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HomeMy WebLinkAbout0156 SOUTHGATE DRIVE . � fr_ - -- - -- - -- - _ _ '; TOWN OF BARNSTABLE BUILDING_ PERMIT APPLICATION .f 1 y Maps Parcel off' 3 'Application # Health Division Date Issued Conservation Division ;Application Planning;Dept; Permit Fee Date Definitive'Plan Approved by Planning Board �1 Historic - OKH Preservation / Hyannis Project Street Address so Q , Village d�yl,Vl�S r Owner Address Telephone 4 7 9— 6 7_ Ra Permit Request , Ccr--e. e_-,�14�-093, t-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ; Total new Zoning District Flood Plain Groundwater Overlay70 Project Valuation Construction Type .o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orting clocu entation. c� Dwelling Type: Single Family 0 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) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric 0 Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -- Commercial ❑Yes Zo .. _ If.yes, site-plan review# Current Use Proposed Use T APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name +,0_%JQ yl WV1�`1�-�— Telephone Number Address �4 -7 E i( =tom oca &V P-- License# q Home Improvement Contractor# ��f Worker's Compensation # W o— -74-(2-z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S 4- SIGNATURE �'(lCJ DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION a FIREPLACE Y r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 's ASSOCIATION PLAN NO. E Vie COMIKOnwealilt ofMassachusettg Department of Irtdustriarticcidenty Office of Investigations 600 Wash ineon,Street Boston, M,4 02111 vwm m ass.gov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orkmisation/IndM6ual): ��(l 0RAr' g u t W�%,VVQ � I-V '' Address' go-�A ( %j A- City/State/Zip: ® (Phone.#: SO$ oZ a^ `k ir—C) Are ou an employer? Check the appropriate box: Type of pioject(required): 1. I am a employer with 1 4. ❑ 1 am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.El I am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and havem employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition comp.insurance.$ [No workers' comp.insurance required] S. ❑ We are a corporation and its 10.C]Electrical repairs or additions 3.❑ 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 12.0 Roof repairs " insurance required]t c. 1S2, §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 secti on below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whither or not those entities have employers. If the subcontractors have employees,they must pravi&their workcrs'comp.policy number. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Wd, 1 (�z sy 4) Expiration Date: 3 Job Site Address: ` (C ��� L9(A�� 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 iip 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 IbIA for insurance coverage verification. r do hereby certify u the_ pains-and penalties of erjury that the information provided above is true and correct Si ` afore: � - Date: Phone# ® C�g Official use only. Do not write in this area, to be completed by city or town official City or Town: Pern it/License# Issuing Authority(circle one); 1.Board of Health 2.Building Department I City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and In 'ru�t���� ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees: Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written " An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's 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." Additionany,MGL ohapter 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 cvidence 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 of necessary, supply sub-contractors)name(s),address(cs) and phone number(s) along with their certificates)ther than the th insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LIP)with no employees o ra 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 a ro ziatc line. City or Towli 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 permitlEcensc 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 onr,affidavit