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HomeMy WebLinkAbout0033 SUNNY KNOLL ROAD i r � i I I a I +� i 1 TO / TIME DATE }+ JE ( ./tj - `��' [ ttRGENT! l�Tetephcaed .' M Retnrne� ( Cnligd to �-- gourcnit � OF ViM I a V1 V1 see " 4YnMs to PHONE 1 4Y�tcult ] Ynn'll MESSAGE OPERA OR: �C 7 23-024-400 SETS 23-027-200 SETS r' .�� f:, r > Town of Barnstable *Permit# 00 a.° 6,0Y� Expires 6 months rom issue date Regulatory Services Fee autxsrAai E MASS Thomas F.Geiler,Director X_PRCL+ ERMI .Building Division G�7 Tom Perry,CBO, Building Commissioner -OCT —3.2012 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ABLE Office: 508-862-4038 ro f(�QF _4 JJ EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ? Z Address1 ` � �� 14q ential Value of Work l Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address IA Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) 7orki tion Supervisor's License#{if applicable)an's Compensation Insurance Check one: ❑ I am a sole proprietor . ❑ Ixn the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# IOU.,7WIS013 1(a Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows_ ❑ 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 a Home Improvement Contractors License&Construction Supervisors License is required SIGNATURE: QAWPFILESTORMSIbuilding permit forms RESS.doc Revised 053012 ■EEff The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 11 11 Please Print Legibly Name(Business/Organization/Individual): �l'` �1 I11P11 l/1q Address: �`2- City/State/Zip: hone#: Are y an employer? Check the app rate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors ti. ❑New construction 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 � �'• x 9. ❑Building addition [No workers'comp.insurance comp'msurance' 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L[J Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑R f repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. er comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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.Lie.#: Expiration Date: S , Job Site Address: City/State/Zip: Attach a copy of the workers'compensatio4plicy eclaration 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 da ainst th violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of DIA for' ce coverage verification. I d re by c fy the p a penal les of perjury that the information provided above is true and correct i a Date: -1121 Phone#: Official use only. Do not write in this area,to be completed by city or town offteiaL 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#: office of Consumer affairs and 13usiness Regt"latlon 10 Park Plaza - S'uite 517CJ jBc)st€in, Massae�41-setts 02116 F - ........ . A cme Im ro erlent q(�Vactor RegistratiorA t�eaistration: 132349 Type': Partnership = Expiration: III 1t2t)13 t 207392 J &a Remodeling Joseph Duarte '_ ��" - -- --------- - . 15 Fall St: _--_____-------~ Wareham, rria 02571 \4 _ Update Address and return card.M21rk reason for chinge. (� Address (� Renewal Employment [] Last Card: 7PS-Ci{lt (} SOM-0004-010/216 �,,((� ,,� �o �elt� License or registration valid for individul use only Offite oftroasa,n a rs �siae-sb►tegu a o„ before the expiration date. 1g found return to: SOME IMPROVEMENT CONTRACTOR Type. ()trice of Consumer Affairs and Business Regulation Registration, .,•132349 10 park Plaza-Suitt 5110 Expiration, .11I1lz013 Partnership Boston,MA o2116 J emodeling;. Jesaph Duarte 15 Fall St. Wareham,ma 02571 Undersecretary of v d without signature of puhlic safct> Board of I�uildit1�Rc`anlatiuns:tud ti[:tnd;tr�t� ConStruCtion Supervisor License License: GS 70077 j0SEP0 C DUARTE 15 FALL ST WAREHA1V1,'MA 02571 � t zpiratton: 12r30i2412 Tr#: 7048 _ - - Z9LGSGZ £S:IZ IIOZ/ZO/IO TO 39Vd Oct 02 12 03: 58p Michael Bedard 1-401-246-2868 p. l . _�:t' �`�'.i:.'i ..