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HomeMy WebLinkAbout0216 SIXTH AVENUE (HYANNIS) �i� �S� c � �` — { ° i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Applications Health Division Date Issued Conservation Division Application Fee v Planning Dept. Permit Fee' Date Definitive-Plan Approved by Planning Board ' Historic - OKH _Preservation / Hyannis Project Street Address /1` S+ x AV_ Village Owner f jViJ1,t-1S ();J)k_ Address Telephone Permit Request <txu_ga� rtisky. �A_L%_t.W% ,ct_24�� 5 wd�.. �►:v. ��,s Square feet: 1 st floor: existing proposed V 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 10000a Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach Npportin"ocu entation. cn ,� Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) }-' `-a o _ -n Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway ❑YJs ❑ No Basement Type: ❑ Full JerCrawl ❑Walkout ❑ Other _a ra Basement Finished Area (sq.ft.) b Basement Unfinished Area (sg ft) 22 ,r d� Number of Baths: Full: existing new — Half: existing i -new 0 Number of Bedrooms: existing I'-- new Total Room Count (not including baths): existing new First Floor Room Count G Heat Type and Fuel: ❑ Gas' ❑ Oil dElectric ❑ Other Central Air: ❑Yes O'�o 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 E d Telephone Number 50G1774 20742 Address AL4, ( �Z D License # 26 C? � 11 ^ ' 11 -- N % T'W ��IM �� U�G3 Z Home Improvement Contractor# /UU 71 f7 Y Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I�//�/3 FOR OFFICIAL USE ONLY -APPLICATION# DATE ISSUED r MAP/PARCEL NO. i' F j ADDRESS VILLAGE r } OWNER DATE OF INSPECTION: FRAME r--- 17— -_r-,.T.y4� r-� F e , - 4 FIREPLACE ELECTRICAL:,.. ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING =+' Y F DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of IndustrialAccidents vOffice of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Or ng� ization/Individual): E D Address: f���' .,�u•� c. ..r.t - VZ.� City/State/Zip: C Phone#: syijr , a0-7 b Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with " 4. J31 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees . These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P t5'• t 9. ❑Building addition [No workers' comp.insurance comp, insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.01 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 repairs insurance required.]t c. 152,§1(4),and we have no . employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a'copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for'insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Si ature: Date: 9 // Phone#: 5_0 - 7,U 2Ln 0 . 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 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 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-contractor(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 Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (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 Commonwealth of Massachusetts Department of Industrial Accidents Office of luvestigations 600'Washington Street Boston,MA 02111 Tol,#617-727-4900 ext 406 or 1-977-MASSAFB Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/09/2013 THIS. CERTIFICATE 1S 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: PAUL SCHLEGEL Schlegel & Schlegel Insurance Brokers Inc PHONEFAX (A/C,No,Ext): 508-771-8381 pvc,No)508-771-0663 34 MAIN STREET ADDRESS: SCHLEGELINSURANCE@VERIZON.NET ADDRESS. PRODUCER _ - CUSTOMER ID M West Yarmouth, MA 02673 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A PHENIX MUTUAL Richard Harold Gardner Dba Gardner Construction INSURER B LIBERTY MUTUAL 92 Park Place INSURER C INSURER D: - Mashpee, MA 02649 