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HomeMy WebLinkAbout0321 WINTER STREET MENEM i I 1 W I Application number................................................ Date Issued................... ..!' SAMS2ABM " •••F•• ••••••••••••••• :�. APR 2 4 2019 ®o 263� `�� Building Inspectors initials...... •. ................ T O��N O!BARNS I.ABLF Map/Parcel......... .... : .�.............................. 'OWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVFS/WEATHERIZATION PROPERTY INFORMATION Address of Project: 44y NUMBER STREET VILLAGE Owner's Name; C� (o e &A Phone Number 11 O -oZ Email Address: i Cell Phone Number Project cost S q ?R _ Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See Date: TYPE OF W 0 Siding Windows (no header char(e)# `� Insulation/Weatherization 0Doors( he der change)# C cal Doors require an inspector's review kJ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to was4e CONTRACTOWS INFORMATION Contractor's name ,P< Home Improvement Contractors Registration(if applicable)# 1/2-7 8 S (attach copy) Construction Supervisor's License# Oc2 3 y iQ _ (attach copy) Email of Contractor Swe ��S C'cjin a, • C C--v% Phone number 4(o/-7/,/-6 3' 9 ALL PROPERTIES THAT HAVE STRUCTURE OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food food is being sewed at your event please obtain a Health Department approval between the hours of Se 00am-930 am or 330 pm-4:30pm. Commercial events may require pipe Department approval. XW®®D/tC®AL/PEEILET STOVES r Manufa cturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE 1C XEN Il IO Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature .Date /APPLICANT9 S SIGNATURE ATUR Signature Date All permit applicadolffare subject to a building official's approval prior to issuance. ti Home Improvement Agreement: Pagel Home Depot License #'s - For the most current listing www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Janice Campbell Salesperson Name: Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. BADE _ CHLOE New England South 1-KI90AJP Customer Last Name Customer First Name Store #/ Branch Name Customer Lead/ PO# 321 Winter Street I (Hyannis MA 02601 Customer Address City State Zip (920) 285-9 1 1 ichloebade@hotmail.COM Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury 101545 Address City State Zip Or Email' customercancellationnortheast@homedepot.com Service Provider Email Address BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR !LIGHT TO CANCEL. Acknowledged by: 04/06�2o1s Customer's Signature Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: "$ 4380.0,0 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONL Y applicable in M0, MA, ME(33%), NJ, W l(9951o) Dep. 1 25.0 % Deposit Amount $ 1095 Remaining Balance $ 3285.00 The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer.Care: 1-800-466-3337 460FI HOE Customer Agreement(24 Jul.18) v 0.1.8 Home Improvement Agreement: Page2 Finance Charges: *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will will not be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of 1windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on page 0 of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: os/o1/2o1s Approximate Finish Date: 06/29/2019 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays In confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emalls and PDF documents. By ii,niIfiglling this paragraph, I consent to receive only electronic records related to this transaction. Initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete copy of this Agreement. Keep it to protect your legal rights. X CLOV 04/06/2019 The Home Depot ustomer's Signature Date Service Provider Name X 1 104/06/2019 908 Boston Turnpike Unit 1 Co-Signer (if ap abl ) I Date Service Provider Address X 04/06/2019 Shrewsbury 1 MA 01545 Si natu n B f of HomelDepot Date City State Zip R-1-073-13-00016 Service Provider Phone Number Service Provider License Number The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 460FI HIDE Customer Agreement(24 Jul.18) v 0.1.8 i "d nwaalth of Massachusatts 'division of Prota;s"sona!It Cnsura 'bard of Building Igegulations and 3tandarg4s UN f `a'.os9Sr+ rvisor m Wires:0112312020 CS-023410 fi .tea 2 BEOtirMST iaa Commissioner � The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Piumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ADDlicant Information Please Print Legibly Name(Businessiomanizationandividual):�T(.