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Home My WebLink About0028 BERNARD CIRCLE t q �f 4 V. S e r r e , NIA o o i n 0 .�' ,. Town of Barnstable _ _ Building Post This Card'So'l hat if>is0.Visible Fromthe Street-Approved Plans Must'be Retainedon Job and this'Card Must be Kept � . Posted,Until Final�lnspectwn Has Been'Made � 4T'l , ,�' ,a y Kr �. : l .� Permit niuct Where rtificate of:_Occupancy is.,RequiredsuchBuild'ngshall Not be Occupied until a Fm� al Inspection hasbeen made. Permit No. B-18-2363 Applicant Name: James Curley Approvals Date Issued: 07/26/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/26/2019 Foundation: Location: 28 BERNARD CIRCLE,CENTERVILLE Map/Lot: 148-030 _ _ Zoning District: RC Sheathing: Owner on Record: ANDREWS,SCOTT F&JENNIFER A Contractor Na e�JAMES P CURLEY Framing: 1 Address: 28 BERNARD CIRCLE Contractor License CSSL-099138 2 CENTERVILLE, MA 02632 " ` " ` ' Est Project Cost: $ 10,000.00 Chimney: Description: Strip and re-roof approximately 24 square of a sphalt roof,shingles. TPbrMit,Fee: $51.00 Insulation: Project Review Req: -Fee Paid $51.00 Date`.. 7/26/2018 Final: ,< , a Plumbing/Gas r� c Rough Plumbing: iN Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within si'tlx monthsLafter issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall`be in compliance with the local zoning by laws a;nd codes. Final Gas: This permit shall be displayed in a location clearly visible from access sheet or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signaturesYby ttie Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing s - - Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: 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 f ' Town of Barnstable RECEiP� 200 Main Street, Hyannis MA 02601 508-862-4038 •63�. � a Application for Building Permit Application No: TB-18-2363 Date Recieved: 7/23/2018 Job Location: 28 BERNARD CIRCLE,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: JAMES P CURLEY State Lic. No: CSSL-099138 Address: Centerville, MA 02632 Applicant Phone: (508) 790-4508 (Home)Owner's Name: ANDREWS,SCOTT F&JENNIFER A Phone: (508)420-6202 (Home)Owner's Address: 28 BERNARD CIRCLE, CENTERVILLE,MA 02632 x Work Description: Strip and re-roof approximately 24 square of asphalt roof shingles. C fV W Total Value Of Work To Be Performed: $10,000.00 vi ao n •• m Structure Size: 0.00 0.00 0 00 M rn Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). r I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of,the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: James Curley 7/23/2018 (508)790-4508 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $10,060.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $51.00 .7/23/2018� 0{�{� $51.00 30 -X300{-X}OC{0� Credit Card 5483 t Total Permit Fee Paid: $51.00 ¢ �E M hTHIS'ISl1aT APE ¢ NW I JW v.. .�. 'own of Barnstableilding 'i. I•'i ` Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept v „Ace /�, Posted Until Final Inspection Has Been Made. Permit En Where a.Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit NO: B-17-4135 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 11/30/2017 Current Use:• Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: .28 BERNARD CIRCLE,CENTERVILLE Map/Lot: 148-030 Zoning District: RC Sheathing: Contractor Name: BRIAN D DENNISON Framing: 1 Owner on Record: ANDREWS, SCOTT.F&JENNIFER A -. - g' it Address: 28 BERNARD CIRCLE Contractor License: CS-095707 2 CENTERVILLE, MA 02632 Est. Project Cost: $9,538.00 Chimney: Description: REPLACE 2 DOORS.29 UVALUE Permit Fee: $48.64 Insulation: Fee Paid: $48.64 Project Review Req: Date: 11/30/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: 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. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 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 Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 oFW Town of Barnstable *Permit# 4 -/7=y13 S� Expires 6 arordtrs rom issue date Regulatory Services Fee ! e enxxsraai.a. =1 A t659. �,0�a Richard V.Scati,Director jl/30�i Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis, NIA 02601 www.town.bamstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERrMLIT APPLICATION - RESEDENTIAL ONLY Not lea/id without Red X-Fi-ess Imprint tbtap/parcel Number A/9 Property Address .2 k reiarce Ytesidentiaf Value of Work$ `/, J 38 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ennf'-Fi'� aCe ►r /''�'G S >enn Q /-O( l_( ( PNT� V r I e M/-� Contractor's Name Telephone Number No i 2_Z1-'! O Q Home Improvement Contractor License#(if applicable) 47 Email: Construction Supervisor's License#(if applicable) 7 o 7 21workman's Compensation Insurance Check one: ❑ I am a sole proprietor m the Homeowner I have Worker's Compensation Insurance Insurance Company Name _ F; r am Workman's Comp. Policy# 161 C 15 8 7 7 9 2-0 Copy of Insurance Compliance Certificate must accompany each permit. y Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side Q'Replacement Windows/doors/sliders.U�-Value (maximum.32)#of windows of doors: 2— Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. I *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conscrvation,etc. ***Note: Property wrier must sign Property Ow ner Letter of Permission. A copy cAthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Tempomry Internet Files\Content.0utlook\2P10I DHR\EXPRESS.doc Revised 040215 I Renewal Agreement Document.and Payment Terms Andersen. dha:Renewal B Andersen of Southern New England Y 8 � Jennifer&'Stott Andrews. . Legal Name:Southern New England Windows,LLC. 28 Benard Circle RI#36079, MA#173245,CT#0634555, Lead Firm#1237 . Centerville;MA 02632 WINDOW RE LACEMERr 10 Reservoir Rd I Smithfield,RI 02917 _ -' . H:(508)420-6202 Phone:866-563-22351 Fax:401-633-6602 1 sales®renewalsne.com C:5083640101 . Buyer(s)Name: Jennifer & Scott Andrews Contract Date: 11/07/17 Buyer(s) Street Address: 28 Benard Circle, Centerville, MA 02632 Primary Telephone Number: (508)420-6202 :: Secondary Telephone Number:_5083640101 Primary Email: lamatson@prodigy.net Secondary Email: . Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southerti.New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $9,538 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be.made by personal check,bank check,credit card,or cash Deposit Received: $0 _ Balance Due: $9,538' Estimated Start: Estimated Completion:. 