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0306 SOUTH STREET
Poo ONO �o �H-7 Cflrzef' Town of BarnstableBuilding .I Post This Card So That it is Visible from the Street-Approved Plans Must be Retained on Job and this Card Must be Kept w "14�5 Posted Until Final Inspection Has Been Made. lap` 639• �� - �Fana+" Permit Where Certificate of Occupancy is Required,such Building shall Not be.Occupied until a Final lnspection.has been.made. Permit No. B-17-3833 Applicant Name: Approvals Date issued: 11/30/2017 Current Use:.. Structure Permit Type: Building-Addition/Alteration-'Commercial Expiration Date: 05/30/2018 Foundation: Location; 306 SOUTH STREET, HYANNIS Map/Lot: 308-086 Zoning District: SF Sheathing:- Owner on Record:. GREAT ISLAND INTERNATIONAL LLC Contractor Name: MATTHEW MASE Framing: 1 Address: 306 SOUTH ST Contractor License:' CS-002439 2 HYANNIS, MA 02601 -. Est..Project Cost: $9,000.00 Chimney: Description: re-roof stripping old shingles dumpster fees paid with TB-17-3811 Permit Fee: $ 181.90 Insulation: Project Review Req: Fee Paid: $0.00 Date:. 11/30/2017 Final: F p ......_ Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved 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 The Certificate of.Occupancy will not be issued until all applicable signatures-by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing 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: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy 11 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 Finai:, All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �„`��L Map U Parcel Cf o Application # � 7-31 3 Health Division Date Issued 1 c l7 .Conservation Division Application Fee Planning Dept. Permit Fee = Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address G SG (4- 4 3 Village L y h h o Owner Df h.I �an Address Telephone Permit Request Ui2 S !2J Tg h1V Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 50 91d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)i - Number of Baths: Full: existing new Half: existing new, Number of Bedrooms: existing _new Cl Total Room Count (not including baths): existing new First Floor Room Count_ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Y:es ❑ 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 1 e Telephone Number 5'> Address �� /T �/���:/l License # 0) 1 51 �`� ��/�-► L� Home Improvement Contractor# Email In C��� 1� ��t �l G° •�d l"► Worker's Compensation # Ue a f� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C.Y t- c SIGNATURE DATE l f , FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED 1, MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. C The Contntoms•ealth of. 1assachitsetts Department of Industrial Accidents office of hivestigatlom 600 TV shingto►i Street Boston, jL4 02111 1111011.Ilia ss.gos,,dia Workers' Compensation Insurance Affida'%it: Builders/ContractorslElectiicians/Plumbers .Uplicant Information �,,� Please Print Legibhv Nat11e(Business.OrEanizadon.'Indi%-idual): v "( Address: �_ela r—� d " ALV CirviState;Zip: tJl2V �'1 Phone #: > r/(� b �G �—� Are vou an employer?Check the appropriates box:'. TNYp a of project(required): 1.❑ I am a employer with 4. L°"(I am a general contractor and I t employees(full and-or part,time).* have hued the sub-contractors 6. ❑I�eLr construction '.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling' ship and have no employees These sub-contractors have S. ❑ Demolition working ing for me in any capacity. employees and have workers` o insurance. ❑Building addition [No workers' comp.insurancecomp- required.] 5. ❑ We are a.corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all wort: officers have exercised their 1 l.❑Plumbing repairs or additions myself No workers' co right of exemption per MGL , � mP 1_.❑ Roof repairs insurance required.]_ c. 152. ti 1(4),and we have no 13.❑ ,Other �� rGfi' employees. [No workers' comp.insurance required.] *Any appLicam that check: boy:al mast also fill out the section below sLon-ing the:r workers'compemationpolicy infortr_auoU- Homeotaners wL•o submit this affidavit indicatinz then are dome all w orS and then here outside contractor,mast submit a new affidavit indicative such- :Contractors that check tLts box must attacted an additional sheet showma the name of the sub-cot:rractors and stare whether or not those endues have employees. If the sub-contractors have employees,rhea must provide their workers'comp.policy number - I ant an etttplos'er tllat is prosiding trorkers'conipetr.sation itisrtrance for ins•etttplos-ees. Belo+r is the policy and job site ittfornration. Insurance Company\ame: Policy'_or Self-ins-Lic=: Expiration Date: Job Site Address: City:Stater'Zip: Arrach a copy-of the workers'compensation policy declaration page(shox%ing 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 S1,7500.00 arud,or one-year imprisonment, as well as civil penalties in the form of a STOP%VORK ORDER and a fine of up to$250.00 a day against the violator- Be advised that a copy of this statement may be forivarded to the Office of Investigations of tlue DL4 r insuu ce co erage ification. I do herebs•certifs.t d the p 't nd pens s of petjnrs'that the inforrrration prosided above is trite and correct. Siunature: Date: Phone r: �er 7/ Official nse oniv. Do not write