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Fax: 508-79 62Y Yi j EXPRESS PERMIT APPLICATION - RESIDENTIAV0NLY fr - No Vad lvm4 `W X-Prs iprint vsp/pareelxmber,251/o3s/ � OF+ A� S�ABLE Pr` Address` 113 Angus Way Hyannis Ma 02601 }oP�Y. x Residential. Value of Work,2,537.00 Minhhum fee of 05.00 for work under'$6MO.09 Owner's Name&Address Virginia Gale Klum r PO Box 575 Centerville Ma,02632 F .Coatcactor'sgame. John P.tyons Cedar CrestProperties,LLC _tl S.TelephoneNim►ber' 74-353-6235 " 'Home ImprovememiConlractarLicense 4(if applicable) 166189 1 ' Obnstntction:Supervisor's License#(if$ppliCable) es-076126 Q�VVorlanan's Compensation Insurance' 4 t M . Check one: I am a sole proprietor ' Q I am the Homeowner x t 0 f have Worker's Compensation Irisorance Co upanyName� Zurich=American i 6zzub=9891 m337 {Workman,s Comp.Policy , ,t Copy of.Insurance Compliance Certificate must accompany each permik Permit R - check box) w a Re-roof urncane nailed old es All construction debris will be fatten to• ` f ` 0 Re-roof(hurricane nailed)(not stripping Going over_exishng^layers of roof) [ Reside ., -' N of doors, F t 4 E) Replacement Windows/doors/slideis.U•Value. 30 ` v (maximum 31�/+of windows - w i I 0'Smoke/Carbon Monoxide detectors 4 xtoor plans marked with ied Sand taapecdons required. Separate Electrical&Fite Permits required . *Where roynired: Issuance ofthis permit does oM exempt compliance vvit6 adm town depaitment iegalettoas i.e.Historiq'Conaervation,etc } $ 1 -_•'•Note: - :Property Owner rhm sip Property Owner Letter ofPermission.`- }#[ - "A copy of the Home Improvement Contractors License Bs Construct oo Supervuon License is r regnired. w. , Y �f :4 •,, n h !!!!*'•••GNATU_IZE ° y ,s`. , o i='_ •. t C:\Usm\deeo(�7c au ft\W.&.\T l umetFdWWontont r W,00MQRE6ZUBNSXPRESS.d v. \AppD SPY '- Re Ased 653012 r r , jT210cmB . T iM1 200 � svin� NA/yam• _ Fax -OCO&790-6230 i Property Owner Must Compleft.> Y Using A BuNc r t Vsiginia Gale Klun =_ ,to Q�nas of iihe s�ub�ea tmpaety bereby=tbotin John R Lyons to sax cm RV beh2 in ap WSIMM to aoA sudwnized by Ois baft penTit Vplcafim for 113 Angue My Hyannis Ma 02601 cfjbb) of own Virginia Gale Klan `Feint Nyme - R-ind owl r a T7te Cominon*'vealth 6fMassarhusetts', °'4 �epa trtt rt oflndissAial Accddenh i _ ,t?�ict ofltn�stigatons ' . WOVO I<3'Ashir��ton Sh�ct ' r►:ntas�.got�drtr I Workers'Commnsatim Insarancte Affidavit:`BuMers/Cont3actors/f1ect ciauM mbers .� t Applicant h&rmathon 4. Please Print I.ejd61y ' ! Name Cedar Crest Properties,LLC-` �`° ' 72 Higgin§Crowell Road' Address: C' /$tate/Zip: W-Yarmouth;Ma'02673 PSvhc#" 774-353-6235 Are you an enooyer2:Check tLr.appropriate boss Type ofpmje t�r gait�td) ' i_❑I am a with 4.❑I am.a g�ai contractor and l' ' empkW 6:'Q New oanstmcttoa' employees(fan and;or pfet-time) 'haw hired t� eo toss 2 lama sole ptoprior Os partner- �-listed on�.atta�d sheet �• ❑ <� ;.'1 hese have Y . B.' z. Demolition ship and have no employees � _ �� � ❑ ' and have*Wows' { wadting formeinffi9'��y' I. 9'❑BaddingaddWon�, y No,wodmn'comp.inim Ce Cow tom_ ,regQ. 5,❑r We ate a copasatioA and its` . 10.❑Electrical repairs or additions. 3 ❑lama emr doiwg all. orlc r officsis 1�a ese iced their 11,❑ g Pegs-or additions [No 'or P`' „% of on perMGL 12.❑Roofrepaits"..+ , c;1s 1 4 a4dvre have so ms=aceregnicadji - ' ( � 13.Qga .window replacement eoaplo}+ees,(No vrmlLoem'' COMP- Via' D ,t. 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Zurich=American Insure Company Name 6zzub-9891 m337 } Potiry#or 4c #: 08/26/2013 JobSite.Address_ 113 Angus Way . { �* ,.Hyannis Ma 02601_ ' 3 Attack a of the workers can madon poLcs dedarat per(slow ,the polity=mbes and espuatiou date Fa.to serum conwW as requued aides Section 25A of MGL c.152'can lead to the impo�tion of criminal penalties cf a" fine by to S1,500 00 andlor cnva-yt#r ;as'a�elt.as civil pi es in 1e form of a S,1'OP WOM ORDM ands fine., 4 of up to$250.00 a thy against the violator: Be iftwdtllat a eppy o.,fts statesoeut maybe fora+a&d to the Ofike of Inv res'it arioag of DIA for insorace cocstage tiwr5catiod �°. •' ' ' --- - - .