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HomeMy WebLinkAbout0032 SUMMERSIDE LANE ell, .a r C Dt 5071430 { IKE " Town of Barnstable *Permit# Expires 6 months fr ue Regulatory Services Fee * BARNSTABIA « Mass z639. � Richard V..Scali,Director - Tom Perry,CBO,Building Commissioner v 200 Main Street,Hyannis,MA 02601': NOV 0'2 2015 'www.town.barnstable.ma.us TOWN'OF a nn T Office: 508-862-4038. :�0' 9&R3�0 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY F Not Valid without Red X-Press Imprint Map/parcel Number Property ess 3 so ih/i), .er z., i'1 Residential Value of Work$ 47 4 �O- U Minimum fee of$35.00 for work under$6000,00 Owner's Name&Address '4e_I� �Ou - - � < Contractor's Name �G.�►Cr d^ - j��� � 6 Telep hone Number b e���j —, • Home Improvement Contractor License#(if applicable) ja lj 'G� Email: Construct Supervisor's License#(if applicable) C� ®� �i� C� . orkman's Compensation Insurance Check one: ❑ I am a Ye proprietor I the Homeowner have Worker's Compensation Insurance - Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to,, ❑ - oof(hurricane nailed)'(not stripping.;Going over existing layers of roof) Re-side _ • ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#ofwindows #of doors: 0, Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.," Separate Electrical&Fire Permits required. *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 required. SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRESS.doc ,- _ } Revised 040215 H . Ilse Commoinvea h of-Vassaclrmetts De,parhment crf lndrrs�iai Accidews O,f ve o,f'Inve-stigadons 600 Washington Street CIA a2111—. >Ivrvn>,.mass govfdia 'Workers' Compensation Insurance Affidavit Builders/ContractorslEIectricians/Plumbers Applicant Infarmaafiag Please.Print Lggibly Name(IIusmemlOrganizal on&&uidaal)- Address: 6 ei W G q D L,�. CitY/S - 'L A)'U I 1}' Phone Are yA an employer?Checkthe appropriate box: Type of project(required). 1.YI am a employer v`ith. 4. ❑I am a general contractor and I 6. ❑New construction employees(full andfor part-time).* _ have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7_ ❑Remodeling slug and have no employees. These sub-contractors have g_ ❑Demolition wonting for Me in any capacity- employees and have workers' [No Workers' comp.insurance comp-insurance 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repair or additions 3.❑ I am a homeowner doing all work officers have eseraised their 11.❑Plumbing repairs er'additiems myself [No workers' - right of exemption per MGL 12.❑Roofrepairs , insurance required.]F c.152,§1(4),andwe have no employees.[No woliC rs' 13.❑Other comp-insurance required.] *Any apgftzat that checks box 91 nmst also U out the section below shaving the¢workers'compensationpoliry information. Homeowners who submit d m of idavu indicating they are doia;ale wa*sad rhea bte outside t omt mctars mmst submit a new affidavit indicEtmg 5UCIL fCaatractors tbat check ibis box must attached an.additianal sheet showing the name of the sub-ccowscto-rs and state whether of not those entities base employees.Iftbesab-cont®ctorshave emplafees;theyn=pmvide their workers'camp.policy number. I ans art etrrpLopr that is prof dbzg tvarkers'cougwLsadoti insurance for iny ewpLayees Belviv is diepoiiey rend job site . infvrrnativn. Insurance Company Name: 6./(/' CA.1-0 e 610 Z9 Policy or Self-ins.Lic.# / J;��� 2,,�4��pirationDate= Job Site City/State!ytp: Attach a ropy ofthe workers'campensationpolicy 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$1,50100 at dfor one-year imprisonment as well as civil penaltiesin the form of a STOP WORK ORDER and a Em of up to M. 0_00 a day agaiut the violator. Be ad;dsed that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage terifrcation- I dv Hereby certr It atnder the inns and stab es oTw pe 'ury thatthe infbrwat vnprovidedabmw is true and correct Sitaature: hate: Phone Offi al use vnniy. Do not write in firs area,to be campleted by city or town vffic at City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.BuRding Department 3.CitglTowa Clerk 4.Electrical Inspector S.Plum-biug Inspector 6.Other Contact Person: Phone#: Information and Instructions ; Massachurseffs Genea aI Laws chapter 152 requires all empIoyeTS ID provide