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HomeMy WebLinkAbout0075 TOBEY WAY �` �y �• l' I 1 f A' 1,� ' v/J '� - r - - Town of Barnstable *Permit# Expires 6 nth issue�t PERMIT Regulatory Services Fee 6 2015 Richard V.Scali,Interim Director TO BARNSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable-ma.us -' Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY R;7-7 � Not Valid withwutRedX-Press Imprint M;'ap/parcel Number Property Address 73 W A� S��-�-�Gl S , --- Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l�F-1L_ tTCXf�i�� 75 1-M —S Contractor's Name A Telephone Number '7® -6� Home Improvement Contractor License#(if applicable) ®-o1 Email: Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation insurance Insurance Company Name kex) Workman's Comp.Policy# W 6- ®Y9/0 P 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 _ Replacement Windows/doors/sliders.U Value (maximum 35)#o doves �' #of oors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspec 'ons required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le_ toric,Conservation,etc. ***Note: Property er sign Property Owner Letter of Permission. A copy of H Improvement.Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN D\Building Changes\MP S RFSS.doc Revised 061313 HOME IMPROVEMENT CONTRACT PLEASE READ THIS c,,�.[�f{ ��j Sold,Furnished and Installed by: Branch Name:Boston North&South Irate:Lr�/:5_ � _ THD At-Home Services,Inc. "a The Home Depot At-home Services Branch Number:31 and 33 908 Bostoo Turnpike,Unit 1,Shrewsbury.MA 01545 Toll Free 877-903-3768 Pcdcrxl W 4 75-2698460;ME Uc#C 02439;Rl Cont.Lic#16427 L CT Lic#HIC.0565522;MA Home improvement Contractor Reg.#126R93 Installation Address: d 6 es-t �.t jc2a /-/,wC! Zip 1'urchascr(s): Work Phone: Home Phone: Cell Phone: Home Address: _Iye�t,.q�,k nA oW% (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑T DO NOT wish to rcceive any marketing emails from The Home Depot Pro'ect Information: Undersigned("Cus-tomer),the owners of the property located at the above installation address,agrees to buy', and T At-Home Services,inc.('The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation')of all materials described on the.below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: roaenw Rd—) oduets: 9 #: Project A.rrmduot RMifing Siding Windows insulation ❑Guttcrk/Covers ❑Entry lkns C]x $ / S/ lation 0—Ins Roofing Siding Windows u $ ❑Gutters/Covers ❑Entry Doom ❑ lktmfing OSiding 0 Windows LJ insulation $ []Gutters/Covers ❑Enos Doors❑ Roofing Siding Windows Insulation Gutters/Covers ❑F,ntry Doors ❑ $ 11ftaimnm25%Ikpa®tot( atlAmumtdaeupanrxcauiun<ithisO)UU ci. Total Contract Amount $ Maine Purchasers may runt deposit rraue than one f>>ad of[fie ContractAr nonnt / `J Customer agree,,,that inuuediately upon completion of the work for each Product,Customer will execute a Completion Cerdfrcate. (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. The Horne Depot reserves the right to issue a Change Order.or terminate this Contract or any individual Pro ducts)included.herein,at its discretion,if The home Depot or its authorized service provider determines that 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 because work required to complete the job was noit included in the Contract. Payment Suminarv_ The Payment Summary# /l 3 l included as part of this Comma;sets 1'urlh the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TOCUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign..Do not sign a Completitin Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot thee costs of matetiaL%labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME.DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'$OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Accent nce and Authorization: Customer agrees and understands that this Agreement is One entire agreement.between Customer and The Home Depot with regard to the Products and installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed . by Customer and The Home Depot Customer acknowledges and agrees that Cu,,touter has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. ccepted by: Sub d by: r AA C stom s �Date Sales C nsultant's Signawrc Date _ Telephone No.Customer'sS gn Sales Consultant License No. CANCELLATiON: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAiNS A FORM TO USE iF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. Nt'rl'Ic&ADDITIONAL.TERMS AND CONDITIONS ARE STATED ON THE RF,WRSF:SIDR AND ARE PART OF THIS CONTRACT 05.14.15 White-Branch File .Yellow-Customer Tel Wd£S:S ZTOZ Z 'apW TZ_=9£809: 'ON XUA pe6wef: WO2Id f CS-070077 Jt IMI C DUARTE ..; WARt HA I MA 702 1,# ` , ! d Offier of Cotmimer Affair's l3ii!