, �J„`,,..OS,dtg�. " °''' cscpiration For OPSiamanghdortgadonvisit: www.Man.Go WS Commissioner 1213111016 -Ae P� Town of Barnstable *Permit# Exp f 6 months frosi sue date • 012016 Regulatory Services F BARNSTAB MAM p 16 �A��C�ABLE Richard V.Scali,Director V Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION 1 RESIDENTIAL ONLY Not Valid without Red X-Press Imprint .. Map/parcel Number Property Address {��S -uG�e:� bJ , ]Residential Value of Work$ `J000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name ��,r - ,, ,up ,,�k Telephone Number ® _ < 7 5(oat) t , Home Improvement Contractor License#(if applicable) Email: 7Co orkman's uction Supervisor's License#(if applicable)W Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [� I have Worker's Com�e�n�sation Insurance Insurance Company Name1— t (� P Y Workman's Comp.Policy# aoaotx_-) SSS900 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 top S2 (❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic'Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.. A copy of the Home Im ovement Contractors License&Construction Supervisors License is e ired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 .77ie Comn oznvealtth of-Vassachusetts Departane zt o,f lfadush ia[Accidents 1�,f -ce o,f Im mligations # 600 Ff�asTiingion,Street _ . Boston,MA 021I1 wro mass govIdia Workers' Compensation Insurance Affidavit-Builders/Contract6rs/Electricians(Plumbers Applicant Information Please Print Lecab Name(Bussineess"Drganiz ifim 9diaidad r Ny k Address.- 6&k eJ �- cifg/statc/z* V-t-57-ja k- Mk 6 L/ phone Are you an employer?Check the appropriate bow: ' Type of project{required}: 1.� I am a employer U th I asar a general contractor and I : 6. ❑New construcfi(m employees(full ancVor 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 1.8. ❑Demolition wo 'ing forme in any capacity. employees and have workers' [No .workers'comp.insurance comp.tnsmmuce 1 q• Pudding addition required.] 5. ❑ We are a corporation and its 1-0.❑Electrical repairs er additions 3111 am.a homeou officers hive exercised�er doing all work 1 Plumbing repairs or'additions �'`� �o,�or� -g • right of exemption per their 1_❑MGL 12tRoofrepairs insurance required.]'s c.152,§1{4h and we have no employees.[No workers' n-El Other comp_insurance required.] •A y WBcm t:that checks box P1 mast also fill out the section below showing their wolleW compensationporicy informadcaL fi Enmemnms who submit this dfiidaOt im&cating they are doing all wc*anti then lie outside coatmaors must submit a new affidavit indicating such^ FCantractors 1hzt check this boas mast attached au additional sheet doming the name of the sub-cw=xcton and stale whether.or nut those entities have employees.Ifthesub-conto=uhave emplafees,thegmustpmride their workers'comp.policy n=ber. I am art empfq—er that is prauiding markers'congmnadan ittsnrancef for airy*employees Below is the policy acid jab site � ir[farrtxatiars _ Irtsurance,Company Name: q&CLS'16 Pfllicy or Self-ins..Lic. �.a o�'�555�ict� Expiration Date: 31 30 k to Job Site Address: � y� ter 9 city/Stafe/Ztp: ! / Attach a copy of the corkers'compensation policy declaration page(showing the policy number and espi moon 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,$1,5.00,60 and ror one-year imprisonment,as we11 as chil penalties.in the form of a STOP WORKORDER and a fine of up to$2 OM a day against the-violator. Be adidsed that a copy of this statement may.be forwarded to the Office of JAvest gations of the DIA far instUmce coverage verification- Ida hereby ccerftfjr ftdth 97R pact t raatties afpee jury tbarfJte irtfbt^avta#iatr p►mzcied abmw is base and correct S.itnature. Date: 2 Phone Official use only. Do not wife in this area,to be comptete.+d by tify or taora official, City or Tonm.: PermitMicense# , Issuing Authority(tdrele one): 1.Board of Health 2.Building Department 3.C ty1rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Ph-one#: 6 on and Instruefions - -Information Massachusetts Gaaeral Laws chapter 152 rer�es all employers to provide workers'compensation for their employees: pit,this fie,aa.mrplvyPe is defined as."-.every person in the service of another under any contract of hire, express or mxplied, oral or writh nm" An ernpfayer is defined as"an individnai,partnership,association,corporation or other legal entity,or any two or more e andinchding the le L&es of a deceased employes,or the of the foregoing engaged in a Joint enterprls , girl repre smtE receiver or trustee of an individual,padnersb ,association or other legal entity,employing employees. However the owner of a dwulling house having not more ffian three apart nmts and who resides therein,or the occapant of the . dwelling house of another who employs persons to do mafiftnauce.construction or repair work-on such dwcIng house or on the grounds or btulding appT�themto shall notbecanse of such employment be deemed to be an