in this area,to be completed bs'city or town official- City or Toyyn: Permit/License# Issuing Authority(circle one): 1.Board of Health '_.Building Department I City/Town Clerk 4.Electrical Inspector Plumbing Inspector 6.Other Contact Person: Phone#: 6 ACORD, Client#: DATE 7M - CERTIFICATE OF ?LIABILITY INSURANCE 11/03/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT 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 Guilhenne Camossato PHONE (978)726 9830 DISCOVERY INSURANCE AGENCY LLC 2S IYANNOUGH RD EMAIL guicdiscovery@gmail.com - ADDRESS: HYANNIS,MA 02601 Phone:(S08)771-4600 Raphaeldiscovery@gmaii.com INSURER(S)AFFORDING COVERAGE gNAIC INSURED INSURER A:Hamilton Specialty Insurance INSURER B: FINISHING PLUS CARPENTRY INC INSURER C: 101 QUAKER ROAD INSURER D:TRAVELERS COMMERCIAL HYANNIS,MA 02601 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER.: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 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 TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL ADOU SUER POLICY EFF -POLICY EXP TR TYPE OF INSURANCE NSR W VD POLICY NUMBER (MMI)D/YYl'1) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,.00 DAMAGE TO RENTED X COMMERCIALGENERAL LIABILITY - PREMISES(Ea ocurrence)' S 500,000.00 (ny one parson) CWM&MADE IX MED EXPA OCCUR $ 10,000.00 X AAHS1000016243 10/13/2017 10/13/2018 PERSONAL B ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 X POLICY PROJECT LOC ' B COMBINED SINGLE UNIT AUTOMOBILE LIABILrrY - (Ee avJdsk) ANY AUTO - ' BODILY INJURY(Per Paraon) _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acddant) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Par axidwM C UMBRELLALIAR OCCUR EACH OCCURRENCE EXCESS IIAB CWMS-MADE AGGREGATE DED RETENTION E D WORKERS COMPENSATION WCSTATUTORY OTH AND EMPLOYERS'LIABILITY YINLIMITS ER ANY E.L.EACH ACCIDENT PROPRIETOWPARTNERIEXECIITNE OFFICER MEMBER EXCLUDED? N N/A N/A 6HUB-7H74189-3-17^ 10/14/2017 10/14/2018 $ 500,000.00 (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ 500,000.00 H Yea.dasclPoe viler DESCRIPTION OF OPERATIONS babes E.1 DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance).The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensationlnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY TOWN OF BARNSTABLE CHANGES OR CANCELATIONS. 367 MAIN STREET HYANNIS,MA 02601 GUILHERME CAMOSSATO 1 1 ®1988-2010 ACORD CORPORATION.All rights reserved. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-002439 - - Construction Supervisor { MATTHEW MASE 200 EAST FALMOUTH tj - EAST FALMOUTH MA 02531i. CA— Expiration: Commissioner OW2612018 /��i„ - Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration =- Registfation: 181438 Type: Individual Expiration: 4 Trl# 264342 MATTHEW.MASE MATTHEW MASE - 200 EAST FALMOUTH HWY EAST FALMOUTH, MA 02536 ` _ - Update Address and return card_Mark reason for change. SCA 1 ii 20AM1.05111 T Address [] Renewal Employment Lost Card Vlze�iantmitcoea��i o�C�ac�iuvelld Office of Consumer Afrairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: istration: 181438 Type: Office of Consumer Affairs and Business Regulation Expiration - °-- Individual 10 Park Plaza-Suite 5170 ^ / Boston,MA 02116 MATTHEW MASE MATTHEW MASE MO EAST FALMOUTH-iK-W EAST FALMOUTH,MA 02536 Undersecretary Not valid without signature r oFtME BAIMSTMIX 163;9. A,� Town of Barnstable Building Department Brian Florence,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 I, 4 4UJ , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner Date � eh ,S �f� hh ��dl Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\9NNOKXY W\RESIDENTILONLYEXPRESS.doc 09/26/17 Town of Barnstable OPINE To Regulatory Services Thomas F.Geiler,Director • Building Division M'S $ Tom Perry,Building Commissioner .s6;q �0 ArEp 39 ° 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax- 508-7.90-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �/l/S /GI/7illii /-P 5 Phone#: �� 7 l� — 2—y.1. Address: `3�� 5dU7� S141;1P011-f Village:_ 1115 Name of Business: GrP97' /9�W,0 /�j f i7�fer�q Type of Business: C C'«d✓ti f'7 Map/Lot: ?08 ob INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the , activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are"not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard, • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. f • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be IIII included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: v 4g2� Date: %?:!�710� Homeoc.doc Rev.5/30/03 TOWN OF BAR NSTABLE BUILDING PERMIT APPLICATION Map _Parcel �0 Permit# _ X& Health Division at 1 l Date Issued. Conservation Division e 0 7 O`er' Fee a Tax Collector 92� (Lob 6 Treasurer o CONNECT D /SEWER ACCOUNT Planning Dept.t. C ! 