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 NTH 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. INSR AVULIbUtiftl - POLICY EFF POLICY EXP - - LTR TYPE OF INSURANCE - INSR W VD POLICY NUMBER (MM/DD/YYYY) (MMIDONYYY) LIMITS A GENERAL LIABILITY CPP0709341 08/20/201308/20/2014 EACHOCCURRENCE $1,000,000 T X COMMERCIAL GENERAL LIABILITY - PREMISES(Ea occurrence) $50,000 CLAIMS-MADE 0 OCCUR MED EXP(Any one person) $5,000 - - PERSONAL&AOV INJURY $1,000,000- - - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- F-1Ea LOC - - $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE - - AGGREGATE $ DEDUCTIBLE $ RETENTION S $ TW WORKERS COMPENSATION WC-0898679 04/06/2013 04/06/2014 X WC ST TU- OER R AND EMPLOYERS'LIABILITY TORY LIMITS YIN B ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT- S 100,000 MI OFFICEREMBER EXCLUDED? RD N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101,Additional Remarks Schedule,if more space is required) THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR RICHARD HAROLD GARDNER CERTIFICATE HOLDER CANCELLATION ED MOGAN/ MOGAN HOMES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 41 JOYCE- ANN ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CENTERVILLE,MA.02 632 ACCORDANCE WITH THE POLICY PROVISIONS. - - AUTHORIZED R PR SENT TN , E-MOGAN OMES @COMCAST.NET ©1 8 -20 19 C D C RPRATION. All rights reserved. ACORD 26(2009l09) The ACORD name and logo are registered mark of ACORD Client#: 15228 2BRANNDR DATE(MM/DDrr"Y) ACORD. CERTIFICATE OF LIABILITY INSURANCE 09/05/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON 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 WANED,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 CONTAC - NAME: Dowling&O'Neil PhONE 508 775-1620 Al No: 5087781218 A/C,No EA Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED - INSURER B:The Hartford Richard Brann D/B/A Brann Drywall INSURER c: 3701 Falmouth Road INSURER D Marstons Mills,MA 026" - INSURER E -3 - INSURER F i _ -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 CONTRACTOR 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. INSR ADO SUB POLICY EFF POLICY EXP TYPE OF INSURANCE LTR I WVD POLICY NUMBER MM/DD MM/DDLIMITS - A GENERAL LIABILITY MPB14383 21311201212/31/201 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY _ PREMISES Ea o.grrence $5OO 000 CLAIMS-MADE F;1 OCCUR MED EXP(Any one person) $1 O 000 X PD Ded:250 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 F—IPOLICYF—]JEa LOC $ - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY _ Fa accident $ ANY AUTO BODILY INJURY(Per parson) $ . ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ - $ B WORKERS COMPENSATION O$WEGLD$356 2I13I2O13 02113/2O1 X WC STATU- OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L EACH ACCIDENT $500 000 OFFICERIMEMBER EXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by_the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mogan and Co.,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 68 Joyce-Anne Road ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S116939/M116936 KKM Rightfax C3-1 9/4/2013 5:44 :001AM YAUE siuu4 rax z)urvur ac o CERTIFICATE OF LIABILITY INSURANCE [�oqn,!