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HomeMy WebLinkAbout0094 BIRCHILL ROAD ACTIVE r 9lisll y �t p Town ®f Barnstable *Permit# � Expires 6 months from issue date Q Regulatory Services Fee 4) uxxsrnBt.L. MASS.639. Richard V.Scali,Interim Director 1 ��� pp�� Building Division -PRESS PEROMOT Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 SEP 112014 www.town.bamstable.ma.us TOWN OF B nI Office: 508-862-4038 ^�d�tl� F230 EXPRESS PERMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 189 t�oZ Property Address 94 1 rch -111 0 Residential Value of Work S �a 8q, �® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address (Pef ey- pV nson ► q4 By-chill Rd ,C Q 1ot-9 j1)111_a , MR . c�,l o3a Contractor's Name`O Ui P1J�n IV t U1'lod QuL/Binan Telephone Number!}b i ` qy 0D Home Improvement Contractor License#(if applicable) �-]j�`� Email: Construction Supervisor's License#(if applicable) (')Cj F-j(j`- X Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Arocnota l iisumnu �& - Workman's Comp.Policy# q "I 3 94 Copy of Insurance Compliance Certificate must accompany each permit. 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) ❑ Re-side `? Replacement Windows/doors/sliders.U-Value e ® (maximum.35)#of windows J #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked-with red S and inspections required. Separate Electrical&Fire Permits required. ''Where required: Issuance of this permit does not exempt compliance with oilier town department regulations,i_e.Historic,Conservation,etc. ***Dote: Property Owner must sign Property Owner Letter of Permission. A copy of the home Improvement.Contractors License&Construction Supervisors License is requ' SIGNATURE: T:\KEVIN-D\Building Changes\EXPRESS PERAUDEXPRESS.doc Revised 061313 • Renewal Ra Uuon,ro31Ar.I atA LaXltfc Tl.179Y49 Andersen. RENEWAL BY ANDERSEN �Lk—„00,� WINDOW at rc�r ..,tea®�, 26 Albion Road • Lincoln,R102865 r Phone 866.563,2235.-Fax 401.633.6tiU2 ED Southern New snslan d VAndows,LLC dib/a . _ Renewal by Andersen of Southern New England CUSTOM WMOW AND DOOR REMODELING AGREEMENT ems) el 6 +�So�nl Date&AVeement � &averts)SwainAddm&Cky Smmwd Lp' .l P-O-.Boic t—� ,�C� .!-•-��'V�� " Ed4ilAddress: NemeT an JIM Buver(s)herebv.jointly and severally agrees to insrchase the products'and%or services of Southern New England Wwdows,LLG d/b%a Renewal by Andersen of South er t New Englaiid("Cionractor"),in acesirdance with the terms and"rpnditions described-on dui front and the•reverse of this agreement and on the attached specification sheets)(collectively;this:Agreement"):: f7 Historic 0!tondo -li HOA? 4 ,' Amounts o1?8 Eubmted Startin pate Method of Payment O Check LP&h b Financed Received 7060it '� 7 � Credit C"are accepted for deposit only-maximum 113 of the.' Balance at Start of Job 3%:V I � prof�(P�-see Ciedt Cwd ftne+rtf6m)By:si 8 J �. ) Estimated Completion Dace Agreernenu you acknowledge ehatthe Balance,at Start of Job and the Balance on Substanpal` g(� 6-�(„I�C Balanegon tial Completion of,ob camoc be made by credit Complath;*Job(3�)p / / card and be made by personal check.bank clued!:or cash. Buyers)agrees and understands ehatehi6 Agreement consdentes the entire und, ":landing between the parties,and.that" Were are.no verbal aodetstandiogs changing any of the terms of this•Agreemen Buyes(s)acknowledges that,Bnyer(s) (1)has read dds.Agreement,understands the terms of this Agreement,and-has vet a completed,signed,and dated copy of this Agreententi"including the two.attached Notices of Cancellation;on the date, itweitten wa'nborie-and(2) s orally informed of Buyee's right to cancel this Agreement..'DO-N-.OT SIGN THIS CONTRACT_ THERE ARE ANY BLANKSPACES. 0h0de island Sales Only)Notice to Buyer.(1)Do not sego - any p - agreed tail Agreement if•" of the s aces intended for the - terms to the event of then available information are left blank.