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0217 BUCKSKIN PATH
� .� a . . .#. R ,. �.: �, v � . . t , � � , �� .,. 4 . . a - . . � . s o �_, o , 1,�. � � - - ` o it r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r: Map Z � Parcel. O � � �` oN440i 0 Application # Health Division �db Date Issued z6h Conservation Division � /!�/�7/ Application Fee �S Planning Dept. Permit Fee ��`� • �� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address S17 Village C��J ���� Owner ��y d' ��� � Address Z �f'�/ j Telephone ,,// Permit Request OP2L l Square feet: 1 st floor: existing 0-0-hroposed /A?Q 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000 Construction Type Lot Size R!V Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family'(# units) Age of Existing Structure 1173 Historic House: ❑Yes %No On Old King's Highway: ❑Yes No Basement Type: 'Full ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) A Number of Baths: Full: existing new (;) Half: existing to new O Number of Bedrooms: existing O 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 D Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name f t' �I`7�IY I rT�L�S, /NCB Telephone Number 5 0'6-76 7- 7/ y t Address !7 3 7 /4 iA&I /V License # g Home Improvement Contractor# L y 3-7 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L !LA 71 OAJ SIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. fv . ADDRESS VILLAGE -. ,i ';. OWNER, ` Y DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION K 316 i 4i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - t _ t r Massachusetts Department of Pdbiic Safety Board of Building Regulations and Standards License: CS-012414 Construction Supervisor • ' STEPHEN W BRITTON PO BOX 897/500.M WEST B `; ,.. ARNSTO BL6 ` ' 028 8 r- Expiration: Commissioner , 07/21/2017 ' � CJlie�pamimoozusecr,�C�a�C%UGaaaccc�ieii.�eCt�. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Re istrationc ` g 4.8798 . Type: ? Expiration 1(f/26f2 17 Corporation I1 4 ARTISANsKITCHENS', rJ STEPHEN BRITTON 937 A MAIN STREET .. OSTERVILLE, MA 02655 Undersecretary • • r X s r ri. Town of Barnstable Regulatory Services ' E A701l�wlAr4 f _ Richard V.Ski,Dirmftr °TamrMTY,}3m'idog,Comnnsaioner 200 Mkm Sheet Hyman,MA 02601 WWW.tD nbarasfablema.IIs Office: 508-862•4038 Faa 508-790-6230 Prope4 Owner Must Complete and Sign This Section If Using A Builder 3 as Owner of the subject property el herel�yaratharize to act on mybehA in all matters relative to work authorized bythis btuM g permit application for. Z/ ( s of Job) `"Tool fences and alarms are the respons��7rtyof the applicant Pools are not to be Eed or 496d before fence is iast&d and all final ' inspections.are perf =ed and accepted. S, of �, of Apphcaut _ /4mei FL Pri=Name m Prime aroe 412 7 IG Date . Town Of Bar stable Regdatorp Services , r, Mr-T-rd V.Sc4 Director , BUffding bivisioxt Tom Perry DwIdmg Commissioner 1a� 200 Main ft=4 gMmik MA MOI - wwmtDIsa nasiahI�naa-us Office: 508-862-4039 Fz= 509-790•-030 • • •ATYIMr"- t JOB i oc OR- VMW number sty - ,name - h®cph�a# :wosicpli�c� CURRMiT MAILINGADDRESS: _ chy/lino - nP W The cent exemption for`jomeownerf was WtMdedto include owner-ocx�ied dweIImes of six or I�ss and to aIIo� homeoy,ums to engage an indrvi&al for hire who does'not Possess a Liczmcq provided thattha owner ants as strocrvison Djfb NII ION oRHOMEOWNER P eason(s)who owns a parcel of land on which he/she resides or intends to reside,on Which.there is,or is intended tD ba,a one or tvo -fam3lp dwelling,. welling, off nTi bd or detached stnttmss accessory to such use and/or fium sti-?e� A person tvho'eons acts more than one home in a tw( -year period shaII not be considrsedahaaicownen Soh 9==ownee'.EL-M subMkto fIe dmg Official an a farm suaptable to the Bm1�Ofiinial,thathrlahr shall be i e monsilile frQ aIl such Wo�p ed�dertha bm7ding permit (Section The nadc uffgned`homeownee'assumes responsibility for compliance w&the State Big Codo and othm applicable codes, bylaws,roles and rMulatM12- - nc rmdarai -home woe ' es athelshe ids 'Token ofBamstahIo Bin7dmg Deparlmcot n>i mm msp�inn probes and eme ss andt of he/sha wM comply wx&said promffinms and requiremers. s� cf ==rwn=r - Approval eBm7d"mg Official • Note- 'Tfiree-fly dwellings canting 35,000 cubic fist or Incr wM be regma ed to comply with the State.Bui diog Code Section W-0 Constrn�m,Ca&cL Hon�ot�•s x - The Code stairs that agny homeowner performing work for which a bniZciiag permit is regnai:d shag be exempt from the provisions of this sermon(Section I09-U-Licensing of contraction Supervisors);provider/that if$ie homeowner engages a personas)for hire to do such work,that sash Homeowner shan act as supervisor.' Mang homeowners who use,this exemption are nnawam.that they are mining the responsMYTTIJrs of a supervisor ( PP�� ,Rnles& _ ns for 11censing'Constrac5nn SIIpervisors,Section 2J5) This.ark of awareness oftrn ressults in serious problems,parfieulaiip wb en$ie:homeaner hirrs nnnse�Persons Ia'ths case;o Board cannot Pr oeeed against tine nmIrcensed person as it would with a&ceased Supervisor_ The homeowner acting as Supervisor is vlf=t e.y responsible. comraunffies as part of$ie To a S=e t�the homeowr rr is My aware of his/her responsilaM es,many req�, p permit appErafson,fat the homeowner=tify thathe/she anaerstands fre r espanslbsMtz'es of a Supervisor. On the lastpage of this issue is a form currently rsed by.seinxd towns. Yon may can t amend and adopt such a fdLl n for use in your commn:Cdy. ifirm Rzviscd 06U 13 . w�s�u.F�rrs�.grr�r�ut ' Wcu7ke& C=pFmszfkmlssrrranc avrL Bzfldersf `am�cbmsMe•cfr� umbers Nan=Ommemlc ,[�—G�1�!SAT (��TGI I��U .