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0043 BACON LANE
Aa den- v ^ f m r- 0 a Town of Barnstable �1HE T EIOPlyfiyT af�LG Planning.& Development Department a�� a Fq Barnstable Historical Commission SARNSTABM 367 Main Street,3 d Floor, Hyannis, Massachusetts 02601 MASS. / 9� s639, . 1� Phone(508)86,2-4787 oi .. .:. - :. Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk 3'aas es 9, ;;, 12241 George Jessop,AIA Cheryl Powell Frances Parks Jack Kay r �L g z` 1�R 4E BARN_.,5 HOLE G UON CLERK DECISION Summary: Demolition Delay.Imposed Pursuant to Chapter,112 Historic Properties,Section `112-3 F BUILDING DEPT. Applicant/Property Owner: Chris&Jack D'Ambrosia Subject Property: 43 Bacon Lane,Centerville JUL 3. 0 2021 Assessor's Map/Parcel: 207/0181000 Hearing Date: July 20, 2021 TOWN OF BARNSTABLE Pursuant to the.Barnstable Historical Commission Chair's.receiving your notice of intent on June 24, 2021, a duly advertised and noticed public hearing was held on July 20, 2021 to determine whether the significant building on this property is preferably preserved and whether demolition delay would be imposed for the full demolition of the single family structure* and garage structure on the parcel addressed as 43 Bacon Lane, Centerville. After review and consideration of public testimony, application and record file, the Commission by a vote of four in favor (Parks, Powell, Fifield, Clark) and two opposed (Jessop, Kay), found that in accordance with.Chapter 1127G the structure is a preferably preserved significant building. In.accordance with Chapter 112-3 G, the:Corn mission determined by a .vote:of four in favor (Clark, Fifield, Parks, Powell, Kay) and one opposed (Jessop) that the full demolition of this structure would be detrimental to the historical, cultural or architectural heritage or resources of the Town and so pursuant to that vote in accordance with Chapter 112-3 H, a demolition delay of 18 months from the date of this decision is imposed for this structure: This decision applies only to the demolition described in the notice of intent'submitted on June 24, 2021. No future demolition shall be permitted without application :and approval from the Barnstable 'Historical Commission. Present and voting on this application were: Nancy.Clark, Marilyn Fifield, George Jessop, Frances.Parks,Cheryl Powell,Jack Kay Nancy Clark, Chair cc; Brian Florence,Building Commissioner Ann Quirk,Town Clerk Y4 Town of Barnstable *Permit# Expires 6 months from issue date °Y Regulatory Services Fee em BAMMBIX v '""M1639. Thomas F.Geiler,Director f0 MPr a Building Division 10 is lo9 LILa- 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 PERMIT APPLICATION - RESIDENTIAL ONLY , r-� Not Valid without Red X-Press Imprint Map/parcel Number Property Address C pJ LA Residential Value of Work /� /.�cP Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ,/�"i/�s. tk?� �nl/t6AroSMi AAC,0,-j LAW Contractor's Name S 2x e a., Telephone Number _'00 ZK Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) / /� X.p I_t^;z PERMIT orkman's Compensation Insurance 5 2009 Check one: OCT ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE Q-I�ave Worker's Compensation Insurance Insurance Company Name ��t/�` �.dJ'!�`C, X;S-1-4 � Workman's Comp.Policy# 42W 6-0 " Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) e-roof(stripping old sh' gle ) li construction debris will be taken to � ❑Re-roof(not stripping. Going over existing layers of roof) A114 ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows '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: j C:\Users\decollikWppData\Loca]\Micros 4windowsUemporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 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: �D� &Y City/State/Zip: oW Phone#: o 02� Are you an,employer?Check the appropriate box: Type of project(required): 1.54�1�ma.employer with ,f 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, working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: 10. Electrical repairs required.] 5. ❑ We are a corporation and its ❑ p irs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEl Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.2<oof 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 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: 2 ter. G Policy#or Self-ins.Lic.#:_ ��/ �l/� 90 Expiration Date: / oZB�,d Job Site Address:y� l'. 