Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0159 WHITEHALL WAY
S� 1,�� ,'�� � ill � Q .,� 2� i i i t Town of Barnstable *Permit# 187 07- Expires 6 months from issue date BAIiNSTABLE, • Regulatory Services Fee -3 Maas Thomas F. Geiler, Director i63p. ,0� �prf�M►``� - uilding Division om e ry,CBO, Building Commissioner JUN 13 2018200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-86TOWN O� bARNS ABU Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint .Map/parcel Number Property Address 10 Residential Value of Work 4(2(2�2 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address pt/I //I191'h 5M I Contractor's Name `'7i^u'��tM C.L t�„ Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) rorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I 'the Homeowner I have Worker's Compensation Insurance r Insurance Company Name ATLAILA-16 Ckl+2NI P_ Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re- ..e - Replacement Windows. U-Value ^ 30 (maximum .44) r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro`erty Owner must sign Property Owner Letter of Permission, H• e Improvement Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILE-S\FORMS\Express\EXPRESS PERMIT.DOC R6vise06O4O9. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street <. , Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Les?ibly Name(Business/Organization/Individual): �7,4! &_/9*4 LLCi Address: we-5/ �9 `' City/State/Zip: M 41 170 0A01 Phone.#: ArWIarmiaa n employer? Check the appropriate bog: Type of project(required): 1. employer with q 4. I am a general contractor and I employees(full and/or part-titn.e).* have hired the sub-contractors 6. ❑New construction . .2.0 I am a sole proprietor or partner listed on the attached sheet. 7.. 0 Remodeling ship and have no employees These sub-contractors have g. - Demolition working 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 repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[l�Other 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.. tcontractors 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 thepolicy andjob site information. / . Insurance Company Name: i41 L`9f,,jl c' Clre2 Policy#or Self-ins.Lie.#: C�.�DS�7�O� Expiration Date: f bf Id®l Job Site Address: City/State/Zip: 96-1%i j filWI a36aj Attach a copy of the workers'compensation policy declaration page(showing the policy num er 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. 1do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral,or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a 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 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 evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)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' F. 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 permit(license applications in any given year,need only submit one affidavit indicating current " policy information(if necessary) and under"Job Site Address"I.he applicant should write"all locations in__(city or town),".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigationts 600 Washington Street Boston, MA 02111 Tel. #617--727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia 1 sToti Town of Barn-stable Regulatory Services ! SA..kNSrAB..cti ! r MAB& $, Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 I161&1,n�lL� as Owner of the su ro esubject P P rtY . C� r hereby authorize R 'Y2. to act on my behalf, in all matters relative to work authorized by this building permit application for. .