8-10 weeks 8-10 weeks ' Amount Financed: $9,538 Method of Payment: Financing We schedule installatiotis based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. . Notes: 50% DEP 50% ON COMP TXS PD IN CENTERVILLE MA Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that:there are no verbal understandings changing or modifying any of the terms of this'Agreernent.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1).has read this Agreement,understands the terms of this Agreement;and has received a completed,signed,and dated copy of this Agreement,including' the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:-Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. i YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/10/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,I.M. dbai Reneival By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Eric Woods Jennifer Andrews Scott Andrews Print Name of Sales Person Print Name Print Name UPDATED: 11/07/17. Page 2 / 10 Massachusetts Department of Public Safety VVI! Board of Building Regulations and Standards License: CS-095707 _�''�' construction Supervisor ' �. BRIAN D DENNISON 7 LAMBS POND CIRC A '' '�L CHARLTON MA 0150T Expiration: Commissioner 09/08/2018 �Ge ffJQ�J'J?1J92R-�?�IX�.CI�f� CYUI�GCL�.�GY��/L(/J�i 'J- T. Office of Consumer Affairs nd Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement'Contractor:Registration ^ -= Registration: 173245 - ' _;'` Type: Supplement Caro 1- v, SOUTHERN NEW ENGLAND WINDOaLIExpiration: 9119/2oie BRIAN DENN18ON I E I —, 26 ALBION RD _= LINCOLN,RI 02865 ^�0— /.Update Address and return.card.Mark reason for change. scA, c• 2wno5n; '—� r j Address �f Renewal -i Employment G Lost Card //r� im:on.6nh cr.A/o��`•/(.era/rud1, (fire of Caasamer Aifnirs R:Bosiuess Regulanon Registradgn valid for individual use only before the OME.IMPROVEMENT CONTRACTOR 'expiration date.If found return to: Office of Consumer Affairs and Business_Regulation Reglstratlon -t73245_ 1YPe: 10 Park Plaza-Suite'5170 Expiration gtit)12018`. Supplement Card rBoston-MA 03116 SOUTHERN NEW ii G"DNIINDOWSLLC. RENEWAL-BY AND ERS_&D' „' BRIAN DENNISON 26 ALBION RDA. LINCOLN,RI02865 l_pbaersecr r,. Not valid-Without`signature f ` The Commonwealth of Massachusetts Department of Industrial Accidents 0 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED R'ITH THE PERNIIT 1D> G AUTHORITY. Applicant Information Please Print Le 'biv .Name (Business!Organizaiion/Individual): e k) �aliJs Address: ,2& ALtc2ip lt'� _ City/State/Zip: /J Phone FEW Are you an employer?Check the appropriate box: Type of project(required): 1..X1 am a employer with �o employees(full and/or part-time).' ?. New construction 2.[-�I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capaciry.[No workers`comp.insurance required.i 9. ❑Demolition I am a homeowner doing all work myself[1Je workers comp.insurance reauired. 0 E]Building addition 4.❑1 am a homeowner anc will be hiring contractors to conduct all work or:my property- I will ensure thai all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions propsierors with nc empleyees. iZ.OPlumbing repairs or additions L 1 am a genera`contractor and 1 have hired the sub-contractors listed on the attached sheet. -� 13_❑Roof re airs These sub-contractors have employees and have worlte--'comp.insurance // E. We are a corporation and iu officers have exercised their right or exempnor.per MGL c 14. Other�Tr'v 152 F 1(4)_anc we hove ne employees.[No workers'comp.insurance requirec.i I '-P/0 4, S 'Any applicant than checks box r'must also fill out the section below showing their workers'compensajoc policy information. Homeowners whc submit this affidavit indicating they are doing all wort:and then,hire outside contactors 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. Lithe sub-contractors ht:ve employees,they must provide their workers comp.policy number. I am an emplover that is providing workers'compensation insurance for mr employees. Below is the policy and job site information. Insurance Company Name: `lire me,n S � gam- a — Policy#'or Self-ins.Lic.ir: ��CA v ISy 6 z q — Expiration Date: f O Job Site Address: f-)-? >"A4/'0 1^!'. City/State/Zip: fQ ,'ll Attach a copy of the workers' compensation policy declaration page(showing the policy number and eap ration date). Failure to secure coverage as required under MGL c. 152:E25A is a criminal violation punishable by a fine up to a1,500.00 and/or one-veal 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 ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. 1 do hereby cerdf}!under th ains and penalties of perjun°that the information provided above.is true and correct Si gn ature: Date: Phone#: L®l Official use only. Do not write in this area:to be completed by city or town official Citv or Town: Per-mit/License k A 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 : ESLERCO-01 SANDERSO A�ORO DATE IMM1DDTYYM CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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(ies)must have ADDITIONAL INSURED provisions or t 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 endorsement(s). CONTACT PRODUCER ME CoBiz Insurance,Inc.-CO PHJ.ONE 303 988-0"6 �A>IICC,No):(303)988-0804 1401 Lawrence St,Ste.1200 E-MAIL -M IL 6d>:( ) Denver,CO 80202 ADDRESS..COMaii@cobizinsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NA1C k INSURER A:Acadia Insurance Company 131325 INSURED INSURER B:Firemens Insurance Company of WA D.C. I21784 Southern New England Windows,LLC.dba Renewal by INSURER c:LibertySu lus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 wsuRERD: Lincoln,M 02865 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE I POLICIES O INSURANCE LISTED N ISSUED INSURED CY PERIO ND CATED. NOTWITHSTANDING ANYREOUIREMENT, TERM OR CONDITION OF ANY CO NTRACTT OR OTHER DOCCUM ABOVE LI ENT WITH RESP CT PTOWHICH 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. LTR_I ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE INSD 1NVD POLICY NUMBER MMIDD MM/DD A I X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE S 1,000,ODO —� DAMAGE TO RENTED 300,0001 I CLAIMS MADE �OCCUR CPA3158728 01/01/2017 01/0112018 PREMI E Ez ocwrrence