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0067 STATICE LANE
�,rI L.,,q NE 3� . � �' ' _,i(+!' "t; .�",. ;. � ,:: � _. .;f•. _.s'R r;.. . .-,�6e.d,,.w r.r�wro-- :.a+- s1—� .F,...y ,... .. t,:. ,,. � ,., � -.. � �„...- FF6 ,fTME,� TOWN OF BARNSTABLE 33219 Permit No. ................ J BUILDING DEPARTMENT TOWN OFFICE BUILDING CashgQ �nur HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to JACQUES N. XORIj Address lot #11 67 Statice Lane, Hyannis USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ..t3 .. 19...8g.......... . �_ ?- December -s r�c'C... ''�. Building`Insp ctor 5 ��..� '°•,w TOWN OF BARNSTABLE BUILDING DEPARTMENT _ SaaaSTAIM TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 y �0 rwY M MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit �$........33.Z/.��............................ .............................................. ..................._.......... ...._...... ...... .. ......._ issued to l..... k..._..._/.or 1 x ..... .._..7/��1-7...: %r3lic'c.......L ...._..» �. ......_..__.. . /.. Please release the performance bond. TOWN OF BARNSTABLF, MASSACHUSETTS I�1G ��� 1 ER A�273 OS64ft�� �t DATE'— WilLr.'i11I>� : Ig 89 �t;�l pXKi p!; APPLICANT CCi:tC. SnowdenPERMIT NO._ �'+V e ADDRESS Yi311i.1)UL17I1i'•LI , J\ 1 (STREET) U.36 3.33 aj`.'p PERMIT TO:7 littild (lW(+J l jr((� t. y (CONTR S LICENSE (TYPL OI IMPROVEMENTI' ��) STORY l J�il)„L t; nsll;Ll NUMBER OF V dtorl LiY(/ N0. (PROPOSED USE) DWELLING UNITS. a �..'. AT CATION) �- Z.Ut /fll 67 'Statx.c. l,rir��, ;i•:,;,ilr;.f.a - .,ZONING { T'`t (STREET) DISTRICT - t - a51 (CROSS`STREET) - AND r { (CROSS STREET) SUBDIVISION BLOCK LOT LOT SIZE-- S` f t BUILDiN If TO BE FT WIDE BY FT. LONG BY FT. IN HEIGHT AND SMAL L CONFORM TYk IN CONSTRUCT TO USE GROUP BASEMENT WALLS OR FOUNDATION REMARKSs SCWiT��NJ—.3�5 (TYPE) Y ` ia ! 1 st) �4L. { S�i�iy ° �'�r?.GV}f (J�tLI I.ILt:3. .+. ,-•>.; i 3 AREA ORSV.y k^l r� � VOLUME- " + 1978 6 .,.:.LL. - t ` a ISO CUBIC FEET) ESTIMATED COST ,$ .`),l�'){J PERMIT 3.�-L UU �yprw'j , 6 i FEE Ir;11, owNER JacqueS *t. 'Mlaritt .3QO'ADDRESS 13ir:i1.66C5. i'�LI' � 'Ae! �f K}+ii1:Ti1:3� 1\Ji V_q(j( BUILDING DEPT. 1 n /BY J., / ✓ 1 IV :THIS PERMIT / a CONVEYS C MIGHT TO OCCUPY ANY STREET, 'ALLEY OR SIDEWALK OR ANY PART THEREOR. EITHER TEMPORARILY C1t{ (PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE +5 w1 41 PROWTHE' '.THE JURISDICTION. STREET 'OR' ALLEY''GRADES AS .WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE'OBTAINr + ass a FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM T.HE.CONO O� ANY•;APPLICABLE,SUBDIVISION RESTRICTIONS. , MUST'BE F SI 1 MINIMUM.-OF` THREE CALL IT10 " x INSPECTtoNs REOUIRED.FOR APPROVED PLANS MUST 8E RETAINED ON JOB AND .THIS WHERE:.F ,tALL�CONSTRUCTION'WORKt CARD KEPTPOSTED UNTIL FINALINSPECTIONHASBEEN APPLiCABL'E-SEPARATE �h} �qPERMITS = FOUN[SATIONS OR NG'STINOS MADE. WHERE`A CERTIFICATE OF OCCUPANCY IS.:''RE- MECHANICAL I:F`LVM IN IONS..; PRIOR TO'COVERINO STRUCTURAL ELECTRICAL,apLVMBINO AND MEMBERSIREADY TO'LATH) QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL x ski„' r J OCCUPAN PECTION BEFORE FINAL INSPECTION HAS CYr, BEEN MADE. �A PJOST R 1THIS�_GAD :50 r+ .gi rr S BUILDING INSPECTION APPROVALS, ) ' I I S I Y y r Ws s FROM STREETS°`� f SC Xtµ �,,.) , , , 1 t- ~� ,;'PLUMBING INSPECTION APPROVALS t t ELECTRICAL INSPECTION APPROVALS' l! p >s� ' C 2 3 aQ HEATING INSPECTION APPROVALS ' ENGINEE G DEPARTMENT OTHER �1 � i1a7--� . n O Y- $, a w $Q BOARD OF HEALTH \` s s � t WORK SHALL NOTPROCEEOUNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION f TOR HAS APPROVED THE VARIODUS STAGES OF W CONSTRUCTION. ORK IS NOT STARTED WITHIN PERMIT 1S ISSUED AS NOTED ggOV MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN g RANGED FOR Y TEL OR WRITT , ,.,i NOTIFICATION. i TOWN OF BARNSTABLE BUILDING OFPARTMENT'. HOMEOWNER LICENSE EXEMPTION Please print. DATE_444 as 8 JOB LOCATION um er reet a r ss "HOMEOWNER"�, ectjon o tow Hamsi�a�✓�� °77/_O ome P one 72'7s g,b, PRESENT MAILING ADDRESS a oe °r Pone 1 t town Is 1191- v t ate ----- --- ©2G a The current exemption for "homeowners" 1P cfl e dwellings of six units or was extended to include owner-o ivi ua for hire who does not ess an to allow such homeowners ccupied acts as supervisor. Possess a license to engage an in- (State Building Code Section provided that the owner DEFINITION OF HOMEOWNER: Person(s) who side owns a parcel of land on which he/she resides or intends on which there is, or ,is intended to be or detached structures accessory to ly- dwe family- dwelling, re- attached , A person who constructs more than one ' a one to six family dwelling, considered a homeowner, such use and/or farm structures. on a. form Such home in a- two-yearperiod shall not be acceptable to the guildin°wner" shall submit to the Buildin� for all such work g Offici Performed under the bu�di that he/she shall be. responsilaa� The undersigned "homeowner" Permit. ectlon bI- Building Code and assumes responsibilit other applicable codes, y f0r compliance with the S ` The undersigned " by-laws, rules and regulations, tat,, Barnstable i homeowner Building Depart certifies that he/she understands 'and that he/she will t minimum inspection the Town of com ly ith said Procedures and re procedures and re quirementsq�irements HOMEOWNER'S SIGNATURE 4 APPROVAL OF BUILDING OFFICIAL ~ Note: Three famil 1.0 comply with Y dwellings 35,000 cubic f eet, State Building Code Section or , 127•p, Const9uctionwill be required red i HOM�WNER 'S EXEMPTION The Code state that : Permit Is „Any Home Owner- (Section required shall be performing work for Home 109' t ' 7 — Llcensln exempt fr the which a building Owner g of Construction provisions shall act engages a Person(s) for. Supervisors) ; °f this section as supervisor . -, hire to do such work thProvided Home that Owf a Many Home Owners who the respoOwnersns who use this exemption are unaware for Licensing Constr of a supervisor that they are often results uctIon Supervisors (see Appendix p, assuming, unlicensed In serious Section. Rules and Regulations Persons, problems, par-ticularl 2 15 Unlicensed In this Y when This lack of- awareness