HomeMy WebLinkAbout0124 SUDBURY LANE /c�V (5adbu y kan2
Town of Barnstable t
H�,•.� � + �, ,, � ,,,�, ,_� + ` ��- Building
Post This Card SgThatg�t is•�/isible From the Street ApprovedPlans.Must be Retained on Job anpthis Card Must'be Kept ,
snftNt3'A E a g
'xcg z • 'r� y x Permit
6" Posted Until Final�ln"spection Has`Been Made A : F 1`" ;
:Where a Certtcaof Occupancy39. s�Requsuch Bu�ld�g shallNot be Occup�ednt�aFnal InuspeMion,hasbemade a y f
Permit No. B-19-1186 Applicant Name: WINDOW WORLD OF BOSTON LLC. Approvals
Datelssued'. 04/11/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Dater 10/11/2019 Foundation:
Location: 124 SUDBURY LANE, HYANNIS Map/Lot 270 299 Zoning District: RB Sheathing:
Owner on Record: DRISCOLL PATRICK G&CARMEN Contractor Name-Jeff C Steele Framing: 1
t,��
Address: 124 SUDBURY LANE Contractor Ucensez GCS 072772 2
ff n
HYANNIS, MA 02601 Est Protect Cost: $15,012.00 Chimney
'v
Description: DOORS,AND WINDOWS Permit Fee: $76.56
Insulation:
Project Review Req:
Fee Paid $76.56
Date 4/11/2019 Final
wt` Plumbing/Gas
x Rough Plumbing:
� ' : Building Official
.- Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work adthorized by this permit is commenced within siz 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. Rough Gas:
All construction,alterations and changes of use of any building and structures•shall be in compliance with the local zoning by lawsiand codes..
This permit shall be displayed in a location clearly visible from access street or`aoadand shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion'of the same.
- Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are, , ded`on this(permit.
Minimum of Five Call Inspections Required for All Construction Work.,,`"
Service:
4
1.Foundation or Footing ,
2.Sheathing Inspection n Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical;Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final-
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
'F' All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
y!� 1IL
p� P Application number...2-11 /
♦ j
®� Date Issued..........y...d(... .��....................................
BARNSTABMNAM
seta 4� Building Inspectors Initials....�V'���...............
Map/Parcel. ......A-..5.`.f...............................
�F
TOWN OF VARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WMOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY MORMATION
Address of Project: IZ ,-1 S� ,- .-7.
NUMBER STREET VILLAGE
Owner's Name:i� ,r Phone Number S 0,T-73 7- 5 D s" 1
Email Address: Cell Phone Number
Project cost$ 115 Check one Residential Commercial
OWNEW S.AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: '-mee 44cC,4 c�„'f,4�-� Date:
TYPE OF WORK
❑ Siding Windows(no header change)# /Z. ❑ Insulation/Weatherization
E Doors (no header change)# Z Commercial Doors require an inspector's review
❑ Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to t,Jc.s4P (►1a.�a ero�.. - �t����•� U
CONTRACTOR'S INFORMATION
Contractor's name �ejC-CSJ e 1e -- �1 � Wf r (rQ�Z StOn
Home Improvement Contractors Registration(if applicable)# ,/ r;6 P S (attach copy)
Construction Supervisor's License# 07 2-7 7 L. (attach copy)
Email of Contractor ktwee496isLo- 15 qd.carn Phone number 7 9'1 - S 3 Z- q?01t
ALL PROPERTIES THAT HAVE STRUCTURES 00ER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Onlvx
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X. X 9 X
Additional tent dimensions can be attached on a separate piece of paper.
Check one:this event is a:for profit non-profit event
Check one:Food served Yes No
Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent
If food is being served atyour eventplease obtain a Health Department approval between the hovers
of 8:00am-9.30 am or 3:30 pm-4.30pm. commercial events may require Fire Department approval
*WOOD/COAL/PELLET STOVES "
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles:front back left side right side
HOM EONVNEW S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 C R 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
LICANT9S SIGNATURE
Signature _ Date
All permz a 'ons are subject to a building official's approval prior to issuance.