indicating current policy information(if pecessary) 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 �it Y �P applicant as roof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each p year.Whom a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.c. a dog license or-permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would hlce to thank you in advance for your cooperation and should you have any questions, please do not bcsitate to give us a call The Department's address,tclephone•and fax number: ht; Cort moilwc4t a of Mt ch-ust<tts Department of Industrial Arcid=ts Office of 7zvestigatious 600 Washington Street Boston, MA 02111 TO. ## 617-727-490.0 ext 4.06 or 1-M-MASSAFE Fax# 617-727-7749 Revised 11-22-06 wwkv.mass.gov/dig •r �oFrHer�r. Town of Barnstable Regulatory Services HMM LE'�; 'Thomas F. Geiler, Director m Fn ,�b` Building Division Tom perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 e�Prop � Owner Must . Complete and Sign This Section Zf Using A Builder t . 1, ( V—i , 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: 1 .(Address of job) Signa re of wner Date Print Name If Property Owner is applyitig for permit please complete the Homeowners License Exemption Form on tb:e reverse side. 1 . Town of Barnstable �o f cr►e tp�� • w Regulatory Services H Thomas F. Geiler,Director + BARNSTABLE, p MAC � i67p• BuiIdin.g Division �� PTF0 MPS n Tom Perry,Building Cornmissioner .. 200 Main Street, Hyannis., MA 02601 yl my.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village , "HOMEOWNER': work hone# name home phone# P CURRE14T 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 Persons)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 he.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 � f 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 Io9.1,1-Licensing of corimcdon 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 arc unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, Rules&'Regulations for Licensing Construction Supervisors;Section 2,15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the.unlicensed person as it would Hith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as 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/ccrtification for use in your community. 10.uY r1VI Page 2 o -;ORD CERTIFICATE OF LIABILITY IN DATE(MMIDDlYYYY) OUCER (508)945-0393 FAX (508)945-4048 04/1A/2009 AGE E1 dredge & )94Lumpkin3 Ins. Agency I- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 697 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ' Chatham, MA 02633 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED Caliber Building and Remodeling:11FO7 INSUSationalNGraOnVeRMuuNAIC# 9 al Ins Co 14788 147 Ridgewood Ave Commerce Group CIGOOI Hyannis, MA 02601 Granite State Ins. Co -ARWC 13102 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L L R NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE MMIDD DATE MMIDD LIMITS MP027360 09/15/2008 09/15/2009 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY $ SOO,OO( ' CLAIMS MADE DAMAGE TO RENTED XD OCCUR $ 500,00( A - MED EXP(Any one person) $ 10,00( PERSONAL&ADV INJURY $ 5OO,OOC GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,00C POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 1,OOO,OOC AUTOMOBILE LIABILITY BBNVCS 02/16/2009 02/16/2010 ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS (Ea accident) $ B X SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) $ 250,0001 NON-OWNED AUTOS BODILY INJURY - (Per accident) $ , 500,000, PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ ANY AUTO AUTO ONLY-EA ACCIDENT $ 100,000 OTHER THAN EA ACC $ EXCESSIUMBRELLA LIABILITY AUTO ONLY: AGG $ OCCUR ❑CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ EMPLOY WORKERS COMPENSATIONNAND - WC7425405 03/02/2009 03/02/2010 $ EMPLOYERS'LIABILITY � WC STATU- OTI} C ANY PROPRIETOR/PARTNER/EXECUTIVE O Y IT E OFFICER/MEMBEREXCLUDED? E.L.EACH ACCIDENT $ ZOO',OOO If as,describe under - SPECIAL PROVISIONS below E.L.DISEASE-EA EMPLOYE $ 1OO,OOO OTHER DISEASE-POLICY LIMIT $ SOO,OOO