Person c th son as It would with case Sour B°ard e w°me Owner hires as. supervlsor cannot is ultimately res Pervl,C proceed agalns-t the ponsibie. The Home Owner To ensure that acting communities require the Home Owner certify that , as part is fully aware of his/her last he/She understandsf the permit appllcatiOn, responslbllitles Page °f thls . lssue the responsibilities of that the many care amend and . Home .Owner to is a form currently used b a .Supervisor. On adopt such a form/certification y several towns, the for use In You may Your community. • JOSFPH ,D. DALUZ TELEPHONE: 775-1120 Building Commissioner EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING `HYANNIS, MASS. 02601 September 21, 1989 Mr. Jacques N. Morin 300 Bearses Way Hyannis, MA 02601 Re: A=273-086 Building, Permit #33219 Dear Mr. Morin: , This office is in. receipt of a written request from Everett Snowden to remove his name and license number. from Building Permit #33219. Please contact this office immediately re the above matter. P ce, osep D. DaLuz Building Commissioner JDD/gr ' y 7-1 Of L ENE t � � a 0 , %5� DP1 0 o? /02 � po �P CERTIFIED PLOT PLAN LOCATION d �'�91�//..5.. ......1?2 •. . . ... SCALE .�''.=.30... DATE PLAN REFERENCE LLE - 0. 261 6iS i ,.. t ICERTIFY THAT THE '�YlS7-,IV Vt 449T/.0.4! SHOWN ON THIS PLAN IS LOCATED. ON THE GROUND AS SHOWN.HEREON AND THAT ITCONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF .197A, .WHEN CONSTRUCTED. DATE 7�9Cti LIES /YIO //!� rr�Ti7"<G//, REGISTERED LAND SUNVE OR i lit ial& I�,r-^=zzarq== ccx x Olio ierr iii■ 1 1 iii■ ..� 7ii■ an gas �� .Li■ _ Olin .3 ■ii■ iiii C' v>' F .'".+«.. . ..c iiii Lr1' iiiil-i iiii,iiri(J� -- M A _ e 'zJbtf� -!� •�� i f G G J'r e —II11�I�;Ullmli I1. � _ — �Bill _ u (oval ZMM mmumm inn Mi lo: rrii �I J _;, ! IIII•!!�Iii' 'illl�IIII';•I!11!ill i I r-r •,! ll I I�IIIII'I.I'll(+ i IIII+I I�! I!!'!il;l.;+( I,I I'I'IIII a(!� ,�I LI+I!�I ,��il�� Ill '► � �I!+lily I�Ih� ���',I�►I,I�I�!III�I�. IIII , 11,�111 � i is - IIIiU I I' u � sill' �I IIiI !II 'I� i l.. Itil l IiI III Ii l I I �,Ill�l I i I;II�I I III•l I.' 4 III!II!,,,,I 'llt i � OA +�, �03 c-o•� .. r ''!'1!'�IIjI I,IIi'II IiIjI i ro•.rr aca — a'o'6a.ox. iill!I ems. _ . • . .ANC ROOM� wwn �IIi!�� � •`� - � - � ulcarir ieoc '4 �DININGRM. � • ©n - BEDROOM' imte emu _wor `� nua,,aunm. -r-e' r-a r r wu•mu�r I a,y�� r 1 :urc. bb ��Sane• B •�' b � .' GARAGE 8 b. R ■ bE b' �/ f.Lq Sf � �GOO/� � • I I l t t I ,aiat ne `rY n✓a wi .. /r '§EQROOM 43 sann[� s,YC,er.r-.•; b �� .n ,r � � >, � � I '� � ... .vsr ff3 GARAGE ROOF ±.. --:-, •� g Roots az �F - I t rr.rr 'z , old a-=-------------------� I I 1 I I I '1 i I I I 1 ------------------------ I I �----'------------ 1 11---- --__--ataM ars•1C ac_- Bu.MT. -- ------------'T , I DEPkE55 8• I ♦�u.PNT. BM.PKT. I•i/%/,%/%/.// I 31/2"dA CONC, FILLED.SR.LALLY 9A5EMENT I I • i 8 � v12"THK.CONC. If /% a4 BU EA.SIDE FTC.(m) j�T.%1 • I I I I 1 :,.,;,.�: n ,. ,LiS"'i 5'i%% 1 ,/ I /St/2"dA LONG I 1 - I r_______________ __________� ________ 1 BRICK 0 3/2x12 MAIN.B4. / FILLED STL LALLY I I l= 3/2x12 MAIN.B4. 'LOCK BASE CO2 T�IIN.LONG C! OPTIONAL I I FIREPLACE �.,, -1• /iHEADER HGT.IB" �1 .. I I f I I 1 ((�/ v'; - i. DOUBtE JOIs7S I I I 1 1•TNK.C.C.gAB f71L I I 2 R. ..10 HEADER /Fl. UNOEF ALL I I 1 BILCO TYPE C I' 1 m TNIL CONC.�� ('/%'J� TRIMMERS IC:�=�il PARALL PARTITONS BULKHEAD OR EWAL 1 1 I 1'1"Y0".12"TW. -�-I 1 AND.2817 OR Ed1K o I 1 I I .1 CONa CMIIA BASE_ m 1 1 -----7d-- _ ---I 1 I 1 1 I 3 s• I I ------------- --� I 1 3•-B•HIGH•8•THK POURED LONG WALL I 1 I 1 TO 16•CONT.COHC.F'fG 1 1 l F' _J �I I I 1 I L _ -___� 1 1 I THK CONC.SLAB RR. W. PKT. • 1 1 I ��==ILL=== "'1 L 11 1 ------ I jl 1 I U.KEYWAY W 1 I I 1%:�' ? %•;%;7 2/2.10 T I /Yt RE-BARS O t'0• // I B .(MIN.3 PM)(SEE OTL) I 1 T9"HIGH A 8"THK.POURED CONC.WALL Y-2" Imo"/� I TWN TO 8"MK•18"CWT.CONG RG(TW) I I g ,R p , I I I 1 w 1 I I I I BM.PKT. a t• _______________ 1 1 I I BM.PKT. i - 1 1 I --' --------------- -- DEPRESS B• 1 I 1 t-- ------ ----- -- --------- r.* t .♦ I 1 L----------- L------------------- --- ___ --------_--------______ I _-- -- __--__ N Y9"HIGH•8•THIL PWRED CWC,WALL C. ON END TO 8.7HK,a 18"COHT.CONC.RC(TYP) q I rs r , Ro »}/a>as t/Y 1 I R.o.3t 3/1. /y DR i _JI • IL-- — _ IF --——————— — —————— ——— 1 � - •I r 1 - 1 r e 1' f r-i Xl- Lr V-cr I —: b -4 ' 4-1-1—-a i LL oR I 1 gommo *I L — — — — — — .. - {c• 1 , L_ �a . r '� r'.• t - 3 a 'tk s4 .. •;., k'' C9 t, � � +S.ti'• ROOF_ FRAMING....PLAN '"Assessor'svaffice(1st Floor): SEPTIC SYSTEM MUST RE � ` Assessor's map and lot number C - INSTALLED IN,COMPLIAN of T"c 13oard of Health(3rd floor): _ ©, WITHTITLE 5, Sewage Permit number "1 ENMRONMENTAL CODE ,H,y,,XL Engineering Department(3rd floor): `� J S TOWN REGULAMONS mop MAS � douse number / �® okDefinitive Plan Approved by Planning_ Board Ee rt lary 6, 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only 'r TOWN . OF BARNSTABLE. BUILDING INSPECTOR APPLICATION FOR PERMIT TO. 5 TYPE OF CONSTRUCTION Wood Frame July 25 , 1989 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inf rmation: Location Lot 11 at "Bavberry Place"- Defin :)division #701 dated 12/20/88 Proposed Use Single-family dwelling i Zoning District RC-1 Fire District $>>anni s Name of Owner Jacques N. Morin Address 300 RParsPs L7ay, H Vqnni g , P�iA f1?,01 Name of Builder 4,a eq tj en Address pName of Architect Gorden Clark, Northsi r3P nPsi aflddress Mn in St YarmozithpQrt , MA 3 bdrms, living M. 'kitchen, mud rm. Number of Rooms dining rm. 2� 6a s Foundation FuL] /�'.nncrete—(:Qoured) 4 ' �i Exterior C1 anbonrd.jC'pdar Shingles Roofing As phal t; Floors 3/4 T&G Sub. /Carpet ,Hardwood,Lin.Interior AyW01I G.L Heating Force Hot Air/Gas Plumbing Coj2PPz:j P-V-C_ Fireplace One (Block & Brick) Approxi mate Cost 85 ,000 .00 n Area Diagram of Lot and Building with Dimensions Fee �o k 2 lb v 0 t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable g_ding t e above construction s Name Everette Snoyd en»»> Construction Supervisor's License —��T ;t MORIN, JACQUES N. No 33219 Permit For 11 Story t Single Family Dweliina Location Lot :#11 , • 67 Statice Lane Hyannis Owner Jacques N. Morin `z3 Type of`Construction Frame x Plot Lot t Permit Granted September 18, 19 89 r r Date of Inspection 19 Date Completed -' f 19 5 � f iro0 PROPOSED ADDITION TO THE EVANS RESIDENCE 67 STATICE LANE, HYANNIS , M.A. ry ARCHITECTS: RICHARD FENUCCIO ARCHITECTS 923 MAIN STREET, YARMOUTHPORT, MA. GENERAL CONTRACTOR: THE HOUSE COMPANY 3. 