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HomeMy WebLinkAbout0015 WASHINGTON AVE EXT. e To 3 Date Time�® wl YOU WERE OUT M of � Saa- 6�o9 Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU ,..URGENT RETURNED YOUR CALL J Meese Operator AMPAD 23-021-200 SETS �� EFFICIENCY® 23-421-400SETS CARBONLESS Ll �--�..---_— — _-- — — ---__— ---- �—i1� � s � � ���- � ' � � � � ��- _ _� _ � _ �� �. � ��_ F � � Q� � � ' ���� �. i t � - �� � � f � �; - - - �_-- - -- --- � > s � w �-� wss ��� o � �S� y � � ��� R ���( �� �� Q� ' i �� �_ ._ � _.� _ - _----- -r - - � - - - l ,ram Town of Barnstable *Permit kA" 0 Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Feen24'� Thomas F.Geiler,Director MAY 2 2 2007 Building Division TOWN OF BARNST E Tom Perry,CEO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numbe O Property Address ' O � ��i��},G i Y� I � �®�h/ .�_ � ' Residential Value of Work_lAt" Minimum fee of$25.00 for work under$6000.00 ':wner's Name&Address Uafo-h" `P-- Tele hone Numbers —k 9 Contra or's Name p Home Imp vement Contractor License#(if applicable) Construction S ervisor's License#(if applicable) ❑Workman's Co ensation Insurance Check one: ❑ I am a so a proprietor ❑ I am the meowner ❑ I have Wor is Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance ertificate must be on file. Permit Request(check box) J ARe-roof(stripping old shingles) All construction debris will betaken to ` ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts DepartmentoflndustrialAccidents Q Office of Investigations �nS 600 Washington Street O ' Boston,MA 02111, wi*.mass,gov/din ' Workers' Compensation Insurance Affiddvit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organizatiowhc ividual): co�M L4 .� -Address: a 112, 'l 10 a City/State/Zip: a 0 60 Phone.#:.co- 1-4 t4 ?3`1 Mco Are you an employ ?Check the appropriate bog: :Type of pioject(required):, 1,❑ �P I am a employer with 4, ❑ I aama general contractor and I employees (full and/ox part-time).* , have hired the sub-contractors 6. ❑New construction . • 2.❑ I am a'sole pioprietor or partner- listed on the•attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition 'FYorking for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insurance comp,insurance,$` required.] 5• ❑ We are a corporation and its 10.❑Electrical rep airs or additions 3. I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right bf exemption per MGL 12.❑Roof repairs insurance,required.]t c. 152, §1(4), and we have no employees, [No workers' 13.7 Other comp,insurance required,] *Any applicant that checks baz#1 must also fill out the section below showing their workers'compensation policy information. f Homeowuers,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 name of the gub-contractors and sate whether ornotthase entities have employees, If the sub-contractors have employees,they must provi&their workers'comp.policy number. 'ormatiox. m an employer that is providing workers'compensat vn insurance for my employees. Below is.the policy and job site cc Company Name:. Policy#e elf-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip• Attach a copy of thewor s' compensationpolicy.declarationpage-(showing the policy number and expiration date). Failure to secure coverage as re wed under Section 25A of MGL c. 152 can lead to the imposition of crurdnal penalties of a f;ne up to$1,500.00 and/or one-year` risonment,as weL1 as ci,rilpenalties inthe form of a STOP'7rORK•ORDER and a se of up to$250.00 a day against the viola Be advised that a copy of this statement maybe forwarded to the•Office of Lvestiaa ions of the Mk for insiance co v a?e verification, ' I d e/�reby cer �under the p ins and penalties of perjury that the information provided above is true and correct. Suture: Date: `0 �7 _ `7 t V<o Of eial use only. Do not write in this area; tb.be completed by ciry or town ofj"iciaL ' City or Town: ' Per�f/License� Issuing�uthority(circle one': 1.Board of Health 2,Bind g D epartment 3. Cityrown