E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS'- Carpentry CERTIFICATE HOLDER' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ' - EXPIRATIQN DATE THEREOF,THE ISSUING INSURER WILL"ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, - ToWn Of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street Hyannis, MA 02601 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Alan R ACORD 25(2001/08) R. Long, President ©ACORD CORPORATION 1988 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A C&' - DA TA Ot *44 ® tip J �1 4 � ^'J/tb Jai _ ddb a 7 r - W 8 s,f I �N, d 1DATICI 39 a. 25 �� Lu i 6 an�c y 1 ; .. V J 0 (4O WIDE m L� � U Z.33a9 Z �OoN OF'�gs 100, v./I iD i LCD O G - NpsrR�yo� CERTIFIED PLOT PLAN IEW CONSTRUCTION ONLYj_: LaT TOP OF FOUNDATION ' Ig.� FEET ABOVE LOW POINT OF ADJACENT IN ROAD. SAj1 �1.�3"�.�1 • El WDGE ENGINEERING CCy. SCALES / � DATE EGl84ERE® CLIENT - I CERTIFY THAT THE FL�LJnrn� REGISTERED — "-- SHOWN ON THIS PLAN IS LOCATED CIVIL LAND JOB NO. L/ 0.S_3 ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR CONFORMS. TO THE ZONING LAWS DR.BYt °� i''! T12 MAIN STREET OF BARNSTAB E CN.By J. 7?; E. ss. HYANNIS, MASS. 61p92 SHEET_LOF� DATE R G. LAND SURVEYOR DECK, PLAN 2' X 8' JOIST HANGERS C❑MP❑SITE DECKING 6' LAG 16 ❑C COLOR: GREY 16 O.C. 2' x 8' PT 15' TRIPLE 2'X8' BEAM TYP @ ALL JOISTS 2' X 8' BL❑CKING @ 1/3 SPAN P❑INTS 15' P.T. BALUSTERS -P.T. DECK POST 5 4 6' GROOVE STYLE FRONT VIEW TRIPLE 2'XB' BEAM BEAM TO POST 4' X 4' PT 6' C❑NCRETE CONNECTOR POST PAD F❑❑TING CONNECTOR 8' DIAMETER X 4' DEEP CONCRETE PIER f`�6'6'- 58' . RIGHT SIDE VIEW I'�T TV 36' 42' 48' 48' LEFT . SIDE VIEW 1 / 4 " = 1 ' f . t License or registration valid for mdrvidul use only a before.the expiration date. If found return to: Board of Building Regulations and Standards ` One Ashburton Place Rm 1301 Boston,Ma:02108 f 4 `✓(7�.)W Not valid without signature Board ofBuilding Regulations aad'Standards ConstrtJction Supervisor License k A License CS 95038 Brrtlxdate. 2f29/4964 Y P 2l28/2'010, .: ''Tr# 95038 ;1 ies#nctib» 00 , STEVEN WHITE 147 RIDGEWOODAVEN�1'�E= -�- HYANNIS„MA-02601 Commissioner + ` ' ✓'/� V�72 ,1Jr^•q'^'=v O�✓��1LL14G4(N' ' Board`of Building.Regulation§and'Standards HOME IMPROVEMENT CONTRACTOR Registrat n \l54359 Exicatiel 28f2011 Tr# 280764 ' Lt3 ability Corporation ' CALIBER BUILDINGR ®I €LING,LLG. STEVEN' WHITE t 147 RIDGEWOOD AVE .` HYANNIS,MA 02601 "~ Administrator w ,m Q. rzti+QlA`"E�fi'k{'�a�e'' T Town of Barnstable *Permit Expires 6 months jr issu d °� Regulatory Services Fee + BA STABLE, + v� 639: Thomas F. Geiler, Director ATfD MPS A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL,ONLY Not Valid without Red X-Press Imprint Map/parcel Number &1,2 �� 3 -----ram - L Property.Address `, sc",A,\ G Ot '�— t SResidential Value of Work" *"` , 6Q o 'vo Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address gcx� o—yt,j, Contractor's Name 13'+2VL ��� C'_ �1po_f �v �%, (44tc,Telephone Number SOR — ;L q 6 —4(00 I lome Improvement Contractor License# (if applicable). CoZo ction Supervisor's License # (if applicable) 9 ! 6 �J kman's Compensation Insurance .� IT p Check one: ❑ I am a sole proprietor APR 14 LOOS PIm the Homeowner ave Worker's Compensation Insurance TO�NN OF BARNSTABLE Insurance Company Name trety�Cflc Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) U Ke-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders..U-Value (maximum.44) *Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. -opy of the Home Improvement Contractors License is required. tiI "NATI;RE: V N-ll.F.Sx 0RMS\building permit forms\EXPRESS.doc Revised 100608 .1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Address: �i[�a��a •� p�r"o( '! City/State/Zip: Q��. S AAA Phone.#: G-0 Are on an employer?Check the appropriate box: Type of project(required): 1. I am a employer with . 'f 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2:0 I am a sole proprietor or partner-' listed on the attached sheet. 7. .E]Remodeling ship and have no employees These sub-contractors have 8.'D Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'•comp.