(Address of fob) �Ile? �S* e of Ov r Date 1 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Reeul�atory Services • awxtvsrwaLe. Thomas F.Geiler,Director Building Division PrED Tom Petry,Building Commissioner 200 Maiui-Street,—Hyannis;MA102601 - ...... www.town.barristable-ma.us Office: 5081862-4038 Fax: 509-790-6230 HOTIEOWNER LICENSE EXEMPTION Please Print DATE-- JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown 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,hocdoes not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible 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,miles and regulations. The undersigned."homeowner"certifies that.he/she understands the Town of Bar.. table,Buildm Depar. cnt minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner 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 p=-vt is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the hamcowncr engage a person(s)for hire to do such work,that such Homeowner shall act as supervisor.. Many homeowners who use this exernption 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 ease,our Board cannot proceed against the unlicensed person'as it x ould 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 hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a fmTrVicertifi cation.for use in your corrununity. Q:forms:homccxcmpt r Commonwealth of Massachusetts ( ' Division of Professional Licensure Board of Building Regulations and Standards Constrg6d6n/Si5p�rvisor CS-042246 , �. E ires: 03/26/2020 GARY C GRAHAM 66 GRANT WAY HYANNIS MA 62601 �r Commissioner CIL Construction Supervisor { Unrestricted--Buildings of any use group which contain less than 36,000 cubic feet{991 cubic meters)of enclosed space. Failure to possess a current edition ofthe'Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.rrass.gov/dpl office of Consumer Affelrs&Buafness Regulation - _ HOME IMPROVEMENT CONTRACTOR = RTYPE:LLC IstratloIl 182219 06IO2I2019 GRAHAM LLC. Sry GARY.GRAHAM f C�1 I 358 WEST INS HYANNIS,MA 02601 Undersecretary l - Registration valid for individual use only before the expiration date.of found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 6170 Boston,MA 02116 - ,i t 3 Not valid without signature ® DATE(MM/DD/YYYY) .aeoRo, CERTIFICATE OF LIABILITY INSURANCE 01,25,201$ 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 00391 -001 NApp MEACT Horgan Insurance Agency,Inc. At o.E:t: (508)775-5830 ac.No.: PO BOX 250 EMAIL Hyannis,MA 02601 ADDRESS: INSURER AFFORDING COVERAGE NAI INSURER A: Atlantic Charter Insurance Company VDAC 44326 INSURED Graham, LLC INSURERS: INSURER C 358 West Main Street INSURER D: Hyannis,MA 02601 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED.ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ggEXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED D�BY PAID CLAIMS. IN TYPE OF INSURANCE IANSR WVD POLICY NUMBER MM/DD/YEYFYY POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMI E E RENTED CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $. EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY R� OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED er accident) AUTOS AUTOS (BODILY INJURYP $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ O DEDg pM RETENTION $ VAC g U. T $ AND EMPLOYERS LIABILITY X TORY LIMITS OER ANyPR�pq�EToq�Pp�TNEq�EXECUTIVEY/" WCV01059005 1/29/2018 1/29/2019 E.L.EACH ACCIDENT: $ 500,000.00 A OFFICER/MEMBER EXCLUDED? �. N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000.00 �bb d E.L.DISEASE-POLICY LIMIT $ 5OOOOO.00 Policy Coverage State: M fi D��sCVfr18N�nF OPERATIONS below , Gary C Graham is covered by the work rs cc imp nsation policy AND Laura A Graham is not covered by I he workers compensation policy_ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION - Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 Main Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Hyannis,MA 02601 WILL ENDEAVOR .TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved.- ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY _. Town of Barnstable � e Regulatory Services 1•� Richard V.Scali,Director Building Division + SeaxsrA LE, + MAC• $ Tom Perry,Building Commissioner 1639. �0 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION -,�I•_�_�_.I_� C�'LI- SO V 3� � - a Vs_a Name: o ry-�Y-- 'M I+ Phone#: 140r r?