69?Y 44&-f City/State/Zip: d�cA t,o l . Odd3oZ 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and naldes of perjury that the information provided above is true and correct. Signature: Date: Phone#: Am— Official use only. Do not write in this area,to be completed by city or town gfj'u;iaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - VAUG-03-2009 12:09 From:MARK SYLVIA INS 5084209227 To:15087906230 P.1/1 pATB(MMIuu/7 r) OR D CERTIFICATE OF LIABILITY INSURANCE 08/03/2009 PhlUl uceR ...... .. # 103846 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Serial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MARK SYLVIA INSURANCE AGENCY HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 771 MAIN STREET ALTER THE COVERACE• AFFOROPD BY THE POLICIES FLOW. OSTERVILLE,MA 02858 TEL; 000 428.0440 FAX: 600.420.0227 INSURERS AFFORDING COVERAGE NAICB INR.UIirjl} INSURER A FARM FAMILY CASUALTY INSURANCE CO DOYL 8 THOMAS CONSTRUCTION INC. INSURCR 13: j PO.BOX lee INSURER C•: CENTER;VILLE, MA 02532 MCLIRFR D: INSURITR In- COVERAGES ITHE POLICIES OI01INSORANCE LISTED BELOW HAVE BQ13N ISSUED TO THE INSURED NAMED ABOVF.FOR TMC POLICY PERIOD INDICATED.NOTWITHSTANDING' .ANY REOUIRL'MONT,TERM OR CONDITION OF ANY CONTRACT OR OTHCR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE!ISSUED OR MAY'PFRTAIN,THE INSURANCE AFFORDED BY THE POLICE$DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, eXCLUSLONS AND CONDITIONS OF SUCH POLICIES,AOGREGATC LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS I F; T p L v x r oN LIMIT TYPL'OF INSURANCE POLICY NUMDpR All IINORAl.LIAdIUTY C-ACtl OCCURRQNCa S 1 000 00( A I X COMMriRCIAL OL!NLTRAL LIABILITY 20OI X0486 07/21/2009 07/21/2010 A . ° /,` 'r go r 50 001 CLAIM?.MADE a OCCUR MED t1XP(Anyone mrann > 500( PRRI70NAL A ADV INJURY S VnNFRAL AGGRI40ATO $ 2mOOI GL AGokb c UMIT APPL/FS PUR PRODUCT6•.COMP/OP AGC i 2 OOO 00( EN' X. POLICY P LOC AUTOMOBILE LIA131LITY COMBINED SINOLF LIMIT iE0 uaai4enq $ ANY AUTO ALL OWNED AUTOS [IODILY INJURY g (Par 1.110A) OCHCOULb AUTOS HIROO:AUTOS BODILY INJURY 6 NON-OWNED AIJ'I'OG IPar aaaidenl) PppOP[;R'7 DAMAGE g . (Pay'eemdnl) I........ (,ARAOS LIABILITY AUTO ONLY-OA ACCII)CNT % ANY gUlO OTHER THAN I'_A ACC $ AUTO ONLY AGO & R1(CCeblUM®RbLLA LIABILITY EACHOCCURRFNC ,� Z -9*11 CLAIMS MADL° AOGRPGATE S .. a DEIDUCTIDL19 "iRUTENTION S G NIORKOR'S COMPENOATION AND 2001 WB39O 07/01/2009 07/0112010 X o •I• A RMPLOYIIRS•LIABILITY [,(,FACH ACCIDENT $ 500,0 A*PROPRlrzTORIPARTNGRIeXCCUI'IVE OPFICLRIMEMI5QR rjXCLUDED? h.L OtLIGASR•[A gmnoYL•:F 6 500,00 IL yoe'doperIb4 unde11 YES500.00 IrPatIA'.PROVIEIO S below GI.OISf ARE±•P01,30 LIMfi 6 IOTHI"-R. 5 DCQCRIPTION OF OPCRATI6NSILOOATION5NBHIC4138IOxCLIJ810N0 ADDED OY GNDORSOMENTISPOC1AL PROV1610NS CARPENTRY t-HE WOR'KERStOMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR TROY A THOMAS, SHAWN DOYLE 7171 CERTIFICATE HOLDER CANCI!LLATION � GHOULO ANY OF THfj ADOVC DLrvCRIf16D POLICIpO OG CANC'OLLUD OHFORhTHLr CXt IRATIC DATE THE COP,THE!ISSUING INSURER WII.1.UNDCAVOR TO MAIL DAYS WR1ITEA TOWN OF BARNSTABLE NOTICC'0 'Ha CERTIFICATE HOLDC'R NAMC'D TO TliO LOFT.01.11'FAILUr7O TO DO GO SHALL BUILD NG DEPARTMENT ATTN SALLY MYANNIS, MA 02601 IMPO •N 0 iLIGATION Oil LIAOILI' P ANY NO UPON TI•IG INBUIiGR,ITS AGENTS OR FAXI 508-790-6230 JS0 Rr.:P 411.1: T T - AUT RIZ L V ACORD 20.(2001108) m A RD CORPORATION 1009 £6666 :�1 ZLOZI£LIV uo�3pudx3 3-I'111�i�31N30 3Nb4 W`dHJNIllO�0a1 SyWOHJ :01 palOialsa2l £1666 �S SC :asuaa!1 aosinjadnS u0lfanaisuOO asuaa�l eioadS ,;u�plln8-I" Rant)" ' ►ur. uo�h'in;a21` ur.t5 1 4 �11�,►�y�r...r.lti �t�.h'� �iµ{»d 1u ►uau�l.xr.da [�•fX;iJlCfiLLl6P,Gw J/ �oonrrzanu ecr��lz a•t- License or registratio rx Board of Building Regulatrbs and Standards before the expiration ration date! If found d for r return to'.vidul use nly HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 Registration: 145954 Tr# 282668 Boston,Ma.02108 Expiration: 3/15/2011 Type: private Corporation DOYLE+THOMAS CONST INC TROY THOMAS ` --- 499 NOTTINGHAM DR Administrator Not valid wit out signature � CENTERVILLE.MA 02632 — - Ff a. . 1 0 � 4 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyle-thomas@comcast.net (508) 328-1635 P.O. BOX 168 Fully Licensed & Insured CENTERVILLE, MA 02632 LIC# 145954 Doyle and Thomas Inc.Proposes to perform the following work: Location of proposed work: Mrs. Joan D'Ambrosia 43 Bacon Lane - Centerville, Ma 02632 Date on which construction should begin: September/October 2009 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried.out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $ 10,954.00 i Red cedar and RPI rubber roofing membrane on low pitch areas In the event that while stripping the roof we find rot that needs to be..replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30.00 for a carpenters laborer, plus the cost of materials. Thank you for Givina us the Onraorttjnity to Hain Ynu ImnrnvP Yrn,r Hr,mp -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier and#30 felt paper,and installed with Timberline architectural shingles using galvanized nails.. (Storm nailed) -All new 8 inch drip edge and pipe flanges to be installed -Timberetex premium ridge cap to be installed -Install of rubber roof on low slope areas as discussed -Remove roof hatch door on the roof and re-sheath as discussed -30 yard container will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property. NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or.evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event or anv instance or non-comonance.univ!iucn portion shall be invalid and the remainder of this contract snap oe in run rorce