r-�--- � 5,0001 MED EXF An one person) 1 - PERSONALS ADV INJURY 5 1.000- GENERAL AGGREGATE $ 2,000,0001 i GEN•L AGGREGATE LIMIT APPLIES PER: I 2,000,000i j X I POLICY L I jEP7 C LOC - PRODUCTS-COMP/OF AGG S LLL� EBL AGGREGATE I-'000--- I OTHER: COMBINED SINGLE LIMIT 5 1,000,D00i A IF AUTOMOBILE LIABILITY - Ea amdent I j X ANY AUTO CPA3158728 01/01/2017 01/01/2018 BODILY INJURY Per person) •5 �I OWNED SCHEDULED BODILY INJURY Per accident% S I AUTOS ONLY AUTOS I PROPERTY DAMAGE i i HIRED NON-OWNED Per awtlenl AUTOS ONLY AUTOS ONLY s I A X I UMBRELLA LIAB I X OCCUR EACH OCCURRENCE c 1,000,OOO) CPA3158728 01/01/2017 01/01/2018 EXCESS LIAB CLAIMS-MADE AGGREGATE S DED X RETENTIONS 0 Aggregate 1,000,000� B WORKERS COMPENSATION I I X STATUTE ERA AND EMPLOYERS'LIABILITY YIN W6A3158729-20 0110112017,01/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EA ACCIDENT OFFICER/MEMBER EXCLUDED? �_ NIA A E.L.DISEASE-EA EMPLOYE i S 1,000,000� (Mandatory in NH) 1,000,U00 If yes,describe under E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below 1,000,0001 g Worker's Compensatio WCA3158730-20 01/01/2017 01/01/2018 917 01/0112017 01/01/2018 1,000,0001 I DESCRIPTION SC Workers OPERATIONS I LOCATIONS O ndudesEAll States OR except ND,O Additional Re a�S�ule,may be attached it more space is n�uired) l I f � I I I I I CERTIFICATE HOLDER CANCELLATION SHOULD AN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE i IFOR Informational Purposes ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map JUParcel Application v Health Division Date Issued _) 7 h y Conservation Division Application Fee Planning Dept. Permit Fee _G_� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address g pa i 111f_. 64 . Village gLT2�b Owner &.b* A .� Address J. CiyL Telephone SR 202— Permit Request c�- SU1P �ltila,t' ✓ e� � , lid �lrK�'1 G i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati OConstruction 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 Kings.Highway:i ❑Yes' ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sqft) � tr' Number of Baths: Full: existing new Half: existing new =;� Number of Bedrooms: existing —new Total Room Count (not including bath.3): 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 j;S445h Vk, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �QQ Name Ji � h Telephone Number c/7 "534 Address ?/ �3 Lw1(p� License # v,P Home Improvement Contractor# oT Worker's Compensation # � �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /rkG4?d- oy-t— Zi 4 SIGNATURE DATE 63 �� FOR OFFICIAL USE ONLY gg APPLICATION# E, 6 DATE ISSUED w i- MAP/PARCEL NO. { ADDRESS VILLAGE ' OWNER F ' E. t 1 DATE OF INSPECTION: F .---FOUNDATION. FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL g GAS: ROUGH FINAL FINAL BUILDING 3 DATE CLOSED OUT- ASSOCIATION PLAN-NO. a Aa Mgol�rv' amass...save., COCA PERMIT AUTHORIZATION FORM I, Scott Andrews ,owner of the property located at: (Owner's Name,printed) 28 Bernard Cir Centerville (Property Street Address) (city) t 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 FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Panic sting Co tra or Date 0� _ for Office Use Only Rev.12132011 The Commonwealth o.f Massachusetts Print Form- Depwiment of Industrial Accidents Office of Investigadons .' I Congress Street Su.te 100 .� Boston,MA 021I4-2017 �. ` wwfv seas&gov/did Workers' Compensation Insurance'Affidavit: Buildirs/Contractors/Electricians/Piumbers �- AP licant Informatioa Please Print Legiblv Name(Business/Ocaanimlion/Individual): Address: J 03 , rt City/State/Zip: i�(,t,l� 1 �� Phone#: Are ou an employer?Ch k the appropriate box: Tape of project(required): am a employer with IDt-e_) 4. Q I am a general contracoor and I employees(full and/or part tune).* have hired the sub-contractors G. Q New construction 2.[] I-an a sole proprietor rn partner- listed on the attached sheet. 7.. ❑Remodeling shill and have no employees These sub-contractors have• g_ 0 Decaolition. woddng for mein.any capacity. employees and have.workers, (No workers'comp.insurance COI V.uhstuance.t r 9. Q lithildu1g addition required:] S. Q We area corporation:and its 10-El Electrical repan or additions 3.❑ I-am a homeowner doing all work officers have exercised their- 11.0 Plumbing repairs or additions myself.[No workers-'comp, right of exemption per MOL insur m=requucd.]t - 152,§1(4),and we have no � u"17 employees.Diu WQrkers' 13_ Other /f - comp.insurancereqflir d] - "may applicant that cheeks box#1 must also fill out the smti m below showing their workeis'eom�rensdtion goody infor�tioa. t Homeowners who submit this affidavit nndieating they are doing all wark2nd then haeontside c onnactnrs must submits new aiidavit iadicaGgg such. -Contractors aw dn&this box,must attached an additional sheet showing the name orthe sub- W ractois and state whetharor not those eaEities;have employees. If the sub-conhactocs have employees,they most provide their worlm'mmp policy cumber- - I am an employer shads propmang workers'compensation omranceforrny employee, Dedew w dxpoluy andlob site information. Insurance=-CompanyName: �(�►'/77E_ t J�1 �'7/1 ° Policy#or Self-ios.Lic.# U)CAItM /� l F..gpiration Date: nov Job Site Address: t � !) I�C�j �/lV't:l`C (_ ty/Stat�e/Zip: I<G�Ci :mod*yi 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.15Z=lead to the imposition of criminal penalties of a fine up to 1,500.00 and/or one-year imprisonments as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violatoi: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do hereby certify under the and enahY"ofpedwy drat the in onnatian provided above is&ue and eomecx Si Ure. e . Phone#: Official use only. Do not write in this-area-lo be completed by city or town of}ieiaL City or Town- PermitUcense# Isstu Authoritychle - L Board of$eaitlr :lading lDepartauent. 3.City/Town Clerk 4.Electrical lnsgerter 5 Plumbing Inspector _ S.Other , !