�� D/Coo n P Address: ,Z r`l a c ,, S+ - City/State/Zip: �J r4o M Phone#: _ S' Are you an employer?Check the appropriate box: Type of project(required): l.Q I a employer with �"employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietoror pumership and have no employees working'fnr me in $• Remodeling any capacity.(No workers'comp.insurance required.] ' 3.01 am a homeowner doi all work myself. 9• ❑Demolition doing yse [No workers'comp.insurance required.] 4, 1 am a homeowner and will be hiringcontractors to conduct all work on 10 Building addition my property. I will ensure that all contractors either have workers'compensation insurance of are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13:a Roof repairs These sub-contracto¢have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14•Q Other 152;§1(4),and we have no employees.(No workers'comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information- Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such'' +Contractors that check this box must attached an additional sheet showing the name of the sub-cmntractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: a ve—te r s % ro0z T1 Policy#or Self-ins.Lic.#: T L 1 9-2.0 l Expiration Date: Z Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratiq date). Failure to secure coverage as required raider MGU c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well di civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi62 u or the pains and penalti .of perjury that the information provided above is true and correct Signafore: 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#: Tlie Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass:gov/dia Workers,Compensation Insurance Affidavit:BnilderalContractorsMectticians/Flumbers. TO BE FILED WITH THE PERMT MG AUTHORITY. Applicant Information Please Print Lesibly ' iTame(Business/Ownization/tndividual): N n r+12 Z�,e n Address:_ City/Stag%Zip: S w/' M or S4 S� Phone#: -7-7 L{ -)--7 5 - L 15. Are Yoman employer?Check the appropriate boa: Type of project(required):, 1.Q i am a employerwidt employees(full and/or part4ime).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working-forme in S. Remodeling any capacity.(No workers'comp.insurance required.] ' ' 9. ❑Demolition 3.E]I am a homeowner doing all work myself(No worim,comp.insurance required.]t p4.QI am a homeowner and will be tiring eontracoots to undue[su work on my property. IwIII 10 Building addition ensure that all contractors either have workers'compensation insurance or are solo 1 LF1 Electrical repairs or additions proprietors with no employees 12.Q Blumbing repairs or additions S.�I am a general contractor and I have hired the sub-contractors listed oa the attached sheet These sub-contractors have employees and have workers'comp.insu ance 2 13.� of repairs Q��-tom/ 6. We are a corporation and its officers have cwtoised their right of exemption per MGL a 1 �'_-'-der W[,� _" 152,§1(4),and we have no employees.(No workets'comp.insurance required.] er kCe.,l 27,V-.S *Any applicant that cheeks boa#1 must also fill out the section below showing their workers'compensation policy infotmatioa 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such, et showing the tContractom that ehecktbis box must attached an additional she name ofthe sub-contractors and state whether or notthosc entities have employees. If the sub-contractors have employees,they must provide their wodm'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Belmv is the policy and job site .' r information. ,,// Insurance Company Name:-�f L nGy VYl iQnl l - e Policy#or Self ins.Lic.#: X 1AJr 5 g i-&5 5 17 Expiration Date: Job Site Address: S 1 G �i n-/� City/State/Zip: IJ I?d S Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expirat o> date). Failure to secure coverage as required under MGL.c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonm as ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. py this statement may be.forwarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby cer*qN1 an enaltaes o information provided above is true and correct Si ttlrt# Date: hone#: 1/0 Ins" - 347 Official use only. Do not write in this area,to be completed by ctty or tmvn officiaL City or Town: PermiVUeeme# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electriad Inspector S.Plumbing Inspector 6.Other Contact Person: Phone k r Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvemekit�Gantractor Registration T ~—~t Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22/2021 P O BOX 105451 ATTN: LICENSE MGMT TEAM ai ATLANTA,GA 30348 -- Update Address and Return Card. SCA 1 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE ,twolement Card before the expiration date. If