�� HOME IMPROVEMENT CONMCTOR ` Registration: 32?49 Expiration; 111I,fi'2w 15 call t .'i3r lath,rnr 02571 j HIM- ` Office r Of Consumer _A_flairs and Business Regulation . ��`��r�•. - - i 0 Park - ;,� - Plaza S Lute 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 126893 - Type: Supplement Card THD AT HOME SERVICES, INC. _ Expiration: 8/3/2016 ANDREW SWEET — 2690 CUMBERLAND PARKWAY SUITE--5o6,% ATLANTA, GA 30339 Update Address and return card.hark reason for change - 3r i :. 2ora osni ,_i Address 1-1 Renewal Employment f j Lost Card 'L C��e �r,�r�ur�ra�uuea�l�a!'C/j`rr:;rcc�cue/l3 I Office of Consumer Affairs&Business Regulation e8 License or registration valid for individul use only :OME•IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ` Registration 126893_:; Type: 10 Park Plaza-Suite 5170 Expird-Itli,W2g)3/2016 Supplement Card Boston,MA 02116 THD AT HOME SERVICES INC THE HOME DEPOT,-ATHOP/IE=SERVICES ANDREW SWEET'S 2690 CUMBERLAND'RARIN_ VAY S � � — A'I'EAN ,GA 30339 Undersecretary No41witut signature Tke Commonwealik of Massachusem :department of Indus&W Accidents f)rwe of Investigaiiins "0 Washington Street Boston,AM 02:1I1 www.mas&govldia Workers' Compensation Insurance Affidavit.-BuilderslContracton/Electricians/Plumbers Applicant Information Please Print Lein Name(Business!organizationandividual): O.'e, o W&M-e— Addressi gog 605-40 City/State/Zip: aW iSyb' Phone#: Are you an employer?Check-pa appropr be : Type of project(required): �mployecs m a employer with 4. I am a general contractor and I 6. ❑New construction (full and/or part-time):* ave hired the sub-contractorrs 2.❑'I am a sole proprietor or partner- , listed on the attached sheet.$ 7. ❑Remodeling ship and have no employees '+ These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance S. ❑ We area corporation and its I0. required.] officers have exercised their 0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l l.[Q Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13 Other /N comp.insurance required.] 'Any applicant that checks box#1 must.also ffil out the section below showing their workers'cohnp�sstion policy nnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the natter of the n6eontrwWs and their workers'comp.policy in motion. law an employer that h pro'viAWg workers'compensation Insurmce,for my a rloyees Below h the policy and job site nf surance Company Name: t v`p't'� W44 ��!Irc, :;�U 5 (!�o Policy#or Self-ins.Lic.#: w C, / / J? l t' / .3 Expiration Date:—3 Job Site Address: City/State/Zip: Attach a copy of the workers'compensatio policy des ration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day agajw the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA or' ce coverage verification. moo I do hereby certify u?nd lets of perjury that the bet Prot►itled is a and sorted afore• // Date: Phone#: �O 7 Offichd use only. Do not write in this area,to be completed by city or town ojjiciat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: ]Phone#: The Commonwealth of Massachusetts t Department of Industrial Accidents t Office of Investigations I Congress Street,Suite 100 } Boston,MA 02114`2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvAicant Information Please Print Legibly r Name(Business/Organization/Individual): Address: 1 /LSi7 GH1 City/State/Zip: 60 Ug, Phone#: 77 — 74—Z3 2.� Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4• ❑ 1 am a general contractor and I employees(full and/or pan-time— arttime have hired the sub-contractors 6. ❑New constriction 2: I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no e � These sub-contractors have employees and have workers' � ❑DeDemolitionemployees working for me in any capacity. [No workers' comp. insurance `° comp. insurance.