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HomeMy WebLinkAbout0025 ALBERTI WAY :75 ,9/lx�4 /JOy �i Town of Barnstable _.� �... ...�..� _ Building s � Post This Card So That it,is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. ^� �� [Where a Certificate of Occupancy is Required,'such Building shall Not be Occupied until a Final Inspection has&been made Permit No. B-19-764 Applicant Name: todd leduc Approvals Date Issued: 03/12/2019 Current Use: Structure Permit Type: Building- Insulation- Residential Expiration Date: 09/12/2019 Foundation: Location: 25 ALBERTI WAY,CENTERVILLE Map/Lot: 248-288 Zoning District: SPLIT Sheathing: Owner on Record: COMMITO,ALBERT J &ANNE L Contractor Name: ,TODD LEDUC Framing: 1 Address: 26 GLENDALE AVE Contractor License: CSSL-106019 2 MELROSE, MA 02176 Est. Project Cost: $3,588.00 Chimney: Description: Insulation;See Contract ) Permit;Fee: $85.00 ? Insulation: Fee Paid:' $85 Project Review Req: i 3 .00 - Date: 3/12/2019 Final:. . Building Official Plumbing/Gas _ Rough Plumbing: 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 Plumbing: All construction,alterations and changes of use.of any building and structures shall 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 inspection for the entire duration of the Rough Gas: i work until the completion of the same. Final Gas: 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:; .. -r r-, • fi Electrical 1.Foundation or Footing 'A 2.Sheathing Inspection w Service: 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 Inspeogn r _ Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final:7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage 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). Health Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Fire Department Final: �oFTHe r�� Town of Barnstable *Permit# ao Is 0:Y3R Expires 6 months from issue date Reg Y ulatoi� SerV1CeS Fee ti -00 BARNSTABLZ v� MASS' Richard V. Scali,Director P IT ArEo��"'� 1LIN 05 20�5 - Building Division Tom Perry,CBO�Build ngCGeom-n`mii mo%y-n fi 200 Main Street,Hyannis,MA 02601 I�-1 L www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY � Not Valid without Red X-Press Imprint Map/parcel Number ,14 Property Address �2 ✓7 lb eg J i 7 n 4ev--,(1 0 esidential, Value of Work$v�.,�( Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresss }i �, .i�J's, i Contractor's Name Ditu i Lk all 13 f' Telephone Number Home Improvement Contractor License#(if applicable)_ Email: Diy'f e J—ch � �� t/t?iei?c h 1,,ie Construction Supervisor's License#(if applicable) C ❑Workman's Compensation Insurance Che k one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's.Comp.-Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request check box - -- Re—roof f hurricane nailed)(stripping-old shingles All-construction debris will be taken to --=- -_ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ' Re-side 13a Replacement Windows/doors/sliders.U-Value (maximum-Itt)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 r lie C'ommo ntEseaM ofManachuseft Department qfIndustrialAccidm& � OffweefInvesfigations 600 Washington Street Bastoz4 M4 02111 i mrrv..ma=gvVdia Workers' Compensat im Insurance.Affidavit:Baders/CantractuwTkcft ciain&Tlambers Applicant Information �ry Please Print Legibly 1Vatne due f.lJ►`�i� � C.� �-��'�/ l City/State/- Sit,\ ,c /A , Fyne:47 Are you an employer?Check the appropriate box. T 4. am a contractor and I 3'Pe of project(required): L❑ I am.a employerwith ❑ I 6. ❑New constructiau employees(€a and/or p�time-- * have hired the sub-c cmhactcxs 2 I am a sole or partner- listed on the attached sheet - �"_Cdeligg ship and have as emplcsy'ees These sub-contractors have S. ❑Demolition 1t�oiking forme in any capac�tl`- employs and have workless' 9. ❑Budding addition [No workers'comp.insurance comp.insurance. . ❑ We w e a corporation and its 1#?_❑Electrical repairs or additions required officers have exercised their 11_ Plu mbin r airs;or additions 3.❑ I am a homeowner doing all Mork ❑ � ep myself[No workers'comp- of exemption.per Iu1GL 12.❑Roof repairs insurance required,] c c-152,§Itq andwe,ham-yen employees.[No wodmrs' 13-❑tither comp-insurance;required.] '�Yny applirsat tbnt cbeck s trot#I Est a1w fill out the section below sliming their woders`campeus�iio 'Policy iafmnntioa �So wnss wbo submit tthis aff davit inducting they as domg€ll v ut cad&m hux outside contactors maxi sab=a new affidavit indicAting.mcb- C*nt m=rs that rhPA this bmc mart attached as additional sheet shooting the naaae oftm smmb-camrcacaors and state wheths Gant those EdffikShTge employees. If thesub<-ontmawsbare employees,&eymustpravidetheir workers'ramp.policy numbM I am an empkor that isprvttit�r'g worker'coB7 nsafio t insurance for my employeeL Below is the paU17 and jab site informatian. Insurance Company Name- - Policy 4 or Self-ins-Lic.