employer" MGL chapter 152, §25C(f7 also sties 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 comm ouwealth-for any applicant who has not produced acceptable evidence of compliance with the insuran ce.coverage required_" Additionally,MCrL chapter 152, §25C(7)states"Neither the cometaawealth nor 2i]ay ofits political subdivisions shall enter into any contract for the perfozmance ofpublic work until acceptable evidencetn of compliance with the incan ce._ r ments of this chapter have been presented to the contacting aufboiity." = �e , Applicants Please fill out the workers'compensation affidavit completely,by checkiag&e boxes that apply to you situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their certiffcat*) of has-t„a ce. Limited Liability Companies(LLC)or Limited LiabRity-Paztaerships(LLP)with no employees other than the. members or partners,are not required to easy workers' compensation in�ce. If an LLC or LLP does have employees, a policy is required. Br,advised that this affrdayif may be submitfin-d to the Departiaent of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-he affidavit. The affidavit should be retauned to the city or town that the application for the permit or license is being requested,not the Department of L aLt a 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 mmnber listed below: Self-insrzt'ed companies should enter their self-m sm-an ce license number on the appropriate Ime. City or Town Officials . f - Please be same that the affidavit is coz:ipletn and primed 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 pen: it/Iiceme number which will be used as a reference number. In addition,an applicant that must submit multipIe pem itllicrose applications in any given year,need only submit one affidavit indicating current p olicv bafbrnation(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 maybe provided to the " applicant as proof that a valid affidavit is on file for Bfm-e 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 venfise (i e. a dog license or permit to bum leaves etc.)said person is NOT required to complete taus 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 Depart nenfs.address,telephone and fax number: _ Capon for of Massachus�_-tts Depa dme nt of 1z dustdal AocZenta . (ice of Jwest� fio= 604.Wtoon Stet Botan�MA 0 111 Tf,-L 4 617 727AM Qxt 4-06 or i-V7=MA.SSAF� ., Fax 9 617-727-7749 1 Revised4-24-07 .maw gQgfdia I • 4 f t f ILALMSTABM MASS. 1639. Town of Barnstable `��' �ArfO MA'S� Regulatory Services. Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder CC y,g eV , as Owner of the subject property hereby authorize La r to act on my behalf, in all matters relative to work authorized by this building permit application for: . �� Sc�c � � '(Address of Job) Cy ` S4 Signature of Owner Date - r Print Name If Property Owner is applying*for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doe Revised 040215 Town of Barnstable Regulatory Services �oFSKWE rti Richard V.Scali,Director Building Division r w BARNST'an Tom Perry;Building Commissioner vMASS. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . ' CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner + Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\,RESS.doc Revised 040215 AC^ Q DATE(MM/DD/YYYY) �vlt CERTIFICATE OF LIABILITY INSURANCE 06/03/2015 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 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 CONTACT Erica H O'Connor HART INSURANCE AGENCY, INC. PHONE 508-759-7326 x205 FAX 508-759-7326 243 MAIN STREET C ac No PO BOX 700 E-MAIL ADDRESS: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIC# INSURER A: PENN-AMERICA INS CO 32859 INSURED Scott Lohr dba Lohr Home Improvement INSURER B: ACADIA INSURANCE COMPANY 31325 23 Grand Oak Rd Forestdale,MA 02644 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLLTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY POLICY EXP LIMITS A GENERAL LIABILITY PAV0059201 05/15/2015 05/15/2016 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED 50,000 - PREMISESS Ea occurrence $ CLAIMS-MADE ©OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ B WORKERS COMPENSATION WC202000555900 03/26/2015 03/26/2016 V WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 5003000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • ✓fie'[�ooi��xo7euiea� a��✓�/�aa°ae�iu°elt°� ., — Office of Consumer Affairs&Bdsiness Regult►tion Massachusetts -Department of Public Safety HOME IMPROVEMENT CONTRACTOR., Board of Building Regulations and Standards Registration 172172 .:Type: DBA �6i9Structi,lrl Expiration 5/31/2016 License: CS-053961 )ME IMPROVEMENT 'i j SCOTT A LOHR { , 23 GRAND OAK RD 1P _OHR z z Forestdale MA OZ644 _ 3 ID.OAK GALE / n .grin'. Expiration Commisssio.nne''r' 06/09/2017- Assessor's office(1 st Floor): ��A Assessor's map and lot number Q�o�THE>o` . Board of Health(3rd floor): �j � Sewage Permit number I� 4,o6 