� Ilo lienby trader the pmres and penahies Qli�+►3'i1iQt tha_in�jonitata'on pror+ide�obas�e is.trite and eorre�t, P� , 03/28/2013 . , ate 74-353-6235 ' _1V s l fflddNSf OJtI}L 5 not n;f r iA thir wvi,M b*C0 /d by 4 Ol • r _ City r or Town: s. g Permitli itenst d r Lssui>.Aatho ity(circle one): 1,Boated of Healith 3.Bm7ding Department 3.Qggo0n C]le* 4.Eketrical Inspector 3.Ptaeobling Vim* n 6 ° s �r Otber Cornet Pet'sop: : MUM A, i r OW.✓ RmWewa License or valid for indivW use only HOME IMPROVEMENT CONTRACTOR before the aspiration data ff found return to: Regisbation: . 165189 Type Olfiia of Consumer Affairs and Badness Repletion Expiration: Wrf 014. LLC It1'FAA.Fhza-Saito 5170 Boston,MA 02116 C:e�a'r Crest Properties LLC p3' - f John Lyonsae0000 72 Wggins Crowell i %Yost Ya nnou ft MA Offi73 sr— lhdetsoer�ary blot vaN wilboat Massachusetts-Department ofPublicSafety Board of Building Regulations and Standards U -Biffibw of any_ um g n 1* s C:onoraction Super%f or contain Aw dm 35,OW cubic fed(991m)of License-CS ffG= enckwed Rnm t' .dui P LXOIltS',` o���• � �� , 72 W YABIILA Faflure to possess a cuuM edition of the massachl ei�s State Building Cade Is cause forMworation of this license. Commissioner Expiration 91A M4 far t>PS,Un nraTtig tt ww+ s€ov/t)Ps CeMcate No: A041033 r - n THE COMMONWEALTH OF MASSACHUSEM Fxwurw OFF OF Lmm AND WoRmRcE DEviwpmENT . DwARTNZw OF LABOR STANDARDS k 19 STMIFORD Smm i?,BOMN,MAMAOMSEM 02114 t DELEADER CONTRACTOR LICENSE CEDAR CREST PROPERTIES LLC 72 HIGGINS CROWELL RD WM YARMOUTH MA M673 - LICENSE: DMI912 EY PIRES: Monday,Jame;17,2013, IN ACCOROANCE VVI Dyf G T, CIL H1;§ 13i?B(b)r.4 D 454 CA+1P61-4 T1315°UCEt4SE IS ISSUED BY 4 THE DEPAR'I`MENT OF LABOR STANDARDS APO CONTRAC'IiUB ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELVING WORK. i t THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR ' THIS LICENSE MUST BE MAWTAQdED BY THE CON memR WHEN ENGAGED IN DELEADING i WORK IN ACCORDANCE WITH KG.I..CH. I I I§ 197B(bx2)AND 454 CMR 22.03. G • NO t�r+�•�. �. '?'ai,� •�i.i iii���... �,f� rcn �. ,�� .. -��.. 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A P BWIT TOWN OF BARNSTABLE SONMENTAL C00E Ab,]D Building Permit Application Project Street Address Village Owner U/QH6 h1 Address 13 .V 64(_�, Id�y Telephone - d. Permit Request 09.ry First Floor a square feet Second Floor square feet Estimated Project Cost $ O Zoning District Flood Plain Water Protection Lot Size ! J-D X /© O Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use ] (�� C Proposed Use Construction Type 0,0 P / RJi l y G H Commercial Residential w Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished TAX Historic House U Unfinished Old King's Highway 0 Number of Baths 1 No.of Bedrooms Total Room Count(not including baths) First Floor V� Heat Type and Fuel 7— G✓J�T Central Air Fireplaces Garage: Detached Other Detached Structures: Pool, Attached Barn None Sheds Other Builder Information Name "0 FA Ij /.,i J k1 6 Telephone Number Address W 6- VOe-yK) License# 0/93--5 7 N�S�A, / A < <-�i ' Home Improvement Contractor# 111163 Worker's Compensation#UJ Q( 315 3 o 0 t4a: G�5— NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r JJ SIGNATURE ` a DATE BUILDING PERMIT DE D FOR THE FOL OWING REASON(S) 1 FOR OFFICIAL USE ONLY P MIT NO. D ISSUED - . r M P/PARCEL NO. , ADDRESS VILLAGE OWNER + . • f DATE OF INSPECTION: - FOUNDATION ` FRAME y cl INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH e FINAL GAS: ROUGH-- FINAL- e FINAL BUILDING DATE CLOSED OUT J t ASSOCIATION PLAN NO. v RIO 162 ��+w ,r / � �x L (ou��a ---- - -- Y•; - 1 _ r'r' �l. �.oW k•fTFA Tbp �{ vvta- R.�9 I_.G.LccY ii" g�I�r. of '•r 1X6 - IG MATCIA y R Fs rAl ,11 A, _ 21A i le, I A, Ay91no�r rtRBP. � - <Iaar� f i �TYf _ � � •�? I � �.�_Iti) //JCL IV-tSUL I wAll I�►A7flSi �j�%I STI f( aasC a $ --- - i .' a�b L' !. c 16•'o.c. _ NoJst� h ;pit i � C �j l a"`�,,k s�• � �' 7�.R S.�L Y. F r K.F�Ci . "�'t': I ;, ; s G �x s A CC C 55 �r_ 1*51 k' CRA49� 5'PALG - T'3AS�r`I Frr! P�A1� VI�iw V ,k I j>'Pr,5, 3 A I H /�D�rTkcrr �A" 13 AN � k V . I $rIL G'o Na. Frsl, S[CTION y I �N� Q-A r ` � C/' c) I l _e ,9� Abt•; OIRT �,J IN;7 0W i — Z_ p�l -2/V re L/6 PockET Ooo 2 •� Ll V1Al(3�. Tlrc• CUI1nIlnOrt N•caltlt of?Itassacl�usetts De rtment of Industrial Accidents 6011 Washington ngton Street Bunton.Afire. 