- SCE,3' -Q'��_f Address: ' cl wh �� t( (� �•�-t Village: Ce n Y�l 1 ry cC 0 (O al Name of Business: C (e a 4- �J-e e, l 4-hq ()CC Type of Business: I yl °� I (Ak I (Y1Q 55 MapUt: 0? C / INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the . dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. C Applicant —Date: l J — I 1 Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town which ou � y ) yo u, t must do by M.G:L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk'.s Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: �I L Fill in please: rtF w � s T}rRV�M APPLICANT'S YOUR NAME/S: ra,n,n""I S iYl x ''H BUSINESS YOUR HOME ADDRESS: 1 5ct (, j h i f e h li Gil a l , Sa 50`6r1`iG"099-7 HVann,-s n'1a u TELEPHONE # Home Telephone Number NAME OF;CORPORATION. NAME OF.NEW BUSINESS (�of 1 n` Q # o nce . 'TYPE'OF BUSINESS Arr�f i--li .I f IS.THIS'A'HOME OCCUPATION. YES NO ADDRESS OF BUSINESS' • S 'A s' MAP/PARCEL NUMBER ' [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules.and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OF 1 E This individual has bee o d of an ermit requirements that pertain to this a of bu iness. q P type thorized ignature** MUST COMPLY WITH HOME OCCUP COMMENTS: . F r IIV FINES. 2. BOARD OF HEALTH This individual has been inform t er irem.ents that pertain to this type of business. . Authorized Sig ature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) _This individual ha or rm of the licensing requirements that pertain to this type of business. Authoriz 6 ignature* COMMENTS: Assessor's offioe (1st floor): 'THE u o � T Assessors map and lot number ..................................r< W Board of Health (3rd floor): � _ � � Sewage Permit number ................................ ........ �?.!.. ..... t BASasTADLE• i Engiieering 'Department (3rd floor): # �,FrIS oo r639. \0� HouBenumber ........................................................................ e war°. APAICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... (�! ? S.. G,Cat...C... ...!.._..J.C., <'.. )..�k'I G`•................................ TYPE OF CONSTRUCTION f .. J w<� �..��.::e.......................................................................... ........................ '..S 19_ � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies ,for . al/permit according/to th/e. following information: Location .....I,b 'I_ `i l/V vl .T.f.. ..!..�...l/��,Cti CA ..... ......��.! 1.. .L.... .................................. .............. ProposedUse ... ................................................................................................ Zoning District .... .. .....!...............................................Fire District ......` C�C.�✓1 vl I / `� J. .--......... ......1 ............�............ V21.-Atfz..ar ...,.Address ....T...0..........� / e ,l, //Name of Owner .....Gr.c.<Ki.....•.......... ..... ........ �. Nameof Builder .....� 1..Q.:......................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Foundation ..po.(Acl�� Number of Rooms .................................................. ...... ............... .! .C..LI.f'....... ...... 4 Exterior ....J .... .(.Y7C' lee- ....�.. <�.... ../.'.�� _SRoofing .............. .. IC<./� ..................................................... Floors (�. / / (i,�?}'7 P.. ..................Interior � (/t e e ��.. V�......�..n..L........... —....---. . �.0............................................ ��� � Heating ............1 .✓...... .....'-.J.V..'.1......6G.....................Plumbing c-� 6-4:...........s............ . ........................ Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________ �� _A!�U__19 i� Area .... `a .z.................... Diagram of Lot and Building with Dimensions Fee �7o S0 SUBJECT TO APPROVAL OF BOARD OF HEALTH X Z�o 5 IU' F� tsr 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 ..... ��'i1.....` . Construction Supervisor's License ... Q!`���..7...../..... GREENBRIER CORP. A=272-189 No ...301 -:` Fer,rnit for ....Ong...S.tQ ry............. Single...F ,�,y...A�aaJ J zzig........:.......... Location .....L.4.t.11.4........15.9..WhitehaJ-1..Way ....................H.Yanais............................................. Owner Greenbrier Cori. Type of Construction ...Frame ............................... ............................................................................... Plot ............................ Lot ................................ Permit Granted October , ............................28....... 19 86 Date of Inspection ....................................19 Date Completed ......................................19 i t i TOWN OF BARNSTABLE Permit No. ..301Q6...... ' ' BUILDING DEPARTMENT Cash TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond . CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot #14, 159 Whitehall Wav Hyarinis, i,assachusetts 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. Burch 31 , 87 ✓ Building Inspector a'fy •�'. TOWN OF BARNSTABLE BUILDING DEPARTMENT t r�1°T % TOWN OFFICE BUILDING rua i6S9' HYANNIS, MASS. 02601 �'o iur►' II MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit .. ......................................................................................................_.......... _...._................. _ �...._» issued to l?fi '�.cJ lam- r-I ra, "^„ A•^/�............ r//. .. .. �'�./ '�M-e WZ1 49111.0 y� Please release the performance bond. Z ur-t�iu,� �X`F."ft R{ 'Tr.F•Yh 'W" 7.',k"^` ��,51��"`Y�,e�9.tr'i.f n '_F „y{ •`4 e��.- s-k-:»,.-.S �' s� �����'s'i$•'�r'r� 3"m`a.x'" "^ityZ�1,a -c �}"'�.�ri, y..��`h�yr 6L�r �" ..t�ya�.w'S)'y2i�fiG„.�� x '�" �" �� F 4 ;BARtSfAfi�. ASSAC##USP1� w ,w #21 �l .�, C�r-,c +'a' n.a'.t"�v x y s. d .r+` ,e„ e•r � � �: - ''1„-i� r c r� a s r F7L � �dci> �? ,Q,bj �.� .,� > t l t� A -•F: �r r e.' � . A >}.c-. .a am F-,„'';� ! � .k:_:p�� - .'- .y ,t-��>+�.nt ;� rr �� Y ,t'r s'• ..�.F.1 a,.. N.t " ,Ctf?tT� � °.5.�' SP- �.„ �19 PERMIT !` 4h'k�;�p.�:'�♦1N"F- adii* �-�b�d���°�"'��t`b �. � N7 ll _�,,,,-„_,,,.„ -^ • - ADDRESS p• �• 130X 510,, Centerville'. " (NO.) (STREET) #n(]t 3(CONTR'S LICENSE) NUMBER OF , PERMIY TO Build Dwelling (_1) STORY Single Family Dwelling DWELLING UNITS (TYPE OF IMPROVEMENT) NO. .)PROPOSED USE) I f Lot 014, 159 WhitehallWa , Hyannis ZONING KC-1 AT (LOCATION) -- _ - y Y DISTRICT, (NO.) (STREET) 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 !ws TO.TYPE USE GROUP BASEMENT WALLS OR FOUNDATION - , (TYPE) REMARkS: Sewage #86-1011 Bond " AREA OR 1572 s ft. 45/000. "7$.50 VOLUME. ESTIMATED COST VO FEEMIT ✓ (CUBIC/SQUARE FEET) OWNERV Greenbrier" Corp. ADDRESS F. O• $OX 51O', Centerville BUILDING DEPT.c x� i. a /� THIS"PERMIT: C.ON V.EYS. NO RIGHT. TO.OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY'PART THEREOF. EITHER TEMPORARILY OR 'P.ERMANENTLYENCROACHMENTS.ON.•PUBLIC-PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY':^THE .JURISDIC:TION..STREES.OR ALLEY GRADES AS.WELL AS DEPTH AND;LO,CATION OF.',PUBLIC SEWERS MAY.B'E-OBTAINED +'FROM-T,HE DEPARTMENT OF. PUBLIC WORKS.'THE ISSUANCE OF THIS PERMIT DOES NOT'.RELEASE THE'APPLICANT.FROM THE CONDITIONS ^.,,OF ANY :APPLICABLE SUBDIVISION RESTRICTIONS., MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS" -WHERE APPLICABLE SEPARATE -'-ALL ECTIONS REQUIRED ED K: '?. CARD KEPT POSTED UNTIL,FINAL INSPECTION HAS.BEEN' .PERMITS' ARE ,REQUIRED. FOR >-ALL WORK:. ELECTRICAL PLUMBING AND �1 "F"OUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF�OCC IPANCY' IS RE- MECH,ANIC,AC'INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOT'BE OCCUPIED UNTIL FINAL INS RE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE., - ,. 3-. FINAL�INSPECTION BEFORE - OCCUPANCY. . . - .. - POST THIS CARD SO° IT IS VISIBLE .'FROM STREET . BUILDING INSPECTION APPROVALS A PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 3 Y &A,5HEATING INSPECTION APPROV LS ENGINEERING DEPARTMENT _ t OTHER. 2 BOARD OF HEALTH , rc, h 8 - WORK'SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL"BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR,HAS APPROVED THE VARIODUS STAGES OF L WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION: t.;PERMIT iS ISSUED AS,NOT.ED ABOVE. NOTIFICATION. r r Sa,�'4 ra k �� `- racy �, � �� `M t r 'e � � � a „7'"}.,t-�x ��" .x wN�a ^K�•-�"'��,.attY� � r�ar 9 . ''�fi:< h „_ '>r3''^t -t'K �, ,�r.w� r ;'>r. T$ a '4. t.: t-.. 