r,:, ABd5TABLL.Engineering Department(3rd floor): / � rasa---House number "7"y 1639.6�®�' Definitive Plan Approved by Planning Board 19 rar APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABL•E BUILDING INSPECTOR APPLICATION FOR PERMIT TO 4d 0 )v::_ 6A o S v G to v s 5 W r� TYPE OF CONSTRUCTION wove ,� ,,� - U.J �v , CjS7 a3 19 9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according the following information: Location Proposed Use w � °� C Zoning bistrict Fire District J�f ce"I•vAj S Name of Owner /,4v/i) f jickc-YAJ Cg4,0,-94 Address `7��8 Scv��D 4v ff1.v�+irPvn; < Name of Builder Nt Address 1 Name of Architect N Glv c` Address Number of Rooms .S Foundation Doti r_✓� Exterior ` c s Roofing Y-P 4 `- 7- Floors /n� `�` d`7 Interior Heating �, t—r-c_ �n Plumbing— Fireplace �cr"i f 4 �✓� %a2Y /V O.v�` Approximate Cost 3 0 o o U o° PP , Area, Diagram of Lot and Building with Dimensions Fee " ` 0 S' - 0* 0, 0 0 M 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. �. /-2 Name Construction Supervisor's License CHAPMAN, DAVID & JACKLYN A:-288-066 `. ~� r _ s No 33198 Permit For ADDITION Single Family Dwelling Location 468 Scudder Avenue Hyannisport Owner David & Jacklyn Chapman Type of Construction Frame Plot Lot Permit Granted September 111,9 89 Date of Inspection 19 Date Completed 19 '�VA4�4 111fo A4 013IM00111INU y Assessor's map and lot number . `..r , J Sewage Permit number ................. ....................................... y�F7HET�� TOWN OF BARNSTABLE • BAH_HSTODLL i ` t639.a BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ....r ` ' ` r .................................................. ....�.......................................................... ..!l................ ........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .:...........................:.....:......:.....c...........................................................................:.......................................................... _1) f 71. Q = i ., ,, ' Proposed Use .....................!..'..!.................................................................................................................................................. .y ZoningDistrict ........................................................................Fire District .................,............................................................ Name of Owner ....r*.. .'........:.... .... 7.......: .: T. ....: .....Address .. `J.......- .. .....`.:.:.j..:.:...:..1.........:...............:.............. Nameof Builder ..................................... .^....`.!...............Address .................................................................................... Nameof Architect ... ............................................................... Address ....................... ........................................................ Number of Rooms ........Foundation �' .......................................................... .............................................................................. Exierior ......... �r 1 ..........................Roofing . .............. ... Floors -. t ..' .Interior ... .. `.'. ................. . F Y Heating ............... ........................: :.....:............. .........Plumbing ....... ........................................................................ Fireplace ....... .........................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee r SUBJECT TO APPROVAL OF"-'BOARD OF HEALTH 1 -- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. < ' Name .................................................................................. Chapman, Carl & Martha C. - A=288-6� No .. 19292.. Permit for ... rebuild and ................ . add to dwelling (destroyed by fire) ............................................................................... Location 468 Scudder Avenue ................................................................ Hyannisport ............................................................................... Owner Carl & Martha C. Chapman Type of Construction ...........frame ............................... ............................................................................... Plot ............................ Lot ................................ IV �j June 13 77 Permit Granted ................` ......................19 Date of Inspection ............. ...................10 Date Completed................:...................19 PERMIT REFUSED ... •..... ................. 19 .. .. A . ............... ,•- ...................... ....................... . ....................... .. •.............................................. \'� ... ......................... Approved ................................................. 