_2o 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 policyres)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 endomement(s). PRODUCER CONTACT NAME: HUB INTERNATIONAL NE LLC PHONE Fax 125 ROUTE 6A A!C No Ext: A/C No E-MAJL SANDWICH,MA 02563 INSURER(S)AFFORDING COVERAGE NAICq INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AM ERICA INSURED INSURER e: _ J M MORIN INCORPORATED INSURERC: 55 MOUNTAIN ASH RD MAIRSTONS MILLS,MA 02648 INSURER 0: 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. ILT R TYPE OF INSURANCE ADD SUB POLICY NUMBER MWDDIYYYY POLICY Y IXP LIMITS - LTR IN5R WVD ( ) - GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S PREMISES(Ea occurrence' CLAWS-MADE I OCCUR MED IXP(Any me prrson) S J - PERSONAL&ADV INJURY S GENERAL AGGREGATE S . GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S POLICY JEa. LOC S AUTOMOBILE LULBILITY Eot t"1�0 SINGLE LIMIT S ANY AUTO BODILY INJURY(Per PeMOn) S ALL OWNED AUTOSU LEO BODILY INJURY(Per accident S AUTOS NON•OWNED - Pd20PEL�TY AGE S IIHIREDAUT05 AUTOS or ace ord S UMBRELLA L.IAB OCCUR - EACH OCCURRENCE S EXCESS LIAB H CLAIMS-MADE AGGREGATE S BED I RETENTION$ S WORKERS COMPENSATION x I wC sTATU- OTH- AND EMPLOYERS•LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNERlEXECUTIV�Y_!._N,� EX-EACH ACCIDENT $500,000 OFFICER/b1EMBER EXCLU,R/E U NIA 7PJUB 01-19-2013 01-19-2014 El.DISEASE•EA EMPLOYEE $500,000 - (Mandatory in NH) 5B784574 If yes.,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attwh ACORD 101,Additional Remarks Schedule,It more space Is required) THE POLICY DESIGNATED ABOVE IS CANCELED EFF.0712812013. CERTIFICATE OL CANCELLA 10 MOGAN HOMES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 68 JOYCE ANNE RD CANCELLED BEFORE THE EXPIRATION.-DATE:. THEREOF,. . CENTERVILLE,MA02632 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD %-• Nlass"I u�ctt�=.01ep irtmcnt i►t.Puhlit itch 'Boar uildin�t Rcwl itis►n> Intl titans$s ' C®sistruct. n.Supervisor:Liven License: CS 26071 - I FRANCI8 E MOGAN: 68 JOYCE ANN RD CENTERVILLE, MA 02632 �--�—-%y�j� Expir.aison. 10/3/2013 s'rkE.mi�.i i�r Tr# 5002 77. -77 /zeoa�enrd�z�irealtl a�'�jli���iclrweh F �.eT c i,rre istration 4a{idyfor individul use On (Offiee of Consumer Affairs&Business P.egula, on 1. y. NVIE IMPROVEME;NT G_ONTRACTOR before the expiration date. If found return to e istraiion. 'JOG- Typa Office of Consumer Affairs and Business Regularion 9 xpiratisn 6/23/2014 :Pntlate Corpor 10 Park Pi -Suite 5170 Ro,tariMA 02116 MOG* N&CO INC. 1 ; Fran `N�rj� ,Jr. 68 - JO.i'CE'ANNE RD Cdntewille,MA 02632 Undersecretary ' _ alid without signature. A t r Town of Barnstable °+ Regulatory Services Thomas F.Geiler,Director - - Ed Building Division Tom Perry,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 Au' as Owner of the subject property hereby authorize �,� V1/1, _G, ,�, c to act on my behalf, in'all matters relative to work authorized by this building permit (Address ofJob) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Sixture of Owner ' Signature of Applicant ` Print�Iame Print Name Date QTORM&OWNERPERMNSIONPOOL•S 62012 Town of Barnstable Regulatory Services f Aa KABSRiF + M,� Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMOTION Please Print DATE: JOB LOCATION: num er 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. DEFWMON 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. C:\Users\d=Uil\AppData\Local\Microsoft\Wmdows\Temporary Internet Fflcs\ContcntOudook\QRE6ZUBN\1DURFSS.doc Revised 053012 Assess office (1st floor): // .......�......... CfTHETO sess�s .map and lot number >�:�.. ... . "" � .. �♦ Q Board of Health (3.rd floor): c� xam �3 Sewage Permit 'number ....."1..4'..... :. :. •.> .......f.. ....... ST t BAU ULE, Engineering Department (3rd floor): ' MA°a r(` FJJ I + oO i639 \e0� House number_ ......:.......... al. ..................� DNA Defin t've Plan Approved uby Plonning Board ----------__________________ ` __ .UM OUN APPLICATIONS PROCESSED' 8:30%9:30 .A.M. and 1:00-2:00 P.M. only r , TOWN OF BARNSTABLE : ..,. BUILDING I HIP ECTOR APPLICATION FOR,PERMIT TO .wD....!g ..SEvo F/am A0 2fr�—� /le.�raV i/ &017 C71W.16r :G ` icy tvvrt°J. .................. .�. ............ ......... ry . • TYPE OF CONSTRUCTION .............1!NP........