(2)Yon are entitled to a copy of this Agreement at the time you'sign it.(3)You may at any time pay off the full unpaid balance due under sa dais Agreementi—din so:doing you uaay be entitled:to ieive a ec partial rebate.of the finance and iusuranoe-charges.(4)Th`e'seller bias no right to unlawfuny eater your premises or commit any.breach of the peace;to repossess goods purchased under this Agreement.(5)Yon'may cancel this Agreement N it has not been signed at.the main office or a branch:ofSce of the seIIer,provided you,nodfythe seller at his or:her main office branch offitz shown m the Agreentent by regisdered.or certified mail,which.shall be pos t not later&an,midoigbt ; Of the third calendar day after the day on which the buyer signs the Ageeeanent;"exc(ndingSun ho)id day and any sy on rvhioh regular mail deliveries are not made Seethe accompanying notice of cancellation form for an explanationof buyer's rights. Buyer(s)receivcd the consuincr education Taten pro%ided,by the Rhode Island.Contractors Rc t,, ton Board. (Bgyrr Inrl&) Renewal by And of Southern Neiv England- it r Buyers) By: Si aturi c duct.Mansger $ignalinri Print Name of Product Ntatrager, Print Name Print Name YOU,;THE:BXMAR(S), MAY:CANCEL THIS TRANSACTION AN'AT. Y TIME PRIOR TO MIDNIGHT OF,THE THIRD, BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE"ATTACHED NOTICE OECANCO"14ON FORMS; FOR AN EXPLANATION OF,THIS RIGHT. mgn E LAT N ' 't— - - NOTICE OF CANCELLATION Date of Transaction :You may cancel Date of Transaction You may cancel this transaction,without - y n or obligation.within this transaction;without any:penalty or obligation,,within three business days from a ove date.If you cancel,any I three business'daps from the above date.If you cancel;any Property traded in,air y payments.'made•by you.under the"I Property traded m,any Payments made by you`under-the Contract or Sale,and any negotiable instrument executed i Contract or Sale,:And any negotiable instrument executed by you wil.I be returned within ten 6usintiss days following I by.you"will.be:returned"within,ten business days following receipt by die Seller of your cancellation noticei aiid.any 1 receipt.by.the Seller of y6ur`6keillation notice,and any security interest arising out .of the transaction will, be security interest arising out of the transaction will" be . . i anceled.lf you cancel,yyoou m��ust make available to.the Seller I canceled.If you cancel,yyoouu must make available to die Seller at your residence,insubstantiapy as good condition as when at your residence,in substantiaily.as,good'condition as when, received,any goods delivered to you tincler,this Contract or I reWwed,any.goods delivered to you under this Contractor. Sale;or you may,if you iriish,comply,wrth'the instru iDni:of .t :Sale;or you 6;%if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Sellers expense'and risk.If you do make"the goods available Sellers eexxppeense and risk.If you do make;the goods available to the Seller and;dte Seller does not pick them up within t' to thii Seller and the Seller does not pick th e»i i,up within twenty days of the date of cancellation,you may retain or I twenty of the date of cancellation..you may retain or dispose of the goods without any further obligation.If you I di;pose, e goods without-any turdter obligation.If you fail to make the goods available to the Seller,or if you agree. I fail to make the goods available;to the Seller.or if you agree to return the g'od3 to the Seller and fail to do so,then you I to return the to the Seller and fan to do so,then you remain liable rperformance.of all obligations under the remain liable or performance of All'obligatioris'.under the Contract.To cancel this transaction,mail or deliver a signed ContractTo cancel this transaction,mail or deliver a signed and.dated copy of this cancellation notice or.any other" l and dated.copy',of this cancellation notice or:aryl otter