-insurance comp. insurance.$ required.] 5. Q We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ME]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.KKRoof repairs insurance required.)t c. 152, §1(4),and we have no employees.to ees. [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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ ( Insurance Company Name: Policy#or Self-ins.Lic.#: �"C P_ J o Expiration Date: 3 1 . Job Site Address: 1 (o SoU-n^ �� — 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 nder the pains-and penalties of perjury that the information provided above is true and correct Si tore: Date: Phone#: 5D �o'Z[�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. P lrs an employee uant to this statute to ee is defined as"...every person in the service of another under any contract of hire, P Y 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 . ` ase�-empioa ur of the forego m engag m a join--en Pns�mcl�mg the lega PresenUWVek-uf�d 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, it necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(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 io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call . The Department's address,telephone-and fax number: The Commonwealth of Massachusetts }department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext-406 or 1-877-MASSAFE Fax#617-727-7749 Revised 1 i-22-06 ' www.mass.gov/dia ar�ccoell'a Board of.Building Regulations anal Standards Construction Supervisor License 41 l icen5e CS 95038' „�� Birthdatec 2/29/19644 t p�ption 2/28/2010, ' '',Tr# 95038 aestnctidn' 00'; STEVEN WHITEi 147 RIDGEWOOD AVENUE HYANNIS,,MA-02601 Commissioner �//L� l/70�7/rI24�Z�IICCLLL/L o�✓4(,G4dCLGG[caeact+ Board of B wing Regulationg and Standards HOME IMPROVEMENT CONTRACTOR Registra 54359 Expiration'=8/2011 Tr# 280764 Ty C#c Liability Corporation CALIBER BUILDING'AND REfiitOUELING,LLC. rr STEVEN WHITE ' : a ' 147 RID6EWOOD AVE", HYANNIS,MA 02601 Administrator License or registration valid for mdividul use only r before the expiration date. If found return to Board of Building Regulations and Standards }; One Ashburton Place Rn1 1301 s[ Boston,Ma.02108 1 � a , Not valid without signature j (p^z 7 S #y'ry`gym t iES i s MA 5 <e� r 3 sic 3- r� as owner(s) of the subject property at: hereby authorize Steve White of Caliber Building And Remodeling, LLC (contractor)to act on my behalf in all matters relative to the building permit application. 3 0 , signature of owner date signature of owner date t From:Faxserverl2 508-945-4048 To:Building Dept. Date:4/14/2009 Time:3:19:04 PM Page 2 of 3 0 TE "ACORD CERTIFICATE OF LIABILITY INSURANCE 04/14/2 9 PRODUCER (508)945-0393 FAX (508)945-4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Lumpkin Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 697 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED Caliber Building and Remodeling- LLC, Steven Whi INSURERA: National Grange Mutual Ins Co 14788 INSURER B: Commerce Group CIG001 147 Ridgewood Ave INSURERc: Granite State Ins. Co.-ARWC 13102 Hyannis, MA 02601 INSURER D: INSURER E: - COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . INSRADD' POLICYEFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS GENERAL LIABILITY MP027360 09/15/2008 09/15/2009 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TSFSO RENTEDPRE Fa orcurence) $ SOO,OOO CLAIMS MADE Fq OCCUR _ MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 . POLICY PEa LOC AUTOMOBILE LIABILITY - BBNVCS 02/16/2009 02/16/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person)B 250,000 HIRED AUTOS BODILY INJURY $ - NON-OWNED AUTOS (Per accident) 500,000 PROPERTY DAMAGE $ (Per accident) 100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION.AND WC7425405 03/02/2009 03/02/2010 WCSTATu- OTH- EMPLOYERS'LIABILITY T RY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? - - E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - - Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE " EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL—ENDEAVOR TO.MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 [Alan UTHORIZED REPRESENTATIVE R. Long, President ACORD 25(2001/08) ©ACORD CORPORATION 1988 Assessors map and lot number ram.."'