Clerk 4.Electrical Lispector 5•Plumbing 7 sp�ctor 6.Other # Contact Person: ,L. Phen i ,Wk- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma t✓D Parcel I A li i n#r p pp Cato �a Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Felt, Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address lwn—1 (' Village Owner Address J lelW0'6A1A q4y\ Ave, Telephone *Permit Request 4404rY4 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new q 9 p p 9 p p Zoning District Flood Plain Groundwater Overlay Project Valuation Z1001) ®� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C Two Family ❑ Multi-Family(#units) Age of Existing Structure /�,9 Historic House: ❑Yes Cho On Old King's Highway: ❑Yes Basement Type: CWFuII ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing OY e., new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes U o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new, size Attached garage:W65isting ❑new size Shed: sting ❑new size Other: a CJ Zoning Board of Appeals Authorization_❑_Appeal# Recorded❑ Commercial ❑Yes C�Yl�lo If yes, site plan review# � Current Use Propose se '` UILD NFO ATION Name 0=4y 4A 01 Telephone Number Ci - 7 8 Y Address /)I q -'0 n 4VLLicerise# 4 r (J Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 47 DATE o� i P FOR OFFICIAL USE ONLY • ;el PERMIT NO. c DATE ISSUED MAP/PARCEL NO. 41 ADDRESS �� :�: VILLAGE d ' OWNER ; ! r DATE OF INSPECTION: FOUNDATION 7 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING o' DATE CLOSED OUT 7 ASSOCIATION PLAN NO. r 1 t The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111' www.mass.govldia ' Workers'Compensation Insurance Mf davit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Orgauization/Individual): Al L4 .� Address: f. oA Ldo City/State/Zip: _ a 0 "0 Phone.#: Qn, Are you an employ el? Check the appropriate box: :Type of project(required):, 1;❑ I am a employer with 4. ❑ I am a general contractor and I , have hired s ub-contractors 6. ❑New construction . employees (full and/or part-time),* • 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, F]Demolition '-�yorking for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insurance comp, insurance,$' required.] 1 5. ❑ We are a corporation and its 10.[J Blectricalrepairs or additions 3:ZI am a homeowner doing ill-work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'camp... right bf exemption per MGL 12.7 Roofrepairs insurance.required.]t c. 152, §1(4), and we have no employees, [No workers' 13:❑ Other comp,insurance required,] *Any applicant that checks boz#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners,wbo 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 name of the$ub-contraotors and state whether ornot those.entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Jam an employer that is providing workers'campensatinn insurance for my employees. Below is,the policy and jab site ormadon. In� ce Company Name: Policy#o elf-ins.Lic.#: Expiration Date: Tab Site Address: City/State/Zip: Attach a copy of the wor s' compensation policy declaration page'(showing the policy number and expiration date), Failure to secure coverage as re red under'Section 25A of MGL a 152 can lead to the imposition of criminal penal ies of a ine up to$1;500.00 and/or one-year' risonment,as Well as civil penalties in the form of a STOP 7rORK,ORDER and G T'Me of up to$250.00 a day against the viola Be advised that a copy-of this statement maybe forwarded to the Office of Investizations of the DLA for msunance cov.,raze verification, ' I d ereby cer ' under the p ins and enalties of perjury that the jnf arrnatian provided above is true.and correct. Sig attire: —1 Date: —0 7 . _ P�0ne= - _g C I © Zciat use only. Do not write in this area; to.be completed by city or town of icial Cis Town: y or .Perre_t/Lic ens e# Issuing Authority(circle one): i :1.Board of Health 2.BuildingDepartment 3. CiY/Town Clerk 4.Electrical inspector 5.Pltinbing Inspector 6.Other Contact