found return to: Reaistr�tlon Expiration Office of Consumer Affairs and Business Regulation 04/22/2021 1000 Washingto4it 10 HOME DEPOT` J ---ir Boston,MA 021 1 ANDREW SWEE1,, 2455 PACES FERF;6f HSC ATLANTA,GA 30339 Undersecretary No sl nature Aco® CERTIFICATE OF LIABILITY INSURANCE^ DATE 021062019Dm 1 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER NAME: ' MARSH USA,INC. P FAx VC. TWO ALLIANCE CENTER c o AIC No 3560 LENOX ROAD,SUITE 2400 EMAIL ADDRESS: ATLANTA.GA 30326 INSURER(S)AFFORDING COVERAGE NAIC q - CN101642069-HomeD-GAW-19-20 INSURER A:Old Republic Insurance Co .24147 INSURED - INSURER 8:New Hampshire Ins Co 1.23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D BUILDING C-20 ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 REVISION NUMBER: 21 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN_ MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN RI I iADDLSUBR i POLICY EFF POLICY E%P [ LIMITS LTR' TYPE OF INSURANCE POLICY NUMBER i MMIDDIYYYY MMIDDIYYYY A X :COMMERCIAL GENERAL LIABILITY MWCY314574 031Oti2019 03I01I2022 EACH OCCURRENCE SED 1.000,000 X I PREMISES(Ea occurrence CLAIMS-MADE OCCUR i S 1.000,000 P��$I,000.000 ;MED EXP(Any one person) S EXCLUDED r PERSONAL 3 ADV INJURY S 1A00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S - 1,000,000 �^POLICY PRO- LOC PRODUCTS-COMPIOP AGG S 1,000.000 i X i JECT A , I OTHER: AUTOMOBILE LIABILITY iMINTB314573 031Oti2019 03/OV2022 1E��B.1N DSINGLELIMIT g 1.000.000 X i ANY.AUTp BODILY INJURY(Per person) i OWNED ^SCHEDULED SELF INSURED AUTO PHY CMG BODILY INJURY(Per accident)'S AUTOS ONLY i AUTOS PROPERTY DAMAGE HIRED i NON-OWNED Per accident 'a AUTOS ONLY i 'AUTOS ONLY, - UMBRELLA LIAR ;OCCUR EACH OCCURRENCE i S —~EXCESS LIAR !CLAIMS-MADE: - AGGREGATE `S ' DED i RETENTIONS _ a 8 j WORKERS COMPENSATION iWC 012717099(AK,NH.NJ,VT) 10310112019 s 03101/2020 X gTATUTE I `OERH :AND EMPLOYERS'LIABILITY YIN ( WC 012717100(WI) 03101/2019 03101/2020 I !- 5.000,000 B IANYPROPRIETORIPARTNERIEXECUTIVE - i E.L.EACH ACCIDENT ,a 'OFFICERIMEMBEREXCLUDED?- N NIA! i E.L.DISEASE-EA EMPLOYEE]3 5.000.000 '(Mandatory in NH) I If yes,describe under ?Continued on Additional Page I E.L.DISEASE-POLICY LIMIT S - 5.000,000 i DESCRIPTION OF OPERATIONS below C ':.Excess Auto 297110011002019 0310112019 03l0112020 Limit: 4,000,000 A ;Excess General Liability MWZX 314580 03/0112019 03/01/2022 Limit: 8.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherlee '- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD f AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMEDINSURED THE HOME DEPOT.INC. MARSH USA.INC. HOME DEPOT U.S.A..INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA.GA 30339 CARRIER NAIC CODE — EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number.WLR C65890549(AL.AR.FL.ID.IA.KS.KY.LA,MS.MO,NE.NM.ND,OK,SC.SD.TN!NV.WY) Effective Date:03101/2019 Expiration Date:0310112020 (EL)Until:55,000.000 Carrier.New Hampshire Insurance Company Policy Number`NC 012717098 (DC.DE.HI"INAD.MN.MT.NY.Rl) Effective Date:03101Q019 Expiration Date:03/01/2020 (EL)Limit:S5.000,000 Carrier:ACE American Insurance Company Policy Number'NCU C65890586(QSI) (AZ.CA.IL.NC.OR?/A,'NA) Effective Date:03101/2019 Expiration Date:0310112020 (EL)UmiC 34.000.000 SIR:31.000.000 SIR for the states of AZ.CA.IL,NC.OR.YA!NA Cartier:National Union Fire Insurance Company Policy Number.XWC 5565596(QSI)(CO,CT.GA,ME,MIAV.OH,PA.UT) Effective Date:03101019 Expiration Date:03/01/2020 (EL)Limit:S4,000,000 31.000,000 SIR for the states of CO.ME, VAI.OH,PA.UT S750.000 SIR for the state of GA S350.000 SIR for the state of CT Carrier:National Union Fire Insurance Company t Policy Number:XWC 5565597(QS1)(MA) Effective Date:03101/2019 Expiration Dale:03/01/2020 (EL)Umit:34.500,000 SIR:3500.000 TX Employers XS Indemnity: Canierlllinios Union Insurance Company Policy Number.TNS C65221019 iTX) Effective Date:0310112019 - Expiration Date:0310112020 (EL)Limit:310,000,000 SIR:31.000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Barnstable Building � I'��`•<•..,:.` ��� '".. ""zs��,-.�c^»:"'�„f�,r�„�r.'f�g' -st ,•m;n.`. �.. .,.�, � �..�:�" y Ln � :3 ,'�'. .z� �`,+ .x >.'.