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HomeMy WebLinkAbout0004 BEE LANE f .. - C s E s _ i Town of Barnstable Building i F°' ... '' Y� ': ��,. fi�� � .,. Y ,�, .,.' e l �`. �.,..P•�P""� �.•<5 .. ..�" � ,� 'i�i ���' ,.a. 'r' � µ � 4P+, «: aPost This CardSo That it.is,Visible°-From•the Street :�Approued�Plans-,Must bemRetamed,on J.ob,andthis Card�Must be�KeptF �� •„ :« SARNlFI'A83:IL. . ` .��=:::; �� .��,�, w ''�/,�, � :, �=�.� �F� f ? ��. �� � �;,"`� � �- ,:�Sy`� ,� �• '''� t �` �� '"s a � Mn�. � . Posted�UntilnFinal�lnspeciio'nHas Been�Made �.,, ;• ��,,, � � � �� � � ,� �� �" Where a Certificate of Occu anc ,:is,Re u�red°sudh Build�n shalllNot,'be Occu �ed�until ayF�nal, Ins eetion has'been made Pei jljlt Permit No. B-18-1453 Applicant Name: CAPE COD INSULATION, INC Approvals Date Issued: 06/05/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/05/2018 Foundation: Location: 4 BEE LANE,CENTERVILLE Map/Lot 248 019 Zoning District: RB Sheathing: Owner on Record: PLIFKA,TERRI Ly Contractor Name ' CAPE COD INSULATION, INC r Framing: 1 a &= Address: 4 BEE LN Contractor Licerise.,153567 CENTERVILLE, MA 02632 „'.. .. ,g . Est Project Cost: $3,500.00 Chimney: a u� R - Description: weatherization v Permit Fee: $85.00 - Insulation: Project.Review Req: 41 Fe'e Paid $85.00 g Date - 6/5/2018 Final: uY Plumbing/Gas Rough Plumbing: w Buildin Official g Final Plumbing: M Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sa rnontOaft&issuance. g v� All work authorized by this permit shall conform to the approved application andythe approved construction documents for'Mk,h this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zomrig by laws aril 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 work until the completion of the same. t , Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures bythe Building and Fire Officials are provided on-this permit. Minimum of Five Call Inspections Required for All Construction Work:,�`rp- z ,,r 1.Foundation or Footing Rough: 2.Sheathing Inspection Final 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: - 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION GJV• Map Parcel BUI+ fiiG-DE Application # . _�I 1y5 PT c Health Division Date Issued Conservation Division MAY 10 2018 Application Fee Planning Dept. T'OVYN Ut NS,_1 SL ` Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4lxJ Village Owner 5!;�,2>Z i ELI 'o-e'i9 Address Telephones /� Permit Request 0/,e-IJ 2V l ,s P f P ,2 E 921 Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation,&S-®< Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .4d-" Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes Uk o On Old King's Highway: ❑Yes A-No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: C Co Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ _® Commercial ❑Yes ❑ No If yes, site plan review# o Current Use Proposed Use c:n o 0 ca Vn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address , �Q °�Dir� ��/� License# /®® U Z& Home Improvement Contractor# Email Worker's Compensation # 4) LZ 4<6 -�/, D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Jam/ .( //cp FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT k; ASSOCIATION PLAN NO. Docu&6n Envelope ID:19AF8021-C8CA-4824-8797-FC01E8967C99 DE THE To Town of Barnstable Regulatory Services BARNSTABLE, Richard V. Scali,Director MASS. o p 9� 1639. ,,0� Building Division ArEo M A't a Paul Roma 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, TERRI PLIFKA , as Owner of the subject property hereby authorize CAPE COD insulation to act on my behalf, in all matters relative to work authorized by this building permit application for: 4 Bee Lane Centerville, MA 02632 (Address of Job) DocuSi9ned by: . . - . . fi P�f 5/7/2018 1 8:02 PM EDT E4FCO64E1A044;q. Signature of Owner Date Terri Pl i fka Print Name If Property.Owner is Applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/M/17 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dla Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTIM AUTHORITY. Atmllcanj Information ` ; Please Print Leeib�jy Name (Business/OrgmlzatiorAndivldual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 phone#: 508-775-1214 Are you an employer?Check the appropriate box; Type of project(required); l Q l am s employer with 48 employees Mll and/or parwime),• 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me In $, ❑ Remodeling any capacity,(No workers'oomp,Insurance required,) 3,C11 am a homeowner doing all work myself-[No workers'comp.Insurance required,)t 9, ❑ Demolition 4,01 am a homeowner and will be hiring contractors to conduct all work on my property, 1 will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11 Electrical repairs or additions proprietors with no employees, 12.