HomeMy WebLinkAbout0094 BEECHWOOD ROAD ��: �E'c°G� t,e�DdG�¢ �/ 41,E �'
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Town of Barnstable
�t Regulatory Services
Richard V. Scali,Director AgUA
A MA
Building Division
�STABM _ g BAMSTABLE
MA�. OAANSiA9LE•C81fFAYRIF•COMT•NYANNI3
•, 9i� 39. • Thomas Perry, CBO "��;"�'°'F"""`""""'�
16 �� 1639-2014
QED"A0� Building Commissioner 575
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
March 24, 2015
Thomas Damelio
16 White Birch Way
W. Barnstable, Ma. 02668
RE: 94 Beechwood Rd., Centerville, Map: 252 Parcel: 037
Dear Mr: Damelio,
This letter is to inquire on the status of building permit application number 201401125
issued to remodel the above referenced property. As you may recall,this office.issued a
building permit on or about March i 2, 2014 and to date this office has no record of any
inspections. Please contact this office to arrange for inspection or provide an update as to' ,
the progress of the work. The application will be considered withdrawn without sufficient
cause provided to this office by April 7, 2014.Thank you for your anticipated cooperation
in this matter.
Respectfully,
L. La on
Local Inspector jeffrey.lauzon@town.bamstable.ma.us
(508) 862-4034
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ���� Parcel 0 / Application
Health Division Date Issued 3 l tzhY
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address
Village
Owner Address
Telephone
Permit Request 4AL,
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuatio Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting d6burntation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) °- r
Age of Existing Structure 5, 4 e,r. t Historic House: ❑Yes Jd No On Old King's"Highway: 0,Yes�0,❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other '
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing a2 new Half: existing newer
Number of Bedrooms: 3 existing d 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
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number
Address l� 4//� 42cR/ License # Z 51W
A)I-/ 4XiLOyIrlw 4�1_ 1 Home Improvement Contractor#
Email ee 4 P�W T1, o .2-f P 4,"4, 1,CsN, Worker's Compensation #
ALL CONSTRUCTION DEBRIS RES LTING FROM THIS PROJECT WILL BE TAKEN TO 4W11
SIGNATURE / DATE oZ /Z /l7
FOR OFFICIAL USE ONLY
t
APPLICATION# . --'-
DATE ISSUED
` MAP/PARCEL NO.
1
a ADDRESS VILLAGE
OWNER'
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
}
,y
}
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r.
t
Tate Pinwo9 pedth of Massachusettr
ffejwrhnwt rxf 17dus&id Acddents
Bice oflimlestigafions
690 Wmbiagtcm SVYeet
Boston,MA 02111
Y tov.mass.gm,1dia
Workers' Campensatiaithmur-ance idavit:Builders/Conti-actorsf0ecfricians/Nambers
Applicant Information Please Print Legibly
era cs�r6tiQnlrnd; an: ��
Ad&ess: 6 ��,,�le
City/StatctLp: OlGCghone47 ,r6t-4 ^O9t a-�
lire you an employer?Check the appropriate box: Type of project req uired)=
L El I am a employer with 4. I au sg contractor and I
6- ❑New construction.
employees(full andlorpart4ime).* �� have hiredthe sub-confractom
2_. I am a sole proprietor orpartnes- listed on the attached sheet; y- ❑Remodeling
ship and have no employees These sob-contractors have S. ❑Demolition
employees and have woricers'
wotising forme in any capa�T Q. ❑Build-mg addition
[No workers'comp.insurance comp.insuranml
. ] 5. ❑ Fire are a corporation and its 10.0 Electrical repairs or additions
reTa'r3.❑ I am a homeowner doing all work officers bz:m emexcised their 11-0 Plumbing repairs or additions
nrfset£LNo workers'conT- right of e--mmption per MGL 12_❑Roof repairs
insurance required.]I c_152,§1(4),and we have no
Other-
employees-[No Workers' 13_❑Other
comp.insurance required.1
*.5ayagptimatthatchecksbox#1mustalsofilloutthesectionbelowshowingtheirwockers'compensationpolic ini -
�Homeowners rho submit this affidavn ie rsunt they are doing an trade=4 dim hire outside contractors mast submit anew affidsrst induBtn sudL
=C.ont acmrs tbst check this boat mast attached as additional sheet sboxing the name of the m4-rocs and sbdP whadw ornot 1ho5a tubes have
mployeas. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an empki w that isptmlidi'ttg workers'rompensadon insurance for nzy employees. Below is tare paHey aed job site
2nfot wadum
Insurance Company Name:
Policy#or Self-iris.lac.4 ExpuationDate:
Job Site Address: Citvistatelzip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required.undea 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 imprlSflIIment,as well as civil penalties in.Ore form of a STOP WORK ORDER and a fine
of up tar$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of
Im-iestigations of the DIA ce coverage verffication_
I do hereby certify u ' s and pan es ofpedury that the info rraa67npratrztid abase fs has and.correct
Si tore: Date:
Phone#:
1OjEd- l arse only. Da not write in tIris area,to be campleted by city or town off ciaL
City or Town: PermitUcense#
Issuing Autharityt(circle one):
1.Board of Health 2.Budding Department 3.City lfown Clunk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone!#:
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract ofhire,
express or implied, oral or written."