workers'compensation for their employees. Pursaantto this SbtUtP,an.erzpinpff---is defined as., every person in the service of another under any contact of hire, express or implied oral or wrifte:u." An employer is defined as"an mdividnat partnersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged is a joint ente rise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or otherlegal 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 II7,aintenaace,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.covexage required-" Additionally,MGL chapter 152, §25C(7)states-Neither the commonwealth nor my of its political subdivisions shall enter intD any contract for the performance ofpubho work until acceptable evidence of compliance with the insm-an ce. requn-ements of this chapter have been presented to the contracting authozity." Applicants Please fill out the workers'compensation affidavit completely,by checlong the boxes that apply to your situation and,if necessary,supply snb­contactor(s)name(s), address(es)and phone numbers) along with their certificates)of innmmce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or par(ners,are not required to taffy workers' compensation insurance. If an LLC or LLP does have employees,a policy is requi ed. B e advised that thus affidayk may be s bm_itted to the Department of industrial e e to and date. affidavit The affidavit should D CA�mat1 on ofimm�ce cov e. Also b sun sign Accidents r r � be returned to the city or town that the application for the permit or license is being requeste(L not the Deparmeat of Turin t i al A ccidmts. Should you have any questions regarding the law or if you are regnaed to obtain a workers' compensation policy,please call the Department at the numbm listed below. Self-maared companies should enter their self-insarance license number on the appropriate Ice. 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 pen�nitllicrose member which will be used as a reference number. In addition, m applicant that must submit multiple perr itlli:oanse applications in any given year,need only submit one affidavit indicating current p olicy infbruation(if necessary)and under"Job Site Address"the applicant should Ovate"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 fiat a valid affidavit is on file for furore permrts or licenses_ Anew affidavitmust be filled out eac h year.Where a home owner or citizen is obtaining a license or permit not related tQ any business or commercial venture (it,. a dog license or permit to bum leaves etc.)said person is NOT regoi rcd to complete this affidavit The Office of Investigations would like to thank you in.adv-�mce 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: -ThL-C�G_mmmt ltlr of Massa chusa is Deparlmmt of l idustdal Accidents Off ice of lavesf gations, �Q4�ashingtan�' � Bmtoaa�MA G� I I I Tf,-L 4 617'27-4900 i�xt 4-06 ar 1-��-I���A�`� Fax 4 f I7-` 27-7M Revised¢24-07 Mass-gov/dia °O�mo�zusea�i Gi�ccutaac/auaeC�• � ------- _ _ Office of ConsumerAffairs°�';usiness Regulation I ME IMPROVEMENT CONTRACTOR I License or registration valid for indiyidul use only egistration: 1"28560 ' before the expiration date. If found return to: y xpiration q/�tL20 Type: Office of Consumer Affairs and Business I r Imo- Individual 10 Park Plaza-Suite 5170 Regulation RICHARD VILLANI e B oston,MA 02116 RICHARD VILLANI -' == i 109 WAGON LANE HYANNIS,MA 02601 Undersecretary ' Not valid without signature Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m3)of enclosed spacer Failure to possess a current dition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS • ti » , / Department of public Safety as Massachusetts - Regulations and Standards goard'of Suil.tng �. Construclton.Supervisor License: CS-074360 VjCHAVW po BOXb West HyannisPor" �Y•, , Expiration 0612312016 commissioner VILLANI CONSTRUCTION INC. Roofing& Siding Specialists PO'Roy 69? West Hyannisport,MA 02672 5OR-77R-7495 1-RRR-766-1041 Member of the Better Business Bureau—Insured—Licensed-Free Estimate Threse Quill July 24, 2015 32 Summerside In. 508-776-9626 J Hyannis Ma. DESCRIPTION Furnish and install the following,labor and materials to re-roof building at 32 Summerside Ln.Hyannis Ma.As follows: Remove existing white cedar sidewall