`nnfo„t Dnrenn. DL---$. " 06/18/2014 22:59 9787778415 PAGE 03 co��xd CERTIFICATE OF LIABILITY INSURANCE ' 16/19/2014� iNiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MOM UPON THE CERTIFICATE HOLDER. THIS CERiiFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TNIL COVERAGE AFFORDED BY THE POLICES - BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MUM INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If Uw caaneete holder to an ADDITIONAL INSURED,OW PO{kT W)swat be anaaSea. If SUBROGATION IS WAIVED,suLyset W r Ihs Wrme we CondMorks of Mo DoNty.coon pencW may rsquim an immkwo mnit A sfemmad m thle csr0 ata am not conw r4oft to am coAftels holder In Hsu of such n PRODUCER COUMITY INSOAANCE AGMCY INC w"m Er (978)774-2463 Ivc N, (978)777-8d1S 123 Sylvan St Danvers, MR 01923 ADDRESS: INsuealAls)A}IbNpN.oovouwA: NNce INSURERA:COINIMCCO Ins. Co.. INSURED Building PAerfora> nee Contracting, L= MAR B;Kola Vndarwriters dba Nauset Insulation m&Ur&R C:Atlantic Charter - P.O. Box 633 - INSURER o:RB Jono• Truro, Na 02666 ►NauRER E: " I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 19 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID GAMS. MER LisTYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE a 1.000.000 x COMMERCIAL GENERAL LAOILITY PREMISES IEM aoarrwla a 50,000 q.AM34AADE FE OCCUR MED EJIP(Arw wo pwwn) a 1 000 8 MP0020002000041 5/1/14 5/1/15 PERSDNA mytwuRY a 1,000 000 ' GENERAL A00REDIITE a 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMNOP AOD 1 1,000,000 POLICY PR0 Lo(; ALrToreoBlLE LUBIUTr 11,000,000 ANIIAUTO BODILY INJURY(Pw pww") A AAUUTOS OWNED s U" ° t�D BGR 2/2/14 2/2/15 BODILY NAM(Par wdita) $ _ - - HMO MT03 ZT a0"Y a a UMBRELLA Lw OCCUR EACH OCCGRPENCE 1 2,000,000 D EMESS UAS HCLOJAS-VAN C[JBW3904112 5/1/14 5/1/15 AGGREGATE 1 2 000 000 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORYIT C AW o la �e�"Luoeo' '�1ei `"� �Y NIA EL.EACH ACCIDENT s 500,000 (fty8lRft"M 00 WM0939900 ii/23%s3 u Fl /23/14 E.L.DISEASE-FA UPI s 500,000 DESCRIPTION Oi OOPERATIONS bmew -` - - EL DISEASE-POLICY Life•► 1 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tAR II ACORD 101,AOOIr O RanoM OWN10^B nwre opew U rew"m CERTIFICATE HOLDER CANCELLATION Town OP Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable, Na THE EXPIRATION DATIL THEREOF, NOTICE WILL BE DELIVERED IN . ACCORDANCE WITH TH LICY PROVISIONS. • - AU'rNOR1i�D REPRES 619W2010ACORINCOWORATION. AH d9hffi reserved. ACORD25(2010105) The ACORD name and low are►e9Blerad marks of ACORD • - fi Massachusetts-Department-of Public Safety k Board of Building Regulations-and Standards Construction Supehisor License--CS-078815 �. i:,- JOSH EMOND ��- POBOX 63.3" s - Truro MA 0266t - Expiration Commissioner,, 03/25/2015 VJis�pam�za�uuea/t/a C ac%uae3ta-` ° . License or registration valid for individal use only Oice of Consawcr Affairs&Business Regalatioa before the expiration date. ff found return to: ME IMPROVEMENT CONTRACTOR, - Office of Consumer Affairs and Business Regulatio g'isb-Aon: AT 42i5 Type .-•_,a 10 Park Plaza-Suite 5170 piration:^1 ] LLC Boston,MA 02116 BUILDING PERFO i 6_0_*N#UCCTING,LLC. ' F� e y JOSH EDMOND z _ 8 KINNIKINNICK RD — TRURO,MA 02666 r _ Undersecretary of valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION," Ii Map Parcel.�,,: V :Application pp Ic # C/ Health Division Date Issued 09 Conservation Division on Fee_44Z Planning'Dept, `Permit Fee: Date Definitive,Plan Approved by Planning Board Historic = OKH Preservation Hyannis Project Street Address �2 e Village 4L -A 0��"Ile Owner _Addressa26 Lae Telephone no , ei I z1, 3o 3 44,Permit Request RA, C4 P. -e)Q P Se A evn_-s A le..hr Aewelmb"7) reum :?A r4 4e 'C L low-tf FRyk kvk 'pee-4 Square feet: 1 st floor: existing ilproposed 2nd floor: existing_proposed --6—Total new Zoning District, Flood Plain- Groundwater Overlay Project Valuation -o Construction Type Lot Size • 3- Grandfathered: L3 Yes' qK0, if Yes, attach supporting documentation. Dwelling Type: Single Family Two Family LJ Multi-Family (# units) Age of Existing Structure cam.0 Historic House: U Yes •N-Ne On Old King's Highway: L3 Yes S-N6 Basement Type: bT_U1_1_" J Crawl LJ Walkout tether U Basement Finished Area(sqft)t 0 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. IP new 0 Half: existing new Number of Bedrooms: existing Q_new Total Room Count (not including baths): existing new First Floor R Count:f4� Heat Type and Fuel: U-G'rs L) Oil U Electric LJ Other o ao Central Air: LJ Yes Ng Fireplaces: Existing New Existing wood/ oal stove—: LJ Flo2:0. 'Detached garage: LJ existing Ll new size—Pool: LJ existing Ll new size Barn: J isting nevAsize Attached garage: LJ existing U new size —Shed: U existing LJ new size Other: Zoning Board of Appeals Authorization Q Appeal # Recorded LJ Commercial LJ Yes Ll No If yes, site plan review # Current Use Proposed.Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name lG 6 a-A2 fS Telephone Number Address License Home Improvement Contractor# 62,16 9 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIIGNATUREz��o DATE -7A2 /0 .a Z , FOR OFFICIAL USE ONLY u. ° APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS _ VILLAGE } OWNER DATE OF INSPECTION: � t FOUNDATION FRAME INSULATION 12-4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL Y GAS: ROUGH FINAL FINAL BUILDING 9 11 W61 A !0 6 0 DATE CLOSED OUT ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: z n �J City/State/Zip: �. Phone #:, p Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t C. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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, tContractors 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. �t Insurance Company Name: f/Ll / .� e.,� �l 6 q Policy#or Self-ins. Lic.#: Expiration Date: 20 Job Site Address: City/State/Zip:. . 