writteri noticeior send a telegram.to Renewal y der sen of I written notice,or send a telegram to Renewal byAndersen of Southern New En land at 26 Albion R p1 1 2865, l Southern New Eng1itd at 2 Albion Road,Lincoln,R102865, NOT LATER THAN MIDNIGHT OF • " Sl NOT LATER THAN NIDNIGHT OF (Date).. I (Date) i HEREBY CANCELTFIISTRANS CT. 1 HEREBY CANCELTHISTRAPISACTION. • 6u►er's Slgtautre PAL Mama Dace 61ryer's Slptatun - PAt Noma Bate . . .... . RbA Copy:White Buyer Copy;Yellow Buyer Copy;pink Southern New England Windows d.b.a Renewal by Andersen of SNE ., Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ,; License;CS-095707 tip,,-I•, BRIAN D DFNNIS,bN 7 IAMBS POND Chariton MA 01567 Expiration Commissioner 09108=16 �paar�rt izraecu s zrWJa 'g'gWe . Office of ConsumerAV Irsd Business Regulation 10 Park Plaza—Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type:. Supplement Card SOUTHERN NEW ENGLAND WINDOW$.Ll Expiration: 911912074 DENNISON BRIAN 1137 PARK EAST DRIVE. WOONSOCKET,RI 02896 Update.Address and return card.Mark reason for ehange. sat 0 2w h5mI ©:Address Renewal 0 Employment n Lost Card. (gee ofCovsvmer ARxtrs&0usmessRegu1 uon License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration data if found return to: Office.of Consumer Affairs and Business Regulhtion �! Roglstro0on.773245. Type• 10 Park Plma-Suite 5170 ` Expiration:.9/1912014 Supplement:aN Boston,NIA 021 id _ SOUTHERN.NEW ENGIAND WINDOWS U.C. " RENEWALSY.ANDERSON° NISON 1137 PARK BRIAN 1137 PARK EAST DRIVE WOONSOCKET;RI 02895 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of IndustnalAccidents Y� Office of Investigations I Congress Street,Suite 100 r. =� Boston MA 02114 2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Au R icant information Please Print���ibly Name (Bus-Bess/organization&dividual): SOUTHERN NEW ENGLAND WINDOWS LLC Address: 26 ALBION ROAD City/State/Zip: LINCOLN, RI 02865 Phone#: 401-228-9800 Are you an employer?Check the appropriate box: 1. I am a employer with 20 4. [] I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling slip and have no employees These sub-contractors have g E3 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.? 9• ❑Building addition required.] 5. 0 We are a corporation and its 10.®Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself. [No workers comp_ right of exemption per MGL insurance required.] t c_ 152, §1(4),and we have no 12.0 Roof repairs employees. 1J.M Other WINDOW REPLACEMENT [No workers' comp. insurance required.] 'Any applicautthat checks box'I must also fill out the section below showing their workers'compensation policy information. Homeo,.VnerS who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. =Con tractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site it formation. Insurance Company Name: ARGONAUT INSURANCE COMPANY Policy T or Self-ins. Lic. #: WC927938352394 08/21/2015 Expiration Date: Job Site Address: p 6 ^ ,U/,! !LF �� Ci /State/Zi W l and e�iration date). Attach a copy of the workers' compensation policy declaration page(showing the policy number Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties 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 d a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fonuarded to the Office of an Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trace and correct. 3 Signature: ���,,, Date: Phone 4. 