errect. in aaaition.anv such portion not in compliance shall be read and internretea so as to nave its intenaea mearnne to the maximum extent allowed under such law and reguiatior: Signed as a sealed instrument on this date: Date: ud� Homeowner Contrac r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION rs 12 Map Parcel,_. ioh� #cQ Health'Division Date IssupdC1 Conservation Division ..Apo.lication Fee Planning,Dept. Perm,it Fee Date Definitive.Plan Approved by Planning Board V Historic - OKH Preservation Hyannis "ev Project Street Address /��41e_ Village ��✓_✓ ��Y'�'�� Owner Address Telephone Z;Xoew&&5K Permit Request;Eo�/ 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 Grandfathered: LJ Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family L] Multi-Family(# units) Age of Existing Structure Historic House: Ll Yes Ll No On Old King's Highway: LJ Yes LJ No Basement Type: D Full LJ Crawl Ll Walkout LJ 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: Q Gas 'LJ Oil Q Electric L] Other I Central Air: LJ Yes El No Fireplaces: Existing New Existingwood/c IstovEggL]Yes-L1No Detached garage: L3 existing Ll new size Pool: L11 existing J new size Barn: LJ ex! ting 4ew,,size. Attached garage: L)existing LJ new size Shed: LJ existing Q new size Other: Zonin'g Board of Appeals Authorization U Appeal # Recorded LJ Commercial L3 Yes L] No If yes, site plan review# Current'Ut6 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Vim 2w_2�w —2-2 Addresz.J- License# Home Improvement Contractor#11011 W Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNAf6R - DATE C/ 00 `e ? FOR OFFICIAL USE ONLY r APPLICATION# ' DATE ISSUED MAP/PARCEL N0. ' i -_ADDRESS VILLAGE OWNER x DATE OF INSPECTION: FOUNDATION FRAME f INSULATION I � 1 FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL $ GAS: ROUGH FINAL FINAL BUILDING j F ' r DATE CLOSED OUT ASSOCIATION PLAN NO. ' I rP� The Commonwealth of Massachusetts -\ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia - Workers' Compensation Imnrance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly N e (Bus' es ganizalionadividual): / 'v • Address: `� ��- e. . City/Sfate/Zip��si 2-�j Phon #' Are you an employer? Check the appropriate bog: 'Type of project(required): 1. 1 am a employer with 4. .0 1 am a general contractor and I 6. ❑New construction have hired the sub-contractors employees (full and/or part-time).* listedlisted on the attached sheet 7. ❑Remodeling 2.❑ 1 am a'sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition and have workers' working' for me in any capacity. • ' employeest 9, � $uilding addition comp. insurance. [No workers' comp.insurance 5. Wt are a corporation and its 10.❑ Electrical repairs or additions required-.] 3.❑ I am a homeowner doing all work oficers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof mpa' insurance required]t c. 152, §1(4), and we have no employees. [No workers' 13.❑//Other G comp.insurance require&] j(7'C�fU '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. iContiactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have cmployecs. If the sub-contractors have employees,they must pr-ovidt their workers'comp.policy number. I am att employer that is providing workers'compensation insurance far my employees..Below is the policy and job site information. i r Insurance Company Name: /�4 ee 2 Z)01 J'� Policy#or.Self ins..Lic. D/SA Expiration Date: Job Site Address: ��'Y'���'City/State/Zip: e� '2—if- 3 Attach a copy of the workers' compensation policy declaration page(showing the policy nurriber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00.and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a,fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of - Investigations of the bIA for insurance coverage verification. I do hereby certify Undhe pains-and pen es a rjury e information provided above'is truet y and correct. Dat 1 D _ Phone#: .�~ o� Cr y z 7' Z. Zi Offx1al use only. Do not write in this area, to be completed by city or town official City_or Town: Perrrdnicense# 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 llistru.ctions 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." AdditionaIly,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 cvideace of compliance mrith 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, i.f necessary, supply sub-contractors)name(s), address(cs) and phone numbcr(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 LL.P does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confizmation 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 nurrtber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp 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/licensc number which will be used as a reference number. In addition, an applicant that must submit multiple permit/licensc 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 ba.