❑Plumbing repairs or additions 5,C]I am a general contractor and I have hired the sub•contracton listed on the attached shoot. These sub-contraotors have employees and have workers'comp,insurance,= 13.[]Roof repairs 6.C]We are a corporation and its officers have exercised that/right of exempdon per MOL o, 14, Other Weatherization 152,11(4),and we have no employees, [No workers'comp.Insurance required.) Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit eds7VIdavit indicating they are doing all work end then hire outside contractors must submit a new affidavit indicating suoh. tContmotors that check this box must attached an additional sheet showing the name bf 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, lam an employer that is providing workers'compensation Insurance for my employees, Below Is the policy and Job site Information. Insurance Company. Name: Atlantic Charter Policy#or Self Ins.Lio,#; WCE00431902 Expiration Date- 06/30/2018 _ Job Site Address; g� Og�_ ._ L,ri Ile City/State/Zip:_/li/�/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MOL c, 152, §25A is a criminal violation punishable by 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$250.00 a day against the violator, A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifioatlon, 1 do hereby cer un r ;e ains and penalties of perjury that the information provided above is true and correct: peY�1w,_�yy try • ' fw■�iirlil�li,r,jj,rwlwYy w,.wwwYwM..Y+,,•N -Date: f'e, r 508- 5-12 4 , Offfctal use only, Do not write in this area, to be completed by city or town official, City or To Permit/License# Issuing Authority(circle one); 1.Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector S► Plumbing Inspector 6,Other Contact Persont Phone#t S � • a 6 ° . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma� usetts 02116 Home Improveme .e tractor Registration Type; Corporatlon x z Regf6ifAtbn; 153567 Cape Cod Insulation, Inc h `° Expiration; 12/14/2018 18 Reardon Circle So, Yarmouth, MA 02664 _ a SCA 1 0 20M•05I11 Update Address and return card, Mark reason for change, C3-Acidzm �_.l'"!.L? ctne:.�l_��t ,oloyment. l. nat.r,<?x�+ .. �s (p691L17L00flUBa�CL a��crooacl tco¢tld• Office of ConsumerAffelrs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Tv e; Corporation before the expiration date, If foun urn to; <- 4il'. .6is.tratlon Ex (ration Office of Consumer Affairs and sl ss Regulation lop �' .' � 12/14/2018 10 Park Plaza• e 8170 Boston,MA 11 Cape Cod Insu Henry Cassldy : � 18 Reardon Circe %Ii` .2,•C�$'\ So,Yarmouth,M � • •�> Under-secreta ry t al hout sl atyy '•1 1 ` I Commonwealth of Massachusetts Division of Professlon'al Llcensure -Board of Building Regulations and Standards Cons Cfiibt��tip�rvlsor Y • : CS-100988 • ,�1 1 s:• ,fy' HENRY E 04 IDY' 8 SHED ROWis WEST YARMO�,TJ`�V1, i� � Commissioner ' i . , CAPECOD-27 KDOYLE A Da DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE E04/03/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER C N ACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No,Ext: ac,No:(877)816-2156 South Dennis,MA 02660 -MAIL ,mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:SafetyIndemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERD:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBERffL (MMIDDM-YYILIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F 1 OCCUR BKW53328281 04/0112018 04/01/2019 DAMAGE TO RENTED 100,000 ESfEaMED EXP(Any one arson 5,000 PERSONAL&ADVINJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY j�T LOC PRODUCTS-COMP/OPAGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 $ ANY AUTO 6232707 04/01/2018 04/01/2019 BODILY INJURY Per person) $ OWNED SCHEDULED1,000,000 AUTOS ONLY X AUTOS IRE � py�/�.�Ep BODILY INJURY Per accident X AUTOS ONLY X AUTOS ONLY P eOPE"%nr. t AMAGE C UMBRELLA LIAB X OCCUR EACH OCCURRENCE 200001000 X EXCESS LIAB CLAIMS-MADE R/O EXCI 0006635002 04/01/2018 04/01/2019 AGGREGATE DED RETENTION$ Aggregate 2,000,000 D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N XA ER ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431903 06/30/2017 0613012018 1,000,000 �ulanFFICER/MEM ffREXCLUDED? ❑N NIA E.L.EACH ACCIDENT 1,000,000 dstory In NH) E.L.DISEASE-EA EMPLOYEE If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C_� , 7 ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OW ASTABLE N S.U L A T I ON` � PM 2, • PIRR GLASS, HAM LOSS SPRAYFOAM SUSPIN OIp R ATTS OUTTIAS INSULATION CIILINOS 1-800-696-661";`ViS a Town`of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: . Dear.Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI) inspector.All work preformed meet's or,exceeds.Federal & State Requirements. Property Owner. . Property Address Village Insulation Installed: Fiberglass Cellulose R-Value " Restricted Unrestricted • Ceilings ( ) (X)' Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls.: 4N r'l (i. o r k F-Pe)ro.r,*t e1 pl 4,, A;,4 y Sincerely H ry E ssi r' President` pe. C Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0`� Application # 01 ,-071 Health Division Date Issued 1 1 3 I S Conservation Division Application F % _ Planning Dept. Permit Fee I I� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 'ell Village Owner Address Address Telephone rs"e ? a?Fy le�)//s' Permit Request ,977)c' jo'-Idolo a ZZez 22" Z/M� P 9_4k 2 Square'feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay $ - Project Valuation Construction Type 7�1®Al Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docum station. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House` ❑Yes ,&No On Old King's I ighway:,,0 Ye-)dNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: Cl existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name �' o�� f -� � ,, �0 Telephone Number 771-f_22—j `I_ Address Ze .off/ (Ta, License # /®,d 9 9' %/ V,e�elj zz�z Home Improvement Contractor# Email Worker's Compensation # k14 �1- 3 l Pe ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE AI-, FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. MassacIIUfsett .. l)i pattmc�nt.of P;r.tulic.SafetY• Board of Building,RLIgulations and Standards Construction suprr•sisor License: CS-100988 ' HENRY E CASSMY 8 SHED ROWa WEST YA.RMOUfiH3 , • /I -Fie? � `�.• ,G .�i.n�"` Expiration Commissioner 11/11/2015 # Office of Consumer Affairs and.Business Regulation 10 Park`Plaza Suite 51.70 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration:, 153567 Type:, private Corporation �n Expiration:." 12/15/2016 Tr# 259188 CAPE COD INSULATION,'INC HENRY CASSIDY _ 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card,Mark reason for change, SCA 1 r:5 20M•05/11 Ej Address Ej Renewal Employment -E] Lost Card - - �8 0477g7Z0�/ZCUBClG��6iC���CWJClC�IlJCC�1 Office of Consumer Affairs&Business Regutltion Lice rnse or registration valid for individul use only i OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: egistrationr -"T53567 Type: Office of Consumer Affairs and Business Regulation j xpiration: A 11+. /20:16 Private Corporation 10 Park Plaza-Suite 5170 a� Boston,MA 02116 ` CAPE COD INSULATION;INC n ' HENRY CASSIDY 18 REARDON CIRCLE SO, YARMOUTH, MA 02664_ g z" Undersecretary N valid wi ut sign e The Commonwealth of Massachusetts Department of Industrial Accidents. Office-of Investigations t i 600 Washington Street -� Boston, MA 02111 i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorAndividual); Address: City/State/Zip: 1& ��LWOAMKA,, OW ti Phone #: � Are you an employer? Check the-appropriate box:, Type of project(required); . - 1. I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or P art-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' comp, insurance.t 9. ❑ Building addition [No workers' comp. insurance p� required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing,all work 11.❑ Plumbing repairs or'additions myself. [No workers' comp. rigHt of exemption per MGL i 2.❑ Roof repairs insurance required.] t c, 152, §1(4), and we have no employees. [No workers' 13. Other U 0 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 Na' e: ' -' - Policy # or Self-ins, Lic, #: 0j 11; /, Expiration Date: Job Site Address: .01 City/State/Zip:._ 4.G- �y Attach a copy of the workers' compensation policyAecla ration.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 V-,500.00 and/or one-year ippr`isonment, 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 insuran,4 covera e verification. I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct. Si nature: Date: Z Phone#: Official use only. Do not write in this area,.to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plum 6. Other bing Inspector _ - . Contact Person: Phone#: -�� O CAPECOD-27 BDELAWRENCE ��. CERTIFICATE OF LIABILITY, INSURANCE (MMIDD/Yl'YY)INSURANCE 6/3012015 THIS CERTIFICATE IY ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS,UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)-must be endorsed, 1f SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency, Inc. PHONE FAX 434 Rte 134 A/c Exc A/c No): (877) 816.2156 South Dennis,MA 02660 EMAIL � ADDRESS: ,INSURER(S)AFFORDING COVERAGE NAIGN INSURER A I Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERB,ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation, Inc. INSURER ca 18 Reardon Circle INSURER o; South Yarmouth,MA 02664 INSURER E: INSURER F a COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY-THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED;OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE -POLICY NUMBER AUDLISUBR MMIDDY� MM/DD�YY - LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $. 