19 ............................................................................... .............................................................................. Assessor's office(1st Floor): ®�� SC-�1C SYS'TF-po �u ,[ya THE Assessor's map and lot number_ INSTALLED IN C®6� L6-1�,WW� QyDi T0`♦ i Board of Health(3rd floor). WM'i ME 5 d� Sewage Permit number g EMI AL CODE AND 1 B,HdSTSDLL, Engineering Department(3rd floor): // Mid House number Th TOM REGULATION`S °°„�i639- Definitive Plan Approved by Planning Board a 19 o rar d APPLICATIONS PROCESSED 8:30-.9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 4,j 0 /e En / rr N C. S r� TYPE OF CONSTRUCTION Gt�ovr� �,�yg,.t 6- �y 6USr Z3 198? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ef6 Proposed Use ur 4 / N Co Zoning District r".—� Fire District ���'�'/is Name of Owner/�t///) t j cAr c-Y n/ Address ` 6 6' Sc v-0 Q ft-^- 4v6 - N�+iJ,000A Name of Builder �M Address Name of Architect /U ON Address Number of Rooms -S Foundation �N cdL-,776- Exterior N 6 C G'S Roofing -4 - 7- Floors Interior 5,f�-�Z 0C,k Heating �/AJA/A /3Y,0145 Plumbing /yfc,(-::,- Fireplace /Vy/J-a Approximate Cost 3 00 60 0.1 00 Area 5- Z S Diagram of Lot and Building with Dimensions Fe 4 — QO`-V 50 �f 0 V 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 Construction Supervisor's License 0/7 3 5-7 s CHAPMAN, DAVID & JACKLYN No 3 319 8 Permit For ADDITION Single Family swelling T_ Location 468 Scudder Avenue Hyannispert i' Owner David & Tack1'j7n Chapman yi `> Type of-Construction Frame I Plot Lot -3 Permit Granted Sep-Lembf r 11 19 89 Date of Inspection 19 x r©ate Co leted 19 s y, 3' r i r S i ! r , . r : I , : : r r E I I I a i I I � : v: I 1, i I t < , ! r I I : Y� zX I ` h jaw- - f1/ON I I : : I I ' I - i - L I i i : i I � v I 1 I' i i : r � 'r 1 ' 1 I • : j t r f I , __;v l �_ � � km ; •Sj . , 1 - -; sU w .:. - : , f : / e Assessor's map and lot-numberR..€C1.........::...... QIY rGM' kl /1'''77 SEPTIC SYSTEM MUST BE _ y— ` INSTALLED IN Sewage Permit number. ��9... WITH ARTICLE MP LIANCE :- . ICLE LI STATE r, ( SANITARY CODE AND TOWN y�F7NEr�� TOWN. OF BARN97AB'EE '� � � BAS'B9T11DL8 i i 9r ° BU11.01AG INSPECTOR .01 t1 r. In , r;•; - yy�•" _ r APPLICATION-FOR PERMIT TO ......... .... TYPE OF CONSTRUCTION ........... . ....................... ... .... .............................:.......................................... is r� i F 71 TO THE-'INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location it .. e.Y:.... ... .d!!: C �..: ......... ..... .................................. ProposedUse :.�.�.! : :1.�.. �' ... . .:................................................... ...................................................................... Zoning District ...................... .Fire District Name of Owner <:.,r?!e'.I. rat"..�&..�►!{.�f.?�.�A�dness . .�� ,fU'ffdC9� C'VA1P L..A ..P A... Name of Builder � e��'��i�t...f dr. ...............Address .................................................................................... Name of Architect ... �..!.. ..............................:..............Address ' (�zm'Ya�'tr�V f✓ 3,�( ' Number of Rooms ( ..................................................Foundation ............-...................:...,:(? ... ............................... E x i e r i o r .(F .�' .... �'?.1�!1. .1.. ............................Roofing ... .�.d•..�:`�.. 5f r�,� ... ....................... Floors Interior ... � ' �@t d.. '.............:................................A .1 e �f , - ......?�.l � ...Heating C Fireplace ��. Wi',I. ...: kf+�/ .L....( ...........................Approximate Co?.�. �... 6�.y............... Definitive Plan Approved by Planning Board r________________-----------19________. Area Diagram of Lot.and Build'ng with Dimensions Fee — SUBJECT TO APPROVAL OF4 OARD OF HEALTH yc INV VIP r e 177 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. L V / �� Name ... ........................................... ......................... Chapman, Carl & Martha C. ' 19292 .- ' rebuild and No ......... Permit_for ................................... add to'-dwelling, (destroyed by fire) -` .........................� ,t 468Scudder Ave". .... ....... Location ........:............ .......:.......... = r Hyannisport ........................ .......... ................... " v Carl & Martha C. Chapman Owner frame- Type of Construction .......................................... 4 ....... ..... ................. i Plot ............................. Lot ........ ................... - f..r . 'r • ............. ;Julie 13 77 Permit Granted' ......... ..............:.....19. Date of Inspection ...... ......�< : ....19 77 . , Date Completed .. .�. .....�......:19 = W �. 7 -`PERMIT UF.USED ; y ........................... .................................... 19 h ................. - .................. ............ .... ......... '] - .. �l ................ ............ .. .. � ...... ...� .............. ................. i 3 ........... + . ................................... . e Approved ............................................ .... 19 c