� 1 J� l�— ire ? �t : yiyaaneurploger?deck.theapgrffgziafrb(k=. T ecE = ❑ I 8==?I crthmcfsr�I �I ❑ I mm a I have-yreathe b- s ❑New Dynes{ful dorg�ime�* Z El am a sole proprietor orgar€ner listed on atiaclied shy 7- �$ ship.andhat*e no employes Theses ass have g- ❑ or< wing fcrme ffi auy CagarSt- - yew a.1 1 WarimrS' 4_ ❑Buil�ng add an ETC3-wad=' camp.iasm-mce comp-msarzMe.- , 5.X We am acargarallQa and its f0.0Ele�repairs eradditians 3.❑ I am a homey doing aU warp affma s hxve er wdsed their 11- ]Plumbing mpairs or additions on'.CdMfS' right of emmpfidn per MGL 7 c 152,�I(4),andwe F��e na UZI$nafnpa=i ixmcrm�nrg r�a1red_I.F 1.��Qt�r empayees.[ISas comp-mc7trant e r j "-dap aup that rhr+r�cbcs"rI�xmst also�aottb=s�fronbcIac�ch�r i'teawo>i�es�mamrnsatioupo�-a �HLLZFW Les R�tTi submit i"his in ffigy MM[=$,--n^[�^��^�t-h^E CD=Ba=Izm.S�SII�mI fl 3EP4L`$Igd3IItt mna�SIICli ors-dW rh-<-k this box mast auadxed m vViti=0 sheet slmoidn.-than»eof ffie Quks-omb=jna amd.ShEir uhadker ornat&. 5_,- amplU-- Iftba-B b.•-�—aloy-s.they apt p—a th—des'-map.pary monbez. I&w,arz emPZvPer L-r=rrr m fbr my ptrq7Layecs. Below is therpu&cp and jab spa prair FcmcmrLance Campa,YName_ Darcy#cr Self-ins_Lim; ti9ul7ate. lob Sif--Addmsr CifgfStatxlCp_ Attach a:copy Qf th-wDrkex-e campeuratian pa-RET decdasstion page{showirtg the p-0Hcy n=ber mad erpiratzon date}: Fzilure to Secfiou.SA ofAML c I52 can 1mcl to the impas7iirm of criminal p=FHf,-s of a fine ng to L OQOQ andlar one yearim ,as x�e11 as ciril gas in$ie falm of a SAP WORK ORDER-zad a fine of mp.to$250.00 a deg against the violator, Be:advised that a campy of his sfatem=t may be fiarwarded to Ilae Office of InreVE[gationa cf DIA for immcanc,!�coverage veniEcti=- IIffDFamvby r sp tr�psriaifessr� ffnatf�euE�ornza#rfxapreruic�£er re istru�zm correct Sian DA Phoneff-- 677 aftid Fcsa ruri£y� Da rcat ffri&is-9&Aweaf to bff cQxrpieW by ct�p ar•t7wa&f,�cinL Ft_` T or Towu:�,}�r 9 L So2 E of$eaHit 2.Rmld32g Dq=tmmt 3.af pTuem a=k 4_Elc cErical5nspectur S.Phmxbg Inspector fi.Cther cc� f f P=Qn: FF urge#: Massar-Errt=tts GtamBI Laws chaptra 152 r'mp¢es all employers to provide workers'compensation for their employe Pormm:tto this sfa�an enp&yee is dcdn_ e as _every pemm in the servic;e of anmffim-under any cantr c t Dfhim, express or ir-oplied, Ural or wEitb=" : An anpkpe7-is d fined as'an niffmidnal,patammhm,assDc action,carporaiion or ather legal enbiy,or any two or mare of the foregoing engaged in a3oid etczgrlse,and mcl gthe legal represe ves of a deceased employer,-or the receiver or trustee of a a individual,per,association or other legal entty,emplaymg emPl°Yee;• However the owner of a a-velliag house havi g notmore f m ffiree apadmecds and who resides theaein,or the occupant of the dwelling house of a rather who employs persons to do ma_�aam,mns=tioa or repair worm on such dwelling house or on the grounds or budding appmtenaz±thereto_shall not because of such employ=&be deemed to be-an employ cr.- MOIL chapter 152, §25C(6)also states thk'every stale or lo-cal lic:6n ag agency shaII withhold the ismance or renewal of a 1"reerrse or permitto operate a business or to consfi-act buildings in the commonwealth for arty applicant,tvlro liar root produced accepb-ble evidence of coiitpliaace with the ingnrance coverage requir ed.y . Additionally,MGL chapter 152, §25C(7 sW='Neifher&e commonwealth nor any of its political subdivisions shall enter into any contract for the PCrfDE ante Df public woik unt a az=ptEble evidence of compliance with the;,,crn`an ce reT mMtS of fhis chapter have been preseuied to f3>e contrantmg anjhDrity.' Applicants Please fill o-ot the vrozkers'compensation affidavit completely,by chea-lmig the boxes that apply to your sit latiDn and,if necessary, supply sub-contractors)name(s), addresses)and phone Mnnber(s)along with their cer��caie(s) of hisum ce. Lh itr d.Liability Companies(LLC)or Lia i Liability Partnessbips(LLP)wino employees other than the members or partners,are nDt regraed to catty workers' compensation incur c-t- If an LLC Dr LLP does have employees;a policy is rued_ Be advised that this affidavitmay be submitted tc)'the Department of Industrial Accidents for confamation ofTngm-ance coverage. Also be sure to sign and date the affidavit. The affidavit should be mtumed to the city or town that the application for the pemit or license is being requested not the Department of Indnstrial-Accidents. Should you have any qu-ts ions regarding ffie 1 aw or H you are required to obtain a vrorkers' compensation policy,please call the Department at the number listed below. Self-insra-ed companies should enter their self-rncrrrance license number on the appropriate lime. City or Tow Officials n ;. ,.. Please be Sure,tiat't$e affidavit is complete and primed IegIly. The Departbent has provided a space at the bot n. of the affidavit for you to fill out is the event the Office of Investigations has to contact you regarding the applicant Please be she;to fill in the pe=aitllicense number which will be used as a reference number. In adEtion,an applicant that must submit multiple pem itllimnse applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under a7Db Site Address"the applicant should writ'all locations in (city or town).