�.K ,4......................................`......:...........................:........ De......:..................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �rT 5"2 SZ i Location ..............Zap............ ......4.✓�.. ....:.........W-.......F...y..1W. /.J.:/�U��.:....�7f.�•.:...'......�... ......... . ..:i.. �'J Proposed Use ................................ 2J! .:Un... .'V1�. l�I�! ...:�....GG/fi?y!. /X /..... Zoning-District ................. ..... .......... .............:................Fire District Name of .Owner -.:/ Ay..#q,....:.4.....✓�IQ..:... Address ...,/.y. ✓�J�� H....A4 cl //U2THc3dR� iy1.9 ©1S.jZ ._...' ... ...... f Name of Builder .. � atir/. �!Z,.. ....:...Address. � X...29�........��< t�t�U�/ .... ..... .. ... ,_�.s-��. ft...J-... .. J M�t x •/S9 jg7AV 84RE'Hf 1/ Rd 3 76 Name of -Architect N� .......:..1�....//zt�../�E !✓.......Address .. f .Y IZ[)/ ✓�....'. `�/J�l..... .ok. f . .. . ........... • - ' 7DT14L � Number of Rooms ............Foundation ...jV*...: .' Exie for NfH/ ....C.ao.lt.....5!`'fM$ .�........._.............•.Roofing .... ;.r:C ..O'....... /./a✓��.LS...... ............ . Floors /8........�rpX....!�Ly.......suz3 F�lI/✓L..........:..........Interior ....CO �.......t..:.....G'•!f 1� . Heating ��CT/�lC ....... Plumbing ...... .':.:.! T! ........./.v i,17//7t/A!......... ........ ............ .................. Or x Fireplace ......Nrh ..`..........::................................ ......... .......Approximate Cost .....:1�.....�Jt, UiQ� Area c........ .........:a - Diagram of Lot and Building with Dimensions Fee .........�Ot ...................... Zt noTE: ! fZl� 5K,uSg— t j3 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. Construction Supervisor's License ...4 OPOO...1..1.4?....... y VILLA, PHYLLIS A. F No =3 2 5 3 7_ `Permit for ADD DORMER r Remodel!,Exi-st. Garage/Singl Family Dwelling � f• .....Y.......`21.6... . .. ..... Location Sixth Avenue �W. Hannisport .................. y` PhXllis A. Villa ' Owner ....... i la �, _ . , ,; - Frame- r Type of .Construction .. ... _ . .. ... ..... .... r Plot ....... tot .............. -' Permit Granted ....JanuarY.ry.4.............19 89 �. Date of Inspection .r ... ... .... ......... •1 q ' Date am t5 ........ .... .... .19 aii w ' y LU 47 'e ?. ✓ ci . AJ `A r�"'.'..�# _r•:!':-:n _ �.`;��r +,i.-:.<t.+�«� :�?;re .'ri'��;:`.4.:.�''��'.' F-i �...e.. t�'�%he�?7-IbW"Y�6.�•F;�l,2a f.s:;ry�A.-.a - ..,. _ .n. .,.n w..+u .�+r..F�,:-,...,. �«?'.3 Acsesso ., office (1st floor): TNE�� TO X��:seslbf,"s map and lot number .. ?. ...03.................. Board of .Health (3rd floor): c o er .....!! Sewage Permit. numb 7"........^..:. ............................ Z SAWSTa.DLE, Engineering-Department (3rd floor): F f� rasa , Op 163q. 9� House number ..................................... Definitive Plan Approved by Planning Board ________________________________19________ . 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 .!"�D....!` ...sl��n/f� Flt,aR Au�,�E t A m�cle/ &IJ17 6401,-r ,G'fU7Z) F`-/fmiG�..,Cc�u�Y1.`.....................o. .................................................... TYPE OF CONSTRUCTION Wr� F-11?Alz c .............. uo ....................................................................................................................... ........... .......ZL............19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ?_ / �S/xt ...... .V :......... W:.....,fit•/ /.r au.� �' „sz sz Location ..............._........................... ........ o.............,r......:.................. M,4-f�7Z lgt_�1?uU�Proposed Use ...k ?(� v ...•..•..-.................... an j '`F...f.../.u..d../......... .....�...i..�......