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04101/2016 04/01/2016 DAMAGE TO NTE1 $ 100,000 PREMISES Ea occurrence) MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES'PER: GENERAL AGGREGATE. $ 2,000,000 X POLICY❑JECT ❑LOC PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON•OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Pere'E.RTYl $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WCE00431901 ,06/30/2015 06130/2016. E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - 0 SCRIPTION OF OPERATIONS,below - E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$'(AOORD 101,Additional Remarks Schedule,may be attached It more space Is required) Workers Compensation includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or.agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle .,ACCORDANCE WITH THE POLICY.PROVISIONS, . , South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • MW mass save pR 3 PERM IT:.AUTHORIZATION yFORM ; I, TERRY PLIFKA ,owner of.the property.located at: (Owner's Name,printed) k 4 Bee Ln CENTERVILLE (Property Street Address) (cltv) . hereby authorize the.Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owner's Signature Date FORrCSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractorto.the above referenced project; Participating Contractor D to O F • of 4 .. . For Office Use Only Rev.12132011 ; __ ._ Town of Barnstable FTHE T !ABLE Regulatory Services s Thomas F.Geiler,Director P MASS' 2 pQ Building Division 1e39. �m ATFo MA'1° Tom Perry,Building Commissioner D'VVS 0 200 Main Street, Hyannis,MA 02601 �S�O�r ��`� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# '4 4 2(p FEE: $ CC SHED REGISTRATION' 120 square feet or less L4 Bee- Lance Cen4e✓vir t Le, Location of shed(address) Village Property owner's name Telephone number Lvx j� �a 2-40 6 Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? n a Old King's Highway Historic District Commission jurisdiction? h D Conservation Commission(signature is required). PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q4bnns-shedreg , REV:121901 JIMIYUHI\U LLUL11U NOTE:not oll•symbols will appear on a map GOLF COURSE FAIRWAY r Y w EDGE OF DECIDUOUS?REES r--> •• 'z'" ^•^^^'�^^ EDGE OF BRUV ORCHARD OR NURSERY V—T—" EDGE OF CONIFEROUS TREES t MARSH AREA r———————— '.IUr . .. _ EDGE OF WATER > = DIRT ROAD DRIVEWAY PARKING LOT ��PAVED ROAD ------ DRAINAGE DITCH --_-_ PATH/TRAIL PARCEL LINE**. tanrno�--MAP# 21 PARCEL NUMBER #Ie60 HOUSE NUMBER 1 FOOT CONTOUR LINE --�— 10 FOOT CONTOUR LINE Elevation based on NGVD29 i�4.9 SPOT ELEVATION STONE WALL X X FENCE ® RETAINING WALL RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK M10 BUILDING/STRUCTURE F4F- DOCK/PIER. Q HYDRANT \ / 6 VALVE ® MANHOLE o POST p7 FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C I N• F O R M A T 1 O N S Y S T E M S U N I T a SIGN ® STORM DRAIN JE x PRINTED SCALE:INFEST- *NOTE:This mop Is an enlargement of a **NOTE:The parcel lines are only graphic representatio DATA SOURCES:Plunimehia(man-made features)werL interpreted from 1995 aerial photographs byI lames 1°=100'scale map and may NOT meet of property boundaries They are not true locations,and W.Sewall Company.Topography and vegetation were iom 1989 aerial photographs by GEOD UTILITY POLE TOWER " ° National Map Accuracy Staodards of this do not represent actual relationships to 0 10 20 p ry p ps physical objects Corporation. Planimetrics,topography,and vegetation d ro meet National Map Accuracy Standards : 1 INOI=20 FEET* enlarged scale. on the map. at a scale of 1°=100'.Parcel lines were digitized fromwn of Barnstable Assessors tax maps. 4 LIGHT POLE O ELECTRIC BOX -:F:\dgn\conservation.dgn 04/04/03 08:47:21 AM Town of Barnstable *Permit# Expires 6 months from k5pe date • Regulatory Services Fee * s ►sr�, ' xuss, g� Thomas F. Geller,Director �prFc ray'' Building D1VIS10n Tom Perry, Building Commissioner • 200 Main Street, Hyannis,MA 02601 PERMIT Office: 508-862-4038 Fax: 508 790-6230 EXPRESS pERMLT APPLICATION - RESIDENTIAL(§ '� 2 2004 Not Valid without Red%Presslmprint TOWN OF BARNSTABLE Map1Parc el Number $ Property Address Value of Work�'00 EZ Residential Owner's Name &Address y Bee, iAPe- Ce,,Je- V;t i e M A . Telephone Number $ `d 6 2 