-A copy of the affidavit that has been officially stuaped or ma deed 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. Anew affidavit must be filled out each year.Whea•e a home owner or citizen is obtaining a license or permit not related tn'any business or comrn=ial vendee (i_e•a dDg license or permit to bran leaves etx-)said person is NOT regvhed to complete f3is a.ffida it J I Tlat Office of Investigations would like to thank you in advance for your coopm-ation and should you have any questions, please dD not hesitate to give i s a call. The Department's addr=,telephone and fax number: aC',CorrrmDrlWealth Of Ma' s Depaztmeat ref led mtdal.A ants I� ZL�I&G2111 Tf.U4 617-W-4- Q�±4- 6 4r 1-3 Fa# 617-727-T74,4 R1 4-24-D7 g vIdEa. CARVArLHO MASTER BATH • e demo bath Interior as needed ` Q °remove existing shower stall j ® °expand/re-frame shower to 34502" �] °add blocking for grab bars in shower[2] °install pre-fab shower pan[white] j e re-plumb shower for showerhead+handheld 6 e add niche with shelf in shower - " °add Ourock to shower walls eo° - Q the 3 shower walls and niche a install NuHeat floor warming mat 24 X 72 e • °the main floor o °install new exhaust fan/light in shower a' e install vanity with stone countertop Oil frame and Install new recessed medicine cabinet 1/2° AMY E;afiirlON` WiOSD J'L RTi SA N ' I TC H E N S INC. lh W 3M Pl W,"YE N10VIDED AQIWT. `Md W Mcaibe ALL DII4EMSIDMS AND SIZE SCALE: DATE: Carvalho Residence roe use Erzft 4 MTdt WO TM DBI6MAT10NSGtvsJ N p-� v�.nMs RE'Mar HUNDTYOF S SIOBS TDWD ADYATME ON 217 Buckskin Path POW urDGMMar Beusn on REDS � l�sm rwD AD)usiMEEMT 1I�Z.,� 4/28/2016 937A Main Street'Osterville,MA 02655 508-428-8828 Centerville MA 02632 "'"°'°E""S8m" TO M SUE`A"DMONS. - - ' • - GARVALHO MASTER'BATH 0 demo bath interior as needed + remove existing shower stall r . expand/re-frame shower to 34"x42" ° y 'add blocking for grab bars in shower[2] i < Y install pre-fab shower pan[white] . I j o re-plumb shower for showerhead+handheld o add niche with shelf in shower 0 add Durock to shaver walls ea C file 3 shower walls and4 niche 2V 35 Jae' 0 install NuHeat floor warming mat 24 X 12 °file main floor a f a install new exhaust fantlight in shover- -- 1 _ � 6 install'vanity with stone countertop c ® ;?frame and install new recessed medicine cabinet r - 1/2' - M1Y E. ..PrrON�C Sol • 13Ea�� oaavNe�elh Ptr. ALL DIMENSIONS AND size SCALE: DATE: �j �7�. DESIGN PLANS AM PROVIDED POR TNe (R I ppd MPmbF Y✓'tRTISAN YJl I`TCHENS 1NC. Carvalho Residence PAIR USe er rNE GIENTOII NISAGeNr D�GNATIONS GIVEN ARE PLANS RENAIN TNC PROPeRTYOP rNI3 �',�\�1 SU87ECT 70 VER[RCATION ON A-1 217 Buckskin Path PIRNANDGNNW8ffU3w*RREIEi JOB SITE AND ADJUSTMENT 1,2r.t• 4/28/2018 937A Main Street Osterville,MA 02655 508-428-8828 Centerville MA 02632 I°I*"°D*PER"NsIoN• TO PIT Bne CONDITIONS. A CARVALHO'MASTER BATH o demo bath Interior as needed 0 e remove eXlstng shower stall I e expand/re-frame shower to 34"xQ- jr r e add blocking for grab bars in shower[2) - . install pre-fab shower pan[whitel e re-plumb shower for showeehead+handheld e add niche with'shelf in showier add Durock to shower walls ' r ea the 3 shower walls and niche -%' sg ' —351W-- a install NuHeat floor warming`mat 24 X 12 e tile main floor e install new exhaust fan/Iight in shaver' / t o Install vanity with stone countertop ® e frame and install new recessed medicine cabinet L 1 eo ea vrr NAYE.�iPROa QIiQ 1/2" - RG6ssTp iro s DOVW F.zwaNY E ALL DIMENSIONS AND SIZE ®' - DATE: SCALE: DATE: DESTON PLANE ARE PROYTDED POR THE lirygyp PkmbcT DESIGNATIONS GIVEN ARE . Carvalho Residence PAEM SERTTNEDUENTOR NTR AGENT i���� ��� SDBR Cf iO VERIFTGTIOn ON (RRTISAN �ITCHENS INC. P MRENAMTIEPROMRTY OPTM d� 1 217 Buckskin Path POPE AND CAN NOT RRDREDORREIeR 7DSSREANDA1N`DMONS. I�Z'.�. 4/a8/2016 937A Main Street'Osterville,MA.02655 508-428-8828 Centerville MA 02632 "'i'NODT PERMISSION. ro�T srrE coNDmONS. ~ i t GARVALHO-MASTER BATH ' demo bath Interior as needed, 0 0 remove existing shower stall . ; o expand/re-frame shower to 34"x42 ° •add blocking for grab bars In shower[2] '*install pre-fab shower pan[white], u re-plumb shower for showerhead+handheld add niche with shelf in shower , add Durock to shower walls eo tile shower walls and niche° .�•� ss" 35 i,a install NuHeat floor warming mat 24 X 72 v the main floor a I I install new exhaust fanlight in shaver ID Install vanity with stone countertop a ® a e frame and Install new recessed medicine cabinet ' R tn" F�®is'iR.liC g DP9pd H Nr. °QQ PANE ARQ PRov[am FOR TTQ CeMftd M-W ALL DIMENSIONS AND SIZE Qv: tE SCALE: DATE: a DESIGNATIONS GIVEN ARE Canralho Residence PAnl USEM TM QGIEMT°RTYGFTHT SUBJECT TO VERIFICATION ON RTISAN ITCHENS INC. PL11 MD cAft"WOROPQRT'OPTNlE �' 217 Buckskin Path FIRM ARDGNNor BQ useD OR RHYQE JOB SITE AND ADJUSTMENT 937A Main Sheet'Osterville,MA, 02655 508-428-5828 Centerville MA 02632 `"QTxoOT°ERMUSION. TO FIT SITE CONDITIONS. • �' Town of Barnstable *Permit#�ao Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director / Building Division �a ® ®i� Tom Perry,CBO, Building Commissioner X-PREY f E 'T00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-�ffi l 3 2 PO6 Fax: 508-790-6230 -�� , a T APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number C Property Address .2 /7 d,`r,/J 0 Calk Sle ;j too-W K> esidenrial Value of Work Y Minimum fee of$25.00 for'work under$6000.00 Owner's Name&Address L &ej Contractor's Name©.0A.