5 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address U--t l a7,P� Village ��a1� Owner �1-f �' �� lel LlL Addres d6a;t'-6 Telephone cQ'g3c Permit Request q b/1_G)� dom"re i424 hona',c eci..D Square feet: 1 st floor: existing_ proposed 2nd floor: existing proposed Total new Valuation 006.On Zoning District 612- Flood Plain Groundwater Overlay Construction Type Lot Size -,`fA' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 10D4 La= , Historic House: ❑Yes 116 No On Old King's Highway: ❑Yes XNo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 6 Basement Unfinished Area(sq.ft) �S/6 Number of Baths: Full: existing new Half: existing / new 8 Number of Bedrooms: existing J" new 0 Total Room Count(not including baths): existing P new D First Floor Room Count Heat Type and Fuel: '0 Gas ❑Oil ❑ Electric ❑Other Central Air: I Yes ❑No Fireplaces: Existing 1 New t") Existing wood/coal stove: Cl Yes )6 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 _Are . BUILDER INFORMATION Name Telephone Number ,10 `77J-lo.l�a Address lll' .a License# _';116 a Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /J �-- SIGNATURE DATE �� O' z FOR OFFICIAL USE ONLY F � 'PERMIT NO. DATE`ISSUED MAP/PARCEL NO. ' t. "f r. f ADDRESS VILLAGE OWNER t r" • DATE OF INSPECTION: FOUNDATION FRAME a " INSULATION FIREPLACE ELECTRICAL: ROUGH) FINAL PLUMBING: ROUGHS FINAL tom- _ l GAS: ROUGH " k FINAL -< FINAL BUILDING DATE CLOSED OUT 'q ASSOCIATION PLAN NO. 'x r k f . n - cn � - _ ', -Q o I;. i;( �.�. j )I o G lao' 1 ire• • - ` > RAMPo !i` I I Q' I RAi P 'Q ! IAtIDIIlG_O ;, o u Q o ---5.- { uP 1 R15ER >Y EXI5TiNG STRUCTURE Q Ln I I I PAR'LAL) Ln w :rING DEC 9 TO Rfn�aµt I I - O - Z wC � O rTti �.tG -LAWI!-- - , RAIT1hG5 1/I 2 Max.,".- �.- . - - EX15Tu1G CONCKE'E-STL-f5- . CAFED VAZ'n RED DSKICK .1 2'NiN.FIN.TREAD - •- •- - - - - _7-MAX.RN.K6ER ' "LAWN LAmt - - - co - b LtNDR.. r9i Phv®CRnatiDPaC�fp \' LAW OFFICES 51,4C ,ti5uUICr-5 Al NEW \ 3OG SDUTH 5TREE7 ' TARDINr,ZONE PARY.tNG'-: iilC!LOADING �5T.MADODTIMBEPS HYANN15,MA.02GO I \ 5PACE - PROP05ED PLAN ' NEW NIC PARKING SPACE EXI.'5TINGPARKING LOT{ STONE P - -- I.P:RTIAL) CVCD LLJ _ '7•e J-d Jib IA.S `' (.' - • ,oI _5� ' ' I l 1-5'4:N6' i I. � �;_a E-rEv ,. .. .. . _ _ y T I 1 3IV _ HO' - .EAH.'11 Q 5 q —s- I j I I ' UP I wsEx z I IXISTtNG STRUCTURI Q F H • .- r RM/P �. I I - i 11 I I I I I I (PAR-tAL) -. - _ Z � _ - Lo LANDIN � ui O �, I;iING DECG,TO kf MAN71II CS) > Q - Z �I: I I I I I r =w �Ir I ! I O f F+V`CK7J<iC RNJP J LAkV 1 RAIUhG5 I11 2 MAY. O _PITCH - , - 5 -NC C KE-E, Or.0 5• E'S I'E n-CAP FRED 04UCK _ s _ > 7 FNN,-, '> > _ FIN.T4PPD 7•MAX.flN.RE5ER ,. - - - S .. e - > '-LAWN. LAMLl 9 a :UP LAN 9 W FF n _ LA I h_ n cR A,zo Pnpll NEW T 50U•li STREET '•-s�r,�oTnsuR,P.AGrsaT > - \\ 30G TnsDlr6 zoNe s PgR1CNG' :-SPACE H/CJ LOADING Ew n sr.wooDMEYtPs HYANN15,MA.02GO J \ :.........,._,.,.� •' SPACE R WC/ RAMP OP05ED LAN _ ,� ,,..... .. ..._....L..,..,... ,..�-...,�, ..�...•,.>. ..., NEW v - MIC PARKING j SPACE EXI'5TINGPARKING LOT { STONE D i i 20' IU 3,4 •I�q•F• I S'-9 SR3' i I >-O• S E,tw - N Y ,O RAVP :1 j 1 I IAMOIIJG_ •• * CAYM ry ! Ii I i I' O LLJ Lo Q g — ;O 5•_ �� UP I RISER i €XISTiNG STRUCTURE Q I— H • T RW,/P i I J f ; I (FaR-+1'L)- z _ IANDIN II I -.I III`III F- u G ISiIN OECK 70 REnnai+J I I cz 0 ERAILIN ;Ili I I i I ! li w (s)C ZO WCOIDICJ7 GS 2Mk - _ PITCHCD E)057JNG COrJCRFE 5tL'F75-. CAPEO VnFn RED BRKIC PIN,I-L-0 _ � '_ '- - •- -- _ - _7•Mal(.AN,RSER - a 9 :UP 7J UW n wAve�at nnRp P cxtD \ LAW,OFF IC ES s10 nsuRP,c�s Al NEW \\ 306 SDU?li STREET _7-CE ZONE t PARKING' ��_,�07ITABEP.S NYANN15.MA.02GO J •SPR(� lilC/ LOADING - _ SPACE ......,.v,.,...,,{ T 4 "PROP05ED t t c/ RAMP PLAtd NEW , v WC PARKING SPACE EXI'5TINGPARKItgG LOT ( STONE I r:RTIAL] I _ _ __ • The Co ' nwn wealth of Massachusetts .Department of Industrial Accidents' "a 60a Washington Street' . w Boston,Mass.' - 1 ' Workers', Com ensation.Jnsurance Affidavit-General Businesses �� J ..,• ;:ary .T#-erttwpa,r -. n.• . .'ts �,a: ,y i,titrl : / ee •L•. eddressc - • ci full address ' ' +' .� • . wo site locaticgj ' am•a sole proprietor and have no ono $usiness ape: C]Retail❑Restaurant/Baating Establishment working in any capacity. [] 0-Mce❑ Wes�includmg•Real Estate,Auios etc.)' I am an em toyer with em 10 ees (full& art time ❑ Other " , //%%//////%////G%��101(er��///////iJi..Ji./%%/ %/%///%/%% am employer providing workers' comuensation for my employees working on this A.- I an 4 a t., ,, 1 t y } 5 :+.ti, •L ,. • :.R�'+t 1S:{.t .t,. .'7:•h. :�,:t�•r:,'1: •::t��'' h c' .•i•, 'ry;S''�r: ,'- :�n: .+'. l.o,'�•',...'ar •Y5 e'• .Jy� ♦f, ` i : , • •1,r:::J• I'i•,' , ,�r .`-'. C .'!', r.J.•. :.•. 'r 1'• -t.�••' .h :y:••. ,., s :9 1':i ,.{' ,` '. .tt.::,•S::.fi.•:i''�ri' ...r,'y';;' :'�".•t.i:•• at....'. °�:4::i:lr yS:G'f..fy,•+i. '7.:. Ij'= •.:!r• �� 7 ,,' .. t3dr'essi r Y �:. ',., ';:�'t;i tt, �3�•;�' ;:t..•. .i i:l•1'fir- P. �.t '�.••r'i•,.f c'�' �Iti4J'•• .:�:;'i J .,....i. .� t .J. ,i ..t•t. y .;: ~ ... '' :r 1 ,:' 1• , hone.:#.::,+.:'., : ; •. .,,:•1',..., .. +. A. ' 1 ` ,N••'• '•'.CCf: ,r' '` '�+ :•�•, ••f•:,n p�y} r:.•li'!a+W,•,`.r',. t• 1 OLLC, •#�• :;5.:' e••'J' .4 ��� + .ins'urarice ..X�:.,,.!:� •i. :.,.;'...•:' ;•::: :.:. J:.,./ ... ./ .. ,:..' • ..... •,•,,;. , ..:...,... .:.,.- Iam a sole proprietor and have hired the independent contractors listed below who have the following workers' .• :' , mpeasation polices: `' �t.,�L rYl t. 1't ;r1h•t •';f.•t•.j,`1. t .It:•. 3!: 't' t� ?+ •a• •1;: t; .E:'r .,v .qE+�• ':T•r:t nY.. :n,'i 7.: • , t in •i18m�: rp •t:.• .. '• '` ..bt r-yi t�' y •..9.t 3: 'ar:: - . Co a :�' +: ,,. :; 5nf e q ,•,.•1 s 1 :rt -ny x} .:n— ••i3. !f f. '.1.. ., •:'I, 'i t .l .:. ,, ,i V1'Z eifdress: .Y . 4'::.:..: 1 ,i:' ;'' ' '' `,,` : 1%! •? ••ti_,�:,• ': •l',•�7°r.�l;C.�'r�:�;f,.•r5:'��' h�. • r .•.''..' l,t• y' ram?. ' S• �� Cl •.