shingles. Install house wrap. Install new window flashing. Install white cedar sidewall shingles. Grade B $7,800.00 Repair front shudders with azec pvc trim$350.00 • j Remove peeling paint. Install primer to bare wood Install 2 coates fmish. $3,900.00 , Remove back deck. $950.00 Remove and replace 4x4 post$150.00 aY We propose hereby to furnish labor&materials complete in accordance with above specification fnr the.cnm of THIRTEEN THOUSAND AND FIFTY DOLLARS: $13.050.00 ACZM DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/13/2015 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 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: Erica Barrett OLDE CAPE COD INSURANCE AGENCY INC. P"-LAtfc"N E t: (508)771-3300 FAX No; E-MAIL - ADDRESS: ericab@Occia.COm 296 WINTER ST. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED _ INSURER B: . VILLANI CONSTRUCTION INC INSURERC: INSURER D: PO BOX 692 INSURER E: WEST HYANNISPORT MA 02672 INSURERF: COVERAGES CERTIFICATE NUMBER: 4926 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. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVDI POLICY NUMBER MM/DD/YYYY) (MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ CLAIMS-MADE DOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A -PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY❑ PRO- ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED. AUTOS AUTOS - N/A - .r BODILY INJURY(Per accident) $ HIRED AUTOS AO OWNED UT PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ FEXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION PER - OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE f IE.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDEDI N/A NIA N/A, 6HU69982A27315 10/02/2015 10/02/2016 Mandatory in NH)i E.L.DISEASE-EA EMPLOYEE $ 500,000 f yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,.may be attached If more space Is required) - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 South Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.Croyy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD oFt"E rw TOWN Of Barnstable *Permit# 60-3 on Expires 6 months fro is date BARNsrABLA = Regulatory Services Fee ntnsw. 1639. 1m�' Thomas F.Geiler,Director '°r�o,�►+* BIAlding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 A Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BA NS Ab LM E%PREMS PERMU APPLICATION - RESIDENTIAL ONLY �6q Not Valid withota deed%Press imprint Map/parcel amber N �� � \ ) Property Address Scam rnQ��A �-� LG►� u�c v)l 11 S Residential Value of Work 3G/Sy.Go Owner's Name&Address ►re ,< 6�\'O-P 3 s �1n ; S � �1 y�,ylA G2(oar �� ll , Contractor's Name 1LJ G��2 t�u }-�Wye v� n,U2 Vue y �- Telephone Number 9-Y-2 L)6-3a e1 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance LI Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name /' P T 1 IM l c i-A 1 I 71 h fit, y'cz Workman's Comp.Policy# C"C 2 — Permit Request(check box) EY 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. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town deparhnent regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. TT EN hvmvement Contaetors LiEense is require' Signature Q Forms:expmtrg Revise053003 - n - a - - The —sue •;..'. - Department of IndustrialArd-cidemYs a e 660 Washington Street BasZon,Mass. 0211.E werlcew compensation b ran Affedx �1G U \�c.J,n s 5� 2 yc-.3a s am a homeov ter 'nY g asl WMk m4selE = -....:::.:. 1=a sale propxaetor agd have no omc work in any cVwity E am an employer providing wo ers'con.pensation for my employees rrworkaing on this job- - 6 phone N: M. `1 1 am a sole proprie-Lor=general contractor or homeowner(cir de one)and have hired the contractors listed below who h;,._ the following warkers'-compensation polices: _._.-.. �gasaxaanva�arase- _ ��c�i°�sx• - PQ inscaa aace�€ae rnR�tiy# _ t�a6ttart$a steaare ro�•tr azs r���irtaf aesndtr�teicaa fir"•.�€��G�l5�renc;�us€4e inxapas"stittn a;f eaixas6asF ptYt�lYits�€a e vp�to Sl,"?i�. ���,a: arse g ars`iangarisaaoment$s weti as cdartTcasslYits oo l �ffaer af� f➢� �Igl38t13Z and r�lease a5°cc slrt1 ally�g£ciusY age anodsrs$anasd$hoc cagy aaf$tt6s sYaleaantrt$maa�tat fn^w�bal�Yt:Ytat€�ffet aa€iovtstt $ear. the&gl.a far�a�ragt�er6frem3imm• 1 des he,eby certify under the air�s andpea,7111es of Perjury crest the ini'o-manor proWded above is true rand correct Si.