AC IO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
03/26/19
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 AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME; amy roberts
M.P.Roberts Insurance Agency Inc. FAX
A/c No Egli: 978-683-8073 A/c No): 978-683 3147
1060 Osgood Street North Andover,MA 01845 ADDRESS: amy@mprobertsinsurance.com
North
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: WESTERN-WORLD INS-COMPANY---" --
INSURED INSURERS: MERCHANTS INS COMPANY
L&P BOSTON OPERATING,INC INSURERC: ASSOCIATED EMPLOYERS
DBA WINDOW WORLD OF BOSTON INSURER D:
15A CUMMINGS PARK
WOBURN,MA 01801 INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY) (MMIDD/YYYY1 LIMITS
x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS MADE FXOCCUR PREMISES a occurrence $ 100,000
MED EXP oneperson) $ 5,000
A NPPS525379 04/05/19 04/05/20 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑JECTT LOC PRODUCTS-COMP/OPAGG $ 1,00000
OTHER: $
AUTOMOBILE LIABILITY COMBBIINd D SINGLE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
B AUTOS ONLY OWNED x AUTOS SCHEDULED MCA1002569 04/05/19 04/05/20 BODILY INJURY(Per accident) $
x HIRED x NON-OWNED PROPERTY DAMAGE $
AUTO ONLY AUTOS ONLY Per accident
x UMBRELLA LIA13 X OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS-MADE AN065362 04/05/19 04/05120 AGGREGATE $ 1,000,000
DED RETENTION$ $
WORKERS COMPENSATION x PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE I JERANY _
C OFFICER/MEMBEREXCLUDED?ECUTIVE7 NIA WCC-500-5018609-2019A 04/05/19 04/05/20 E.L EACHACdDENr $ 1,000,000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE• $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REP ENTATIVE
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
The Commonwealth ofMassachusetfs
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
• www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information l Please Print Leg-ib
U /ly
Name(Business/Organization/Individua1):,4.1 f7 Stoi►Q,Pla/�4 r �/!l'. gf� t✓.iit�aw c✓y��d �D 3`�dll
Address: ► 5 A Cup„rr;in A s a r GC
City/State/Zip: WobtIrl, MA 0 1 k o I Phone#: 7,? I - 9 3 Z-q,?()5
Are you an employer?Check the appropriate box:
Type of project(required):
L dI am a employer with employees(full and/or part-time).* 7. ❑New construction
In I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.] 9.
IM I am a homeowner doing all work myself[No workers'comp.insurance required.]t ❑Demolition
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ Of repairs
These sub-contractors have employees and have workers'comp.insurance.x
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.EJ Other k,,� IA l
152,§1(4),and we have no employees.[No workers'comp.insurance required.] r v 4v e
*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. r
Insurance Company Name: A SS t)c.cui e G
Policy#or Self-ins.Lic.#: kVC-c- -5()0- So I g Z O 19 L! Expiration Date: 0
Job Site Address: 1211 U&r yl ./,!I . . City/State/Zip: 1 //r1 13 i —
Attach a copy of the workers'compensation policy declaration page(showing the policy numb •and egpira 'on date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 'olator.A co o this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verific 'on.
I do hereby certi un he pa' a enalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone
Of use o not write in this area,to be completed by city or tmvn 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#:
In ®rmnati®n 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 j oint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to'do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be de
emed.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 complianc6-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 perm t/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 Department's address,telephone and fax number: _
The Commonwealth of Massachusetts
Department of Industrial Accidents :r
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 wwwmass.gov/dia
i
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-072772 Expires: 04/07/2020
JEFF C STEELE
24 SHERWOOD AVE
DANVERS MA 01923
r
Commissioner
i
�'//IP �i"`nrirn.nyru-r'rrf/�c�r+`=f�u�,rrcw:ir-f/'
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:LLC
Registratlom- Expiration
188025. . 04/11/2020
WINDOW WORLD OF BOSTON,LLC.