-5� Telephone Number 9'&0X'--9177 Homejmprovement Contractor License#(if applicable) /G 0 -S Construction Supervisor's Lice.^-#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Ipa-Se Homeowner have Worker's Compensation Insurance Insurance Company Name '00�Go-wi 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. Going over existing layers of roof) ❑ Re-side Replacement Windo door iders. U-Value (maximu .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 sign Property Owner Letter of Permission. A copy of the Home Impr ve Contractors License is required. or SIGNATURE: Q:Forms:expmtr Revise061306 4 OFFICE: (508)997-1111 !lE MA. Builder's Lic.#021330 FAX: (508)997-1297 ACWA FREE Home Improvement TOLL FREE: 1-800-407-1111 men Inc. Contractor's License WEBSITE: #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6)•FAIRHAVEN, MA 02719 #15179 R.I. NAME / DATE ADDRESS (iGFi IP CODE ,t ADDRESS OF JOBS TEL 4 l/ 77I 2Jc�7 JOB DE CRIPTION gram .t-- Dolw r Board of Building Regulations and Standards 'License orregistration valid far:,ittdividul use only HOME IM [tOVEMENT CONTRACTOR be€ore the expiration date. If found,return tdf Ilxd of�utldtng I3�cgal;itions atnd Standards Reg�stcation00508 fJ•ne asltitsR7 ' 4 p�ra d ^f9 ��2008 Roy#ott,Ma:02168 . .'. n '' r. TypS p,lement Card CARE FREE HOM� 1C JESSE MOTTA 239 Huttleston ave ` `w ' ` i /a Fairhaven,MA 02719 Administrator Not valid without sign ure Scheduled Start Scheduled Completion A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two(2) layers of shi s,each additional layer to be charged @ ftz. D. Replacement of rotted roof boards/plywood to be charged @ ft2• E. Existing chimney flashings will be reused; replacement, if necessary, is not included. F.Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes,fires and any natural disasters, the ability to obtain materials, or any other hconditions beyond the control of the&gmpany. Cost of Project$ `1 ��� PAYMENT TERMS 11,21 — Date 1. You,the Owner,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees,interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CAR EE HOMES, IN 1yN,l A PIED,:{ (� B / `�/Ga7G,� / Buyer acknowledges Owner l t -�`�-+vc ". ---- - —- y CARE FREE HOMES,INC. receipt of fully completed copy of this Agreement Owner ----------- All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room_ 1301 Boston,MA 02108 Tel. (617)727-8598 Department of Industrial Accidents Office.of Investigations: ' d 600 Washington Street Boston,MA 02111'. www mass.gov/dia Workers' Compensation Insurance AffiidaAt: Builders/Contractors/Electricians/Plumbers kpulicant Information Please Print Legibly .1 lame usiness/Or `3(B ganization/7ndividual): (rj��L•-c_- �/"••e'e— �6/�IG-�� Address: G :G Ue. �- fill, City/State/Zip: ,I�yl�- Phone#: :S•y f-. ,99 .� .re yo employer?Check the-appropriate bog:. Type of project(required):- Ly'I am a employer with y 4, ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the,sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance: g ❑ gig addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.❑ Electrical repairs or.additions ❑ 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.[4,�er ny applicant that checks box#1 must also 5ll out the section below showing their workers'compensation policy information: iomeown. .who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such mtracton;that check this box must attached an additional sheet showing the name of the sub-contractors and their workers,comp.policy information. . !m an employer that is providing workers'compensation insurance for my employees'Below is the policy and job site Formation. surance Company Name: licy#or Self-ins.Lic..#: Expiration Date: b Site Address: 1? City/State/Zip: 1;44 tech a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). dure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a .e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may•lie forwarded to the Office of iestigations of the DIA for insurance coverage verification. 'o hereby cejW&under the pa'. and ' s of perjury that_theTinformation provided above is true and correct. attire:. one#:. Official use only. Do not write in this area,to be completed by city.or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. i ursuant to this statute, an employee is defimed as"...every person in the service of another under any contract of hire, &press or implied,oral or written." ,n employer is defined as�:"an?ndMdnal,:partnership,,association,corporation or other legal entity,or any two or more f the foregoing engaged in a joint enterprise,and including the legal represeniaiives of a deceased employer,or the' eceiver or trustee of an individual,Partnership, association or other legal entity,employing employees. Howcv..er:the caner of a dwelling house having not more than three apartments and who resides therein, or.the occupant of the welling house of another who employs persons to do maintenance, construction or repair woik•on such dwelling house ir on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." vfGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or too operate a business or to construct buildings in the lth for any commonwea •enewal of a license or permit p „ 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 ;rater into any contract for the performance of public work until acceptable evidence.of compliance with the insurance -equirements 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),addresses) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners; 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 lime. 