401-228-9800 Official use only. Do not write in this area,to be completed by city or town official. City or o�vn: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumb 6.Other ing Inspector Contact Person: Phone#: r AC Rd' CERTIFICATE OF �� `,� LIABILITY INSURANCE 00/12/2014 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: N the certificate holder Is an ADDITIONAL INSURED,the POIIcy(les)must be endorsed. It 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 endorsemsnt(s PRODUCERl/illin of New Je rsey, Inc. c/o 26 Century Blvd ' PNOrBe FAX P.O. Boat 305292 1- 7 - 3 67-2 7 EalA1L Nashville, TN 372305191 VS& :cutificatesewillim.con INSURER 48)AFFORDING COVERAGE NAIC 8 INSURERA:Belective Iasurance of as 39926 INSURED Southern n am England Nindors LLC INSURER B:The Beacon mutual Ins:araace D/B/A Eeaeral by Andersen 24017 26 Albion Road INSURER t insurance 19801 Lincoln, RI 02065 INSURIMD: INSURER E: INSURER F COVERAGES CERTIFICATE NUM13ER4029160 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INER L LTR TYPE OF INSURANCE POLICY NUMBER Pip EFF POLICY':JP larfTS X COMMERCIAL GENERAL LIABRM EACH OCCURRENCE $ 2,000,000 CLNMS 41ADE OCCUR A PREMISES $ 100,000 MEDEXP one $ 20,000 8 2029459 08/10/2014 08/10/2015 PERSONALAADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER J� LOC GENERAL AGGREGATE $ 3,000,000 POLICY LnJ PRODUCTS.COMPIOPAGGR$ 2,000.000 OTHER: AUTOMOBILE LIABILITY ODk031NED SINGLE LIMB A xANYALITO Es a N ALLOWNED SCHEDULED BODILY KIURY(Par Peraon)AUTOS AUTOS B 2029459 08/20/2014 08/10/2025 BODILYiNJURY(pere ) X HIREDAUTOS X WNED N pRppySIM A X urreREw LIAB X OCCUR EXCESS LIAR EACH OCCURRENCE $ S1000.000. CLAIMS-MADE 8 2029439 08/20/2014 08/10/2035 AGGREGATE DED R�B4ilON $ 5,000,000 WORKERS OOMPBEATION $ AND EMPLOYERS'LIABILITY' X S'T�A OTH B ANY PROPRIETORIPARTNERMIECUTIVE YIN EMBBE EXCLUDED? a NIA E.L EACH ACCIDENT 0000068028 08/21/2014 08/21/2014 $ 1,000,000 M yyaapa,deserlbe and r EL DISEASE-EA EMPLO $ 1,000,000 DESCRIPTION OF OPERATIONS below EL pSEASE-POLICY LIMB $ 1,000,000 C ork Camp/EL Cant W927938352394 08/22/2014 08/21/2023 .L Ea. Accident - $1,000,000 tatutory Lindta - RC L. Disease Policr Lmt - $1,000,000 L Disease Be. Employee - $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Addtaond Remake.SgNduts,may be ztladied If mom apm b ragWW) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I southern nE LLC AUTHORIZED REPRESENTATIVE 26 Albion road _ A ' cola, lu 02063-0000 r�ta4�J 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD OR ID:6629625 BATCE:Batch M: 79627 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map , / Parcel Permit# Health Division (� G owi�, r 3" � Date Issued 3 • Z �d Conservation Division d S ®� �'/ � � r Fee- Tax Collector Ib TreasurerL4_A_JL�� ct.2l e� �T t �le�ZO C G Planning Dept. fy A Date Definitive Plan Approved by Planning Board Historic-OKH A)A `' Preservation/Hyannis Project Street Address Cf Aiv-at al aw Village Ce;l V I to mk, oa& 3 c;z Owner -f fOK _-Jo� Address 9 ,/ ; i �`�/ Ce,i-lec^v re Telephone 5_0 2- 7 7,K- 6& Z.K Permit Request "I- 4 • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 7� Valuation ,If® °O Zoning District ?(� W Flood Plain G Groundwater Overlay Construction Type wand axy 6& a9 Lot Size Grandfathered: ❑Yes a No If yes, attach supporting documentation. exr y r . Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structured Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes A No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Others itrc� iLtrry.e Basement Finished Area(sq.ft.) Akyse 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: 0 Gas ❑Oil ❑ Electric ❑Other AJv hec& ��► Central Air: ❑Yes X No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No ached garag :❑existing to new size ;LYxad 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 Sf No If yes, site plan review# Current Use Proposed Use C a.r :5 TU"6.9 BUILDER INFORMATION >- h e r o-e ° Name Telephone Number Address License Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RES G FROM THIS PROJECT,WILL BE TAKEN TO SIGNATUR r DATE 711f 0 + FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED `"_: .y ' MAP/PARCEL NO. a �' s 4 ADDRESS a g` "" . VILLAGE OWNER 3 DATE OF INSPECTION; - FOUNDATION FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ,ROUGH FINAL FINAL BUILDING ' 1-r {• Cam.