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HomeMy WebLinkAbout0041 SHOREY ROAD «� ����V -- - - -'� __ . ._ _ �. 0 Town ®f Barnstable Building - j ,That��t�is\/isible>From ih�e:5treet�.-A roved;;=Plans'Must.be:,Reta�ned on,J.ob,antl this Card Muse'Ke t , � fi Post This Card So ,. , + BARA`t3[`ABM s ,3 ,, pp.. , f.-. P_ i . M, jnHas Beeri'IVlade' . Posted UntilFinal Inspect o eie•a Cert�ficate:of;Occu anc ,.;is Re aired such.Buildm shall NotleOccuMied until a FinalAlns ection,has been made W 1 � �� lY1w a. .: ''mac»;.ps..:.f,Ys%;.yl�a'°.., 9'.. -a«aw-�a:< >`vs agz'' m';` .a",. `:.,.J ra.c �.-;..:z ,.','. ,,, .c_,,... ......�da�..':- a., � rG<. a:;,..._....: - Permit No. B-18-1819 Applicant Name: INSULATE 2 SAVE INC. Approvals Date Issued: 07/03/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/03/2019 Foundation: Location: 41 SHOREY ROAD, HYANNIS Map/Lot: 267-169 Zoning District: RB Sheathing: Owner on Record: BARRY,SUSAN M&HAYES,DAMES P TRS - t Contractor Narne: ' INSULATE 2 SAVE, INC. Framing: 1 Address: 31 COLONIAL DRIVE yContractor License;• 180747 2 ti ' PROSPECT,CT 06712 Est Project Cost: $3,751.00 Chimney: Description: weatherization PLitrn Fete: $85.00 Insulation: Fee Pay°d' $85.00 Project Review Req: signed installers certificate needed to close $ ,; Final: Date; 7/3/2018 o- - �� Plumbing/Gas Rough Plumbing: uBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed'by this permit is commenced within six months after ssuance. Rough Gas: . All work authorized by this permit shall conform to the approved appl3ication`and theapproved construction documents for which`this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws-and codes. Final Gas: = This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical r Service: The Certificate of occupancy will not be issued until all applicable signatures,by the Building and Fire Officials are;provided on this permit. Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footingm •- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: - 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT s �••. i:a: _.�: - as :..�.. / �• L xs° - •2 _'_ac � � - 2_ � l:1294f:d 63f.< �:A ::Ya Y'- 8 <:: �:�'t '+�=iY;. - - ® t Y},V2 3: 'a i'a � 4 - - i a✓.i � s�v".�4' �A i.�i3. � �.�ao.;`S- _ - � �'S is 8 � �-:. - �t t ..i �'J:SL.'._a<s�7[�'*,•i�> 8..12=8sa ��II • 6.v Sf > .Ei0.6 ti.�t • Ll.�a S.Y2•! � , / t - i'8. _- t � a 8= :.N �> >.�•a: t:aur:. Ar tia: i}� � �d_ii[5:23;.. 1 &::'e,:�-E �' ?• s:a .ta.- i'44i9 _d.Y- 2z:.I:.tt � 1 �t.v^n_ _ YRx� �'- __ _n $ j xx f x �e 6 Section 6—Pr*d.S . . Oil Tank Storage [ Smoke moors Flaming Son Q;Heating System ❑ Masonry ChimneyocA Addh*Private w y II Public D Sew ago:Disposal Mwicipaf On She Historic.District ❑ Hyannis Historic ? t�id. i gs - Debris pispowl Facility 6 .1c Ps: I;' using a C Yes:O No M Po Section 7—Flood Zt Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes', No Igo Section 8-Zog L&n ' Zoning District_ Prq�usei Lot, Ft. Sq. Tom Frontage=percentage of Lot Coverage ;i of Dwelling U ion Setbacks Front Yard Req ______-- ;�p Reit Yard ReQigred Propoded Side Yard Requiredif -- s;a S o Y i relief from the Zo€ing.Board in&e.pasO Yes Q No seem 9—.Gonstru.edw... . r Nate ��/cam Telepbwe .�i� �h6ye .�s�. city IIA'ae� ©d �a Dde Lke=-Nwber 24 j 7 4./ _. Licenw Type Unda I MdWstMO,M _rules.and ftpWiM G e:I a SBdIft Code. I mftstwd ft CMWper, a sus pa.ivqWed'by 790 CbM andthe Towff ofB=MVw Section 10-Hume Name Q' A e���'t- Teiep�+e 6Q�-Sl� ?