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0418 STRAWBERRY HILL ROAD
�� s�,��� ��c � .� .� f ... r , S y Town of Barnstable Buildin PostTThis Card SoThatit is Uisible.From="the Street ApprovetlP,lans,MusL begRetamV* 9 ed on Job and this Card Mustbe Kept ^ iPosted Until Final Inspect�onxHas BeenMade lbsa ,, �: c "d until a:Final.lns`\eetion'iHas been mad ;, ermit Where3a Certificate ofOccupancy isRequired,such Bung shall Not be Oc p pew .. ,,, „ Permit No. B-18-2852 Applicant Name: MICHAEL PATERNO Approvals Date Issued: 01/23/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/23/2019 Foundation: Location: 418 STRAWBERRY HILL ROAD, HYANNIS .., Map/Lot: 248-1524 Zoning District: RB Sheathing: Owner on Record: HYNES,ROBERT E& DOROTHEA F TRS .. g4,Contractor Name",.,MICHAEL J PATERNO Framing: 1 Address: C/O ROBERT E&DOROTHEA F HYNES - Contractor LicenseCS 070321 2 x 'T 2 F HYDE PARK, MA 02136 Este Protect Cost: $9,000.00 Chimney: Description: repairr rot on rafters remove skylight floor repair new rubber roof :Permit Fee: $ 130.90 Insulation: nall on 3 season room, new entry door, replacing existing. change Fee Pald $ 130.90 of contractor to ' ��a v�'y� � Final: George Ryan ®ale 1/23/2019 /Project Review Req: Plumbing/Gas g/Gas Rough Plumbing: Building Official <� t, Final Plumbing: e AlRough Gas: E = Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months�after-issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures shalllb�e iri compl anc Wit i ,the local zoning by-laws and codes. %This permit shall be displayed in a location clearly visible from access street orkroad and,shall be maintained open for public6 inspection for the entire duration of the Service: work until the completion of the same. � Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. ,. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final:. "Persons contraa!7k unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Oxlime . c Applic aflon Number...... .....f-4f..: ��. ............... s u► . _ Pc®it Fee..................... ............OthetFve........................ TotalFee Paid.......... . ..... ...:........................ . . ..... TOWN OF BARNSTABLE Permit Approvally. .......................on...... ..... BUILDING PERMIT — Map....................................::Paget.......................::.................... APPLICATION Section I— Owner's Information.and Project Location Project Address fr < ,•�b Q .,�c s�wJJ �.19 Vil1age 1'e/L e,c•� )) Owners Name © <1_'n <, 4-1 <AC 5 ' Owners Legal Address -A 51r---6 City State © _ y Owners Celli .� `/ 0? �"! . E-mail Section 2-Use of Structure ' Use Grroup ElComme cial Stedadre over 35,000 is feed" cn z :o Commercial Structure under 35,00 cubic r rn ❑ Single/Two Family Dwelling Section 3—Type of Permit; , ❑ New Construction ❑ Move/Relocate ❑ 'Accessory.Structure ❑: Change of use 0 Demo' (entire stricture) ❑ Finish Basement ❑ Faauly/Amnesty ❑ Fire_Alarm r. ❑: Deck` Apartment-:` ❑=Sprinkler System Rebuild4-4 r ❑ Addition ❑y Retaining wall ❑ Solar ` ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4-Work Description r • f T sect tmdate&?J9201 9 Application Number...................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project . �i Age of Structure - Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wince ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas _❑ Fire Suppression 44 ❑ Heatin system El yst Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last imdatM 2/92019 OFTNE r, Town of Barnstable ' Building Department Services t : B"NSTABLE, : Brian Florence,CBO MASS.9�A ��� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6236 NOTICE TO THE BUILDING DIVISION OF r CHANGE OF LICENSED CONSTRUCTION SUPERVISOR .A • 1 I, DnY �_�jjto - , owner of property located at STr ro w b&(T �� ��� ;hereby certify that m iGikCZA�ica�� is no longer Construction Supervisor fisted on the application for the project under construction as authorized by., building permit (�- d, issued on a 201 . r I understand that the project under construction'must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. PR0))E1M4ftER DATE q/forms/newcontr reference R-5 780 CMR rev:08/23/17 r �a<r,t*r�norr.r-� ,ca.�x�-.anar.�w,:rvo b11' F'_t �17� .. . . ....... ....._.