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HomeMy WebLinkAbout0309 BUCKSKIN PATH Town of Barnstable Kling 'Post.h Card So That rt is'V sible`From the St`reet5 Approved4Plans Must be`:Retanied on lob and this Card Must be Kept r �nari�rntat e Permit `Posted Until.Final Inspection3 Has Been Madet aWhere a Certificate of Occupancy is Requ red;auch Building shall Not_be Occupied until a Fnal.lnspection has been made ,n, Permit No. B-19-3556 Applicant Name:. HARRON, PHILIP L Approvals Date Issued: 11/15/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 05/15/2020 Foundation: Location: 309 BUCKSKIN PATH,CENTERVILLE Map/Lot: 171 027 . Zoning District: RC Sheathing: Owner on Record: HARRON, PHILIP L Contractor Name ,HOMEOWNER IS APPLICANT Framing: 1 Address: 237 BUCKSKIN PATH Contractor License: EXEMPT 2 CENTERVILLE, MA 02632 ( W Est. Project Cost: $2,000.QO . Chimney: Description: Enclose an open breezeway to turn into a mu�droom. Put'in 2 Permit Fee: $85.00 sliders 2 doors and two windows. 9 X 15. Add smoke, Insulation: Fee Paid $85.00 Project Review Req: HEATED SPACE TO COMPLY WITH 2O15 IECC. GARAGE FIRE r , Date: 11/15/2019 Final: SEPARATION REQUIRED. HEAT DETECTOR REQUIRED IN< ' GARAGE AND SMOKE DETECTOR REQUIRED IN ADDITIONAL Plumbing/Gas LIVING SPACE. Rough Plumbing: ;Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six,months after--Issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and striuctures shall be in compliance with the local zo ring by-laws and codes. 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 Final Gas: work until the completion of the same. 'g • Electrical The Certificate of Occupancy will not be issued until all applicable signatures byxhe Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection ym r Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Priorto Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TFIE Application Number. ... =13.—..Z�S.&�S&................ ... .......... .... ELARNWABLE, MASS. Permit Fee.:...............`.....................Other Fee:....................... Total Fee Paid.... ..... ..................... ...... .................... I&Ntt)l, TOWN OF BARNSTABLE Permit Approval by.. ( ......................On... ........ �����zTBUILDING PERT . ..... M* ...............:......Parcel.......0.0­7......................... ap..... APPLICATION 1,9 Section 1 — Owner's InAtiation and Project Location Project Address_ &j�VIA PaPA Village Lohrrvilte, Owners Name Owners Legal Address 01 (�Q(/Wk('A Pa+vl City—cbnkr-,Ji�[L State zip Owners Cell# 774 - 9 &173 E-mail Section 2 Use of Structure , Use Group_ F Commercial Structure over 35,000 cubic feet Commercial'9tructuie-'�h&r 35,000 cubic feet Ld Single/Two Family Dwelling' Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate EJ Accessory Structure E] Change of uses El Demo/(entire structure) ❑ Finish Basement El Family/Amnesty E] Fire Alarm :0 UU Rebuild El ' Deck Apartment ❑ Sprinkler Sysie CD F E] Addition ❑ Retaining wall E] Solar X Renovation* ❑ Pool 0 Insulation C= M Other-Specify _U Section 4 - Work Description rr, W C-VL i/i ID '2 A4 A r'O Pvm OTXA- elil'At a L)DOr- t, fcv wlqAvw , ski,` U r 'Vc -1-171 M(— I---* ffy% A—r t Nv r- 0 o©r j,01, Uri- ��h V, &/.Z., �loori►� I rtc-s"V,� b dv�,6 ltv�ll bc C-7wp(li t-0 4-L., r6"4 �V ' cb wte- 1 7 + Kta V& kr WjK i� 0-VA, A.0,rm,05f WiPiS aA adl:A'MV-1 . 5rkot4- bc,l /kr /f d&t-I'n Jr s. T 6�+—.4.