-1p 7,� A �/CO (rDU� S1� Crty ! ale,, &" azip Ke a Number 1 7 Exphradon Date reg a r ties tinder the yesandi u ors far Doane Cis I d myresps . . . # Stae.Bui�g Code. I tad tl ° by 7901 PLC... Date a SOCGM 1l—Hie.4 - Hr a pwners.Name NJ Tei a Number a0 d6 6 - 7 a V Cell or WO&, sw N Lid mY resooslfies.ur the rules and (fit t�e:�6aebusow S'to BWdlng Code. I mad tle requked by 790 CMIt and tt Town of Barnstable• - w AA► �a/ate T 777 nth Department ❑ Zoning Board(if required) � Historic District ❑ Site PIaA Review(if refit "❑ Fire Depgw2ent ❑ Conservation ❑ f Far.cocurl work,please take yo plans directly tri tie fore ��. , n 13-Owner's as Owner . the ec t propeq hereby atorfze to act om �.reve to work author' Y behalf.,�?� by this-building a cat on for. (Address djob �a 3�� S gna zg of Owner cue o Prizt Name Lag Wdste&IMW1 'DocuSigri Envelope ID'-E5CAE57F-30DO-4438-95BF-887C9487E1 68 1 A RISE Engineering RI S& 5 Dupont Ave,South Yamwuth,MA 02064 CONTRACT ENs^iINWlw SUS-588-1926 FAX 508-St&IN3 p i PROGRAM r[imcaxrRacrGw+� oar7tv�arer CANDJ!£.glBiO�R,FOR7rpRK�s CLC44ES �sc�samr.. SUSAN ARMSTRONG (203)206-7286 05/04/2018 252758 .26004 41 Shorey Road 31 Colonial Drive ��. muim WY, West Hyannisport,MA 02672 Prosped,CT 06712 DESCRIPTION QTY COST. 1N,CEIdTIVE TOTAL ! ATTIC DAMMING-R-38 FIBERGLASS 20 $4920. $36 90 $1.2.30 Provide labor and materials to install a 12"layer of R-38 unlaced fibefglass.batts for damming purposes. ATTIC'FLA7-10.OPEN R-37 t;El.LULOSE v 1.075 $1;677.00 $1.g5-.75; $4.i925 provide labor and materials to install a 10"layer of R-37 Gass! Cellulose to-open attic space. ATTIC HATCH;SEAL&INSULATE 1 $60.o0 $45 00 $15.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insertion board.Weatherstrip the perimeter. VENTILATION CHUTES 66 $230.34 $172-76 457 58 Provids labor and materials to install ventilation chutes in the rafter bays to mairtaln ak flow. VENT FUTURE BATH FAN TO ROOF 4" 2 $237,50 $178 13 $59 37 Provide tabor and materials to_instai an insulated exhaust hose with roof mounted flapper vent to exhaust future bathrooM fan(s). 4°X 16°SOFFIT VENTS10 $289:10 $21683 Provide labor avid materials to install 4"X 16"rectangular aluminum sofFt vents to increase ventilation in attic areas.Specify color.White or Gray. ' AIR.SEALItJG 8 $640.00 $640;00 $0.00 :Provide labor and materials to seal areas of your home against wasteful;excess air leakage.Materials to be used to seal your home can induce caulks,foams and other products. Primary areas for scaling include air leakage.to'attics,basements.attached garb and otherunhe$Wd areas windows are not ) A reduction in cubic feet per minute(Cfm)oi,air infatrat{ort will occur,but the actual number of cfm is not guaranteed. At:ihe completion of the weatherization work,and at no additional cx7si � to the homeowner,a final blower door andlor combustion safety andlysis will be condukted by the sub-oontractor. WEATfi6RS RlP f W SWEEP 2 $160.00 Provide labonand materials to install Q-ion weatherstripping and a V' doorsweep to doar(s)to restrict air leakage. BASEMENT SILLS:.Ri 9 FIBERGLASS t3ATT 136 $297a34. $223:38 $74 45 Provide labor and materials to install R-i9 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. DocuS,�ini E`ve e ID E5CAE57F_30D0-4438_95BF_-887C94487E168 RISE En&eefing ISE'i" 5 Dupont Ave,South Yarmouth,MA 02M �INEEa:Nc CONTRACT 508-568.1826 FAX 508.568.1933 Page 2 PROGRAM THS CONTRACT IS ENTERED INTO BETVEpI RILE CLC-NES An TKE CWTOMM FOR'"rof'K AS CLOW vrow ORDER CUSTOMER DATE CLICKTO SUSAN ARMSTRONG (203)205-7286 05/04/2018 252758 26004 STfNWr 41 Shorey Road 31 Colonial Drive West Hyannisport,MA 02672 Prospect,CT 06712 DESCRIPTION OTY COST INCENTIVE TOTAL INtULATE BULKHEAD DOOR 1 $110.00 $82.50 $27.50 Provide labor and materials to insulate the tack of the door to the basement's bulkhead with