__..............._. :...,.._..... j bffce of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, MasSachusetts 02118 Home I;mprovement,eCaritractor Registration ' i Typo: Corporation RYAN HOLMES CONTf ACTING INC, Registration: 173263 612 NW SUNSET DR: :� + Expiration: {l1t 15t2021 STUART.FL 34994 ia i Update Address and Return Card. SGA f C, 20M-05/" t Office of Consumer Affairs a SuslnessiReguiation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Corooralion before the.ex'pirsafion date, if found return to: Registration gxpirajion Office of Consumer Affairs and Business Regulation i 173283 01/1512021 1000 Washington Street•Suite 710 RYAN NOLMES CONTf31\GTiNE3,1NC. Boston,MA 02118 i y l i y, GEORGE RYAN 612 NW SUNSET OR C , STUART,FL 34994 kzvt and With ut signature Undersecretary j I Application-Number........................................... Section 9-.Construction Supervisor Name Gam. 0'� Telephone Number �FS SO -7 5� 1 d ddress,6✓eZ Se-1 ��/ City,� or�' State r/� Zip License Number License Type y�� o C iradon Date / �6 �I' Exp Contractors Email ✓��Cy N t QG L � V C�r�C�t'Cell"# Sy�S S y°b S Z y o ,vim understand my responsibilities under the rales and regulations for Licensed Construction Supervisor in accordance with 780 CUR the Massachuls Building Code. I understand the construction inspection procedures,specific inspections and ddocumentation 80 CUR Town of Barnstable.Attach a copy of yourlicense. ' Signature' Section-10-Home Improvement Conti-actor Telephon6 Number.505 .50 q -J 1 cy1 (3 Address b .T- -o City State )`/,< Tip 41 Ct 0 C) ` Registration Number Expiration Date I understand my responsib ' ' s under the rates and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts Burl ' I understand the constzuction inspection procedures,specific inspections and docimmentation bby 780 Town of Barnstable.Attach a copy of your IUC... Signature Date Section 11-Home Owners License Exemption Home Owners Name: r Telephone Numb , , Cell or Work Number I understand my responsib 114;es under the rates and rggalations for Licensed Contraction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and p documentation by 780 CMR and the Towri of Bamsiable. Si Date PLICANT SIGNATURE Signature Date/oZ,- ✓%- J�' Punt Name Gco Af�A-- Telephone Number S0 �f So G ,,1_ to �E- .ail: ermit to:_ L I C o kjl'(�P►CT, y T e ....A.wrA. 1M/1Mo Section 12—Department Sign-Offs f Health Department © Zoning Board(if required) Historic District ❑ Site Plan Review Cif required) ❑ Fire Department ❑ Conservation q For commercial work,please take your plans directly to the,frr'e deparftmt for approval r Section 13-Owner's Authorization as Owner of the-subject property hereby authorize - Y'AtU to act on mybehal� in all matters relative to ork authorized by this building permit application for:1 Lt I (Address of j o -) _ - Az l8 Si date Print Name i • 4 . 1 Last wdated:2/92018 Town of Barnstable REEI T UAWWAOM 200 Main Street, Hyannis MA 02601 508-862-4038 s6,3o. °' °� Application for Building Permit Application No: B-18-2852 Date Recieved: 8/30/2018 Job Location: 418 STRAWBERRY HILL ROAD,HYANNIS Permit For: Building-Addition/Alteration-Residential Contractor's Name: MICHAEL J PATERNO State Lic. No: CS-070321 Address: MASHPEE, MA 02649 Applicant Phone: (Home)Owner's Name: HYNES,ROBERT E& DOROTHEA F Phone: TRS (Home)Owner's Address: C/O ROBERT E&DOROTHEA F HYNES, HYDE PARK, MA 02136 .Work Description: repairr rot on rafters remove skylight floor repair new rubber roof nail on 3 season room, new entry door, replacing existing. change of contractor to George Ryan Total Value Of Work To Be Performed: $9,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: MICHAEL PATERNO 8/30/2018 ` Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $9,000.00. Date Paid Amount Paid I Check#or CC# Pay Type Total Permit Fee: $130.90 8/30/2018 i $95.90 1962 Check Total Permit Fee Paid: $130.90 12/11/2018 $3s.o 111853 Check f Town of Barnstable Building Permit P.ostThis Card So That rt�s:U�sibleFrom he Street,=A roved,Plans Mustb'eRetamed on Job and:#h�s�CardMust be Ke "t �` Posted Until Final Inspection HasYBeentMade.� :�� �, , � � � �� �� eat Where a CertificateofOccupanc�y s�Required, uch Building shall Notbe Occwpied until aFinal Inspectionhas been made , :. .. - Permit No. B-18-2852 Applicant Name: MICHAEL PATERNO Ap provals Date Issued: 09/27/2018 Current Use: ' Structure Permit Type: Building-Addition/Alteration-Residential 'Expiration Date: 03/27/12019 Foundation: Location: 418 STRAWBERRY HILL ROAD,HYANNIS Map/Lot: 248-152 Zoning District: RB Sheathing: � A Owner on Record: HYNES,ROBERT E`&DOROTHEA F TRS Contractor Name MICHAEL J PATERNO Framing: 1 - " Address: C/O,ROBERT E&DOROTHEAf HYNES Contractor License: CS 070321 s 2 HYDE PARK, MA 02136 K = Est Project Cost: $9,000.00 Chimney: Description: rapiar rot on rafters remove skylight floor repair ne-w rubber roof Permit Fee: ,> $95.90 nall on 3 season room;new entry door, r6placirigk existing Insulation: Fee-Paidf $95.90 Project Review Req: Date , 9/27/2018 Final: k - Plumbing/Gas - Rough Plumbing: {l Building Official {y Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents`'for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shallbe in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or'road and shall be maintained open for publi6inspectibn for the entire duration of the gr work until the completion of the same.' Electrical Service: The Certificate of Occupancy will riot be issued until all applicable signatures�by,the Building and Fire Officials rglprovided on,this permit.' Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing.' 2.Sheathing Inspection = Final' . a 3.All Fireplaces must be inspected at the throat level before firest"flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection)., 6.Insulation Low Voltage Final: 7.Final Inspection before Occu inc p P Y Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting wifh unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site `� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT oApplicationN=Irl. ........................ ................... ...Other Fee.... ......:. MAtas. Petmrt Fee.... . ...... .�........... ..... • s TotalFee Paid....... ........ ... ............................ .... TOWN OF BA MITA; RE Permit Approiml by........ ...on...... ....... . BUILDING PERA&4 , Z12--.-Y8................. aw............. .. APPLICATION Section I—Owner's Information and Project Location Project Address Owners Name - O a o lw y- H V /✓lam Owners Legal Address T_17\G 0 kA— S c' �-f D (� State zip dal 3 6 Owners Cell# )-mail Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3-Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description p o I c—(6 t-doR )1- h-/l- v$ r-R 2p� t� D 3 Sn#50k ;xC T Act Tm%te&2/9/2019 Application Number.................................................... Section 5-Detail 9 Cost of Proposed Construction 000. Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind'Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wning ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression f ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private 1 i Sewage Disposal ❑ Municipal '❑ On Site Historic District [] Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I an using a crane ❑ Yes ❑ No .l Section 7—Flood Zone Flood Zone Designation 4 Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yazd Required Proposed Rear Yard Required Proposed Side Yard Required . . Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated:2/92019 i .. ......... r Town of Barnstable Building Department Servic�t\q% of BAR%STABt KAMBrian Florence,CBO Building Commissioner 7 91 8` 56 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 C"i�:JRS)11QN Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1,T f(1 oAhea ; n P_5 ,as Owner of the subject property hereby authorize PQi P f r1t7 CO n.5}r A y}1 n to act on mbehalf n y , in A] matters relative to work authorized by this building permit application for: `ti fpnni5R �Q (Address of b) **Pool fences and alarms are the responsibility of the applicant.Pools ;are not to be filled:or utilized before fence is installed and all final inspections are performed and accepted. Signature°of Owner Signature of Applicant C. tin F o r� hPa 1 5 Print Name Print Name 1 1611 D ate Q'FORMS-.O WNERPERMI SSIONPOOLS Revf 08/16117 C�Lce (po�rfz�r�rcueal�a�-G��2�autar�cvfe.G`C� '- - Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 154110 03/02/2020 One Ashburton Place-Suite 1301 MICHAEL PATERNO Boston,MA 02108 MICHAEL J.PATERNO w 146 QUINAQUISSET AVE. MASHPEE,MA 02649 - Not ilaild without signature Undersecretary 9 r a 1 y . Soa d achusetts p °t Builgi^g Regu a ent of Co^stense: CS�� ttons an c. S uctio^ Supe visor q Stangargs °146 .'. . MIC HqE�'P 4 i MAShpEE nQj SSEAVE A 02649 NUE . 7 n►rnissi' Expiration: p 19 0311612 The Commonwealth of Massachusetts", Department of IndustrialAccidents °= Office of Investigations Y 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t [ Please Print Legibly Name(Business/Organization/Individual): %"I- ��" C (Z7��6T /4--`;, Address: SST T `,A-V/7 City/State/Zip: Mk 6 4 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4..❑ I am a general contractor and I * have hired the sub-contractors ' ,6. ❑New`construction employees(full and/or part-time). 2 I am a sole proprietor or partner- n slisted on the attached sheet. 7."❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity.' employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance required.] 