4 t 1 1..���V~� 7 'k.:."+ -a,, r d�:Y • �'4.,` wg i_, Y-� fi3 ` �s .Fp_-bN*`r,40 E clr 30° FarST i 12 E.i4 R 5 'T$14�K DArN - IIN Lo r r O sIq +.• , y 5 7/ ° J �o c t *1 Y G-u L ` (Spy W (V;,a� Lo CERTIFYTHAT THE A `I FO Q QN T1 DID µ xri �+ �g w ocM SHOWN ®N THI PL/�N la7 rp•��p`� A � ,. 1 a LOCATED••ONl THE GROUND �LEVAUL A, ", �`� LEVY AS INDICATED...AND CONFORMS No. 10612 : 0 TO THE ZONING LAWS OF $ � ,,�L MA �����s Tti<¢�',° '' �_.. x, ATE RE $ ERED LANDS EYO LEVY & ELDREDGE ASSOCIATES,INC. CLIEN'� °=' PLOT '," Lm ,"'"Y I ENGINEERS - LANDSCAPE ARCHITECTS " JOB IVY?,Jam ' ` ark r' T- 4ALL W k 3 a PLANNERS— LAND SURVEYORS DR. ®Y• fi y . 889 WW MAIN STREET CHKD.,®Y=.. 2, ' °F' A -1T3 : M/�xskY9 F CENTER ILLE, MA..0202 SHEET-I.OF..L. ` N 31 9 � Assessor's offioe Ost floor): ' . p V�' STALLED SEPTIC SYSTEM MUST S TMEAssessor's ma and lot number ........... ..... . . ...........Board of Health;{3rd floor): � -EY IN COMPLIAR9Crf- e�Q Sewa ,e Permit, number ..........................: ......, .�... WITH TITLE 5 Z Basa9TODLE, Engineering Department (3rd floo): � 9 `,!S r; 'A ENVIRONMENTAL CODE A��� moo r6 q. \00p House number ........................... TO RECUL14TI®�! DNA TOWN Y APPL.4tATIONS PROCESSED 8:30-9:30,A.M, and 1:00'-2:00 P.M.:only,' TOWN" 'OF B,A-RNSTA.BL.E . . B U 11 D I N G-- --11S�P E C T 0 R APPLICATION FOR PERMIT TOQi..1 .. //� .. TYPE OF CONSTRUCTION .............Q.Q.... ...... ..S�-�lY1'e..................................................... .................... TO THE INSPECTOR OF BUILDINGS: f The undersigned hereby applies for 'a permit according to the f Ilowing infor ation: 14 Location .....(CP... .....::.. .-1.....vv ..�.....if.. .1............. . . . CA!l.n i-�................................ ProposedUse ...... ...... �:j..L?':1. .• e.... 1 - 1!...F... ...............:...............;............................:................................. Zoning District .... �. ........................Fire District ...... ... .'�'� 4�/. Address c.......4�...j. :... eYt....1°�'( (// .. Name of Owner ................... .1.�'. ...........f�.�. ....`.0 Name of Builder ..... . .. Address Name of Architect .......................................................:•...........Address Number of Rooms ..........:......................... ..... .......:.Foundation ��...G.C/...... . ( .0�. .. ... t � � l llp , � II� Exterior .... -J ..s. 1. .. !.4.5.......(�C1 ..C...... .. .Roofing .. Apx:z/ ..................... ..... , //d= �' Floors ll.... .. . . ... .... �'J�.... e.........................Interior. .....��............ }._.... .. ... Heating ..................Plumbing ... ...r7 .'-. ......`. ........ ` Fireplace t..Approximate Co ...... Definitive Plan Approved by Planning Board _ _ d__19 ;Area I,-5 ,Z.....•.:..•.,.:•.... .9 . Diagram of Lot and Building' with Dimensions Fee 7 ......................... SUBJECT TO APPROVAL OF 'BOARD'OF HEALTH C, -17 Cc"-c ck e ' 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 ...` .. ` r Construction Supervisor's License ........... GREENBRIER CORP. No ....30106 . Permit for ..One Story.............. sL ..�., _ •_ ,. z t Single ,Family Dwelling � . ~ Lot #14 159 Whitehall Way Location ' ................ Hyannis ....................:................ .{" ✓11 ..... . ..... .... Greenbrier Corp.......`.... Owner 40, Type of Construction Frame ...... ...-............ ,,.-- r5 (^ f�r�` ♦,,, ` i r : .y. .... t, �1 .�,�,i ;•r t1 •� � fir' '< J 1 1 ., .j` � 't ••4�, • .. 1 ..... ......... .......... ...... ; _• �,,,.. 4' 1 i�'�"`r^� v , .. -v , Plot .. ......... Lot ................................ x' a Permit Granted ....October 28 ., 0 86 ............. ...... Date of•Fns ection -'�..".......19 �% ; Date Completed ...... /....... 19 ..