-nature---z--t_ Date ('lint mate 1( a'l �� 1l � �r c-��t'rJ c-r �ea�ne� € .safI6tia6 use msn$v do notwrite inthis area to€se tmnala!eYed by CRY 3s town official m a,14 e6fw or gown- 11 #1Building Department OUceinsing 0a2rd a Q check if irraelis$e response is required ��ttcttnea`s Office �... i� �F$taSSls IBelxsr$asc;4Y �< y =. trrvised V93 P}AT Liberty Mutual Group Liberty PO Box 7202 Mutual. Portsmouth,NH 03802-7202 Telephone(S00)653-7893 Fax(603)431-5693 November 11. 2004 TOWN OF BARNSTABLE BLDG DEPT 367 MAIN ST HYANNIS.MA 02601- RE: Certificate of Workers Compensation Insurance Insured: NICKERSON HOME IMPROVEMENT INC PO BOX 2476 ORLEANS,MA 02653 Policy Number: WC2-31S-318102-034 Effective: 11/6/200 F Expiration: 11/6/2005 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability: Bodily Injury By Accident: $ 1.000,000 Each Accident Bodily Injury by Disease: $ 1,000,000 Each Person- Bodily Injury by Disease: $ 1,000,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions,and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you,the certificate holder. This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notiljN you of such cancellation. AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY IMUT UAL[INSURANCE GROUP as respects such insurance as is alTorded by those companies. i cc: Insured: Producer of Record: NICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGCY INC PO BOX 2476 PO BOX 1658 ORLEANS, MA 02653 ORLEANS. MA 02653 t t i t goo-t ' v /z� �rrr zagz.�tea�/• u � AW&P License or.registration valid for individul use only Boar o m m egu ate �s a before the expiration date. l.f.found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards. Registration: 133851 One Ashburton Place Rm 1301 Expiration: 8/17/2005 Boston,Ma.02108 Ty: Private Corporation NICKERSON HOME IMPROVEMENT MARK NICKERSON �� 12 COMMERE DRIVE `'. � �• Not valid without signature _ ORLEANS,MA 02653 Administrator • Page No. of Pages. ,y NICKERSON HOME IMPROVEMENT, INC. 124362 P.O. Box 2476 HYANNIS, MA 02601 Q Q ►]I5 (508) 790-5880 Fax (508) 255-5107 PHONE DATE TO Terese Quffi 508-428-5400 X212 3/14/2005 135 Main Street JOB NAME I LOCATION l Hyannis MA 02601 32 Summerside Lane Hyannis , JOB NUMBER' JOB PHONE W • •- Strip shingles off entire roof, reserve for reinstall roof vents Renail all loose sheathing Install 8"white aluminum drip edge on all lower edges Install ice&water shield on all lower edges and in all valleys Install black underlayrnent felt paper on entire roof Install new flanges around vent pipes Install 25 year 3 tab Seal King algae resistant shingles on entire roof All trash and debris wilt be removed and disposed of properly; All labor, materials and debris removal` - OPTIONS: To install 30 year Woodscape Series algae re ' architectural°shingles add I to above Block old vents and install new ridge vent ad to above YeS PLEASE INDICATE SHINGLE COLOR AND YES TO ANY OPTION ON RETURNED PROPOSAL Repair rotted wood at ) man hour plus the cost of materials /v�✓ �` ��� ep Per Only items specified above are included in this proposal Materials guaranteed by manufacturers Nickerson Home Improvement Inc. guarantees workmanship for 10 years WI~ PROPOSE_ herebv to furni r:` -ial and labor—r^fmnlple7t-ee,in�yaccordance with the above specifications,for the sum of: �1 A s "."'00 Dollars dollars($ 3,920.®®) Payment to be made as follows: deposit upon signin,& progress payments upon request, balance upon completion All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance.Our Note:�Th.sr Lei may be !l workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 days. j ACCEPTANCE OF PROPOSAL—The above prices, specifications ' and conditions are satisfactory and are hereby accepted. You are authorized Signatur to do the work as specified. Payment will be made as outlined above. Signature - Date of Acceptance: �oFs KKETokti Town of Barnstable Regulatory Services BaaxsrABLE, Mass. Thomas F.Geiler,Director ES►A. & Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign,This Section . If Using A Builder I` g��5- au L1� , as Owner of the subject property hereby authorizeX )J i c V e.f-'�G%4 ffiyvu_ uQ-e )I.ce a to act on my behalf, in all matters relative to work authorized by this building permit application for: 3 a SL�,W,yy iy; d-e Ls,YLe N c),n y) (Address of Job) r gnature of Owner ate Print Name Q:FORM&O WNERPERMISSION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '3� Parcel (0 �=-J Permit# . Health Division V • - l�'4eifl •Date Issued Conservation Division Fee - `: C'J 62 Tax Collector �lpl(r(J Treasure , MT W f ONM A$EWER CONNECTION PERMIT FROM THE Planning Dept. ENGINEERING DIMON PRIOR TO ��taN Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village amn Ls r ' �Q S , , f3Q 0 2 P are Owner L.