02111 - Workers, Compensation Insurance Afridavit ARniic� --- Please PRINT 1e biv - �nr tntor•mation • name. r�ii� 1"ook m 14 cttl ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ 1 am an employer providing workers' compensation for my employees working on this Job. address! city: phone* incur nce cc neiicv# I am a sole proprietor.general contracto ,or homeowner 'rein one)and have hired the contractors listed below who the following workers' compensation polices: 9 �44Ln[►;1m n�mc 1� r� /Y//rY �- 77 / J tncurnncc rn " neiicy# we i 3 r9 30 0 )8 Ba i company name* address- city phone#- ins •• neiiev# _ . .. .. :Atiach additionai'sheei ff riiieisar _�+- "�''s°�"�'+ `^"' " �•'"` '""'"' '�' Failure to se coverage as required under Section 3A of A1GL 152 can lead to the imposition oteriminal peaaltia of a line rep to 51300.00 sac• cure one years,imprisonment as well as civil penalties in the form of a STOP NVOR1s ORDER and a not of S100.00 a day against me. I understand the COPY of this statement may be forwarded to the omce of investigations of the DIA for corerage.verification. !do herchr certijj•and• the pains and penalties ojp urn that the injotvnation ptwsdded above is trae and cvrrert Signature . _ Print name p g ofiicial•use only do not write in this area to be completed by city or two otQcW City or town• permitnieem# rtnuiiding Department ptueensing hoard check if immediate response is required 05eieetmen's Omce Diimlth Department - contact person: phone#: r'tOther. v�� Information and Instructions ; Massachusetts General Laws chapter 15_' section 25 requires all employers to provide workers' compensation for » -ice of another under an-., . In ee is defined as eve person in the. service . �r an c nr t employees. As quoted from.flue la p D P contract of hire, express or implied, oral or written. An eiyzphov r is defined as an individual. partnership, association. corporation or other legal entity. or any two or n 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 owner of a dweilinL 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 or on.the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renawal of a license or Permit to operate a business or to construct buiidin;s in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the in coverage required. Additionally. 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 chapic been presented to the contracting authority. .+: }::fT •i"•:. .y.. .i.Y�r r.IN.N:•{..:,,7ir%J."•Il!_`y ;.. .�Yt•eii� .^'�,.«.•.1ir� .�"•a'..�..�. Applicants Please *"I in the workers' compensation affidavit completely, by checking the box that applies to your situation an supplying company names. address and phone numbers as ail affidavits 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"iaw"or if you are requi to obtain a workers' compensation policy, please call the Department at the number listed below. —: .- _. ..w..e..n• ... .. ... ..1w.. >: ;_::: . . . :�;.:'�'".•�.wu: .. .. �::-!l�i''..�'r.+y�'.:f.:' .=new.w:;J'af..•e:•�t.}..:... . City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnL the Department by mail or FAX unless other arrangements have been made. T71e Office of investigations would like to thank you in advance for you cooperation and should you have any quest please do not hesitate to give.us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts 4ri w Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 nhnne #- (617) 727-4900 ext. 406, 409 or 375 �r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION 113 N mber " Stre4 addressf Section of town "HOMEOWNER" / N e -�5 Home phone Work phone PRESENT MAILING ADDRESS // 1-fY At-6 4JI9Y 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor I DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comp with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. I HOME OWNER' S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1 . 