5. [],We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work, µ officers have exercised their 11.❑Plumbing repairs°or additions myself [No workers'comp: r right of exemption per MGL 12.❑Roof repairs. insurance required.]t c. 152,§1(4),and we have no -" employees. [No workers' 13.❑Other comp.insurance required.] ` *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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: Policy#or Self-ins.Lia#: Expiration Date:" b F Job Site Address: 1 , s �I` y �jG6 �1� City/State/Zip: Nyj�-/VV/- ° j�- ,y Attach a copy of the workers'compensation policy declaration page(showing the policy,number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal.penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do,hereby certify under the airs and penalties of perjury that the information provided above is true andQcorrec4 sighafore: Date: Phone#• S 6 3 ® ., 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#: 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 i receiver or trustee of an individual,partnership,association or other legal entity,ernPto 'mg emplo yees.ees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy,information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,ILIA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MMSAFE Revised 4-24-07 Fax##f 17-727-7749 www.mass.gov/dia �I Application Number.......................................... Section 9—.Construction Supervisor. Name �� OL � l Telephone Number S Address L Z u�4 Scl--zT f�-V&Y Nfi-SHI lie StateHF Zip Da�_ License Number eS O�63 a( License Type uv /2S7 /Expiration Date Contractors Email I�cTM-Tl�j G�,YiST��i p G G ell# -off ��' 0 6 —T�iur I understand my responsibilities under the rates and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 78 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date � -3 o J Section.10—Home Improvement Contractor Name M(C07S /'/l Y7zG��. Telephone Number S d 3 O Address V/S amity M�} �I Z/z. State zip D Y Registration Number /J O Expiration Date-') -/S ^ / 9 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your IUC... Signature Date j10 Section 11-Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 E. CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date ` � c .� a Print Name I�L fT� � Telephone Number s OK f6 - 0e, i. E-mail permit to: NJ v� ��7'I�RM OWrJ<Ue-TI0k cr) C0HCAST Al 14r -- Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) . Historic District ❑ Site Plan Review(if regWred) ❑ Fire Department ❑ . ; Conservation h For commercial work,please take your plans directly to the fire deparbnent for approval Section 13-Owner's Authorization L , as Owner of the-subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: i (Address of job) ' Signature of Owner a date i Print Name t Last=dale&:2/92018 Shea, Sally From: Shea, Sally Sent: Wednesday,April 04, 2018 9:38 AM - - To: Parziale,Jim Subject: RE:.Permit/Application:TB-18-811 at 418 STRAWBERRY HILL ROAD, HYANNIS for Building -Addition/Alteration - Residential '.Hi James, Please notify the applicant of what you need. If you make note of what is needed on the application review notes we will know you have already reviewed ahe application. - Appreciated Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 From: Parziale, Jim y Sent: Wednesday, April 04;_2018 8:48 AM ` To: Shea, Sally Subject: RE: Permit/Application: TB-18-811 at 418 STRAWBERRY HILL ROAD, HYANNIS for Building -Addition/Alteration - Residential They need to supply us with a schematic of the existing septic system, we have nothing on file From: Sousa,Vanessa Sent:Tuesday, April 3, 2018 2:09 PM . .,To: Parziale, Jim Subject: FW: Permit/Application: TB-18-81fat 418 STRAWBERRY.HILL ROAD,.HYANNIS for Building Addition/Alteration Residential Jim Please review.Thank you! Vanessa From: Shea, Sally - Sent: Tuesday, April 03, 2018 2:09 PM - 1 To: Sousa, Vanessa Subject: Permit/Application: TB-18-811 at 418 STRAWBERRY HILL ROAD, HYANNIS for Building -Addition/Alteration - Residential This one is on the dash for a bit can someone look at this? Appreciated. Y` `Sally Shea Town of Barnstable Assistant Zoning Admin/ Lead Permit Tech. 508-862-4031 E 2 °FTHE r Town of Barnstable *Permit# �. �►. Expires 6 moldlisfrpuzissue dote Regulatory $erviees Fee aj BAartsTAst.e. v MAC $ Thomas F.Geller,Director s639. PTfD MP't A Building.Division -PRESS PERN11T Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 V . 