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 e6mmonwealth of Massachus�kCs a Dr_partmont of ladias6al Accidents Office of luvestigai.ous 600 Washington Suet Poston; IYfA 02111 Tc1. # 617-727-49,0.0 ext 4.06 4r 1-877-M.ASSA.FE Fax# 617-727-7749 Revised 11-22-06 www—mass..gov/dia THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / � �0�"- IL DATA 7_u a m r-r-V I I I • g.u n �l CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) f 07/21/2008 R (508) 432-4822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE hleen W. Kenney Incorporated Insurance Agent HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR �120, Main Street, suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1 - West Harwich MA 02671-0001 INSURERS AFFORDING COVERAGE - NAIC# INSURED 1Nt,uRm n LIBERTY MUTUAL INSURANCE THOMA5 TURCKETTA r1:,1IR'rR'n DBA YANKEE BUILDERS NUI?tl? 65 RED TOP ROAD - BREWSTER MA 02631- IrlisuRrRr ' COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD•L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDlYYI DATE(MMfDD/YY) GENERAL LIABILITY / / / EACH OCCURI,![=W: 'C DAMHC•t 10 U.L(J I ED COMMERCIAL GENERAL LIANILI I Y F'R'rML';r;i rr�urrimcnr,c 16 CLAIM'_'MADE 0Cn IR / / - /. MED t.%;f'.IAnV r.,ne R91'sn l 5' . PtK'•ONAL-Si AC'IVINJUPY l6 / I-rNrRAI ACC-FF(4ATr istId'LAQi:•I;ti;AlELIMII AI'I'LIE':..IIER: I'It(iLiIA:I`'-.i_(iMIY PA_•G FRO I'ijLli_Y •FCT Liii_ AUTOMOBILE LIABILITY / / i_.t_iMNINEI', IIJGLt LIMI I - ' - IEe�flCCUaantl ANY AI ITC) ALL OVVfQtLi ALI10_l / / - / _ ru"1r!II Y illi,A IR"i - (P(n w,:;,m) ;6 '-4 HEL)L ILtL'r HI I I - 1 HINED All IU_: / / / nar,nY1I,m (F'ry rn:ridcnl) lS NbIV{!VY mAtITOli - / 111 OPEN I Y DAMAGE - Y� I I'er acaaen[I GARAGE LIABILITY - AI I 10 i ONLY-EAACi_ILIEN 1 f' MI•i AI ITC! _ - / - i i 1Htk I HAI,[ rn ni:i: s All I iJ ONLY: f. EXCESS/UMBRELLA LIABILITY - I / I / EACH CiCi_Lq?I{Etdia �' in_.i_UR ❑ CLAIM'---MAL- - AC•CPEC-Alt $ LtEL4li:IIbl-h Od ld 2008 OQ ld 2009 wr:ViTnru imI WORKERS COMPENSATION AND WC1-31S-3.21523-013 / / / TL"!F'YIIMITr4 rR EMPLOYERS'LIABILITY - ANY PF,0PF'IfTR/PARIT F(NFR/FX (ITIVr -t.L.tACH Hi_CIDLII1 }. 100,000 i! CihrlCaR.IMtMLjtl?t%:i_LULitU'7 / / t.L EAWI'LOYEE B 100,000 IrYeS,JeS,TlrleUnder - - 500,000 ;PFCIAI PR'OVI;410Nt;Iwlow - r I r!I;rA;r F'lll IC:'r'I IMIT $� OTHER DESCRIPTION OF OPERATIONS,LOCATIONSMEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - N coverage for worker's comp <� J u: CERTIFICATE HOLDER CANCELLATION tA - - - ( - SHOULD ANY ,L OF THE ABOVE DESCRIBED POLICIES BE CANCEL� ,ED BEMIRE THE sam palmerine' - - EXPIRATION DATE THEREOF, THE ISSUING INSURE WILL EIb&VOR TO MAIL DAYS WRfTTEN NOTICE TO THE CERTIFICATE HOL ER NAMED TO THE LEFT,BUT town Of barnStable FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. • - - AUTHORIZED REPRESENTATIVE '/T � ACOR'D 25(24101108).: lh,ACCORD/lGC►.ORPORA71ON 1988 INS025(nicopfi f Thomas.L. Turcketta d/b/a/YANKEE BUILDERS 65 RED TOP ROAD BREWSTER, MA 02631 508-385-3672 www.tomturcketta.com email tom@tomturcketta.com Construction Supervisor Home Improvement License#029893 Contractor Reg#110124 September, 15 08 P , I, Joan D'Ambrosia give permit ion to Thomas, L Turcketta to perform repairs on my home @#43 Bacon Lane Centerville, Ma. 02832. oan M, D'Ambrosi l t I License or registration valid for individul use only \ ✓!ze Uom���za�uu } before the expiration date, Board of Building Regulations and Standards Board ofBuild'nffound iefuio to: • I .HOME IMPROVEMENT CO, t g Regulation found and Standards One Ashburton Place Rm 1301 Registratron,;110124 i Boston,Ma.02108 Expiration_10/6%200a Type DBA� Y NKEE BUILDERS , • HOMAS TURCKETTA .: T r- -Not valid without signature — 65 RED TOP RD BREWSTER. MA 02631 Deputy.4dm+eistrator r 7 -- -- ✓ '.p... .. t. !Board of Building-Regulations and Standards f � Construction Supervisor License E License: CS 29893 B+rthdate8/2/1955 #s+ Exp ration 8/2/2009 Tr# 872az- ? f THOMAS L TURCKETtiTA�r+ t„ x 65.RED TOP RD BREWSTER,MA 02631 Commissioner f vjq tjV rL P Town of Barnstable *Permit# 60 7a L4(p. F.Vi~es 6nonMshom Inue dam Regulatory Services Fee � U Thomas F.Geiler,Director I X-PP EE.SS PERMIT Builcfng Division MAR 2 6 2007 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.townbamstable.ma.us - Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Bed X Press Imprint Map/parcel Number 2-0 Property Address. 'Y,3 12 c,4 A, Residential Value of Work %3Z r Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address A. Contractor's Name V Qesc—o 1l a Le—.; Telephone Number 9 /5-/(. Home Improvement Contractor License#(if applicable) f 2 Y-7 9 3 Construction Supervisor's License#(if applicable) ❑WoAmun's Compensation Insurance Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensatign Insurance Insurance Company Name 1�"\�5 - Workman's Comp.Policy# l Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - ❑ Re-roof(stripping old shingles) All construction debris will be taken to []Re roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Valued t{' (maximum.44) 4awRg *where required: Issuance of this permit does not exempt compliance with other town departrnent regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Impro ement Contractors License is required. SIGNATURE: Ila 3&le Zcrz-7- Q:Fonns:expmtrg Revise071405 The Commonwealth ofMassachusetts 67 Department oflndust"Accidents Office of Invesdgadons 600 Washington Street Boston, MA 02111 www•mas&gov/dda u,p Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizatioMndividual): Address: City/State/Zip. 4Lad..0 Phone#: :,�C7Sti F[No n employer? Check the*appropriate box:- a employer with . 