o.Sg� Contractor's Name rovement Contractor License 0(if applicable) Q —i Home imP P CDa ervisor,s License#(if applicable) a Construction Sup o CM 's Compensation Insurance []Workman Check one: o X (] I am a sole proprietor , z can I am the Homeowner _ [] I have Worker's Compensation Insurance m Cn Insurance Comp any Name Worlands Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to Going over existing layers of roof) []Re-roof(not stripping• g Re-side' (� Replacement Windows. U-Value maximum.44) *Where requited Tssuaace of tbzs permit does not exempt compliance with other town departraent regulations,i.e.Historic,Conservation,M. ***Note,, Property Owner must signPropertp Owner Letter of Permission. Home Improvemeat Contractors License is required. Signature p( TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 t� Permit# 4, Health Division y o j ��s ��`r� `�,_I, Date Issued 4 - 4 - 03 Conservation Division S> �� C�� Application Fee - dz Collector a �., �/ �3 Permit Fee Treasurer -- — ILII/� SEPTIC SYSTEM MUST BE N 3 INSTILLED IN COMPLIAN 11 Planning Dept. M TITLE 5 9 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AIdG TOMI RECUUTIONS Historic-OKH Preservation/Hyannis Project Street Address �I T ,& Lith Q Village o Owner WL61 Ptyck Address t -=� Telephone `7� ' 0�2✓� Permit Request N tc_e_k_rv5 k.►,-�L, co � rn Square feet: 1st floor: existing k2W proposed — 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6Qc7 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family(#units) Age of Existing Structure L Historic House: ❑Yes Flo On Old King's Highway: ❑Yes &No Basement Type: ❑ Full 9crawl ❑Walkout ❑Other PGfq J Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name tc �e� - . Telephone Number Address AIC. G�— _ License# V t Ch kw Home Improvement Contractor# 0 Z6 3=2 Worker's Compensation# v ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 dwrJ Q4 SIGNATURE �� DATE � 6 5 FOR OFFICIAL USE ONLY c PERMIT NO. DATE ISSUED MAP/PARCEL-NO.{ ADDRESS VILLAGE ; OWNER DATE OF INSPECTION:r. - �-- FOUNDATIONc�-1-► FRAME INSULATION _ FIREPLACE —, ELECTRICAL: ROUGH. FINAL- f i i > PLUMBING: ROUGH; _' ": FINAL GAS: ROUGH w ' FINAL . FINAL BUILDING .:� 0 C) i DATE CLOSED OUT'; '; ✓ �� ASSCt'li(ATION PLAN NO. ;. The Commonwealth of Massachusetts _ Department of Industrial Accidents Office o//nyestlyJA as - 600 Washington Street ` ' Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit a Jea name: location �+ 1 t w S 2 l N�1-CJ iTC�� phone city [ I am a homeowner performing all work myself. ' I am a sole proprietor and have no one working in any capacity Fill I am an employer providing workers' compensation for my employees working on this job 4 SS>L�"-'.'r;�rd<.�s*�i v�S}.,,.y,nZas.`c'•'r..c-�yiisl,�r''�''�-`'g..F,r''*y r,.Jr.�tr.�'x�-,�ux,':i".��, '' t 'ti i F-sf.q' Tt+ 7 t —A, 34 y om an name, 4 e t ;s 4 a r Kdi ant oval* y�—yqN r y{xS;.r VR rii S rzzl.n Ev9 ' 1 '`s `1 z 7 •u L r C"`L .;s�,a.'• v, L ,y,,�'C"!.f St ;ru,.:1*' `' "r3 `,_„! ' T"' : i {'l C7 Pt'r —"`rb �M �M��s�s,,��T>,. .""�,�.ti �, ae.`�'A�' `2'ar .e;.:.�r iaddre s ri p d/ �'�}Lri6 b i '�".,Y L I 4y, y,iri 1r}l t`+4 L „( 1 h 1 1 v �1-vd� �, '� t '1'f l i t-�-T f Lai~lE'D 46 L.,..y � J•Y ,,�.v,,t:• r-f,"�r''3 "`:-,�r^"' ,s,. s t t �'r �',�` '�✓..``,�.- gar 'f 3 isNi a t3.t fin. w� ry<ea cc qYs?'v fi ' f . ` }',f�i., t F cis 1'. U''[t1. l t l' t �i 7 - s Js -ir'+. s s 7t l wrr adS -g �s 'J.4 ` .�r+rwv' �"P�x�lr� �. X r d"", t g�:C r f QhOn.O#' ` S t `,`'t•t-4�1 ',.r ��.5y's� f? i A tt.F i L 1 l> v a.. 7ys _Ee}' 7'>•.itvr• r r f.+ ,7 :n„� Y .{ "("ai" � r `S- an.Y ,N ;.`r'ra`�� Y ansurhncdco .. �. [] I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices:NO x ry '4 r sstl"`'ae -y°` .r/ 7� +t r',�i..�'Y....e .� 'r3r17 t 4s't�y%Y "rvl '9' _ t,.' h k j.l 1>seti r� ` 15 .yam tee? r�r `r e"t a �r r s ti r„1.. "�. y:... Fir, ."',' v � ¢@r'h '1"'' 'k 4 �+' .Z k }'� [ `"'�' rs�l K r :r ,t dxv^hti'Yr°- r 1 ,he, -+:13'2S, v5$.''' i�, -t., ,v �+, �( +"'ze 1 .1 : °s t r 5- colas as name R A L b i" Nth r , S1 mII rfS L; � y5 7 r r t �� t i4 7 :a O vt-e ;r�' "ssGf+�cC�"` "p>awr'�'q v a„'t rt�_,"'t-rF' - �,r 'k t� 't 9y r�r f,t 6 �' t OR, t 4... t t 5✓` .,- .x 1. 4 x wr7^1:4r"'�fc'[5F'ret.�.r5. y 4° �•'F`ys'n7a.:at r'3, rp,+`T� t ..� ''>•y,° :. fro s�3�a r1 r 4.,. +t 1 r na a } y v :.tk tv �fiws s ,fit [ '.`c,:.. },�y yr+ '".yi rin'at spay 1: '`-C"i z� rid �.�p 13 it r.i•rr - E 110TI8 'r`+''� �! x '�y^"'r' F '+t . M '"[ s-: i s r ' 't CI A4 u F c h i y 1 S�,,may 9� ,?a. i? r Vt.� J +.Iiy br �. , ',�`eYe�i.�.,,ii"".£,l. +. Gdti; s��'`'`tyt.s:;..3 rc�vtx t .+'��.r�r„�..'i• °X �'[7�{v!��, -a.°�)�r;y 4���, .� '.��. :.Ly, .