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 nll 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 L (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-libenses..An 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 (ie. 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 Qf hvesdgations 600 Washington Street, . A Boston,MA 02111 r Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 cursed 5-26-05 www.mass.gov/dia Client#: 50238 CAREFRE1 -ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) o9losros PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 341 Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 3700 Plymouth,MA 02361-3700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Ins. CO. Care Free Homes Inc INSURER B: Acadia Insurance 239 Huttleston Avenue INSURER C: Fairhaven, MA 02719 INSURER D: INSURER E: COVERAGES' 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OON POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS GENERAL LIABILITYAPP258739 09/01/06 09/01/07 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT ED PR MI E rr n $250 000 CLAIMS MADE ®OCCUR MED EXP.(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 o0O 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND APP258740 09/01106 09101/07 WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $50_0,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 11f) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #24141 DAC © ACORD CORPORATION 1988 L _ l' • �F ZHE p� The Town of Barnstable anx►vsTnai.E. r M^� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION c Location of shed(address) Village � 1� C U CX, Property o er's name Telephone number 171 - 01P Size of Shed Map/Parcel# Signature Date �I Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) Z �� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION F ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN c � 2/ C Q-forms-shedreg STANDARD LEGEND NOTE:not all symbols will appear on a map r� ❑ GOLF COURSE FAIRWAY - -'- EDGE OF DECIDUOUS TREES r— f Y a MAP 171 / 1' , \ ' _' � EDGE OF BRUSH / ORCHARD OR NURSERY I OF CONIFEROUS TREES 19 ; ; MAP 171 - - f EDGE MARSH AREA / 227 - EDGE OF WATER � ' 1 .._._... �.,,.. __ _.�....- DIRT ROAD 232 r.,r :. DRIVEWAY rJPARKING LOT PAVED ROAD DRAINAGE DITCH , j , PATH TRAIL i i y, \5 \\MAP 171 / / --_ — PARCEL LINE %:; /, MAP 110 E--MAP# y^ 1 S '' j 21 E PARCEL NUMBER #1860 E HOUSE NUMBER ' - - 2 FOOT CONTOUR LINE AP 171 217 i ....,�Vi .._..... ` •' ,; /; : ,�. .__...._ `_..................._..�'�__MA;P 40 10 FOOT CONTOUR LINE 4 %.,, t ;' j�4.9 SPOT ELEVATION 1 °� %i ; 242 `Yv / \ f o` x.> > STONE WALL ;� Z Z -X—X- FENCE RETAINING WALL - _.._�. RAIL ROAD TRACK � MAP 171 � - � -- -- � � - - ,,. i .. - STONE JETTY .... Pw' SWIMMING POOL 205 PORCH/DECK f" • 0 BUILDING/STRUCTURE P 171 °4.•:° DOCK/PIER/JETTY. \ HYDRANT E) OO_ VALVE MANHOLE � / .,� `" \^�'� \ �•` / POST Fr FLAG POLE o O T O W N O F B A R N S T A B L E G E O G R A P H 1 G 1 N F O R M A T 1 O N S Y S T E M S U N 1 T ,o SIGN ® STORM DRAIN PRINTED SCALE:IN FEET *NOTE:This ma is an enlargement of a **NOTE:The arcel lines are only graphic re resentations DATA SOURCES: Planimetrics man-made features were interpreted from 1995 aerialphotographs b The James N P 9 P P I ) y p TOWER w � e 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE ;+ 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s t INCH=40 FEET* enlarged scale. on the map, a, ., at a seole of 1 100'. Parcel lines were digitized from 19.99 Town of Barnstable Assessor's tax maps. O LIGHT POLE O ELECTRIC BOX i3. Assessor's map and lot number ..... .. —.A.],i.....L.: ,I S IC SEPTIC SYSTEM MUST BE "f INSTALLED IN COMPLIANCE Sewage Permit number ........ ... ,,�. : � ......... A n I WITH AF71CLE 11 STATE 'I "IT A?Y CODE ANDJOWN TOWN OF BARNS e;-ABLE i B6SH9TADLE, S , ;� 7 ' "6q` ��� { �t BUJIDING , INSPECTOR 0 YPY a c) t, vE t+-: PO APPLICATION FOR PERMIT TO �:..PZCA� i?,�.6........... .��.. ............... .........:..................... TYPE OF CONSTRUCTION ". .......................... ...��'........19....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 2-17..... !. � .....112 �fvl�� /LL, ................. ..Locationj......................................................................................... ProposedUse .............w.... . ..... .............................................................................................................. ................... Zoning District ....../8.. ........................ .. .. ..Fire District ......�..^............................................................. Name of Owner ..... .U ..... 1.'(. .}�Q...................Address .�..�..'."`�C�(� Ilr� f/-/.f.! ... /f%/�j.. � � r Name of Builder Address ..... A � �. ...............J r............................... ....................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .........w`...............5....................