An employer is dewed as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements.of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno 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 Indusirial
Accidents for confirmation of insrrranc�6 coverage.- Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be are 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/licease number which will be used as a reference number. In addition,an applicant
that must submit multiple permitJlicease applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address;telephone and fax number.
The Commnnwcalth of Massachusetts
Department of hiclustrial Accidents
Office of kvestigatiGm
600 Washington Street
Boston,MA 02111
TeL#617 727-4900 at406 or 1-9 MAS 'E
Revised 4-24-07 Fax#617-` 27- 49
www.mass-gov/dia
�TME Town of Barnstable
t Regulatory Services
MAM Richard v.ScaI4 Interim Director
' Building Division
Tom Perry,Building Commissioner
200 Main street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
_ Complete and Sign This Section
If ITsi_ri�A Builder
/ S S , as Owner of the subject ro
� l P Pert7
hereby authorize. Wr,4-4-
to act on my behalf,
in all matters relative to work authorized by this building permit
(Address of Job)
Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner tune o Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS 10113 .
1'Vn++ ..
Regulatory Services ....:
Richard V.Scab,Interim Director r r
Building Division
Tom Perry,Building Commissioner
Hyannis,MA 02601
iMAM.6M9� �' 260 Main Street
www.towni.barnstable.ma.us
'Fax: 508-790-623.0
Office: 508-862-4038 .
HOMEOWNER LICENSE EXE1Vi MON
Please Print
DATE:
village
JOB LOCATION: street
. number
work phone#
°HONMoWNER: home phone#
name
CURRENT NAILING ADDRESS:
zip code
city/town stateor exem tion for"home_�ers"was extended to include awn license,
ovaded thattheoownerra units
as sus ervisor..allow I
The current p
homeowners to engage an individual for hire who does not possess
ON OF HOMEOWNER
be,
or two-
and/or farm structures-
dwelling,
person who constructs more than one
owns a parcel of land on which he/she resides or intends�o reside,on which there is,or is intended to constructs
a one a form
Person(s)who P Official on
family dwelling, attached or detached structures accessory to such use Official
Section
in a two-year period shall not be considered a homeons ble for. rall sumch"homeowner"
k' erOrme �t d r to buildin
homecia that he/she shall be res o
acceptable to the Building Offi 1,
109.1.1 -
licable codes,
)
e undersi ed"homeowner'.'assumes responsibility for compliance with the state Building Code and other app
Th �
bylaws,rules and regulations. Department minimum inspection
The undersigned"homeowner" certifies that he/sheunderstands
comply
��aid procedures and equirementtss. P
procedures and requirements and that he/she will P
Signature of Homeowner '
f Building Off cial with the State Building Code
Approval o be aired to comply
Note: Three-familY dwellings containing 35,000 cubic feet or larger will b q
Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION
shall be exempt
states that: `.`Any homeowner performing work for wisSuIIlerviso s);provided thalding permit is t if the homeowner
The Code sta of constructionP
from the provisions of this section(Section 109.1.1-Licehsing
engages a person(s)for hire to do such work,that such Homeowner shall.act as supervis ingthe responsibilities of a supervisor
naware that they Section 2.15� This lack of awareness often .