^� tl J l�ln 1' tt tiy�, '"x� ,;,.f .rri i sx .} r..,�b s l'+,ctya �;�Y�t'F 1 ty 7r •i r-t� i t:G�'�',41 `T�rv,� $i 1�,. �Y�`�''A`? d gljaT .ri il- !e k9�:'vfry L� y5� _i "`".�+,:,�5 �^�'°`s'�'[+�� �•✓3 r � '1'v��1 Y�,�w 4 '�. .5 it y 1 �. r r r .j fi 9' ..,t ,,,�...trrs. � F Y �" .ir.-1L a^^/'t' +, 1•N `. �'+d '( r tv. .'31.4 -�'rr i` Yflr jf.. COm an halnC �S�r f43r e r � v t t r rrr y� 3ys NUMis� �1r 7 :�,^ry t4 �r �T a Fh� 3 a �Y 1 n c a f s y s lr.�f Kjsra,S. bseWc� �-n `'f.Tt4 ad�rss. = �Pf vr�cJ s y t r F h 3y9 r x3 t? yMak T�v S FY �Ri�ny ��y .R-- dam.1 s .�.''itvi -�. a , Cat Y s x t».t 'r t .i-.i r r },c J #,'f .l7y.' �� 'yw ,�y3+'1` - LF" y t E!x al( J i S �r ; ¢Yt `'-'*` .dry ,•"� �,r h•r 1. x, '.y�i,: :.,,''�"1 ao- s+rvF� ,4 k , hone•# e -s .,4 - y��Sw`�,"d'St a,.*�z�`j�,.�.C-.�"x.F.w"4�•'���-+_ y� 34'ry,Ft3 dttv:r,+" t Cr?-.t ".w, q.'c' �i 'x y e t-.eS 7 Y�'`'i^"�' �,s� '+,aS�1s'i Failure to secure coverage as required under Section 25A of MGL 15Z 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 farm 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. I do hereby certify under the pains and a ties of per'u that the information provided above is true and correct. Date 0� Signature , l Print name Phone# 2d L d 7 S 3 official use only do not write in this area to be completed by city or town official city or town: permittlicense# (-1Building Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone�; (—lOther (revised 9195 PIA) 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 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 section 25 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,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. EM 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 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 IME?I Town of Barnstable °^ Regulatory Services " )LAMN ' nines Thomas F.Geller,Director 9`�plE16 p.�A�°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 - Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 3 ' 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: 0 - Estimated Cost Address of Work: Owner's Name: ( co Date of Application: toy' I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date wner's Name ti oFT►+E, Town of Barnstable i yPvi '�O� Regulatory Services + BnFMA$&LE, = Thomas F.Geiler,Director 4'pr16;9.,b`e Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder L , as Owner of the subject property. hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for(address of job) Signature of Owner Date Print Name 4 Uru � c l O17 G rcCz� l S4 �� �— M+1Hce�y wr�j — The Town of Barnstable v 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 EXEIYIPTION IPlease Print DATE: LA 10 - t JOB LOCATION: —I number ���J a street 2 village "HOMEOWNER": AIC4kAc' -G vc -n O'd`I�J� �O -Z--Z,056 F�K i. Ito name home phone# -work phone# CURRENT MAILING ADDRESS: �-1,f Pt N, _ 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. DEFINMON 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 B arnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re ' e pts. _ATgnature 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 perrnit 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 fomnlcertification for use in your community. -roo P1;,*C3PER1-v LANE J A^Y BVOT 13E tCCLJR^-rE STANDARDLEGEND NOTE:not all-symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES ..... • EDGE OF BRUSH ORCHALID OR NURSERY V-7-V-1 EDGE OF CONIFEROUS TREES MARSH AREA ...................................................: Z ` t EDGE OF WATER DIRT ROAD I _ I— DRIVEWAY I PARKING LOT I PAVED ROAD I� - — -- DRAINAGE DITCH 48 ————— PATH/TRAIL PARCEL LINE** MAP 110 MAP# 21 E PARCEL NUMBER #1860 HOUSE NUMBER 2 FOOT CONTOUR LINE s 10 FOOT CONTOUR LINE / Elevation based on NGVD29 ( 4 X4.9 SPOT ELEVATION STONE WALL -X X FENCE RETAINING WALL RAIL ROAD TRACK ------ STONE JETTY SWIMMING POOL PORCH/DECK 0 BUILDING/STRUCTURE DOCK/PIER HYDRANT 9 VALVE ® MANHOLE o POST 0F? FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T a SIGN ® STORM DRAIN x PRINTED SCALE:IN FEET *NOTE:This map is on enlargement of a **NOTE:The parcel lines are only graphic representation DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James o TOWER r W. 1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE " ` 0 10 20 National Map Accuracy Standards of this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=20 FEET* enlarged scale. on the map. at o scale of 1"=100'. Parcel lines were digitized from FY2003 Town of Barnstable Assessors tax maps.' :4 LIGHT POLE O ELECTRIC BOX F:\dgn\conservation.dgn 04/04/03 08:47:21 AM Assessor's map.and lot number .........:....