... .. :...... e 0/<` fjL �,/ '�O' / `�Lr-Qypi THE 1• Sewage Permit number2 N..... SEPTIC: House number �.� `� w ALLI= ..................... ..... ........... ............. ��T ANTE E IRON�rIEN CODE AND TOWN OF BARNSTABL TOWN SE ULATIONS� ,f BUILDING INSPECTOR APPLICATION FOR PERMIT TO . ............. : . r' ................... ..............................................� TYPE OF CONSTRUCTION ...................... . ........ .F- 1-of-e �. ..C.. ......... ................ TO THE INSPECTOR OF�BUILDINGS: The undersigned hereby/applies for permit according to the following information: Location ..................:.... ...Q ................(../ Proposed Use ...........................e.. 1..(:�(/ ...'C............. ( : `� �-� S. Zoning District, ........................ .,�...:..............................Fire District .................... .............................................. ' Name of Owner ...........(�)A7.ZA..Laxvt.........�., .. ddress ....... ... ....... x ��4.,-..4 Nameof. Builder" ........................ /../.! . -..................Address ........................................................................:........... Name of Architect ...........................................Address ...................... .......................................................... . ........................ - Number of Rooms ..................4�.........................................Foundation .......... 0.�.".4. ..... .... .... . .......... .... 1. Exterior ../. .. ....2- -eloAk......- ...../�..C.�..�/..... .......Roofing ............./. 4....�....Z��.�.......................... l�. 1 � � .....Interior �1.'r`� . Floors ............... l{ ...:..... .. . .. ... ........... .. ...G Heating .............. ................. ............................Plumbing ...:........... - / �. � Fireplace ..................................................................................Approximate Cost ............... �....... .. ................... ..: Definitive Plan Approved by Planning Board ______-__----��J- _______19 Area ..."s........ Diagram of Lot and Building with Dimensions Fee � �J........ SUBJECT TO APPROVAL OF BOARD OF HEALTH e:&o f Flo dx- /lJ b OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of a le re n the construction. Name .. ..... ......................... ....................................... GREENBRIER CORP. No Permit for .......... Single Family I................................................... . ...Dwelling............ Location ....Lot #21 156 Southcfate Drive Hyannis:; .................. .............................7.......... ....... Owner' Greenbrier Corp ..........................................-"!................... Type of Construction .....Frame........................ ..... ....... ................................................................................. Plot ............................ Lot ................................ July 6, Permit,Granted ........................................19 82 Date of Inspection ................. ....... 19 Date Completed .......... ...........19 .4 01 w _ ' Assessor's ma and lot number ,,..,,, �.�a t p , C/ ?DL �'l �l�S� TNETO t Sewage Permit number'..., :. ................... Z 13AMSTADLE. House number .......................... .....................-exl-)......... NAGS. 039, CEO N Ar. TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO 4 ���� / &zv r ............ ...... .......... , ............................... ... ....... .`.................... TYPE OF CONSTRUCTION �4 /Cl..r� ..a .......... �� 9 ." ........ ............................ .............. . ...............19. '�� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc/ording to the following information: Location .......................L.... �... .. !................ L1� ... Tl`,,!.!!