rigid board at R-10 or greater with the required fire rating and seal the doors edge with weatherstripping to restrict air leakage. INCENTIVE SUMMER 2018 MAY ONLY 1 $om $100.00 -s1OOA0 YOUR INCENTIVES EXPLAINED: RISE Engineering has applied all applicable,eligible incentives and you will only be billed the net amount Some measures recommended for your harm qualify Wan incentive from the Cape Light Compact of 75%of the cost for insulation measures. LIMITED TIME SPECIAi-OFFER: Your offer from the Cape Light Compact has an additional$100 incentive applied towards the weatheriaation work outlined in this proposal,amount not to 9XO"d the dollar value of your co-pay.This special incentive is available to homeowners who sign their weathelizetlon proposal during the month of May,2018,all work to be completed by August 31,2018. Total: $3,750.08 Prograrn Incentive_ $3.113.25 Customer Total: $637.11 WE AGREE HERBY TO FUR141514 SERIACES•OoMPL.ETE IN ACCORDANCE Wm!ABOVE SPEMCATTON&FOR THE SUN OF ""Six Hundred Thirty-Seven&731100 Dollars $637.73 UPON FINAL BLSPWION AND APPROVAL BY RISE ENBMEERING.CUSTOMER AGREES TO REWr AMDUNT DN6IN FULL PNrmm OF I%WILL Be CHARGED pONTNLY ON ANY UNPAID BALAMCEAFTER NI DAY&SEEREYERBE FOR WoRTANT MFORNAnm On GuARANTM,mmm OF Rmcwc Acfuu"AND C4NNwtCTbR RC'-W-y IN - ca jju� Amy's 04O4WnA614C0._ NOTE:THIS CONTRACT WAY BE WnHORAVM BY US IF NOT EXECUTED VWWN " ' DATE OF ACCEPTANCE $Q OAYB ACCEPTANCE OF CONTRACT-VIE ABOVE PREE%SPBCOVAM"ANO OONpINNIS ARE BAMFACTORY TO US AND ARE NEREDYACCEHffiYOU AREAUTMOII2l*!m C07KC WWK As PREPM0-PAYN19"WILL BE MADE:AS 0UTu NED'ABOVE'.. �DocuSi,ri Envelom IDs E5CAE57F-30D0-443&95BF-887C9487E1.68 UOC 69n Cr}Y@ pe 1U:C01.+t.CJ!�yyU�yypp-,:�pr-vur-ur ,vu Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division o Paul Roma Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barastable.ma.us Office: 508-8624038 - Fax.. 508-79.0-6230 Property Owner Must Complete and Sign This Section If Using A Builder ; SUSAN ARMSTRONG ; as dwn.e�o£the subject properly S u� a� f��,� to act on my be hereby authorize , in all matters relative to work authorized by this building permit application for: 41 Shorey Road West Hyannisport, MA 02672 (,Address of Job) Signature of Owner /1,f2 Date 5usan Armstrong " P..rint.Name" X>f Property 4woer is applying for permit,please complete the Homeowners license Exemption Forwi T . C-\Users\decollik\AppDataU.ocalV1 tic*osoft\'Wmdows\lNetcache\Content.outlook\L.7U69Ln\EXPRESS(2)doc 01l25/17 The Comrrnnwealth of Massachusetts Deparhnent gflnrlustratt!'Accidents > I Congress Street,Suite 100 110slot;MA'02114-2:.017 t wwry mass.go lctia Workers'Compensation Insurance Affidavit;Builders/Contractors/Electricians/P[6 bers. . TO BE FtLE1D:WITH THE"PERMMITTING AUTHORITY. Applicant Information Please Print:Legibly. Name(Business/Organization/individual): Insulate2Save Inca Address:410 Grove Street City/State/Zip:Fall River MA 02720 Phone;.#; 508-567-6706 Are you an employer?Check the appropriate box-_ Type of project(required). I.CD tam a employer with 20 employees(full and/orpatt-time).. 7, New construction 2.0:lain a sole proprietor or partnership.and have no.employees working for me in an m $, ❑ temcdeling y capaciyN ' 9. Demolition In I am a homeowner doing gill work myset£[No workers'comp.insurance required)t to Q.Building addition 410 I am a homeowner and will be hiring contractors to conduct all work ommy property. [will ensure that all contractors either have workers'compensation insurance,or arc sole 11.Q Electrical repairs or additions proprietors with no employees. 