+.A- 11/1 1CMA1 0 e j Application Number.................................................... Section 5—Detail Cost of Proposed Construction 2000 00 Square Footage of Project Age of Structure 73 Dig Safe Number l y e 1lca2 �u # Of Bedrooms Existing 3 Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method Q fqA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics dWiring ❑ Oil Tank Storage (Smoke Detectors [] Plumbing ❑ Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply Public ,. ❑ Private - Sewage Disposal ❑ Municipal '/ LJ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: AA I am using a crane ❑ Yes 2No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland coastal bank? Yes El No W � , Section 8—Zoning Information Zoning District �C., Proposed Use Avb—ftm Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage V#of Dwelling Units (on site) a Setbacks Front Yard Required Proposed f {{ f Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes U No P .. Last updated: 11/15/2018 e U O - -. H may` O .oC �� /, Z � Oct M F l04 jx w� nor 0 SMOKE DETECTORS REVIEWED J _ _ _ ��1319 S L UILDING EPT. DATE o U-"TK!F v FIR DEPARTMENT DATE: BOTN,SIGNATURES ARE REQUIRED FOR PERMITTING ram^ CD V- V O Barnstable Bldg.Dept. Approved by: Permit#: a co x15 � o Of o rn �fl � �pc(' fd L6M O CO cu C 0 n Q "' 0 t Yin�dtL Y lUe,�vxr� GUl� 7- OCTca U .y 23 2019 #2 w �jlc�C i fJ(� wall CD 7' £ _ , °oVIN 5 ; , Co o M o _0o �� N (If M O p EO M Cc Lo p ' N L CO Yinidti tovo N Cr'7 N C p >C i _ �� Fx•�r',�--Gu mil) . . 4 VM The Commonwealth of Massachusetts Department of IndustridAccidents k Office of Investigations 600 Washington Street ' Boston,MA 02111 www massgov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 1 ` Name(Business/Organizadon/Individual): i �'41 It� 1'l � �✓` Address• °l cl�5 " � - City/State/Zip: ►-t.�� I�t- a. 0-26e phone#: >76PP73 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 1 employees(full and/or part-time).* have hired the sub-contractors 6: ❑ construction s proprietor partner- . listed on e act. �7. Remodeling 2.El I am ale eto or the shee ro p o p p . ship and have no employees „ . These sub-contractors have g• ❑Demolition working for me in any capacity.: - employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] . 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their. 11.❑Plumbing repairs or additions right of exemption per MGL myself.[No workers comp. • F 12.❑Roofrepaus ' insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] J . *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 mast submit a new affidavit indicating such. tConttactots that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not thole entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. - I am an employer that is providing workers'compensation insurance for my employees. Below is thepg cy and job site information. Insurance Company Name: Policy#or Self--,ins.Lie.#: Expiration Date: Job Site Address:- City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as'required under Section 25A of MGL c: 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 c the pains and penalties of perjury that the information pro above is true and correct Si afore - Date: ZS '��9 r Phone#• 77 SS'(917 3 Official use only. Do not write in this area,to be completed by city or town qjycia[ City or Town: Permit/License# f Issuing Authority(circle one): .y . r 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: 'Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate n bnsmess or to conshmet bwldings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'corimpensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 , - Departmeat of Indastriat Accidents Office of Investigations 600 Washington Street Boston,MA 42111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia Application Number........................................ . Section 9- Construction Supervisor Name elephone Number Address 1ty State Zip License Number License Type Expiration Date Contractors Email Cell # 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`s Name Tele Number 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: In.l 1 c�C-r Telephone Number 7 71f^ 5 - Cell or Work Number 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 documentatiMre ' by �andthe Tow�of rnstable. . Signature Date APPLICANT SIGNATURE Signature Date C-"-I& -19' Print Name I���Ip 9.7 Telephone Number 77�-35 3�17 j E-mail ermit to: +( �,�►�re,a 4� 1 Cc, C t p ` Last uvdated: 11/15/2018 Section 12 —Department Sign-Offs l`~ Health Department ❑ Zoning Board(if required) Historic District _ ❑ Site Plan Review(if required) ❑ Fire Department ❑ �f Conservation ❑ ��,, For commercial work,please take your plans directly to the fire department for,approvak Section 13— Owner's Authorization L , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho ' by this building permit application for: (Address of job) Signature of Owner date Print.Name '- Last updated: 11/15/2018 THE TOWN OF BARNSTABLE am BUILDING . INSPECTOR ,TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informa).�;n: Zoning District - .......Fire District ............................................... NomeofO�ner�./���������. �—.-''_A66rex _ ___.______._. Name. of Builder .---_.---------'-------...Address ....................... ............................................................ Name of Architect ....................................................................Address ................. T- � Number of Room, — _._'---'--Foon6otion ._............ ..r'-- ____. ~ Exlerior ............ ...............................Roofing .. .............. Floors ---`---�^~ ---_._--,_---'_.-|nte,iov -- Heating ................. ..----.�.......Plumbing -. .................................. � Fireplace --'' --_'----Approx/moHeCos -- . .�="-�........ Definitive Plan by Planning Board ----------- Diagram of Lot and Building v04 Dimensions SUBJECT TO. Jr APPROVAL BOARD HEALTH �^^�� ^ ' SEPTIC SYSTEM MUST BE � 8NSTALLED IN COMPLIANCE ' WITH ARTICLE 11 STATE SANITARY CODE AND TOWN REGULATIONSq., � � 11, hereby agree, to conform to aff.the Rules and, Regulations of the Town of Barnstable regarding | / � � | ^ � � � . . � ' ' the above -^----'^—~ Small, Alan ' m one story � No —' . Permit for .................................... _ dwelling ' -----^--------------------'' ` ' , Buckskin Path � ^ Location -----..~~-------------.. . Centery � / ----^--..... .........;........................................... \ . .Alan SuuaII Owner ...................................... _.. ^ ' . '.. ----- ' Type of Construction —frame .................................... ` � ^ -----.--_-----------'-----. � � ^ � Plot ............................ Lot --.#12------ /~ ~- Maroh 12 �� Permit Granted ---_------- ......lV ^~ . ' Dote of Inspection ................... ---'l9 Dote Completed —����.�~a ����--..l9 ^ , ~-������� l�� . � . ������ ' c^ -~ ' ^ / --.-----------_------- lg / ` .-------'------------------ ~'_,-----�---------.—..------.. » . � _,_,_,______._._'____._,,.__,___. / ' ' ` | —.-----~..—.~—.—..—.----.--.--.— Approved ................................................. 19 ) � ^ � -----------------.-----.---.. �................._ ....... ................................................... \ ` / � Town of BarnstableBuilding P„ost This Ca"rd So,That rt Is,VisibleFrom the Street Approved Plans;Must be Retained on,,Job and this,Card Must be Kept .; MAC.' � � ` , x �' r` 3 ,M Permt • r:as� � Poste.d Until"vFinal'InspectionhHas Beene Made �x,� N 3 enrR Where aCertificate of Occupancyis Required,such Bwldmg shallNo#:be Occupied untld aFlnal Inspection has been made Permit No. B-18-3488 Applicant Name: MICHAELJ AUPPERLEE Approvals Date Issued: 10/22/2018 Current Use:. Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 04/22/2019 Foundation: Location: 309 BUCKSKIN PATH,CENTERVILLE Map/Lot: 171-027 Zoning District: RC Sheathing: Owner on Record: HARRON, PHILIP L Contractor Name::- _MICHAEL AUPPERLEE DBA Framing: 1 Address: 237 BUCKSKIN PATH IVIiCHAEL AUPPERLEE 2 RENOVATIONS CENTERVILLE, MA 02632 Chimne Contractor License: 153440 Y Description: chimney rebuild exterior and above smoke chamber-what started as a bad leak from chimney cap. discovered mortar missing/cracked Est Project Cost: $5,000.00 Insulation: throughout and dry laid flu liners Permit Fee: $85.00 Final: Project Review Req: Fee Paid: $85.00 •`Date: 10/22/2018 Plumbing/Gas Rough Plumbing: ;Lx Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized 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=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 Toning 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 for qublic inspection for the entire duration of the work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provide-d'on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final' 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health 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 "Persons contracting with unregistered contractors.do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: . . i -.. ..J.......... G Application ...... •e s + * ; t KA88. Permit Fee.................... ......Othea Fee.................:...... 059. Total Fee Paid......ro........Orr ...........p� ........................ d 1� o zzhv TOWN OF BARNSTABLE Permit Approval by........ F . .. BUILDING PERNIIT ... ..._....1 ....I...........Parcel........(,r a:. -.. ... . .. APPLICATION Section I—Owner's Information and Project Location Project Address 301 k, village Cep- /1!J Ile Owners Name-, Ph 111e rro h Owners Legal Address C State zip 0 owners Cell# E-mail Ph%�7 1c;�h&acre#�;dwsGC.of6, - -Section 2—Use of Structure 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 El Demo/(entire structure) El FinishBasement ❑ Family/Amnesty ElFire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify ► H 1`C f� &I-error- v. abov-e S�tif�e � Section 4 -Work Description _ tlJlt�1` S' r leaS e? /-P -r- k �``=/`doi�t G�j? u'7iY1YLe �JZ�n /J"�LC uerPCi/ rt��� � miSS � � /C/�Ct�ed� �fhroc�l C�� T Act nndntPd:2/9=1 S Application Number.................................................... Section 5—Detail Ob Cost of Proposed Construction D6 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing ` s 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 ❑ Plumbing ❑ Gas _❑ Fire Suppression ❑ Heating System Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal '❑ On Site lEstoric District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility. /e,,,,5 1f, �t�.���'.`// I am using a crane ❑ Yes l® No s Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Rr Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. 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 undated:2/9/2019 } ; , I r i k ! I j , : t , f t r f i : 1 I i I a x } : : y , , _ } I : y I. • i i : I I I I , r { 4 , , , • f 1 , : 1 ' I : i v ` I 1 i 1 I _ �1 I : 91 1 1 a T^ a a , i : _ 1 i � 3 r i , s 1 • i i 1 ( s Fs. : Sic � rerr� , s : hb , w 5 , i I • , i : 2 I 8 , i er a. . , j u, t A , y , r r 6� : I : i S ! j , i t t _ t : : a S } • i� .o , • r 1 v �J e t , i lot s - ti �rh � s } s. t y. ..... ._. ..,..