#: ExpitationDate: web Site Attach i copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coxmrage as required under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,SQfl_t)Q and/or one-year imprisonment,as well as civil penalties in the fbna of a STOP WORK ORDER and a tine. of up to S250.00 a day against the violator: Be advised that a Copy of this statement may be,forwarded to the Office of luvestigations of the DIA far institrance coverage vvrificatson. I do hereby cerdJ3,ujd Jer the pans andpenalaies ofpedk7 that the information presided abmw is true and correct Sstmattre r lC� ( late- --- Phone#: �(,F A,r 0-),7' 7 ©facial use only. Do not write in this area,to be ceampleted by city:or lawn offl" City or Town.: PermitlLkense# Issaing.Authority(circle Sae): 1.Board of Health 2.ceding Department 3.ciVroym Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions r Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pm-snant­tD 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 Iocal 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 ofpublic words 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 inmzance. 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 insuttance 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 permi licrose number which will be used as a reference number. In addition,an applicant that must submit multiple pemuitllicense 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 maybe 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 The Office of Investigations would like to than 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 Indusftial Accidents Office of Xnvestigatiolas 604 WasbiVou Stet Baton,MA 0�1 I I TfJ.#617 727-4900�j t 406 or 1­97` MASSAFE Revised 4-24-07 Fax#617-727-7749 www mass_govfdia �7�0�THE r�ti O,n * BAMSrABLE, "9: ,�� Town of Barnstable QED MA'I A ..Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A'Builder I i�2 ' •.i^ 7` t , subject as Owner of the hereby authorize >+o-e to act on my behalf, in all matters relative to work authorized by this building permit application for: S 4/ Signature of Owner Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. l QAWPFILESTORMS\building permit formslsmokecarbondetectors.doc Revised 040714 r pp THE ram, Town of Barnstable Regulatory Services BARNy iaass.Bis� Richard V.Scali,Director �A i6gq. �b lE16.39tp 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 HOMEOWNER LICENSE EXEMPTION DATE: Please Print 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 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:\WPFILES\FORMS\building permit forms\smokecarbondetectors.doc Revised 040714 Massachusetts -Department of Public Safety Board of Buildai�ng Regulations and Standards CullS uCLion Supervisor License: CS-073Sg7 DAVI�w COL 21A1 PPIICCADU,LY ;gpe Commissiionneer' ExPiration 12107M16 7---`--.mod. Office ofCnsumerA I,-1s e l � �cuaaa _OME IMP Bnsi ess g `Q a ROVEM_ENT CON" egaiathon egis'tratdon: ;Fi 28799 TRACTOR P►ration:: Type r David Collins Individual David Collins ' 20 PICCADILLY Rp ``M' Sandwich,MA 02563 Undersecretary— 4 ojrG 1110liq G �. 1 � -� PERMIT Town of Barnstable *Permit# 0 Expires 6 months from issue date Regulatory Services Fee 1"m'1"9. Richard V.Scab Interim Director TOWN ® of STABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMrr APPLICATION - RESIDENTIAL ONLY qq �j )Map/parcel Number ��Not Valid without Red X-Press Imprint �C� y Property Address ❑Residential Value of Work$1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address rr1-� l be iZ T ` tr;W1u L-t Contractor's Name 1 / i on /S V Telephone Number Home Improvement Contractor License#(if applicable)M Y 7 '7 '2 Emaii:JDA � Construction Supervisor's License# if applicable) /' 7 tit ❑Workman's Compensation Insurance hec ne: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [Z—Replacement Windows/doors/sliders.U-Value ;- ( (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. { ***Note: Property Owner must sign Property er Letter of Permission. A copy o7te ome Im rTA en ontractors License&Construction Supervisors License is requiredSIGNATURE: r TAKEVIN_Muilding Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts s. Department of IndustrialAccidents 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" Maine(Business/Organization/Individual): D%1 y -- Address: // ' City/State/Zip: sal �' � - Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.LL am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). , 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity, employees and have workers' y p t3' # 9. ❑Building addition [No workers'comp. insurance comp.insurance. El required.] 