2 2009 www.town.bamstable.ma.us Office: 508-862-4038 TOWN OF BAM&TAHLL— 0-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid.without Red X-Press Imprint Map/parcel Number � �`��' Property Address W Residential Value of Work 1 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Nam Telephone Telephone Number_;;��7t Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) lP 3,53T OWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner . ❑ I have Worker's Compensation Insurance r Insurance.Company Name Workman s Comp.Policy#� � �L� / Copy of Insurance Compliance Certificate must accompany each permit. rr 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) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *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&Construction Supervisors License is "wired. SIGNATURE: Zzz�2 Q:\WPFILESTORMS\building permit forms EXPRESS.dO Revised 090809 I The Commonwealth of Massachusetts Department of Industrial Accidents IA (_` Office of Investigations j= 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): �Iyic ' Address: Zrg' City/State/Zip: Phone #: - ARarn ou an employer? Check the.appropriate box: Type of project(required): 1. a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* have hired the sub-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 me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition .[No workers' comp. insurance comp. insurance.[ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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.❑ 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#] 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. tContractors 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 andjob site information. Insurance Company Name: IU1J� �w Policy#or Self-ins.Lic.M MW 71 i Expiration Date: Job Site Address: // � 7J� ;, /Y, i�� i� City/StatelZip: s'j� � �1�«s Attach a copy of the workers' compensation policy declaration page(showing the policy4'number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify i der the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phones 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): J. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: 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 receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that.the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the.applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i i Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE 1 Revised 4-24-07 Fax # 617-127-7749 www.mass.gov/dia .I Town of Barnstable Regulatory Services =n M • esA&3. " Thomas F. Geiler,Director nes. Eo39. �0� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ! ram. .�9 to act on my behalf; in all matters relative to work authorized by this building permit application for. (Address of Job) zMe SignaUre of Owner at 4eMT AI�CX s Print Name If Property..Owner is-applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNER.PERMISSION Town of Barnstable o Regulatory Services EAIRNSTABLE Thomas F.Geiler,Director MASS. v� 039. Building Division PrED MA'!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": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided.that the owner acts as supervisor. 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 Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe 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:\W PF ILES\FO RM S\hom eex empt.DOC -'� Massachusetts= Department of.Puhlic Sufeh Board of Building= Re-hitions and Standards Construction Supervisor License License: CS 63537 Restricted to: 00 *� DAVID R COX PO BOX 401 � t4 S YARMOUTH, MA 02664 Expiration: 10/15/2011 ('ummissiuner Tr#: 5822 71. y Board of Building Regulations and Standards License or registration valid for individul use only HOME IM�,�OVEMENT CONTRACTOR before the expiration date. If found return to: i Board of Building Regulations and Standards Registration: 100497 One Ashburton Place Rm 1301 i Expiration 6/18 2010. Tr# 268012 Boston,Ma.02108 f. rType Private Corporation i1't . DAVID COX,INC Da Cox t;vid 19 LAVENDER LN /,v%1 A.Not valid without s' nature W.YARMOUTH,MA 02673 Administrator r From:Kathy Geddis FaxID:Northwood Insurance .Page 2 of 2 Date:11/12/2009 09:59 AM Page:2 of 2 . .0 CERTIFICATE OF LIABILITY INSURANCE OP ID KG DATE(MM/DDIYYIY) fir.../ DAVID-2 11/12/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Ins. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 540 Main Street, Suite 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-771-1632 Fax:508-393-2955 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Co. INSURER 8: Tzavelers Insurance Company David COX, Inc. INSURER C: P. 0. BOX 401 INSURER D. S Yarmouth MA 02664 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR LE TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YYYY) DATE(MM/DD/YYYY) LIMITS GENERAL.LIABILITY - EACH OCCURRENCE $ 1000000 A COMMERCIAL GENERAL LIABILITY I-680-1481M796-COF-0903/14/09. 