Person: Phone Y: I torm no ana ins-cruc ups Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to t1 s statute, an employee is defined as"...every Berson in the service of another under any contract ofhife, express or implied, oral or written." An employer is defined as "an individual,partnership;association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a�deceased employer, or the receiver or trusteAl-of an individual,pa-tnership,association or other legal entity,employing employees. However the owner of a dxel ing house having not more than three apartments and who resides therein;or the occupant of.the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced:acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter_152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable eviderree of cor<Lipliance +ith't3ie insLaTce' requirements of this chapter have been presented to the contracting authority..'•• Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-eontiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability'Companies(LLC)or Limited Liability Partnerships(LLP)with no'employees other than the. members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate`line. City or Town Officials Please be sure that the affidavit is complete*and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple perraWlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessity)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit: The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please'do not hesitate to give us a call. The Department's address,telephone-and fax number:. 4 CO.Mmonweath of MawwhUsetts Df,--partmfmzt of lndx t al A.eezdezts ' Qfflve of Investigattoas 600 Washington Street TO.##617-727 00-0 ext 406 or I 477 MASSAFE Fax#6.17-727-770 Revised 11-22.06 www.Mass.gQV/dia °F1HE� � Town of Barnstable Regulatory Services '+ sA MASS.- - Thomas F. Geiler� .Director 9 ASS. � 39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: Q Estimated Cost "_0 ,_-Address of Work: ���.! Aue 14 ' y Y l Q'o*i —Owner's Name: Y\ `Q 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 XOwnei pulling own permit Notice is hereby given that: OWA'ERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICA-BLE HOME IMPROVEMENT WORT;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. , OR JQL Date Owner's Name Town of Barnstable CF SNE 1p� Regulatory Services S � snxtvsTns Thomas F.Geiler,Director . i.E, 9g, 1659. ��� Building Division revs s Tom Perry,Building.Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �' ✓' O .JOB LOCATION: ` �,�,(�(/ number street village"HOMEOWNER": O --7-2 6 C-to- t Y— 14 O Q � I . name II,^, home phone# work phone# CURRENT MARJNG ADDRESS: S Yet ri C 3K)j ) off UC �,LC�1 - d city/town state zip code .The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units br less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as . suvervisor. 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 of two-family-dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such . "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section l09.1.1) 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 ToTM of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re ents. V Si a re of om 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 t amend and adopt such a form/certification for use in your community: Q:forms:bomeexempt Proposal Cape Cod Insulation , Inc . 455 Yarmouth Rd. Hyannis,MA 02601 508-775-1214 Fax- 508-778-5735 DATE ESTIMATE NO. 1-800-696-6611 cap ecodinsulation.com 5/18/2007 6293 Insulation,Gutters,Suspended Ceilings SUBMITTED TO JOB LOCATION Mr. Stephen Harne 15 Washington Ave Ext Hyannis,Ma. 02601 JOB SPECIFICATIONS CONTRACT PRICE Ceilings with 10",R-30 Kraft faced batts with proper vents installed at eaves. 