—J .n,.,, 41 yq y x /j r �.. C7 �'1 J f � 4✓� .s 1. t A. 1 �t►,E, Town of Barnstable *Permit# d'r 6 l 7( Expires 6 months rom issue date Regulatory Services Fee &Is 0C? SS ITThomas F.Geiler,Director r A Building Division 9�A fC MA'I ` VIP-- APR 14 2008 Tom Perry,CBO, Building Commissioner 00 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABL`'Z www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230, EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number a- x Property Address ' 11�q [residential Value of Work 5, S- Minimum fee of$25.00 for work under p$6000.00 Owner's Name&AddressA A Contractor's Name � � j�✓C ..- Telephone Number �5��SR 5 = Yt 3 Home Improvement Contractor License#(if applicable) E C, U-4rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner []]/I have Worker's Compensation Insurance Insurance Company Name ^Na X:J f ft Q- �;t 1 P C,�n. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) D-I�e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,3, *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement,Contractors License is required. l SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 T 1lIassachusetts The Commonwealth 0 f Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business!OrganizationandividuaI): F)f Address: City/State/Zip: Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with 1 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.•msurance comp.inmrrancg$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I qu 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 ram]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'convensation 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.. tr—=trdctors Oat 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 Nam y,ra, va Lt-rA A/-LL& Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: /. � ll I-, "1 2 10,.ad Z&1 4,�4 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy n r 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 tip 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 WA for insurance coverage verification. I do hereby certit&.under the pains-and penalties of perjury that the information provided above is true and correct. SSienature e en c-1 r.a ' E) l'o�Q���- Date t� � � [�� _ Phone 3(,-y-(,l(/V 5 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a 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 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 frith the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance-with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers) 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 Towu 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 permit4icense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit.must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. -no 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. The Commonwealth of Massachusetts Dgwtnent of Industrial Accidents 0mce of InVestigatfons 600 Washington Street Boston, MA 02111 Tel. #617-727-4WO ext 4-06 Qr 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia �a oFtKeraw• Town of Barnstable Regulatory Services RAMSTASie Thomas F. Geiler,Director i639. �$A `fig' _ lF6.19 " Building Division Tom Perry, Building Commissioner' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder U m !4'h , as Owner of the subject property hereby authorize )(-170 �A G al to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date G{l i 14 rri f A� h <1(C~ F Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. -Town of Barnstable �pP SHE tp�� y� o� Regulatory Services " Thomas F.Geiler Director sntwszwet E. �: y' MASS' 0.19. Building Division lfD 11A�A 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: - JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners".was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible 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 requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner 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 helshe 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. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION LZ,5& 4,7/z Map 2 7X Parcel j��• Permit# � 70 7 46 +��'�f 0� B.�f��f�i"�LE �/ i /Health Division X r9`I '"`t� 7�?6 Date Issued ry O !