JEFF C,STEELE ,Q
15A CUMMINGS PARK
W OBURN,MA 01801 Undersecretary
W1ndoWV Word of Boston MA"IC Registration
Offides&S owroorns x: Number:
U 15A Cummings Park ;U 295 Old Oak Stream: 106026
Woburn,MA 01801 Pembroke,MA 0235t i Federal 10 Al(781)932/4805 (781)828.52811 82-1898432
www-WindowW rldolooston.com
Customer: P-Ac�,!t bIes "se -, Phone(h)s
In"Address: �1i{ S..d��J .J r{ Phone(w)>
city: A :�fj
State:MA Zip f E-mail
a
WINDOW WORLD GLASS OPT[ONS
—1DDO Sarles Single-hung AR-Weld $199 2 Solaria,.Elite-Dual Pans $119 1212A
_2000 Series OH AII-Weld $215 I TripisjOane/Krypton $389
I I 4t7M Series DH AIWVeId $240
k(p {•Series
-Wel Woobalyl
6000 Series DH AIId $2s0 WINDOW OP 10NS
2 Uts Slider $374 P
�3 L1te Sgde ter w+r-0 tvr vs uo $575 _mare"'makage warranty(4 OD/8000) $Is INCWDED
=Picture I Fixed Zile(0.83 UO $355 _i M Screens �. $9 OiCLUDEO
_Picture/Fixed Ills(84-130 Un $445 S N4 T� relation on Jambs a�Head $11 OtCLUOED
Awning $310 �y_Doub Strgngth Glass(40*6000) $16 iNCLUDEO
_Casement Pitts$49(DH Sash Rain MO Double locks(>28') $51NCLUDED
_2 Ute Casement $595 _-Full Sheens . S26
—3 Ills Casement arx ra rm ox vt ue $910 1LColo Grids to 81) $65-T f S
—Basement Hoppe $434 i Prak- .(ands S7b
Bay Window-Soffit Mount/INS Seal$2860 i Stntul,led Divided LRe K $182
Bow Window-SoN Mount/INS Seat$2785 f Tem red OH Sash(BSO)�SO) $75 -
_Garden Window $200_ Otlsa're Glass(BSO)(TSOp- $76
—Say,Bow,Garden Oversize(+109 Un $975 I Orteliyte(4015D Or 5W40) $75
—Belge/Almond $40 11 Foamknhanced Frame
_Woad Grain Irmerfor(Swies 4000/6o0a 0*51$100
flight oaki Durk 0ouChewy/fox Wood IsRE1978 PUILTHOMES(EPA LWAD SAFE RENOVATION)
fthAfw*) ,_Lead fale Practices Regcr— $30
8ro-Eldertor(Arch.BromeIAmericanT-411100 M1�HOME WAS BUILT IN THE YE6R 1A$InitlM
Dasig-CoforExteriar $175 I MISCELLANEOUS
—Spelriably Window E -��ExteriorAlumirwm Gadding{rwo-Bend)
Window Color c.3-4ri f e. / Q Tgtured$90 U G-8 Smooth$90 S
rnxee otawa ; Fadib Color
NON CUST M RS Metalrmillow Removal $75
t' Now Cbnawcdon Vinyl Remove $17b 2t o 41
Vinyl RaBng Pane Door Sit $1095 t 4D - - x.
Ytnyl RoEing Patio Door Sit. $1195 —�lhrll� end Cladding $20
AddtobasepricetorCustomRd6nQlraSODoor$1250 K.;_Mull td:Form Multi Unit $30 r2y
French Rail SBdmil Path Door S1L or 8b. $1395 I InswAnterlor/Exterlor Stops; $50_1a_QP_
French Rag Sliding Pella,Door OR. $1495 JyTi_Instati'nferior Casing �_Stans At $96j_&
_Rench Rah Sliding Farb Door Oft. $1595 Insul a Weight Boxes = $20
_Custom ExsedorCiack irg SWO —T.r- Roof r Say/Bow Windows 9 $500
LI SolarZone erae or ETC Glass $305J2'.!O _�Exlstlgg New Cont.Ext.Rei o Fit Si s
Grids Patio Door $210 Rm eoiral of Existing eayl $250
Woodgraln Interiors $M I Repall,Sill,Jamb or repfacepg nosing $75 (]o
Exterior Designer Colors ss95 Full SpbSM(Single)replacirment $175
_'LL Interim Casing 2111 31rs $275 5 i Mu11i s Removal $50
_ttandleset options $ Bay/Ebw Conversion ExL Rego Fit $450
3 f (New -n will Not Mafch) ,
i
Door Color / cJ21 ji+.P O ROUND-UP FOR WINDOW WORLD CARES
°" Outride V st Jude Chlldren'SReseg liosplfat $ Gq
Customer declines exterior wrap and understands painting andjoitrepair may be ragWed Initial
Customer declines grids on �vindow3ldcors Injtial
DISlil6lMEH�CastmneraresporalQfalortltaldoeMghtearRrBanvithlldseordrxtP71sfk9.slau�ig,WamSyslemdstmina _ @tddlglramllasin
eexssal25.m•1lmfenwmranOaCanBoAs 7mtAppmr6.tigiedcDiWrclApprayai fdryol8o npmNng6stdewagcPemel rdionadhemuloon.