�1 f f , t 1 r ' d fl 1 T-T UNIT 1 i f p� , i ✓✓✓ r i ! i e t tt t , $.. * < 1 Y 1� 1 t a T I , : 1 3 ' t 4:12 :_ I 1 TA", An �l T; , { F -•4. a _._ _ __ a 41; 44 A lz .. ': 1 f { F + t s + x ? I t ', , P� t OT , A A'. `m. C"9 i © F i f ; 1 r 1 f l� ; li 17 F K I t dnlx� 1 t 17, r- 1 ACo CERTIFICATE OF LIABILITY INSURANCE FDATE(MWDDnYYY) �► 10/19/2018 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 endorsements). PRODUCER - CONTACT NAME: Sharon Covino McShea Insurance Agency,Inc PHONNo,E 508)420-9011 1 FAX. No): 508 420-9010 1645 Falmouth Road,Rt 28 BLDG D n DD RLESS:" sharon@mcsheainsurance.com Centerville, MA 02632 INSURERS AFFORDING COVERAGE NAIC# INSURERA: AIM MUTUAL INSURED INSURER8: NATIONAL GRANGE MUTUAL 14788 Aupperlee,Michael INSURERC: AIM Mutual DBA Michael Aupperlee Renovations 169 Sandalwood Dr INSURERD: Cotuit, MA 02635-2315 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-77165 REVISION NUMBER: 9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLT R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POI ICY EFF POLDICY EXP O/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY MPJ26304 02/09►2018 02/09/2019 EACH OCCURRENCE $ 300,000 DAMAGE TO RENTED CLAIMS-MADE )( OCCUR —PREMISES(E.occu ence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3O0 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600,000 X POLICY❑JE� F—] LOC PRODUCTS-COMP/OP AGG $ 600,000 OTHER: $ B AUTOMOBILE LIABILITY M1 T4893T 09/30/2018 09/30/2019 E�aB tleDISINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 250,000 AO OS ONLY X WNED SCHEDULED BODILY INJURY(Per accident) $ '500 000 AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY - Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ___FDED_7 RETENTION$ - $ `+ WORKERS COMPENSATION WCC5OO5O11 O97 06/19/2018 06/19/2019 _ STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N, E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? F7N] N/A - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED EPRESENTATIVE SSC ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SSC on October 19,2018 at 10:52AM Commonwealth of Massachusetts 9 Division of Professional Licensure Board of Building Regulations and Standards �i Construction,���e .T�1 & 2 Family j CSFA-049205 ; p Tres 07/1412020 MICHAEL J AUPPERLE .? 169 SANDALW,0015.619, 0 ' COTUIT MA 026j5 ��, S� � 'r.`s' Commissioner Office of Consumer Affairs&Businesi`Regulaficil HOME.IMPROVEMENT CONTRACTOR TYPE: Individual _>Registration Expiration __=j1_53440:-, 12J10/2018 MICHAEL AUPPERLEE D/B/A Michael Auppeflee Renovations Michael Aupperlelw e 169 Sandaood`Dr.` ' Cotuit,MA.02635 --- ..Undersecretary Construction Supervisor 1&2 Family Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl . —— f Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation _. ,., 10 Park Plaza-Suite 5170 Boston,MA 02116 i " Not valid witho sit nature „ PI r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dhz Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): we%!k l�u.pP P �2ti d y b S C Address: 11611 > �r City/State/Zip: Coliaf � 144 6a-6;S Phone#: ado >6 $ Are you an employer?Check the appropriate bog: Type of project(required): 1.2 I am a employer with 4. ❑ I am a general contractor and I —'�—* have hired the sub-contractors 6. []New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor mein an capacity. employees and have workers' y p �'• � 9. ❑Building addition . [No workers' comp.insurance comp.insurance.: required.] 1. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs . insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other .,7,a e;, P e l ei(o/ comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the poncy and job site information. / Insurance Company Name: it tum l bExpiration Policy#or Self-ins.Lic.#: W CC � D�B//0�'i �7 Date Job Site Address: 36 Sk,, AYA City/State/Zip: &,,/2rvfAl Attach a copy of themorkers'compensation policy declaration page(showing the policy number and expiration date). .. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. , I do hereby certify under the pains an enaldes of perju that the information provided above is true and correct.' Signature: Date: Phone#: C '7 7 S 3 3 y Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner,of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no,employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE ' Revised 4-24-07 Fax#617-727-7749 www,maw.gov/dia . 