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HomeMy WebLinkAbout0025 BLANTYRE AVENUE y � "�' �- � , s rt — . . �� o _ - � .. .x �, ;� ._ � . �. s . fl � � o ,. .�.f a. v . . ,. -- - ---�. s — -=�, 3, u w ,. a ,a �. �i — ,, .. � a � � .. Town of Barnstable Building il?ostF` his Gard ffi- tart rs as>bl From the Street A roved Tans Mus# a Retained on Job and this Car Must be Ke t �R := here �C�ertificate�of®ccu an °�srRe; uirecl,such Buildin"$ hall�Not be Occu ied'un#il�a� anal Iris action has�een'�nade, Permit Permit No. B-17-3111 Applicant Name: THOMAS R. DEMAYO Approvals Date Issued: 09/25/2017 Current Use: Structure Permit Type: Building-Deck Expiration Date: 03/25/2018 foundation: - Sonars Location: 25 BLANTYRE AVENUE,CENTERVILLE Map/Lot 228-025 Zoning.District: RD-1 Sheathing: 14 Owner on Record: LONGO,DAMES L&JEANN£'M £'; Contractor Name THOMAS R.'DEMAYp Framing: ro s�/�7 7e/HG Address: 4 FAYE LANE ` Contractor Ucense 183850 2 4 _..... .. . ._.: _: LONDONDfRRY,NH 03053 r of ectCost: "$40,000.00 Chimney: Description: Construct Exterior'Deck,made from,P.T. Lum a 3St�pported on Permit Fee: $110.00 Concrete Sonotubes. Insulation: '. `FeePaid° $110.00 APPROX 25:X.35'RMCK Date 9/25/2017 Final: ... Project Review Req: Construct Exterior Deck,made.from P.T-Lumber Supported ones -,r.� Plumbing/Gas Concrete.Sonotubes. o um Rough Plumbing: APPROX 25 X 35 RMCK ' Building Official final Plumbing: Nall This permit shall be deemed abandoned and invalid unless the work aut d-rized by this permit is commenced within six months after:issuance. Rough Gas: All work authorized by this permit shall conform to the approved application nd tFie approved construction documentsafNEW ch hi permit has been granted. j All construction,alterations and changes of use of any building and structures shall be in compliance with the local zorungby laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street ov So and shall.be maintained open for publk ins cttop 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 i3uildingandfire Officials are prove on this permit Service: - Minimum of five Call Inspections Required for.All Construction Work: § �, 1.Foundation or Footing 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 S.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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, r Parcel UQ Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee t.. N Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -Zs- C.-5 tx<— Village �!Cn -tf_r u d(- Owner Y�Cf V11-t's L_0 0 Address 5 Telephone Permit Request Coy1 �1 �-r L tc_4 �,O_ o-o-r &ckf rK ac. .e -Prey Q ym tr Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District -a qFlood Plain Groundwater Overlay Project Valuatien 4Q' 0_b)-Q Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure S'0 ` a+-� Historic House: ❑Yes Flo On Old King's Highway: ❑Yes 0 I'I�o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: , Z Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# p Current Use Proposed Use M� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name / " t/yh as It Mew U Telephone Number 3&q - 1 Address 9 5- IU)1 '�Lil Vlo(3 Lw License# o-5-7 "a 3 3 (" 6-el rn; 4-6)'' � Home Improvement Contractor# 1�'3 Email �� `� G� w►� �°�'� f'l-, ' orker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO d3`I Dt"jps tit SIGNATUR l. .t�' " DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` a�' u�arrss - �98�as�rg�oAet - ' vcrvrR�e�g �a Workers' C®pensafinmIcs AT1ixvit APPEcau#Infk n ffin I''dease Fri Env FUG fl4w,-n az LA S ZCeuk - Are}m an a [pbyer?.Clie ktiue agpragriate ba= Type of I-❑ I am a�PL�� � 4. ❑I am a general c�:actr ad I P�1wt d}=employees(full andfor Fart-sme * hiredit � El New ooastr� ddiag 2-❑ I am a sole prnpdntar orFsrtm— atta* sbeeL ?- ( e° �Ysese smb-com�xadn�.ha�e • s�and Isar on errFPi�� _• �. �]I3emaldiorF andhave ems'' waling forte is any ° 9. Q:aa a�ag Camp.wadonw - a comp' # m7im -] . . ' 5. ❑ We arc a and ifs 16:El Elechicai repaim or ad s 3-❑ F ama hams doing ag vo& affioers nave used t 1L❑MMAiMgMPe=ar adaious MYNrigbt of a per li�fM �� �- �.