`..1!9 G -6 L SEPTIC SYSTEM MUST E i T E tOi� O - 3 6 INSTALLED IN CO, a �♦"' Sewage Permit- number .............. ............. ....... ................ WITH TITLE 5 r House number 1.7..8 .���:. .... .....::........ MENTAL COD STABLE,51. Eld!llROld E r rasa . TOWN REGULATIONS °'"�owaY'a�0�' TOWN '` OF BARNSTABLE BUILDINGINSPECTOR ,yam, _ /� APPLICATION FOR PERMIT TO &42 1�1.&�'� � � ,!/...... ...... ........ .... ................................................ TYPE OF CONSTRUCTION ............... .... ........................................................................... ........... .........f.:..-......19.. '�— h TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r r J Location .... ...�r..nl.P..........�..�............. 'sl.�.e' .,Ll✓.../../Q.... .............................................. ProposedUse ............/..4.�. l .1/.. .F.../........... .�. .. ................................................ Zoning District ..j�.. ............ . .......... ................Fire District ..: .. . .....r.- [/ . ...... /`- Name of Owner Address —..... ..... ...... ........... P Nameof Builder ............... ................ ...... .. ..Address .................................................................................... Nameof Architect ...., � ....Address................................................ ...............................................................................,.... Number of Rooms .............................. ..............................Foundation ....... b..�l. .....L? .�.�'/�.P...` .. . .. Exterior ......... CGS........ 1..el.r,�'.................Roofing ............/�73.1...............4J.. /.. ,1 c® Floors ....................................................................Interior ............ .................... Heatin S ...................Plumbing COO/ .. � Fireplace .................... ....)1,z ..................................Approximate. Cost ................, �. !.................. Definitive Plan Approved by Planning Board ________________________________19________ . Area 50..1... .. ................... Diagram of Lot and Building 'with Dimensions ` L g 9 ��P /��/J/�''��� Fee .................... �J.................. SUBJECT TO APPROVAL OF BOARD OF HEALTH /}P V i 10 ll 33 12 T /,z,/A /01--, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnsto r a in the above construction. Name . ....... .... .... . . Construction Supervisor's License .................................... j No ..,28655 Permit for . ?.O1a..t0.......... r .single family dwell in 4 , .................. .q' .ee. . . : ... r Location L<)t.19......: .......... Centerville y .......................................................................... . . C Owner Falcoiz. re&.t..maneg ���t. ............. Type of Construction ....... rail ......................_........................................................ Plot ............................ Lot.................................. . n Permit Granted ....................... . +..'19 85 c € Date of Inspection ....:. 19 Date Completed ........ ..... ............ . 44 1z M ' t .�Sy AssessoIrl's map and lot number ......... THErO CS 'P- -��6ewage Permit number .............. ............... SARNSTAXE, House number /7 AF-Il'!!P.:AJ..,.*.... ..........I............ ..... ... 1639 0 mpk"'I TOWN OF BARNSTABLE . {,BJILDING INSPECTOR APPLICATION FOR PERMIT TO .............................................. .TYPE OF CONSTRUCTION ............... .....rR <�............................................................................ ........... ........I q.. TO THE INSPECTOR OF BUILDINGS:- The undersigned hereby applies for a permit according to the following information: Location ........ ............... . .. ............ Proposed Use ............ ........... ..... . .................................... ...............I......................... Zoning District ............I.f..1.114Z.....................................:......Fire District ...............r.......0....................................... -7— Name of Owner, oo7 S7. ..75;--Address,0 ... ...... ....... 17 1 Name of Builder ,,.o!r,_7Address .................................................................................... Nameof Architect ...............................................................:..Aciclress .................................................................................... z!5. ..... ..Number of Rooms .............................. ...............................Foundation ...... . .... !!51.0.,�V Exterior ........../ ...... Ix. . .....................Roofing ........... 7..... .J.4. Floors ............../f...................................................................Interior ............ ...fir.. j...................... Heating ...... ........... .........................Plumbing .................................................................................. Fireplace ........................ 4)...................................................Approximate Cost ........... ................... COO Definitive Plan'Approved by Planning Board --------------------------------19--------- Area ................. ..Diagram of Lot and ................. B*uilding with Dimensions Fee .0.7S SUBJECT TO APPROVAL OF BOARD OF HEALTH (rK10 - OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree'lo conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... %e A Construction Supervisor's License .................................... FALCON CREST MANAGEMENT A=248"19 No ... Permit for AddXtiQn...t.Q........... single family dwelling ........................................................ .. . . ..... Location Lot 19 strazt ............................................... Centerville ............................................................................... Falcon Qpq.5t. . Owner ................. ..geMea-t............. Type of Construction ......... ...................... ................................................................................ Plot ............................ Lot ................................ Permit Granted. ........................11/12......19 Date of Inspection .................................19 Date Completed ......................................19 Co [(I M "^ee Lc^ne- February 24,1982 lir,Walter White 387 Strawberry Hill Road Centerville,Wi 02632 Dear Mr.White: According to our records the existing dwellings on Bee Lane and Pine Street,Centerville were assessed in 1947,This,of course,was prior to zoning and therefore the dwellings are non-conforming. The Planning Board has accepted the "Approval Not Required"provision and I submit for your edification the enclosed copy taken from the Muni cipal Planning &Subidvisicxi Legislation,Chapter 41 -81L, I trust this will clear up the matter for your closing. Peace, JDD/gr Enc. Joseph D, DaLuz Building Canmissioner TOWN OF BARNSTABLE PLANNING BOARD 21 January 1982 Mr.Walter White 387 Strawberry Hill Rd. Centerville,Massachusetts 02632 Re:Bee Lane,Centerville Dear Mr.White: The plan in question has been reviewed by the Planning Board and was found to have the incorrect zoning district.On Monday, 18 January 1982 the Board voted to request the Engineer to make the correction from RB Zoning District to RD-1 Zoning District. The lots noted on the plan are believed to have pre-dated the zoning change. Structures as well are believed to pre-exist zoning. cc:E.Joslin Whitney Whitney &Bassett Box 462 W.Hyannisport,Ma 02672- ncer lary Anne Grafton-Rodgers Chair Barnstable Planning Board Barry M.Foss,Mortgage Officer January 8,198'i; Mr.Walter R.White 387 Strawberry Hill Road Centerville,Massachusetts 02632 Dear Mr.White: Subject to receipt of a new subdivision plan,our Committee met and agreed to release the rear building and lot from the present mortgage on the property at Pine Street and Bee Lane in Centerville,subject to either of the following conditions. 1) A principal payment of $5,000.00 and no change in .the current interest rate,or 2)No principal payment and the interest rate being increased to 14.00%. Also,the bank will need to receive a certificate stating that the remaing lot complies with zoning.Even though subdivision control law provides for an "approval not required",a variance is still required under zoning By-law. On receipt of the new subdivision plan,certificate of compliance and your choice of one of the above conditions,we will ask our attorney to complete the required partial release and advise you when it is available. Thank you for your cooperation. BMF/mh Sincerely yours. BarryTI.Fosb Mortgage Officer P.S.There will be a $35.00 drawing fee for the partial release. Yarmouth Port,Massachusetts 02675 Telephone 362-3242 /dcS/OAx^AAaiA/. Quicki-Note® To Bob Smith Town Counsel natfi lf4January 19 82 Subject White plan ?zo.dist. Mr.White was in needing a cettification that the Zoning was proper on this plan...27 Apr.81...signed by P.B.(Brown-clerk) Found that Bee Ln is in Cent according to Pet Maps in Engineering... Zoning Dist there is not as noted on the plan but RD-1 (20,000 s.f.) What do we do in this situation...houses were an existing non-conforming use...plan was only a perimiter but owned by 1 party.??? /v>q T/OrjAL. 47-231 Poly Display Pack (50 Sets) 47-232 Desk Dispenser (125 Sets) Made in U.S.A. From Cryt Mary Anne