�•• 'r.,•' :•c•.ti '� •r , .ivyr'}.J•`,rlrjl'�^i.. :t::y,��;. ,";:. ,,,ytj:� ;r •1•',r ,i r.'; t �,. ':i: '�� f •.t•,,.LL''y 1, :'4 a+' rt J'r f,•' ,:.,r•i•:'. '''rQ ict:ir'",r,.}h ,�`I•• .���•• •K• •.tt'.r'•tt' C:�}'•'." ' :CO. �'`Y'� y+i•''•J':•rv., l;.!'.••.'.`':-F':U••v�':�^.'i' ��� 1 J� .���//����/�O� insiu'snce �' '' _ 4 / t: !' i�ti ti! •4;.1: :'t ;i' r J i,w.,�'f•, �' i r••...'!.itits.. s Vi '�•-•7'. 'f .:(^ t' •,, •r'•ti�. 'L, t:•" �)%���•'���•'�••' r,'.a..1}',;' ,11,,� •�•'.t•• �.1. ..f 9II• ,n•'g]Ife 7•i'a address: •. ; , •• .�,:, ;a• . • +: i, Js.. - ii!F•1.:,- !J:S, rt`;/!,.'3';tf T•LLre, 1-4 .1.4, :�. 7•,• Cl _ ;,- i•ty .:u, :.ttiC 's. �.17 ve.i' !. u +.ai;' �;St:� ;'t.l.. Iv., . • y. :i•4y•, J•.y<y tJ'.... ,r .,f. p .:1. ,t;.�. '•• , j,t'r' 1: tt, 1.,, w ''t<•'' •�� i.t•. •s .,i+:' •.:.,; ;•.•,•. i`I.t•rll ,'.,+'•�! _fit;;•1 `':'•• 1: 'r.t :."r':•. •' . .�•• r. {•,i.:'r•:>f,.,, ..*•1.: ,,;; •i1:r' :si.}: .r: 'f. ,.1�• ..0'l1CY:'#�rY �` ' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminalpenalties of a fine up to 51,500.00 and/or one years'impr(sonment as well as civil penalties W the foim of a STOP WORK OILDER and a fine of S100.00 a day against me. I understand that copy of this statement maybe forwarded to the Office of Investigations of the D14for coverage verification. j do hereby certi rider epains a penalties of perjury that the information provided above is Prue and correct Date Signature ; y, Phone# 7•7��.� a Print name . . . . s— .: ial use only do not write in this area to be completed by city or town officialoffic _ permit/license it ❑Building Department - city or town (]Licensing Board ` ediate res once is required ❑Selectmen's Ofrice ❑•checkifimm P ❑Health Department ' contact person: phone ; []Other ' -i (rev;edScd 2C43) . Infornriation and Instructions' General Laws'ch4 pter�152 section 25•requires all employers to-provide workers' comp ens atidn for*the:r•. Massachusetts• erson in the service'of another under any contract mzployees• As quoted from the Iaw' , an employee is.defined as every p ` express or inrzpli *4 oral or written. ' of hire;. xp r An empjoyer is defined.as an individual,partnership, association, corporation or other legal entity, or any-two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased,employer, or the receiver or a association or other legal entity, employing employees. 'However the owner of a trustee of an individual,p .rtnershi P�. dwelling house having'not'inore than three apartments and-who resides therein, or the,occupant,of the dwelling house of •_ other who en�l.. p ous to do•maintenance, contraction or repair work on such dwelling house or on the grounds or tenant thereto shall not because of such.employment.bedeemed to be an employer. binding app • ` licensing ag ency shall iNithhold the issuance or renewal ate'or local g Y That''every s�t g section 25 also'states ry , 152 s ec MGL chapter' s r to construct buildings in the.cbmmonwealth for any applicant who has of a license or permit.to operate a business o . not produced acceptable evidence'of.compliance with the insurance coverage req•wired. Additionally, neither the' ' cot p onwealth nor.�Y•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 ep guthority. Applicants -to your Please fill,in .the workers' compensation affidavicompletely, a certilies ficae of Insthe box itsasPalaffidavitslmay be submitted supply company narfte� address and phone numb g to the Departrn6t'of Industrial Accidents-for confirmation of insurance coverage. Also'be sure to sign and date the affidavit. Th:e�afJdavrt should be returned to the city or towndthat ou have an catio�nti ornthepermit��e`Iawe or if is yo ale requested, not the Department of Industrial Accidents.. Shoal y Y q � s'•compensation pplicy,please call the Department at the number'list fA below. required to obtain a worker ,City or T owns . Pleasebe sure that the affidavit is complete andprinted legibly. The Department dare°arding the applicant Please ottorA f the aff davit for you to fill out ffi the event the Office of Investigations h s y g be sure to frllin the Perrrnt/hcen.e number.which will b'e used as a reference number. The.affidavits;rnay.be.returned to the Departmentbj�.r of FAx.unless other'arrangements havebeenmade. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a-call.• ; . y 'j / artmen is address,telephone and fax number: , The D ep The Commonwealth Of Massachusetts- Department of Industrial Accidents 6ifEce of ta�esS�atiens . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 4 DATE A , CERTIFICATE OF LIABILITY INSURANCE 5112M/200 PRODUCER + • THIS CERTIFICATE IS ISSUED AS A MAI TER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 320 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,7 1MA 02 6 O1 s r INSURERS AFFORDING OVERAGE INSURED Roy Brown Home Repair INSURERA: P NATIONAL GRANGE MUTUAL 34 Horatio Lane ' INSURERB: Centerville, MA 02632 INSURERC: • 508-775-6582 INSURERD: INSURER E: S COVERAGES 5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDI�ATED.