•t _:"_" iL>�'!i-%'', .^i!vi': :I;�=r�tij-'1'=. --„rt• -..4/v. _ - __ CERTIFICATE OF LIABILITY INSURANCE GATT a..aa+r yr, a THIS CERTIFICATE IS ISSUED AS A MATTER OF IMFORMATICH ONLY AND CONFa,RB to RIGHTS UPOIIf THE CERTIFICATE MOLDER.THIS CERTIFICATE DOES NOT AFF RMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT gE AMIEW THE ISSUING "SURER(S),AUTHOR290 REPRESENTAN-W OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the eMMeate holder is an ADDITIONAL INSURED,the poltoy{tasj suet be endorud. If SUBROGATIDN IS WAIVED,subject to 'I the terans and conditions of 1hs policy,certain policies may eepuiaa an eodofteln mL A abdettwat on this cartifkate does not confar rigtda ED the certificate holder in lieu of such andom ems R- wlooueeR PAUL 6 SULLIVAN INS AGCY INC r I 1467 S MAIN ST ! FALL RIVER,MA 02724 ' Me F.B.(50 z - PAX1� aatMr A�ADI1CeeODDYt3rAc►E �wue0 1 A: . bum ("SUM JOSEPH DUARTE&JOHN DALEY Rmalla 06A J&J REMODELING 94e1MER o: 15 WILSON WAY „ D: MIDDLEBOROUGH MA 02346 WsuRER E: ef- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; j THIS 15 TO CERTIFY 7HAT THE POLICES OF INSURAWCE,LISTED BELOW HAVE BEEN ISSUED TO THE WSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO. NOTWITHSTANDING ANY REOLRREMENT TERM OR CONOMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED E Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7HE TERMS, EXCLUSIONS AND CONDRIOVS Of SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAIDCLAIUS. LL RR TYPE or ww Mce I POLICY M 104910 P WDOJY Lon$ GENERAL LABILITY EAC1fOGCUaRttiCE 3 COMI IE ACIAL GENEWIL VAINI..T' ` N S euenar o. f CLANSJAADE MOCCUR ( IED 61m fM one peraoa) S PERSON^6 ADV IMAA%Y S GENFRALAQOREGATIV 3 GENLAGOM"IMLIWAPPLIESPER: I PRODUCTS-COUPIOPAOD S POLICY At0- lOL I $ AUT01010"UAftrty ■ t ANY AUTO 60mv PUUW(PRO pomp) AUIM R sMEaLaEDµ/TO$ AUTOS eDDRY WLInY V+ar ecMON-OHIREC AUTOSAUTOS NED AUTOS i nee- 3 1 ! f 3 uMeleE LA LIAa OCCUR EACH OGCIIP(C1ICE 3 fJICE80 LU1a OtAUS-YAOE i - ; AGOREGATE S . OEO RETENTIONS V f I � S i 3 A Mw 04PLOveng uAeluTr YIN WC5 J1S384800-012 M012 2/2Q013 ANr PROPalE70RIPARTM£RrEtt£t;Vfrv£ M7A El.IJ1C„ACC1DfNi S j OFFIC90UMFMKA EXCLUIXO' Y� (1la ndalory in MM) E.L.01WASE-EA EWItOYE 3 1ONG II}es,AnaOe under DE8CRPTIOM OF GPERATIOH:4 EL DISEASE-POLICY La1T $ 50000 pe$CRPnOM OF OPERATOMf fLOCATN M r VEMCLE!(A14eD ACOtO Iot,Addiiowl Rrnrise 6ahedlry,if nNeepece a.re"Irea) Workers compmution insurance cowrage applies only to the workem Doff" Mallon laws of the state of MA. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFIZA—TE HOLDER ` SHOULD ANYOF THEABM OEWRIBED POLICIES BE CANCEL{EO BEFORE TOWN OF BARNSTABLE TINE EXPIRATUM DATE THERISOF, NOTICE MRLL BE WLNERM IN 200 MAIN STREET AccalwacEwm+THE POLICY rRMSIONS. HYANNIS MA 02601 AYTIgMIXcO R9RELIerRA11YE Jolt Fkkfdao A 1"Ill- p10 ACORD CORPORATION. All rights re"wed. ACORD 23(201CM5) The ACORO name and logo am mg1stwed marks of ACORO Ci0.T e0.. U9S1217 Z'1C&T 00C. 1505L11 rtaraa An•]es son 4/76/2012 a aTa: N�rage : of I [Ai! ¢ert.taute canceler ew aapercedes AL1.prerLWely a»Ned Clrtlfacatea. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnishett and installed by: 3 ( l Branch Name.: 1loston Date: G D '1'HD Al-Home Services,inc. d/b/a The Home.Depot M-Hume Services 908 Boston Turnpike.,Unit 1,Shrewsbury,MA 01545 'full Free(900)657-5182;Fax(508)845-0O17 Branch Number:31 Federal ID#75 2698460:ME Lic#C 02439:RI Cont.Lic#16427 CI'Line#HIC_0165522;MA Home Improvement/Cnnn.cu,r Rest,A 126893 / installation Address: J/!17t"1 1/lOt� I FJ 1 �Jr Pl� /Q O �® ` City 'lIalt: Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: a , hoct 0113 3 Home Address: _ (ifdiffercnL from installation Address) City State 'Lip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing:ernails from The Home Depot Prolect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrree%to huv, and THD At-Home Services.inc.("The Hume Depot",l agrees to furnish.deliver and arrange for the installation("Installation")of all mal.crials described un the below and on the referenced Spec Shcei(s), all of which are incorporated into this Contract by this reference,along with any applicahle SLaw Supplement and Payment Summary attached hereto and any Change Orders(collc Lively, "Contract."): Joh#: (l." w Products: _._ Spec Sheet(s)#: Project Amount ❑Roofing ❑Sid!ng Windows Q Insulation $ ❑Gutters/Covers ❑Entry Doors El55-� 0 1 ltoofing ElSiding Windows D Insulation ❑(lutiern/Covert; ❑Iiolry Doors ❑ I LIRotifing LjSiding U Windows U Insulation ❑Gutters/Covers ❑Entry Doors❑� I I QRooling ❑tiiding❑Windows ❑insu.hitiun ❑Gutters/Covers ❑I?ntry Drxvs ❑ Minimum 25%Deposit or Contract Amount due upon execution of thin contract. Total Contract Amount $ Maine PurrhAwrs may not dep mit snore than one-third of the Contras Amount. a Customer agrees that,inunediately upon completion of the work for cacti Product.,C.us].omer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance.due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. 'file Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual 1'roduct(s)included herein,at its discretion,if The IIome Depot or its authorized service provider deterrninc.Ural it.cannot perform its obligations due to a structural problem with the home,environmental hazards Such as mold,asbestos or lead paint,other safety concerns,pricing errors or be-cause work required to complete the job was not included in the Contract. Payment Summary: The Payment Sununary#. 513 included as part of this Conn act,sets forth the total Contract amount and payments'reyuirui For the deposits and final payments by Product(as applicable). NOTICE T'O CC15'I'OMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate.for each listed Product as defined by individual Spec Sheets)before work orb that Product is complete. In the event of termination of this Contract.Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plats any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE 14OMF. DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Accen'rsince and Authorization: Customer agrees and uncicrsrands that this Agreement is the entire agreement between Customer and The Home.Depot with regard to the Prcxiucts and installation services and Supersedes all prior discussions and agreements,either oral or written,relating to said Pi-miucts and Tnstallation.This Agreement cannot be assigned or amended except.by a writing signed by Customer and The.Homc Depot-Customer acknowledges and agrees that Customer has read,underxhmds,voluntarily accepts thc terms of:md has received a copy of]his Ag,Reemenl.. Accepted by: Submlt M hy: Customer's Signature Dat Sales Con. ihanC's Signature Date 'CLo � ,, G,1-dF�cicphone No. Customer's Signature Dal: Sales Cansullanl.License No, CANCELLATION-. Cl1S'I'OMER .MAY CANCEL THIS (as upplioihlc) AGREEMENT W1'111OU1'PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE. THIRD BUSINESS DAY Al,-I'ER SIGNING THIS AGREEMENT. THE STATF, SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE iF ONF ,iS SPECiFIC:ALLY PRESCRIBED RY I,AW IN CUSTOMER'S STATE. NI)TICIL:ADDITIONAL.TERMS AND C ONDITIONS ARE';S'I'ATF:D ON'I'HF.REVERSE SIDE AND ARL FART OF PHIS CONTRACT - L/6 d SHd zodea aWOH << yLZ�ZL 6905 3N0Hd'KGdX32692 Z2:2 6£-90-M2 and Bus ��s e� zl�t on 0siC� =, Suite 5.17Y. _ �� ��.r1�Plaza - S ; .