60 BENJAMIN FRANKLIN WAY, HYANNIS, MA. .�,rr ��; `5'.``t'7;,r1-`g• Fi��''. 1�i..f. ♦..� Y .+ r" .i 'RSL�. '.�#-. .�'; T .y "•dry - Xy 4 Ol r :� �I• ± O +r +i AV b tT l0 tQ _ A.15,wHAL-T 3N1 r-JCai 5�8"- box M'� 2x 10 �E� -� r44APT F� F-^ri e�i—r �L/4N VVkJT, Dr-IN coo o' ��'.� � �,.�tdary xiv�'��•'S 4�Y�� �� '���•a ::,,�3't y�,,.a=�.^' - � 2K� p.'T. SILL r ,T`:a r � �. x� . ----- -- ---- — — -- — -T Tt N , _ to a .y.. n,� r4 66N�3 I I�5G3-I D : I r 1: ........... I'i I �I�L n�r, GONG. O�Fz_ VA" P.j°ff46a-) • C�CI�i'�: UnI G�CGAV. (�D�� r F7 J I.L . 1 • 1 S1�E�T / oc Z S//Ei'TS HLYN/,laG4� SC-�/�� /ygr/NoC.� cz, 7z.z3 cep. T O 7Z. ! 7/.�. �S7�q Ti c Z , Lot // `� ��✓ O O `YS` FdN--w�. 1 , 00 07 3/' +7ZFSr r AV u,.L 70 7A ?II LoT ' /a / 70 CERTIFIED PLOT PLAN LOCATION . ir2l�rsT.9l,3LL�C/-fj/9rrNis� r SCALE . .. . . .. .. . .. ... DATE / PLAN REFERENCE . �3L7! .. l-o7- Epp AAD �yGJ KELLEY No. 26100 �o� L LA�`�S 1 CERTIFY THAT THE .. ?r f SHOWN OMTHIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. --��-- DATE . . . . . . . . . . . . . . . REGISTERED LAND SURVEYOR Nb rj n J il;.: Y' L Y - 1 ��15/v r.� L r.10.• I \ I / 26X t/o I / ' sus ; 7G�1 WAIr1�X.oTr if pc. --� ¢ui�T w lo; 1 / T. t. ¢ HE�v6g � I ' V b6 PI w6TW.Hj� I \� I / l oJc,T?�tX� r�N�l-I OI.ce�- i w/ N�� Ar71T1oN , cp, �o oN ,CA61 T I \ I �Fil.a'rTE �INda� -ro �P11eW6w T H IL. �M�ME IN o�E.�lirllsl ICI FYI°. en. 4 b' (6APfVT er'`�lc'o 6P, To rMTCN i Nam_2=Z. A_0 I rtiBi�l� � - I I ritOr4&H per'' oj�I"/4 xq 112 MI I, FLXXIH "AH PI°xr✓P APOVc- vwY 8Y cw N•)16 . 1 X �JOOO 5+E I-F 6W EoC(Fa�e vG G.Or 0 KI ra►a EN A3 x ----7 i P-M, 42 HiG^ti� eTv • � pk — o.w ELECTRICAL FIXTURE SCHEDULE SYM MANUFACTURER'S UNIT QUANTITY 1 A Halo H99T/993 Recessed- Small Aperture Housing- Black Coilex Baffle -- r I x \ 1v� ice+•-,o� �. � WRr4 1/2" \ �ovE�FR I P6 31 11n �+OeA a �n 2X4 vtr►zT Y pie i rJ cps. ; w�1:t- ors �,� I � \`�� yHct+j 1'0L,� T i i i I`vio.e� e� b N ` J t,iNEN "o N L Ta rvI I 66 E�CI�'�'• �Et7�ca7r�t 48'��iTY j t.iNts of Wow r�1,oW / . K 6- 9'' SH di�Y � o ! �i EP- �rtI � r IpI 4� b II o IQ �— — \ N 1,�`Fri n l �,c�• c�y��%s !`TT'C- ,i ,i ` G1�• ¢°KNEE � - - - .. FY Vr-NT �. 1�1/ jA-�-iMV• —.._-- — �K�rt�I�HT F�"1 Gc*.rTkn'�T• ivnP,o•�E ( 2%2x4°it) NFY (�•O• ►w•ner/ Installed by E.C. 2 Install on Top of Exposed Beam stalled by E.C. I ►�(�q°G''>�ro At��T1DN To THE plied by Owner/ 1 2nd Floor Bathroom �7 �E V�� HYANr�IGi HA , 2nd Floor Bathroom �G1-Ipt� �EN�JG�10 /�eC�t-irTE��j� 3 x WA�V �l' 4T loJ.1. k 1 WT, ? =.T16� 2x 12 nr,. ai¢I�ti T� Exl�Az^ r�IIo1�T { F�6 5 v1;NTFPIT b - ��'��• 2X I'o J or�s'(�'ci1�Fz sud -w Vic , u,Ga.J of Sj5 i 1 GEA►'J JET• M MATCH E?XW" 1 ' I •� � � FEE.' of Eix. - � . , � 2xlo FL. .lol�i� C� Iti.,G,<i. Cows, wcJ.J�- --- �i r�-1� Jun�*J 8".coti►G. wat;L ov�� I(� tj/ tJ o L y . A 4 =.r r RICKCHIMNEY •- _ ` ", ., - r e 1 2x8.GRIM. H _ . 12 1 i, EADER O LEAD FLASFIING I �*� Z 12 j i 1 200 RIDGE BD. co H ASPHALT ROOF SHINGLES - 1 \ ♦ 2x10 O 16' O.C. ON 1/2' CDX PLYWOOD J*a s11A 1 1.EaR am ♦ ♦ xm MAiIERs t Boom % Us amima Jots. 2nd FLOOR CEILING LINE _ w ao am ♦ \ 2x8 RAFTERS O t8' O.C. Z t�LLAR TIES ? PROP—R—VENT t/2'�¢m0at `♦, 6- FBGL IN SUL 6' BATT INSUI r 6am IX3 FuRoo 1C ♦% ♦ ♦ Al BEDROOM / TOP OF LOW PLATE w TO To 1 SPLAYb CEILING J auh > C' . •, .:_....... b a t i p I \ STNRaEtI ~ 1 t t \ \ ALCONY I • \ 2n&f100R LINE oloe I jaww II \ ` \ ,.TOP:OF PLATE CONT`SOFFIT VENT — —�\� > a W y. 2x70016'-0.0 __------ 3 .. 'zW��c DOUBLE UNDER 1/2' SHEETROCK 'y rc S rn R N 2x4 STUDS ALL'PARALLEL 0 16,O.0 PARTITIONS W 4'.13ATi mt. . 1N8ULATION o i Z 4. cc .m y Its ,. - i� � � c: n PF`...FIREPLACE W12 1BL FLOOR uN g + LIVING R �M 1Q�2�-0, ' WU E 1 >Dno�rwoeps �t j': d CD CF F&A . t 1ws+tts — — 2x10 JOISTS O 16, D.C. .'. /4 LALLY 1 1 COL (TYP) 11 k: x`77''r,HIGHj� POURED-. 1 r -T0 16�'..rc ALL • - i . I I a i_ -�..2:,N „��•- ,CONC.M 7FIK CONT. pi r_U it TOP.OF FOUN, ! CONC- FLOW F .. CONCRETE WASH .,,,e X = RED`BRICK CHIM. w CONT RIDGE,COME,VENT(TYP) . ` +` i,s tea,t } x swtY Si t a '� a',�"` t. ., +tea 4 ASPHALT; SFBN m h y w �4or ^� >1 ;'wo RIDGE �_ c _ warp om sruw r, QA a '2x8 .S •ts' W i 3 `. .2x8 COLLAR TIES • ,.�� a sew 1 - 1-22 _-------- ��---� BOTMM Or COLLAR T,p Qk mill a ear PROP R iT / i VAULTED CEILING `V INSUL 1 2x8 BLOCKING t g 1 3 ca.rruh' •I t cawr.SOI{fT Win ' jj� F BEDROOM 02 � a m e 2"nook ttr�S n �x <c: t 44 s OF KATE 12x/0 FtR 1015T5 t0 t C � z tj fi t' Salo a000we- r01A {� ' •` � tI.:- _ 't•J t i �� •'' aT.�Q•rIQ�NQT �- �,�l .��p,!w ...rX - ova RUPLA a 1 � 1 � "To', 1 x t �.,. ;, at NNG'RAI 2xt0 n.R: SI/8! r+r stoartB.; FOGUJNSUL z : :3[bct2 tgAp!BIK _WFWL Alm ': ; t-.,ra#r .'� wi 1' r � F.. '�' •-+�' i t.? _ E..{ `1. ��:. !♦- :F ..Snt:t1�, t. ,,y 1�2'#Z•� Y: �8., as f. -;y �FB'0'O C z' IF H.U1Ut 'It r.x. = :d s rz :' :CINDE : ) a r r ;�,. •".-3':'a'��t' ;yS r. '-��,' 1 .. .•: :!. :;w,tn:a wti:. „ 4 >..Er.. �.:. ,._.. 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'.�, per., �" .:s;. ,r.� ,.3 > y•• cice,• -f1•"�a._e.....ne.ra....t:u.+.: ia•.•r-rn„z..u..+aa _n,+..w•.v+..w_.....,�....�,,.-v_M1,�,.s...a. �..y� _.. .,.,•`� ..,-•...s_w..r... ,.�-�--...w..ur,•u.._ ...., sa«,+a...a-,. Md......+,.......:.....,...._..._....,...� .._ ,-. ."M.._J. ....r......a.se.arz ,- ....• .etu,.w<.�....r..+.uw...,.eucc+:.sruaa..•r.w..,. r d A"a4anrs.$Ym4il 6-r laartt A" EV44 tS rocattow5 pfvperty� • Lane----, JrLo r Cl v4rgas 1G,Ilgf 5 2 staty dcvelCu o o yt0. (v7 yNCv�{f— r 714.57 ref: 2fCooXppa,- 2i5C� fCoodfows 0- 1&re6y Certify Liar thW yCovlLu 6 m mpayrdfve aid &mn a w w , roy 'a0 s PAUL gazA C with W-V a c- lw dati -( e8� tae Ca�ci.t7cow CMVEa e �l f jv tv Tilt [� 6 -aiws &V No 31311 ara un�fv y, �, o e t,ar die am e construction, with.rosy�rtiurira.L 4 °� se�yo� ion4C Yg%a!vm nm bus plan.was not mace for►�cora ng sv p es or-{orusc inpec� c�escrY-pttans. Ueri� o . 