NO D(TRA WORK IF NOT IN WRRINGi
Customer agrees a terms o paymen as fa, ows-
Extra Labor&Materials :
Site Set Up,Pgrmi6 Disposal&Delivery Fees $389.00
�e Total Amount tS •-
Custor#'order Deposit 33% Cka
Projej Start Payment 33% '/-{9CT
Balance Doe Day of Installation S 10&0
I Amount Financed ) 012
Wedow%Url of Boston antlGpates stating 8s wo*an I�SiW¢-1;aklnd so ''comp1aW in�fi�s.Sd'du�t try laTL Yes t
Any deposit milidred b adrance of lbe start of me wool*$WkLL NO exc�aed 331/3%of the total price or the odual co am material or Main
sliftlalonfluorcustom maderzMA.Which mug be didelell in advance of life Stint of wo to ag gul she Project will prodedanscheduls.No09payment
slldbedemartQedul�ptecor�aetiseomptefedtfltLesaitslallonotlothparrtes.
AB Irome ImptoyParllJd egabadmsand subcmlbaaott shrittrc legKtemd and mat arty hipdms abort(a conirap or stttxanlau0('�elagrtg to a mgistragaa shtiutd Da
• dheaed Ip:Olgcg al Consumer Ands and BsNaas Heplda0on.Tea Park Pieao,$oite:5170 Bodo!1v MA 07116.Phone:1617)g9�r3.6700 ,
No work shag begin par IO the dome of We contract said trammblal to are owner of a copy of 111th contract 'r'
Window Wedd of Boston under provision of Chapter 142A of the general laws is mquUed to apply f and ow all caristmcllonriolated permits.Wxtdow Workt of
Boston shag na be demand frspambie for Ways into work desanned in lids apurrei0 cataed f roingiatury,petmb granting dpenclm authOdBes Orindliduals.
Notice:11 The PURCNASERIS)oaaimUs own eaasWcltoasalal dpermitsfortheworkdeeaibe unaorfhfsagreementatd17%wlmunregisteradconUutors,
The PUIOASERI6)Is hereby adeised that Is the giant of a diapule,judgement and Ormliaymen;[be PURCHASERis)will nil be englied to make a claim or
collection from the puaraMy kind establisbad by chapter 1424.M.O.L. ;
You[be buyer may cam Ibis transaction at any Ilene pr or to midnig of me ih d bus mass day after Ike ale of Ibis Iranseelion.
moute at cancellation must be is would p0stmsrited no late than mid_ght of the following Ill d business day.
ThisWhkwWodd•frmdd oamt4u4 lad L&P Bosl6n0 -r en at*mmnsowworld,his,
IMAP
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ffi 1
:Do of Ill II er x gkcoo. Date'
Salesmen:Do not sTon ll then are any blank spaces. Date o wrec Df nol sign R Ihsre am any"W spaces. Date
i
IL -
i
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIOl
Map Q Parcel o2 Cq
Permit# 4
Health Division Date Issue
Conservation Division Fee
Tax Collector
Treasurer .ecscJ �`��Z9�Zv
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address a 614
Village 1v IV L S
Owner
1r(,G f coAddress l�
Telephone �?17
9
Permit Request c
Square feet: 1 t floor: existing proposed 2nd floor: existing proposed Total new
Valuation ���U- Zoning District Flood Plain Groundwater Overlay
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 ❑No If yes, site plan review#
Current Use Proposed Use
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BUILDER INFORMATION
' Name Telephone Number ��� ��� 03az
r Address ,I�i i, I�ILi License#
Home Improvement Contractor# /0 y�`d
i Worker's Compensation# Alwid /7/C
L76 �(21
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �ti G`'`�/l CyC,
SI;NARE DATE YL
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FOR OFFICIAL USE ONLY
is — - - -
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6
PERMIT NO. _
DATE ISSUED '
MAP/PARCEL NO.