<yw` „� ,. ` ". Post This Card So That it�s Visible:From the Streeter Approved.PlansMust:be;Reta�nedYon J.ob and his Card Must be Kept Q Map Posted Until Final Inspection Has Been Njade < �� ' Where a Certificate of Occupancy is Required;suchBuld�ngshall NotPbe Occupied until a Final hspection has been�made kk Permit Permit No. B-18-3286 Applicant Name: Stephen Dickinson Approvals Date Issued: 10/05/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/05/2019 Foundation: Location: 321 WINTER STREET, HYANNIS Map Lot: 310-211 Zoning District: RB Sheathing: Owner on Record: WELLS,GAY D,TR Contractor Name"". STEPHEN T DICKINSON Framing: 1 Address: 321 WINTER STREET Contractor License:, CS-081843 2 HYANNIS, MA 02601 Est.,Pr,ojpct Cost: $ 1,777.00 Chimney: Description: 3 replacement windows-Like for Like replacement-:No Change to Permit Fee: $35.00 Header Insulation: Fee Paid:' $35.00 Project Review Req: Date 10/5/2018 Final: Plumbing/Gas Rough Plumbing: `..Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application•and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or:road and shall be maintained open for,public mspeet�on for the entire duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: :. 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) - 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building -:v� ��,: .''+�' �i✓ �� --• .: £4 �- ,. :fir. ., : ����--• •x.. $,, y- i�,,� ,, ., -:,, P This.Gard So That3it�s 2UIsible From the Street-App,roued;Flans:Must be Retained on.Job and„this Ca!, , st De,Ke, EAANST`AEii.B. •.. ..,, ' �, ..- ,.,; �, r- _a F `'z • b" Posted Until Final Inspection Has6een Made F x717 ;. � €. n> Per Where a Certificate of Occupancy is Required,such Bu�Idmg shall 71t 9. Occu�p�ed until a Fi»a!Inspection>ha ,been made '1 ei mit «,- �.. ,,. 9 �u. ,- •. , •�, ,� RI Pa _ Permit No. B-18-2490 Applicant Name: RetroFit Insulation Approvals. Date Issued: 08/14/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/14/2019 Foundation: Location: 321 WINTER STREET, HYANNIS Map/Lot: 310 211 Zoning District: RB Sheathing: Vb Owner on Record: WELLS,GAY D,TR Contractokr NameRETROFIT INSULATION Framing: 1 Address: 321 WINTER STREET a Co ractoi �icense 160461 2 HYANNIS, MA 02601 Est Project Cost: $2,853.00 Chimney: Description: Install 10" layer cellulose open attic,damming,Install thermal tent Pe-rmit Fee: - $85.00 cover,propa vents,damming,air sealing,dooe`*its and sweeps, 10 Insulation: W, •� Fee Paid�' $85.00 ml poly over open ground,install R-21 closed i&ll spray foam : Final: insulation to crawlspace perimeter wall. Date 8/14/2018 Project Review Req: Plumbing/Gas aa Rough Plumbing: --- - ,- Building Official Final Plumbing: k � � £ - qn Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authonzed'bythis permit is commenced within siz n nihs after{ssuance. All work authorized by this permit shall conform to the approved application i d the approved construction documents for�which LFiis permit has been granted. W � , f �T< Electrical All construction,alterations and changes of use of any building and structures shall be it compliance with the local zomng�by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and'shall be- aintained open for public inspection for the entire duration of the Service: work until the completion of the same. j Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Off ci Is are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. , Final: "Persons contractin • unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Town of Barnstable *Pere# F.VsmmWaftrdate Regulatory Services Fee + RMUMAMA ► Thomas F Geiter,Director nn Building Division �. Tom.Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA€I2601 www.tovvn.barnstabte.ma us Office:- 508-862-4038 Fax:509-790-6230. EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yutid whftaf.Red X-frees Imprint Map/parcel Number . 310 211 Property Address--3 �`1 iN i`4-t e_v j�.Residmtial Value of Work 0 U U. woluium fee of$35.00 for work under$600&00 - Owner's Dame&Address Al V' 'S 3;;z 1 Vv i n-he il Sa- Uy"4Ntil f s IM4 v a&6 l � Pi�Z� o`rne �fg�em,,,w Contractorts Name A P-y"G w-r4 lyorl Telephone Number 151e Home Improvement Contractor license#(if applica6Te} Construction-Supervisor's License#(if applicable) CS '7`/ S, E N jWorkinan's Compensation Insurance R�v 2 2011 Check one Iania sole paroprietar TOW BARNSTAB E. I am the ficaneawtier` [ ' I have,Worker's Compensation Insurance Insurance Company Name° �,f✓ ["d ��r`.�-a� q� it A Worlanan's Comp:Poltcyt# Copy of Insurance Compliance Certificate mast aecom any each permit` Permit Request(check boxy (Rt4wo rtrricane nailed strippingoId shin es All construct�on`debris wilt be taken to . v�� � 11ltl,i f l } va t t 'e-roof(hurrieane nailed)(not stripping. Going over CxJsting layers of oofj Q Re-side #of doors Replacement:tVu do s(datirslsltders"U Value maximum.35)#afwir►dows . rttz�uire� Tssttance ofttt�pentttt d not�comptiance with other.town depa�regnl�#ians;i.e:Historic,Cons�rvgtinn,e�c- ***Note: i'roP rty Q roust sign Property{hvt er Letter or Perm ion. - py o Home Improvement Cnntraetors Licen,.