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor P (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section,..2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Homel wner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ;: CR of Barnstable The Town' P Department of Health Safety and Environmental Services , Building Division 367 Main Street,Hyaaais MA M 01 Ralph Crosses OM= SOS 790-6227 Building Comm F= 508-775-3344 For office use only Permit no. Dau AFFIDAVIT HOME IMPROVEMENTTO CONTRACTOR SUPPLEMENT aion,alterations;renovation,�modern�on,conversion, MGL c. 142A requires that the"rzconstru ed demolition. or eonsaucdon of an addition to MY Pm' °ter O0� reuto��al, am building containing at least one but not more than foist dweilsag or stirs with other to such residence or building be done by registered c,�nu'act =with curtain Ca=pdoM along rapiremcwL Type of Worie Est.Address of Work: Osmer.Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work ccduded by law job under SI,000 Yudding not ovvtset-occupicu Owner pulling aim permit Notice is hercby gh=that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING�N�EHAG�CAS To THE FOR APPLICABLE HOME WROVE�N'r ARBTIRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERTURY I hcreby apply for a permit as the agent of the tmmcr: Date Contra=name Registration No. .: .. _.._ �.'. .., - � >� '.'n � t, sip. { ♦t c :'r,p - -';T',--`Y---_—*!,;:.," �;,�"^"/ r , -70 Assessor's map fond lot nu a ��.... .. �3 , Sewage- ermitj numb r ° 9 ARNSTAD E House number .......................... r Mb t L ..........._....._.:...... 3... ........ 9B t ON P9 a\e� " TOWN OFARNSTABLE BUILDING IN:S'PECT0R r APPLICATION FOR PERMIT TO ....i...�D !`� .©`n �'� � ......:.. ....... R TYPE OF .CONSTRUCTION. ,.(,1U7 .... "A �"................. : ..... ................... .....z ............... `- .�.�....................19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to .-the following .information: Location .... ...t . .Cr...... ljMe................................ :..,............ Proposed Use ............. . ............................................. . ZoningDistrict• ............................................................:...........Fire District ...................................................,.......................... ow�c5 }.. A�P4a�^....��..)�«eIR Address ..�� e v..t� Name of Owner �. .... .�+J ........ ` ` i } - Name of Builder ..... 1 .. WC<� .............Address 3a... .+ ...:......Ker........ .............. ..�....... Co 5 . , Name of Architect :........Address .... ..................................... ........... Number of Rooms �� .......Foundation :.VVK! .&Q m.�'`?... `" q:zv cCL��....:..` ...... ...... Exterior ......... e 4ms.. ..............Roofing .......C,/� � ... ..................... .................................... Floors .......Interior ........ ..... ............................ Heating ..........................:......� Plumbing ....: ��' .....I.... ............ " Fireplace. .......... .� . .............................................................Approximate Cost+...........74 4?...... 4 Definitive Plan Approved by Planning Board _" ______________________19________. Area ...a. .a............................. Diagram of Lot and Building with Dimensions r ,.. Fee ......../Q,6:............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH �1 3b: OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules,and Regulations of the Town of Barnstable• regarding the above construction. r Name ................................ Construction Supervisor's License. 3R ` .1.......:.. PHILBRICK, '1THOMAS & MARIA14 No 26�!94• Permit for .......BUILD GARAGE... Accessory to Dwelhn............... location ....113.. ? .wad'......... ........ - _ . ....................................... 'Centerville...........................:... .. -„ - Owner,. ..:Thomas :& Marian Philbrick ' Type of Construction .Frame............... �Z •� r - -,' .. t � Plot `... .......... Lot ................................... - w Permit Granted .......F.eb. r..?l'....'19 84 Date-of Inspection ::...........................`.....!19 Date"Completed ..... .....1 S17 t ,E ..� � e j� \ .1. � tam .I ." a� !• Vj S. w Y..— �• �"'� .�• Cry''� ` - ,. t 1 � r r.I ♦ / 0 � c.. i � ��!►� ,. !� Gar �/ y I � �1 .r i1 ►'^`�o� � `�S � ,, '' a e,� � '. %� ', ,►'r;> ,