Many homeowners who.tian for Licensing Construction 5upervisorrsassum
(see Appendix Q�Rules&R gu
arl when the homeowner hires unlicensed personse��T a��g our S Supervisor ns t '
results in serious problems,pa ttcnl. y
proceed.against the unlicensed person as it would with a licensed Supervisor. The hom communities require,as part of the
ultimately resp
onsible.
that he/she understands the responsibilities of a Supervisor. On the last page
To ensure that the homeowner is fully aware of his/her responsibilites,man
permit application,that the homeowner certify
ntl used by several towns. You may care t amend and adopt such aform/certification for use in.
of this issue is a form curre y
your community.
Q:\WpFILESTORMS\buildingpermitfom►s\EX]? SS.doc
..v
Revised 061313. +K�
Massachusetts - Department of Public Safety
Board.of Building Regulations and Standards
Construction Supen isor 1 & 2 Family
License: CSFA-047420
THOMAS P DAME-UO
16 WHITE BIRCH WrA , 1
W BARNSTAB MN026`68
Expiration
j Commissioner 04/07/2015
��e�pa»amaaivaec��a�C�j�a�oac�ccoeCG.r_.__..��__-.----=...._-----._ •---- ____ ---- __.._. ---
OVOffice of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 118952 Type: Office of Consumer Affairs and Business Regulation
xpiration, r5/8/2015:. DBA 10 Park Plaza-Suite 5170
t� Boston,MA 02116
THOMAS P DAME LIO BLDG&REMODELING
THOMAS DAMELIO G' = t Y
16 WHITE BIRCH WAY;, j
W. BARNSTABLE,MA 02668 Undersecretary Not valid without signature
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application #
Health Division Date Issued z-
Conservation Division Application Fee 11
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
1161)2-
Historic - OKH _ Preservation / Hyannis
Project Stree Address q'T ,�{ Z� � RID
Vil age�C���V�`l��
_ � l �55 c�
O�w erg r I (� l� '� Address
Telephone" � 0 D �- 5
�Pernit•Request"""'��M.Z�U l rJ Cs ��,� I��Z�1� W �._S � �C T�,(� l�
LcPP�rL-ems' Si_ Sit d0ltj -
�P2 R14 ( TS a _—
Square feet: 1 st floor: existing proposed d floor!ounLdwater
proposed Total new
Zoning District Flood Plain erlay
1
Pro ect Valuation { 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
w,
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:y❑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
APPLICANT INFORMATION
(BUILDER"OR°H2OMEOWNER)
CName,1 wtS pa,�)b rJ Ca S-P V AtTeI� NOmber. � v U
_9� 4
!�-r Jl L cerise #
nn __ 11
Ott" N �M D , Home Improvement Contractor# 1
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATU DATE -� v�
FOR OFFICIAL USE ONLY
y
:APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER'
t� k
A
:R
y '
DATE OF INSPECTION:
r
FOUNDATION
FRAME
i
` INSULATION
FIREPLACE
A ELECTRICAL: ROUGH FINAL
'a5 PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
t
DATE CLOSED OUT
's
ASSOCIATION PLAN NO.
f '
The Commonwealth'of Massachusetts
Department oflndustrial Accidents
Office of Investigations _1
600 Washington Street
Boston,AM 02111
•� V www.mass.gov/din
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers
Applicant Information Please-Print Legibly
Name(Business/Organization/Individual): .
(7X-ddress (LET
C--ity/State/Zip: 0� �1/�-�t oZ66( Phone.#:
e you an employer. Check the appropriate box:
R Type of protect(required):.
4. I am a general contractor and I
1� I am a employer with � Q ❑ g 6. Q New construction .
J employees(full and/or part-time).*. have hired the sub:contractors
2!❑ I am a'sole proprietor or partner- listed on the'aftached sheet. 7.KIRemodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp,insurance.
t 9. ❑Building addition
required.] 51,❑ We are a corporation and its, 10.0 Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their, . 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.El Roof repairs
c. 152 4
insurance required.]t , §1(4),and we have no Other❑ ,
employees. [No workers' 13. =
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 anew 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. F
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a'copy of the workers' compensation policy declaration page-(showing the policy number and expiration date).
Failure.to secure coverage as required under Section:25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK ORDER and a fine -
of up to$250.00 a day against the violator. Be advised that a copy of this statemerit.may be forwarded to the Office of '
Investi ations of the DIA for urance coverage verification.
I do hereby ertc-_ der t tes of perjury that the information provided above•is true and correct.