&Caastruction Sapery tors I ceaptse_is CAUS1ssldeiatliklAppl3ata 1i1 VtrniowstT . ntCrtadites�Cc�ntentCJukloa}1I)CliT8TAAZtFSS,doc:. Revised 072LI0 . '. _. , . �... ` ✓/J.E ZrJG'J'v?IZG°dAlG'ELSGl.Iv �.r✓f`G!/4:Q'�dLlf2�. , •:. - . Office of Consumer Affairs&Susfatss Regulation License or registrafianali3 for isrdividtir use onty [IMPROVEMENT CO T, RC3©R before the expiration datil- If faun s ref rrz o: r of 4f ee,of Consumer Affairs and Business Ren ration Registration-t,a7go Type:. IIIPgrkPlaza-Suite517t1 t rrsri StrppItmei Ca d Boston,INa 02116 CAPfZZI HOME, -MMMI-PNc.. GARY GUS%A�s���� _� CaluO,TAA 02635 TSkc#crsecretary itTrs, id it out siunai r€e t t :tcr u rtt f:�epal'tn rat€##f Public Safct} � �trarc4 t f Building, Rc=��#tn€�i#c►� �tn�2�tanct�zrsls � Ccsits#r#Icticsn super+ats r. Teens Lic6se- CS 74640 _ - Rom•s:'� GARy GUSTA .SOIL 8 oRT WAY ;3 i fCH,MA 02563 T##. 7058 ('tatx##tti'�Ear#Lrr .. Y . f Client#:47298 CAPIHOM 4-ACORD. CERTIFICATE OF LIABILITY INSURANCE D6/02/011") THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT Karen Walther NAME: Rogers&Gray Ins.-So.Dennis PHONE -760-4630 - -258-2230A/c No Ex :508 , o 434 Route 134 E-MAIL waltherka o ers ra .com P.0.Box 1601 PRODUCER g g y South Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED - -. INSURER A:National Grange Insurance Co. - Capiai Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capiai Enterprises,Ina - INSURER C: 1645 Newtown Road Cotult,MA 02635 INSURER D: INSURER E: INSURER F: - 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER MM/DD MM/DD LIMITS . A GENERAL LIABILITY MPB1075H 06/08/2011 06/0812012 EACH OCCURRENCE $1 000 000 X MERCIAL GENERAL LIABILITY DAMAGERENTED PREMISESS(Ea occurrence) $SOO,000 CLAIMS-MADE �OCCUR - MED EXP(Any one person) $10,000 COM PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG• $2,000,000 7'POLICY PRO- LOC - _ $ . A AUTOMOBILE LIABILITY ti M1 M28044 06/08/2011 06/08/2012 COMBINED SINGLE LIMIT g $-- ANY AUTO -', _ (Ea accident) 500,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS - - BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS - - $ X1 Drive Other Car $ A UMBRELIALIAB X OCCUR - CUB1076H - 06/08/2011 06/08/2012 EACH OCCURRENCE. $5 000 000 - - EXCESS LIAR CLAIMS-MADE - - - AGGREGATE s5,000,000 DEDUCTIBLE $ X RETENTION 10000 ' $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU- I oTH- AND EMPLOYERS'LIABILITY - _ _ ANY PROPRIETOR/PARTNER/EXECUTIVEY/N - E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $1,000,000 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - - Additional insured status is provided under the general liability when required by a written contract with the certificate holder CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE i ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S67537/M67480 MEE Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT 11 ,.OWN THE PROPERTY LOCATED AT 3)-� a� IN l � rri,yI�i w 1, , MASSACHUSETTS: I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT JO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780:CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE . MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE:: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: . - APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 APPLICANT'S TELEPHONE: _ 508-428-9518 :. ,RESPONSIBLE OFFICER: ' RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE:OFFICER TELEPHONE: The Commonwealth ofMassachusetis Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavits Builders/Contractors/Electricians/Plumber.s Apuflcant Information Please Print Legibly Name(Business/Organization/Individual): L A P l 2 �raOlt.rri t'ti tf6' Address: 1045- Alewiown -kp' City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project required): 1.E34am a employer with 4. ❑ I am a general contractor and I employees(full and/or part=time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g: ❑Demolition Workingfor in an capacity. employees and have workers' y P ty 9.. ❑Building addition [No workers'.comp.insurance comp.insurance.: • . 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P • 3.❑ I am a homeowner doing all work officers have exercised their 1 L(]Plumbing repairs or additions myself[No workers'comp.' right of exemption per MGL 12.[jKRoof repairs insurance required]t c. 152;§l(4),and we have,no employees. [No workers' l3.