�Conservation Division J!i -2 AM 9: 3S Application Fee Tax Collector f Permit Fee Treasurer --%f 7 64Z_ " APpJICANT MUST OBTAIN A SEWER CONNECTION PBRMIT FROM THE Planning Dept. ENOMERING DIVISION PRIOR TO CONSTRUCTION, Date Definitive Plan Approved by Planning Board Qit c fC Historic-OKH Preservation/Hyannis Project Street Address 159 &qo 12�Ftw LZ �OA Village f pNN l`7 �-'l� • ®/ Owner Al"e-1.1AA1 L r rN Address &A�-1 Telephone 52)6 MI Permit Request `�o ;� ►� '��t.�D�-Clsv �2 e_ _ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft,) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing. ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing, ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed-Use /R/ BUILDER INFORMATION W Name JAHa"; Telephone Number 506 3c\4 (n Address TO O P!!Y— License# _0* 0f �o® ` KAP—WaoM, "A 0z(o7 3 Home Improvement Contractor# IzA 0 qe A i rs4, 0®, Worker's Compensation# 43 116+1 ®® ALL CONSTRUCTION DEBRIS RESULTING FR M THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 02p G - i - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED _ • -+ ,` r r MAP/PARCEL NO. rs ADDRESS VILLAGE ` ' OWNER - ' F , DATE OF INSPECTION: - FOUNDATION FRAME ' 1, INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL > PLUMBING: ROUGH FINAL' GAS: ROUG FINAL- FINAL BUILDING ? ! cr- ' DATE'CLOSED OUT ' £ ASSOCIATION PLAN NOS_ The Commonwealth of Massachusetts ` � 7 Department of Industrial Accidents OlAce 0115vestlpsde®s ,600 Washington Street Boston, Mass. 02111 ' Workers' Compensation Insurance Affidavit Applicant information: Pleas�PRINTkbFic lucntion 11q WH l lCoAU1--- A,� 1�/ tCMH` ,600l`7 , UA- 0Z-�l d ?onea 5o€� !Co I am a homecµner performing all work myself. I am a sole proprietor hase no one ssorking in any capacity I am an employer pplrro�idin�gj woorrxkerrs'lcompensation for my employees working on this job. e comnsny name• �� Y ' ✓�=�1tP�t�jJ o address' 4/• � ��T CM YAizF-too-m '-`a^ 02-14013 phone#' 508) 3 A G 1011!) insurance co t7 r�� �,� 1��' 0-40% policy# 451 l &+1 oQ - F-, I am a sole proprietor. zenerai contractor. or homeowner(circle one) and have hired the contractors listed below \rho hale the follo\sM2 corker I-ompensation polices: ,4 ` company name: -- address' - cn• phone#' insurance co policy# company name: address: tiP•• phone R" insurance co Dona# Failure to secure coverage as required under Secnon 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day stainst me. I oaderstatrd that a COPY of this statement may be forwarded to the Office of Investigations of the DU for coverage verifieatioa. I do hereby cerri -u er the pain a d pena 'es of perjury that the information provided'above is true and corrs a ,!fa tG Signature -��'" `" ate Print name JALkE-5 �J ' �C_^'YQ��Ql�3 Phonek E508 394 �fo� Econt2ctperson: o not%rite in this area to be completed by city or town oMcial YARMOUTI permidlicense y rlB:udtrg Department(]Lng Board response is required 261 ❑Sen's Office� Dcpanmeot phoney;_ (508) 398-2231 ext. Information and Instructions ' %135S3chusetts General La��s chapter 152 section '_5 requires all employers to provide workers' compensation for their :fnipio.\ees. As quoted from the *_lacy an emploYee is defined as ever-_ person in the service of another under anN zowract of'hire. express or implied, oral or written. An empluYer is defined as an indi% idual. partnership, association. corporation or other legal entity, or any Mo or more of :Ice foreuoing enuaged in a joint enterprise. and including the legal representatives of a deceased employer, or the lecei\er or trustee of an individual . partnership, association or other legal entity, employing employees. Ho%kever the ,a\k iier of a dwell in`: House hay ing not more than three apartments and who resides therein. or the occupant of the d\\elkna house of another ho emplo-s persons to do maintenance , construction or repair work on such dwelling house Or 01 the ,r0LII1 is or building appurtenant thereto shall not because of such employment be deemed to be an emplo\er. \1Gt. Jmpter 1 section =5 also states that every state or local licensing agency shall