Signafore Date:
Phone#: 1 ' �
Official use only. Do not write in this area,to be,completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone`#: 5± "
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
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.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit.or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a.space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"an-locations in (city or .
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where.a home owner or citizen is obtaining a license or permit not related io any business or commercial venture
(i.e. a dog license or permit to 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.
t.
The Department's address,telephone-and fax number:.
The Commoi Mehl of Massachusetts
Department of Industrial Aeeidents
Office of Investigations
600 Washington Suet
Boston,ILIA 02 111
Tel.#617-727-4900 ext 406 or 1-977-MASSAFE
Revised 11-22-06 Fax#617-727-7749
w.mass..gov/dia
Dec 22 2011 12:14:10 EST FROM: HM/86805220048 - MSG# 10276064-007-1 PAGE 004 OF 004
�"'� p • � NlKs
AC 4R CERTIFICATE OF LIABILITY INSURANCE R027 , 12—TE 22-201'1
THIS CERTIFICATEIS 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 CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificato holder is an ADDITIONALINSURED,the policy(iog) rnust be endorsed. If SUBROGATIONIS WAIVED,subject to
the CerrTIS and conditions of the policy,certain policiLas may require an andorsearnent. A Statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
CONTACT PRnouc/R NAME THE .,�ARZ"�'Of2)�
..,_,....,,w,�,, ,Mw.,,,,.,,,.,.•,•,.,, n.,,.,..•.
INTUIT INSURANCE SERVICES INC FH(JNE
AC.Nn.F.x11. .866-467-8730 IAJr,Nn)• (A6.8)443-Fi1�,?
250822 P : ( ) ~ F': (888) 443-6'l12 MAIL
PO BOX 3 015 ADDRE R:
PRODUCER
SANANTONIO TX 78265 rv.V.i7aMEf3.lL.9........................................................... ........... .........................................................................................................
INSUREH(SI AFFOAbING COVERAGE' NAIC
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fNS'URFD INSURERA Twin C1t=�Fire Ins Co
LEWIS & WELDON CUSTOM CABINETRY LLC uys��r<E e
Ill AIRPORT RD wsuwM c
HYANNIS MA 02601 IN UviffiU
INSURER E
INSURER F:.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 'rHEINSURED NAMED ABOVE FUR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY RF.QuIREMFNT, TERM OR l'ONDITION-OF ANY CONTRACT OR OTH(,,R DOCUMENT WITH RF:3PL.(7 TO WHICH THIS
(•'ERTIFICATE;. MAY BF ISSUED OR MAY PERTAIN, THC INSURANCE AFFORDED (W THE POLICIES DESCRII3FO HFREIN IS SUBJECT TO ALL THE TFFRMS,
EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR _: rYPE Of'ny&#Avw ..�� . . POLICY NUMBER lMMA7DlYVYYC.- LMMZDlYVYYr-. �_...._ UMIrS .
RENERAL LIAENVrY -
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ANY PROPRIETCI"ARTNER/EXECUTIVE :N/A - - E F EACH ACCIDENT 1 100, 000
A OFF'ICER-MEMBEREXCLUDLDt F - _
IMondmro,V in NM 76 WEG. JX5703 rg/'�,Q/,�,Q�L X, .f1;:/�,(I/.l.1,L� L:L DIur:A`SE- EA EMPLOYE' F 100, 000
IF YON.<Iafti:rihJ MOO; - - FJ+SF._........ .. .............. ... ..... . ........... ....
DESCRIPTIL)N OF OPERATIONS hiYlOw - - 'E.I,-I)1$ oucv F,.IMI'r s 5.0 0....0..O.n...
09SCR/P7'I0N OF OPERA7IONS l LOCArrONS/V9141CLSS/Arroch ACORO 707,AddkA mal Rmmralas Sohoduln.,N imoia 4wo is rmqudod) - -
Those usual to the Insulr°ed' s Operations . Working on House Kitchen. Cabinetry
Interior Remodeling: MEG ELLIOTT 508 PRINCE HINCKLEY ROAD CENTERVILLE, MA.
02632
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
TOWN OF BARNSTABLE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS,
200 MAIN S"T` AWHOR,ZEO 1rePIW5ENrAT1VE
HYANN I S , MA 0 2 6 01
y' 1988-2009.ACORD CORPORATION.,All rights reserved.