1 • t � 1 t , , + + , S : i { • . 1 i I ` i • t ! I 1 k ' t ' t f • ' y t 1 f i x vi € Lfe 2 il•-P u+ I Aft--s. 1 s 1 � i 1 i , 1 7 .. a ' 1 Y t s t. Y� 7 1 , f ' • s { t 1 t e 2 t } Jr bras f 6. t O , i Application Number........................................... Section 9—.Construction Supervisor Name A-u p a-rI :e P Telephone Number 5 O q -? 7 6 1W O Address.A-9 Sooldalwooal /.fir City__a- State Zip OPT - v` License Number 6-'19 ,90Y License Type CSj=i Expiration Date Contractors Emnil_ h e o ( ,d A a 0 1 . C a ran Cell# 1516X 7 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 t Town of B le.Attach a copy of your license. Signature .� Date' ? _ Section-10—Home Improvement Contractor Name *z2a gL"y' Telephone Number • S'62 ??g ' g 3, 3 6 Address Ie? .5 a.Ai/iWOW)2,city 'j Y State /�i e zip 1)"DLI ? S w Registration Number1 S 3 i/y d Expiration Date �Q k. I understand my responsibilities under the rales and regulations for Home Improvement Contractors in accordance with 780 w w CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and cimmentation required by 780 CMR RoAp Town of B le.Attach a copy of your H.LC... Signature Date -7 Section 11—Home Owners License Exemption { Home Owners Name: Telephone Number Cell or Work Number 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. Signature Date APPLICANT SIGNATURE Signature Date /o i? Print Name 8: c4me l A u „ e__--/e r, Telephone Number 563 a E-mail permit to: /� ,�,n ,�1 46/ . e- n m T e..F.....7..a_.s.mmPNnIo Section 12—Department Sign-Offs ` tl 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 deparftnent for approval Section 13—Owner's Authorization as Owner of the-subject property hereby authorize 1P Y0 to act.on my behalf in all matters relative to work authorized 7 this building permit application for: (Address of j ob) o 1 7 rk/ S' e f Prin Namer . �- I . o Last iwdatc&219/2018 table *Permit# 5-4� zL Town of Barns .� Expires 6 months from issue date y . '4 3 1ARNSI'AHLE. Regulatory Services Fee • a , r • 9 tKAss. Thomas F.Geiler,Director Building Division ®� Peter F.DiMatteo, Building Commissioner 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 TO RAP 1 ZOO Fax: 508-790-6230 Z EXPRESS PERMIT APPLICATION - RESIDENTIAL MFY8A/%S? (' Not Valid without Red X-Press Imprint �eL� Map/parcel Number ! 716 Al2 ,/ Property Address V�7 VCk�kIJAI Mf7 (6 Z-1Z- o residential Value of Work / A /�0 Owner's Name&Address !/101�O/�A7'1 ,' /���� V Contractor's Name �ftrT t 'C�U►��C/ � �� � Telephone Number ���� �97— Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ' i Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Ins1uranceL /v�" Insurance Company Name 'Z W 1 U7 Z,v Workman's Comp.Policy# ��% 9/ V53 Permit Request(check.box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) VRe-side. ❑ Replacement 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. Signature Q:Forms:expmtrg:rev-070601 • R f Town of Barnstable *Permit# O� THE Tp� Fr Tres 6 months from issue date • .,�tntsrnet.e. • Regulatory Services Fee r� russ. Thomas F.Geiler,Director 1639. .0 QED MPt6 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner �s 367 Main Street, Hyannis,MA 02601w U Office. 508-862-4038 TO J N 1 kRQ®�' Fax: 508-790-6230 %N OF BOO/ EXPRESS Valid without PERMIT APPLICATION P PLI A IONNot egRNSTq Map/parcel Number 1� Property Address \Clci ��'�'Lt\��{"� ' `�1 �"� �VJI� esidential OR ❑Commercial Value of Work Owner's Name&Address tce "� 1 ( Telephone Number (Sb 99� Contractor's Name �..