5. ❑ 10.We are a corporation and its ❑ ectrical repairs or additions 3.❑ 1 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] 11 . *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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: .q Job Site Address: 61 itw iL�4 � A City/State/Zip:C�'l 4 i/1 Attach a copy of the workers' compensation policy declar Lion page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under t pai and p alties of perjury that the information provided above is true and correct Si afore: ` Date: Phone#: T U^ �T 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 1. 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(0)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( )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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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. 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 Tel,#f 17-727-4900 ext 406 or 1-877-MASS.AFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia 9 � x B MSrABM a,� Town of Barnstable " Regulatory Services Richard V.5cali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabie.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i��1; � � y � � i�_ y�T•w i as Owner of the subject property hereby authorize !'� I v to act on my behalf, in all matters relative to work authorized by this building permit application for: ��f WHV (Address of Job) Si ature of Owner Date Print Name v If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_Muilding Changes\EXPRESS PERM111EXPRESS.doc ti Revised 061313 - V t , i i c y `` p O w N U) 7 a c m w L a � c 0 0 O (U c Lo as ym ~ c ° d � E 7 frl 0 U o U 3 kFUyy U � J • a � U a 3 l�l Ao .0 R - o � 7 � N R i R tn Ln - 7 i G i y z . m L C 0 b60Z/10/ZL i lauoisstwwoo i uo!;ej!dx3 .: Of<ce or Consumer Affairs&g £9SZO:tVW H;)IMQN�'S �ME IMPROVEME psmess Regulation i Q2I A I'II(It'a�Id OZ Ex 9�stration: �28799 CONTRACTOR P ratio I S[$IIO�M QIAdQ I n 5/20/2015 Type: 'v •�, pavid°Collins = Individual n 1 a ,' LbS£10 Sp ;asua�i� 1 it aos!.uadns uo►13n.t.asuoD, David Collins spJepue;S pue suoi;eln6a8 6u!PI!n8 jo PJeoB 20 PIGCADIL A}a;eS o!Ignd bo uaw eda Sa LYRD } Q-'s,4asnyoessew nd►Nich , MA 02563 •.y-f n F �� - _ 5 U dersecreta A-vry 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 Ledbly Name (Business/Organization/individual): T Ay) (1 j G���'7 I Address: City/State/Zip: �fh1 ���C - Phone#: > 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. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. [J 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.❑ Plumbing repairs or additions • myself. [No workers' comp. right of exemption per MGL 12.❑-Roof repairs insurance required.] t c. 152,§t(4), and we have no employees. [No workers' 13.0 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. .Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der 'n d penalties of pedury hat the information provi&d above is true and correct Si attire: k Date: Phone#: 5 S 1 �� Official use only. Do not write in this.areA to he completed by a ty or town offlerai City or Town PermidUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Ingpeeter C.^ 5/6 7 BIKE Town of Barnstable *Permit# QQ 6 a 9 c Expires 6 months rom issue date Regulatory Services Fee a OD M^S& $ Thomas F.Geiler,Director 16;q �0 a Building Division 1 �� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ` Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY \ Not Valid without Red X-Press Imprint Map/parcel Number �l 0 Property Address OW ®Residential Value of Work � da-a� �! Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address pae.part � • Q Mbllri� ��y �Q�l�crvi��e Contractor's Name Telephone_Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor am the Homeowner APR 2 5 2007 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) L�Ke-roof(stripping old shingles) All construction debris will betaken to 1 ae! d 4 ❑Re-roof(not stripping. Going over existing layers of roof) t� ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) .G *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home ImprqivemepLContracto is License is required. SIGNATURE; Q:Fonns:expmtrg Revise071405 ' The Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations d 600 Washington Street Boston,MA 02111' �•�'� wtvw.mass.gov/dia ' Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print LeLAbl Name;(Business/Organizationadividual): trt L'1.1^L b Address: 4S- AI NA C„)A y City/State/Zip: CetJTfrVit Phone.