�sz,g�{4k�a,�awe ma eMPUTem required-1t {^. [No WO&E& 13-0ff m k � cam- -] f far �s'lamsta1wfMcv11bemcfieabebar I &ffrwa&mec�pPw=ff p'Tgi ML ��omevsvaga�m said das ef�dac� t3�ep��sg��dHieah�ocem��sn�micaaess�daeit �, fc��B�ceYe�rtl�sb���,e�ffi.a�i6�slsi�eets5a�gthea�otthe �ast�te��eraocE�ase�b� emp9opees Tff ml)- as have Mey--pmvide twgr$at7 '=MP Parmy MM'M I arrt au eutp er tiiatis praufdirg�varkeas'ca sa�ioort iies�raats f ar �PIo3' Hdow is tFrs prr&rp and jab sue BLSMMComgaayxsm Pd&cy¢or Sf im Iia Job Site Addm =-D(S- IQ�L'f�'1 le 41/� Aftach a cuff of fie warkere comFewafimPolicF declaratian 1a'(shwwing Me poFcy number and e3q&zdoa fie). Fa&m to semen eovemp as requirednudes Sergi 25A of MsI.c�M can lead to tm impositi=of cri-in—A peaa}tses of a figs up to$L50D Oa endfor a e-yearimpasso as w&as civd peaakies m flee f=ai of a SAP WDKK OBDERand a ffne o€up to$25=a day ag—Arnst the vialainr. Be a&ised fbat a copy offt sh&=erd maybe fzvarded to IbB Office of IQv ofthe DI&for coverage vim. 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O.1 • it•: I a a ■■ UI Ilan■ - •rnl .L n ►�■ 1 it•. 1 nta . i71.• • 1 .•: -. i:f •�■F - ■■of - a••■�' •1 ••1. �.+. •.•dram ►LI■ ■; •.:/n 1 a• :n�/ l■ ..■• 1■Yal�. • .not n r1_ Lf/IOI - ■.• ram. • a man 1 s ■am �■ rt. a«R m � �a m .. r• rnnu �r u n•_ 1 a � G■ • ■ •.+■•:o■n •••a . .. n n_ra. ••a rt :••_n r. m •n ...•� .0 n■ :n. t•a a -.■ r_ ..■ ■.:+■m .tl i ��...inn• .�±■ ■ �� r■ 1 Town of.Barnstable Building Department Services s� Man Florence, CBO R Building Commissioner a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section , If Using A Builder I, J 4 V�' l7 ,as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final ' inspections are performed and accepted. 0 igna a of er Signature of Applicant ! A Print Name Print Name Aut Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Q, Building Commissioner 200 Main Street, Hyannis,MA 02601 >aASS. www.town.barnstable.ma.us 1619. ll� Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEN=ON Please Print DATE: JOB LOCATION: number met village "HOMEOWNER": 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 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 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certirication for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 0&/16/17 �� y ACC DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/5/2017 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Jill DeHetre NAME: Cross Insurance-Wakefield PHONE (781)914-1000 FAX C No (781)224-5777 A/ 401 Edgewater Place Suite 220 AIL ADDRESS:7dehetre@crosaagency.com INSURERS AFFORDING COVERAGE NAIC S Wakefield MA 01880 INSURERA Ohio Security Ins Co 24082 INSURED INSURER B Associated Employers Insurance Thomas DeMayo INSURER C: 95 N Winds Lane INSURER D: INSURER E: W Barnstable MA 02668 INSURERF: COVERAGES CERTIFICATE NUMBER-CL179521940 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/Y MM/DD/Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE OCCUR D AGE TOR NTED 300 000 PREMISES Ea occurrence $ BKS(18)58028711 5/12/2017 5/12/2018 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY 7JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employment Related Practices $ 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A �'�—�^-^ , E.L.EACH ACCIDENT $ 100,000 B (Mandatory in NH) �CC50050163412017A_3 8/22/2017 ! 8/22/2018 E.L.DISEASE-EA EMPLOYE $ 100 000 ff yes,describe under — -- -� DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �* Vincent Thorne/AH3 d� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INsn2517MAntt f ACCPRh® - DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/24/2017 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jill DeHetre NAME: Cross Insurance-Wakefield PHONE (781)914-1000 FAX (781)224-5777 A/C No 401 Edgewater Place Suite 220 AIL -ADDRESS:]dehetre@crossagency.com INSURERS AFFORDING COVERAGE NAIC# Wakefield MA 01880 INSURER A:Ohio Security Ins Co 24082 INSURED INSURER B: Thomas DeMayo INSURER C: 95 N Winds Lane INSURER D: INSURER E W Barnstable MA 02668 INSURER F: COVERAGES CERTIFICATE NUMBERCL1752410712 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR EXP LTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MWDD/YYY MM/DCY EFF DNYYY LIMITS R COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE 7 OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ BKS(18)58028711 5/12/2017 5/12/2018 MEDEXP(Anyoneperson) $ .15,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 x POLICY JECTPRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: Employment Related Practices $ 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE y I'E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A C (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ i If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Fax: 508-790-6230 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Vincent Thorne/AH3 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSn25 nmenti f ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $338.00 Ref# Description Coverage Code Form No. Edition Date Tax&Assessment TEXAS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $85.00 Ref# Description Coverage Code Form No. Edition Date Terrorism TERO Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $7.00 Ref# Description Coverage Code Form No.. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium, Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Limit 1 T� Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium. Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# i Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001,AMS Services,Inc. ' C�l26 (�'a99299267ZL!/ECGLGI&O��i G%p4dcZGlllCJe� —,. . . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:. a Registration:: '1,83850 Type: Office of Consumer Affairs and Business Regulation Expiration:``1i717/2017 Individual 10 Park Plaza-Suite 5170 -� Boston,MA 02116 THOMAS R. DEMAYO .'-"- THOMAS DEMAYO 95 NORTHWINDS LANE W. BARNSTABLE, MA 02668 Undersecretary Not valid withou nature Massachusetts Department of Public Safet;/ Board of Building Regulations and Standards License: CS-057233 Construction Supervisor THOMAS R DEMAYO {.. 95 NORTH WINDS LANE; WEST BARNSTABLE IM` •-0266 I Expiration: Commissioner 12/04/2017 _ .. - {� , . ��- ., . a.. . k _ - - s - x E1. .. �:. . i I // �� ( ,(, r�' T 1 NIAa _ c o 5� ��lt�(a i ov s� � ' � ' a2� - - 01 5: xr �e�7 �: , � � ( t,�y� I l I . J.:,..,. . . -,. { .. .....1 .. - I I _ . . ; . :, IIEE _ . rA�r J - ;: , ,, ,:. 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':A ?I .' +hL a is Yu A�� .6 9 GEI.1� 2.-�l1.L... DONALD I l�'EYER> 11 �in 1 ? _ m. Professioxal BueGJfapAssr I -�� -._ ,h G6� Q- S.O , Q eoMM x4 per/ V. _ R-"_-. .::' .i. ;.;.r: . - - --..--..;..... ... ,..:... m . . . ,n Now OT"p9swummy As 2-0 T ,07- - .: .- - - Of So.Ya uU',; A02686 -.---..Y.Vtv�7-,Y.-Pooql�� ,oq�-n�pgoom�, yz�,,�, �,!.. .. ,'�­:c'.,,.-:.---.�..­�, -�-.- .-��;.,*d,.,:..:.--.:,.",.,-.-..;�.,.-�.-*-..*;::,�,,�:1,1 . . ----. - (508)99i.5296 Town of Barnstable Expires 6 months from issue date s. �, i Regulatory Services Fee•8 v s's"'�' 8 16 Thomas F.Geflers Director Building Division E N Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 A U G 18 2 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL,ONLY Not Valid without Red X Press Imprint Map/parcelNumber Property Address i (�Resident* value of Wo_rki �2WO Minimum fee of•$25.00 for work under$6000.00 Owner's Naive&Address �T g :�;VS&n RA-44;z Contractor!s_hlame Telephone Number Home Improvemmt Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman'.s.Compensation Insurance Check one: I am a sole proprietor I an 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) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Gomg over existing layers of roof) 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 must sip Property Owner Letter of Permission. Home Impzovement Contractors License is required. Signature QFarms:expmtrg .. Revise063004 The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations -> 600 Washington Street y Boston,MA 02111' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organizationadividual): ae"L ILI) . Address: mil 7 City/State/Zip: Phone#• L�5 — 776 13( i Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or.additions required.] _. . 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.,[No workers' comp. c..152, §1(4),and we have no. 12.❑ Roof repairs insurance required.]t employees. [No workers'' comp.insurance required.] 13.❑ Other -------- *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `• t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.06 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 DIA for insurance coverage verification. I do hereby certify der th pains and enaIt. of perjury that the information provided above is true and correct Signafore: Date: O Phone#: Official use only. Do not write in this area,to be completed by city,or town offccia� 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#: t Information and Instructions .� N, Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. fined as"...eve in the service of another under any contract o , Pursuant to this statute, an employee is de "...every Person express or implied,oral or written." An employer is defined as -`an indivi¢ual,.:pa�e#ip,.assoc#tion,corporation or other legal emtity,or any two or more ed in a joint enterprise, and including the legal representatives of a deceased employer,or the ' � e foregoing engaged ] , of the g g individual,partnership,association or other legal entity, employing employees.'However:tlte receiver or trustee of an owner of a dwelling house having not more than three apartments and who resides therein,or.the occupant of the persons to do maintenance, construction or repair worknn such dwelling house dwelling house of another who employs or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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-contractors)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 y, members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have ed that this affidavit may be submitted to the Department of Industrial employees, a policy is required. Be advis 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 Deparanent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' sation policy,please call the Department at the number listed below.. Self-insured companies should enter their compen 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 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 oncicenses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents } office of Investigations ;. 600 Washingfon-Sreet� . Boston,MA 02.111. Tel.#617-727-4900 ext 406 or-1-.877-MASSAFE Fax#617 72 7-7749 -26-05 Revised 5 www.mass.gov/dia Town of Barnstable ��FTME 1p�O Regulatory Services ' Thomas F.Geiler,Director aAMUM31A pM 39: p�.� Building Division lfc�r Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us lice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: OS JOB LOCATION, �? /��Ci✓�Th�l� ffY� � r �✓� '•�e number V Z street village "HOMEOWNER!': ea, R9-7`71-Z_) z- 5'0b3-77j-7 36 j name // home pbone# work phone# CURRENT MAILNG ADDRESS: hle &7 i'vi le 1, -fldb�i city/town state up 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 ,,,;n;,mrrr ' ection procedures and requirements and that he/she will comply with said procedures and require Signs of Homeowner Approval of Building Official - Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board•cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/sbe 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 fmmVecrtification for use in your community. Q:forms:homeexempt