�..t.f.r i�c ors9. ............ Zoning District �� �.I,. I.............................................Fire District ............//.,.1!�' 1U Name of Owner ..f��.�/�f/S �. V/� 8 ,7vSEAl7 /?oG .. /t✓!iR/7t! �... b!5_ �..........................Address .............................................�........................e............ 32 Name of Builder Address .l ,X....Z.fa........S. �FMN/ .....!??!9':.. ��. s/ f ....... �..... /59 6�lT t3,VC Ht/! Rd`_ Jdk z 76 Name of Architect ...lV/! ...."....L /. :�i:"!!..../�E.f1✓`r!!V......Address Jy?KY4!?l r..'/�'1��9.....C�� S/.. ... ............................. . 7107,-ad- 6 - Number of Rooms I4\!01,!M6...../..`.........................................Foundation ....*,/9.................................................................. Exlerior ..WH!Tr...CEN ..... 5/ ,/NtiLL'..��......................Roofing .......RIP)....t'f".b.rb<..... ................... r Floors ..-%........L .... ,/��...... .Y:� S qIC/qd2.....................Interior .....0AK........f"......... Heating ... LECTI?/.0........................................................Plumbing ....../...../�� 7 ...........�.....�r-)G7i.nvN......... Fireplace .........Approximate Cost a�5 1ja�1, ;"yx Area'......**� Diagram of Lot and Building with Dimensions Fee Cbb E" C F- r _ 13 L r44' 26 44 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 ........ ...... y Construction Supervisor's License ...r'�'� .....7_ .K...... VILLA, PHYLLIS A. A=245--103 9�f-/03 No Permit for Add-Do.rMex...&...Remodel Exist. Garage .......Sin l e...F.am.i.ly...pXpjj;i g....... Location ....�ZU...-5.ix.th...Ave.nqg.................. ................W., .......................... Owner ...Rhyjl.i.s....A.....Villa. ..................... Type of Construction ........Fr.dMe.................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....January....4.!.........19 89 .. .... .. .... . Date of Inspection ....................................19 Date Completed ......................................19 1 � KITCHENDESIGNS Designed For.AND t 4�- This is an original design and must not be released orcapied unless applicable En fee or deposit has been Equipment U INC �1 \� paid or order placed. and Address: oG 4yoz The Purchaser under nds that an order has been placed and anychanges in A measurements or a lances MUST b approved by K 8 B Designs Unlimited. Specifications TOM F. LECKSTROM C.K.D. City �' �P��I Spa�'�"State:��y..Z;p: aa6�oZ � �� �_ � �y�3 Certified Kitchen Designer Principal Approved By. Date: Range S) 74 ti5 Mw:) 5 866 Main Street,Osterville,Massachusetts 02655 = r • �� E!�0 3 �r Ph:508-428-3999 Fox:508-420-3640 Designed By: 7o F i� k7ke, cat,Scale. W 0' All measurements are finish measurements unless otherwise noted. Cook Top 4 x N o NA • Vt1�--�U � Cook Top ��� fiioN r l D Vt24I Jpo Wall Oven w'2 t, �� l t oZ f Microwave 30" M�crLo s grace i�f s 3`a ;.a�F :k;: :r �_.•"�°,. -._.� "}x'xi� y +�de'��'d�a� -.:� � �iG4tr�' Y �.�.. ) � `� � N!!d A �� t� Compactor S r46e 9 Z•$�IrAvla Dishwasher�t<�to k-ivs15 3 I D .S - 1 Refn g aSF'r - t rr a �Fu as BASS C464 Wine Storage wit , I 6 + 3 "7 tPut s �A04,w4ek Ice Maker 4 ^ F�tt�Sl rto ' 110 0ti �Oo�§ �eS74. t4 �ti�t�tLsiti�.� I � _• �. f-� d Sink aaXas S; cq .� -L11 ep - Ctorj� Sink MNh 71 Soffit lam:CD Ab C_Q:, a �^ C K�bo C-0 a(f l r Warming Drawer y Glass -a A11 [' pr' p n v a(.7 e1- .1� `� �' -� 1 V D•�6`C `o y,�0 y ) �� Z „F.,•. Base Cab Toe Space p Flooring Material Wl _ 1 co Hood Venting S�rav�� S-a{.TO'__, �►RI/� ,off`t �� O Appliance Panels �m'LT T Under Cab Lights rr G Casings Counter ToP Ulf ��o M S}ep sr PRa�l.e r i 9 +-- P_,A S•����r�, Faucet ,::r B TOAR F. L.ECKST'BOM e� _ BEGIST63.NO. . Backsplash Coiling H or DATE P A G& cm