12,QPlumbing repairs or additions 5.0 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet; 13.D Roof repairs These sub-cottractors have employees.and have workers'pomp,insurance.: 6,E]We area corporation and its officers have exercised their right.of.exemption per MOL:c. l4.�x ©ther I nSUlatiOn , 152,§1(4),and we have no employees.[No, workers'comp:insurance required.) 'Any applicant that checks box#t I must also fill out the section bctow showing their workers'compensation policy information. t-Homeowners who submit this affidavit indicating.they are dicing all work and then hire outside contractors must submit a new affiidavit indicating such. Contractors that check.this box.must attached an additi al.sheet showing the name`of the sub contractors and:state tivhcther or'not those,.entities have employees: If the.sub-contractors have employees;they must provide their workers'comp.policy number. Tam an employer that is providing workers'compensation insurtince for my employees Below is the policy and job site :information. Insurance Company Name: Liberty Mutual Insurance` — Policy#or Self-ins.I ic.#: XWS 56418741 Expiration' Date:: 12/10/2018 Job.Site Address l .J . i City/State/Zip f be)t"1� el Attach a.copy of the workers'cam nsation policy declaration page{showing the:poitcy nambe and eacpiration date)! Failure to secure coverage as required under.MGL c. 1,52.,§25A is a criminal violation punishable by a:ftne up to$,j,500.00 And/or one-year imprisonment,,as well as,civil:penalties in the form of a.STOP WORK ORDER.and a;fine of 11100$250 00 a day against the violator,A copy of this statement.may be forwarded to the Office of lrivestigations of the DIA for insurance, coverage verification.: 1 do hereby ceta antler the `' s ttn a tires of perjury y tltui the nformativ ,pravide�f uhrrve:rs trrt and earrec ' `Signature:. _ Date: J . Phone# 508-567-6706 Offtelail use only. Do not write in this area.to be completed by city or town official' City or Town: Permit/License.# Issuing Authority(circle one):, I.,Board of Health 2:.Building:Department.3.City/Town:Clerk 4: Electrical Inspector 5.Plumbing Inspector S:Other Contect"Person: - Phone#: . Office of Consumer;Affairs and Business. egu ation 10 Park Plaza - Suite 5170 Boston, Ma , usetts 02116 Home Im rovern ��° , =tractor Registration Type: Corporation Registration: 180747 INSULATE 2 SAVE , INC. 931w w Expiration: 12/28/2018 410 Grove Sti Fallriver, MA 02720 s a Address and return card. MArk reason for change. Update XA 1 0 20 -0s111 l Ci Addte. .CJ n+wel.CI Ennplo fen# O Lost Card d75Z. Jflyftr797,1Yi2[LIlK7b/!d-C !d?Ad'bJCICPLtd3 d , Office of.Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration.valld for Individual use only.. TYPE:Crarporati06 before the expiration date. !found return to:.. Office of Consumer Affairs and Business Regulation ExRlratlon 10 Park Plaza-,Suite 5170 12J2872018 Boston,MA 02116 � � t - INSULATE 2 SA i Roland tangev�� 410 grove St Faildver,MA 027 Undersecretary Not valid witttoUt sinatut x CWS91:'r rSweafth of Mnsadwsefts , Mvrsloh of Proussiono Lic"Sure t..,, Board of f3aiitding R orations and Standards CSA03861 f{tt�t IF ,itttiirR' 1"; , y CBmmissionet .4 CERTIFICATE OF S.SStiED.AS Aim pFRIOAtO[�!t?N&YAtF :Np f 3tOFS NQ�JkFfi�fATIYELY:OR ?. .. NB aAT11fElY Ate, XTEN t 2ALTiliii Tj4 66Lt�lAE Tim C AIE OS DANCE VS NOT'CONSMVT E.A TI$ - ,, �,At+E?•TEE ccATE HOu>EPL 1f a anAt 117110 AL'g ps ' � + Trts wAnra; p664 � ham : subJectto the: ana opt r .W +w L ftu it 4�f 1: I' �Y�eQt�@a�ER Ash. Anthony►F Cordeira Insurance RAe� 171. 