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowner.who submit this affidavit indicating they are doing all worICand then hire outside contractors must submit a new affidavit indicating such. $Contractors ghat check this l oimust attached an additional sheet showing the name of the sub-contractors and state whethdi 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 isproviding.workers'compensation insurance for my em,ployem Below is the poUcy and.job site . information. Insurance Company Name: -N -ep T y ¢ (74 J!!1 Z/ �3ZG Policy#or Self-ins.Lic.#: N : G G S� 'Expiration Date: ,�! Wi'a-I-?� SSA-._ Job Site Address. _- _ _ City/State/Zip: 1�y.�NAI%d 1 M.4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine UP. $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 verage verification I do hereby certify un the and penalties of perjury that the information provided above is true and correct Signature: Date: It A p 9 S le t Phone#: z Offcial 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#: J TOWN OF BARNSTABLE BUILDING PERMIT APPLIC.ATION. Map ® Parcel ` 1 BUILDING DEPT. Application # Health Division Date Issued 8 A h sti JUNConservation Division Application Fee Planning Dept. TOWN OF BARNSTABLE ' Permit Fee Date Definitive Plan Approved by Planning Board - Historic - OKH _ Preservation/ Hyannis Project Street Address i r—' 5rGpeo o Village Owner Address 3z` Telephone _ Permit Request /L ® 22- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size , D 4-D-D Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure -Historic House: ❑Yes�YNo 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: JGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes No - Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:0 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 e j Q effi I rI Proposed Use �y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address �� sr- License# 6 Home Improvement Contractor# Email J,LAMS 2. Worker's Compensation # ALL.CONSTRUCTION DEBR ESULTING FROM THIS PROJECT WILL BETAKEN TO i SIGNATUR DATE l' FOR OFFICIAL USE ONLY = APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION GI Sores q` 4 (e FRAME Y INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL .f FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ti El°ti Town?of Barnstable , o� Regulatory Services A $ Richard V.Scab,Director 1659. .� '��► Building Division Tom Perry,Bolding Commissioner 200 Main Street,Hyannis,MA 02601 y www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign.This Section If Using ABuilder I, (2-4Z tk� tA ,as Owner of the subject Property hereby authorize !l` o t— I to act on my behalf, in all matters relative to work authorized bytbis binding permit application for. c 2. 1 (Address of Job) '' "Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utiiiwd before fence is ingalled and all final inspections are performed and accepted. S' of Owner tore Ap)pRcaat uJl �� T P t ame N .. - .Pant ,. Date 4 14 Q:roxMS:owrrERPERMISSioreoors Town of Barnstable Regulatory Services �oFT rory� Richard V.Scali,Director BniIding Division ztiarn;rA MX Tom Perry,Building Commissioner KS p$�r s � 200 Main Street Hyannis,MA 02601 wwFv town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICE=EXEATTON PIease Print DATE: JOB LOCATION number street vUlagc "HOMEC)WNER": . name home phone# wmic phone# CURRENT Iv�CT ADDRES S: city/fawn 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 snch workperformed 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 requited to comply with the State Building Code Section 127.0 Construction Control b HOMEOWNER'S F,IEll MON 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 109.11-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 tally 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:IWFFILFSIFORMS%bufldingpermitfo=\F MRESS.doc Revised b61313 t e C 7:ZS ems~ o - 4 Sore 0 BIE� v + f. �Q 1 - F � «v.�.wMM.......+.w.x+.w..,�...vwrw.,.....,•, Y� .u�-..�'^�...euw... r..��n.a,..a.nv. .. ♦ e d. .. - a (7 �� "f�lAl�EJ7a cP.� r wwkera' CampensafianInsur;mce AffifaviL RmId--r-JC=&=WnMecftichnsThmiber7S APPHemit Iufamnatign Please Print Tame ® oQ �o rz-DES' Addressr Are you an empbyer?Checktlte apprapriate ba= Type of project(regaired): am a co�sctarandI I_El I sat a employer v.�itb. 4. ❑I general 6� ❑New oonsfructiog employees(frill andfor part-fiime)-* have hired the sub-contractors Z.l " I am a sale proprietor or partmr. , Pined o4 the attached sheet ?-❑Ran delim;g ship and leave no emplWees These sub-cantractass.have $_ ❑Demolition w Q former III enpployees and have wadzers' , °fib �y � $ 9. ❑S.uilt�addition [No wodmm,Comp.ms�nce. CQmP-mSUGUI reTILM&j 5_ ❑ We are a corpozatim and its ld=R Electrical repairs of add e- 3.