•-.............................Roofing ..../.,5�4 ......J....................................................... Floors C/ .......................Interior.............. ....................................... Heating .......ml ...............................................................Plumbing e, d Fireplace .........................:........................................................Approximate Cost ....... 4� .�..................................... . Definitive Plan Approved by Planning Board _____ ________________________19________, Area ...`Q'.................... 81) Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH } a, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. y Name_ ...... ... ...................... f Carvalho Ruy 19455 enclose No ........::....... Permit-,for .................................... r porch 217 B ckskin, Paths r Location ..........: .............................................s. �. 1 Centerville o '•, Ruy Carvalh • Owner .....................................:......::...... ............ frame ; Type of,Construction .......................................... Plot ............................ Lot ............................... i August 2 77 Permit Granted" .......... ......................19 r , �.. Date of Inspection �� v e ....... ... .. ............... .....19 Date Completed ...............19 PERMIT"REFUSED ................... ..................... 19 r ., ............................................ ................. f , .... .......... ................................................ - .t .............. ............................................................. Approved ................................................ 19 .......................................................... Assessor's map and lot number .....................J1 V _�,. ... ..... ' IC 7 T. .WSewage Permit number ry w yofTNEro�♦ TOWN OF BARNSTABLE i BA" TAIILE, i 9� ;p9. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ........190/t C.1....................................................................... TYPEOF CONSTRUCTION ......../!/rr�rl. ........................................................................................................... ..................�.............:.........19..7.7 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1..!..7.....8gck3,,r1.v..../2,4r/i- C..' lc,i—zF4V./C.G ................................................................. /� .;. ProposedUse .....�.v./I/.....!..'...6.0.M...................................................................................................................................... Zoning District ......�..C........................ ..Fire District ......` '.. ....................................................... ............................. f Name of Owner "I�va i u n .... ?..l y (,A-k1/��/_/-) Address ...-�....1..7../`�v C/�T f 1r1'/� �i9-i/mac ( ��-/ , .............................................................. .......................................................... Name of Builder }J. FRT' t�"' 7'ChFL- ..................................-.................Address ............ .................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. f Exterior .........(6„C.........5. �/LGt .................................Roofing ....�SQ�/�LT.`................................................... Floors '.........................................................................Interior .................................................................................... / Heating ...............................................................Plumbing ..... .................................................................................. Fireplace ........................................Approximate Cost Definitive Plan Approved by Planning Board ________________________________19________. Area f'`Q'.................... Diagram of Lot and Building with Dimensions Fee /� SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name(�-� AAs A. �1 ..........P...................... ✓................. . . ......................... r, 1 Carvalho, Ruy A=171-18' • �A No 19455 Permit for ,,,,,enclose porch ............................................................................... Location 217 Buckskin Path ............................................................... Centerville ............................................................................... Owner Ruy Caryalho. Type of Construction fraigte . . .... ........................................... .............................. Plot ............................ Lot ............................ Permit Granted gust 2 19 77 Date of Inspection ........... ........................19 Date Completed ................ ....................19 PERM T REFUSED e.. ............ .��. ......................... 19 .�....... .... ..... ................. .......................................... . ............................... .............................................. ....................... ..... ....... . ................................................................... Approved ................................................ 19 ................................................................................ ............................................................................... n G= y�%TH E T�4 ao� TOWN OF R�AR:NSTARLE VASIL i HAHB9TADLE, • � . `0 i6391MAI DUILDIIG IHSPECTOR Gp • � i . � APPLICATION FOR PERMIT TO ..:... . . .:........:... !!