03/1.4/10 PREMISEs(Eaoccurence) $ 300000 CLAIMS MADE -1 OCCUR MED EXP(Any one person) $ 5000 X Business -Owners - PERSONAL&ADV INJURY $ 1000000 - -GENERAL AGGREGATE $ 2 0 0 0 0 O 0 GENL AGGREGATE LIMIT APPLIES PER: - - - PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 0 POLICY PRO- JECT LOC CSL 2000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS - - (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ _. (Per accident) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY. - - AGG $ EXCESS/UMBRELLA LIABILITY - - EACH OCCURRENCE .$ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE - $ RETENTION $. $ WORKERS COMPENSATION - H- AND EMPLOYERS'LIABILITY Y/N - TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ 6KUB91OX742209 07/15/09 07/15/10 E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100000 It yes,describe,under SPECIAL PROVISIONS below - E L.DISEASE-POLICY LIMIT $ 500000 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS .. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWNBAR DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL '10- DAYS WRITTEN - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BUILDING DEPT REPRESENTATIVES. 367 MAIN STREET AUTHORIZ REPRESETATIVE HYANNIS MA 02601 �� ACORD 25(2009/01) ©1988-2009 AC )RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �t►,E, Town of Barnstable *Permit# 2= Expires 6 months fro issu date �+ Regulatory Services Fee ' v. swrwsTAa tro . as F.Geiler,Director p `,-CRESS �y�Building Division rED MA'S MAY - 2 20C bm Perry,CBO, Building Commissioner ` 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTASL-Fww.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 r [Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owrv,-r's Name&Address �' n Contractor's Name /Sr�F .b Telephone Number ( ,� Home Improvement Contractor License#(if applicable) MY.7-7 tworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �► I have Worker's Compensation Insurance 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) ❑ Re-side Replacement Windows/doors/sliders.U-Value a_—� (maximum.35) *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: QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 I t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 i www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual)� CNI" GVOCR2�/S Address: s' - City/State/Zip:��,o.�.lov��.�� y Phone#- Are you an employer? Check the,appropriate box:. Type of project(required): 1.((I am a employer with / 4. ❑,I am a general contractor and I 6. ❑New construction employees(hill and/or part-time).* have hired the sub=contractors 7. Remodeling 2.[] 1 am sole proprietor or partner- listed on.the attached sheet. g a ship and have no employees. k -These sub-contractors have 8. [] Demolition wor�ng forme in any capacity. workers' comp. insurance. 9: ❑ Building addition o workers' comp. insurance 5. 0 We are a corporation and its . [1`1 , 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL. 11.❑ Plumbing repairs or.additions ,152 1(4),and we have no.myself.'[No workers' comp. c.• § 12.0 Roof repairs insurance r aired: t employees. [No workers' eq �, .- 13.14Other o comp.insurance required.]' ,Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infom-Atiou `* Homeowners.who submit this affidavit indicating they are doing all work and then hiry 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 their workers'comp.policy information. am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site nformation. insurance Company Name: c S ?olicy#or Self-ins.Lic.#:� �s�d �'r 2Lgty,f Expiration Date: lob Site Address: 111. City/State/Zip; kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to.secure coverage as required under Secti6n.25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of nvestigations of the DIA for insurance coverage verification. 