625.00 Exterior walls with 3 1/2",R-15 Kraft faced batts. Slopes with 8", R-30 High density Kraft faced batts with proper vents. Highwalls with 3 1/2", R-13 Kraft faced batts. CONTRACT PRICE $625.00 Keith Presswood keithpresswood@verizon.net Proposal is good for 30 days unless otherwise noted. Owner is to keep jobsite clear of any work hazards.Any alteration or deviation from the above specifications will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays are beyond our control. Our workers are fully covered by Workman Comp Insurance and we will furnish you a copy upon request. Owner to carry any other necessary insurances.Payment is due for the amount invoiced upon receipt. Invoices unpaid after 30 days will be subject to a 1 1/2%monthly interest charge. Customer is responsible for any collection costs incurred. Thank you for the opportunity to bid on your project. We do not warrant against and shall not be liable for any damage or injury,including but not limited to mold accumulation. Acceptance Signature Cape Cod Insulation, Inc. 05/18/2007 455 Yarmouth Road - Hyannis, Ma. 02601 Ph.1-800-696-6611 Fax. 1-508-778-5735 To: Town of Barnstable Building Department Cape Cod Insulation will be installing 10" R-30 Kraft faced batts in flat ceilings: 8" R-30 Cathedral batts in slopes. 3 1/2 R-15 Kraft faced batts in outside walls. Keith Presswood Sales Manager C r i I -2-2-- 6 7O7 F -iTO WN OFB � 9. 2) { I - June 1 9S. Q !$7514 DATE 19 PEF2MIT NO. APPLICAN�. Stephen Harne ADDRESS Washington Ave.F.xt.Hyannis OWNER T1 (NO.) (STREET) (CONTR•S LICENSE) BUILD fETURE NUMBER OF r PERMIT TO Build� $rage reeZewcl�/ ) STORY single family dwelling DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 15 Washington Ave. Ext. , Hyannis, MA 02601 ZONING RB AT (LOCATION) DISTRICT (NO.) (STREET) C�- ' w' BETWEEN AND (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 k TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION .(TYPE) '- - REMARKS: �1 AREA OR 696 it. 2,000.00 PERMIT $ SO.uO •; VOLUME q• ESTIMATED COST FEE (CUBIC/SQUARE FEET) OWNER Stephen Harris "I r w BUILDI ADDRESS 15 '�auhiRgtori flVe. ,:,x1:. , iiyar�nis, (1A UZb BY 100 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED -. FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. 1;' 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 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL a MEM8ER5(READY To LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE ,3 OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 � 2 2 2 .P 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT t 2 BOARD OF HEALTH (JTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL 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. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. a # G r 1 I Kai �s 5� S vly o ,> .. fto Jja Al 1 K S c to® „ t r a , , l•'a#�c .R. i i lk .a•/n'' y w 'S wtira�0 , load µ4� 4Xrs 3 � Gum .n y' - i .�:L.yld } tt�}'}.�r. q 7 r-3rL'a..F,rn .i c•. J • ,5i y, I,-j. ., •s t �. ;e. �y �tr +r .i, NX >1 eG� li• r Y ! Y - • ,-x*a#•.ye t�' �_ ia. Y.;';!,t... .#y�l' e_�l!I�sl'M' '1'.� 11�^ ' �'... ...__.. .. tY �,f` �, �� i � , 3 �� ���� S�' n ! ��,5 Give'� �h � �� - ��� s��/�s s ���� -� �� ��� ._ 11%02'94 17:02 226177277122 DEPT IND ACCID Z 001 . - 0; Conuwnweaftfi, o/ &IJaclia4etb .. aL.��c2rtmen�n�J'"�fria[�ccidenti 600 Wwkwytoit SbE l .lames J.Campbell &ton, ///aessw" 02111 Commissioner Workers' Compensation insurance Affidavit taaas�,�a1 with a principal place of business at: (Myise"Jzlp) do hereby certify under the pains and penalties of perjury, that: 0 l am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. () i am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number (�1 am a homeowner performing ail the work myself. 1 understand that a copy of&,is statement will be forv:zrded to the Office of invesdradons of the DIA for coverage verification and that failure to secure cove-age as reiz i,-ed under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisdn¢of a fine of up to s 1,500.00 and/or cr, years' imprisonment as well as civil penalties in the for:of a STO P WORK ORDER and a fine of S 100.00 a day against me. Signed this day of S i Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # . . &PLNnAMZ The Town of Barnstable MAS& tee$ Department of Health Safety and Environmental Services 1659. '. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only 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: Est.Cost Address of Work: Owner Name: �'��/� 14,4-7e Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: 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. - OR Date Owner's name TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION / - Number fftreet address Section of town "HOMEOWNER" X 7/- LL8-/ �z5�. .. Name Home phone Work phone PRESENT MAILING ADDRESS h�t ^117 _c City town State Zip code The current exemption for "homeowners" was extended to include owner-occupiec dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, 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 Off ici on a form acceptable to the Building Official, that he/she shall be responsib for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes .responsibility for compliance with the St< Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic to comply with State Building Code Section 127. 0,oConstructiwill be required HOME ONTNER'S EXEMPTION The code state 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 Ownei 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 awarene_ often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner' actir. as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man 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 currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. V, XEC - 29'v- 92' TUE 1 4 14Z DES LAUR I EPS ASS0 P 01 UNREGISTERED, LAND FI,.E NUMBER: 58� DEED 80AK:''34 PAGE:464"' ' { .` 10 40 & 41 'A'TORN Ey+ ALAN M. SECAI + zt "a PLAN BDOK. 4 s PAGE:101 �LENOER. NONE f t — PLAN'EN OF OWNER: DORIS J. OORE REGISTERED LAND AIIPLICANT: STEPHEN & DOROTHY HARNE REGISTRATION BOOK:' 734 PAGE 464 DATE:_12 29 92 T� SCALE: CERTIFICATE OF TITLE: - FLOOD HAZARD INFORMATION PLAN NUMBER. LOT(S): FLOOD MAP COMMUNITY No.: 250001 ZONE: C ASSESSORS MAP PANEL: 0005C DATED: 8-19-35 MAP:— BLOCK: PARCEL:®�® MORTGAGE INSPECTION PLAN IN r BARNSTABLE Lot 32 Lot 39 Concrete Bound 100.01 Lots 40 & 41 10,000 S.F. w Lot 31 U.J CD ® LLJ CD �z 1 Story —J Lot 30' 26'± 100.01 WASHiNGT0N AVENUE BANK USE ONLI THIS la THE E NOT THE RESULT OF A INSTRUMENT SURVEY AND IS . FT E MEASUREMENT,0 AP I � RSULT CERTIFiEO TO THE TITLE INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. THERE ARE NO DEEDED EASEMENTS OR ENCROACHMENTS WI''H RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEP'f AS SHOWN. DES LAURIERS & ASSOCIATES INC. THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL - 130 WEST STREET WI'rHIN A SPECIAL FLOOD HAZARD ZONE. WALPOLE, MA 02081 - (800)287-8800 (508)668-5010 THE. LOCATION OF THE DWELLING AS SHOWN HEREON EIIHER WAS INCOMPLIANCE WITH THE LOCAL ZONING ICY-LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY), OR IS I.XCEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER �. MASS. G.L. TITLE VII, CHAPTER 40A, SECTION 7, x' GENERAL NOTES: (1) The declarations mode above ore on the basis of my knowledge, Information, and belief as the resuit of ® mortgage plot pion tape survey inspection made to the normal standard of care of registered land surveyors practicing in mossochuselts. (2) Declarations ore mode to the above named client only as of this dote. (3) This plan was not made foP recording purposes, for use in preparing deed descriptions or for constructions, (4) Verifications of property line dimensions, 6.. A. A.A.m #® J"Q§Y17TPnj QIAPN@V. e Assessor's office(1st Floolik .,Assessor's map and lot numbs Conservation(4th Floor): Board of Health(3rd floor) _ ; �_ w � Sewage Permit number a ' �o�y ant c Q . Engineering Department 3rd floor): 1 0 +ago. \oa° House number ( { �' �oarr�. 