�•v�'�(�. ProposedUse .............................. ..: � l „-r'.............!.�.ZC'............y.... ............................................ f Zoning District ........................ � ..................................Fire District .�...s _ / .................. . ........... ` ......... ................. ^^ Name of Owner ..........(, 7x .?..`.-�?.......�`-:.�C- cldress ......... ,'!(1 .... (. ....... Nameof Builder. ...................... �:::..................Address .................................................................................... Nameof Architect ..................................................................Address ....................�............................................................... Number of Rooms ..................( '........................................Foundation ...........f!....!a. ..T. ,rp /� �[ rf��.... / Exterior C .,C7 vliYd7. l ..... .C , 6,AW Roofin /"f X✓�4 7 ........... ............... g ........... `............................................................/ �� j� Floors ...............1/.. �- ....... .. IP�T ....Interior .................... /� Heating .... ....r-Y15r....................Plumbing .................... .... ? .. .��..� .....t . Fireplace ..................................................Approximate Cost .....................3. ..................... Definitive Plan Approved by Planning Board ____________rA'� _____ 19 _r. Area .......................................... Diagram of Lot and Building with Dimensions ! ! Fee ` SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS t I hereby agree to conform to all the Rules and Regulations of the Town of Barn"s#able regarding-jhe above' construction. f Name ..... .,......f:........................ ..................................... GREENBRIER CORP. A=306-273 No 2.4191 Permit for ...One Story Single Family Dwelli-ng ......................................................................... ..... Lot #21 156 S"out a e Drive Location ........................ ........... ...... ...... Hyannis ............................. _ ...z: me ....... .............. Owner .Greenbier .......,.... ..... ..... ............ Type of Constru6fion ...rw't ......... ......................... Plot ............... ................................ ` July 6, 82 t Permit Grante I ........................................19 Date of Inspe ion .......:............................19 0 i Date Comple 19 v a. l� a K k is. hF �QCiC Kf`CF` s;x i ro i` J a (F1jUA' Fou►-IpA�'O'J W F / 35t -� `` 71 ;50 0 47 � 3 OF AAl I DO _V\J 0 � 4�° CERTIFIED PLOT PLAN f GNp SUR� . LoT Z/ Pc-R/wIiI;�� Di?ivE NEW CONSTRUCTION- ONLY f�>° ": - ' " t. >TOP OF ifOUNDATIOK IS... FEET t. IN -ABOVE .iL .W POINT OFADJACENT'0 s Y ROAD, ` SCALE= 1 ••_ DATE: 6tf9,✓Rz LDREDGf ENGINE£ !NG C4:lN eke i✓a�lElz I CERTIFY THAT THE FycJNDA-r o IV :` CLIENT SHOWN ON THIS PLAN IS LOCATED. E_GISTERED REGISTERED �0 NO:,glw 3 ON THE GROUND AS INDICATED AND CIVIL LAND CONFORMS. TO THE ZONING LAWS ENGINEER SURVEYOR DR. QY� '' .• • r OF BARNS TA13 E , SS. J 7?.If. T! 2 MAIN STREET CN.BY ._ 0 8�'H YA N hLl 9 MASS SHEET.L OF DATE R 0. LAND SURVEYOR ... , 777 TOWN -OF .BARNSTABLE- PermitrNo ,;f4191 i Building Inspector } !,.. 111AUTrasi Cash; j i - - OCCUP ANCY 'PERMIT Bond --- - T "No building nor structure shall be erected, and,no land, building'or'structure'shall'be used for a new, different, changed, or. enlarged :use without a Building Permit therefor first having been 'obtained-from the Building'Inspector. No building shall be occupied-until a certific to.of occupancy has been''.Iisiued,bf��the Building .Inspector.''; _ r' Issued to GrembrieY Corp ~"Address 1nf 491 I SA gnj1t-baaf-6 Trixrn' F�r^nr�ir, Wiring Inspector `C!. !yf/ � r � "" d inspection date Af r _ Plumbing Inspector{ � —' Inspection date Gas Inspector .4 g{' - 4,;, ,. Inspection,date j, X Engineering Department z 'Inspection THIS PERMIT WILL NOT;,BE VALID, AND THE BUILDING SHALL 'NOT BE OCCUPIED UNTIL \SIGNED•..,BY THE BUILDING' INSPECTOR UPON SATISFACTORY 'COMPLIANCE. WITH TOWN^ REQUIREMENTS. r,, r}' "' Building;Inspector _„