`1 •� Address Telephone `JL- Permit Request A 64 S.,co U Y4 � rD 6-0 � 49 X Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost A,200 . Vb Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family J4 Two Family ❑ Multi-Family(#units) Age of Existing Structure 5 Historic House: ❑Yes ❑No .On Old King's Highway: ❑Yes l No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full existing ) t 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 jk 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❑ r Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation#. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE vZC r I FOR OFFICIAL USE ONLY - PERMIT NO. €'1 DATE ISSUED. MAP/PARCEL NO. Z-I - ADDRESS ` VIL'LAGE ~` 7 OWNER DATE OF INSPECTIOP.4% - • °' .. � •ter FOUNDATION , FRAME r INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGHP` ` FINAL ,s • ice - GAS: ROUGH. FINAL FINAL BUILDING _ DATE CLOSED OUT t ASSOCIATION PLAN NO. � ` i The Commonwealth of Massachusetts ---- — Department of Industrial Accidents s^ T °-'- • ,�{__--r _ OIJJct'ollayes�getinos 600 Washington Street Boston,Mess Workers' Com ensation Insara,1 davitXxx raiii�vr�IIraiir.^�n�n� i �� �/CQ Snri+4A name: �. , 3 S u m/ri�15 l_A GvI locations hone# city I am a homeowner perforaung all work� •�� have no one %%%%%%% I I am a sole as this job. woricing myemp:?oY }:.}}:;:<,?...:<:::}?.:.......-. workers Inver ............. . ....... . .... . ..... .:...:::.::::::::::.:.:..:.:..:....:......:.:::.:..... ... an ..... �P ,... . .. .................. ....... .... . ..... ... .........:,.................:...-.....h ... .{... ..... •.,.. i' , .v. :v:.....;,,,.... •:.....::::......... 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M ..x,}•.. .rCa2d... �Oiicv in]urance-to- %: ?> ::;'; :' ii eanlndto the of erimtivalpenahies of a fine up w S23�.00 ar r ,r,. �a•�etlasi2UofMGL10 is the form of ai STOP WORE ORDER and a fine of 5100.00 a day against mr- I °mod Faijare w seettre coverage� doII p� a ve:iSeation. one Years'impnsomnent as to the Ofilee of h"adPt'aus of the Dm for covn2g copy of this statement may be forwarded paw msd peltalties of Perry��infor"iziDn prvI above is a w md correct I do hereby certify Date Siffiature Phnae# _ Print name do not write in this area to be com*ted by city or town official ofSdal we only ❑Building Departtttent perrdtitieense# — ❑Licensing Board city or town: ❑Selectmen's omce ❑checklf 1ma►ediats response is required ❑Health Depa�testt ph0�#' OOther-- contact person: _nS�PIAl — , Information and Instructions T ' compensation for their ,yiassachusetts General Laws chapter 152 section 25 requires all employers to provide workers ��in the service of another under any contr�. employees. As quoted from the"law", an employee is defined as every'P of hire, et-press or implied, oral or written- !n er is defined as Parmership, association, corporation or other legal entity, or anv two or more of An emp y the legal representatives of a deceased emplover, or the receiver or the foregoing engaged in a joint enterprise, and including to employees. However the owner of a tr ustee of an individual,partnership, association or other legal entity, employing emP Y house of artnents and who resides therein, or the occupant of the dwelling dwelling house having not more than three.ap grounds or another who employs persons to do maintenance, c �or repair work on such dwelling house or on the gr y building appurtenant thereto shall not because of such employment be deemed to-be an employer. state or local licensing agency shall withhold the issuance or renewal MGL chapter 152 section 25 also states that every