4. [] I am a general contractor and I Type of project(required): oyees(full and/or part-time).* have'hired the sub-contractors 6. ❑ New construction a sole proprietor or partner_ listed on the attached sheet t 7. ❑ Remodeling nd have no employeesThese sub-contractors have8. ❑Demolition ng for me in any capacity. workers'coVV.insurance, orkers' comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.) officers have exercised their 10.0 Electrical repairs or additions 3.01 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself[No workers'comp, C. 152,110),and we have no insurance required.]t employees. [No workers' 12.[]Roof repairs . comp.insurance required.) 13 OtherOeUTf 0�Y applicant trat chedM box#1 must also fill out tie section below showing t Homeowners who submit this affidavit mdi Heir woticaa'compensation policy information: rating City are doing all work and teen hire outside ooatractors must aabmit a new affidavit indicating such, trst check tusbox must attached an additional sheet showing tie name of tie subcontractors and their workers 'comp.policy iafotmahoa I a�x an employer that Isproviding workers'compensation Insurance for my employees Below is thepolicy andjob site fnfo►matlon. Insurance Company Name: #: � � O'er Expiration Date: t z ) lob Site Address: G , -� tatez Attach a copy of the workers'compensation policy declaration page( owi sh ��/5ng the policy� ����� 'cC�r p g number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 15.2 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 >f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification, do hereby cerY nder the pains and penalties of perjury that the information provided above is true and corre a ature: Date one 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/Tois,n Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: lntormation anct instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Ponsaant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged'in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the -owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for die 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 tie 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(LLQ 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 Indastdal Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' conq nsation policy,please call the Department at the number listed below Self-insured companies should enter their self-insurance license number on the appropriate line. My or Town OMelals - 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' hcathng ent policy information(if necessary)and under"Job Site Address"the applicant should write"all locati in (city or town)."A copy of the affidavit that has been officially stamped or marked by the cityor 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: h` The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington.Street Boston;,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE evised 5-26-OS Fax #617-727-7749 ' www.mass.gov/dia 318 VASCO NUNEZ CARPENTRY 79 Mayfair Rd: SOUTH DENNIS, MA 02660 . MA Lic. #069680 H.I.C. #124793 (866) 398-1511 • Toll Free (508) 398-1511 Dennis, MA PHONE GATE TO: Mrs. Robert Dambrosia 508:=778 `2698 2/28/2007 43 Bacon Lane JOB NAME i LOCATION Centerville MA 02632 Sun Room Harvey windows JOB.NUMBER :.. JOB PHONE . c r+ . 2698 ,. _ SAME We hereby submit specifications and estimates for: - ..1. Remove seven wooden Andersen gliding windows, ( _circa1940' ) , and replace/install with seven H.ar.ve_y,.Industry r:epj:acement':style.."Classic": all vinyl .double hung windows in same locations...:East side will have two sets of mullion windows, ( :two windows put together ) , west side-will have three single windows,, and the south side will have two sets of mullion windows.'_ .. * New 'HdYVe'y windows will have white vinyl exterior with white vinyl interior, white sash locks, and a 6/1 'grille pattern with grilles applied to the- exterior and between the glass. New windows, will have.Low-E argon gas filled insulated glass, and tilt wash ability. 2. Remove any storm/screen windows, and NOT to by applied.again. Supply interior/exterior trim where needed. .° Take old window' to to;.1n landfill. 5. Make arrangement for delivery of, new Harvey 'windows. 6. Supply town of Barnstable building permii r This proposal does not "include any painting, staining -or repairs not described above. "* All Harvey Industry products described' above will be prepaid by home owner. 31Z+4 If your home is in a historical area, please see attached'lettei . 