- • ` � '` ssachusetts. 02116 ri V. improve ontra.ct�restitin w Ra9iPstraflon . 128893 Type; SUP pfeman CaN . mp`railoR: 313/201 h The k'JGP i�f� �J+ ® .l - ®Pi1C.SPvl P 239D CJ1iBERLAND PARKWAY :f '�J w r�T �i�ITA.; GA 30339 nr ;yg� UpdatedrPME add return card. Birk renson jor chnngc. Address [j Renewal .r .Employntent ❑ Lost Cnrd 50N7-04i02-G��""IjjO""77i219 L09204L Z1LldGUL giness egul l .. . ti3 ice of confumer Affnia's 036 Beis�ness Regulation. License or registrat[on vnlPd.far PndP�.iduP use only before the expiration date. If found rcturn:.t©:' " IS WE ®iSice of Consumer r�47uirs as d`business Rcgnfation % (MOMS lMPF GVSMEP�9T GOFf7r'i�CfOR . Typ®: 10 Park?'Inz a-Suitc�17.0 ,� .Registrat(ori:.;9268�3 Supplement Gard Boston,MA 02116 ' J)e Hams+Depbl`}X H�trie��rv��es 0) !C UM3E RLA I�ll7 PA�tF�611/`1S -----�` i i1i 1�iti, GA 303 9" .� �'-'` 'IVOt vnlid with ut sinaturc Undersecretary, 4Pi August 17, 2012 Y Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres-CSSL# 100546 HIC # 163528 Michael Viola -CSSL#099403 HIC# 140993 v Robert Reposa CS # 60526 HIC# 147080 Timothy Thomas-CS# 51899 HIC# 152121 Joseph Duarte CS # 70077 HIC# 132349 Douglas Szynal ,CSSL# 103950 HIC# 146142 Brian Laroche - CSSL# 1.00478 "HIC# 152612 Joseph Mckeon CSSL# 98863 HIC# 132614 If you have any questions please`contact Mike Bedard our permit coordinator at - 508-962-6942 or myself at 617-438-9017r S' cer y, ussel Jo t e r Branc stallation Manager. THD At-Home Services, Inc._ 908 Boston Turnpike• Unit 1 Shrewsbury, MA 01545 Phone:774-275-2139•Fax: 508-845-6076•Toll.Free: 800-657-5182 ng1neering Dept.(3rd floor) Map 3 O Patcei Permit# 3 q J `. House# � ) q�•� �FjS° Date Issued Board of Healthtrd floor)(8:15 -9:30/1:00-4:30) Fee 6 d� Conservation.:Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) tME tp;_ efinitiv Plan Approved by Planning Board 19 'R� _ BARNSTABLE. MASS TOWN OF BARNSTABLEF°"9' Building�Permit Application Project Street Address P D ctlsJ LT,- .J Village Owner ck_Q c Address - + Telephone �. 0e 0- a10 it _ Permit Request . A OF— First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ �� Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name e?�fj (2- oc/l awG Telephone Number Address + r7 71 te License# (Yl I , Home Improvement Contractor# Worker's Compensation# 0-r—I5/ Y !,;)s6 3 0/4 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -- DATE BUILDING PERMIT DENIED FOR THE FOLLO NG REASON(S) FOR OFFICIAL USE ONLY .PERMIT NO. DATE ISSU)ED MAP/PARCEL NO. ADDRESS _ VILLAGE OWNER f t DATE OF INSPECTION: FOUNDATION FRAME , INSULATION ` k FIREPLACE 1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH k FINAL r GAS: ROUGH FINAL ` FINAL BUILDING • ', � it { 111JJ A �.t,� � � • DATE CLOSED OUT ASSOCIATION PLAN NO. . , THE r, F Barnstable The Town 0- mf genIth Safety and EnvironmeIItaI S ervlcES � � Department o ]Building Division 367 Main Street,Hyannis MA 02601 r Ralph Qms-= Office: 508=90-b227 Building Comm Fax: 508-7,90-6230 For office use only Permit no. Date AFFIDAVIT, HOME IMPROVEMENT CONTRACTOR LAW _ SUPPLEM&NT TO PERMIT APPLICATION ` MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, d