❑ I am.a homeowner doing a� officers hmm exe=ed their 11-Q Plumbing repairs or additions myself[Noworkmm,camp. of per MIiI. IZ.❑l afrepsis iIIsmance required,]7 c.M§IM andwe have no t employees.[No voAoe& 13_❑other cord-inmrance rPquirea] •AspsggICKMtdfateber sbos#lmastalesfMcmt esmfimbgawsraafg&drwodcess'eo®p—CHi Porugitfaemsd = E@3MMWWMSVdWsakmgtAzle8$idz¢ itifWr—gdIepi¢edaizZs1FwakanddumlfEm c amct5dbmitanemsf&davft sty ' =C.az=zCtVa$zt 6w-7E ids b=Est attarbed sa addifinas2 street dMWI 9 thenoneof the sd)-e�.znd state wheths anug tow hates em lkrjeas.7€fiesdrcr�+*=�+=+Rhave emptcFw%dse}'—,GrgsinidE&ek umda s'-Mq vaTz-Y zu h— I am tTtL ELLLp Br flt�is pram g Yt�rkets'c4r�essrtfiart irLsriraiLce yr earp2by $eroev 1s 1ttR pLr cy arm jaFi s i�Lfdrmaiioa. . Irsst=e;Company NMII Palficy l or Sdf-iD&Inc-4- - nDafe: Job Site Ad&e= City/S , -4W016 Q2,4a rlf ach a copy of the worltere camapensafiaapolicy decJkratian gage(shaving the pooUcY number and expiration dice).' Fad to somm cove'raage as required under Section 25A of MQ,c.13Z c-au IMd to the iaipositioa of Mirnimal PeLzalt"ses of a fimuptoSUOD-ODamVcwonL—yewimpm=mexd as weR as ci4s1 penalties n the fo=o€a STOP WOKK OMERaud a rme of up to$25M a day azzihstjift violator. Be adtnsed first a copy of this shtememt maybe forwnded to the Office of I estigatiaas o€the DTA verification = T&7 her* ��a p . a.�fFet�xc�}'ffiefhie igfbnna6=provi&d ahmv is true and wrecat Daft, "ham . Phone alai we only. 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I n. ■- ■�.!a ■ O w.1• rtOP�■ •1 O.1■.!�•• . ■• - 1 n ■•••1 n. r- ■ •• •-I n i■- a.• t.:n. ■ •• - n.1 ■ n■: •■ 7- u Inul - •.+m � • ►�■ - I G■■.•1 nn •- 71►• • 1 - .■ -:I •�\w - ■•n - •••t r n •11■ i:!I •r r_mtn• rw�" ■7 ■�m 1 ■• - .■�• n .n r■Yu�.w • r■n■■� ■+. •�:.1■n •• q�■all ir-■ [I r•nm -'r n Gr■- ■ • ■• • ■ •w■-.tt•bO • .!- t• n.t■ ••t /t _a .ta r: •/ ••a ►1•■i] .I■•la tl/ t- a•). rl �■- 1■:a ■n i3■ :•■■:•.R I- -a■•1■- -t•a r► ■PIn■�f 1•i■9.1 Bill 041 03 21irlli.Vrw r ' 1�,■ r. s ]i_/ •••, lY. ••• • 51V Massachusetts Department of Public Safety 1 Board of.Building Regulations and Standards �t p,> License: CS-014501 Construction Supervisor , ;_. STURGIS ST.PETER - P.O.BOX 372 BARNSTABLE IVIA 0�263Ua ` l , F ^M � Expiration: Commissioner 08/2312017 ��eamr�zaouaeaLC�a�P%1/lar9ac�u�eL Office of Consumer Affairs&Business Regulation - License_or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:�N.00390 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration:-6Ea:6/20.18 Individual Boston,NIA 02116 STURGIS ST.PETER--'- Sturgis St.Peter Y, 65 Cindy Lane/P.O Box Barnstable,MA 02630 Undersecretary Not v id with t signature ' x a `,M1Y 4i I.W., 1.t:1VJUJ 1KHC .1 if 1Go �fENT: DUNNING:KIRRANE, MCNICHOLS &GA'RNER LLP DEED BOOK 1188 PAGE 159 E PL B K: 14 P 'GE 41 LOT - APPLICANT: GAY`WELLS ASSESSORS PLAN 310 PLOT .211 ' MORTGAGE INSPECTION'PLAN OF LAND LOCATED AT 321 WINTER STREET BARNSTABLE, MASSACHUSETTS SCALE: V=20' June 11, 2008 Lot L, rd eSwP L D "P` Lot 3ZI ; W 1 ��j T cz BIZ IS l� I CERTIFY TO DUNNING,KIRRANE,MCNICHOLS&GARNER,LLP,AND ITS TITLE INSURANCE COMPANY HAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THI PLAN WAS-PREPARED UNDER MY IMMEDIATE SUPERVISION.. .THE LOCATION OF-THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE_ "GONG�BY-LAWS .WITH RE IN SPECT TO , HORIZONTAL, ` DIMENSIONAL REQUIREMENTS. . , 'THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY #250001-0005C DATED 8/19/85 BY- THE F.I.A. c NOTE: THE EXACT LOCATION OF THE BUILDINGS SHOWN CANNOT BE DETERMINED AN ACCURATE INSTRUMENT SURVEY - Kenneth Re Ferreira Engineering, Inc. P.O. Box 1903 -A New Bedford, MA 02741-1903 508-992-0020 Fax: 992-3374 GENERAL NOTES:(1)The declarations made above are on the basis of my knowledge, information,and belief as the result of a mortgage plo 17 tan tape survey inspection made to the normal standard ofcare of registered land surveyors practicing in Massachusetts. (2)Declarations are mad Q the ahnVe named Client oniv ne of this dwe. (iI Thic ninn urge not msvia t'nr rnrnrll:nn ....r....onr- F.:. :» ,,.....-.-,,..t,.•..1 -3---_:_.:___ _.. c_.. il t• ; r ' ' , L f Town of Barnstable Permit: 0® 1 �O Regulatory Services Date: °pIME r Thomas F. Geiler, Director Building Division swruvsrnsr.e, Torn Perry, Building Commissioner 639. ��� 200 Main Street, Hyannis, MA 02601 prFDj��� www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT fPhone: lj1� Install-at: .jz/ !l /^ Village_ /�� ,.Irt5' . - 7 p� I ' Date:'Map/Marcel: �. sed B. Type: Eadyia / (Circulating C. Manufacturer: , �i� , Lab. No. D. Model No.: Ch-irnney— �A.New(Existin (If existing, please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue-?