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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY n EACH OCCURRENCE $ X 30( hCOMMERCIAL GENERAL LIABILITY _ • - - - .FIRE DAMAGE(Any one tire) $ _ CLAIMS MADE i n OCCUR - '. - MED EXP(Any one person) $1 500,000 A�—�- MPK34477 05/05/04 05/05%05 PERSONAL&ADVINJURY $ -- — GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ° PRODUCTS-COMP/OP AGG $600 ,000 n POLICY PRO_ JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ - A (Ea accident) e ALL OWNED AUTOS - - BODILY INJURY?SCHEDULED AUTOS $(Perperson) HIRED AUTOS BODILY INJURY $; NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE. $ (Per accident) GARAGE LIABILITY ANY AUTO - _I AUTO ONLY-E4 ACCIDENT $� • � - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE ; AGGREGATE ; $ DEDUCIBLE n $ RETENTION $ -" - - _ _ - $ WORKERS COMPENSATION AND ' WC'TAT OTH- EMPLOYERS'LIABILITY TORY LIMIF.S ER _ 886X262-2-02, 05/31/04 05/31/05 E.L.EACH ACCID;ENT $1 r - E.L.DISEASE-EA EMPLOYEE $1 OTHER y _ E.L.DISEASE-POLICY.LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 136CANCELLED BEFORE THE EXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING,INSURER WILL ENDEAVOR TO MAIL- o ;DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHELEFT,BUT FAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE / a .• � ��� ACORD 25-5 (7/97) / O ACORD CORPORATION 1988 j ' yfl�THE Tp�� Town of Barnstable Regulatory Services tea" La$ Thomas F.Geiler,Director m .659,{lk Building Division Tom Perry, Building Commissioner 3 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 -Fa : 508-790-6230 Property Owner Must Complete and Sign. This Section. a If Using .A, Builder ,.I f y r ........ zS..Owner-.of the.subject property_ ........._... ._ hereby authorize - : . .to`act ony.behalf,. in all matters telative to wo authorizeY d•b: this building'p etxn t a lication for: pP (Addtess of J b) Signatate of ez Date n '?17 P t Name • . j. ' ; ' r GJ � � ARp pP gUl1 DI �t license ONST, GUL477pNS �� .. RUCTtpN.SUP `(Yymber.�3� ERVtSpR � Blr a� � 065525 fe 0 i P�i+�esOV f 2006 ! AL'BE r Tr.no: 4425 RT R,BROW 0 �HORATIO IN -,\ 4 'gdihin.ist- ...... rator �, x i MORTGAGE INSPECTION PLAN lBOSTON SURVEY, INC. 04-03850 P.O. Box 290220 Charlestown, MA 02129 (617) 242-1313 MAIN (617) 242-1616 FAX APPLICANT.- YANNATOS DEED/CERT: 9489-198 LOCATION: 306 SOUTH STREET PLAN REF: CITY, STATE: HYANNIS, MA 92.66 to to to to N N r c_ #306 3STORY SOUTH STREET 1994/CI Rnctnn C�;NOV.C�,N✓.i�'g LOT CONFIGURATION BASED_ CERTIFIED TO: ON ASSESSORS MAP PREPARED: 04-19-2004 INSTRUMENT SURVEY RECOMMENED SCALE:-1 inch = 40 feet np it. The.permanent structures are approximately located on it GEORGE According to Federal Emergency Management Agency ground asshown. They either conformed to the setback 8 C maps, the major improvements on this property fall in an requirements nts of the local zoning ordinances in effect at COLLINS No.41784 ^ the time of construction, or are exempt from violation area designated as Zone e- forcement action under M.G.L. Title VIt, Chapter 40 A, ate. Community Panel No:vZ:SU 0C-) k r)rJ Section 7, and that there are no encroachments of major Effective Date: `�- '7 improvements either way across property lines except as shown and noted hereon. NOTE: Zone C is areas of minimal flooding(no shading). This designation is not based on an,elevation certificate. NOTE:This is not a boundary or title insurance survey.'This plan w prepared in accordance to procedural and technical standards for Mortgage Loan Inspections as adopted by the Massachusetts Board of Registration of professional engin ers and land surveyors,250 CMR 6.05,and use for any other purpose is prohibited.This plan is not to be used for recording, preparing deed descriptions,or construction. "J, Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. r/ D BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fe Checked ;: [Rev. 11/99J leaveLlank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: {- q City or Town of: Barnstable To the In pect r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 3Q6 5 u.r 4 ('� e Map 3 02 096- Parcel Owner or Tenant 1kh 7Z Telephone No. Owner's Address ?o l, C� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) OPurpose of Building Utility Authorization No.11 Existing Service /o c? Amps A / eta Volts Overhead Q" Undgrd❑ No.of Meters ® New Service Amps / Y-o Volts Overhead❑ Undgrd e No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable maybe waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Sus .(Paddle)Fans No.of Total P Transformers KVA No.of Lighting Outlets o.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Lighting Fixtures wi 'ng Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No:of Ot urners FIRE ALARMS I No.of Zones No.of Switches No.of Gas urners No.of Detection and Initiating Devices No.of Rang No.of Air ond. Tot No.of Alerting Devices Heat Pu Number Tons KW No.of Self-Contained m No. Waste is o ers P .._.._ __....._..__._....._..._._....__......