6uing Ccutior�a,property cl�irnens�ows, fences or - confcgu•radow" 6c caccornIPC 5racconry a* accZat:� instmmenr,SWvey w�mcuy refUct' rrnr itprmatian-) tf=- w wltar is s"n:It mmu -Tor�age paryoses 0*19 tom: M84471 coloni a,..L 12�nb szz ve nc-r Coca 1t2C., 269 bxwvmSCPEZC, h2MVM, a2339• photo 617.K6•-1186 pw 6i'7 SW..aW2'5 BRIAN AND LAUREL EVANS - SHED ADDITION SCALE 1/4 = 1' i� BRIAN. AND LAUREL EVANS - SHED ADDITION SCALE 1/4" = 1' THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A�C(, I DATA I(�.SPl1Ae_T �l�iN��l c S oN ISM FELT �z GULL C i S if IJ �JNn NV S DouaL 7 X10 iiF.�?j i..^ The Town of Barnstable t a�arsrA► . s Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner 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: IWf sti hated Cost (gDo"o Address of Work: v2L.Q41— CP Lh Owner's Name: Date of Application: l ' �� '115P) I.hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under S1,000 Building not owner-occupied 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. Date Owner's Name gIbmis:Affidav "�"\ . The Commonwealth of Massachusetts .. _: . . =- Department of Industrial Accidents . oxce 911MOstiONORs 600 Washington Street . --I Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: %-1 ah ��h location- !v-7 ;/ —a 4�.i G� Lki city & hone# -60 1� ❑ I am a h meowner performing all work myself. _ . ❑ I am a sole r rietor and have no one worldn in anv capacity ❑ I am an employer providing workers' compensation for my employees working,on this job.: :: ::: :::::::::::::::::.::::: : ComAanV name:.. :..:.:.;... a UI CSS > �.;:;.. f% "2 ::s s as t±as 2 > 3` ?' :` <' ?isfi:< 2+[: >i isi`:'?"'''':"'>!r::[j isi ? ......... i`Giyi?:i:i isf i f `'i:i`':i < :a? '? 2`i> 'i . ? ;?i;i; . :..;::. :::...:...::..:......::. .::.::..:.:.:., .::.:;.:,.;:..:.:::... ..;::::.;....:::. ... :. .: :>:,.,.,.:>:::>::.::: ::::::::.;::.. cites;.: . :: ;..:. .;shone#:; .;;:.:;;:.;.::; . :•::::•:�::::.. olicv#:.insurance co.. .:.. :>:;:.;:::>s::':<:::>:::>;>:; ::..: ,: .. /%/%/ I am a sole proprietor,general contractor, r homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: comuanvname .,........ ,. .. Q d�'1-314 t ._... .. .lr ::.:::.;:..<::::;.;:::.;:.:::.:. ....-..-...-.....-.....-..........-..--....,.....-...- .add-ess t: :: .. :.... .:.:.:::.;,:...:::. . _.. .............::......::....... .. ..._.-::::::.:::::..,:.:,:::::............._.....,....................................................................... ..........:.....:.:::::::: ........................::::::..........................................................:......... ...........................................:..... :. . ..... ;::::.............. .......... .............................................:..:: ::._::::::.:::::::::::.<.:.;.;;:.;;:...:.•;......................... ::.. .......... ... :: :................ I. :;:;: .. .....:::::..::.::::.:...:.:::: ::•:::. :..:..: :.: .:: .......::::::•:::::..:: .:::::::.::::::: rj� .: .... .............. .. .... .::.:.......... ....................:.:......... ,�.- _, ;:;:.... .::.. insurance ca = te�'3 . `.�,.:.... .... .. ohcv# %�i. camt�anv name.:,:: address: :.:..... ::::::::....... ;«:>:;>:::... t1tV' ::::•::::..... ... .... ::::::::.:::. .::.;:.:;:...:: ........::::::.:•:..:: .... ;; .:.... -XI 11 e1nran »< ''''» �. Fafiure 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 nm 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 e ' the p ' and penalties of perjury that the information provided above is wip and correct. Signature Date I D - 1"l '�0) _ Printname �e1Ain �1. t',- `Ih4 Phone# 77�• 6v0)['J oiflcial use only do not write in this area to be completed by city or town official city or town: permit/license 0 ClBading Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office . ❑Health Department contact person: phone#; _ _ ❑Other (Devised 9/95 PJA) ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X$55/sq. foot= GARAGE (UNFINISHED) CO square feet X$25/sq. foot= q, PORCH square feet X $20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Cost 49 g990915bi Building Division g 8AZ2WAq 367 Main Street,Hyannis MA 02601 sbS9. � Eo fit' Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION )g� Please Print DATE. 4- J ` JOB LOCATION: 7 Lh 15 number street street / village "HOMEOWNER": 11. 20�9 v, 1�� 7 6 -60) I� name home phoned work phone CURRENT MAILING ADDRESS: FMA . ah city/town state zip code The current exemption for was extended to include owner-accunied 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. DEFINMON 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 knerfor med 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 unde ed"homeowner"certifies that he/she understands the Town of Barnstable Building De ) ent um idknecrion procedures and requirements and that he/she will comply with said pro c d n 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 EXEMMON The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unawm 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMMN TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION SEPTIC SYSTEM R:7R9�°V° Sr: Map �7 Parcel 8� •G�7 INSTALLEC`IN Cd P-L- !AM rmit# Health Division /.e� ��—9,� WITH TITLE: Date Issued Conservation Division /d 11 7 Tnwn i, n,,,-c,;1,.. Fee Tax Collector • `b1��1 y Treasurer /o Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 6-7 t lk n h7 .5 Village � - Owner �- Address •C) Telephone 77 6101*)19 Permit Request )C o� Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cos Zonin District ' G— Flood Plain Groundwater Overlay Y Construction Type Lot Size £957 &c- Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes XNo Basement Type: gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft)ii Number of Baths: Full:existing ,.new Half: existing 1 new Number of Bedrooms: existing new Total Room Count(not including baths): existing (P new First Floor Room Count Q Heat Type and Fuel.XGas ❑Oil Cl Electric ❑Other Central Air: ❑Yes >No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garagQ<existing ❑new size LC Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use 6 n ak &kWilfj Ve_�$� t posed Use /2_-iy a� BUILDER INFORMATION Name Telephone Number Address! r- �Gl, e�Y-- License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C�) FOR OFFICIAL USE ONLY _ RMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS *' VILLAGE OWNER- DATE OF INSPECTION: } FOUNDATION N E r i 4 FRAMED _ s INSOL-'APION FIREPLACE^ h~ 't ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 4 1 GAS: ROUGH FINAL ~ FINAL BUILDING L�' DATE CLOSED OUT ' ASSOCIATION PLAN NO. _ e r - k. I Assessor's offige(1st Floor): Assessor's map and lot number �O�tNE Board of Health(3rd floor): � V��a � d'"Q^� #� Sewage Permit number t Bdaa9Y11BLL I Engineering Department(3rd floor): / J(� Y`, raee House number t0 �ow,'eso' tp*Definitive Plan Approved by Planning Board F,ah-njS rr 0; 19 . 