19 APPLICATIP NSWOCESSED 8:36-9:30 A.M.and 1:00-2:00 P.M.only TOWN OVBARNSTABLE BUILD [NG 'J SPECTOR U%APPLICON FOR PERMIT TO 6l.i� �5515 � TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location _ %/ ter,c Sri _ / ' ram,.. Proposed Use C Zoning District Fire District Name of Owner Address- Name of Builder s' � Address .SY1,"25 Name of Architect Address Number of Rooms Foundation Exterior �r Roofing Floors �4/✓0�CC 7 Interior �---- Heating �^ Plumbing Fireplace Approximate Costi�® Area . Diagram of Lot and Building with Dimension Fee IV �Z OCCUPANCY PERMITS REQUIRED FORt4EW DWELLINGS .2V I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. )CNarne Construction Supervisor's License t (309. 102) No 4ftTtt*- -*Permit For Build future Qard'ge/breezeway F Location 15 Washington Ave. , Ext. Hyannis, MA 02601 . 7 Owner' Stephen: Harne f - Type of Coristruct'ion Plot Lot y. t - , Permitf Granted 19 Date of Inspection: / Frame t € 1916 « . r Insulation 19 Fireplace 19 //��}} c/� Date Completed l� ., 19 . r ' 1 f t APPLICATION FOR PERMIT TO INSTALL AND REQUES �� �` � � � FOR ELECTRICAL SERVICE' 11 Inspector of res a0 .,�Z Wiring Permit # COM/Electric# gown of Massachusetts Building Per # Date Customer: s::�ZL on (Street #) -- / Lot # �d f in the pviilllAa/g�e�of /-5 utility pole number or undergioLnd number 1n? /n r Customer's billing address Temporary New installation Change of service 1,""' Starting date 10/a �9 Job description I'W',"PAmnz if -� ¢'CJ/ 'Ga f f0 �>.C7 /S�3 /� '1,Q Service entrance voltage Amperage /S"U Phase Wire size (cu.or al.) Conductor per phase l Number of meters A Water heater Off peak: Yes—No— Estimated load:Electric heat T kw, lights kw,RangesS S dryer Motors, H.P. & Phase Ready for first inspection Ready for final inspection y��. CS� —Telephone 9791-�S 1f 'Electrical Contractor � c-��/ Lic. # phone # Address Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS DATE FEE CHARGE Temporary Service Roughing in Service and MeterOff Peak Meter Final Approval Disapproved' `For the following reasons CERTIFICATE OF INSPECTION t Date ZIA To the COMMONWEALTH ELECTRIC"COMPANY. The:installation described above has been completed and has this day been inspected and approval granted for connectio your service. �.'�..� Inspector of Wires . � WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION {p Permit Good For One Year From Date Of Issue CA 46 INSPECTOR'S NOTICE f Office Use Only��/Zy < ' 04e Tommouweafth of Magoac4utietta Permit No. (� Pepartrttent of rubiit: Oafetp Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 PLEASE PRINT IN INK/O� TY E A� INFORMATION) Date W /!7 City or Town of To the Inspoctor of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Nuum"bier,) S� G 1 ��il�� iC/ (/U� - 4 7- Owner or Tenant Owner's Address Is this permit In conjunction with at building permit: Yes ❑ No [B'- (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service eQ_ Amps la?_,0/_�r�Volts Overhead Rr Undgrnd ❑ No. of Meters New Service O Amps/--;,70 / 510 Volts Overhead ❑ Undgrnd [0" No. of Meters Number of Feeders and Ampacity _3 �O Location and Nature of Proposed Electrical Work l No. of Lighting Outlets �/ No. of Hot Tubs No. of Transformers Total K VA No. of Lighting Fixtures JO Swimming Pool Above In- // grad. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges / No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Sell Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal ❑Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO Q' I have submitted valid proof of same to the Office. YES O NO 0 If you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND 0 OTHE 0 (Please Specify) _ (Expiration Dale) Estimated Value f lectrical Vyork $ &M. 60 Work to Start/_ /-,,6 y _ Inspection Date Requested: Rough Final Signed under the P aItles of perjury: y FIRM NAME � / �/I�//_ LIC. NO. Licensee p111� 71- Signature �i LIC. NO. Address 'i�/ �lr/��v� E U Bus. Tel. No. 1 AIL Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner �nt (Plead eck on ) Telephone No. 7���V� / PERMIT FEE $ & ..— (Signature of C)wnar or Agent) x-6565