$ 9. Building addition required.] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have.exercised their 11. Plumbing repairs or additions myself,[No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.}t c. 152, §1(4),and we have no employees. [No workers' 13Qther 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 ail work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insuranr Company Name: Policy#or Self-ins.Lic.•#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyAnder the a' s and venaides ffof2erJU2 that the information provided Bove ' true and correct Si ature. 1Da te .. . . . Phone#: Official use only. Do not write in this area,to be completed by city or town offtciaL 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#: ACIORE0® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDnmY) 07/152015 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAX 3560 LENOX ROAD,SUITE 2400 ML91 No ATLANTA,GA 30326 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC S 100492-HomeD-GAW-1&16 INSURER A:Steadled Insurance Company 26387 INSURED THD AT=HOME SERVICES,INC. INSURER B:7Jmch American Insurance Co 16535 _ DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 MW CUMBERLAND PARKWAY,SUITE 300 ATLANTA,GA 30339 INSURER o:minas National Insurance Company 23817 _ <<; INSURER E- INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-(M746646-13 REVISION NUMBER e 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. ILTR TYPE OF INSURANCE ADDLS B POLICY NUMBER I MMUDD� MMW�DIYY�W LIMITS A I X COMMERCIAL GENERAL LIABILITY GL04887714-05 1030120t5 031012016 EACH OCCURRENCE S 9,000,000 1 DAMAGE TO RENTEU-- CLAIMS-MADE o OCCUR i PREMISES Ea occurrence) S 1,00R000 iUNJTS OF POLICY XS EXCLUDED MED EXP(Any one person) S :OF SIR:SI M PER OCC 9,000,000 PERSONAL$ADVINJURY $ GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9.000,000 P X OLICY❑jE.T LOC ( ' PRODUCTS-COMPIOPAGG S 9.000,000 OTHER: I S B AUTOMOBILE uABIL.RY iBAP 2938863-12 �03/012D15 03/012016 COMBINED SINGLE UMR Ea accide S + 1,OOD,000 nt X ANY AUTO 1 BODILY INJURY(Per person) S ALL OWNED I SCHEDULED ;SELF INSURED AUTO PHY DMG AUTOS 1 AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED ( PROPERTY DAMAGE AUTOS Per accident S S UMBRELLA LAB I OCCUR I ` EACH OCCURRENCE S EXCESS LLAS CLAIMS-MADE AGGREGATE $ DED RETENnONS I $ C WORKERS COMPENSATION W0017731493(AOS) 03/D12015 03/012016 X 1PER I I OTH. C AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE Y 1 N W0017731495(AK,KY,NH,NJ.VT) 03I012015 03/01/2016 D OFFICERIMEMBER EXCLUDED? N❑N I A EL EACH ACCIDENT _S 1.000.000 (Mandatory In NH) WC017731494(FL) 031012015 031012016 E.L.DISEASE-EAEMPLo S 1,000,E If yes,describe under C0r111fiued on Addltiorel DESCRIPTION OF OPERATIONS Wow Page EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Sehedute,may he aHaeIt tt more space is required) I - EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30M AUTHORIZED REPRESENTATIVE of Marsh USA Inc_ Mamashi Multhelee —JwLoLuo40r+d ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Scate l u 40 bate :11-28-00 " 1gtt Cap e FvuytneRAAA4 49 ka boo road 65.00 ! 02601 318.52....� I 15.56 26.2 1 28.4 i 24.50 4.00 28 8 X 310.57 —�� 12' EASEMENT g o R SERVE o O O O DRIVE i 12.83 I 1 27 O 20.00 �- a Q 3 10.00 9 �' IC I PROPOSED 38RCi 328't TO EDGE OF WETLAND 26.9 X .. �/ TOF 30.0 °D Lt1 w / ST#1 27.9 GAR O LOT 1 STP / I— /Lv 46.487 SF 28.7 i F w-_W L51. 36 21.00 .4 BENai�T0P OF-ea—Z---C E E E 183.10 30.00 ASSUMED DATUM 31.9X I 107.39 i Y a - r sleeted Ptw Oi -tang its kgc,,A4j.•i0at, 1�,9 $oa cus ea Avrtt poi ti.. WON ,�, H.,o d'm+ '3eif eo t I as deAc�t i b ed in a deed O r :� JOH:'J YOUNG in lfj �_ No.30078 �� t2 Ate O ""'`, a►ad eco%d 15 0 15 30 45 P CRAIGVILLE = _ 1 _. BEACH - Vt- iq S v, ------------------------------------ -ROAD v +w«e errt"13 ab. OQ/�d` Y � eafJy th �.. Bo TOBEY WA., f , _ : SHEET 1.:OF 2 .. r *M� TOWN OF BARNSTABLE Permit No. ..:� ..... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 .ML .6}9• HYANNIS.MASS.02601 Bond ......x........ CERTIFICATE OF USE AND OCCUPANCY Issued to George E. Carrington Address 75 Tobey Way Hyannisport, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD 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. ... . March..21..... . .... . 19...94.......... .......... Building Inspector i T ...__"•,� y ".n -'..r-_r - ._ �`'.-^•e.Gf .'�)t✓ .. A - ?_ ' � P� EL y 1� P %BARNSTABLE, MASSACHUSE S T,- I L DH or DATE DC'Cc;PIyJ'_ j 19 J i PERMIT NO. +`Q 36363 APPLICANT GWlIE:I. ADDRESS L,1 ste_d Bwlc)w e (NOJ (STREET) �J (C'ON�ft'S V-ICENS'E) ( PERMIT TO BUild LWe il.n ( ) STORY Siiagle Z Gi..i it"; I�L"�elli1_"ZC.(DWEBERNG UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) - 75 Tobev Way, H annis ortZONING AT (LOCATION) — RB (NO.) (STREET) DISTRICT ' ••fv BETWEEN yy AND . .`4 ' (CROSS STREET) (CROSS STREET) - _. " LOT: SUBDIVISION LOT_'_ BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE `#'�'• USE GROUP BASEMENT WALLS OR FOUNDATION . - ••.��: (TYPE) REMARKS: t i f Js U AREA OR ESTIMATED COST 676 sq. A. VOLUMEEC^ 53� 000. 00 PERMIT $50. '01G a _ (CUBIC/SQUARE FEET) OWNER ADDRESS 102 v-Lan E .. it I iGC,l1i 171 BUILDING DEPT. BY . T— J\ -..-. .-. FROM TH _ C• ELEASE'_t-HE A-PPC cA T FROM THE , O CITi ..; 5 OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL MINAL INSPECTION TI To LATHE FINAL INSPECTION HAS BEEN MADE.3. FINAL INSPECTION BEFORE ' OCCUPANCY. _ I POST THIS CARD SO IT IS VISIBLE FROM STREET -. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS uez 'j 3'// 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I/ -�1-/ . - RD OF H TH l OTHER - SITE PLAN REVIEW APPROVAL i WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ti I TOWN OF BARNSTABLE i BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ------------------ Please print. ` DATE ..JOB LOCATION 15 ► o be L-a n e Number Street Address Section 01 Town "HOMEOWNER" G-eocc�. 01 r F'l A q57- 303 5- Name Home Phone Work Phone PRESENT MAILING ADDRESS l b g -54-aki ha p2 �Aa,uo',1 6aS3(k City/T6kqn State Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and to allow such 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 to six 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 acceptabl.'a to the Building Official, that he/she shall be resnonsible f_or all such work ar;rformed under the building nermit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for. compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town o : Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE �l APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will. be required* to comply with State Building Code Section 127.0, Construction } v c q r. 16 HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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' Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2.15) . This lack of awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To- ensure that the Home Owner is fu lly aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue. is a form currentlyp You may care to amend and adopt such a form/certification yforvuselino our Y communit Y �4 S CO MMOI�I��EA_I.�TH OF I�rSAS. � . •ACHUSE3 TZ v _ . —E DEI AI�1ET OF 1?-DUSTRIAL ACCIDENTS -L 600-WASHrNGTON STT 130STON, )vLASSACHUS=S 02111 Janes Gamoaei WORKERS` COMPENSATION INSURANCE AFFIDAVIT 1. (liccnscc/perrniacc) with a principal placc of business/residcncc at: (Ciry/Sta(C/Zip) do hcrcby ccrtify, undcr the pains and pcnalacs of perjuq} that: j ) 1 am an cmplovcr providing ncc following workcrs' compcnsation covcragc for my cmployccs woiking on this job. r lnsurancc Company Policy Numbcr `l t ) l am 2 solc ro rictor and havc no one workin for mc.p p g () 1 am a solc proprictor,gcncral conmaor or homcowncr (cirdc onc) and havc hircd the contraaors listcd bcloK• who havc the following workcrs'compcnsation insumncc policics: Namc of Conaaaor Insusancc Company/Policy Numba N'2mc of Contract tu or lnsancc Company/Policy lvumbcr N2mc of Contraaor lnsunncc Company/Policy Numbcr 1 am a homcowncr performing all the work myscl£ 1','0'TTE Plcasc be a•2sc tbu wbilc bomcowncrs who cmploy