'do hereby ertify r C"ep �nje alties of erjury that the information provided above is true and correct: ii ab11e: a Dater 5 8 0 ?hone FFOffildidonly.. Do not write in this area,to be completedby city.or town official:n: ► 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 Date: 4/28/2009 Timet 1003 AM Tot @ 9,5083626115 Page: 002 r Client#:9742 2BAKERAS ACORUM CERTIFICATE OF LIABILITY INSURANCE 042820 9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insuranc Baker&Associates,lnc. INSURER B: Associated Employers Insurance P O Box 923 INSURER C: Centerville,MA 02632-0071 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRI TYPE OF INSURANCE POLICY NUMBER PDAATTE D PDATCYE NWllIDRAnON LIMITS A GENERAL LIABILITY BINDER289147 04/19109 04/19/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I $1 OO O00 CLAIMS MADE n OCCUR MED EXP y one person $5 000 X PD Ded:250 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2 OOO O00 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) ALL OWNED AUTOS BODILY INJURY on e Per person)SCHEDULED AUTOS ( $ I HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ - (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIMLITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE - $ RETENTION $ $ TU�B WORKERS COMPENSATION AND WCC5002454012009 04/23109 04/23/10 X WC SLtMff 0ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $100,000 ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? NO E.L.DISEASE-FA EMPLOYEEI$100 000 If yes,describe udder SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Robert Hynes DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL _JQ_ DAYS WRITTEN 418 Strawberry Hill Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Centerville,MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOPRESENTATIVE C. ACORD 25(2001108)1 of 2 #S56680/M56679 L.S1 o ACORD CORPORATION 1988 l �'THE Town of Barnstable Regulatory Services, MAR& E Thomas F.Geiler,Director 1639. . En ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usina A Builder I, / L& ,as Owner of the subject property hereby authorized f to act on my behalf, o z in all matters relative to work authorized by this Building permit application for. All �6 (Addriss of Job) Sig ature of Own Date LC 'tHP- Oar Print Name If Property Owner is applying for permit please complete the Homeowners License+Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISS ION Town of Barnstable Regulatory Services Thomas F.Geiler,Director BARNSPABLE, 9 MA & q,A i639• .0 Building Division rFD ,�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4.038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: state zip P 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 Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisbrs,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 a, -a,(- -stisects 'partrint-cwt of Public sarctN 1' Board A gA ld if%.ws. 4'c'wy"Ih'¢ p $s and sui" � "Ipp d�",k *.. *. �r yr uc.pn se° Cs 74477 BRETT J B'U'SSIERE w , `�*xr ;T 111 WAREHAM LAKE SHORED k EAST WAREHAM,. MA 02538 1/6/2011 8715 Y lie V�arrvrreanwea`C�i r��✓��aavac�utdelt6 ' a\ _—_ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: - Registration: ,162600 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration 3/26/2011 Tr# 282115 Boston,Ma.02108 Type Private Corporation BAKER&ASSOCIATES MARK BAKER 521 SHOOTFLYING HILLAD CENTERVILLE, MA 02632 Administrator Not valid without signature �� fie Var»nrzarur�,t� a��eacu•�icr.GP.�6 , Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration 162600 One Ashburton Place Rim 1301 6^ Expiration 3l26/2011 Boston,Ma.02108 Type Supplement Card BAKER&ASSOCIATES.INC BRETT BUSSIERE 521 SHOOTFLYING HILL RD � �� / CENTERVILLE, MA 02632 - _-- --- ------ Administrator Not vali ithot�t signature Assessor's offioe (1st floor): pFTME skg To AE,ssor .!s map and lot number .. y ...../sue?.......... , Board of Health (3rd floor): `O�Q ♦� Sewage Permit number t BAH39TSDLL, ............................................ MA Engineering Department (3rd floor): moo 039. •� Housenumber ........................................................................ '°ttoyoe.` 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 ......... 1.QC.......:..� .Q1'C�................................................................... TYPEOF CONSTRUCTION ........................................... Y .'?M ................................................................... ...................... 19. .l.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby(applies for a permit according to the following information: �J/ Location .....vv�s .l �?�...'.,. ...... ...:� 5 ..... J.. � .��.f ...wx.�/.....'.?..d?.................................... Proposed Use e�. (...v �Z G .................................................................. Zoning District ....!..J..... ..................................................Fire District 3. �Y..!�/i/...�. ......................................... Name of Owner !?. . h 5................................Addressl ...c�r � ... P2n.. .. /././.......v.l. ... .....e... ....... 6 Nameof Builder . .....o...................... ..�>..�:,5.........................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........ Foundation �j�.................................................... /......J............................................................ Exterior ........1��.d. .. .........................................................Roofing ..... .5Y..!!..`'./. ....................................................... .......X�......................(............................................ Floors ......................................................................................Interior Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ................---0...........o..... .``rr................................ . _ /.:p.... ..... Definitive Plan Approved by Planning Board ________________________ ______19________ . Area ..... . .................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i J 1 _ i 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. Nam ...... . ............ .. ?............... Construction Supervisor's Li se .................................... rr � BYNES, D0BI]RT ' \ ^ � m� 3l283 Enclose Porch .." -----.� permit for ------------ � " Single. Family Dwelling ^ � 4I8 St a�b Hill Ro � Location ------'�--..��r��-------� ' - - B i t ' ' .^ .................. .������—�����------. ' ' . . ' � e ' Owner -------mbe�t--I{ . --------- � � Type of Construction ..F������—'--'----' ' ^ ; . ---------.--'--------------' . , p�» �� . . x ---------� ----------' ' . . - ' 0oto�er 8�~ O7 .� Permit G,onhed ---------��---]9 . ' Date of Inspection -----------.]P . Doha Completed ...........................��--'l9 ` f ' ' _ = . . . ~ ^ ' - ~ | | ^ , ` \ � Assessor's offioe (1st floor): _: ' ofTNETo Asse sore map and lot number .._........................................64--, Board of Health (3rd floor): Sewage Permit number t BAL33TAMLE Engineering Department. Ord floor): roea 1b3q• House number APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00_2:00 P.M. only__ TOWN OF BARNSTABLE BUILDING INSPECTOR ff APPLICATION FOR PERMIT TO .. !..D P ............................................................... TYPEOF CONSTRUCTION ...............:'...............:........... ................................................................. yO� ............................... ................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: / Location ..... �• .�{.�f �? ,..'.� .. .°.'!.: .... f. ...... -P.1� .1�. t.2.. .... !...........��cf?...............`..................... Proposed Use ../�.C� C' r• ..v ..... 7� 5i , ���. . . . ............... . ....................... Zoning District ......... Fire District ra Name of Owner .. ................:...............Addressf.fx f• , �, 1�-, h V Nameof Builder . ................ .....`......F.........................Address .................................................................................... Name of Architect ..................................................................Address ......................... Numberof Rooms ...,....�......................................................Foundation /��./........................................................ r ��- C) v ......................Roofing h 17.24 � r,�` Floors ......................................................................................Interior .......5 ......................... ....: ........................................ Heating ..............................................................................:...Plumbing .............'................................... Fireplace "............................................................Approximate Cost �? Definitive Plan Approved by Planning Board --------------------------------19________ . Area/....� � Diagram of Lot and Building with Dimensions Fee ........... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 --I l ' rY 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. NamlK—~fit' ✓I Wiz-.......�__._.�.. ................................... Construction Supervisor's License .................................... HYNES, ROBERT A=248-152 l ja, Nor.31283.. permit for ..Enclose P.orch. ... .. .... .. JN , :Single Family Dwelling Location ....4.18.. StrawberrX Hill Road . Hyannisport ........... Owner .........Robert...HYne.s............. Type of Construction ...Frame .................:.......... ............................................................................... Plot ............................ .Lot ................................ October 8 , 87 Permit Granted ........................................19 t Date of Inspection ....................................19 Date Completed ......................................19