�af Z �- Home Improvement Contractor License#(if applicable) bc� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance _ Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensati n Insurance T iL �h Insurance Company Name J Workman's Comp.Policy# c Permit Request(check box) ❑ Re-roof(stripping old shingles) [t�}'I ee--roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify). *Where required: Issuance of t does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Sianature cxpmg gay Assessor's office(1st Floor):.• / _ {_ Assessors map a d lot number (�� "�-t CO / �-- �' r�a� :A--: o�THE o p cA Conservation '` \�..r� 'R_�-�° .�T�. �✓dNr � P e Board of Health(3rd floor): , � t-� r ' w Sewage Permit number " EN!/ �i� 1 ... Engineering Department(3rd floor): � A i030• House number �L'.' v� ALA,� Definitive Plan Approved by Planning Board 19 Q APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 30 C[ tP •/U CR N �{ U f'Ile 1�,6 f-1' TYPE OF CONSTRUCTION } us uh f 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use -3 Ar Z.,,j © � Zoning District ��� Fire District C b M t Name of Owner V")t I JaAl�/�/ICP / [ �� W Address 0 l/ 09,vt-,?, !/ Name of Builder P/� +�� \ _��'w� /'P Name of Architect L F (Sr M �� �o Address Number of Rooms ! Foundation'E, +V L Q Exterior Roofing TAP A S4 f Floors / Interior Heating /" ® Plumbing A,) VVI�5_ v Fireplace wQ��" Approximate Cost rea �, o0 Diagram of Lot and Building with Dimensions ? ee `ICJ O Qn 41 o f f I� J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the bove construction. Name 0 Construction Supervisor's License McCURDY, WILLIAM & ALICE r . No 35285. Permit For BUILD ADDITION Single Family Dwelling Location •309 Buckskin Path Centerville - y -Owner William & Alice McCurdy -Owne t Type of Construction Frame �^ Plot Loti(4, Permit Granted ./ August 14 , i 9; 92 ' Date of Inspection - 19 Date Completed 7-� 19ir r el ro mew i or tn r . v y. •A1s ;;i•LS'dY,.y`:b JHax`fi-M'y5n+[ 1 g, COMMONWEALTH DEPARTMeHT:OF.PUWC SAFETY 1 " OF 1.O1O,COMMONWEALTH AVE: .. Ao TON,MASS.02213 MASSACHUSETTS ENCLOSE CHECK�OR=MONEY.ORDER ;LICENSE r rl EXPIRATION DATE CONSTR. .:SUPERVISOR< t :' FOR,REQUIRED FEE, 07/31/199.3 k� RESTRICTIONS EFFECTIVE DATE . �" MADE PAYABLE TO LIC-NO? .r " �7(31/�991 04425$ '`eOMMISSIONER OF PUBLIC.SAFETY' j' FREMONT C STAPLES , s r;.:. (DP1�oTs�NOc )• SS !l 034-40-0688 " 1.11 =SCARLETT DRIVE ..PtYMOUTH MA 02360 p/I � . -._ PHOTO.(BLASTING OPR ONLY) FEE: 1`{�� •J •�J/i.� _. :.100 .,i HEICjHT NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY Y a ' y �TAMP,ED•OR-_SIGNATURE OF THE COMMISSIONER �O :l �_� f 4 0o ti `I j a 1' 09;r 949 i,, I 01 DETACH .-LICENSE =ST ' /.d k F. t TNf9 DOCVMNT tMU81'r \ r q. i CARRIED ON ^. +r JME HOLDERF(y �a�g 4 , 81GNAT E pF GN NAME IN FULL ABOVE SIGNATURE LINE •. .OTH I' ll gN gi THUMB:.PRINT EO 11Y TN bCCUPA ON „° �y?'y11 a ? y COMA! R• ��"t I `f ^ 200M•2•67.81429. } u V 1GG �«i�YZi��E�t!Z%1�G�t.1�l.LWJC�:fr4�Z�••I.OfiTiLO HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and �_at.:andard One Ashburton Place — Room 1:?0, Boston , Massachusetts 021.08 'I HOME IMPROVEMENT CONTRACTOR r `Registration 106531 Expiration 07/23/94 Type - INDIVIDUAL Registration 106531 Type - INDIVIDUAL Fremont C . Staples Expiration 07/23/94 182 Shore ( �` Falmouth MA 02540 Fremont C. Staples 182 Shore Falmouth MA 02540 ADMINISTRATOR 4 t � t l o - z 04 f cf DRAWING TITLE: 2�to��.-✓� Jam!1�� � i ! cam-• ,�;; � v S�. ��� ��(��D�i t� 3/4 IJv,iJ PELTS 2 o.L. I L DRAWN BY: �p I I CHECKED BY: 4,\` -! FRDATE: OJECT NO. SHEET NO. �'';�G�, k 12�' GC>i.�G. F=e"I'I i�� V — _•r - ` _ • ' __ ell i_ ll OF . 2 YC IL L�CX�1 r i I : I N C�)Z�IZS� i�—od f i • d�4C._ F' '�J`'(II-..�C=1 �O�I�.�I�TIOI�-� u� F, 4 j FV � �Pp � , 1,1_ /- :J i vv p ------------ - PA �c 7io n i✓� e w. f- D G D _Y 3 xy