persoas to do raaiatcamcc.coostructios or ccaair work on a l c'wclling of not raorc tna:thrcc units is wbicb tsc bomcowacr also residu or oa the grounds appurtcoant tbcrcto arc mot Ecocralll• :. considcrcd to be cmploycrs undo the Woricri Compcnsatioa Act(GL C.152.scci. 1(5)),appliutioa by a boracowacr:or a liccnsc or perrnit m2y cvidcocc the lcgal stasis oft=cm-_?loycr uadcr the Workcrs'Cornpcssation Act i unocrstanc tnat a copy of tius statcrncnt wits ix for,, rdcd to the Dcpa:zr cnt of Industrial Acadcnu'Ofiscc of Jnscrancc for.covcra;c .erifscation and that fa.ilurc to sccurc covcragc rs rcSuircd undcr Section 25A of MGL]52 c:,n ksd to ncc imposition of uiminJ pcnzd6cs consisting of a fsnc of up to S]500.00 and/or imprisonment of up to onc ycnr and civil penalties in the form of:Stop work Ordcr and a fsnc of S)00.00 a day against mc. Si-ncd this day of • l9 L cc Licensor/Pcrmiuor iccnscc/Pcrmi C II No. bed tDow6 2 D� poaaC no 220 gpd ,t eaehina a tea 201 41 201 �-_ Capaat,tfl` 1127 cpd hot 1 "-20 f 5 0 Zip /--0 �.on�,1�� bat- 6-12=9/ u9 /1atf of I'oa,�11 I.R PN,. 2500 :S 3 —a\ --- - I - . i i I ?. rc Pto?ite. No Scate _ S.W. C mvt dpace n- loon -7t6 0,X0 i d ! -6 pat 1• 41, Sl-etch P"Lan o f J.and in /V yana i,dpot t Nq 9ot geoae C. C�n geifu,� a ,Lott a,, de�b ed in a deed 4,ecotded in book 978 page 551 i Ct euafi i onj. ate oa an a4dwnpd datum. Slew Pit # P-7762 �rte-_-_A e�,t-_'i s%tvfs.tcJ�Ze� c,%tcZ-o �rler, li-- l}ade Wit. £d 13avc y No watea encounte-,ted the ouvcrla l i on �lwwn on th is, p tan pP/ic, te4,i 2 min. pet l" Coca te1.I on jhe 7,wuncL o.,- aJwwn heltwK I and 'eptacel. the bui.Lclifu;, that wain- p -1 SIP 1 9I 2 f n � coax G44e Ae.` %f;.;•1nt ` ..Gory i---- z7 27.4 m s•t,�, P�h°324�0 No Assessors.effice(1st Floor): a C�+ Assessor's map and lot number y6 �I �� � �� � �7 �! � ti TMc to`` Conservation-(4th Floor):{ t✓ �ad��93 ( w Board of keealth(3rd floor):- / a SEPTIC SYSTEA#mu • Sewage Permjt number d ( INSTALLED IN C®MP��� seassr�ntt ` r6 q. Engineering Department(3rd floor): c J WI Tli�6 ,FIT°LE�, �o House number "�'' "/ ENVIRONMENTAL ��� L� �Definitive Plan Approved by Planning Board 19 AND 'OWN APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN'. OF BARNSTABLE BUILDING ASPECTOR APPLICATION FOR PERMIT TO I�ph S�(`u G�' r h 0. 1� �Gt►m c y�F Y Li-e-`l t via TYPE OF CONSTRUCTION On d. F ra 0 r✓ 19 l' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L'Iobe-yi Proposed Use 51 na.0 PC�tvn —Dui Z��►vt� Zoning District Fire DistrictG/ Name of owner csUt'a-(.. CCLf t't y1 h Address /0 -2 5+C01 Y1e12C Name of Builder ` Address Name of Architect ' V aloft M 6L IA hl2_ Address F avtyl t-5 iP0r+ Number of Rooms 5 Foundation en LL C-0 Y\ Exterior J �l t Tc- E.dag-- S Roofing- _ S p 4CL Floors O—QT-12 e, " V 1'J1�:1 1 Interior cJ �y e-'e; no Heating So fce ct 0' l Plumbing Co n oe c P: A 2. Fireplace YV 1G} Approximate Cost Ll 5 3, 6 d y • Q6 Area 676 QV ov Diagram of Lot and Building with Dimensions Fee 52) d r f���ti II u OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Siipervisor's License CARRINGTON, GEORGE E. No Permit For One Story r Single Family Dwelling 7 5 TobeY Wa i . -Location Y � • Hyannisport a Owner ,-George E. Carrington Type'of Construction Frame p Plot Lot h r Permit Granted December 2 , 19 93 _ Date of I pection: Frame f��o 19 Insulation 19 Fireplace 19 Dat ompleted Z 19 • e 50.00' o EXISTING n DWELLING z4.1S° 311.00' �� EXST. 1 3.18.52 1Z EASEMENT LOT 2 r18.op f" e� 1Q° 8.1.! 25,504 SF. r a 1cd L 24.E 4 _ I:;-- I certify that the foundation shown on PLOT PLAN OF LAND this plan is as it actually exists on the ground and that it to the town of -���T�® f N 1 Barnstable zon' rts.regarding HYAN N ISPORT,MASS. T yard setbac \���` PREPARED FOR PAUL ANTIP®STI R.L.S. date:A9ay % DATE:MAY 8,2001 SCALE:1 "=40' hood zone pord CAPE & ISLANDS ENGINEERING Lftobey �`�L'�L1r��':)� C!! ASHPEE,MAS S. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel a?3 9 .r Permit# Health Division Date Issued 1 O c �� Conservation Division J > 3 �,�. �f� O t Tax Collector STALLED IN COMPLIA�`�f� _ WITH TITLE 5 Treasur ENVIRONMENTAL CODE AND _ T o� Planning Dept. OWN REGULATIONS Date Definitive Plan Approved by Planning Board ` 0k Historic-OKH Preservation/Hyannis Project Street Address 15- be-c j [A)CL WAyCi nnos bnl-f Mid Village ct Owner _ pMe— Carnr,c fon Address P 8t, ,t Telephone ,56 L Permit Request li o n o n s l ' C`I w e l �M/Z, A AID li3ey) eC>J 14) Square feet: 1 st floor: existing15% proposed 1,M 2nd floor: existing 4 6 proposed y Total new It a _ Valuation 13 . ao a Zoning District Flood Plain Groundwater Overlay Construction Type_ W oad Lot Size=TJJZ) s•F• Grandfathered: ❑Yes 2/No If yes, attach supporting documentation. Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units) Age of Existing Structure rS Historic House: ❑Yes U No On Old King's Highway: ❑Yes 2No Basement Type: ❑Full C/Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ® Basement Unfinished Area(sq.ft) b, Number of Baths: Full: existing _ new Half: existing new 0 Number of Bedrooms: existing new Total Room Count(not including baths): existing new 3 First Floor Room Count Heat Type and Fuel: MGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes U No Fireplaces: Existing 46 New;_ Existing wood/coal stove: ❑Yes �§ No Detached garage:❑existing ❑new size 0 Pool:❑existing ❑new size U Barn:❑existing' ❑new size O Attached garage: ❑existing mew size ZZXIS Shed: dexisting ❑new size Q Other: C� Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 5Ao If yes, site plan review# Current Use Sinale 4�rY►.w ct utll f nq Proposed Use n71na)e (46 11AC; `✓tom v�Y BUILDER INFORMATION Name ,inrADn Telephone Number �69-1? 1-7 b 44 Address wee hMe rs Q_� dav:i_ License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7;) Z FOR OFFICIAL USE ONLY - PERMIT-NO. 4 } DATE ISSUED v MAP/PARCEL NO. r ADDRESS ' VILLAGE , OWNER DATE OF INSPEC 1 ° FOUNDATION (Q` FRAME R_ INSULATION P Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH, FINAL - FINAL BUILDING - (`. DATE CLOSED OUT ' ASSOCIATION PLAN NO. _ TOWN OF BARNSTABLE ADDITION--CERTIFICATE OF OCCUPANCY PARCEL ID 246 239 GEOBASE ID 36517 ADDRESS 75 TOBEY WAY PHONE HYANNIS ZIP - LOT BLOCK LOT SIDE DBA DEVELOPMENT DISTRICT HY PERMIT 57021 DESCRIPTION CERT.OF OCC--ADDITION--BLDG.PMT.952686 PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Ox THE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE PBARNST MASS. i639. ED Mi►� BUILDING DIVIRON BY - ----, DATE ISSUED 11/08/2001 EXPIRATION DATE .. tt � \ ABLE PARCEL ID ::46 239 E )LEASE ' " 7 ADDRESS 75 TOBEY WAX + PHONE HYANNIS . ',. ,�{ ZIP LOT BLOCK LOT SIZE I}BA " i DEVELOPMENT 'I)ISTFLCT HY PERMIT 52686 DESCRIPTION ADD GARAGE/FAM.RM.\BDRM SEWN#01-203 PERMIT ,TYPE BADDI TITLE BUILDING PERMIT ADDITION CONTRACTORS: PROPERTY OWNER Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $427..80 BOND THE CONSTRUCTION CONS $138,000.00 434 RESID ADD/ALT/CONY 1 PRIVATE P:.Q) * HAIZNMA83. � s 1639. Fp�'►l BUILDING DIVI ION BY DATE ISSUED 04/10/200.1 EXPIRATION DATE � �.. I _ . �+E PARCEL ID '21.46 239 GELd.0 AS� 2.D t,`�4.a517 AL S 75 TOBEY I'WAY PHONE �•+;. YE1I tiI ZIP.' I ir: L a , S T D E; t M IT 52636 DESCRIPTION ADD G-A 'AGR//a9AP',[lcm.\BDRM SEWPT#Ci',; -2013 :IJx IT TYPE BADDI TITLE BUILDING ­ADD-07 0 q GON` RAC ORS �R,0PEIR":CY OWNER ` -Department of Health 'Safety AIRCIfITE�TES,R a , and Environmental Setvices �tHE 434 .Lt¢c a)-IT? .1;�.4j1•.�jrAL.A/�;s«,14.9�V , I •, �L1�V�IrlXA"n .C:�. '(*.,S:.r�«,.. MASS. i639- Fp•-MII;I A BUILDING DIvfsi X DATE ISSUEs', 04/I10/200-I. EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- COTE HMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR AGRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS P DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY;APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION .PERMITS ARE REQUIRED 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF FOR OCCU- .ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. ` CH- 3.INSULATION. OCCUPIED UNTIL FINAL L INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. • <, BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 J t- o/ BOARD OF HEALTH III HER: a� SITE PLAN REVIEW APPROVAL G iL��c9 t WORK SHALL NOT.PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS ,:THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD.CAN BE ARRANGED.FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. - S 70 '21 e `l • f B. UILDING PERMIT IV �g F=" -4 VJS� A-esJT % /-/& O r;-�1 J S i5crrak s_ 1- ;9;5�,--FTH COMMONWEALTH OF MASSACHUSETTS FEES �.