3f?8=6TJ,g4gT 5!t&&764Qg Fa1t Rnreralf�Ei2721 ; AMSiJItED lkSt�A LibetlYA . lnsuk*2 Seve,inc. ems: 41Q`Grove:St easuR�c: FA Riva.MA 02720 s � IkS E COY�GES,' F: CERTtF�C/�TE'AlE11 ;' 7- The(fY7H%IT TFIE ROl 1GES;OF tNsu i At CF'LSTBp BELOW HAVE BEEN:1$SIiED TO 7i EEX OTWFTHS7AA hG ANY REQUIREMENT,TERM OR' CAFF:O ON'B ANY C REtiCT OR OTHERAY BE lSS�tEp OR MAY PERTAIN THE.INSURANCFAFFORDEQBYTHE,P(3lJl�tD C4NDtTTON$OF SUCH POW ICIES LIMITS SHOWN MAY HAVEBEEN:- SEE3 HEREIN,tS SUB ACT T(3ALL THE TERMS, LTR - - TYPEOF$ q� - .SY PAID:CIAIII�. UABMITY Poi.ACY kua� _' CLOAr.MADE'.17 OCCUR EACif $: �. .y♦ ' A Y Y BK8 564t8741D@ �AHA'tEt81AETAPPLlESPER 12ltOd17 t2f1OH8iSONAt& fR�1i1R1! PRO. POttCY E6T LOC OTHER PROS'SK�PAGG $ UABI ' s v ANYAUTO $ r� A SCHEOLLM IN3 {Per ! .AV�Qt�Y AUTOS'• Y Y BAA.36418741 4 ONLY. 12ItQH7 t2moll8 Boa�Yut K{aera �s. AtfTOS'ONLY ' X.00CUR, $ A tlae cx�tlasnAnDe Y Y USO 56418741 Fact 1 2/1O/t7 t2Yt , �8 LC.irorraze . RETElt}'p►H AND, $ A qNY YIN a MIA XtN5 56418741 : 12/ 117 12lt0t18 $ NS El- :< DESC }pp pP p I t•OcA owj Y@/C{Eg. 101.Add�Coao Reecarta Sdtedt9e,maY 6e mad ,more spm is c y. CCATE1iOLBER CANCEi LASHOAON 1LD AkY OF THE ABOVE P-0tlt 5 {��. IMM- THE t'i7ttTE 7-118kEOF P'oof-of Insurance Ac d AWH.Tt BO€iCY AUTHORIM ACORC2 { �; ACM name and bgO&ere ofACE�RE1 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(860)392-6108,FAX(800)851-8424 t 8/17/2017 'Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 ` BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET HYANNIS MA 02601 Re: Insured: SUSAN M BARRY&JAMES P HAYES TRUSTEES Property Address: 41 SHOREY ROAD,HYANNISPORT, MA 02672: Policy Number: 1134107 Type Loss: All Other Section 1 Losses r_D Date of Loss: 08/16/2017 " Claim Number: 416714 >s Claim has been made involving loss,damage or destruction of the above captioned property,which may either . exceed$1000.00,or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. lfl'any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number;date of loss and claim or file number. MPIUA Claims Division i CMA00021 c Town of Barnstable *Permit# 00103&;�o Expires 6 montlis from issue date Regulatory Services Fee ` S Thomas F.Geiler,Director Building Division — Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY (off �j Not Valid without Red X-Press Imprint Map/parcel Number � I 1 Property Address - 8Residential Value of Work / C5. • Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address O Contractor's Name V e-�d� �.. ►�Y✓I e�4 t �'�/Q� :F Telephone Numb �C' Home Improvement Contractor License#(if applicable) C? a(0 Construction Supervisor's License#(if applicable) a ❑Workman's Compensation Insurance IT Check one: X-PRESS PERM e-ram a sole proprietor ❑ I am the Homeowner . J U N 12 2007 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABL E Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file., P,:drmit Request(check box) e I ❑ Re-roof(stripping old shingles).All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) r- ❑ Re-side t, `� �� 5" l^eg S i G,491- � Replacement Windows/doors/sliders. U-Value ! (maximum.44) *Where required: Issuance of this permit does not exempt compliance with of departmep�regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.'-,- _. _ A copy of the Home Improvement Contractor cense is required. SIGNATURE: � 5 ✓ —_-���"'�-_ Z� Lfl/ (�, Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents r _ Office of Investigations + a 600 Washington Street Boston,MA 02111 . . www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers AwDlicant Information Please Print Legibly Name(Business/Organization/Individual): 1/j< t� Address: C,009f 2 Ca t2 4 s'> — City/State/Zip:O,NAI's<i9/34 � /��9� Phone 4: l B Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I ,� .employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.1�1 l am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P n'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. 