in the commonwealth for any applicant who has of a license or permit to operate a business or to construct buildings neither the not produced acceptable evidence of compliance with the insurance coverage veratge require for quirhe performanced� Public work until p of its political subdivisions shall into y I nor any P of this chapter have been presented to the contracting acceptable evidence of compliance with the insurance requirements authority. Applicants ' compensation affidavit campletdy,by checUV the box that applies to your situation and Please fill in the workers mimibers along with a certificate of insurance as all affidavits may be suPP1Y COcompanyaddress phone Indust Accidents{� mation of insurance coverage- Also be sure to sign and submitted to theDepartment�shoed be returned to the cuY or town that the application for the permit or license is date the affida © - Should Y�have�y questions regarding the "law"or,if you being requested,not the Department of Industrial the Department at the member listed below. are required to obtain a worersk caanPensatiM Pow''P / ME City or Towns P that �• The Department has provided a space at the bottom of the Please be sure the affidavit is complete re the applicant. Please to fiIl out is the event the Ofiace of Investigations has to contact you gard�gbe returned to affidavit for you member. The affidavits may be sure to fill in the permit ease mmiber which will be used as a refezence the Department by mad or FAX unless other. . have been made.' The Office of Investigations would Ii1ce to thank you inadva nce for you cooperation and should you have any questions. please do not hesitate to give us a caII. N„ The Department's address,telephone and fax number: . . The Commonwealth Of Massachusetts Department of Industrial Accidents Office of mvestlDatlons 600 Washington street Boston,Ma. 02111 fax*: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 The Town of Barnstable FtHE Tp�O Department of Health Safety and Environmental Services Building Division BARNsz'asz.e, ' 367 Main Street,Hyannis MA 02601 utwss. 9 i639. 10� �prEO MA'1� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: " a2 JOB LOCATION: 3,L 5u m✓71-Q/) S t de C'✓1 r-)f S number C - street C village "HOMEOWNER": L' !7 e Sm, , 6_& O namd home phone# work phone# CURRENT MAILING ADDRESS: S G'� ' 0 3LIG V 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 f all such work performed:under.the.buildin ermit._, . .. (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 procedur s requirements. Signature omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply . with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN STANDARD LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY E _coo EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY X EDGE OF CONIFEROUS TREES XMARSH AREA • i� X (---� EDGE OF WATER DIRT ROAD 1_ DRIVEWAY E—PARKING LOT MAP 3: : ---- PAVED ROAD "---- DRAINAGE DITCH 1 PATH/TRAIL v r PARCEL LINE** MAP 110 E - MAP# 21 E PARCEL NUMBER #11160 —HOUSE NUMBER 7 2 FOOT CONTOUR LINE: 1:0 10 FOOT OONTOUR LINE_. Elmvation based on NGVD29` 4.9 SPOT ELEVATION 00o STONE WALL -X—X— FENCE w RETAINING WALL I �+� RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK �j BUILDING/STRUCTURE L0— DOCK/PIER Q HYDRANT e VALVE O MANHOLE o POST pFP RAS POLE T O W N O F B A R N S T A B L E O E 0 6 R A P H I C 1 N F O R M A T I O N S Y S T E M S U N 1 T SIGN, ® STORM DRAIN w PRIM SOME:IN FEET *NOTE.This MP a an erdagemmt of o **NOTE The pond lines we only gmphic mpleserrialioas DATA SOURCES:Planimetria(man-mode fealums)were interpmw hom 1995 amiol phmopmphs by The James 1°=100'ale map and may NOT mast of pmpeq boundaries.They am not hue loation,and W.Sewall Compony.Topogmphy and wegetalion were in"reted faun19B9 medal phologmphs by GEOD UTIIIIY POLE TOWER w e 0 10 20 N*nd Map Acamcy Standards at thit do not mpretent auud mlatiaahips to physical objects Cotpmation.Planimwiq topogmphg and vegetation were mapped to meet Natiaml Map Aaaaacy Standards UGHT FOIE o EIECIRIC BO1I s 1 INOI=20 FEET* enlaeged sale. an the map• at a soda of 1°=100'.Pamel lines were fthizud faun2000 Town of Bamsmble Amesafs tax maps. SCAnS r Outdoor 11 Play Center :,,1,.c _ 1 v CL dPnt i AA I��3,�R'��•it �f n.