✓� BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed ' Repaired Upgraded Abandoned g y y g p y (fib p ( >> pg ( >, O by: :� G at 15 7o be has been installed in accordance wit the provisions of 31JO CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to applicationcl� ated c�' Approved Design Flow (gpd) Installer V i l o�. Designer: Inspector Date r v� The issuance of this certificate shall not be construed as a guarantee that the syste n will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 The Town of Barnstable 94, r"?�-" Regulatory Services a �e� Thomas F. Geller, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: . 508-790-62=0 HOMEOWNER.LICENSE E71 EMON �/ Please Print DATE: `f- c)I JOB LOCATION: L11) 0 be L4 WaI4 number s t �y village ,,// ••HOMEOWNER":G Fzk6E 0 C_4g12,L//� -T y�,) 569- T71 7&4 96a `f�o�3 • name home phone r# work phone ti • CURRENT MAILING ADDRESS: 111.� Hy6�.1�1►s�Pl �M14 OZIo�Z 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 all be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and req ' ements and that he/she will comply with said proced es and requirements. gn ure o o eowner 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 ION 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 I o9.I.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 pan of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in vour community. Q:FORMS:EXEMFM ,I HASchech CONFL IANCE REPORT Massachusetts Energy Code MScheck Software Uersion 2.01 Release 2 � PermiQ a ; i i Checked by/Date { CITY: Barnstable STATE: Haseschusetts HDD: 6137 CONSYR1ICTION TYPE. I or Z Family, Detached NF, 7lKG SYSTEH TYPE: Other (Mon-Electric Resistance) DATE: 1-i5--2991 DATE OF PLANS: G1i15181 TITLE: Paul Antipasti PROJECT I n1FORmy l on: Carrington Residence 75 Tobey Way " West Hyannispart,liA NOTES: 31 Meatherdeck Road " Bourne,NA 82532 i 428-5736 COHPL I ANCE: PRSSES r--� Required Un = 13B Your Home 937 Area or Cauity Cont. Glaziog/Doer Perimeter R-Ualue R-Ualue U-Ualue . USE ---------------�--------- CEILINGS 1936 30.0 0.8 WRLLS: Wood Frame, 16" O.C. 1786 13.A 68 ®.8 GIAZIPM: Uindoms or Doors 267 0.190 187 GLAZING: skylights 36 8.609 22 DOORS 32 0.350 11 FLOORS: Over Unconditioned Space 1776 19•0 0.0 83 HUAC EQUIPMEMY: Furnace, 85.8 dWUE ------------------------------------------------ COpPLIANCE STATEMENT: The proposed building design described here is consistent with the building plane, specifications, and other calculations submitted with the permit application. The proposed building; has been designed to meet the requirements of the Alassachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HUAC equipment selected to heat or cool the building shall be no greater the of the design load as specified in Sections 780CHR 1318 nd J .�. Ai lder/Designe -�► Date i0'd L119 V99 Rog uOLgQl.nsui /Cuol.oO HLZ= LO iO-LO-qaA I he commonwealth of Massachusetts Department of Industrial Accidents �•�•�- ` ' �Icc®lttt�e�stlgat�Q�s 600 Washington Street .��_���,• Boston,Mass. 02111 v Workers' Compensation Insurance Affidavit rJame: �F 0 R&r-- Ci4 A i,i N6-?a� siN , UJ NVAMVIspai2T /LIB} Oa(o 7d, hone= 50,f— 77/_ 6 41 Q I am a homeowner performing all work myself. ® I am a sole proprietor and have no one working in any capacity O I an, an employer providing workers' compensation for my empiovees working on this job. comes name: ,R• cT ��VJL } U� eoN5'1 R0V)0/J yy�� address• .r.: 0 1.80,Yl 6ap !'O P,ESTD F}Lf__ .,: /Vl/or D � 41 phone N. 1f3 3 i tsursnee co. �s.+� ST,�ITi: Holies it �� Jr �' I am a sole proprietor, general contractor,or omeowne (circle one) and have hired the contractors listed below who have the following workers' comoensation.. polices: �sonaaa.s rtai„e: IZ_lGt�n� F0 t)LJAA-1-?b1V 0-0. ZNC, t address; o�o� Onio r, 5rt �✓-�'j2Vo.OU7Z-t nez phone4• insurance ce. SAVES af—P— ;� �C IS[J �7y [/VS CO. nalicv� C 001630-02 . 