#: I `137C Are you an employer?Check the appropriate box: :Type of project(required):, 1,❑ I am a employer to er with 4. [] I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* . have hired the sub-contractors . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employee6 and have workers' 9. Buil�ng addition [No workers' comp,insurance comp,insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions '3. I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers'comp. right 6f exemption per MGL 110 Roof repairs insurance.required.]t c. 152, §1(4),and we have no ' 13.❑ Other 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. t Homeowners•who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit anew affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees, If the sub-contractors have employees,they must provide their workers'comp.policy number. I a►n an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: Policy#or Self-ins.Lic.A Expiration Date: Jab Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the INA for insurance coverage verification. I do hereby c ti gd r th nsandpenalties of perjury that the information provided apoygis true and correct, Si tore: ( Date: Phone# FBoard only. Do not write in this area, to.be completed by.city ar.town official n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information anct 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 ehapter..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 evidense•of•compliance withtlie insurance- requirements of this chapter have been presenteddto the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that ibis 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 Sire 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 io 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 clo not hesitate to give us a call. The Department's address,telephone-and fax number:: The Commonwealth of Mmac&wtts Dtpartaemt of hidustrial A cddemts P.Met of Invesdgattons 600 Wash n,&6 Street: Bwonx.MA 0.2111 - . TeJ.#617-727;4400 ext 406 or I 477 MASSAFE Fax#617-727-7749 Revised 11-22:06 w .masa-&ov/dia THE Town of Barnstable ` CF 1p� " regulatory Services snxrtsTnste, t Thomas F.Geiler,Director MASS 9q, 6 9 ��� Building Division ArE p �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: On R 6z \ 1 W number _ street village "HOMEOWNER": A O -�71 q 31 74 V J 5 7S 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 re ' e ents. 6h6!L Signature of Homeotll 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." r 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 TOWN OF BARNSTABLE Permit nlo. . ...... BUILDING DEPARTMENT `�� TOWN OFFICE BUILDING Cash �. ' 'tnuY HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to _ i:1'c:3itY,i Y'ti;i.Vl ll u.l�lY4 Address \,C Li Lei V.il,i.0 1, 1'id S 6 d C L I U S e CIL6 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. - ........;� ur n a`fy��•'. TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 11saaer0 TOWN OFFICE BUILDING 639 � HYANNIS, MASS. 02601 i MEMO TO: Town Clerk FROM: Building Department 1 DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $k..... C _...... .... .................................................................................. .......... ....»...... ........... . ......._ issued to /f7C..�..ids..... l,t`.. G• `3.....................................A�......... Please release the performance bond. . THE FOLLOWING IS/ARE THE BEST � IMAGES FROM POOR QUALITY ORIGINALS) i M Ac� C DATA li � PBSUILDING OPE R M TOWN OF BARNSTABLE, MASSACHUSETTS 1 T JOB WEATHER CARD DATE "�rll 19 Ufi PERMIT NO. 1 �) 9 ra.. 2t1:C �1. t�Eli tl:! ..il L'i.nc APPLICANT ADDRESS .l i IN0.) (STREET) t ' (CONTR•S LICENSE) .CU, A. dwo.II;, � ��:1-i'ih�"i:: i"i.?ili�S.l•.• ciW 7..1..L�::.! NUMBER OF PERMIT TO (_) STORY c, DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) lot #6A 25 r.lbe I.:' tr r l ZONING AT (LOCATION) i �l;;, ° i;;lltitT 11<e. DISTRICT (ND.) (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 ` 3 1 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION - (TYPE) i REMARKS: c_ . fit: r AREA OR VOLUME '('``� t L• ESTIMATED COST $ `� f. 6 FEE MIT c (CUBIC/SQUARE FEET) 7 OWNER _ _:m .i :..;I�c..L �..i.-t ,.. BUILDING DEPT. ADDRESS BY ✓ ?� THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OF ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINEC FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION: _ ( OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. _ MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE'APPLICABLE SEPARATE ! ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FORELECTRICAL, PLUMBING AND j 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. { 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 3J MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3, FINAL INSPECTION BEFORE ., - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE hROR"Ta STREET BUILDING kNSPECTION PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0/1 I 3 I CH V EATING 'NSPECTING APPROVALS REFRIG ATION INSPECTION APPROALS 10 ( OTHER 2 J 2 { WCRK SnA.L_ NCT PROCEED UNT:L THE PERMIT WILL BF:I:.)VF: N'I'..". AND VOID IF CONSTRUCTION. INSPECTION IS INDICATED ON THIS CAR,' INSPECTOR SAS APPROVED T1+E VA�!CUS WORK IS NOT ST.'1 1:I I'IN SIX MONTHS OF DATE THE CAN BE ARRAIh'G-D FOR BY TELEPHQN1 STAGES OF CONSTRUCTION. PERMIT IS ISSUE^ A. ABOVE. OR WRITTEN NOTIFICATION. • .o r ce �� ..�� d•C sIX n / f- � q � �2� 04 490 ,lip, N Q� JOH O y _ N 9974 r`r CJ=Q.TIPIE-:D ALaT ALAS E y TE��9 gcF L L �;C T N EQ�f3�( e-t--i2:T r F-.t-' 714 AT E i �CISrt� �cUr�DA-n�l oh•1�t�--I t S C•LL IS e� 74ULtrJ 11_.l G. ,JcaB r.�" 65-153 "LdT' t5 L.dcA'rED i!-i �L-fX7'101-J To 4-7 6 2=y r>✓. �A GQ &'-e: -eM7 "T 4E 8--YlSMQ .&AOLY JME5w S =*-bwjJ 1=As7 MA . , o2s37 J6— 4.1".e, sf4E-E7r t of I Assessor's c#ice (1st floor): �L�(�'_ "4 of�'9-� Assessor's map and lot number ................... ....... ........ SEPTIC SYSTEM ���' i„ P�pGTHETod♦ FNSTALLED IN COMPLIANC Board of Health (3rd floor): `O Sewage Permit number ........ :`.. .v. .:.T..r.. WITH TITLE 5 = BAgggTSDLE, Engineering Department (3rd floor): = ENVIRONMENTAL CODE ANC 'oo MAa •� 2 �: House number ................• �... . .1t%... , TOWN REGULATIONS '''�oMpra.e APPLICATIONS PROCESSED 8:30 9:30 A.M. and, 1:00-2:00 P.M. only r I TOWN. OFBARNSTABLE 13.1.1ILDING'* (INSPECTOR APPLICATION FOR PERMIT TO ..... >tl............................:................................:. .................... ........................... TYPE OF CONSTRUCTION ..... A... a -- J ..----- 19. 6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location l Ar.....WI..A......At.'SKI2 T/..........!�y........ '! !... n.✓..ILLt............................................................. ProposedUse .... ..... ............................................................................................ Zoning District ....t ...#3 ...Fire District C� ..c/T 0 S T ........................................................... ........................................................:...... Name of Owner ..........Address .0�.��..P! ..Sr....C 'vlr4.. .�!1 .4.4............ Name of Builder 4TN.,!!41.1 �4.10q .4.4 0.... 4:-�ii IpAcld 3...ress .A. 44.!�.9T !� ../�h...Ct'!��,Lr/!✓{Ct,t- Name of Architect ..C...i!!Z 4..... 1. -.S4.. ...................Address 0 A.....I.A 4/..!�T7.4.b..44-w. Number of Rooms ....... .............................Foundation ..../i.v.1'r ..it Q.'vf K,t- ! . ....................... Exterior ...... ...... !t*............................... Roofing /9 s. /i7LT S Floors Tf' !9.L.4...... .. .Interior ..3.4. .;.d0/. $IQ.... L/�Sl t �..................... Heating W 4 ........................Plumbing /!T/i!-s......W/o.. Fireplace ........ ................................................................Approximate Cost I D *a . .r...... .. ........ ........................... Definitive Plan Approved by Planning Board =- -192-13__. Area ..:............................ Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTH S ze %q 4? 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 ..�11..../ .............................. 8 Construction Supervisor's License ov.a.�I k............ MADDALENA, THELMA +28989 One o y - 1 o ............. Permit for ................. .................. Single -Family Dwellin �. ...................... ............................................. Location Lot #6A, 25 Alberti Way .............................................................. •s; Centerville G� ....... . .........Thelma Maddalena.......p......P. ....... - � •N.± Y � �- ! { � :, ' 1 i Owner ......... Frame Type-of-Construction ..'..............................: ........ ................+........ ..........:.. �.........< .............. { Plot .... ...... Lot ............ ................. - t March 3, 86 t Permit Granted ` Date of Ins'ection✓ '!'ybrr. .. p !� 19'� y u Date Completed ........ ��.........19 s t '` k -i +