� a $_: ` �.� � _i s Elm :r • • ,I-t y sty= alai _ F -�r t� "`` pg { lea { f II t l aP t f� ww" �.z'";+r s�`""°i $ii P l� �`y' gE Your headquarters for '� � Pqs� x.. * Q, r fun! .( Pfi 'A }It MO; r� _ +4 yk',,,, ,� .h, .fwa. 'cs..rF ,�• � � � Eclipse Of Great fun...great times...great Two passenger lawn swing Glide tide with patented Safe-I"Glide Guard Uovulo m TWo Comfort- T Rid '" lide with special race car feature (car not included) fe/ Durable,long-lasting Super Kote-paint .......... Clear, concise owner's manual Includes toll-free 800 number for customer TV SE assistance Must be anchored in concrete or should use Hedstrom Auger Anchors Assembled dimensions: • • •- Windsor II -11, 6. - �.i t � _ � s- .i 1' -� may.'1/� ` 4-.i•'�' 4 passenger swing so more kids can have more fun! * Four P4 • L. f"- R �"•Q .RM passenger t Glide ride with patented Safe-V Glide Guard Covee ti * Two wrap around sling swings 3 i y * Chain trapeze with rings * 6-1/2' Race V ffide"slide with special race car feature (car not included) A I t Durable,long lasting Super Kote1. t 'e3 conciseowner's * Includes toll-free 800 number for customer �2 X assistance Me Must •• 1 1 1 1 1 • '� *�...pm= - 3.ay. �. "G ,f` 1-�:•ay �r r.- •� s � � . r •#i .- t �ts„�r,�^ co�porahon °..,:,r� ?+ �pw.t,�+ r��r,�• Ej30'x 9 5'x 4' package includes: pool, ladder and skimmer (filter sold separately) • Galvanized steel wall • ` " • 6-1/2" sage resin top ledge accepts optional Moonbeams"fiber optic lighting without adhesive E ® � • 5-1/2"sage galvanized steel upright wall supports ` x • 20 mil heavy-duty vinyl winterized liner �. ;, : • 25 year limited warranty on wall and frame; s + 15 years on liner ' Va �� ,Includes installation video 4 =. • 10,398 gal. capacity;402 sq. ft. swimming area • Also available in 24'x 4' (#41041); 11,709 gal. capacity;452 sq. ft. swimming area L • 33'x 9 6'x 51" package •ncludes: �®- pool, ladder and skimmer - ` (filter sold separately , 52 pool height for more fun. • Stril ung"Shell"pattern on galvanized steel wall, Krystal KoteF"liquid vinyl finish • 7"wide top ledge, 6"wide posts;Krystal Kote"" { m A liquid vinyl top coat; two-piece cap 4 " • Hot-dipped galvanized steel frame components a � �t • M �° • • Deluxe border bottom/print 18 gauge winterizeda C vinyl liner; easy to install V-Bead =® a - • Oval shape with integrated bracing system # " " ensures a true straight side wall � , �� " • 25 year limited warranty • Holds 15,000 gal.;452 sq. ft. swim area l • �, • Also available in 24'x 52" (#38052);holdsg 14,600 gal.;452 sq. ft. swim area ' I • e e � I " All that fun and a hideaway tent too! z. • Hideaway tent with anchors r + Two passenger airglide ' ;3 • Two Kid Comfort®swings j •Trapeze , • 7' 3"deep well slide • Rust resistant dichromate non-protrusion hardware • Child contact areas are made of plastic for comfortable and safer play 111 • Clear, concise owner's manual �1 Q� �t • Lifetime warranty on Wohnanized pressure- treated wood g= • Includes toll-free 800 number for customer a� � assistance `'' P • Ground anchor kit recommended •Assembled dimensions: 12' 8"1 x 6' 6"w x 6' 7"h y , Good times, great friends—season after season • Premium playground lumber ' X� ' r • Two sling swings • One acrobatic swing • Overhead monkey ladder 'f • 8' Race'n'Rides"plastic wave slide with special race car feature (car not included) ,'" • Play platform with multicolored canopy }� • Climbing rope ladder •Angled wooden access ladder • Clear, concise owners manual r • Includes toll-free 800 number for customer assistance t • Ground anchors included ` •Assembled dimensions: 13'1 x 12' w x 8'h 15'x 4' package includes: pool, ladder and skimmer (filter sold separately) y * Galvanized steel wall - • 4"wide white galvanized steel top rail y �,, • 2- 4"wide w galvanized steel upright_ 3/ 'dhit a g a1 wall _ h supports * 14 ga. winterized vinyl liner g- A ' OW14 it"im • 10 year limited warranty on wall, frame and liner a « , • Includes installation video • Also available in 18 ft. x 4 ft. #38021 (top inset) and 24 ft. x 4 ft. #38022 (bottom inset) pro, t e 24'x 12'x 4' package includes: pool, ladder and skimmer (filter sold separately) ' E * Contemporary stripped pattern on galvanized steel wall; Krystal Kote®liquid vinyl finish * 6"wide top ledge, 5"posts; Krystal Kote®liquid �:w vinyl top coat; two piece cap * All frame components.are hot-dipped galvanized * 16 mil.heavy-duty winterized vinyl liner " * Oval shape with integrated bracing system ensures a true straight wall • 20 year limited warranty • Includes installation video ' * Holds 8,000 gal.; 257 sq. ft. swim area * Also available in 24'x 4' (#41031);holds 13,500 gal.;452 sq. ft. swim area n, �' nr.oni� The "Good Guys" always win in this ..