ACORD 2'5 (2009/09) The ACORD namo and logo arc registered MArks of ACORD
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71m O~!77/!)L04t111£' L O• tS6CxCiLUQGt�1
Office of Consumer Affairs&B loess Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: ,�;�64880 Type:
.4.
Expiration: .3I28l2013 Private Corporatiq
LE S &WELDON STONt CABINETRY, LLC. t t
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CLARENCE HARFJ '
111 AIRPORT RD
HYANNIS, MA 02601 ,E sz"f f` Undersecretary t
Massachusetts - Department of Public Sat'etv
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 97094
CHUCK HAR�AR
11 •PERCIVAL DRIVE
WEST?BAN:TABI_rE, MA 0266`
Expiration: 7/16/2012
C'utuniissioiier' Tr#: 263
Xea„��za�z ���
Off-tee of Consumer Affairs & Bu'iness Regulation
HOME IMPROVEMENT CONTRACTOR
' Registration: 154680 TYPe 2
_ Expiration: .312 812 0 1 3 Private Corporatic;
LEWfS &WELDON CLFSTOM CAB[NETRY, LLC.
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CLARENCE HAR i J
111 AIRPORT RD
HYANNIS, MA 02601
Li
ndersecretary o y
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Board of Buildin- Rc�-ulations and Standards
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Construction Supervisor' License
License: CS 97094
CHUCK HAR;�7R ,4N.- t
11 PERCIVAL DRIVE
WEST BARN&TABLE,,MA 0266'
Expiration: -7/16/2012
( mmi>ci�mer Tr#:' 263
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LEWIS &WELDON
i
CUSTOM BUILDERS
i DESIGN * BUILD
111 Airport Road
Hyannis, Massachusetts 02601
508-778-5757 office
508-778-5111 faz
www.1etvisa:ndwv ldon.corn
PROPERTY OWNER AUTHORIZATION
We, David and Hazel Hasseltine
b
As owner/owners of the subject property hereby authorize Lewis and Weldon to•act.on
my/our behalf, in all matters relative to work authorized by this building permit
application and all subsequent sub permits governed by the Electrical Code, as well as
Plumbing code for the job located at
94 Beechwood Road Centerville,'Ma 02632
(. i~f',�,,1�'/G s i'".:!(�./r✓,1.�L'f,, '-1...-;.._ i '�rfG j'r2,�..� / � '
Signature of Owner/Owners � Date
J A-AA D el
Print Name/Names
Lewis & Weldon Authorized Representative, D to
Print Name
�o
saunas TOWN OF BARNSTABLE Permit No. -__-----__---.______------
MSTAX Building Inspector Cash
rua -------------""-
OCCUPANCY PERMIT Bond ------------
- ,
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Ar-tnur Vviliia as, 1 Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
.............................................. 19...... ................................................................_.__......._. ...._._..__. .._
Building Inspector
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Ass'essor's map and lot number l3
...........................
THE t0�
Sewage Permit number A!2::./zO...........y?,:M
a NWIC VOW MUIR BABH9TADLE, i
House number ...... ......................................................... o IN Comm" M163 9 �
. � �'?' ypy a
�0
TOWN OF BARN,&To Cft0'0G mo
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
...xP _, Vim. e... :.�... .. 41.101 ...................
TYPE OF CONSTRUCTION ..... ............................................................................................
E TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:.
Location .. ... .. .°. ...4st°E ... ?: .............Xd. ......./f 9.... ..... .. .... :.................
... ....
ProposedUse ......... ...}?drffo.�y .................................................................................................
Zoning District ............F.,D..../. ........................................Fire District .1007h'.d./�1<���...... .-� .,�s8t�/l'4�:..................
Name of Owner .... f. 7,4C.. . ./ 14M. :47 ................
Nameof Builder ..................4?,n.f....................................Address ........................ �m.r............................................
Nameof Architect ............N.10/.44e,................................Address ....................................................................................
Numberof Rooms. ............ Ie...........................................Foundation ..............................................................................
1
Exlerior ......lf?. ... a+�l�P.ae�lk�...�a .. .%9!<rtlf°.............Roofing ..... ........5 ....... j�.�Rcr� .......................
Floors ..` � .�� '( e�rJ (, . .� Interior ........ °. `�..5/ ��i��
Heating ccS. �!!`�RI-4Y.R. .................Plumbing /.4'.( fd.C. ..