_... P To als: Detection/AlertingDevices Municipal t--No.!gDishw rs S e/Area Heating KW '~ Local ❑ Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: y No.of Devices or Equivalent 41 No.erf lWater KW No.of BNo.allasts of Data Wiring: � Heate,P Si ns Ballasts No.of Devices or Equivalent H�iromas a e Bathtubs No.of Motors Total HP Telecommunications firing: o. g No.of Devices or E uivalent TIi : Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage.is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested.in accordance with NEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:�,>% C,r Ge—,o f LIC.NO.:I Ll7&,7 Licensee: �, e' c C a ill Signature�C2Q/ LIC.NO.: /Y7417 (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: J2PT 2am'V4y9 Address:— Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Telephone No. FP ERMIT FEE:$ �Q e 00 Signature JJO �tflw�£ T SAP E CT-Ibto � �a ►�� �'1��-0 -N o �2.uc�eai� 'D e�E --�pP K�S 711 j BL +� �S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,`z� Map Parcel d �� Permit# � TO��N :.0, B�:RNSTABLE Health Divisions '1ti15 Date Issued Conservation Division 20i14 SAY 13 A j j' �0 Application Fee D� Tax Collector Permit Fee PC�� Treasurer [A V I SI ON Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �j�� ��& h ✓� Village Hey eymt)/ JJ Owner Gr d- g Address o a6G/ Telephone 50 F 7A t Permit Request n Square feet: 1 st floor: existing 120 proposed f 1 W 2nd floor: existing �1/2-- proposed vG�� Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 d&W Construction Type Lot Size , S 2 c/^- Grandfathered: ❑Yes /12fNo If yes, attach supporting documentation. Dwelling Type: Single Family X, Two Family ❑ Multi-Family(#units) Age of Existing Structure f 70 Historic House: ❑Yes Ao On Old King's Highway: ❑Yes XNo Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I'll a Number of Baths: Full: existing ;I— new_a Half: existing iJ new Number of Bedrooms: existing_ new c:> Total Room Count(not including baths): existing new r-2— First Floor Room Count Heat Type and Fuel: ).Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes >(No Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes �610 Detached garage:❑existing ❑new size Pool:❑existing Cl 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 ' BUILDER INFORMATION Name Telephone Number 4�—Oy- 71a —2 Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO clamY) SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED <1 ' MAP/PARCEL NO. i ADDRESS V.IL'LAGE OWNER f C DATE OF INSPECTION: J FOUNDATION i FRAME INSULATION FIREPLACE L 4 f... � ELECTRICAL: ROUGH FINAL • PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL ; FINAL BUILDING r DATE CLOSED.OUT , t ASSOCIATION PLAN NO. oFINE r Town of Barnstable Regulatory Services BAatvsraBM Thomas F.Geiler,Director KAss. A i639• ��� Building Division lFc ru►+ 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 EXEMPTION Please Print DATE: 13 JOB LOCATION: number street village "HOMEOWNER": / c9 / Y - .-._ ame m oe 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 ,I require ents. 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: "An homeowner performing work for which a building permit is required shall-be exempt-from.the provisions `= Y P . g 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:forms:homeexempt The Commonwealth of Massachusetts Department of Indtistrial Accidents — _ 600 Washington Street Boston,Mass. .02111 `-- Workers' Com ens ation.•Insurance AffidaZZ&vit-General Businesses 'fir/ S y �, ..EIS ,.. •`rteF :e-..x — — —_ name: 91L� ' dz 7 address' city �ftti� / state zip' © �l phone# 77� work site location(full address): ❑ I am a sole proprietor and have no one, Business Type: ❑ Retail❑Restaurant/Bar/Eating Establishment working in any capacity. Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em to er with em to ees(full& art time.). Other %/%/%/%%//. !!�l//%/% %/% �%%%/�%%/%%///O/�//%%%/%%/%%%% LJ I am an employer providing workers' compensation for my employees working on this job.. company name: wi address. ... . .: . ::. city: phone.# insurance co:. . :. .. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: address• city: oh ne# insurance co. :. olic # ,j company name::•: .•.. city: atone#"s insurance so. 7. Failure to secure coverage as required under Section 25A of MGL 152 can lead to,the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify nder thepains and penalties ofperjury that the information provided above is true and correct Date.S � —D Print name 4- AW e&f�/ r S S / R/ c C4 se Phone# v a official use only . do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department -- ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept?A03) i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers-to provide workers' compensation for their. employees. As quoted from the"law' 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be.returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 8titce of Investl®atlens 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext.406 °FZHE to Town of Barnstable P Regulatory Services i t saxxsTasLE.NAM ' Thomas F.Geiler,Director 039 � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost 3D�� Address of Work: _S:!q a Owner's Name: 9-� o' Date of Application: S_— / 3 —D l� I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 OBuilding not owner-occupied El Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav __ I ...r _. /fir Assessor's :map' and lot number ... .............. � ..... ; I SEPT�I,C SYS"�-:,,'M P,"ISST B JIMSTALLcIJ ! ' r ?IAN E l �, ! V'JITH A 7s l,wl� IJ STATE r Sewage--Permit number "" —.... P Q 4 :.. . .l3.?...,�� > E . . Sf�P fTAR* CODE A: �.fl,N. 12 r , QIGULAT.� ?.Sa. *THE r ; TOWN-`-' OF BARNSTABLE ¢ "�& y DUILDIN-G INSPECTOR i6 q. co r, '., 'F�YPY a' e • APPLICATION FOR PERMIT TO ...4.....r'...�.."'....