3 nc N7TlaN y . _,g6Ri (iha_ Zabr e Nns_'ru o address: 37-3 W1A.5d_P.. E 'N1Ar 0 7449 ahone =: Msurance rn �EGIDN IN,'_s URANs_ nolicv if W C 'At:;:h addidonil_sheei if aeeesaa�._ � ._;e�-••*r—r ^ `��"r Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition or cr;tainal penaities ora fine up to S1S00.00 and/or one;•ears' imprisonment as -ell as civil penalties in the form of a STOP WORK ORDER and a nine of S100.00 a day against me. I understand that a cnpy of this statement may be for%2rded to the Ot lice orinvcstigations of the Di.•►for covenQe s•erilicadon. I do herebt•cerrif der the pains d en it es of perjury that th rtforrrtation provides above is trtre and correct. Sienan»r DateLIZ / Print name Phone= — otTiciai use only do not M rite in this area to be completed by tiny or town ofrcial cim or town: permit/license s riBuilding Department CoLieensinm Board check irimmediate response is required Qselectmen's Once Inliealth Department tonne/persan: phone p: fl0there i �o73�x (f9 v m T; M A- a s 53 4/ a -S�3 - 6017 (n5u►-anc� : EsTF�� Ciqs(JALT yoL • # WCDo-=7� a�� �q God�� � R� mos h J ih R b a 6 4 q I v)S L)rancc: C NR 7 9 9 0 7,2 qIV- The Town of Barnstable r � � 1AItIVSrABLE. • Regulatory Services Fo;ot'�� Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790=6230. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Ad d i h D rn Estimated Cost 3 ` Address of Work: q5 -To be UR4� W• O�AOM(126rfi M 4 Owner's Name: l 3Po q e ('x rn nA' 0 n Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied Towner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. 4/d 4o Date O er's Name q:forms:Affidav r ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) aob , square feet X$115/sq. foot (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value o`c b 00 RESIDENTIAL ADDITIONS OR ALTERATIONS If loc ted: ❑ North of Route 6 - any work visible from outside -needs approval from OKH In Hyannis - If work visible from outside - Check to see if it's included in the Hyannis Historic Waterfront District - if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: ❑ Map/parcel number Approval S' -offs from: ealth 2- - onservation (if exterior work) Tax Collector Treasurer rr If ZBA relief(Special Permit or Variance is required for project: ❑Copy of ZBA Decision rc�Se✓ �L� l ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one yeaof [ SZBA decision date. �.e� --- reet address hrOwner's name & address ❑� ermi t request - full description of proposed project(u-value of replacement windows if applicable) Q/ uare footage - proposed project stimated project cost [ umplete Dwelling information for Assessor's Office '�{ O k-c-- M Udder's information `t 'lure .f Plot plan ` FSS --Plans - 4 sets measuring 11" x 17" fully dimensionlized with foundation, floor plan, cross section. framing schedule & smokes, with a Red S (SB or SH) Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name &Worker's Comp policy numher �Ener`_v Compliance Form Copy ut nstruction Supervisor's License & Home Improvement Specialist's License Olt � Homeowner's License Exemption Form. Fee Llll�l\I:1'S - ❑ Need Hume Improvement License No plot plan required PIERS & DOCKS ❑Need Construction Super license AND Home Improvement License Ow ncr cannot pull own permit q loran,permlt,l -� US;�II;1111 y a l � lid 4 � j l A . �.�. � !• '• '•i l - ��� � �^ �,�f�<< r y- , y ,� ,.'� ,, .. _ � _ i 4 r�, � � �y'l ,''.� .. '� ��•<. ��. u � _ , _ _� :. i r. F. �� .�.. ,. . � �. ' . I ,� 1 '". ,�, .. ., � �� � V A y ro. ;� �� . .�J yam. . �;},i. � ;7., � .'�':.." �i /_y // '. ;b'. r � � ' .i .�fa ��►►cc 1 �iT. �l .�r ,�1�/ T�y{� ` ' 7 , ,a+r+ _,� ,„ , � _. .�� � , � �► �t,� -- i � __ .� �� µ •- _ r 1 .......-_-... ..._.__.... . 1 i 1 � ij — — 3� r t : I M® DErECr E ol ?S ®> --- ---- �1NG .......... •- ---..- --- T v Y_ 1 �[_O L [ I L VA71[?A� fi r. r)T a • •u�ci co cr: oRAwM m yH,. -� - - 1lEVf6H0 1i4 il�/IP_yr-!.1 ! ill, ,�,rytt�t:t•, i%f�i�l __ „�. COAWM10 MNMMw .`y i FM ._1T FRI LrL ; _ I �i (— N CGJ••� 2g •2 ArL/MAicP C, F • Qi \ 'A ♦Kw A.T. 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