11-2 %1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pai and penalties of perjury that the information provided a ove is true and correct. Signature: Date: Phone#: -36 a U VA7 Official use only. Do not write in this area, to be completed by city or town official ` City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector,5. Plumbing Inspector 6. Other Contact Person: Phone#:. Information and Instructions 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 1 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tk bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia HIC Registration Complaints Page 1 of 1 The'Official Website of the Office of Consumer Affairs&Business Regulation (OCABR) Mass.Gov Consumer Affairs and Business Regulation Home > Consumer> Housing Information > Home Improvement Contractor Program > ................................................................................................................................................................................................................................................................... HIC Registration Complaints License Type License# 164040 Restriction Name RICHARD SOARES City, State, Zip W. BARNSTABLE, MA, 02668 Expiration Date 8/14/2011 Status Current No complaints found for this Licensee. Back To Search ©2009 Commonwealth of Massachusetts http://db.state.ma.us/homeimprovement/licdetails.asp?txtSearchLN=65832 9/l/2009 1 �Jas�,;tOitjscti-� - t)cpartm,,im I,lt Public Restricted to: 00 Board 'it' Buiitiiwl Keutflalifw, and Siant urd, �=- Construction Supervisor License 00- Unrestricted License: CS 85267 G1- 1 2 Family Homes Restricted to: 00 RICHARD D SOARES " " Failure to possess a current edition of the 18 SPRUCE ST =' _ , Massachusetts State Building Code W BARTNSTABLE, MA02668 is cause for revocation of this license. 1 Refer to: WWW.Mass.Gov/DPS Expiration: 2/22/2011 i „nnii• i: n•r Tr 10727 ...... ..... FF �zHE, Town of Barnstable 'Regulatory Services anxxgrenr.E, Thomas F. Geiler,Director Mnes. . fo;p `�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: S08-862-4038 Fax: S08-790-6230 Property OwnerMu.st Complete and Sign This Section If Using A Builder I, w S , as Owner of the subject property hereby authorize GCe 4e, J n, .A _A to act on my behalf, in all matters relative to work authorized by this building permit application for (Address of Job) 4 Signature of Owner Date Print Name if P%pejU Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. 0:FORMS:O WNERPERMIS SION Town of Barnstable ��c►+t:ram, " Regulatory Services O� 4 r Thomas F. Geiler;Director ,' ��' Building Division pTf0 a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �i!0 JOB LOCATION �/-�fJ � 1i�'� r""' if num6i r-..� street village "HOMEOWNER': ` name home phone# work phone# CURRENT MAILING ADDRESS: ' city/town tate zip code The current exemption for"homeowners"was extended to include owner-occ ed dwellings of six units or less and ' to allow homeowners to engage an individual for hire who does not possess a licen rovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,On which there 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 ear period riod shall not be considered a homeowner, Such e 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 of er applicable codes,bylaws,rules and regulations. d '`'OThe undersigned`-+homeowner"�certtfies that he/she understands the Town of Barnstable Budding Department x t rr . i.x,_ . - mac. .,. minimum inspection procedures and requirements and that he/she will comply-wtth said procedures and+� requirements. Signature of Homeowner Approval of Building Official *, Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION q• The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,,many communities require,as part of the permit application, • that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomr/craifrcation for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC �Y+ )l,XE•RGY CONSERVATION APPLICATION FORM FOR ENERGY EFFf CICIENCY FOR ONE, AI D TWO-FAMILY DETACHED RESIDENTIAL, CONSTRUCTION (790 clviR 6x.00) Applicant Name: T44 Site Address: print Town: . Applicant Phone: 9 �"�C) Applicant Signature: WX Date of Application:' NEW CONSTRUCTION: choose ONE of the following two'o tions 790 CKR TABU 6107.1 PRESCRIPTfVE ENVELOPE COMPONENT CRITTERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MA�frMUM 'MINIMUM Ceiling or Slab QOption 1: Basement Fenestration exposed Wall Floor 'Wall Perimeter AP•UE HSPF SE. U-factor floors R Value R-Value R-Value R-Value R-Value and Depth National Appliancc•Encrgy R-1 0 ConscrYatioh Act(NAECA)i 5 R-3 8 R-19 R-19 R-10 4 ft.- 1997 as amended,minimums { cater as applicable ! Note: Thi form i not required if you choose either of the two versions ofREScheck as listed below. R �SchegkVersion 4.1i.2 or later variant software analysis must be completed OIP3tion 2: 1 7,80 C ' 6107.3.2 4 RESch ck—Web whi h can be accessed at http•//www enerYcodes. oy/rescheckl I3z`� OIVS' R. l S.TO XISTING BU11JDl GS.O VER 5 YEARS OLD *p Eldiags under 5 ye old must use opt) 1 or 42 in New Construction section above. Co�nplete the following formula to determ• e the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b- a) SF 100x :. _ g_ b a (b) Glazing area equals SF If glazing js<`40%.u9e;the below, y 40 % 0Cecc'd to "S OOM" section O CMR TABLE 6101.3 PRESCR-IPTI'VE NVELOPE C .MPO.NENT CRITERIA ADDITIONS TO EXISTING LOW-RxSE RESYDENTL41,BUILDINGS MAXIM MINIMUM Ceiling and ,Slab Perimeter ❑ Fenestration -Wall -Floor $asement Wall t R_Value Exposed floors. R-Value R-value R-Value U-factor R-Value and Depth .39 R-37 a R-13 • R-19 R-10 R-10, 4 feet - alue over the entire ceiling insulation achieves the full R v g u ed in lace of R 37 if the ins ul ) a R-30 ceilinginsula tion ma y be s Y P . area(i.e, n com ressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area�of the addition. t Note: Owner to fill out Consumer Inforination Form . found in Appendix 120T c@ f 9 � 4 _ _ �➢,e�,:` .( I� ....... ___ �'�.-- oor 1-0 Ile number 040617-12 UNREGISTERED LAND ' Attorn LAW OFFICE OF ANGELA PHILBROOK ^� Deed Book 12359 Pie 245 Lender: COMPASS BANK 1 Plan.Book 252 Page 32 Lots 56 ' Owner: HERBERT&LILLIAN DAVIS REGISTERED LAND i A licant: SCOTT&JENNIFER ANDREWS Rem Book Sheet Lot 0): Date: 7/2/2004 Certificate of Title Assessor's Ma 1 Blk: Lot 30 Census Tract MORTGAGE INSPECTION PLAN. Scale: 1"=40' 28 BERNARD CIRCLE, CENTERVILLE, MA 6'6) She 1 Deck S \� #28 1� 1 St.ry. S. 3 Paved Q-6 y R=1 RER.NARD C ............................................................._............................................-- ........ .................................................................... ......... .......... CERTIFICATION .,�.r I CERTIFY TO THE ABOVE ATTORNEY,BANK AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING,FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BY LAWS IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS.GENERAL LAW TITLE VII, CHAPTER 40A,SECTION 7. ................... ............................ ...........--- -- _................ -.-............... . ----_-------..-----------. ... ........._............:-............._........_.... .