'fir t'^rti`STc „ `Q: , ** If this proposal is satisfactory, please sign -the YELLOW copy and 'return with payment- schedule. ** Please make a check payable to Vasco. Nunez Carpentry-in the. amount of ..$3721.87 for your re:. Harvey Industry windows described above, and please include this check':..with' your signed oroposal. Allow 3 weeks for delivery. We Propose hereby to fumish material and labor—complete in accordance with the above specifications,for the sum of: Four Thousand Nine Hundred Thirty One and 87/10& Dollars dollars($ 4: 531,. 3-7 ). Payment to be made as follows: Labor: 50% Down payment to start 'at time oz ,start. . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .$ 605.00 Labor: 505 Upon completion at time of completion. . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . ...$ 605.0 To al Labor Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1210.00 All material is guaranteed to be as specified.All work to be completed in a professional _ f manner according to standard practices.Any alteration or deviation from above specifications _ Authorized involving extra costs will be executed only upon written orders,and will become an extra . SignatureJ. f ZG charge over and above the estimate.All agreements contingent,upon strikes,accidents or nt' !; delays beyond our control.Owner to carry fire.tornado,and other necessary insurance.Our ' Note:This propo al may be , workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 30 days. Acceptance Of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as na Si specified.Payment.will be made as outlined above. g Signature; Bate of Accept: G , . PRODUCT 13128M USE WITH 771 ENVELOPE NEBS To Reorder.1-800-225-6380 or www.nebs.com PRINTED IN u.s.n. `.B Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 124793 Expfrdtion: 8/25/2007 4 Type: Individual I Vasco E. Nunez,III Vasco Nunez,III 79 Mayfair Rd. S.Dennis,MA 02660 Administrator �f "&106011691W. 0 6&WNT lei License: CONSTRUCTION SUPERVISOR ' Number -CS 069680 ; i Birthdate 10/03/:1948 Expires 10/0312 Tr,no: 2714.0 Restrtcteii f VASCQ E NUNEZ III 79 MAYFAIR S DENNIS, MA 02660 .` J. Commissioner r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map cA07 Parcel r T. , r�,g�E Permit# Health Division SW' �r 23—y2Z�p— icy Date Issued Conservation Division Cf1 Application Fee Tax Collector --4LZ Permit Fee -r B Treasurer g.�.. fd SEM SYSTW MUST BE WSTALLM W COMPMNCtE Planning Dept. YM TM$ Date Definitive Plan Approved by Planning Board WVROAI.CODE ANL TOWN REGULA MNS Historic-OKH Preservation/Hyannis 0 2 O Project Street Address Village Owner r �l ���✓ Gjl.2jB�o�%� Address Telephone Permit Request 6ulsru BOL A, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District d Flood Plain Groundwater Overlay Project Valuation --id`�'� — Construction Type Lot Size 1-7s"o6 Grandfathered: 0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes No On Old King's Highway: ❑Yes No Basement Type: ❑Full ❑Crawl ❑Walkout 90ther �a �4s> iiek r- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new d Half: existing new Number of Bedrooms: existing new D Total Room Count(not including baths):existing new O First Floor Room Count 3 Heat Type and Fuel: ❑Gas it ❑Electric ❑Other Central Air: ❑Yes *No Fireplaces: Existing C9 New Existing wood/coal stove: ❑Yes ,<No Detached garage:Aexisting ❑new size Pool:Cl existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded 0 Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use �/,,,BUILDER INFORMATION ,1 Name / /�� �'� 2 ✓ Telephone Number Address S2 �# ��/�/�� License# 0'7-3 5(� / Home Improvement Contractor# 1.�a9 GYP �oj?Il)- Worker's Compensation# (36?— ��- ALL CONSTRUCTION EBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY PERMJT:NO. DATE ISSUED ' MAP/PARCEL NO. ' - ADDRESS~ VILLAGE OWNER- DATE OF INSPECTION: FOUNDATION FRAME y INSULATION 1 FIREPLACE ` ELECTRICAL: ROUGH FINAL- PLUMBING: ROIT FINAL GAS: ROU(g FINAL _ z � • FINAL BUILDING x < f L✓ / ' DATE CLOSED OUT €r- ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office efiarestigatioas 600 Washington Street Boston,Mass. 02111 3" Workers' Com ,en�ation Insurance Affidavit name: location �� ��dil/ �✓'� city 0,WrU ✓/LLB phone# lJ 77$•,�:a679. ❑ I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one worldz in any capacity %/%���/%%% %%%//------ an e 1 I er_ rovidin workers' compensation for my employees working on this job.:}::::::;.}:.}:.>;;:.:.}:.?::::.}:.?:t.}:;t.:::??:<::.:.}:.:•.?}:t.:},:.}:;;;.???:t.:am mp oy P g...........................:..�:::::::.:.::....:...:::::.::::..::::::::::.:::.:.......:.:..::::::.�::.�:::.}:t.}:;.;::.::.:::::::.::.................:..........................:..?...?.......:...:..:.::: :...:...:...:.:......:.. >`ililr a e% 'i•":•:f'`• i':`i':is?i%::'•<iii; isi' <it':'+:' ?%`':%i% 3><a'%i %. .{:.r,};;ti<:%`%• 1 } `_'•;;':;.:%�:`:'';`; ?;:: �tSUlT:ahc . I.am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who efollowin workers co ensation ofices:.....................:..:.:::.::.::::.:::::::::.::::::r.:::::•::::::.:,::•::._::::,.?.:::.:::::.:::::::::.:.::::::;;:;:..:::::.:::::::.;•{::::.i n:;;:.:�:°._;:.,?.. 