� ... play center! ` vr - a • Premium playground lumber m •Two sling swings; one acrobatic swing • Overhead monkey ladder • 8' Race'n'Rides" plastic wave slide with special race car feature (car not included) • Extra large sandbox •Angled wooden access ladder • Western Red Cedar walls and floor • Climbing rope ladder [ •Multicolored reversible fort canopy • Clear, concise owner's manual f' • Includes toll-free 800 number for customer assistance • Ground anchors included •Assembled dimensions: 13'1 x 12' w x 9'h a For backyard family fun and r , excitement! ' • Galvanized steel frame with arched legs for added stability -. • Durable jumping mat is UV-treated to ' See protect against the sun's rays g - • Cross-over-center spring design W ' Our distributes weight evenly Display •Weather-resistant safety pad covers springs and frame for a •Meets or exceeds all Complete Federal and voluntary ASTM safety standards Assortment of • For ages 6 and up (for use by one Backyard products person lighter 1 and Accessories than 250 lbs.) NII , ,. . . • a " i • • • • • .�``` ' ` Com m �+.y g ,w � �m�, 'r '� , �. Value-packed 4-leg gymset for your IM" � active children uj _ ' • Two contour swings .,w •Trapeze chinning bar s i • Glide ride with patented Safe-TT"Glide Guard Cover® • 6-1/2' Race'n'Rides"slide with special race car feature (car not included) ^' • Durable,long-lasting Super Kote—paint finish • Clear, concise owner's manual s s fl • Includes toll-free 800 number for customer assistance ° t ' •Must be anchored in concrete or should usez. 3. Hedstrom Auger Anchors •Assembled dimensions: I F 4"1 x 8' 10"w x 6'h 6' !f 15'x 3' complete package includes: pool, ladder and filter • Sturdy steel wall; 1/2"white top rail • 10 gauge vinyl.,liner emu, • Aqua Brilliant water purifier " • Galvanized steel ladder r 1/25 HP UL Listed filter , _ ai eel • 1 year limited warranty `` ,e r- � h Ydl l�e L iS 3r1 a, 4 7 15'x 4' complete package a ` �' includes: pool, ladder, filter ` and skimmer +. - • Galvanized steel wall `- • 1-1/2"white galvanized steel top rail • 2"wide white galvanized steel upright • 12 ga.winterized vinyl liner See • 2 year limited warranty on wall, Our frame and liner Display • Installation video • 4,574 gal. capacity; 177 for O sq. ft. swimming area Complete •Aqua-Brilliant purifying system Assortment O¢ Backyard Products and Accessories Town of Barnstable FINE Regulatory Services Thomas F.Geiler,Director BARNHABLE, MASS. $ Building Division .i63q 10 ptFD 39 a Tom Perry,Building Commissioner c� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# LA , FEE: $ , 5 v� -� IAZY SHED REGISTRATION co 120 square feet or less ' 710 Location of shed(address) Village. Go cn Property owner's name Telephone number 3 . 7 Qr-? �, Size of Shed Map/Parcel# Signa a Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) -3�/ PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 �.� � c►� -a54-S(a DA VID FLEMINC & A SSO CIA TES MOR TGA GE INSPEC T10N PLAN ND LA SIRMTAS This plan was not done with an Instrument surrey 38 POND SWE'T. FAX and Is to be used for mortgage purposes only (617) 43a-o 136 STONMAM, .4L4SS, (6 f 7) 279-0725 DA T 7. 7- 99 SCALE: ;f = r 30 certify that this dwelling k IoSqLe approximately as shown and conformed to n the zoning bylaws of the 6iE} owr, of eQ"j7*&e l/SI�.INiI&0 . M-4 g when constructed and is not located in a flood plain hazard zone.' n CER 77FIED TO FLEET MORTGAGE. �.r o Dew & Pion .Reference IV CALENDA 6r IACOI, A3AAA0Y49C.E County Reg. of Deeds AND THEIR 77 7LE INSURANCE COMPANY A e Bk.-7394 Ad Z66 N g Pc.eK. 19/ 'Od• /O9 0 O e O t O N . J SovNO FadN o J:` S8:' 7 1 oT A %wooD nI�F c F 6ALLA6116C it s-poe/wbob �1 i �5 c5(�MNJE/��/DE LANE -�,•j o.q'S^. ,Q I ✓ wA y 1 �► G�ST �a`�` 4,.v � �:�su��