89---M-A , �,� �e� �FOypY A, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only 7 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO (10TltSfirllet a si np_,1 e—fami 1 v r WP1 1 in v TYPE OF CONSTRUCTION Wood Frame July 25. 1989 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: o Location Lot 11 at Bayberry Place"- Definfltive Subdivision J701- dat—d 12/20/88 4 Proposed Use Single-family dwelling r Zoning District RC-1 Fire District 14vgnni s Name of Owner Jacques N. Morin Address 300 RearSes Wgv H�ranni c . MA 09601, �'GE3'PE77" SNacw,vE/V y�fK•no a�,�o,� /�?ft Name,of Builder atiti+ a- � '--� i Address _ "'�"'"�"��—�'�" F Name of Architect Gorden C1 ark, F-mytO*Ac$A ddress Ma i:Q Sf V. ,4—r,n111-hnnrf- y MA bdrms, livexg rm. ,kitchen, mud rm. T Number of Rooms fining rat.. 2. baf7hs Foundation', 11g„11 /Cr)ncrat-r, Cnn„rarll t 1 Exterior C1 anl-,oarr1/C PH gr Shi nrrl oc Roofing Asphalt � f` Floors 3/4 T&G Sub. /Car-pet—Hardwood.Lin.Interior `D4Y Mm _ - - - . - - _ Heating Force Hot Air/Gas Plumbing Connp-�/P V M_ -r,4-'q Fireplace One (Block & Brick) Approximate Cost r M5 .000.011 . � Area Diagram of Lot and Building with Dimensions f Fee } ,y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town.of Barnstable regarding the above,construction. Name Everette SnowdenlM>> Construction Supervisor's License 036333 MORIN, JACQUES N. A=273-086 No 33219 Permit For 11,Story Single Family Dwelling , Location Lot #11 , 67 Statice LLne Hyannis Owner Jacques N. Morin Type of Construction Frame i Plot Lot Permit Granted September 18, 1989 Date of Inspection 19 Date Completed 19 I . s PERMIT COMPLETED 1,11-IL. COMMONWEALTH °jEPARTMENT OF PUSUC SAFETY OF `1010 COMMONWEALTH AVE. MASSACHUSETTS ,SOSTON,MASS.0221.5 e ENCLOSE CHECK OR MONEY ORDER LICENSE EXPIRATION DATE CONSTR. SUPERVISOR ? FOR REQUIRED FEE, 08131/1993 �w MADE PAYABLE TO RESTRICTIONS F• ',. F EFFECTIVE DATE LIC NO. NONE 08/31/1991 042406 "COMMISSIONER OF PUBLIC SAFETY" JEFFREY GOLDSTEIN ; (DO NOT SEND CASH). 16 COVE LN POBX 474 I CUMMAQU I D MA 02637 PHOTO(BUSTMG OPq ONLY FEE: 10O.•00 i HEIGHT: N OT -UNTIL SIGNS v LICENSEE AND oFFlanuv SIGN NAME IN FULL-ABOVE SIGNATURE LINE . -OR SIG A URE OF THE COMMISSIONER 40, D+ NO ��fTACt.H';LICE I SE STUB THIS UOCUME EN MUST BE///j CARRIED HOLDER THE PERSON of SIGNATURE OF LICENSEE SIGN-NAME I_N FULL-ABOVE SIGNATURE LINE OTHERS-RIGHT THUMB PRINT EDE N TTH$WOCCUPATHEN �ION � ?° COMMISSIONER - i f IO97p VW SIUUEAH aolvtuswlwav ( _ Apm u t l4ue.l3 ua8 09 i uta;spiaq da�Ila� buedco0 aSnoH a41 /V80 '3ut OHO WtZ/90 Uotaeatdx3 N0I1V8GddOO 31VAISd - adAl C _ Z£600I uollpilst6as Y bOlOVdihOJ INMA0ddkl 3WOH I Assessor's office 1st Floor): �) �j� �/�/ /}�7 �ySY Assessor's map and lot number �( / (� (p !/(/ /� �p�TwE toy ���ALL�® 96� STSIE �PL6Ai�O� �esw�n.. ACCrTa0�. v Board of Health(3rd floor): cif 5 d� Sewage Permit number �U NVI IRO NTAL ODE AND t DAUST U Engineering Department(3rd floor): � �� T R�OUL� IO3�� House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 1n10[%7 Fj"/ultt TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 407 3T,*T rGE LkN15 4r6LJ J1S . MA • Proposed Use V*Mt k.tr EOM &1114 Zoning District IC e — Fire District�YA�/�✓lS D3Got Name of Owner ' 'PA.J % 1."x - V,/AwjS Address (01 S?ATT►c.� LA+�6' AYAgu.S . MA. Name of Builder '74C H;2!66- to• jRrNIPC 60!d2MI Address btu $ll!12 �110eM:04 a-&#j WA!C }�ikNMT/y�• Name of Architect Address 1-263 r4,00a 5 T. YAsetov-r4 pAm MA. Number of Roor4 Z.. Foundation 0—jLj ;� -WA-io t r==&5-- Exterior t'� �• '� Roofing T"b"I't is Floors � �T Interior. Heating P µA Plumbing 'r7e- 12c— Fireplace t-J& Approximate Cost Area ®�I Diagram of Lot and Building with Dimensions Fee �' P a.orNs OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin a above construction. Namw&4 Construction Supervisor's License O �� EVANS, BRIAN & LAUREL ,No 36056 Permit For ADDITIONS & ALTERATIONS Single Family Dwelling Location 67 Stattice Lane , Hyannis i - ,y Owner Brian -& Laurel Evans Type of Construction Frame 77 Plot r• ' Lot Permit Granted: July 2 7, '`.19 93 ; Date of inspection' 19 _ x Date Completed 9Va 19 _ n. ..� C Town of Barnstable *Permit#cP640?6 7k/6 Expires 6 months from issue date PERMIT Regulatory Services Fee o?S • M )(.PRESS Thomas F.Geiler,Director 7 2007 ]Building Division DEC m Tom Perry,CBO, Building Commissioner -f0WN OF BARNS-TABLE 200 Main street,Hyannis,MA 02601. www.town.bamstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 EXPRESS PERAHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number a d 961�Q Q Property Address (J ( QL4_2, � ry� t9- Residential Value of Work �j ! s Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name F� �Aur Cd_jl�&uA_r�_ Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Oworkman's Compensation Insurance Ched one: ❑ I am a sole proprietor ❑ I am the Homeowner [�,I have Worker's Compensation Insurance Insurance Company Name T k-,2- -&Ztj Workman's Comp.Policy# 05 J O L 3,5 cS U Copy of Insurance Compliance Certificate must be on file, Permit Request(check box) 3-Re-roof(stripping old shingles) All construction debris will be taken to �1/�C Q cJ C�itrt ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: !` Q:Fonns:expmtrg Revise061306 t The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations : 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/!Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 'Po City/State/Zip: t�'��(-i 1 -� A- (3oL3_5Phone #': �� _ y� o�2 vZ Are you an employer?Check the appropriate box: Type of project(required): 1.M1I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling j ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 12.,�Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'.compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Nfly Policy#or Self-ins. Lie.#: D 25 0 L 3 5,50�- Expiration Date: Job Site Address: J��-c� City/State/Zip: /'V (.c� . Attach a copy of the workers' compensation policy declaration page(showing the policy num r 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$250.00 a day against the violator. Be advised that a copy-of-this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der the ains and lties of perjury that the information provided above is true and correct Si ature: Dater Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building(Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ( r SN Board ®f_Buflding Re j a. �K L ons One Ashburton Place - I3® f1301 Standards -Boston o 1��,��a c�u�et�� 0�1 H®tee �j �°®ve.�.e.�t �' ���� a ®� POSER CONST Registration: 112538 DEAN FRASER SUCTION Co. Type: DBq h,C, 13OX 145 Expiration: 3/23l2009 C®TUIT, &1A 02635 TrO 127s2o DP-"-CAI a SOM-05/08-PC8490 - C71- dflryp n Address and return e asd$date ❑ Addrw� k reason for cha nge. e.B®ard®fBUfldig� nati® neal HOIWE � and Standards EMPlDYIDent ][®st hard EflREfli d CORi �gi�tdon: '' �4C'B'OR Lfls�e®r��tsatd®n � d�de�atda[n; 2 538 before �for Boat®f� taa9aoaa date. If found re �e®n)y D8 TM 127s2D one cab ua�� tam to. Vie: Dp%t ton Plaee lati®n®and Standards F'RASER CON87-RUCTIO,,� '-' Boston,Af 021ag �ffi 1301 DEAN J ASER �O.! . 4558 RT 28 COTUIT, MA D2@35 N®t v without iadnagu e i .........:.::::::.�::i:U:::::::iii'-:•::.�:}?i}::: .�:.�J;{ ...� .: .:::::::::isii:'::::.:v:ii:::::::.iiiiil:::::::.;^:?}w.�:ii;_::::::is;?;.�.�::?v�i: TE ..........:::-:.........:.:::::::::.�:.;:.:;:.::.�::.:::.::;:::::::::.::.:::.r.:�:::;.;:.>:.:::::: o .:.:;;.:::::.�:.:�:;�:a•::::::.;:.;:.;:::::.:�:.:.>:.:::;.:::::.:.;::.:.�.�.;.:;>:::::::;.;:.::.:::::. DA M -:.r. PHIS CERTIFI 10-15-07 CAPE IS ISSUED-�AS-A��-A�gTTER�OF END OR ATI INFORM -�s WISE & QUINN INs accv ONLY AND CONFERS NO RIGHYS UPON THE CEFiY 449 PLEASANT ST AT ER THE COVERAGEIA FORDED®V TliOT O END LICIEg BBELOW.EXT BROCKTON 24WCB MA 02301 COMPANY COMPANIES AFFORDING COVERAGE t INSURED A HARTFORD UNDERWRITERS INSURANCE COMPANY FRASER CONSTRUCTION LLC COMPANY PO BOX 1845 COTUIT MA 02635 COMPANY C COMPANY 17 HIS ;::? :;t:> :<:>` ':: ::«::::::::::> : : ;:: :is:::::: :>:....:'>::::::::::><z:::;;>?>::>::>:>::::;::::::»':>::;»::>::>s:<::..:.::.:;;;:.;;-:::::::.�::..........IS TO CERTIFY .............:::.:�:::::::;;:;:;::::::::;.::.;:: .::.;'::::.;>:;.;:.;•:::::;:;:.;:;::::;:.;:.;;;:.::::.�:;;;;;:.;:.:.�:.::.::.;:.:.�:.:.;>;;::.�:.;.:.::;;:::..:::::........ THAT THE POLIO :::::::::.::::;.::.::.;::;:::.;;:.;;;:.;:.;:.:;:.;;:.;:.:.:;:.::.;;; '::.:.;;:.;::.:.;:::;:.;;;:.:.;:.::.;;:;:.:.;.;•:;:.;;;:.::::;:.:.;::;:.;;.;:.:.;:.;::.:::::::::....... POLICIES OF INSURANCE LISTED INDICATED N '7WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN ON BYETHE CONTRACT OROTHER DESCRIBED DOCUMENT WITN ISSUED TO H FOPECT POLICWHI PERIOD IXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �U RESPECT TO WHICH THIS SUBJECT TO ALL THE TERMS, CO TYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE POUCV EXpIRAT10N GENERAL LIABILITY DATE(MMWDIY1r) DATE(MMIDDIVV) LIMITS COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ CLAIMS MADE E:j OCCUR. PRODUCTS-COMP/OP AGG. OWNER'S&CONTRACTOR'S PROT. PERSONAL&ADV.INJURY $ EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) AUTOMOBILE LIABILITY FIRE ANY AUTO MED.EXPENSE(Any one person) I; COMBINED SINGLE ALL OWNED AUTOS LIMIT $ SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per Person) $ NON-OWNED AUTOS BODILY INJURY (PerAccldent) $ .GARAGE LIABILITY PROPERTY DAMAGE $ ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ ONLY- EXCESS LUU3IUTY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (6S60UB-0850L35-5-07 THEPROPRIEfOR/ 09-26-07 09-26-08 STATUTORYUMITS EACH ACCIDENT '''' PARTNERS/EXECUTIVE INCL $`"' OFFICERS ARE: X EXCL DISEASE—POUCY LIMIT OTHER $ DISEASE—EACH EMPLOYEE $ 50 0 )ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECUU ITEMS :....THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CE ....I S . •.;;:;:>:;:.>::;;:<.;;:.;s:.>:.;;:.;:.::::.;;�:.::�I:;;:.;::.:;.;:.;;;:::::.;.:.;:.:.:::::;;:;.;:.;:.;•::::::;;;:::;::.;:.:;:::::.;:.;;>::::.�::�;:.;;.�':.:.::..::. ........ IFICATE HOLD... ER AFFECTING WOR :. ER5 COMP COVE RA SHOULD ANy OF THE ABOVE DESCRIBED POLICIES BE.CANOE tFn ®EFOgE...THE.... EXPIRATION DATE THEREOF, THE ISSUING COAAPANY WILL ENDEAVOR TO{ AL ERASER ENTERPRISES LLC 10 DAYS llVNITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE PO BOX 1845 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE OTU I T MA 02635 LIABILITY OF ANY KIND UPON THE NO OBLIGATION OR COMPANY,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTA �gut, CONS--- YRUCTION Fraser - A . Itruction Roof ng & Siding S 508.428-2292 0. Box-1845, Cotui Pecialists Email: fraser t AA- 02635 construction w.frase Yerizon.net phone 1-598_ rroofng_com ,�e 428-2292 &FAX 1-SOg_428_p123 MARTIAL FII �® VT ®MLY cLU SSA , g�A�'E: Nove L tuber 14, 2007 DING RIGHT SIDE OF,GA NAME: Laurel Evans RAGE MAIL ADDRESS: 1, O J08 ADDRESS: 67 RON 35 South Yar Statics L mouthRE' SO8-775e6913 ane Hyannis, MA' !VIA 02664 ERASER C®RSTRUC and professions T`ION hereb like marl Y proposes . Specifications and local building ner and accordance perform the folio -Re Hail-Remove and Haul awa i ode. ance with the manufa to ervices in a neat all plywood she l of the old.roo fm s sheathing as nee g material ded, - SUP ply and Install IKO CA IRON CLAD p GE-30 YEAR W REAV'WEIG R ECTION, CLAS ARRANTY' S YEAR IKO Laminated SELF SEAL FIRE RATED Architectural, Algae SEALING antiberglass As Supply and Install IKO A granule,70 mhaltShingles, UNDEAYURGA,RD (Iee c� Water Ph for Cambridge 30 AR Counter AIENT SYS Shield) WAT TEM 3' ERp and Instal! Rash Skylight, OF Cheeks, Ch. & valleys, P Supply 15#FELT PREA'IIU1V1 UND Y and Ad1 Flashing Points.meter of Roof, Supply and Install hick's ventilated RLA Y1VpEN i PAPER Drip Edge or g,9 Supply and Install or`,ANT Altarninu m Drip Edge Clean &Remove - Debris from Work area daily, Color:Color to snatch back IE® D RTI''T`VOOD PRICE-$5,195 Main Front FRICE-$2,275 Right side of garage Initial =- Initial tRIM�*ORK: r Replace front rakes on doghouses & entrance with PVC Replace Fascia on doghouses with PVC PRICE- $795 Initial 2% Discount if paid by check immediately upon completion NO MONEY DOWN - NO Payment at the start or part way.thru Payments accepted are: CASH- CHECK- MASTERCARD -VISA-AMERICAN EXPRESS * Any payments not made within 30 days of completion will be charged 18%for every 30 days the payment is late. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per,panel including Materials'&Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$50.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years.. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw,this proposal. FRASER CONSTRUCTION: Carries,Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: i0meowner Fraser onstruction r � I Engineering Dept. (3rd floor) Map 273 Parcel 86---7- Permit# o(J f(� �(�� �q House#"q 6� 1Z1� �, - Date Issued �l ��o � _ -1917 B�dfHea�tF-rd oor)"($:15 9" / 1:00-4 30) ® 1`—�'S Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ) Planning Dept. (1st floor/School Admin. Bldg.) t►�rq { De ' itiv Plan Approved by Planning Board 19 CONNBMO THE TOWN OF BARNSTABLE osTo s Building Permit Application 4Projieceet Address 67 Statice Lane, Hyannis, MA ( 175411�-y ;;1* 1 Village Hyannis Owner EVANS,, Brian & Laurel Address P•0. Box 35, 'S.Yarmouth,MA 02664 Telephone (508) 775-6913 Permit Request 8x12 attached. shed addition (96 sq.ft. ) First Floor square feet Second Floor square feet Construction Type wood frame Estimated Project Cost $ bS"('ap.QB Zoning District RC-1 Flood Plain Water Protection Lot Size .37 ac Grandfathered ❑Yes ❑No Dwelling Type: Single Family U Two Family ❑ Multi-Family(#units) Age of Existing Structure 7 yrs. Historic House ❑Yes UNo On Old King's Highway ❑Yes IffNo Basement Type: $Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) none Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 2 New 0 Half: Existing 1 New 0 No.of Bedrooms: Existing 3 New 0 Total Room Count(not including baths): Existing 6 New 0 First Floor Room Count Heat Type and Fuel: ZIGas ❑Oil ❑Electric ❑Other Central Air ❑Yes Wlo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) XIAttached(size) 2-car ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes X3 No If yes, site plan review# Current Use single family residence Proposed Use single family residence Builder Information Name Jeffrey Goldstein Telephone Number (508) 771-0303 Address The House Company License# CS O42406 60 Benjamin Fran]:lin TATay Home Improvement Contractor# 100932 Hyannis, MA 02601 Worker's Compensation# SWC 170-0318-00 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEB RESULTING FROM THIS PROJECT WILL BE TAKEN TO Town of Barnsta e landfill SIGNATURE DATE 8/19/97 BUILDING ER N D FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. t. 4 ADDRESS VILLAGE' 1 OWNER - f _ DATE OF-INSPECTION: FOUNDATION FRAME INSULATION ` ` FIREPLACE r -f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH r FINAL GAS: RIB _ FINAL - FINAL BUILDING �- Z �Q 1 DATE CLOSED OUTIOMM ASSOCIATION PLA IF BRIAN AND LAUREL LVANS - IEDADDITION THE BRIA - N AND LAUREL EV SHED ADDITION THE HOUSE COMPANY 7/15/97 SCALE 1/4" = 1, Rpq�!Vj 6-r wura;L alGLvts tocatt'on•Opmpaty Pya4vws I.,Ot7 ' Lt v 31't • ICAR4= 1G,119 f 5 2 sto dove 11 t i N 4 no. 67 gam4c dock,/ 4H E� lot to - - aP41 ref: 2 fCootC g"d-. fcood Dw, �- 1&re6y Certtf y thar tQ,pavv&s been, for' �N of aacd • v-� �� PAUL �a x�ce sJ�oww�ier�n oCoes nop� aid uv a c�C N tiA axr� with an a c :'ve cfat�f -�q•8� tie Caine Q CMVER oCwe � rrn. t7 -�s &V ft 311u �O�C. e , tar thi trine ,of comoucaom wars,rasp�r� 4 ��yo♦ ionaC n%u!vm z.cff"tis,p am carts nor made for r=r;� sv p es or,�ocmm irt.,pr c�eec� cCescripttoll� Uec-i� prOf7ero iows; fences or rot-1 , confioracowma 6c oiCCowc�Ct6grxo► Cy an accuravo f 150, inAmmenr5a"ey w"mcuj ref Cec rmr inf ormati on.) 6 4*V w&W is S906t,VWrem '%rYlotVaye purposes on6j. fliZ t2o: C010t2l�kL 1&nb SZ.igVE IOEE COMPAny,I0C. 260 bXWVM 5CpE ECG i'2aJ•7OWM,MASS. 02359•' X"C 617 826-Z186 VNX 611826-46Z5 I�f I f � TOWN OF BARNSTABLE, MASSACHUSETTS ii MiM � �1 r,na-tT ° µ.x.ve-•a - ASSESSORS MAPS_ o z•s+.� 4; (D O \ b v B6 �• a'o _ G9� ,I M1r O• !• T14Y J 1 �a4 GLAa J � •fie � N y 2oa Q •2d - Y , G 1 [ z00 aF°c _ 2 y O � oA�ti .pc p J" � , 81.0 r Rr e c AC 'r vo- 1 \ Eib to .30Ac •OF'r,v� 1"B(°-13 ® .30AC 110-4 -nAGE i�. u. 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Z �- 33 AC Eli I a7.r. BC 8 901 ,o f Y 23AC J P�� V2 as A O ©z3y U OPCN30 ti J 23d •Q J Y > V 11 ° © O 0 O )AC ° SFy E ti 0 8s.7 la w 7 ^ , ry 5 .z14C z30 Q ZZ1 2 .20A0 z p � 85-Iq,'S 238. v 'S3 ® r jl }•. 14 .a�4c P .j5•c a .34"- N ZS,AC 2"4< © 4 Arc_ .f .a 4 103Z 95-bn W 0 1 v � 4 ° ¢ .2zgt 4' a (n-tit- .174C Q 85-rs 237 P v * Iw` ll ..22AC 24AC W 2>> .•I' zed. 1taC eS.r"r a� AC 0� � � Jn �P- 4 � i � 39 1 A� J .19 SAC BS_ 4 apJ27AC 2S6 F ".IBAC .� O3 O O ^ { lS90 M .1Q,4jC ?! I II C !,A �7'2 L 8S_4Om �G" "0 O y. as GJ 1 Ac c i I 106 ets ,>- fl:l 244E < -114C Os-I 4j1 Z'AC I .il. tzz�Q Q ry .17AC (I A,: o, r .20AC 2b1 1- �_ ;V t24 2 n �,O i Q pe 9oPE1° 2OAC r :, 1 •oo .34.E O Q .o �QrpP `zo- '9< 206 n sage vi w `25 9 r. F AC AC .I 1141 D 26 °0 23AC .35..E >, L� (Ht 12-20�'1.•(9 85-Ib Z 'ZIAC ,T 41� ZZ PREPARED UNDER THE DIRECTION OF THE. R SCALE r.WO' �G'... BARNSTABLE BOARD OF A99E590R5 AVIS AIRMAP INC. EA E:99ACHUSETTS CORHECTICUT 11. _I ASPt-kkuT' SLA[06I-F_5 oN_ IS# FELT OV Ef, S/g`1 G.Dx PLYu1OoD OVER 2x/o 0 �tEra I-S.50N "TVVCi< koJSE WAP(P ova I/.,"C,by fie-Ywcab wt-A �L K.4 mbs l(." 0—e , P.-r. PI.Aif CownA1VOO5 Wu6LE ZXl01fif,(�D�R �F,�aR�rJc� dN 4,q poOS, _ 13" 5� 3 w/ loXlo WfrZ� �� „ v . /O �btA. P/E2s " y Zf ' DEP)i ` a r ° ` t o I' . The Corm onivealth of Afassac'husetts Department of Industrial Accidents f office 81100092110ns 600 l ashington Street Boston, Mass. 02111 `-' Workers' Compensation Insurance Affidavit .�nlicant information: Please PRINT lepl�l""'"' '�`�- ' _..... .. . _ _ _ .. ..._._.......,___...__....__ .._-...__.. .__._...-d�,�'_=_arse_...__...._.. owner nameEVANS, Brian & Laurel project location: 67 Statice Lane, Hyannis, MA 02601 city Hyannis Phone (508) 775-6913 I am a homeowner performing all work myself. I am a sole proprietor and have no one working to any capacity .ta '.m�'+#i .r'."_ .p"u".:"7!".:z--zd�M:ancan.r�sag�;s+^Ra�rto•�' vrY�aTT >^.0 P9'•s�w..u�r.�w."'^°g,f ,•�^,•aT*'* ;a+:Yat{t .�^..... +n,.,.p�,. is.:..s..:._....�=�./.r.s ...:_ :e::l,.wrs.,:�•r�.....ur,�:i+w.:r�.�.�...�.3r. ;..�.x�;r^ �:,M �.rn:Lia.:ratJC.';e:•�3....�:.c:� .as,:s:73 e.::...�.........<,..._�......� )M.I am an employer providing workers' compensation for my employees working on this job. enmpany name: The House Cornpany address: 60 Benjamin Franklin Way, city: Hyannis, MA 02601 . phone M (508) 771-0303 insurance co. Credit General Insurance Company Policy# SWC 170-0318-00 I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- address: city phone#• insurance co policy# t a _" 1/R:FI'i. .?1Kr_.........�...-^T+ram; f T9 _y..i.�'.'.ire.."T'itiT.^^-,.�'�'fie�nwxg-:'�Cp'r,; u � a:��a*r._<`�..T^i' '.:e;.-• -+..--� �...�_....�._.._. - �....___....�lv^i' �.a:.:...'+�:...i+i�..:�.:t:.►wau:w�'a5- -it"d►..L'S4t r .s:,:LYr+�i-.b..'+.s.ii:�.,ec. comnany name• address• city- phone#: insurance co policy# 'Attach'additional shcef if necessaryryrr n _ _ect i necessary,.:,Jur.-i�ru.�sa__-..:.L'-:"�'+Yit..t,s�T.�i'Wr`��.r'S'stl' Mild" '7�Aa1'SYakt""'i: '!i`�•.Lh:s i.`Y�RL Failure to secure coverage as required under Section 25A of NIGL 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 NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement maN b onvarded to the Office of Investigations of the DIA for coverage verification. 1 do herehp ertify under /t,pains and penalties of perjury that the information provided above is true and correct. Sienature Date 8/19/97 Print n e r y Goldstein Phone# (508) 771-0303 e9f - 0l YY �official use only do not write in this area to be completed by city or town official �. city or town: permit/license# rilluilding Department ❑Licensing Board 0 check if immediate response is required QSelectmen's Mee C]llealth Department ' contact person: phone#: rJOther _ Irmscd;m;PJA 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 e►nploree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An en►plm er is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foreuoing enLaged 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 dAvellim, 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 renem,-al 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. 77 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers 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. Citv 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. r,>auv-,,...••-,....._.. ...,»�,..,-a... -• .t .-r,s •.,..w .:..ca+..,.v..,,..ro �r477r�.•sa..ryro,v'cl..'4'�^'m."'�"°.r".a+�.. ^t•.T, !.N.Rf/f..d^fOr. TllK7""�T4V.P►,l'7W'sM+a"'.'>+r!,t>•W Tile Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations -. 600 «'ashington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 • CF ZFIE Tp� The Town of Barnstable • BARNSTABLE, • 9q, MASS. �0� Department of Health Safety and Environmental Services ArE 639. A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: attached shed addition Est. Cost $5,000.00 Address of Work: 67 Statice Lane, Hyannis, MA 02601 Owner's Name EVANS, Brian & Laurel Date of Permit Application: 8/19/97 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied 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 PERJURY I hereby apply fo ermi as agent f the owner: 8/19/97 Je tein (The House Co. ) 100932 Date Contractor Name Registration No. OR Date Owner's Name j HOME IMPROVEMENT CONTRACTORS REGISTRATION j Board of Building Regulations and Standardsi One Ashburton Place — Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT'-CONTRACTOR Registration ,100932 Expiration 06/24/98 1 Type — PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR Registration 100932 OHC INC . DBA/ THE HOUSE COMPANY Type - PRIVATE CORPORATION Jeffrey Goldstein Expiration 06/24/98 60 Ben Franklin Way Hyannis MA 02601 OHC INC. DBA/ THE HOUSE COS, Jeffrey Goldstein t4W Ben Franklin Way ADMINISTRATOR Hyannis MA 02601 U ' 45rr, a DEPARTMENT OF PUBLIC SArFi"i 4554E ONE ASHBURTON PLACE , RM 1301 BOSTON , ,MA 0210E-1.618 CONSTRUCTION SUPERVISOR LICENSE Number: Expires: ReF'_ricted To: 00 JEFFREY GOLDST,IN �' r 7> De-tack bottom, fold sign on —�__.._..._. PO BX 1166 rl , op back, and lanilnat,e license card. BARNSTABLE , MA 02630 F" ep t.op for receipt and aiige ` c; „fires notlficat_o?l. Restricted To: 00 , DBp,ARTRENT OF PUBLIC SAFETY 4 5 6 4 8 CORSTR CTI 8 SUPERVISOR LICENSE 00 - None Expires: 1G - : & 2 Family ;ao�-es Restricted Poi . 00 Failure to possess a current, edtion of the Massachusetts State Buiilding Code _-JBFtlBY GOLDSTEIN is cause for revocation of this license. ""BARNSTABLB, MA 02630 NOTICE _ NOTICE TO G TO EMPLOYEES EMPLOYEES o,M Sve The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: CREDIT GENERAL INSURANCE COMPANY NAME OF INSURANCE _OMPANY 709 BROOKPARK RD CLEVELAND OH 44109-5833 ADDRESS OF INSURANCE COMPANY SWC 170-0318-00 _ _- 05-03-97 POLICY NUMBER EFFECTIVE DATES PHOENIX RISK SERVICES, INC. 3201 ENTERPRISE PKWY BEACHWOOD OH 44122-7320 (216)831-7500 NAME OF INSURANCE AGENT ADDRESS PHONE THE HOUSE COMPANY, INC. O.H.C. iNC P 0 BOX 1166 BARNSTABLE MA 02630 EMPLOYER ADDRESS EMPLOYER'S WORKER'S COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above Named insurer is required in cases of personal injuries arising out of and in the course of employ- ment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Worker's Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The emp'-)yee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work relat- ed injury. In cases requh' hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME Cr HOSPITAL ADDRESS ~ TO BE POSTED BY EMPLOYED