� ............... °............. TYPE OF CONSTRUCTION .....................:. ... .... ...................................;: g .................................................. : G 7 '. TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to 'the following information: �`; .' 0 Location ......� ..... ... Y ....... ��• ss .. ...... ' ...`. ........ n ProposedUse .... ...................................... ...................................................... ....................... ............. Zoning District ..... .. . I.. ..... ...................Fire District .. p Name of Owne ....... .. .. ............ ...e.... ......... .Address ......................... Nameof Buil`der ....................................................................Address .................................................................................... Nameof Architect ................:.................................................Address ............... �. ........................................................ r L a Number of Roo .........i�.................................................Foundation ....... .. : .... ........ ... . Exterior : �" � . .. . .. ....:.... ...... 4� 1�.....................................................Roofing ..... FloorsInterior ..........................:........................................ ........... ........ : ... .. �„ ..�. a ° � ... Heating , - , 1 °s... '��'.............................................Plumbing ............. I. Fireplace ...........................Approximate Cost . � :. .... Definitive Plan Approved by Planning Board ________________-___________-19 Diagram of Lot and Building with Dimensions F� 0 ^ N SUBJECT TO APPROVAL OF BOARD OF ,HEALTH v L1 Uj VLd > � LU o UJ a. Q = tip i u^� Ld �. ix Q U 44. nz: U -e W : ELs i ca W CJ O 0 I hereby agree to conform to all the Rules and Regulations of the Town of B. nWi[ �13rcling . e above construction. co Z Name ..... ...... �....... � Small, Alan E. / �^ ' one � No —.����9�. Permit for -----....������-- single-f ----.��.�s��.. | ������r-.���.������r�.----.— r7 � ' / /4u^kakio Path 1 � Location ....................................................... ' � . . Centerville —..-----..----.-----------...,~`.... � [xwner ...........Alan..I��_@oaal]___.___._ ' o | _ � Type of Conxtruction' ................ r.aPe............... } - —.—.—.-.—.—_._----,--.,.---,-... / { �2I Plot ------..--.. Lot . ..=` / - -. ----.. � ^ _�� ~' . Parn�h Granted Juroza l5 lg ��" - -----'—:—'----'' - | | Date of Inspection lQ | ' | | - � , � PERMIT REFUSED ( � / . . l9 | .-------. - -----------.. r , .----.~--...----.—,---.--^-----. � . '`---~^-^^^'—`^—^--'----^—''~—`--' � --~~---'-----'~~'`'~---^^_—^^^'^—' ! . .---.—.—..----.—.—.--...—..—~..... Approved / ................................................. lA _ -------'--------^------^^--- -------'---~------^—'~~'—^--^— �t r Town of Barnstable *Permit#& 1 -3Pv Expires 6 months from issue date • Regulatory Services Fee &UMSPABLE, ' v� i 6 9 •� Thomas F.Geiler,Director A 3 : Building Division Tom Perry, Building Commissioner A-PRESS. PERM T 200 Main Street, Hyannis,MA 02601 APR 14 ZOOS Office: 508-862-4038 Fax: 508-790-6230 'TOWN Op BARNSTABLE EXPRESS PERMIT APPLICATION RESIDENTIAL ONL Not Valid without Red X-Press Imprint Map/parcel Number ( " Property Address Pl &16A SOid/ �� ��° �✓�'�'� Residential Value of Work 1� 7�� Owner's Name&Address 1l del, Contractor's Name AZ rA69& R/G'A:�,// TTelephone Number ���' 9��✓- ���� Home Improvement Contractor License#(if applicable) lao 16 02 Construction Supervisor's License#(if applicable) <orkman's Compensation Insurance Check one: - ❑ I am a sole proprietor VI the Homeowner e Worker's Compensation Insurance a Insurance Company Name ' /7 fin' /. /0 � ®� 00/ 2—00 3 t' Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will betaken to ❑Re-roof(not stripping. Going over existing layers of roof) eRe-side V Fes-21 ve f Z dReplacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note- Pr perry 0' r m si r erty Owner Letter of Permission. Signature Q:Forms:expmtrg Revised121901 Town of Barnstable ti Regulatory Services NAM ' Thomas F.Geiler,Director 9�A 039. 10�' ' rEON,prA Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section If Using A Builder I, R11 if �/ 1�'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) e- SignatA of Owner ate 1 V v PvR ¢o Print Name Q:FORM&OWNERPERMISSION Rkni.ineering De t. 3raCfloor Ma Parcel Dept.�) p Permit# ' House# a�f 2-� - Date Issue (it t� Board of Health(3rd floor)(8:15-9:30/1:00-4:30) - Fee d� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) 1HE rq Definitive Plan Approved by Planning Board 19 _ • BARNSTABLE. 1E0 AAA B,� ' TOWN OF BARNSTABLE Building Permit Application Project Street Address _ / 7 /j u CK.d`/L`i,-. Q� . Village' C' nT-c�y a VC Owner' �v y �r9�/09� Address _ / a c,<_-X ' -- .-Telephone ,, - Permit Request o o y �• , t . r ..First•Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ y 6 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Ef Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) r ❑None ❑Shed(size) _ ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal#.. Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name -�S- L C,11'7 9AY `` b Telephone Number ,S`�8 XZ_8 .2 Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS-BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '09—i¢y SIGNATURE DATE BUILJ1j!Jg,PE,RMITD4N%1D OR TH.9 FOLL/O�WING REASON(S) �.I/ + FOR OFFICIAL USE ONLY _ PERMIT INTO. DATE ISSUED MAP/PARCEL NO. w 1 ADDRESS VILLAGE! OWNER .. DATE OF INSPECTION: FOUNDATION r r FRAME 1 j INSULATION FIREPLACE ' ELECTRICAL: ' ROUGH FINAL - 4 4 , r PLUMBING: ROUGH -` ' FINAL 5 4 GAS: ROUGH ' FINAL ; » F FINAL BUILDING 1 DATE CLOSED OUT " ASSOCIATION PLAN NO. - • The Commonwealth of.4fascaalusetts _i::.� ,. i. �;_-- Deparinuent of Industrial Accidents y � f Office flUM stigai/nos 600 11'a.vhitt,tun Street Bo.ctoit, Ma.u. (12111 Workers' Compensation Insurance Affidavit applicant information: _. __..Please PRIIYTIebj�2[Y---�_-.._-..-.... - - name: location: 61N. Phone# �d 5�-z `3 2 I-Z d I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity ......vim. _- __: L..._.,.r_r.:r.-....rc.w_;.rrr�aa..+..i•.-_._-.l:.r :f. ��...._...- :_r..:':�L .: - __ � ....:a• -- ---Lam.+�.......-r.-�__� I am an employer providing workers' compensation for my employees working on this job. comnan%, name: address: cih: phone#• insurance co. policy# Cj 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: phone#• insurance co. pniiev# _..-_._.... .._ ._.�_-.-....- rI.0 JJiu_.._rr.wr. :l .�....1�•.,.�Lr..r..r -11 - - ..1� _._.-.L..��Y._... .L__� comnanv name: address: tits Phone#: - insurance co. nolicy it Attach additional sheet ifnecessar -• _ � =� --�""::ems:•-.� _ ..:-r:. ,�. .. ..:,,::,.:���.:�• �..,:-.. �. Failure to secure coverage as required under Section 25A of 11IGL 152 can lead to the imposition of criminal penalties of atline up to S1.500.00 andior one%cars' imprisonment as well as'civil penalties in the form of a STOP R'ORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be fortv:trded to the Office of Investigations of the DIA for coverage verification. I do herehy certify and he pain and 7ialtiesf perjure•that the information provided above is true and correct. Si_nature Date �� "'r %/. /27 '7 '_ Print name �L C Zo A Phone# �� $ `��� � ;2 12 y official use onh do not write in this area to.be completed by city or town of 021 ,R city or town: permit/liccnse# f iBuiiding Department CjLiccnsing Board I]check if immediate response is required [3Sclectmen's Office f C3I1calth Department contact person: P hone#: nUthcr E, •j - Information and Instructions G, _ Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the: employees. As quoted from the "la%%` an enrploree 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 the fore�goin�g en�ga�ged in a joint enterprise, and including; the legal representatives of a deceased emplover. 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 d\\!cllin�g house of another who employs persons to do maintenance , construction or repair work on such dwelling hoc or on the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even, state or local licensing agency shall withhold the issuance or reneNNId 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 coverabe required. Additionally. 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 h: 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 supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverege. 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. City or Towns Please be sore 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. Plea hich will be used as a reference number. The affidavits may be returned t be sure to fill in the permit/license number w the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have an,, question please do not hesitate to give us a call. .....�.,.r�...w�.,.+.�e..w.www.+.:�sw.+.+—*.w.'w+-w—..�...�or..w..r�.owal�'!r-•-.rv.���w+wr-�...' 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 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 I . me r - ®f Barnstable . .� The. Town Department 'De artment of Health Safety and Environmental Services ` —AL � Building Division 367 Main Stow,Hyannis MA M601 Raipa CT5s, � Office: 508-790-6227 Building C= : Fax: 508 190-6230 For office use only Permit no. Date , AFFIDAVIT' HOME MOROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, r movatlon, repair, modernization. conversion, improvement, removal, demolition, t one construction of than ditton to our dwelling pre-ex Ing to owner occupied building containing at fens but not by registered contractors, with structures which are adjacent to such residence or building be done certain exceptions,along with other requirements Type of Work: %L �°' Address of Work: Owner's Name Date of Permit Appiicntion: f I hereby certify that: Registration is not required for the following renson(s): Work excluded by law _Job under 51,000. Building not owner-occupied Owner puiling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLIG_W oGRAM OR G HOME �iJROvEMENT WORK DO A►RANTY FUND UNDER MGI.O 14?�i � ACCESS TO THE AwumATION PR SIG,IED UNDER PENALTIES OF PER.TURY I hereby apply for a permit as the agent of the awaer. f9-7 - L C4zZ-4— r Co % ®G / Registration lyo. Date Contractor Name y 7 UJ-. yt4�LlI/CILf.IIG �✓�'� • s Jfie TDamm ac/zud DBPAflTNBIT OF PUBLIC.SAFETY d. CORSTRUCTIDA SUPERVISOR LICSRSB Runber Bspires BittGdate:. A36101 0512811998 05/2811949._ r `� lestrl�''ede l'o AB j g~ '""+' 4 �zdir JAMBS L �CASBAULT r 193 CLAM ou COMB Y- � T= 374 i0ain»eoaeuiea i a�✓>'ffanoac/u aelC HOME IMPROVEMENT CONTRACTOR,.= • Registration. 120689. 4� Type - DBA t :Expiration 02/21/98 , 4 tJ L ;CAZEAULT CO .: ,J_QMES L. CAZEAULT T F 31 MAIN ST ADMINISTRATOR ' pOSTERVILLE MA 0 �.ss`.e' ,.ci