3.❑ I am a homeowner doing all work h i ❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs L insurance required.].t c. 152, §1(4),and we have no employees. [No workers' .13.�Otherl comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.01 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 her7bifyunder t ,e gains:and penalties of perjury that the information provided above is true and correct Si afar �' - ` ` -�"��— Date: a e Phone#: �'4 7 Y/cs Official use only. Do not write in this area,to be completed by city or town of lciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual;partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile Address"the applicant should write"all-locations in (city or town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Department of Industrial Aceidents Office of Investigations 600 Washington Street Boston, MA 02111 Tell. 4 617-727-4900 ext 40.6 or 1-877-NIASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.go-v/dia Town of Barnstable, Regulatory Services Thomas F.Geller,Director `bA ,e59. b,� Building Division lfD NIA' TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wyew,town.barnstable.ma.us Of$ee: 508-862-403 8 Fax: 50.8-790-623 0 Property Owner Must Complete and Sign.This Section If Using A Builder as Owner of the subject property herebyauthorize4ZI�j�,��,� ��� to act on my behalf, in all matters relative to work authorized bythis wilding permit application for; . (Adgftss of3ob) o� s ature of Date Print Name Q�pPN?S:Ov�n�RPE,RMI55I0N u t I"" u. _� �-- -- ae onvnioruaetr�CL a�✓���,r.�aella _ Board of Building Regulations and Standards �. l —e — HOME IMPROVEMENT CONTRACTOR Registration:` 100053 Expiration: 6/8/2008 Type. Individual VICTOR J.WIINIKAINEN ' Victor Wiinikainen" i 58 CAPE COD LN �"�' BARNSTABLE,MA 02630 Deputy Administrator, 'A� License or registration valid for individul use only before the expiration date. If found return to: y Board of Building Regulations and Standards i One Ashburton Place Rm 1301 Boston'Ma.02108 00& I Not alid without signature y i l' THE FOLLOWING IS/ARE THE BEST.. ' IMAGES FROM`,POOR QUALITYORIGINAL (S) I M, DATA f Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee - �®=`� Thomas F.Geiler,Director Building Division X-PRES,S PERMIT Tom Perry,CBO, Building Commissioner AUG 2 5 2005 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ,TOWN QF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint lap/parcel Number J► 1 roperty Address Residential Value of Work +� Minimum fee of$25.00 for work under$6000.00 --lam 'wr►er's Name&Address r 4® , /_ t' V 'ontractor's Name �6�, U l�l(1/�lC�y�L Telephone Number�d� 2l [ome Improvement Contractor License#(if applicable) .onstruction Supervisors License#(if applicable) ]Workman's Compensation Insurance Board of Building Regulations and standards HOME IM„, OVEMENT CONTRACTOR Check e: ,�' .R, � I am a sole proprietor RegI ratfopN j00053 I am the Homeowner l-xpir ❑ I have Workers Compensation Insurance ;rTypn0Sidual VICTOR J.WIINf -N-M.- "11` isurance Company Name 7 a Victor WiinikarnenA 58 CAPE COD LN Jorkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. BARNSTABLE,MA 02630 Administrator ermit Request(check box) - ±Z ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) g Cn r a: Re-side G/091a / ( � � ❑ Replacement Windows. U-Value (maximum.44) Z- r--rt *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Consery tion,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ome Impro ement Contrar4tors License is required. IGNATURE: :Forms:expmtrg evise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly r Name (Business/Organizationdridividual): Il Address. �. - City/State/Zip:9,4R, t5c�v<, ( ( Phone Are you an employer? Check the appropriate box:. Type of project(required): 1.