at 1 lessi one 6nconstruction t t ot�moref than fourn to any dwelling units aring to owner occupied building containing contractors, with which are adjacent to such residence or building be done by registered certain exceptions,along with other requirements. Type of Work: � Est. Cost Address of Woric: o - Owner's Name Date of Permit Application: �d I hereby certify that: Re`istration is not required for the following resson(s): Work excluded by law _Job under 51,000. _Building not owner-occupied Owner pulling own permit Notice is hereby given that: 7S's'FiR OWNERS PULLING 'SIR OWN PER511T OR DEALING WITH UNREG CONTRACTORS FOR APPLICABLE HOME RAM OR G�iJROVEMENT WORK DO�D UNDER MGLO 14Z.� � ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a pertnit as the agent of the owner. 0//'�? Date Contractor Name Registration No• r - f :x The Commonwealth of Afassac•huseffs Department of Industrial Accidents 1 y ,_ - Office ofluestigations ' •\_, 'l' '_r;^'' h00 li'a.vNiz tun Street Bttstun„ a.u. 02111 Workers' Compensation Insurance Affidavit •Applicant information: Please PRINT lebjbjv name• �-02GZ/✓` C location: C (k city ���" ; phone tr I am a homeowner performing all work myself. I am a sole proprietor and have no one workin_u in any capacity ...A:. .•.^��.•._ ..—•_.P.'._w__......._•ew._.�7 . .'1�M:+'7Ta� r�IT}�.►_aw.�.s.�..ft_rw��. yrn.�w...• .w..4+.�_:r v..__._ am an employer providing workers' compensation for my employees working on this job. cr mminv narne: address: insuranccco. 121INCY# �• s C3963c,) 7 ['1 I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed belo,.v who have the following workers' compensation polices: Comnarn• narnc address: phone#• insurance rn. nolicv# c_omnam narme: r a addresc: Phone#- 4. insurance co:• nolicy# -777 Attach addititinaf sheet if necessary, __ T"�� :rL.•.LQ,i.wr lL F.IIIurc to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of 2 fine up to S1.500.00 andior une%cars• imprisonment as .ell as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the once of investigations of the DIA for coverage verification. I do herehr certif r c Ire s and pen s of perjun•that the information provided above is true and correct. Si^_nature Date /D-6_� Print namc Phone# Ao cial use only do not write in this area to be completed by cin•or town official � cin•or taw n: permit/liccnsc# I—t l3uiidin-,Department C3Liccnsing Board 7 check if immediate response is required Selectmen's Office ► f: p O t C3I1calth Department phone#• r-IOther contact person: l. information and Instructions ` 4 Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for thei employees. As quoted from the "law". an emploree is defined as every person in the service of another under am, contract of hire, express or implied, oral or written. An enzplurer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more the forcgoing cnuagcd 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 , construction or repair work on such dwelling hog or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer MGL chapter 152 section 25 also states that even- state or local licensing agency shall withhold the issuance of- 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. 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 h., been presented to the contracting authority. ....__._.�..__._.._ Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that tite 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. . City oC rolwns Please be dire 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. Plea be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to �-,ive us a call. _n....,...,...