'tO1t2D w n .......:........ 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Qli :................ Failure to secure coverage as required under Section 25A bf MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification Tdohereby°certifyunder a ns dpena&i0�0 fury t e-information-pr-anded-above_islrim-arid_corsect _ ... ` Date — 'Signature Mr,I ,. r Print name' Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# CIBuilding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; _❑Other (devised 9/95 P7eu Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is.defined as every person in the service of another under any ooubract of hire, express or implied, oral or written. associatio corporation or other le al entity or any two or more of An employer is defined as an individual, Partnership, n, rp 8_ � ..� the foregoing engaged in a joint enterprise, and including the.legal representatives of a deceased employer,'orthe receiver or trustee of an individual,partnership, association or other legal entity, employing employees., However the owner.of a .. . dwellin house having not more than three apartments and who resides therein, or the occupant of the dwelling house of g • another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or buildingappurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal ' ant who has ' o operate a business or to construct buildings m the commonwealth for any applicant . e or permit t of a licens p . P not produced acceptable evidence of compliance with the insurance 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 chapter have been presented to the contracting authority. ------------ Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all 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 forthe,permit or license is being requested, not the Depaitment.:of Industrial Accidents. Should you have any questions regarding the"law of if-you are required,to obtain a workers compensation policy,please ca11`tlie Depaitinent at the number" below:. City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom"or& affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please—Asir . be sure to fill in the.pernutthcense number which willbe used as a reference number..The affidavits mayie'retxuned t� aiigements have been'ma e'. y.. the Departmentby,mail:o FAX unless other arr The Office of Investigations would like to thank you in advance.,for you cooperation and should you have anyguestions, . Please do not hesitate to give us a'call. w' /////O��-/�/%/O////���% The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of inves"gauans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727 n7749 ` : phone #: (617) 727-4900 ext. 406, 409 or 375 09J18l02 061sepm P. 001 344 Yarmouth Road 259 Queen Anne Road Hyannis,MA 02601 Harwich,MA 02645 508-771-5007 508430-2800 Fax 508-771-7070. COAL Fax 508-430-1115 Toll Free 1 (800)368-SHED Q11A ormnnwooDnRoaurrs www.pineharbor.com (7433) pineharbor@capecod.net Bob D'Ambrosia 43 Bacon Lane CentervMe,MA 02632 508-778-2698 PROPOSAL TO CONSTRUCT IVX12' ADDITION TO AN EXISTING GARAGE • ✓ 4 SONO TUBE FOOTINGS STRIP EXISTING SIDING SHINGLES FROM WALL • ATTACH NEW WOOD FLOOR TO EXISTING.PRESSURE TREATED JOISTS.CDX PLYWOOD • POST&BEAM FRAME SYSTEM[ • 28" REAR OVERHANG FOR STORAGE(OPEN BACK) • ATTACH NEW ROOF TO OLD ROOF& REFLASH UNDER EXISTING ROOF LINE.ROOF PITCH TO MATCH EXISTING • ✓.4'BEAD BOARD DOUBLE DOOR ON GABLE END FACING OUT • ✓RED CEDAR ROOF SHINGLES WITH COPPER STEP FLASHING • ✓(I)LARGE-6-LITE SASH ON FRONT WALL CROWN MOLDING ON GABLE END& SOFFET TO MATCH EXISTING TRIM • 4 LIU SASH IN GABLE END OVER DOORS OR TRANSOM WINDOW • ✓ALL PRIMED TRIM TO BE USED • RED CEDAR SHINGLE SIDING ON FRONT& LEFT GABLE • RESIDE EXISTING GABLE END WITH RED CEDAR SHINGLES • POST HEIGHT TO BE DETERMINER BY EXISTING WALL HEIGHTS • ALL LABOR&MATERIALS TO COMPLETION • ✓CLEAN UP OF ALL DEBRIS WE PROPOSE HEREBY TO FURNISH MATERIALS&LABOR COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF: TOTAL JOB O $5,270 (FI� U D TWO HUNDRED SEVENTY) SIGNATURE: ALI.MATERIAL IS OU D TO . AS SPECIFIE .ALL ORK TO BE COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER ACCORDING TO THE SPECIFICATIO SUBMPrrED,PER STANDARD PRACTICES.ANY ALTERATION OR DEVIATION FROM ABOVE SPECLFICATTONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME.AN EXTRA CHARGE OVER AND ABOVE.THE HSTIMACE.ALL AGREEMENTS CONTINOENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE TORNADO&OTHER NECEbSARY INSURANCE+.OUR WORKERS ARE kULLY COVERED BY WORKMEN'S COMPENSATION INSURANCE. ACCEPTANCE OF PROPOSAL:THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENTS WILL BE MADE AS OUTLINED ABOVE. SIGNATURE: SIGNATURE: r The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with.certain exceptions,along with other requirements. .