- ......................... FLOOD DETERMINATION BY SCALE,THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL,FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY e 4 250001 0015 C AS ZONE C DATED 8/19/1985 BY THE NATIONAL FLOOD INSURANCE PROGRAM. i P� nrqs e � S,9 o=� DAVID y Otde Stone Land Survey Co.,-Inc. G. c •� N - .470 County'Street o GREENHALGH Taunton, MA 02780- NO.3461s A � Tel: (800) 993-3302 ESS\o�P ` Fax: (800) - 304 SUM �� O , PLEASE NOTE: This inspection is not the result of an instrument survey.The structures as shown are appr to only. An instrument survey would be required for an accurate determination of building locations,encroachments,property line dimensions,fences and lot configuration and may reflect I different information than shown here: The land as shown is based on client furnished information only or.assessors map 8 occupation and may be subject to further out-sales,takings,easements and rights of way. No responsibility is extended to the landowner or occupant and is not to be recorded. . Town of Barnstable Permit: r � `0� v � Regulatory Services Date: OpTHE T Thomas F.Geiler,Director °k �> P� Building Division Fee. BARNSTABLE, Tom Perry, Building Commissioner Ih(lOf s639. �0� 200 Main Street, Hyannis, MA 02601 Aleo �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE , SOLID FUEL STOVE PERMIT Owner: j Cr -� �z �j�� -rS' Phone: Install at: .� ` r i �'�r-rc✓� �/rc'..p Village: o Map/Parcel: l Date: C' Stove Ad�v, sed o _ B. Type: Radia P Circulating vt rn C. Manufacturer: Lab. No. ` ) D. Model No.: CnNe yjA 'Existing (If existing, please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? �o - D. Pre-fab Type and Manufacturer E. Pdasaty: Lined/Unlined Hearth A. Materials: B. Sub Floor Construction: (-e } Installer Name: r C Address:l� .f Phone: ( Location of Installation: 401--ze-1,te H.I.0 Registration # �"";�' � •=-� � DD Construction Supervisor# (4 6Z(r`7 OR cheek Homeowner,Installing, no license required N APPLICANTS SIGNATURE, �---- " APPROVED BY: C16V U. 1 Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector , t Q:forms:stove Rev 103107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street �< Boston,MA 02111• www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): . 10-4 Address 4.. Phone.#: -3 • 40/ � City/State/Zip Are you an employer? Check the appropriate box: .Type of project(required) 1.❑ I am a employer with 4• *11*a general contractor and I 6. ❑New construction . epeoyees(full and/or part tune)•* • have hired the sub-tach.contractors • [2. am a'sole proprietor or partner- listed on the'attached sheet. 7. [�eeffiodeling ship and have no employees These sub-contractors have g Demolition employees and have workers' working for me in any capacity. $, 9. []Building addition [No workers' comp.insurance comp. insurance. 5. We are a corporation and its 10.❑Electrical repairs or additions required.] ' 3.❑ I a homeowner doing all work . officers have exercised their ME]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12,0 Roof repairs . insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeownen.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 pub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. compensation insurance for my employees. Below is.the policy and job site' lam an employer that is providing workers' information. o Insurance Company Name:z4%I e��•r ��j C Policy#or Self-ins.Lic.#:_ ©�� 2� Expiration Date: -7 7 o /0 Job Site Address:�.�.1_1• 2`� - ��a-c P4'�� City/State/Zip:/& ' Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as.required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the IDIA for insurance coverage verification. Ido hereby certify under thepains•andp hies of perjury that the information provided above is true and correct. Signature: Date: — Phone# g D r0fj,7cially. Do not write in this area,to be completed by.city or town official: ' 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#: 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." Additionany,MGL ehapter..152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compl an 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-cont�actor(s)name(s),addresses)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate'line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used.as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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:. P Tbe Commonwealth of 1 azsarhusetts Depart=nt of ladusWal Accidents, Office of fnvestalgations 60t Washington Street Boston,.MA 02111 Tel. #617-727 4000 ext 406 or 1-977 MASSA.FE Revised 11-22-06 Fax#617-727-7749 .mass goat/dia THE FOLLOWING IS/ARE THE . BEST IMAGES FROM POOR QUALITY . ORIGINALS) I m �C&FL DATA , HIC Registration Lookup Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation RELATED LINKS y Home Improvement t Contractor i Registration Home Page Home > Consumer > Home Improvement Contracting > ............................................................._............... .........................._..............................._............................................. ,... ............................... Home Improvement Contractor Registration Lookup The list is current as of Thursday, September 10, 2009. You can search/filter the registration list by any of the criteria below. Search by Registration Number 164040 Search Registration Number Search by Registrant Name Search by City F77 .. . .. .... _. Zip Code Search Registrants 1 I Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION COMPLAINT NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS RICHARD 18 SPRUCE ST i SOARES, Kit-HARD {164040 1 8/14/2011 Current i SOARES W. gARNSTABLE;MA 02668 ;.__... _ 026 ©2009 Commonwealth of Massachusetts Nj:1ssstchusctts- Betr►rtmcnt of P Board of Building Rc u61ic sat.et�, Construction Su .ul'rtions;'"(ISt•ind:irdti License: Cg Pe visor License Restricted to:4 00, 267 RICHARDD ;SOARES' ` 18 SPRUCE$j 'w BARTNSTABLE, MA 02668 C'o�nnussiuur Expiration: 2/22/2011 Tr#: 10727 http://db.state.ma.us/homeimprovemenvilceiib%,%,..'