- r D. Pre-fab Type and Manufacturer e E. Masonry: Lined/Unlined o% �Hearth.��. cr; A. Materials: B. Sub Floor Construction: AV*�A)46 r� Installer - Name: Address: Phone: Location of Installation: H.I.0 Registration # Construction Supervisor# OR check— Homeowner Installing, no license required APPLICANTS-SIGNATUR—E-, APPROVED"BY: - - d Please make checks payable to the Town of Barnstable. *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rcv 103107 [ rr 1, " The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name-(Business/Organization/Individual): Address:•}3:Z/ [City/State/Zip;- .��td�/S D Phone.#: 3A' S �"�-2.D3Z Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction .2.❑ I am a sole proprietor or partner-" listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition . [No workers comp. comp.mP insurance. 10. Electrical re airs or additions re 5. ❑ We are a corporation and its ❑ P ----�— 'v d6idg,all w� officers have exercised their 43. s am a homeowner,doing all works 11.❑Plumbing repairs or additions m self. o workers'co right of exemption per MGL Y �-� _ mP� 12.❑Roof repairs msura_nce requtred]at 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'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their worker;'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Sign 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#: n t 1 V % 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 of 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' 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"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 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 Investigations 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 V ww.mass.gov/dia n i f t Town of Barnstable �THE Tp� , v ti y�P Regulatory Services BARNSPABLF, Thomas F.Geiler,Director f�A.O� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vr".town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print JOB1OCAnON:-"ta,1?Z,L��I.�� .. � T, r�,a,a�.t. DZd4�1 number street village "HOMEOWNER",--. "name home phone# work phone# /+ �. ,CURTU NkUlAiLING 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. Signabaf of eown7 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:homeexempt A i TME ,ti Town of Barnstable Regulatory Services MASS. Thomas F.Geiler,Director 1639. �Fc�a Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Prop erty,.IOwner•. :. �. = , t Complete and Sign This Section, • . . _ ,: �. �, If Us Diu A Bu 1°der as Owner of the subject property hereby authorize 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 ', Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:O WNERPERM ISSION ZONING SUMMARY ZONING DISTRICT: RB DISTRICT Locus / / MIN. LOT SIZE 43;560 S.F: MIN. LOT FRONTAGE 20' MIN. LOT WIDTH � 100' MIN. FRONT SETBACK 20' MIN. SIDE SETBACK 10` MIN. REAR SETBACK 10' MAX. BUILDING HEIGHT 30, tr. et t n5 r SITE IS LOCATED WITHIN THE WELLHEAD N° PROTECTION OVERLAY DISTRICT �p�n rt South m LOCUS; MAP o3 06' SCALE 1"=2000' 00 ^D { ho, ASSESSORS MAP 310 PARCEL 211 PROPOSED EX. SHED DECK DECK \` ; GARAGE PLAN OF LAND EXISTING �\ ' DWELLING �� LOCATED AT #321 WINTER STREET HYANNIS, MA N PREPARED FOR ti GAY WELLS DATE: AUGUST 2, 2016 A off 508-362-4541 8` QJALA. I fax 508-362-9880 N6 409830 I downcape.com down � e � �uil i7c j EA civil engineers Scale:V=. 20' - Ion d surveyors 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.L.S. YARMOUTHPORT MA 02675 ICE # ' 6_'23 ' � 16-231. ZONING SUMMARY Rou e 28 ZONING DISTRICT: RB DISTRICT Locus � MIN. LOT SIZE 43,560 S.F. � �o MIN. LOT FRONTAGE 20' Q. ° MIN. LOT WIDTH 100' MIN. 'FRONT SETBACK 20 a MIN. SIDE SETBACK 10' r MIN. REAR SETBACK 10' MAX. 'BUILDING HEIGHT 30' tr et t SITE IS LOCATED WITHIN THE WELLHEAD �te'en5 N°r h�otn St. PROTECTION OVERLAY DISTRICT St. St. South a _ O LOCUS MAP �o' 03 06, CO o y SCALE 1 =2000 f o " M ASSESSORS.MAP 310 PARCEL 211 h DEOIPOSED EX, TOu�N 51<wEiz SHED DECK , GARAGE �\ . PLAN OF LAND EXISTING LOCATED AT DWELLING �w #321 WINTER STREET cc HYANNIS, MA .v c II PREPARED FOR co s GAY WELLS Q + . ��SNOFA44 DATE: JULY 29, 2016 OF iyA c ss c DANIELA. yGs DANIELA �yGJ, OJALA OJALA off 508-362-4541 N0.40980 CIVIL Cn fax 508-362-9880 No.46502 downcape.com lgNOSURVE� O/ST '� down cope engineering, inc. /ONAcivil engineers Scale: 1"= 20' �� land surveyors 939 Main Street ( Rte 6A) C 1[ ' 6_ � ' 0 10 20 30 40 50 FEET YARMOU THPOR T MA 02675 tt DATE DANIEL A. OJALA, P.L.S. 16-231 P � I l � w J m J W r z ® m up LL 0 z