�/,.,/t../0:�... .... ............... ... ............... TYPE OF .CONSTRUCTION ..... ............................. ........................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to. the following information: /n ' Location ......................... +........ ... -'....... / NItCX. Q.✓..... L Proposed Use ............................A.�......... ..........................................................................., ZoningDistrict ..�.....ek.4,n.. .............................................Fire District ...........././....... ..+................................................... Name of Owner*....... o ``� .....74/? Address ... ...../...�.. �� ...........v .....'.................... Name of Builder ... ... .... � ........ Address .... ....'":........ �1� �✓ .... Nameof Architect ............ ..........................................Address .................:.:.::............................................................ �� Pe,r's1 ,r' el?w Gam/ ..Number of Rooms ............... ..............................................Foundation ...... ............................ ' Exterior .:`. ..........� 149// .......................Roofing ... �� ........... /4Vf ....................... Floors //�1.�...............................................Interior .../.. ........ a 1.....w C./ ........................ C Heatinge1" ..��V !L......14 f ¢ .....Plumbing ............. ............ ... Fireplace ................. .:...........................................:.................Approximate Cost .............................. .................. ............... . .1��Definitive Plan Approved by Planning Board ---------------------_----------19________. Area �. ....... ....... Diagram of Lot and Building .with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a .j r 1 I herebyagree to conform to all the Rules and Regulations of the Town of Barnstable garding the above 9 construction. Nam ................. ........1 " 'Thrope, Dr. Robert 18079 add to single No ................. Pe'rmit for' P . . , ...................................... fAmily dwelling. .ti....:ti.............`.•• • 53 MapleAvenue Location .............. ............................................Hyanni s .................................................................. ............ Dr. Robert Thrope .. Owner ............................................ frame Type of-Construction -Construction .......................................... .......................................................... ..................... Plot ........................ Lot .......... ..................... Permit-Granted ........Dec.e:mbe.r. ...3..........19 75 ...... . ...... . Date of Inspqctfon ....................................19 Date Completed ........... ....... ...............19 7k T _:PERMIT`REFUSED ........................i................. .... 19............... �z ................................................................... . . .................................................................................. ....................... .............................................. ................................................................... .......... Approved ................................................ 19 ............................................................I .................. .............. ....................................... ................... .. Assessor's :map,)and lot number ...:, .v.......:........£:'.`.:...:...... Sewage .Permit number P/l.a .r tF. . ...... ?�A. . yoF?HET TOWN OF BARNSTABLE Z BAHHSTADLE, i "6 9 D BUILDING : INSPECTOR MPY ft• - APPLICATIONFOR PERMIT TO ............... :.!: ...�...! �` .r%........................................................................ TYPEOF CONSTRUCTION ..............................t!......................... .....:..... ............................................................. .......`. .............-:...............19...L � TO THE INSPECTOR OF BUILDINGS: -The -undersigned herebyp,applies for a permit according to. the following information: Location ...'s: ............!.! .. ! I4.............. '.:.!....�................':........ ... : ':/`v....:.................................................... '.. +. ' / �' ..!'.................... .f .. Proposed Use ........... ....................................• .......... ............ ................... .... ZoningDistrict ................. .�.`................................... ............Fire District ............. ..... .`.?`.°.s:........: .......................I............. Name of Owner .:..... s........... ..... ... ..:'.t:Address ...J.`: .... f.....:. f............. . 4... :.................... Name of Builder ............7!.t?.......'f................Address ....:f.. .... ' • E......`..!;...... .!.. .... Nameof Architect ..............:..............:.....................................Address ............................:....................................................... J JNumber of Rooms foy %{.. �•�..�'' ..................�..................................................Foundation - - . .� Exterior.: " 0. ` O'1 re,. ' ' .. ..f�.::.a.............!.:�r�.l`.... ....................... Roofing ....:......... w. Floors .Interior 4 Heating ..`fa.%.......s�r`.. ...................... ..