�,_. ........Aso...1.T--•T•....�.q•.o..._-----. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts �� Department of Industrial Accidents Office of Investigations 600 NVashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 cxt. 406, 409 or 375 Engineering Dept. (3rd floor) Map (� Parcel 4 I Permit# 1 H,00uusee�# Pis Date I suediDpw Boa� Uh(3r floor (8:15 - 30%;1:00-4:30) 3 �o�j:r Fee Conservation Office(4th floor)(8:30-9:30/1:00=2:00) Planning De t.(1st floor/School Admin. Bldg.) �t►+E rq D mitive Pla pproved by Planning Board 19 BARNSTABLE.` MA9. SS P ` TOWN OF BARNSTABLE, 'E° +'� 8 Building Permit Application Project Street Address 50 4 � -2 Village i Owner Address Telephone + + pPermit Request Ze f , `First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ e L: Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 f Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name CV_& -1 �' f'ti-LGc,l�Q^ Telephone Number Address "7/ _ 19-4C4 On 01/1 License# Home Improvement Contractor# Worker's Compensation# / . /S /5 36 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE f/ /,2 P I HE FOLLOWING REASON(S) t * �•" FOR OFFICIAL USE ONLY +PERMIT NO. - , � z _• - � Kam, DATE ISSUED MAP/PARCEL NO. ADDRESS - VILLAGE ✓ . + OWNER. + { DATE OF INSPECTION: r FOUNDATION r — FRAME INSULATION ' y FIREPLACE ; _ 1 e ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH + —FINAL ,— GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. the TownBarnstable of wRg- g Department of gealth Safety and Environmental Services . � °� Building Division 367 Main Suns,Hyannis MA=601 Raiph C-=Ie: Office: 508-7,90-6227 Building Carr..: Fax: 508•7,90-6Z30 For office use only Permit no. Date " AFTIDAVIT HOME MWRoVEMENT CONTRACTOR LAW SUppLEMEINT TO PERMIT APPLICATION „ air, modernization. MGL c. 142A requires that the reconstructfon, alterations, renovation, rep conversion, improvement, removal, demolition, construction of an than addition dwelling punitsre-or ng to owner occupied building containing at least one but a contractors, with structures which are adjacent to such residence or building be done by registered certain exceptions,along with other requirements. Type of Work: Est.Cast Address of Work: Owner's Name w `� Date of Permit Application: I hereby certify that: l Registration is not required for the following resson(s): Work excluded by law Job under S1,000. —Building not owner-occupied owner pulling own permit Notice is hereby given that: OWNERS PULLING THEM OWN PERMIT OR DEALING WITH UNREGISTERED T HAVE CONTRACTORS FOR APPLICABLE HOME PROGRAM IMPR AN'I'Y FUND UNDER MGLEM= WORK DO O 14Z.� ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the Owner. /Dri ? lion NO- Bare Name �= Date '�•iet�vm..�,v,.�w.{N..,y.�.2+:�: ,. - � 01 Y�fii' vY!. -+•:....,.�.,.e:....,_�.._� - . - i 4• r � r p- t- } 1 . i ` HOME IMPROVEMENT CONTRACTORS :,REGISTRATIONf . Board of Building Regulations and'' Standards One Ashburton Place Room 1301 Boston , �Massachusetts '021.08 J - - HOME` I P O t t M R VEMENT CONTRACTOR 4 Registration 112536 Expi.ration'+04/06/99 = �, �, r ...Typef DB A 4 t HOME IMPROVEMENT •.;; EMENT CONTRACTOR . Registration 112536 FRASER 'CONSTRUCTION Type DBA ' DEAN C -. FRASER ,ty; Expiration 04/06/99 f 71 TARRAGON CIR s € -` COTU I T` MA 02635 t E t FRASER CONSTRUCTION C. FRASER no IN TRAR- 11 TARRAGON CIR M IS T O �s COTUIT MA 02635 Tltc• CtI111/11011111calth of Massachuscas Dc partmeNt of Jurlustrial.4cculeflts OlfiC9VIhTV0Sff9a1lons i 608 if ushingtulr Strcc't Bttstotr.Alaas: 02111 Worken' Compensation Insurance Affidavit _ �lililirint information• PIcTi s gm7le- jjv—�—�-M narn Inc-i on- -7 1 //g a C GY) C�� sits• nhnnc M I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity - -- -;---•----.