-:_. , 9/10/2009 0KE Town' of Barnstable ermit p�� e1 Expires 6 Mkoiltlisfiront issue date 3 tnttNSrABC.e, � . Re'gulatory Services Fee MAS& Thomas F. Geiler, Director Building Division Z41cy Tom Perry, CBO, Building Commissioner .200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-740.:6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY // Not Valid without Reif X-Preys Imprint Map/parcel Number Property Address � C�Zvl ' esi dent ial Value of Work Minimum.fee of$25.00 for work under$6000.00 Owner's Name&Address=__51,C � � Contractor's Name �� Telephone Number Home Improvement Contractor License#(if applicable) PERMIT Construction Supervisor's License#(if applicable) JUL 2 8 2009 ❑Workman's Compensation Insurance Check one: TOWN OF BARNSTABLE 2Ia a sole proprietor - am the Homeowner ❑ I have Worker's Compensation Insurance - Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file: Permit Request(check box). El Re-roof(stripping old.shingles) All construction debris.will be taken to6,,,. Ff Ke-roof(not-stripping. Going over L existing layers of roof) fi El Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.. *"Note: Property Owner mu ign Property Owner Letter of Permission, H me Imp,p ent Contractors License& Construct Supervisors License is required. SIGNATURE: 0/ Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC Rcvise060,109 •M The Coin in onivealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 °�" :,•� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl / Name(Business/Organization/Individual): )c-14.' Address: Z� t City/State/Zip: �C'el�r�nl� f�1� GZ��Z. Phone.#: . ` Are you an employer? Check the appropriate bog: 'Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have 8. '❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. [� We are a corporation and its 10.❑Electrical repairs or additions 3.®I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' crimp. right of exemption per MGL 12 �oof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. M 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 31,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penaltie f perjury that the information provided above ifs true aQnd correct. Si<anature• f'� Date �l `l�V 1 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 S.Plumbing Inspector 6. Other 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 tiustee 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 notIbecause 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.licen'se 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«zth 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 youx situation and, if necessary,supply sub-conti actor(s)name(s),address(es)and.phon,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 permittlicense 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 " Address" (.he applicant should write"all locations in policy information(if necessary) and under Job Stte Addr pp (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 a license or en is obtaining li permit not related fo any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: , ' i r The Commonwealth of Massachusetts Department of Industrial Accidents Office of fnvestigatfons 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia f Town .of Barnstable Regulatory Services slttrxsr�r.e. Thomas F. Geiler,Director Building )Division PrfD '� Tom Perry,Building Commissioner -200 Main=Street-Hyannis;MA 02601 T rww.town.barnstable_rna.us Office: 509-862-4038 Fax: 508-790-6230 EIOMEOV NER LICENSE EXEMPTION Please Print DATE: � 2— � JOB LOCATION: .number street l village "HOMEOWNER': name ®® home phone # work phone# CURRENT MAILING ADDRESS: 69 0201 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. DEFIINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/sbe 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 Nwitli the State Building Code and other applicable codes, bylaws,rules and regulations, The undersigned."homeowner"certifies that.he/she understands the Town of Barpstable•Building Departrnent minimum inspection procedur d requiremtuts and that he/she will comply with said.procedures and requirements. Signatzrro of Homcovmcr Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet, cr will be required to comply with the State Building Code Igt Section 127.0. Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is rcquiiod shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner.engages a per`on(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 assurrring the responsibilities of a supervisor(see Appendix Q, . Rules&Regulations for Licensing Constrvetion 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 bommwner is fully aware of his/her responsibilities,many communities require,as part of the permit application, ' that the homeowner certify thkt he/she undmtands 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 fom✓ccrtifi cation'for use in your community. IHEr, Town of Barn-stable Regulatory Services f f 9sxes[�$ 'Thomas F. Geiler, Director oa�� Building Division 0 Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town_barnstable.ma.us Office: S08-862-4039 Fax: 508-790-62 Property QwnerMnst Complete ax-id Sign This' Section If Using .A Builder as Owner of the subject property hereby authorize to act on my behalf, M all matters relative to work authotiwd by this building permit application for. (Address of fob) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Assessor's ma and lot number ....././.......................... p zr� SE IC SMU MM BE a ✓" INSTALLED NN COMPLIANCE 3 WITH-ARTICLE If STATESewa a Permit number ........ . .................................... SAN'TARY CODE AND TOWN Qy�`7HETo�I TOWN OF BA199 1ABLE Z.-BARBSTADLE� i no a Mb 9 R06LRemu NSPECTOR APPLICATION FOR PERMIT TO ..S.lY1 lP,, alrl ly„awpx nz................................................................. TYPEOF CONSTRUCTION ..........Y,Iood-fraras........................................................................:..:.................... j.4nuau.25....................19-n... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according.to the following information: Lot 56 Bernard Circle, Centerville, Mass.. Location ................................................................................................................................................ .............. ProposedUse ..residential .................................................................................................. Zoning District ..R.!.D'1... .......Fire District Centerville-Osterville .......:........... ................ �........................................................ Nottin hair Drive Centerville Name of OwnerNOY'?1ieSt Homes Inc.? _ Address a�.... ................................. ..................ti............ .............. ...................... y,�r Name of Builder Same Address :.....same e ....................................... ............. #...... none . Name of Architect ..................................................................Address ............................ ..................................................... Number of Rooms 6 ..............Foundation full 1OT concrete .................................................... .................................................................. halt Exterior ...............................S1d11.19...........................:.. ....Roofing .a .?........................................................................... r t .................................Interior .. �C .!N �. ,................................................................ Floors ....................................ca....p.e......... � Heating .......................... ..................................Plumbing .2....bathS.............................................................. Fireplace ..........................Ye.S................................................Approximate Cost ...... ........................ Definitive Plan Approved by Planning Board ________________________________19________. Area ....A.'�..`..Q 00....s��. ...:......- � � �t Diagram of Lot and Building with Dimensions Fee ......... .V..�...................... y SUBJECT TO APPROVAL OF BOARD OF HEALTH L �y J �d 0o M i le - I I hereby agree to conform to all the Rules and Regulations of:the Town o arnstable regarding the above construction. Name .. . . .... .... ........................... Normest Homes, Inc. 16856 one story, No ................. Permit for .................................... single family dwelling -Bernard Circle Location ................................................................ Centerville ............................................................................... Owner ormest Homes, Inc. Type of Construction frame ................................................................................ Plot Lot .......#56.................. ............................ Permit Granted ........Janua.r�r 28 19 74 Date of Inspection .......19 ..... ... .. . ........ ... .. .... + t Date Completed 9 I PERMIT REFUSED I i ` ............................ IC.. ................. 19 ......................... .... ...................................... .............................................................................. i ............................................................................... Approved ................................................ 19 ............................................................................... ..................... ......................................................... f yv 1 r• 5 b C, }r V 4 Ll its OFFICE AND MODEL HOMES: ASHLEY DRIVE, CENTERVILLE, MASS. TEL. (617) 775-6812 (617) 428-9101 fi G A, r ILE The 0stervifle One of the most beautiful and practical homes designed to provide every convenience. Large foyer with WOODDEC%WTHSE^* guest closet leads to spacious living room-dining room combination. The magnificently treed outside is seen through sliding glass doors opening to a large wooden deck. 2 full baths and 3 bedrooms with large closets (one bedroom is beautifully wood panelled for use as a den). Wall-to-wall carpeting throughout. Intriguing B SLIDER kitchen features Whirlpool appliances, including self-cleaning range. Oversize garage and full basement. DEN Professional) landscaped for easymaintenance. KITCHEN 12'-9"%,0 BEDROOM 11'9"%12' DINING 11 9"%12• VO W-OR ANDING HALL 26' Builder on premises daily (including Sundays) 9 a.m. —6 p.m. GARAGE c. L H LIVING ROOM - MASTER BEDROOM DIRECTIONS: - IS Cross Sagamore Bridge, follow Rt. 6 to Rt. 132. Right on Rt. 132 for 11/2 miles to right at traffic 9'0VE%HUD FOYER BATH f light (Phinney's Lane) 2 miles on Phinney's Lane to right on Rt. 28. 1/4 mile on Rt. 28 to right at I o Old Stage Rd. (Howard Johnson's and Mobil station at traffic light) 11/2 miles on Old Stage Rd. 68' to PINERIDGE on left. {! to e ttill rpd ty&}4 ISl{��StA`I`+ f> � ��ee iJaoivrnoouaea�ry�✓Ow4Jrtc�urdcha +f�� d„��,+ t", SOME G RUVtU EN LUN 1 Rn L TI U"t �+ j}4,ttn .r _ 11�rT�I� ,' 5 S I}r7fi ypit �' "491Y�y ki•; - + � i�I� J1'.1C J411): iitll Rd. ;q r i.. <a,Zill'iiS MAU2b01 �'ir�'$ x ADMINISTRATOR �� 1 �tirxY� j e #;�,e s �� Y �. F "IMP 3 '1 {.; .y A F p ++ " 6F�.I'fas. Q `�// �IMU)h t`A S+ ,Vof il t qq 4 IN q.°II �f 4 )))) 1 �y4r1f•f �I�1 EY>�� ,l lZ�1IIt`�! •1 y 1�3•N"1�' ( p ' x`• .� 19�Sy r rWAS ES 1ow 5 WHOM N .r Assessor's office(1st Floor): Assessor's map and lot n mbe 0 o� rwc To SEPTIC SYSTEM U.QX Conservation `? t Board of Health(3rd floor): EMSTALLED IN COMP Sewage Permit number ^ y g�®ps g� p@�p��I�TH TITLE::5 �tlIPffi®®tll�l�A�B�Ai�io®® _ 6 0. Engineering Department(3rd floor): � ¢�JS �,®�� ,��E��I®� o rsr►�� House number O E• Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BAiRNSTABLE M BUILDING 'INIPECTOR , , �Zxf� ,2x fZ APPLICATION FOR PERMIT TO ,�U��C.C� , �G V �� /N �a VG Ll �- (yo A)Cl c t �� TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: Th undersigned hereby applies for a permit according to the following information: T n k AAG V-q/- Proposed Use ��iv�� vL �CY-e�e- ✓ Zoning District 1« !r' Fire District k Name of Owner�/�i�Ali', C`�ra�,S �r�i 74 S Address SG �?�YN a kd Name of Builder kX Yz;a(-& Address Name of Architect Address ?4 — Number of Rooms �tv4 Foundation Exterior G h 6~� S Roofing S rs�1't Floors Interior ✓ e Heating A/U Plumbing �LD Fireplace A/U Approximate Cost Area 131? oO Diagram of Lot and Building with Dimensions Fee 1 a tib IV \ 36 �Z o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �`•� Construction Supervisor's License 0173 D / GILLIS, FRANCIS I/r li No 35866 Permit For ADDITION iyw - r Single Family Dwelling Location 28 Bernard Circle l Centerville - Owner Francis Gillis Type of Construction Frame t Plot Lot A r Permit Granted May 13 , 19 93 Date of Inspection Date Completed /LG U ' 19 T s r - + t r� a 28 Be a �