withhold the issuance or "encN\al of a license or permit to operate a business or to construct buildings in the commonw#alth for any ,applicant N%ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the common\\ealth nor any of its political subdivisions shall enter into any contract for the performance of public \\ork until acceptable evidence of compliance with the insurance requirements of this chapter ha%e hc,�n presented to the contracting authority. Applit.:nts Please till in the \workers' compensation affidavit completely, by checking the box that applies to your situation and supply in`, compan% names, address and phone numbers as all affidavits may be submitted to the Department of lindusulal .-accidents for confirmation of insurance coverage. Also be sure to sign and date the afridavit. The aftidON it 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 %%orkers' compensation police, please call the Department at the number listed below. Ciry or Towns 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. The affidavits may be returned to 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 questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents MCC of INVIS011dons 600 Washington Street Boston, Ma. 02111 fax 111: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 f E 'down of Barnstable ' o� Regulatory Servides a, sz& Thomas F.Geiler,Director sss ,�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 permit no. Date . AFFIDAVIT HONM 7N2ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstru do l,alterations,ction of an addition to myp e existing oow�•en,repair, roccupied Ion, .==rovemeut,removal,demolition,or construbuigding containing at least one but not more than four dwelling units or to structures which are adjacent#o such residence or building b e done by registered contractors,with certain exceptions,along with other requuirements. ` �} ��n� gstim4ted Cost Type of Wozk: (:®IJ � I , 9 ' l Address of Work' j t Owner's Name: LO !L—i—I A Date of Application: I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law []Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT O UNREGISTEREDR DEALINGWIT11 IMTROVEMENT WORK AV NOT SE CONTRACTORS FOR AppLICAALE HOME ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FITIVD UNDER MGL c.142A. SIGNED UNDER PBN S OF PB Ihereby apply for apermit as the age.At of the ovmer: Contractor Name Registration No. Date OR ., Owne='s Name �oF the T�� Town of Barnstable Regulatory Services S ssi.E,�= Thomas F.Geiler,Director 9c�A 1639• A.m Building Division rfD FM'� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Fax: 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section if Using ABuilder ..l ,as Owner of the subject property hereby authorized " �"a to act on my behalf, in all matters relative to work authorized by this buildin'g`�permit application for: (Address of Job) Signature of Owner Date Print Name Q..F0RMS:0WNERPfiRMISSI0N ✓�ie Varnmwou�rea.�i a�'✓�oczclucaetf4 BOARD OF BUILDING REGULATIONS License:CONSTRUCTION SUPERVISOR Number: CS 016008 Birthdate: 11/01/1946 _ Expires: 11/01%2005 Tr.no: 7725.0 Restricted: 00 JAMES D SEAMAN _ PO BOX 424 8a y W YARMOUTH, MA 02673 Administrator ` p r t ,� ✓�ze 7°aavnzaruuea�i a�✓1/ �zuael76 Board of Building Regulations and Standards License or registration valid for individul use only i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 121550 Board of Building Regulations and Standards ` Expiration: 5/20/2006 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Individual • JAMES D.SEAMAN` JAMES SEAMAN 497 MAIN ST. ` W.YARMOUTH, MA 02673 Administrator Not valid without signature COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE IN REAL ESTATE LICENSED REAL ESTATE BROKER I ISSUES THIS LICENSE TO JAMES D SEAMAN PO BOX 424 W' YARMOUTH' MA' "026733-0424 98831 11/01/05 830420 1 S ���l� ��� 66z 7 i d , I II I f j I � F II j i I -� _��I . I I , I• I I I � I-, I I i ! it e b 4,/ I-oaT t�c -a N y i Sly T j �6 •A G Q (� f l L cl 1 '5'1 ( ,)td(-rtt-d aT L- V/AY M L.-"20 SS •-- lj�.CTI c��