---_ -,..._......_.ter-;-,...-�.•. �--s-----^_--------•---'- I am an employer providing workers' compensation for my employees working on this job. emml•tny n• roe• fF4&t>421.--1 liti �PL� !C 7YC>'1 pile!rrcc� city nhnnc#- incnrnnce rn. J-4 rZ /- /y, 1-cc..�.Q nn ccr�,Ll S y�i'd 36_�_16 I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below WrIo the .oilowing workerS' compensation police: cmmP•tny nntne- adrlrrcc� cit— nhnnc a. incur—nrr ro nniiev 0 __..._._ .._ ...�._....._. �-.���...�-.- _—ire- �:.+� -__ _ _l• _ _- ___ cnntnnn-v nninl•' atl�lrrcc• rim. nhnnc tt• incurnnre cn nniic�• Attach additional sheet if necessary—..y ._..• _ �i' :v....: ... .. .••..�..-�:.....a. •r......,:..�.+ur.•o�.-...v: .:.'�»��._.a-. Farlurc to secure ctt -eracc:ts required under tic_ c+ t�iann"_g of h1GL 153 Can lead to the imposition of errmtnai penalties of a line up t S1.500.UU ndrur unc cars' imprisonment as 11c11:ts civil Penalties in the form 0172 STOP 1�'ORK ORDER and a fine ofS100.00 a daV against me. I understand that a coPe of this statentet ma% be furn•nrded to the Office of Im•estiCztions of the DIA for coverage verification. 1 do herchr c fir unrlc r1r rr rrs ar pert !tics of perjure•t/tar the information prorided above is true and correct. 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Yktik .;{_.Y,;•Y ...}.r?y?k:kk ;:�:ky;:y}.;yy;Y:;;,-:.3>Y;�::k;`.�:•,`.} r.. i.xs �iri>ii� 2 #f>ty#\#s r rrr�� ..:,kkk2ikYi,. 2.YY„kk,'�t,k\Y,xt •.kk•.,:,,,E•,•::,::r•:•..........,.x....:..: k.{,.x,:n.{,Y,.n`.,,•.\„dkkkzk•kk`k`#k`2k2'U,:....tt :;.•`.�>�.,.....: ..-..:.�•....:i;G?�{�-a�,.,r{;•;G,v;y3i}k�;t�'ktiY.....`:`•.....kk...........�..........k4.....\-....:}r\.....-..v....................\.}}:}::.:}}Y�-......-.......t...----\.-.........\.\\4}:4...<.............................. ' F . j' TOWN OF BARNSTABLE :' //�-� �` BAR*-W 1240 r i ! Ordinance or Regulation Mame ofs'Offender/Manager � .� iJGriun, Address of Offerides.�_ Village/State/Zip �* ; Business Name Business Address , . 1290 Signature of Enforcing.Offic r .: Village/State/Zip Location of Offense 3,3 Eumol kAolI PIYC A� / Enforcing Dept Division Offense UQts NCt i2-e-t ri Facts 1 r(S�vL't�yrf d- �i�VrhJ ate. It, �eud 4fth4 ilx Jh *yCA r g. 11 -k) /CL ,d V/1 W1 ti 7 � J. I-Kilore -k ezy This will serve only as a warning. At this time no legal action has b eri' taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by th Town. r�s� l i�► �l � �6,oie I�- Real Estate System - General Property Inquiry] Helpe [ ] el—Id-: 30=7a-15 ;-;..,,Account No: 218035 Parent : : 'KNOLL,cat.ion:.-, 33-.SUNNY: L DR: Neighborhood: 61AC Fire Dist: HY < ;vel Lot :�2 Lot Size: . .18 Acres rrent Own: BANNON, -DENNIS J State Class : 101 9 BOWDOIN ST APT 10 No. Bldgs : 1 Area: 1144 BOSTON MA 02114 Year Added: Deed Date: 100193 Reference : 8840/327 January 1st : BANNON, DENNIS J Deed MMDD: 1093 Deed Ref : 8840/327 Comments : Values : Land: 20700 Buildings : 65700 Extra Features : Road System: 33 Index: 1561 (SUNNY KNOLL DRVIE ) Frntg: 100 Index: ( ) Frntg: Control Info: Last Auto Upd: 102895 Status : C Last TAGS Update: 102495 Land Reviewed By: Date : 0000 Bldgs Reviewed By: ME Date: 0588 Tax Title : Account : Taken: Account Status : Hold Status: Press XMT for more data Cancel [ ] Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ J Parcel Number [307] [116] [ J [ ] [ ] 1 F