f
F
ADDRESS' . . VILLAGE ;
OWNER, .
DATE OF INSPECTION:
FOUNDATION -
FRAME
INSULATION `
FIREPLACE
t
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ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING -yr
z
DATE CLOSED OUT
ASSOCIATION PLAN NO.
n
The Commonwealth of Massachusetts
Department of Industrial Accidents
Olfice ofla�estigatloos .
i.... ... l:=
600 Washington Street _
~ '°ram.yif Boston,Mass. 02111
^. z ram,•, Workers' Com ensation�Insurance Affidavit
name
A3�flitC..I2f.iTT{UL'II�RtITi✓%����������jj%��1�/`.
¢�G rLC 'Dr1.5CC)1
l `
location � r��"d
city 4V r&VL VL-1 s " ��� hone#
C I am a ho eowner performing all work msseif.
❑ I a sole proprietor and have no one working in any capacity
I am an employer providing workers compensation for my employees working on this job.
com_annv name �5�
< address
city � '�t�CisnI�I
phone# � d
insurance cn. ewiC`� oliev#
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the .olloi•ing workers' compensation polices: :; ::.::::;;: >:;:.:;.;;;:;.;>: ......
H.
compa
ny name:
.address: .
...::;:::.
hone•# _.:.::..:::. ;
.:;.>::;::.;:.::.::::.
city:
......
:... .:.;....
insurnnce cn. "
// //
: :... ::
comnany name.
address:
<..:: h one#. ... .. ,
city-
..... .::.:.::.....
imurnncc co. ...
= � r / ��%/
t ..,......,,
Failure to secure coverage as required tinder Section 25A of MGL 152"can lead to the Lttpositlon of criminal penalties of a tine tip to 51,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification
1 do her ay certify untie t and penalties of perjury that the information provided above is true and correct
Date -
. Sisnature ..
Nev r,
Phone
Print name
e o�nci-i use only do not write in this area to be completed by city or town official
permiWcense# ❑Building Department ?,
city or town: ❑Licensing Board
❑Selectmen's Ofllce
check if immediate response is required ❑Lieslth Department
phone#; ❑Other
contact person: `
i";
Information and Instructions
all to to provide workers' compensation for their
Massachusetts General Laws chapter 152 section 25 requires employers P
employees. As quoted from the"law",an employee is defined as every person in the service of another under any cont,,ac
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
trustee of as individual,Partnership, association or other legal entity, employing employees. However the owner of a
than three apartments and Ades therein' or the occupant of the dwelling house of
dwelling house having not more
work an such dwelling house or on the grounds c
another who employs persons to do maintenance, construction or repair
building appurtenant thereto shall not because of such employment be deemed to bean employer.
- . •- � .. - .
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renef
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h:
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neifl erthe
commonwealth nor any of its political subdivisions shall enter into anY contract for the performance of public work until
of this r have been presented to the cowacting
acceptable evidence of compliance with the insurance requirem ents
authority.
PP
A licants
r
f completely,b the box that applies to your situation and
Please fill in the workers' compensation affidavit comp y, y checking
supplying company names,address and phone numbers along with a certificate of insuran a ash affida�to sign ign and
to the Department of Industrial Accidents:f°r-ca�mation of m coved • e is
submitted eP application for the emit or livens
date the affidavit. The aff lavit should be zetumed to the c�'or town that the P
big requested,not the Department of Industrial Accidents. Should you have any questions regarding the'"law"or if yc
are required to obtain a workers' � Policy Please call the Department at the number listed below.