� Type of Work: Estimated Cost ��� ' Address of Work: 114-3 .r/ Owner's Name: end . ` Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded bylaw ❑Job Under$1,000 Znerilding not owner-occupied pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR q:forms:Affidav :rev-122001 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /Ol Please Print DATE: JOB LOCATION: fit� f—I1wc number street village / "HOMEOWNER": �7��> 'I ...�v Gi�c�a/� ®0 name home phone# work phone# CURRENT MAILING ADDRESS: �k�'T�sL�/GC8 I1 A- ,(3 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 undersi ed"homeowner"certifies that he/she understands the Town of Barnstable Building Deparlmem inspection r edures and requirements and that he/she will comply with said procede�mm: equire� - Signature ol 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 fonn currently used by several towns, You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN - / try .. t .. _ 3' ! Y `-.,C \'l• �. 1 ��r Y' •a. WhVr �Y P�hefarbor.PoSh edr - r - - r 6 _ Pine Harbor Wood, roducts 1s family owned and operated =° with over'25=year`s of experience in.the construction of quality rPost &Behm-sheds.and structures t We stand l O % behind our workmanship -'Oursheds are Handcrafted piece`by piece' , _� here oti Cape Cod and:built on yourproperty lNo Prefab! r ... " Our Post&Beam shedsliprovide a charming focal;pomt.on § . � i� your property. Ot;r different desrgns'allowayou tomatcl`your _ , home architecture andrehoose a stylethat-will reflect yourr. :personal styl - e 1`; ., >r _ t • _ .. ry . ti - ' utmost' ThePine Harb i Post & Beam difference.includes qual'' craftsmanship t where the T importance. )k .use full-dunensional"sawmilled,pine"in-our framing and,siding,-providing you with-an extremely durable"" ' structure with rugg 'd'.good looks No stick.framing hereL When you'place:an order,wi-th-us, you.,are scheduled_ �imrned'iatelq and givers an installation date That is t ate,your .! she will-be built; that is our commitment-to ou Weather permittirig.6f couese! :.� Y tTo ensure that you receiVe'tlie most professionallyy built Post & Beam shed possible, our own-Pme Harbor certified installers are extensively trained in our Post&Beam mstallatron"system=to ensure quality and consistency e. cy Atxhis time we`at Pine.Harbor°would`like to thank you fo_rconsidering us°in youri search for a shed Please feel free to call us anytime with your questions or thoughts, -Ask a-neighbor or a-friend arid chances.are, they-have a Pine Harbor 4x Y Post Beam shed ..` a, k - _ Standard Post &.Beam-Sheds�Come With �;T • %"plywood floor.CDX exterior grade , •Post and Beam`•frame- 1 r Board and Batten siding r `¢ *6'5"inside wall�height , . • 36" standard door,40" ramp'included • Heavy Vk Duty:hasp -v� 4 # w" • Stationary_windows'with floerboai and*shutter •`Handmade oak!handle t t • 8"-x 12" o:l uvers for ventilation _ •t25 yr Asphaltshingles p9 oor,frimifig. Solid concrete-blockk t • , (2'�x 8',on 12'deep sheds y _ �r; `-Our Post& ea ' sheds are.bu><lt'oii`yourypr'operty.- " J Common"Uses For. T>: Helpf {. r, hits " ToSt & Beam Sheds •Shed site prep is important Grade of land can be deceiving , arden Tools,and Supplies ;:Patio Furniture A1eve1 site evil]look better,be more '• * ' t , funeUonal and provide easy access!' -.� Garden Tractors ✓Bikes and Toys r 3^ ry l Mowers " x Grills StaitilSeal within 30 days to preserve�--� E ,z . l �Playhouses� Pool Supplies .. ,- the tifetinie.'of sped •Bunkhouses Motorcycles fk •When choosing a size„we'strongly Studios Snowblower 1 , :recomttiend-ordenng one:size larger _ Outdoor Furniture anit much more•...` t than',you think you need:You always_'; _ } ' ,Protect'Your:Tnyestments __ � need storage space."Do-it once-do it.right! � 17 IN"gle Color Ch4t: 25 yr.3-tab Certainteed asphaltshingles.,Standard'choices below'. Colors are:not exact.Other upgraded options available:.�a j Chestnut-Brown _.Slate Blende } FroASlende - Snow White Black Blende Weatheredwood ;�1Vloire Black :Wood Blende ' ` •' �,� 'fir : 'sip e-x 'tr - ,,, r. ` r -y W`r5^•t13 '� :.n a - • St Mart Shed De 49 , . 7 Our mostpopular design; a classic peaked a ;roof with`.2.pit& is perfect for`shelV:rig �" and hanging space on walls-while keeping; , E -floor spaceat a maximum'..Traditional and No f functional. r . r ' Y � I �rp 0 �K. tir size Prieih , 3 "6x8 x - 1 $960:00_ • lOvl0 $16,80:00 .' �� f, 11 6x10 $1080 00� 1Ox12 ..1. . .$1750:00 ' ` l *` 1 .8x8 $10.40.00 10x14 r $217000 ' r r J _71 � p l;> 8xI0,.7-. $150,0.00 1OX16 $2440:00 3q ---� k ' 12. $2200.00 y �w. 8x14. $165060, "r 12x14. . .'. $2620.00 <, 12v16 _ f$2980.00 Price is•subject:to change w,th6ut notice.,-Pace.does not include 5%sales tax. a • You will love the cute look of these sheds b f` Our-traditional rt=front,ro6f keeps'the sho profile,-of the building smaller an3 cuter; Loft ' d 'is.not av4ilable one this model _ Lj : r rr- Size Odel $880.00 8x14: $1550:00 ` e - 6x0 -_a y '-$1040 00 1Ox10 r $1580.00 Y 8x8. ,'$980 00 1Ox12. . . . . . . . . ... $1650.00 t a- 8x10. . . $1210.06 1Oxl4. . , $1970.00 • _n.%d 8x12 . : x: $1410.00 1Ox16. . . 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