—D,^ ! x. f t ' J a .. . DATE CLOSED OUT T f ASSOCIATION PLAN NO. _ � r Yt �¢ N LOTTO & 2 35500 S.F. �3 i S �V ' L=1200 CERTIFIED PLOT PLAN I CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN IS LOCATED ON THE FOR GROUND AS SHOWN AND THAT IT CONFORMS 94 BIRCHILL RD. , CENTERVILLE , MA. TO THE MINIMUM BUILDING SETBACK ASSESSORS MAP 189 PARCEL 21 REQUIREMENTS OF THE TOWN OF BARNSTABLE. PREPARED FOR PETER & SHARON JOHNSON OF AZgS s SCALE: 1" = 50' DATE: AUGUST 24,2001 STEWN by WELLER & ASSOCIATESp 1645 FAI-MOUTH RD. - SUITE 4C CENTERVILLE, MA 02632 (508) 775-0735 J _ • 1 1 11 1 � 1 1 1 1 11 I 1 • r I lei 11 161 1 1:1 It 7I0 • 11 1 '1 11 ' 117111111 ■ 11 1 - /1 1 1 • 1 1jill, '• •'• 111•- / 1 • 1 • 11 ' :11111 • ' 1 1,� 1 ' • 1 1 •1 �1 11 , 1 ' N 1 11 • • •1 . � • _ � 1 1 I 1 1 \` 1 1 11 LI •� I � a, , .11 • 1 1 �. 1 � .. 1 1 . �• 1 .• • 11 I . 1 , „ t /////O/00///////O///%%%//// / NMI! Ix 1 , , : , 1 _ ryti i I i titil IN • i, . I jr, • T I , . II 11, '•u 1: 1, iuse oldy lot wrfte in d&arm to be compkled by city or tons offlcial ■ i. I Omming Board ■ „ , _ ■ • i, . sponse is required ■ Depuftcut ■ • contact person: phone Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than.three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, consa=on or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. °-Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and address and phone numbers along with a certificate of insurance as all affidavits may be ' supplying company names, _ ,submitted to the Department of industrial Acadents for confirmation of insurance coverage. Also be sure to sign an 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' compensadda policy,Please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please __ - number. The affidavits may be retntned to eimit/license number which will be used as a reference Y to fill in the .. _ be sure P the Department by marl or FAX unless other arrangements have been made. i The Office of Investigations would like to thank you is advance for you cooperation and should you have any questrons. 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 Me of IWBsduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat, 406, 409 or 375 of VIE r : . The Town of Barnstable 1AMSMU • MASS ��� Department of Health Safety and Environmental Services 'OrEDMD'tA Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the`reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: a1 f� /rtt�r�a a NeG .5 �%�5 Estimated Cost—AQ-.DOS Address of Work: !Zf/ 2d C -k-r-y6�/P hO 0.;2 63.), Owner's Name: Jy' -F- 5ti� p �D ham, c�= Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ®Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR - �v oho rrn1. 7 � -D a Owner's Name q:fomis:Affidav ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot Total Estimated Project Value For O tce Use Only Inclusiona Aff rdable Housin Fee idential 0 Commercial" Property Owner's Name Project Location Project Value Permit Number **Existing Sq. Ft. ** posed New Sq. Ft. Fee $ IABFORM 1/3/00 � "pF"E t �7 �O • The Town of Barnstable BARNSTABMASS.`� ' Regulatory Services 9 tHass. �' g ry '9 163 �0 ArE s Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 0260.1 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE: /f n,� JOB LOCATION: Q'*r fILGt i/� v 4�'- ` Ile 1y(, D 1,3`� number street village "HOMEOWNER": i oh nSa7L 500�i —77�`�i�y7�{ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners'was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or . farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re irements. Si azure of Home er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules.&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN i :CI hNr 61 VAT/(2.) - erw --g It YA-,l I — _ III I I III C EI.•!1 M1kVf•• _ i' i L FtONM. WALLY i V'-O•mi/ ). Oetow a2aoE P ANCHOP. "BOLT PEX• CODe Y oy AAUP PR.00T -&t--- GRADE 4 CONPA-r FILL h F Y`C00l, 5LAO SLOPED I � i i' nknP CON/ +,-- ._.. OH. DOOR y-n. ao.