` ..................Plumbing ���� r 1}•V Fireplace ...........................if........I...............................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area r..f 7: ......%............ ......... l � = Diagram of Lot and Building with Dimensions Fee ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH / 44 . 1 .r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... ........................ Thrope, Dr. Robert A=307-86 No 18079 Permit for add to single ... ... .................................... tamily dwelling & r t ...............................................u/............ Location .........54..-.Maf.6.1.e...Avenue. ....................... .... ..... . .. .... . ...... . . ........................ i s......................................... Owner ..........D.r.....R.o.ber.t...Th�o.p.e.......................... . .. Type of Construction .......................................... ................... ............................................................. Plot ............................ Lot ................................ December 3 75 Permit Granted ............ ...........19 Date of Inspection ..................... ...........19 Date Completed ....................... .......19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................... ........................................................... . . . . . ....... .......... .................................. .................... ..................... Approved ................................................ 19 ............................................................................... ............................................................................... pnri .•cw - =Na t"alE+:?r.� "s`b' rrs A``'}*F """,:rEsYE t•-++�.�..:���'^[�v.,c s.,-.. f- ,x,:?�" " '; -t -a,.rs+e� -� ' _O APPLICATION.FOR PERMIT TO"INSTALL AND REQUEST FOR ELECTRICAL SERVICE Inspector of We Wiring Permit# COM/Electric Town of "'�`�5 Massachusetts Building Permit# Date f r' 92o6 S. Customer.: on (Street#) Lot#` ' in the village of S utility pole.number or underground number _ Customers billing address .71 Temporary New installation Ch,ange of service Starting,Date Job description G4:.f / LtJ GC/!f i. Service entrance voltage Arriperage` Phase t' " Wireksize(cu.'or 60 2: Conductor per phase Nu tuber of meters Water heater Off peak:Yes- No— Estimated load Electric heat kw, lights kw, Range dryer Motors, H.P. &Phase Ready for first inspection. Ready for final inspection Electrical Contractor T�i�/� g`a S� Lic.# --- �d�' Telephone# xe Address �� ell vrr� Sf S. y{ Additional Remarks: Do Not Write Below This Line {• ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS DATE FEE CHARGE + Temporary Service Roughing-in Service and Meter Off Peak Meter Final Approval., !. Disapproved' "For:the following reasons - - i CERTIFICATE OF INSPECTION DATE r ... ' .To the COMMONWEALTH ELECTRIC COMPANY:The installation described above has been_completed and has this day been inspected and li approval granted.for connection to"your.service. _ Inspector of Wires . WIRING INSPECTOR TO BE.NOTIFIED WHEN WORK IS-READY FOR INSPECTION Permit Good For One Year.From Date Of Issue cnas-1 White-, COM/Electric Green Inspector Canary Town Receipt Pink Inspectors Copy Goldenrod Electrical Contractor to tC .. x ..s_ ec. i.F�:K_�v. ._ ?.,Y[>-.�.n.. CO.M Electrc . - I . Office Use only/ 'F The Commonwealth of Massachusetts Permit No. Department of Public Safety Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.•OO 3I90 (lesveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachuseru Electrical Code. 527 CMR 1 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date TOWN OF BARNSTABLE To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) Owner or Tenant J == ' 'e.. IfP,,7 -) Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building _Utility Authorization NO. Existing Service Amps `'IG / Volts Overhead ® Undgrd ❑ No. of Meters_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work )eAd No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above In- 8 g Swimming Pool grnd. ❑ grnd. ❑ Generators KVA ;. No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting F Battery Units .* m to No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and ' 8 No. of Air Cond. ` tons Initiating Devices No. of Disposals No. of pumps Total Total No. of Sounding Devices Tons KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal ❑ Connect ❑Other Connection No. of No. of Water Heaters Signsf Ballasts Wirinoltage No. Hydro Massage Tubs No. of Motors Total HP '.�. OTHER: .r.� r< INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Lia i Insurance Policy including Completed Operations Coverage or it ubstantial equivalent. YES ty NO I have submitted valid proof of same to this office. YES NO If you have checked YES, please indicate the type qf coverage by cnecking the appropriate bo INSURANCE �BOND ❑ OTHER ❑ (Please Specify) V xpira on ate Estimated Value of Electrical Work $ / Work to Start Inspection Date Requested: Rough �y$/ Final 14 Signed under the penalties of perjury: FIRM NAME LIC...10./ Licensee / ignatu a LIC. NO.;57 Address / — us. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WA VER: I am aware that the L ensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Amer Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent