Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0010 STRAIGHTWAY
1� Si�� r �N � wA r I I I I i i I i d I r .. ..�.._ �._.. .. __ � � -... ..... ♦ � a . - . - �. .ram - - .v..-.... __ r - - - -- . .. I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION BUILDING DEPT. Application, # �' �- Li5 Map Parcel J Health Division JUN 17 2016 f Date Issued. 7719h le Conservation Division Application Fee OWN OF BARNSTABLE Planning Dept. I IPermit Fee Date Definitive Plan Approved by Planning Board lq& Historic - OKH _ Preservation/ Hyannis . A) F P�zl✓ Project Street Address _IO tjA 01w,'"®f Village Owner (� /1C nak Address l b 3f7 , k w a.f l nri�s /'I�1 y�DD1 Telephone 61; - 5_9(o-g10S Pejrrmit(�Request -1-s-6A ei I"e,(- 0� K-30 14--fd t- o� 2�Et'` (q 7), 6-P Pr' 2t'r/G �1V1, IAS�L�I ho54. ( /4a.rn'�� oe-G '� 7✓TiIY'G 63'�h i'bny /nS�p�/ vC,..�• l�.v{-�S 1.4. (-f4c, 6�1S (1,16, 3.5 -/3 f,-4 GA t-&t 41, �Ac d T41s1mfl stye y..+ o.tr oP.. 5rav�d m(roVu paur rg�- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�' L 0-Z Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 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 ❑ 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 LINO If yes, site plan review# Current Use Proposed Use _ APPLICANT INFORMATION - - - -- R (BUILDER OR HOMEOWNER) Name Rjmd La,It 6 r Telephone Number SD$-S&7-6,20(v Address 410 wrv-C Sk License # P.b S%(e( ail NA 0)-7 20 Home Improvement Contractor# I bD 7 q Email SJ a n i h v I�to a sa - WrV I Worker's Compensation # S .SL q( A "Jq f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A"ep �n/�a�e. 1�Vraysl.cr: 103 A;,,4- 1(�dt' 'Fell �,�,ru' �,� Oa?)-O SIGNATURE /G" ( �" /�---- DATE c FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS •; VILLAGE rt f OWNER DATE OF INSPECTION: G [[ r C; y FOUNDATION 41 FRAME .} INSULATION FIREPLACE 0 i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. i T— -- The Contituinwealth of Massachusetts De artment of lndttstr' (Accidents - !! ' 1 Congress Street,Suite 100 Boston,MA 02,114-201.7 .0 lvww m6ss.govldia w rkers' Compensation insurance.Affidavit:.Builders/Contractors/Electricians/Plumbers; ,TO BE FiLED WITH.THE PERMITTING AUTEI0121TY. Applicant information Please Print Legibly, Insulate2Saye!Roland Lan evin Nal7ltr (Businesslprganzation(individual); 9 Address:410 Grove Street Cify/StatOZipi,Fall River MA 02720 Plione#:508-567-6706 Are yon an employer'Check the appropriate box- T�pe of or (required): I [D I am a ernployec with 20 employees,(full and`or part-time).* 7. exV et)tiStrttetlOtl- 2.r�j i am a sole props ietor or parrnership and hay e no employees working forme in. . El Remodeling any capacity,f\o workers comp:insurance requtred.1 30 I am a homeowner doing all work myself.(No workers'Orrlp..insurance.required:)t 9. ❑.Demolition 10 E]13tiildin addition 4.❑'1 am a homeowner and will be hiring contractors to conduct all work on tiny property. i will ensure that all contractors either have workers cm ,160saaoo insurance of arc sole; l I.❑_ lecfrical repairs or additions proprietors withino employees. 12. Plumbing repairs or additions 5.❑The e sulrcentrinctoa haved I ave aoorkerscfors listed omp nsurn the rancrattached ahect; 13. Roof repa trs: 6.�We.are a co po6tion ut d its officers have;.exercised their right of exemption per Mi G L c, I []✓ :Otherinsulation 152,§1 tril.and ive have.no employees.[No workers'comp.insurance regtaired:j *:Any applicamthat checks-box#1 must also fill out the section bcldwv showing their workers'eorrXp'ci'rsation�policy infor3iuition:>� r Homeowners who submit this affidavit indicating they are doing all-work and then,hire outside contractors must submit a new affidavit indicating suctt. -Contractors that:check this box must anached'an additional sheet showing the.name of the.sub-contractors and Mate whalici or not those miftas have employees. 1f the sub-contractors have'employees,they must,provide their workers`comp:policy number. I atn(tit efnploi%er fhat is providin{r'ii,orkerc'et iiipensatiotr insurance for nt•y employees: Below is the policy-trtrct jab site b forination. Insurance C.onijiany iVa tile :Liberty Mutual Insurance Policy n or Self-ins:Lie,'#I;XWS 56418741 P p3ttitian Datc;_12110(16. Jib Site Address (7 `cS�/�:ah't c•rdy CitylStatt/Zip: j{,tar� s 1I :Y C�� 4eol Attaeh.a copy,of toe workers compensation policy declaration page(shooing the policy number and.expiration date). FailUrc to secure c coverage as required Linder MGL c.,15.2? §25A is a criminal violation punishable by,a fine up to S 1,500.00 and/or one-year irnprisonment;as well as civil penalties'in the forth of a STOP WORK ORD) Rand a.filne of up to S250:00 a day against the viollttor.A copy of this:statement may be forwarded to t4 c Office of fnvcstigat.ioiis of the DIA for insurance_ coverage verificatidi . do herehj%certify under the pailS and nalti s of erjuty that the information abnvi�is trite and correct: Signature: Date. to 1(o Phone ;508-567-0.706i Offrchil use only; Dn not write.in this ureic,tti be completed by citj or torvii,gfjiciul City or Town: _ P.ermitll;eense:# 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#: Office of Consumer Affairs and Business Regulation -- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cot actor Registration Registration: 180747 Type: Corporation w fn Expiration: 12/29/2016 Tr# 261507 INSULATE 2 SAVE , INC. - ROLAND LANGEVIN _ - 410GROVE ST FALLRIVER, MA.02720 �. - --- — Update Address and return card M#k reason for change. Address. 1:1 '.Renewal P .Employment L] Lost Card SCA 1 L'a 20M-05/11 �e�an�nca�uunrz,�/� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �3OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: rt tegistration 60747 Type: Office of Consumer Affairs and Business Regulation ,Expiration 1 2/2 912 0 1:6 Corporation 10 Park Plaza-Suite 5170 Boston MA 02.116 INSULATE 2 SAVE"INC ROLAND LANGEVINt ' 410 GROVE ST FALLRfVER,MA 02720 —'a Undersecreta—ry Not valid without signature i Massachusetts Department of Public Safety I° Board of Building Regulations and Standards License: CS-103861a _ Construction Supervisor : ROLAND LANGEVIN 56 HIGHCREST ROARS FALL RIVER MA 0272tt ( ,ten Expiration: Commissioner 08/24/2017 C i i y DATE(MM/DDYYYY) ,acoR CERTIFICATE OF LIABILITY INSURANCE 12/7/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL. INSURED,the policy(es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions.ofthe policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anthony F. Cordeiro Insurance PHONE FAX Fkm, (508) 677-0407 NO- (508) 677-0409 _No171 Pleasant Street E-MAIL S: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSUR'c S AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURERD: Fall River, MA 02720 INSURER'E: INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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.LNAITS,.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR VND POLICY NUMBER M/DD/Y MM/DD/YYYY LIMITS A GE.NERALLIABILITY Y Y BKS 56418741 12/10/15 12/10/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY $ 300 OOO CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATELNITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 rxi POLICY 7 PROT LOC $ AUTOMOBILE LIABILITY 12/10/15 12/10/16 COMB[NED SINGLE LIMIT A Y Y BAA 56418741 E Vidert $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE AUTOS eraoudent $ $ A X• UmBRELLAUAB X OCCUR Y Y USO 56418741 12/10/15 12/10/16 EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION S $ A WORKERS COMPENSATION XWS 56418741 12/10/15 12/10/16 X I WC STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE NIA E.L.EACH ACCIDENT $ 5010,000 OFFICERMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $ 500,000 ffyyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rermrks Schedule,if more space is requred) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORLZEDREPRESENTATIVE ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: May261'6 0147p : ` Eec[era!IS3 S O,Sii4G5524 RISE Ong;ate rrn �!contracto Reslstr Ko s1ss 9tA.Corttsaetcr Regtshut3on!to 420978 . A,diviRi6m:grT�teistlL,Eagtrltgnug., CTcontractoi Rag�tratkca.No"&Z#3t20' IY S:I3upoat"Ave,Soti#6 Ystanbuth.MA'02564 t 1NEWOO Page: ; 1 PROGRAM': rir�scastRucf�s oi:+roDErr+4uwse t1TGCC-HES a�cy aw�ae n�wstaxFxFoxwoarc�s ta7srowi:R mom! uRTE eca�rs wosSi,oaa�t Giegoty .Ntenal�y `5 2193 4 Uf�4©2 s�x�BTRE£7.. antaNg 8iAEE'F .- . o siIy IS Thayer Heights Raad - rit - .. •........ 9tLLlI@6 CRY BTATF.7SV 1 •._.BCRY,fL6:GT1(i C7:lTE.7JP —•'• s Hyarutts,MAf}2t50# HoOinton 'MA 6048 77 'JOB DESCI IPT t3N ACR"SEAT II�G;I'mvtde"labor arsd materitds'tg seat areas of your home against wastefal,excess W eaimge Thu wup ;) �- concut vsrsth c#se'use of.,spec #tools and d'ragstostcc tests to assuce;thst yomr home will be left with a hca?lltfut revel re av+d tadoor air goaMy.Matena>3 to tie used ivseat your:liotac can:include;cs�};s,fms,weathastrcgpingand oilrerproductshedvvOcicing innhidcacr,t" hours; A"""oeduaiotrtc':+xilitc pt r"miaute'(cfm} on vn-occcu..butitfie:actual;uurnbcr of:c&n:u:nprguaca itced: S920 00 yg:SF tb1G pr andc£ horsnd:tnata eels taScal heaAn and/or eooimg ducts wstlnn de grated untieeted areas Chcs wrsrk w►il be ' ,Perforrrud'nt the rate af$75 gar snszt.Pes"hour,whidt includes mtctenals "{2}warknng hours, SIS©;tJO nand-a:doorsNrep to{3)door(s)ttirestruf mrleakage ATR;S£At.�Attsi Pcavrde;tabar sad ntatertalsfa tnstall'.:' ton weazi�ersuspp?.g - 5231 oa: ATTxC Ft.AT'Proutsle'IEbor sad;ii atertais to cnS- s9'layer afR 3ti itnfaced.sbaglass tiiitts to"(927);sgtSare;feet ofattia;'spece: q Jt� OY .. - ... AT'TfC FI.A'[`';Provtde labor ae►d:materrsts;ta tasrali a 24°.layer ofR-d4 Gass 1 Geltulase iiilded to(t3)sgastc; t aEYogai;attic space RE[�t0'VAl;;..Rem�ve;(.I80)square feat of_�att style insgtatcaa.iom the;atuc area,, SI74:6a I ATT'1C ACCESS Provuielabot and ncatenais to make$1) access opening from ane atttc area to another b.cutting a passage tht ough shealhcng•This assess gill be&k.open"as.R is, r'.too common uttl ated non 5rewalled atba areas :. $31;31 A'!'tC ACGE$S Pros is tabor and rnatenals w Iasui the back of tlie'atuc door vnth 2"rigcB Thee nax bond:artd sea[;the loots edge wcth' wcathetstipprng to nrsttsct asr,-Yeaikage`_ - .: V F1+iT EI A[iON i'rovidc laboracid asatensis romsta#!{I)insulated exhaust hose-vrtthmauatedilapper_ucnt to cxhaust,futute'bati�room` Tarr sj::, • s $!ibaU: ; I A FtOh provide Lzkaor and materials to insssit vennteton ehutts.in,{tit}:;taftor bays':'to masntain air f]otiv: YENS I 522336, i CL}NIM03t=V!fAI - Provide labor and mi;ersaErta insiatl 3 5"R=:3 Cibci8Iass Batt nisOltt :ib{1.84)"sgsiare fact<of tasee alt aea z 't rigid fibegltsss tnsulstson will b€uzssa3lzd::ovarthe�surface.. . 7aso May 26.16 01:47p, p•4 . t Fgderet ID 0 054►40$8'29 Rj$g Engineering - qt t:orttraetorRoglatraftort-No a1fi6. MA COttiMCWT Reswunum No 120970 C A division of Thlelsch Eegine-ering CT Corgi Regtstratlon No SUM V 5 Dupont Arc,South Vansovtb,HA e2b64 CONTRACT Sti8,568.1926 FAX 508-S68.1933 Page 2 PROGRAM TIGCC-HES t►uaeoxmAcraewtr�wrotttmverrisisf . FJtiO AND Ttfa.eiR7DtOrR.POA.atORICAS pEaCWaEDBHdtY _ CU8TMIR PEG= DATE cum vrONaQaDhR . Gmgory Mc nally (617)596-9105 05/25/2016 219344 0000*2. BPJtVICti.a7R2ES.�--.._•. Ba.L.@I0�STREET 10 Strai&"Y 15 Thayer Heights Road etztvtceem.srATa,tcv_ r eureoemau►Taz� � ~- .. Hyannis,MA.02601 Hopkinton,MA 01748 JOB DESCRIPTION COMMON ALiS:Provide labor and materiab Eo.instad blown in Class 1 Cellulose to(55)square feet of 4"covaram waft through an intwor sudwe drilland-pwg nmksod..Pings will be sparkled and left in a relatively smooth eonditioa.Finish sanding and touch-up prnningtpaiating will lie the:erstoomes responsibility. Flonteowner has received a copy of the EPWiRenovaie Rigbt Lead-Safe information guide.explaining the potential 4isk of she teed hazardeVosura fmm the weatherIzation work to be perforated.Your signature is your acknowedgemart of moeipt and agrgemem;toprooeed. $-101.15 BASF.Man DOOR;Provide Iabor and materials to.insulate the bade of the basement door leading to the buprhaad with 2-rigid board that meets the sections R-316.5.4 and.316.6 mquirementi of butTding code. Scal all edges and seams with FSK tape. S72.22' CRAWt,SPAC6t,Provide labor and materials to install(278).squam feet of 6 ml polyethylene over open ground in designated crawlspaor/earthm base.meat air as. $214.06 REMON'AU Iteroove:552)squaw fed of batt style imsutation from the aawispace area $341.44 CRAWLSPACE.Erotide,labct and'ntatetials to ittstall (190)square feet of R 10 rigid Therttau insulation to the cmwtspaee perimm call up to the saltand agamst-tits:band joist $74520 iTitCENT'IYB:AISE.Eagirseeri will apply all applicable,eligible i ioeoti`es to this contract. You will be billed oniy.thc Net amount. Curraitly. for elWbk-measars;National Grid offers 7596 incentim not to exceed$4.000 per calendar year,and an incentive of 100%for the Air Sealing an caitum For the safety mid beatth ofycur bonWs indoor air quality,v`awill be conducting a blower door diagnostic of the available air flow in your home both before the_vwork is begun,and attar the weathe tftafto vwlt is complete:We will.also conduct a diagnostic assessnens of the oocibiastion fumes in tba ciroatat flue ofyaw heating system and water beater.This has a value of$90 end is at no cost toyou. W0.00 May 2616 01 r48p P•5 reaeral�nas.aa RISE Engineerism RI"Wj1ata►Regts7ra MI Nosills h%Qan"Cw Regtatrat{on ft 1=78 A divisEon of•thI sets Engfoeeriog CT c=tBaw Regis m#w No SM20 R11 SE ~ 5 DWmat Ave,Soutb YermOutb,MA QUM CONTRACT 508-SU-1926 FAX503.59-1933 Page 3 PROGRAM Wo C0&gM T1a MW RtYrieM Ra a NGCC-OW FQR VX A0 onewmaww CUMMM PW$w oAte CtaFirTa vrawc " Gregory Mcnally (617)596-9105 05l25/2016 219344 00002 swim aww] -- 4 glum a1AmT 10 StraigbtWay IS Thayer HeigbIs Road 9aRVICE CRY•aTATa,ZSP- aSWNG CnY,BYATCSID'._..•__M.M . Hyannis,MA 02601 Hopkinton,MA 01748 JOB DESCRIPTION Total: $6,021.29 , Program Incentive: $4,531.20 Customer Total: $1,490 09 WE AOM HEREBY TO RM"H 8MWX8•COMGLEM IN ACCOROMM WRH ABOVE SFECRICATMa FOR THE 8UU OP --one Thousand Four Hundred Ninety&09/100 Dollars $1,480-g9 WOIIfM%L Mpg=M Alm APPROVAL BY RIOFtBQOC MMOM CWTOMFA AORffGTo M WTMOURT OU6 W FULL.WMM$roF 1%iYILLRE ClNRBF.D MOM1iLY OM A1Af t11�Ata'.6ALANC@APY8R Si0AYa: WRQIYORTA[.1TOBCAMATWYCM:GUARAY1eE&RK =OFREOSI=L&CH'0kW" nM1D C01fIRAC'.YOR RE618TRAT10N. . 0o WT 9tG!'1 TWs CONTRACT 1F THm ARS ANY aL Aw SPACES " AUTNOAta'�610W1StIR6•RISaP.A�t��ehCp ^_ ��[ ACC�TAM // �/ , IDOTE:TiCtCDkn1ACTMAY�IYRHORAYIMBYttBiFtiOTEx6WTEDWniW. f4ATEOFACCEATAl10E ����iL�.�-�-p�I --.�_.._ .. - ACCEPTANCE aFcoarRAeT•T1R ABOVE PRR>w7,SPEGtiIGl7i0[i6MMTOR1 MWO . :� aA1taPAGTORYTOYOA![D"AR@!(0iF8YACCSPTED.YOUAREAtlSNORited,T000T1t@Y10RK. - pAYL ASaRECQRED PATI®LTWILi8EMA08AaWRLUIfaABDVE ` t May 2616 01:48p p.6 Tow- pL •arm : agr iwomo ¢ .� �;, .. ., . . ,• :� $off• ._�.. �_...��r�iwi�r M' � traw. ww�•..i�1` 4,rrM.•' r ..�"....n.......,..• . • ... .. �. .....w• , i�a3�:mattaxs:c�eL�anoc:�rorl+�aaz��b;�► •: ... ,; � i i d yes a � 1 .1 Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 6 oaS' Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address -5- .<191d&ZIM k [�PResidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) . Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: -PRESS PERMIT ❑ I am a sole proprietor I am the Homeowner APR 1 3 2007 I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) VRe-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign,Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE I Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street ' Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Ayplicant Information Please Print Legibly Name(Business/Organization/Individual): c!/Z�/O/LX Address: /� fail 6&fe✓fW' /Z7 City/State/Zip: a r Phone t <�5'/,7 Are you an employer?Check the appropriate box: Type of project(required):. . am a genera contract and Ior 1.El I am a employer with 4 I l� 6, []New construction . employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• [_]Demolition workingfor mein an capacity. employees and have workers' , Y P tY• •$. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required] 5. F] We are a corporation and its 10.❑Electrical repairs or additions 3.;5 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration.page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby certift under the pains and penalties of perjury that t e information provided above is true and correct. Signature: Date: U Phone#: lDS FOther only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): A. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the W eiv-jnr tmstee-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 produce&acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until-acceptable evidence.of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-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 appropriateline. 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 " of the affidavit that has been officially stamped or marked b the city or town may be provided to the town). A copy Y P Y h' Y applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining'a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions please do not hesitate to give us a call. The Department's address,telephone-and fax number: Jb,,Commomwi ft of Massa hvwtts Depart mnt of Industrial A.ecidmts Office of Investigations 600 Washirigto i Street Boston,MA 02111 Tel.##617-727-4900 ext 406 or 1-977 MASSAFE Fax##617-727-770 Revised 11-22-06 www..mass.gov/eta tKKE T Town of Barnstable " Regulatory. Services y� " o� Thomas F.Geiler,Director * BARNMBLE, 9 MASS. g 1G39. Building Division rFD MA'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ` Please Print DATE: JOB LOCATION: number street —'— village "HOMEOWNER':�,�� /Ly /11�/YR�GY �/7;5 7�-�1�� S�s•Z os — name home phone# work phone# CURRENT MAILING ADDRESS: �© S 7lrll Gt�{T`+�j7fi city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of H o r Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction-Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Assessor's map and to rnumber - !'/• a; �pgTHETp� Sewage Permit number :.. ....... ........... ......... d�Q ♦� • ; Z BASIISTA.B i House number .............. NAM s............ ...... _ s� 0 39. NOR y TOWN ' OF "BARNSTABLE BUILDING. INSPECTOR , APPLICATION FOR PERMIT TO .:...RPMl=4 4h...9..ne=ak.p� .................. TYPE OF CONSTRUCTION .........i.......Wood... ....n ame ....�j....... dam.. .. ...epa V.................................................... .......................193:... TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Location ....1.0..S�aig. �way,,..Hy, vnyti�, MA ........................................................................................................... ProposedUse .....DW2? c vt ............:......... .... ........................................ . ....................... . ........................ Zoning District ............... ........ ...................................Fire District ...........4.. !zt-_Ot.�........................... ................ Name of Owner .AA....SbtC(4..UMJ. ................................... Address (TPA p.aam.Y.)...Ad�it1�..� 5 H� tiny Cnawe 22 Rd. (Ue�s yatcmau h MA. Name of Builder',QmC1h..��. 1 ...��s.,...inC,,.....................Address ...........�9..................................x.......,........................r None Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .....................................................:............Foundation Exterior ....................................................................................Roofing .. ................................................ Floors ............................ ................................. ................Interior ............................................................................. ... Heating ............... ..............................................................Plumbing ......................................... .................................... Fireplace ........................... ...... ........ ......................... ...Approximate e Cost .........$27:.000.:0.0 .... ........ Definitive Plan Approved by Planning Board -----------_____—-----------19---_--- . Area ./:............ f t and Building with Dimensions - Diagram o Lot g Fee . z. . SUBJECT TO APPROVAL OF -BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. r.� .:................ 0 1� 2 CLARK,,,,MRS . SHARN r. 25000 , REPAIR FIRE DAMAGE No .................. Permit for .................................... Single Family Dwelling ....................:.......................................................... 10 Straightway Location ................................................................ Hyannis ............................................................................... ` Mrs . Sharn Clark Owner .................................................................. Type of Construction Frame .......................................... ................. .............. ................... ........... ... .... . Plot ............................ Lot ................................ Permit Granted ...... ..........19 83 -Date of.Inspection ....... 9 Date Completed ........ .........I c ) 7 / 3 Assessor's map and lot number ....... .. /. *'THE Sewage Permit number .................................................... d� ♦,► Z DAUSTABLE i House number ............. .....:........................ ........ .......... +� M6 a 39• .9 'E0 M0 d\ TOWN OF BARNSTABLE BUILDING INSPECTOR e-1)9Z? APPLICATION FOR PERMIT TO .....ktRtt.iJ n IIQ q&.................................................................................. .................. TYPE OF CONSTRUCTION ......... IVoar� {arc rae A�e dtzvK ...hepa...iit5 .................. . ... ...... ....................................................... ?......... ..:......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... �nni6.,...M.a......................................................................................................................... ProposedUse ..... U. .in,.............................................................. .................................................................................. ZoningDistrict ................. :5................................................Fire District ......... .............................. Name of Owner .K%,6... Sh.aA t CtaA.k..................................Address IR'—wir�uhcrlr.,caf„Adam..a ..." Name of Builder'Qivan Con6tL.. Co. , Inc, 546 Hici nz Ch � st Ywu1ut ,MA., ................................ a VC�? Name of Architect ........................... .Address Number of Rooms ..................................................................Foundation Exlerior ...........................................................Roofing ..................................................................................... Floors ......................................................................................Interior .................................................................................... Heating .Plumbing .............:.................................................................... " Fireplace ...................................................... ........................Approximate Cost .......... 2sO(�:. �......... ........................ .... ... .. ...:. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area 41k � ''�. ................ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �. a � Name ...... 0 1 �i Z � C���� ?�lS SB�D� ��=�S7—I23 � ' . ` 25000 REPAIR FIRE DAY14GII No ................. Permit for .................................... ' Single Family Dwelling ----''----^^--^'^^----`---'~'--`' lO Straightway Location ---.—.----...----------.—.. � � Hyannis � ----.-----.---.—.—.--,—..----- . � Mrs . Shazo Clark � Owner ---.--.-----'-----'---'--' � � Frame Type of Construction -------------- � � —.--~..--.~-----------.-----.. � Plot ............................ Lot ................................ � ' Permit Granted ............�Lpzil_25._.]g 83 Date of Inspection ------------lQ Date Completed ......................................lQ � � [ d8 | k ��� , � � . . ' ` � � �� .