❑ jam a employer with - . 4. ❑ I am a general contractor and I 6. ❑ New construction employees(fall'and/or part-time).* have hired the sub-contractors 2. I an a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.❑ Electrical repairs or.additions required:] . . 3.❑ I am a homeowner doing all work right of exemption per MGL 1.11:1 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.[:3 Roof repairs insurance required.]t employees. [No workers' 3. comp.insurance required.] 1ther �r�s2s€ c��e.�-S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: a t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy information. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance.Company Name: Policy#or Self-ins.Lie.#: Expiration.Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in ttie form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to.the Office of . Investigations of the DIA for insurance coverage verification. I do hereby ce thefiay'q and penalties of erjury that the information provided above is true and correct Si mature: Date: Phone#: 67 �S C -Z Z. O Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector _ 6.Other Contact Person: Phone#: i pfINE, Town of Barnstable Regulatory Services MA�I Thomas F. Geiler,Director 163q. ArEDMA'IA Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Y Office: 508-862-4038 Fax: 508-790-6230 a Property Owner Must Complete and Sign This Section If Using A Builder I, D Y1 © f-O , as Owner of the subject property hereby authorize Y!e AWM n,to act on my behalf, in all matters relative to work authorized by this building permit application for: (Adress of Job ) CA Signature of lOwner Date �► � Q�r6qX Print Name { Q:FORMS:O WNERPERMIS SION q . ,.� a °* /� .T Town of Barnstable *Permit# ? 6 0 x r �' �FtMEap�, �• ` Expires 6 months from issue date D Regulatory Servicesee r ..VBAg$SFABLE �� >�r 6 Thomas F.Geiler,Director 139� ♦0PER v A,Eo► �" Building Division Jr � , .. t r } � s�� s Tom Perry, Building Commissioner SEP p 87003 200 Main Street, Hyannis,MA 02601 TQwN OFB ' u ' ffice 0855 852-4038 gR O NS7A- l.lE Fax 508 790 62310 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number,lC�7 g4W z Property,Address Value of Work.- � ,�Residential- �...� - t �;Owner;s Name£&Address 3/12 x , ;. :Contractor s Name �� d� � � � ��[ ' Telephone Number ,afm oveme't-Contractor License#(if applicable) '•y - Constructton::Supervsor's License#(if applicable) k k:❑Worlmtan's Compensation Insurance A am a sole proprietor u 7 ❑':I am the Homeowner F ❑.I have Worker's Compensation Insurance � dj0 0 -'Insurance Company Name } VVorlanan's Comp.Policy µPermitRequest(check box) Re-roof(stripp shingles) All construction debris will be taken to' vmxofaing,old ❑Re-roof(not stripping. Going over existing layers of roof) ! ❑ Re-side Replacement Windows. U-Value (maximum.44) _' Y � 4 *Rf►eyyr�e required Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc., , Pro erty Owner must sign Property Owner Letter of Permission. Improvement Contractors License is required. Signature Q Forms ezpmtrg ' t 'Reviseo, 3 I �tKE rti Town of Barnstable °^ Regulatory Services anx AS& nsass. Thomas F.Geiler,Director 039. 't � Building Division ts. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, .?.