(y i 3g•.n. I-- z A.n,. �G�R f2tA A). S(ACE 1'-0- tO u,VJ fi770 A7 VLA'.O- l�,�•O" .lx-O fLID6e - 7 �NO VENTIN() A30PALT r-oOF /SAI fEGf „pC• d VVEL to x PL CNO 1aU77CRj� ; �� - IX 69AyCIA- SO Ff('I KOV(.H (Nu iA.IE L0 ' LV�- N'EADfrR J-.7XV TPA ilArtV _ 91�Q'sluo} 7)LV>c/L'CX w4 Ix6 cno) �oucw) 00k10 BLOL/L /, WAy VP _ , IxS TR.Iwk 4 O T•/-// iIDIN6• /`t✓�8'Gt�14 q oo O &0 INyUGA nO✓� v�, �q2 p a+b PT.s Ik L W/SEAL ,ANCNOC BOLT /}2 CCDE 4f I cq CONI• r-rb. V'M/A/, � * PIELOIJ 6A4OL — — DAAIP PkOOF $FLOW 6/NDE Y"coVr. SkA3 5LDPe'D CON C. AORON TD GRADE The Town of Barnstable BARMABIZ MAS& �0� Department of Health Safety and Environmental Services � " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner September 12, 1994 Ms. Sharon Malone 94 Birchill Road Centerville, MA 02632 RE: A 189 021 94 Birchill Road,Centerville Dear Ms.Malone: This office is in receipt of a complaint alleging that you are operating a business at the above referenced location. In addition there is a sign advertising same on the premises. The property is located in a Residence C zoning district and only single family dwellings are permitted. There is no record on file of a Variance to permit a business use of the property. Please contact this office immediately re the above matter. Very truly yours, CIoria M.Urenas Zoning Enforcement Officer GMU/gr l� z4w 9-a6- 9y �� .� ' I! � - . ,� .r _-� I � ���-� � _Q� — ��� .. � � ��� ��� 9� � -l� ` C���u�� ��- o�3� 3 or"'I R18'P 021 . LOC 0094 BIRCHILL ROAD CTY 10 TDS 300 CO KEY 110150 - ---MAILING ADDRESS----- -- __,CA 1011 PCs 00 YR 00 PARENT CROCKER, jAMES H JR MAP AREA 41AC iv MT'!`: 2001 P 0 BOIXI 45.!6 S P.11. SP2 UT 1 . 82 SO FT 1464 OSTERVILLE MA 02655 AYB 1966 EYB 1975 OBS CONST LAND 32800 imp 98700 OTHER --- -LEGAL DESCRIPTION---- TRUE MKT 131500 REA CLASSIFIE.'_.' #LAND 1 32, 000 ASO LND 32800 ASD imp 98700 ASD OTH #BLDG(S) -CARD-1 1 90, 700 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 94 BIRCHILL RD TAX EXEMPT ORR 0124- 0196 0027 0161 RESIDENT'L 131500 131500 131500 #SR AMES WAY OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE 05/94 PRICE 87600 ORB 9194/262 AFL: I L LAST ACTIVITY 08/15/94 OCR Y 04� a�RM MnBM The 'Town of Barnstable ' Department of Health Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner September 12, 1994 Ms. Sharon Malone 94 Birchill Road Centerville, MA 02632 RE: A 189 021 94 Birchill Road,Centerville Dear Ms.Malone: This office is in receipt of a complaint alleging that you are operating a business at the above referenced location. In addition there is a sign advertising same on the premises. The property is located in a Residence C zoning district and only single family dwellings are permitted. There is no record on file of a Variance to permit a business use of the property. Please contact this office immediately re the above matter. Very truly yours, CIGM.Urenas Zoning Enforcement Officer GMU/gr x 0 M Gc�C-7cgy.0 , -cameo .l3Y 3 � ,rl� f a C 0 U i :- i P4 N .. I W o U w � COD a, o \ cw o a d w o 3 3 ti � — ' �a a•, ALf ►) A BAHSSTABLE TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 1 TO THE INSPECTOR OF BUILDINGS: The-understgned hereby appHes-for a permit according to the following information; Location^ Proposed Use Zoning District Fire District Nome of Ovyjer^T/!^!..?...Address .... Name of Builder Address .... Nome of Architect Address Number of Rooms .1?!^..Foundation .0?.Roofing Floors Interior Fireplac€ Difinitive Plan Approved by PlanWfng Board Diagram of lot and Building with Dimensions Heating Plumbing ^y^frrT-. .Approximate Cost 19 '"77W's.r -fee 7-^ I hereby agree tg conform to construction. Nami .Small,Alan No Permit for s in£l©f a^lj dw®.Ipjg Loca tron^.*:!rchill..^ad CenteryiU.© Owner Type of Construction Plot Lot .iz. n .j March 9 lo 66PermitGranted19 Dote of Inspection 19 Date Completed 19 PERMIT REFUSED 19 Approved 19 % !(; f V *> 'Is: