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0014 BRIARCLIFF LANE
l � -� . . , . F , � , : : � - . - . �, '� �, .. _, . z �� p . � F o �„ � � � _ n �; .< 'III � - � .. - ',I. _ �. r ., - - o , < ., ��; �. � .. o . L�_ -. a.: Town of BarnstableBuilding . � .^rr .,ro,�, � 7"�.r, n yx �, '�c �n,'" -w+ -; y �„ k �i c� s. p`�` � ... 2,Y IPost This Card So That�t�sVisibBAPNnASM le,From the Street Appro�edRlan Must be Retained on Job and this Card Must be Kept i o M" ,Postei Until=Final Inspection HasBeen Matle y 163iA ♦ - 3' .... e z...a $ e x �� .• m ✓-. e ' mit 0reoruct° Where a Certificate of Occupancy is Required,such Bu�ldmg sfi'%W'Not be Occupied until final Inspection has been made A Permit NO. B-20-389 Applicant Name: MESONERO, CLARA E Approvals Date Issued: 02/10/2020 Current Use: Structure Permit.Type: •Building-Smoke Detector-Fire Alarm Dection Expiration.Date: 08/10/2020 Foundation: System Map/Lot: 208-105 Zoning District: RC Sheathing: Location: 14 BRIARCLIFF LANE,CENTERVILLE Contractor Name: Framing: 1 Owner on Record: MESONERO,CLARA E Contractor License: 2 Address: 464 STARBOARD LANE Est Project Cost: $0.00 Chimney: OSTERVILLE, MA 02655 Permit Fee: $35.00 Description: CHANGE EXISTING BATTERY SMOKES TO HARD WIRES SMOKES n Fee Paid $35.00 Insulation: Project Review Req: "< Date 2/10/2020 Final: '� Plumbing/Gas Rough Plumbing: Building i This,permit shall be deemed abandoned and invalid unless the work author¢e, by this permit is commenced within six;months after issuance. Final Plumbing: 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,bylaws and codes. Rough 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. Final Gas:. r The Certificate of Occupancy will not be issued until all applicable signatures by°the Building and,Fire Officials are�p'rovided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing fi �� 2.Sheathing Inspection Q 3.All Fireplaces must be inspected at the throat level before firest flu e;lirnng isinstalledi, •, _ g . Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy ' Low Voltage Final: 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I - THE Application ber... V..'.. ............... >iARN18PABI,E, MASS. g Permit Fee.......................................Other Fee:....................... s639�. FD Mpl� TotalFee Paid............................................................ TOWN OF BARNSTABLE Permit Approval b 1,.J&.7t ..............On...�:. ...�w✓'V BUILDING PERMIT Map........(0.................P=el..........W15....................... APPLICATION Section 1 - Owner's Information and Project Location Project Address_ L'-) e I Ap cLLF Village Owners Name UL ICLA All ESCAN Owners Legal Address ( STj��,� f�4A16 FEB 10 2010 City ��t L(,(5� State Zip 4 2-6 Owners Cell# $ 3� ���ev E-mail 5, yVl u�l� ? 0.�) 1 . 0J t Section 2 —Use of Structure Y Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty VFire Alarm - Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description L4Aoj(,6 ni 5nii/.. PA,nS.`! S.Mye_6 s n 4+A(Zl) TactimrlateA• 11/14/)niR Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil.Tank Storage ❑ Smoke Detectors 'iXi Plumbing ❑ Gas Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom i Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway 1 Debris Disposal Facility: I am using a crane ❑ Yes ❑ No lj Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information { Zoning District Proposed Use Lot Area Sq. Ft. Jr 1 Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 7 Its 0 co LLJ Cf) Lod tk1/ cv u<r,J sltaAEk, �1 SMOKE DETECTORS R E1NEAAAD iw is S E i JIEi s DATE )EPA; S \ o cn n f - i "ERMIT fN � "MIMED F0JR � Sri BOTH SIGNATURES ARE 'acc ' , \ ca =vi ri1 r Ljj �. � 14 + &7, FC: r �Y n�" The Commonwealth of Massachusetts Department of IndushWAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ' Please Print Leziibly Name(Business/Orgmization/Individual): Address: L-)(i City/State/Zip: S U)' Phone#: a �2-0b 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 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 ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity.c aci employees and have workers' 9. Building addition [No workers'comp.insurance comp.msurance.t El 5. We are a corporation and its 10.❑Electrical repairs or additions required.] ❑ officers have exercised their 11. re 3. I am a homeowner doing all work ❑Plumbing Pairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance requha]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. *Contractors that check this box must attached an additional sheet showing the name of the sub-coatiactors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. "r 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy,declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D or` ce coverage verification. I do hereby certify nd e p ndpenalcles f erjury that the information provided above is true and correctIdoherebyc7 nd ep �Si`_ Date 2 [P Phone lsaa Official use only. Do not write in this area,to be completed by city or town ofjiciai 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#: f 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." w 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 innirarice. 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 retuned 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 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 Departments address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Me of Investigntioas 6W Washington Street Briton,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Revised 4-2407 Fax#617-727-7749 vvwwMaw.gov/dia Application Number........................................... Section 9= Construction Supervisor Name ']� MMAI,,I/ Telephone Number Address Go City ©`TM i L tAtate i�/ - Zip �-Z ( License NumberO6 �a 22 License Type L2 Expiration Date Z, 2(� Contractors Email 5C,h Vlh A-w /p C120(,--S(.X—)6 I Cell # 5 � g q3 ! 1 30 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable:Attach a copy of your license. Signature Date Section 10-Home Improvement Contractor Name Telephone Number r Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number,6_ 9 _720F2 Cell or Work Number c I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts- tate Building Code. I understand the construction inspection procedures,specific inspections and documentation re q d by 7 0 CMR and the Town of Barnstable. -� 0 Signature / Date _APPLICANT SIGNATURE Signature - '' -Date- - Print Name' 5"fQ>� � �� �/ LTelephone Number PD 0 " E-mail permit to: D C V (—*p JA C-C4$(I Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required), ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ , For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization i L , 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) Signature of Owner date Print Name Last updated: 11/15/2018 � p Town of Barnstable Building ate`, c � � �� � � �., .._ ,., ..�.g b_ .._ �: . . . ,• �� . ,� Post This Card So That tt�s;V�s�ble`From the Street Approved'Plans Must be'Retamed on J.ob3and this Card Must be Kept v$ 1' , Posted Unt�l`Final Inspection Has Been Made .` 3 TM oeAat° yyWhere a Certificate'of Occupancy is Required,such Building shall Not,be Occupied until a Final Inspectio639. n has been made ��g �� _ 5....w, a..,PSd^,x,N.<.TS..,.,.., ,,.......,ro.ro„..a. ....,... _w,.. .,eb... .-a. ..,c.:...-, . «.s .a. � < «. .....„•,,M.. ... ._ .,. ... .. ., .erp.4x.m. ..,„,y Permit NO. B-19-4061 Applicant Name: STEPHEN SCHMALL Approvals Date issued: 12/19/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 06/19/2020 Foundation: Location: 14 BRIARCLIFF LANE,CENTERVILLE Map/Lot: 208-105 Zoning District: RC Sheathing: Owner on Record: BOVI, ERNEST& DIANNA L Contractor Name: : STEPHEN A SCHMALL Framing: 1 Address: 14 BRIARCLIFF LN Contractor License ,CS-006553 2 4 CENTERVILLE, MA 02632 Est Project Cost: $50;000.00 Chimney: Description: Strip and Re-Roof Main House Attached Gargage and Detached Permit Fee: $305.00 Shed. Insulation: Fee Paitl $305.00 ,, Remodel Kitchen with New.Cabinets,Counters, Flooring and Final: 0 .?_)to zo Appliances $ Date 12/19/2019 "` Remodel Bath with Walk-in Tile Shower and Flooring Using Existing; __. Plumbing/Gas Toilet : Y Install New Front&Side Door Assembly x L ✓ Rough Plumbing: Pour Concrete Slab in Existing Crawl Space(currently lust sand �'- „ Building Official Final Plumbing: floor) ' Rough Gas: Project Review Req: NO STRUCTURAL CHANGES. REMODEL EXISTfNG This permit shall be deemed abandoned and invalid unless the work authored by this permit is commenced within six:months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for whlch`tt is permit has been granted. All construction,alterations and changes of use of any building and structures shall be incompliance with,the I•ocal zoning by laws and codes. Electrical This permit shall be displayed in a location clearly visible from access street or road and�shall be maintained open forpublic inspection for the entire duration of the k Service: work until the completion of the same. *. g A" a. , s Rough: T / The Certificate of Occupancy will not be issued until all applicable signatures by.the,Buildmg and Fire.:Offi 1 s are pro4ided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: 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. Fire Department Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). -4q Permit Fee.................Ju....................Other Fee:....................... tea, � TOWF=Paid.................................................................... TOWN OF BARNSTABLE Pmoft Approval by...... . ............... WELDING PERMIT MV......... > .............1.. ........... APPLICATION Section I —Owner's hdormation and Project Location Project Address 14 BRLARCLIFF LANE Village CENTERVILLE Owners Name CLARA MESONERO Owners Legal Address 464 STARBOARD�ANE City--2—sT,ERVILLE . State MA Zip 02655 Owners Cell# 508-776-7508 I. E-mail—SCHMALL@COMCAST.NET Sect4 2—Use of Structure F Use Group R_251> Commercial Structure over 35,0 f is ee> ❑ Commercial Structure,-under 35,@ .cubic fM nX Single/Two Family Dwelling Section 3—Type of Permit F1 New Construction 0 Move (Relocate ❑ AccessoU Structure ❑ Change of Se El Demo/(entire structure) El Finish Basement El Family/Amnesty 0 Fire Alarm Rebuild Dock Apartment El Sprinkler System ❑ Addition Retaining wall Solar Renovation ❑ Pool El bsulation Other—Specify Section 4 -Work Description 1. STRIP AND RE-ROOF MAIN HOUSE,ATTACHED GARAGE&DETACHED SHED 2. REMODEL KITCHEN WITH NEWICABINETS,COUNTERS, FLOORING&APPLIANCES 3. REMODEL BATH WITH WALK-INJ TILE SHOWER&FLOOKINU U.51NU EXR5 I ING I 01tt I 4. INSTALL NEW FRONT&SIDE DOOR ASSEMBLY 5. POUR CONCRETE SLAB IN EXISTING CRAWL SPACE(CURRENTLY JUST SAND FLOOR Lag updated:11/1512018 i Application Number.. .............. ..... Section 5—Detail Cost of Proposed Construction $50,000100 3quareFootage of Project 1,080 SF Age of Structure so+i-YRS. I Dig Safe Number #Of Bedrooms Existing 2 Total#Of Bedrooms(proposal) 2 110 MPH wind Zone Compliance Meth d ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage 0 Smoke Detectors ❑ Plumbing ❑ Gas' ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney Add/relocate bedroom Water supply Public . ❑ Private Sewage Disposal ❑ M x icipal ❑ On Site f Historic District ❑ Hyannis Historic Distract ❑ Old Kings Highway Debris Disposal Facility. CAVOSSA DISPOP AL CORP. + I am using a crane C Yes ❑ No � - I Suction 7 Flood Zone 1oo�ne Designation { Ithin o adja—mac nt to a wetland,coastal be k? Yes ❑ No ❑ + Section 8—Zoning Information 4 1 �orting Di'"ct f — Proposed Use Lot Area Sq.Ft ! Total Frontage Percentage of It Coverage #of Dwelling Units on site r Setbacks Front Yard Requ bred Proposed Rear Yard Requ red Proposed Side Yard Itequued Proposed Has this property had relief from the Zo ' I Board in the past? ❑ ??? p Yes ❑ No . . . Last updated:TU15/ M I Application Number........................................... Section 9-Construction Supervisor Name STEPHEN SCHMALL Telephone Number 508-939-1800 Address 464 STARBOARD LANE City OSTERVILLE State MA Zip 02655 License Number 006553 Li I e Type UNRESTRICTE YP PxpirationDate 2/26/2020(RENEWED) Contractors Email SCHMALL@COMCAST.NET (ell# 508-939-1800 I understand my responsibilities under the rules a 3d regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I v uderstand the construction inspection procedures,specific inspections and documentation re 80 CMIt and the Town of.Barnstable.Attach a copy of your license. Signature Date Section 10 Home Improvement Contractor Name STEPHEN SCHMALL Telephone Number 508-939-1800 Address 464 STARBOARD LANE' City OSTERVILLE State MA Zip 02655 Registration Number 138031 Ex iiatlon Date 10/9/2020 I understand my responsibilities under the rules d regulations an gulch ns for Home Improvement Contractors in accordance with.780 CMR the Massachusetts State Building Code. I t In iderstsnd the construction inspection procedures,specific inspections and_ documentation required by 780 CMR and the Town ofBarnstable.Attach a copy of your ILLC... , Signature Date Section 11 —Home Owners License Exemption Home Owners Name: i Telephone Number Cell or Work Number I understand my responsibilities under the rules an I regulations for Licensed Construction Supervisor in accordance with,780 � CMR the Massachusetts State Building Code. I UE derstand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Tow i of Barnstable. 1 Signature Date IPLI[� T SIGNATURE Signature i �G Dat 12/3/19 I e Pr1IIt 1Gje STEPHEN SCHMALL Telephone N112IIber 508-939-1800 F E-mail permit to: SCHMALL@COMCAST.NET Last undated:11/152018 ' II I Section 2--Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan R i ew(if required ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your p d Erectly to the fire department for gpprovaL Section 1 i —Owner's Authorization CLARA MESONERO, MD I, as.Owner of the subject property hereby authorize STEPHEN SCHMALL I to act on-my behalf, in all matters relative to work authorized by this building permit application for: 14 BRIARCLIFF LANE, CENTERVILI_E, MA Address of j ob) 12/3/19 Sature�of date , CLARA SE ONERO Print Name I I i i i I,astwdatc&iinsnoig 9 \ 693 CNa+j ra ,tiati OoL) re •� y l % i J ,�Ca r Lai OCR �' Con monwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards `Constrydt.3n Is pervisor E r CS-006553 0 Eires: 02/26/2020 Ip S f EPHEN A SCHMALL-� 464 STARBOARD LN „ < , OSTERVILLE MA�,02655 10 Commissioner lL i Office of Consumer Afr**�gusiness Regulation s HOME IMPROVEMENT CONTRACTOR s TYKE;Individual e ishati n_ EW won 38A 10/09/2020 STEPHEN SCg'l STEPHEN A.SCHMA 464 STARBOARD LN ' OSTERVILLE,MA 02655 . Undersecretary f - Th Gv nwealth of Massachusetts Department of IndustridAccidents Of,�ee of Investigations 60 WashbTion Street ostm MA 02111 .mass-govldia Workers'Compensation Insurance tier ' P Arm vrt.Bulders/Contractors/Electdckm/Pilmbers licant Information i I Please Print Legibly Name(Busine5siorgenization/ti,divid„al): STEPHE SCHMALL Address: 464 STARBOARD LANE I OSTERVILLE,MA,02655 508-939-1800 City/State/Zip: I I Phone#• Are you an employer?Check the appropilate bo Type of project(required): 1.El I am a employer with ® Im a general contractor and I employees(full and/or part-time).* h7e hired the sub-contrac ors 6• New construction I 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ©Remodeling ship and have no employees These have 8. ❑Demolition working for mein any capacity. ploy shave workers' 9. ��g addition l [No workers'comp.instance S. Cam a��oration and its ME]Electrical repairs or additions d] 3.El I am a homeowner doing all work oZcers have exercised their i L Plumb' + omg .I � tug repairs or additionsrequirr , ' myself[No workers'comp. of exemption per MGL 12.E]goof repairs insurance ]t c. 152,§1(41 and we have no l emlployees.[No workers' 13.❑Other Icamp.,msurenve required-] *Any applicant that checks box#i must also fill out the on belo showing their workers'compensation policy information. t Homeowners who smit ub this sfdavit indicating they,�e doing al�wozk and then hie outside contractors must submit a new affidavit indicating such I 3Contractors that check this box must attached an additional sheet sbbwmg the name of the sob-contractors and state whefficr or not those entities have employees, if the sob-cc1nuactnrs have employees,they rest pmvid.their workers'comp.policy number. ] I am an employer that is providing workers'compens+ ' n insurance for my employees. Below is the policy and job site j information. I 1 1 FAIR INSURANCE AGENCY-TRAVELERS INDEMNITY CO OF AMERICA Insurance Company Name: I l Policy#or Self ins1Lie.#: MPP9074A I Expiration Date: 5/3/2020 + Job Site Address: 114 BRIARCLIFF LANE ( City/StddZip: CENTRVILLE, MA 02632 Attach a copy of the workers'compensation policy declaration,page(showing the policy number and expiration date). Fail=to secure coyerage as required under Section 2!A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00.and/or one-yew imprisonment,as ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against flee violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov ' verification. ' I do hereby certify under the Pains q!fpe that the information provided above is true and correct Si . S7£P319&S6,W"-.0 Date: 2/3/19 I Phone#: 508-939-1800 ' Ofj%dd use only Do not write in this areg to be conrldedby city or town of trial City or Town: Permit/License# i F Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.C' /Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other t contact Persout Phone#: • t AC40 12/03/2019 Y) CERTIFICATE OF LIABILITY INSURANCE DATEtMM/ 019 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 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 Jackie Stewart NAME: The Fair Insurance Agency Inc. PNN Ertl: (508)775 3131 Fq c,No: (508)790-1677 619 Main Street EaVIAIL jackie@thefairagency.com ADDRESS: Suite 1 INSURER(S)AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURERA: Main Street America 29939 INSURED INSURER B: Travelers Indemnity Co ofAmenca JR CONSTRUCTION MANAGEMENT CORP INSURER C: 957 OLD FALMOUTH RD INSURER D: INSURER E: MARSTONS MILLS MA 02648-2114 INSURERF: COVERAGES CERTIFICATE NUMBER: 19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MOMIDD LICY�F MMID I POLICY E'LP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 A MPP9074A 05/03/2019 05/03/2020 PERSONAL&ADVINJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a JECT El LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER. Identity Recovery $ 25,000 AUTOMOBILE LIABILITY MBINED SINGLE LIMIT (CEO accident $ A14YAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acc dent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTERH- AND EMPLAYERS'LJABIL.1T1f ANY PROPRIETOR/PARTNER/EXECUTNE YIN E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? NIA 1K834505UB 02/12/2019 02/12/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff 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 Steve Schmall ACCORDANCE WITH THE POLICY PROVISIONS. 14 Briarcliff Lane AUTHORIZED REPRESENTATIVE Centerville MA 02632 lof4t"a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD f he Commonwealth of Massachure& epa'? of lndurMd AecW ents e of Investigations 60q Washbtgton Street 1 llosto)4 AM 02111 , .massgov/dia Workers' Compensation Ins>i ance davit:Builders/Contractors/Electricians/Plumbers Ay cant information Please Print Legibly Name(BusineWlOrgeniaafion/individual): STEPHE14 SCHMALL Address: i �STARBOARD LANE City/State/Zip: OSTERVILLE,MA,02655 508-939-1800 I II Phone M Are you an employer?Check the approp'i'ate bolzl. Type of ro ect 1.❑ I am a employer with- 14• ®I In a general contractor and I P ] ( 1 } employees full and/or * have hired the 6. ❑New construction (, part-time). 2.❑ I am a sole proprietor or partner- on the attached sheet. 7. ®Remodeling ship and have no employees Thesesub-cont<ac6ars have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition , [No workers'comp.insurance crimp.msurence.t required.] 101 VUt are a corporation and its 10. 1 Electrical repairs or additions 1 3.El I am a homewnea do all work ozeers have exercised their i 1. Plumb'mg � i � mg repairs or additions myself-[No workers'comp. right of exemption per MGL 12.0 Roof repaizs ' insurance .]t c.�152,§I(4),aadwe have no i e Joyces.[No workers' 13.❑Other comp.-insura ace required.] *Any applicant that checks box fit must also 8A out the section klu Vshwing their workers'oompensalion policy iofonnatioa t Homeowners who submit this affidavit indicating they tee,doing a]work and them hire outside contractors must submit a new affidavit indicating such. tCout actors that check this box must attached an additionsl'sbeet sh ming the name of the'sub-contractor;and slate whether or not those entities have employees. If the sob�ntractors have employee§,they must provid their workers'comp.policy number. I am an employer that is provi&g workers'compens ' n insurance for my employees. Below is the policy and job site information. Insurance Company,Name• Policy#or Self-ins lLia#: I ( Expiration Date: Job Site Address: 114 BRIARCLIFF LANE I City/Statdzip: Attach a copy of t)ie workers'compensation policy eclaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2 A of MGL c. 152 can lead to the imposition of criminal penalties of a t fine up to$1,500.00i 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 irw ance coverage verification. I do hereby certify under thepams and penalties ofpg quty that the information provided above is true and correct Si • 5'7£ c^yt SLrPCc° Date: 2/3/19 Phone#: 508-939-1800 , s S O,Ok al use only Do not write in this are q1,to be conWIded by city or town official City or Town: 1 PermiVUcense# r Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.C' /Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:: Phone#: +R Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee X-PRESS PERMIT Thomas F.Geiler,Director© Building Division O JUL 27 2006 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN :OF B ARNSTABLE www:town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ` MaplparcelNumber �Lt. 0�/0 Property Address� �YI Residential Value of Work d,'/U Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I 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. Ez t Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to . ❑Re-roof(not stripping: Going over existing layers of roof) Re-side Replacement Windows. U-Value a o)• 7 (maximum.44) *Whererequired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement C ntractors License is required. SIGNATURE: �GLGL. Q:Forms:expmtrg Revise071405 f 1 ne t,ommonweaim of mussuc:rivaeccs� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Pluirlabers Applicant Information Please Print Legibly Name (Business/Ora nizationadividual): _Df 4A `V1 Z l36? V Address: Bl l ftCL 1 rl— L City/State/Zip: C/ > �t LLC Phone#: 5V b 3V 5 1W Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. Q 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 S. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9• Q Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions eq ] 3. I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t 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.. TContractors 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 aned jao 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;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 ceV under the pains and penal 'es ofperjury that the information provided above is true and correct S1 ature: Date: Phone#: �tP Of vial 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 Evalth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing*Inspector 6. Other j 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 inswance regUirements 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 Liibfiity 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 maybe provided to the . applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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. #1 617-727-4900 ext 406 or 1-1077-MA-SSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.zov/dha 7HEro�°� TOWN OF BAR NSTABLE I EARNSTAXLE, i M6 9 a• BUILDING INSPECTOR ,o�,a unY APPLICATIONFOR PERMIT TO ............................:................................................................................................ TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......... ............L ,. .. ........... ..............................................................6.................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ..........................6..............................................Fire District ..................................:........................................... iName of Owner ......................................................................Address .................................................................................... Name of Builder NFaIo2F &A-DVC�,,,,,,,,,,,,,,,,,,,,,Address ............ .......... .................................................................................... Nameof Architect ................6.................................................Address ...............................................................................:.:.. Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Difinitive Plan Approved by Planning Board ________________________________19-------- . Diagram of Lot and Building with Dimensions JIM /f ? 4 � ( - U�' W/ av c� i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. /,/� /� Name/�L!'���� � E �a�e 4141 1 .... � - NG6 ................. Permit for .................................... .L'......................................................................... Location ................................................................ � ..-------..-----------------. Ovvner ----.-----------------' Type ofConstruction .......................................... ` -----..^-----------------'--- Plot ............................ Lot ----------'' ~ - � Permit Granted ........................................ Dote of Inspection ------------]q Date Completed ...................................... PERMIT REFUSED ----.'._--------------.. lV � --------------------------' � ............................................. . --------------.----..—...---.. � � ----.---,—~----.—..—..—.—.—~.~— ' Approved ................................................ lA . � ---------------.—..'—.,----~—. � - ----------.---------.......... �� ' A- �ofTNETp�y TOWN OF BrlRNSTABLE • BARNSTADLE, i Mb 9�MO INSPECTOR �F �'' D APPLICATION FOR PERMIT TO (/L?��.lr!!`j!►?�C......... .:!YJ7.i � ��~ 1..�( ���. ...... TYPE OF CONSTRUCTION !!!yjti .. J-4... .................... TO THE INSPECTOR OF BUILDINGS: 0 The undersigned hereby applies for a permit according to the following information: s Location .... . .......... . ..... .: . 1. .. .......................... ......... .......................................................................... ProposedUse ...... .. .. . ....... ..... ..... .. . .. . .... ........................................................................................................................ Zoning District ........................................................................Fire District ..Cr>a/:.... .. .. .. . ..... /� �..... Name of Owner!//.. ........C !..?SJ:.. .......JbZAeel....................Address .,1 ......... . .......... ...... ... ... .. K�. .. . Name of Builder....-yI X� .Address 1.U.�� Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .....1. .........................................Foundation Exterior ! ••� .. .. ... ........... ..................Roofing . ...... ......................... Floors ..... .... ....................Interior 04 Heating ..................................................................................Plumbing .1�. .^L.D`�rf!-4G�.. !1'�t.. .......P.. .. . ....... Fireplace ....... ....................................................................Approximate Cost ..... .............. .... � O ,0 0 Difinitive Plan Approved by Planning Board ________________________________19-------- . / Diagram ofAot and Building with Dimensions N ; . IL Oa LLJ d m w U/7 Z (n_ 0 co� N� Mit O ,Ocn ¢� z � � H �I f�� - O Q CH j 1 0 z 6 c r a G° t --v /Ye!!tP tMrrr r��id�€1 o y. v Z J w F- CL a+ U 1 lienLIJ .� H Q ,,� Rr 3 t i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............. Grinnell, William G. � i i DEC 31 99rO No" 13.089. ... Permit for remodel kitchen .... . .... t. and enclose porch ........................................................................ 14 Briarcliff Lane Location ................................................................ Centerville .................. ' Owner 1glliam G. Grinnell ................................... ......................... { Type of Construction 'frame.................... ! t Plot ............................ Lot ................................ i I i Permit Granted ...........May.. 4......... .....19 70 Date of Inspection Date Completed ......................................19 1 PERMIT REFUSED ................................................................ 19 i ............................................................................... ............................................................................... ............................................................................... i Approved ................................................. 19 ............................................................................... f ..................... .........................................................