�li , as Owner of the subject property m to act on behalf, hereby authorize l Y in all matters relative to work authorized by this building permit application for:. (Ad ess of Job Signature of O ner y Date Print N e , QTORMS:OWNERPERMISSION x •'" , � k ;;3 Board of Building Regulations and Standards r HOME IM -R(:�VEMENT CONTRACTOR .yt Rea'! I sn tfl0053 ,.; _ �M1x 6E& 004 YP loqiii!idual ' VICTOR J. I)q WIINI�I��V W t Victor Winikainen -- 58 CAPE COD LN % BARNSTABLE,IVIA 02630 � �"' - Administrator, THE TOWN TOWN OF BARNSTABLE 22 . i EA"STODLE, i "b q � BUILDING INSPECTOR �Ep AIPY�'• ' AA APPLICATION FOR PERMIT TO .......PI.IP A r`. ...... ........ P4.�...Siy�.. .......................... TYPEOF CONSTRUCTION ............... ................................................................................... 2. T.S�ht ...... ..................197 TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies for a permit according to the following information: Locati` A.. �.�.7. .P.l�. iywi� p . ............. .r................�.✓........... .A ......["Q. ............................. Proposed Use ............... .......1FA.9414,!. .. . '!t'Gr i�/.!43....................................................... . .............................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ... `f6'&N .l POD(o.'Z,Xe.4 ..Address 04. A.�r,.T� OQL�!!�!r ,t........... .4... C . Name of Builder �0$..I... .......PROT6A j"T5!-r....Address ...4.0)e... .�� ! OQ<<.p�".5.................. LL ,�f� / 1 �p �............. Name of Architect C^r4�S r 4TOAQf aL�— .'..Sox ���'!� �r%�a Address .... .....................�............ .....,... ..................... Number of Rooms .............. ..........................................Foundation ..........L..Q.N...A,-#j:.l=.. . ...................... Exterior !Y........ ...............................................Roofing ......... �.r► ........?.k.w.g.�i..................... Floors ........... � ,w�o dam!.................................................Interior .............VAq .&V 14 'L...................................... / � II Heating .......FCNLCA.......Mot......?n1.4.......................Plumbing .........�...!�..b!��'.............................................. p Fireplace .............. .QI.G9.................................................Approximate Cost .... ..A.1.900........................................... Definitive Plan Approved by Planning Board _--_-s_-_---19 72. �4/s S� Diagram of Lot and Building with Dimensions / ` E: // d SUBJECT TO APPROVAL OF BOARD OF HEALTH Iv W ff LL O U ' I C7a. � _ � I QQ � ZJ i � ypP'Iw �l d � w > w z. Q n � mLL � i t a7� tj. m f �- LU tj ry OU? Q 0 F- j Z � (f) I 0 < � w --- -- ----- - - - - -� - - - = tZ L-, O-o_- Pac - - - _. :D IiJ � U) s � ��� C o � o � Qo w � � 7 � LU cn d a 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding th above construction. � • Na ;4 _ Aboxn & Proctor, Inc. ' 15113 one story No ................. Permit for .................................... � single family dwelling � ----~--'—~^—^--'---'—'—^'--'----' Shorey Road Location --.----:.----~--------. ' West � .--.—.—__,,_,.��.���.�� ,^. ..................... Aboro 8; Proctor, Inc. Owner frame Typo of Construction -------------- ----.~---..--.----.---.---_—.. �� Plot ---------. Lot --.-��------. ' . Permit Granted June ... Date of Inspection Dote Completed ..4...../ ........ Ito ` ^ PERMIT REFUSED ^ ____..___,.__.--------.—.. lg \ � ..----.~.—.—,--.--.....—~---~--- / � | � � _..~—.--.--,.~---.—...~.--.—.—'..... � � —^--'---'--'—.,....----..—.-..,..--. l ( ^ .—.—'.--..--.-.—.---..—..-..-.—.,..., ^ . � { i Approved ................................................ 19 � . . ' ---------------.----.------. / -----------.---------.—....~.,' � . ' ' �