Fireplace ....... ......;X .........................................Approximate Cost ....71K.401...............................................
Definitive Plan Approved by Planning Board -----------_------_-----------19 . Area .... ..................
Diagram of Lot and Building with Dimensions Fee .......- .............
................
SUBJECT TO APPROVAL OF BOARD OF HEALTH �j
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .�i: ..11c.. �sr� t�. c................
r X I
R. Arthur Williams, Iric.
[�.Io ... Permit for ......aiX19.l.Q............... 10,
Family. Dwelli.rlg...........................
.............................................
Location 4Pt...A.10...9.4....aee.chwaod...Rd..
Centerville
.................... ..........................................................
Owner ....R?...Arthur...Williams.,—Inc.
Type'of Construction ....Fr-amja.........................
.......... .................................................................. t
Plot ............................ Lot ................................
Permit Granted March 6 , ........................I............... .19 80
Date of Inspection ...... .......:19
'19
........ .......... ..
Date Completed ........��**............ .
PETIT REFUSED
..........................
...... 19
..............
.............. ...........................................-.
.............. ...........................................
..................... ........................
..............
4x=
ZID
Approved ..........Vic.................................. 19
. ...............................................................................
...............................................................................
J
71,
�I
Assessor's map and lot number :-f,�'°'�:....... �......
a O*THE tO�
Sewage Permit number .
E Z BABB$T11DLE, i
House number �j ............. s MABa
........................................... OO 1
639 9�
a`
TOWN OF . BARNSTABLE
BUILDING INSPECTOR
APPLICATION. FOR PERMIT TO .....� F�.+. ... ?....,..... :: .......... 1r �.:! ..............:..
c
TYPE OF CONSTRUCTION
:. ... ...............................................................................................
. .....✓f....................19
TO. THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .. 46
..t:.: � <�: .... a:� ............ �. ?. ... / .f
ProposedUse ..........�.!6j�',J+.. '`.��� . . .. ...................................................................................................
' Zoning District ............
......... ?I� ....�...........................................Fire District %:�s`f�.......Z77T.c4l�.A�..
Name of Owner .. ;1{ /,!a;.• ,,i►�i✓ , � :s. !%� ...........Address ... � .:: �aa�,�r, ra. ;�,`...f//�/,�...............
' r'
Name of Builder E�m,.,f....................................Address `} t..:............................................
Nameof Architect ................1l�e�� ,................................Address ....................................................................................
Numberof Rooms ............:.�.,A: ..........................................Foundation ..............................................................................
Exterior ...... ' ................ Roofng ......... .......................
Floors ... �'��.y. fir. .. % - ��,��. (,.1 ~��~...............Interior ...... 1/, ........
_� ...,., . ._. ..
Heating .......... ?:?....... .........................Plumbing ...=,.......... .. .....................................
Fireplace -......X4..............................................Approximate Cost ....'.' d
..............................................
Definitive Plan Approved by Planning Board --------------------------------19--------. Area ������: .................
Diagram of Lot and Building with Dimensions Fee � k.�"'"" '
SUBJECT TO APPROVAL OF BOARD OF HEALTH
0 d
3
IV4
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. �'
Name .A M...'�. ���. ... ����J,a.�� „..................
_a
~R. Arthur Williams, Inc.
3
- ��
,
`
No Perm ,5.' 1.e-----_. ~
I' D_
a�iIl' we'; lizlg
--------------'------------ |
� Lot #169 94 Beeohvvooc3 Rd.
Location ---------------------.
..................Ce«z±/ex`Fi-1-1-e................................ `
Owner —��.�—���.��!!�� z..'�!��.�
Type of Construction ..� iFra~^--------- '
` .
'
'
~
Plot .........................Permit Granted .....A.............................19
�
Date of Inspecti/...................................19
Date
Completed _
LPEO/RMIT EFUSED
19
� .
-----. --~—. .
Approved
�
............ ____-------. lg
�
«
-------------'—'-------~—'--
--------------------^^'^^—~—'
U ' �
Lewis and Weldon Custom Cabinets Hasseltine, David
111 Airport Road 94 Beechwood Road
Hyannis, Ma 02601 Centerville, MA 02632
Ph: 508-778-5757 508-778-0275
Fax: 508-778-5111 12/22/2011 davehasseltine@yahoo.com
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