1,11010111
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of t
affidavit fbr you to fill out in the event the Office of Investigations has to contact you regarding aPPli - Please
be sure to fill in the peimit/licease number which will be used as a reference number. The affidavits may be returned fin
the Department by mail or FAX unless other anmng=Pnts have been made.
The Office of Investigations world like to thank.you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
r
The Department's address,telephone and fax member..
_. . The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Imlestl0adons
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 eat. 406, 409 or 375
THE T�
The Town of Barnstable
9 �$165
Department of Health Safety and Environmental Services
BuildAL
ing Division
367 Main Street,Hyannis MA 02601
Ralph Crossen
Office: 508-862-4038 Building Commissio^.e:
Fax: 508-790-6230
Permit no.
DateG`�/
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PEItNIIT AppUCATION
MGL c. 142A requires that the"reconstruction+alterations+renovation,repast,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any P s , owner-occupied
building containing at least one but not more than four dwelling units or to sttucmres which ate adjacent to
such residence or building be done by registered contractors,with cep exceptions,along with other
requirements.
Type of Work: �<J Estimated Cost
YP
Address of Work
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under S1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that: DEALING WITS UNREGISTERED
OWNERS PULLING THEIR OWN PERNIIT ORPROVIMPROVEMENTVEWORK DO NOT HAVE
CONTRACTORS FOR APPLICABLE HOME h�VIPT OR GIIA►RANTY FUND UNDER MGL c. 142A.
ACCESS TO THE ARBITRATION PROGRAM
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
6
Date
Contractor Name Registration No.
OR
Date Owner's Name
' �iEe r�in�xonu��� ��
NONE INPROMENT ONTRACT'OR
Registration: 105040
ExPiratior 7/16/02
TyQe* Private Corporatio
A.-Ness-Ins.-_
David Ness
581 Cohannet Street .
Taunton Np 02780
ADMINISTRATOR
n:
TOWN OF BARNSTABLE Permit No. --------25885_
Building Inspector
»nmc Cash
----------
OCCUPANCY PERMIT Bond --------------X-- / -
Issued to Capricorn Realty Trust , Address
lot #36 124 Sudbury Lanes �yannis
Wiring Inspector � .».. Inspection date
Plumbing Inspector , Inspection date
f
Gas Inspector f� 1 uaEi ' Inspection,date
..I 4- 94
Engineering,Department—,or Inspection date �-
Board-of Health 1`� ,s ¢ U Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING/SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
4ilding Inspector
1
9
# ' FROM -
TOWN OF BARNSTABLE
lair. Francais I. h <: BUILDING- DEPARTMENT
Town Clerk �-"—*,*667• MAIN STREET HYANNOS; MA Om
Phone. .4120
SUBJECT: _
i- FOLDHERE
If DATE -
MESS`AGE
Work has been leted•tom-Permit ?5885 (Capri
Please release- BCnd.
^z-
• SIGNED A17
DATE - -.
REPLY - '
.. SIGNED. ,
Ne7.RM1 RECIPIENT: RETAIN WHITE COPY,RETURN'PINK COPY '
- - PRINTED IN U.S.K.
SENDER: SNAP OUT YELLOW COPY ONLY.SEND:WH.ITE AND PINK COPIES.WITH CARBON INTACT.
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CERTIFIED PLOT PLAN
as
e,
d // �3 u l� L ��/�
� b JrU Y
ROBERT, .r���n �' -14 /V'/-V-/_s
NEW CONSTRUCTION ONLY / ._. .akucE. _
TO OF FOUNDATION 15 FEET. E�oREoc,. IN
ABOVE LOW POINT OF ADJACENT
ROAD. Nvsu +���� i SCArLE,+ t.,,¢D ,, DATEt / Z_ s f .
ELORI D f ENGINEERING CA:1IV �c•o I CERTIFY THAT. THE Fo0 AfPA�-r0fV
CLIP'
EOISTE ER REGISTERED, z SHO /N ON THfS PLAN FS I.00ATE�
CIVIL. LAND JOB `NO. 2..,. ` .Old ;THE GROUND AS, INDICATED AN.O
I j � r. CON.
TO -THE ZONING LAWS
ENGINEER SURVEYOR , : Df� DY -- -
OF i6ARN$TA13LE ; k1ASS
7.1.2. .M A IN .S.T R E ET CH.QY� r r.
HYANRI Ml�SS. `` =F
SHEET.,_ OF
D TE 'L REi3 AND "'SURVEYOR
7HOUS(
ssor's map and lot number•.....Q..7.G 'aaq •.. � YaE�i 'MOT MONNECT.TO.TOM.Sewage Permit number , AHHS E,
, // .fin B TADL number ............... ...� .7.:... M._.: ...... ... "63 e�.
9�0 9
TOWN . OF� BAR�NSTABLE " .
BUIL:D`IRG 'INSPECTOR
'APPLICATION FOR PERMIT'TO Construct Single Family Dwelling
.TYPE OF CONSTRUCTION .......Wood Frame.................................. ............. ............... .......................
. ............19.,&3
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a' permit according to the following informdtiori:,
Location ...:....•Lot...# 6.... Sudbury..Zanea. .......:.........................' Hyannis.,... .......................................
ProposedUse .............................:.........:.:................................................................:................................................................
•
Zoning District R.r.Br.......:..................................:...........:....:Fire District ...I�ys�TlZl15.�....MA........................
Name of Owner' Capricorn Realty Trust Address 765„Falmouth Road,„„Hyannis,,,,,MA
Name of Builder Franco Real Estate Dev '...CO Address .7.65„Falmouth •Road,.„•. .ya, 9 ,�,,,,,k1A
:Ic.
Nameof Architect-..............................................'..................-'..Address ......................................................................:..........
Number of Rooms ,_
six 'Foundation ..................................P:C
R
Exle-ior Clapboard and or shingles ,.,Roofing Asphalt, shingles .• .
...............................................:................................. . .....................
Floors Carpet Interior .Sheetrock...'...... .............. ..........................
................................................................. .. {
Gas. - F.W.A. ...Plumbing ......Two -. =Copper.............................................
Heating ............................................................................... ......
` None. 40 000.00
Fireplace ............................................:.....................................Approximate. Cost ...... ...... ....................................................
- s
1056 sq. ft.
Definitive Plan Approved by PlanningtBoard ________________________________19________. Area ..........................................
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 f the-Town of Barnstable.regarding the above
construction. .
Name ... , �:�.....Pre.........
Construction Supervisor's License ......000 8
,,CAFIAICORN REALTY TRUST ,
W
0 25835 Permit for .One..StorX...........
r.
` Single Family Dwellin
............. .........................................F.g..! ........ _
Location Lot 36 , 12 4 Sudbury Lane - t
Hyannis......................... r .
Capri
Ow rnRealtyTrust. .•• •• ••.. A
Type Construction Frame
..... .ME. ............ ` ..................`.. ..........................
Plot `.. ........ Lots.. .........?.................. T
Perm ranted ......Dec............................'16 ' ........1*9 8 3 `
T Date Inspection .. .................................19 ,
Date 'Completed :.�/. t?, ..Z..;... ....19- Py
�
�
`
!
�
�
�
THE
MASL
BUILDING INSPECTOR
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Name of Builder �ranco Real Estate Dev. DoAddress .�N�5...FAIDPIAth...RP4.d.,...ByPXj)2j.s
Diagram of Lot and Building with Dimensions Fee ..........19'.'s-6
SUBJECT TO AP PROVAL OF BOARD OF HEALTH
-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ^ �
�
| hereby agree to conform to all the Rules and Regulations above
construction. '
Nome .__..Pres.�., 1
/
OOomAo 1
Construction Supervisor's License ----����,�----. �
1
CAPRICORN Vf9�
RUST A=270-229
No ..258.85.. Pere Story
Single Family Dwelling
' Lot 36, 124 Sudbury Lane
Location ................................................................
Hyannis
Owner ,,Capricorn Realty Trust
.. .. . ... .....
Type of Construction „Frame
................................................................................
Plot ............................ Lot ................................
Dec. -16 ,
Permit Granted ........................................19 83
Date of-Inspection ....................................19
Date Completed ......................................19
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