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0978 BUMPS RIVER ROAD
9 7 41 g4jR T� Tk� -q �gdg' m Nt--'�Q NCO �gp gk XV, AA pqgM v 'M At NtM OEM, 111 M gi�j I A MIN" NMI. EPA ggw' w �WE AMR I YAR &A av" VRT W'S'.x-'ROPE f 11 pil VIM,: itjgi 'ne IV J11 a I kN p Al ig, f -51 "MA U, W MR1 M�l z" ,WN, 44—wMUTA4 .3k a R f4 INIf WA&i !� `*' "i", Azib to Town of Barnsta le *Permit# u es 6 months from issue date �. Regulatory Services.� � f. • snnxsrnsrt•:, • MASS. Richard V.Scali,Director JUL 059. �. 2 6 2017 D ` Building Divisio,01A/Aj0 Paul Roma,BuildingCommissioner, 200 Main Street,Hyannis,MA 02601 A �`�SABLE www.town.barnstable.ma.us Office: 508-862-40.38 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY 7NotCi 6 Valid without Red X-Press Imprint Map/parcel Number c, 0 Property Address 7 5� Cfi-1Z r (Irl- 4 [Residential Value of Work$ 3w Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name J4- /��OA�< a?t'OUI � Telephone Number Home Improvement Contractor License#(if applicable) 6 �®� Email: Construction Supervisor's License#(if applicable) �� 6 13 DWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name d in Workman's Comp.Policy# 1Z _�Od Copy of Insurance Compliance.Certificate must accompany each permit. Permit Re est(check box) ✓ � (f Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum..32)#of windows t #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. G A copy of the Home Improvement Contractors License&Construction Supervisors License.is required. SIGNATURE: tV QAWPFILES\FORMS\building permit forms\02RESS.doc 01/25/17 . 4 17M Coramo nrrea&it of-`ysr diusetls D'eparknatt of ludrasaid Accide7ds - Orke 00m.W69atiem 600 Wa'5hfiwidn S�2-eet' Easton,AIA 0211 }Vrvxu Ma=g4"ilia Workers' CimpensatramInsurance Afffiiw&' BuilderslContractarsM,6cfdci ns Iombers A=Hcamt1i3fQrMafiGn L Please P'riut Le Na=1(Busfi ss m±�inerl a Address: J. ld��+ Cv✓,�c`I �, Are you an employer?Checkthe appropriate ban ' T of project r 4_ I am a Qeneral coafiractos and I Type P ] � t�}�ed}: I.�I am a employer n� d ❑ b 6. New ognstmc6bn employees(f311 andfor part4ime).* have hired the sub=r�nzs mg 2.❑ I am a sale proprietor or-partner- listed arlf$e attached sheet.. �- ❑RP�ode Mese sib-contractors have s1vp and have no employees. 9- ❑Demolition Working form is any capadty. _ employees aadhace Wo&.ers' 9. ❑Building addifica LNO filsumnce, comp-im arrmf retp, ized 5. ❑ We are a coapcyrafion and its 1 ❑Eleoti al repaim or addition 3.❑ I am a homeorum.•er doing all work ofdcen ixave exridsed du!ir 1 L❑P3umbiagrepai s or additioms. se>€{�To iight of exempfiou per MO- ,� nrLL,pl1lTllTPd Y - c.152,§I{4k and we have no L❑Rnafrepairs employees-(No worms' 13.❑Otaer � ed comp.mwxrance required-) 'dayaWicsst&atchedcsfaait mast Rho McattheswfioabeUowssesdagdidwworker'compeaszd npaHcgiaff3=Jfi=- ISoxow messwlsosubmitthiszfWavifim, 21itgdmyzmdaiagRUwaaicaudt5mhaeoutsidecmt3cmtsams#mff=tamewmffidareltmdicstic sarlh FCbn=ci=*zt,-badthi boxmustatiadredmzddifiaoal shed showing denameofibesub-ca msadsEalewbedmarnotftseendtieshn-P employees.If themub-caatra±asIm-employe%they avusI pm- e&dr—dLE 'tamp.paHU aumbet lam an errtp r tT a is prauidirq workers'con3lrertsdia rt hwurancefor ary ctrrlO&yzes $etodv is i7te patio•artd jail si fe inforinalfatL / huormce Company-L&M: "Policy 41 or^aelf-ms Iic. / ✓.6 0piaa4iaaDate:_ ' Job S�mdt l /�U �f ' V�r tl city/Stafezip: Ck ' �Gf'1 i/l P ^ Attach a copy of the worhers'ctmipensationpolrcy-dedarath m page(showing the policy,number and eipu-ation date). Fa&m to sew coverage as requiredunder Se-cfaon 25A of MGL r-157-can lead io the imlpossfion of criminal penalties of a fine BP to$L,�.40 0G andfar one-year imprison as w6U as civil penalties m the farm of a STOP WORK ORDER-and a fine of up to$250.00 a day against the viohfcr. Be adcdsed that a copy of this sfatemerttsuag be f wwuded to the Office of . Investizations of10DIA for i�nsuraace coverage;-umdEaaion- I*hen4y certyy under&0'r mtd psi erjaxy thdtha iarorma6mj-prm7,&d abatra is trw and ca'rretat Sisaatar� Date ��~ aaL Are arxFy. D�a not errrte iu t]'�irretc,�r He crrttspfefesd lap t�ty arten�u n�'rciat' �,' A- city or Town: - Perr-;i.bT,itetxse# rnuing Anthor4(tdr&one) L BOard of$eaYEh 1 BuRding Departatent 3.Cit3 ITmrt Clerk 4.Electrical Inspector S.Phunbing Inspector 6.Other Coact Person: Phone#: — -- - - - 6 Informatip atdascas •�'�ensEtim far fbeir=3pIoyees. p" M�ce�r_hase�G�eaal Laws chapter l52 regmrm an�o'y=to�� p�.��s side,an�Ioyw is defined as_`�—�Yper ia.' a service of aotberIInder any oo�xact oft or imPHDcL.and orwtitIzzi" An err Ioyer is defined as-an m�iduA pa fn�,assoriat L0A corpora ion or other legal=ELY.or any two or more of the=faregviag i J Vie• the I of a deceased employer,or ibe m a Dint andmchidmg legal recei V=or trastes of an fiVEY duals per,assoofit'on or other legal entity,eozplq=lg C[npmY=S- However fhe owner of a dweffirnghonsehz&gnotmarefbanf ,=apad"is andwho rendesfbercia,or the o=Tm t ofthe- dw Mag house of anti a who employs persons to do mafiftm m x,c a*aaEon or repair work on such dwelling Iiovse or an the grounds or bmVmg app thereto shall notbecanse of snrh employmedbe deemedto be an mqployea." MGL cdzapter 152,§25C(6)also sfes that¢egery sib or local licensing agency shall withhold ffie issuance ar r enawal of a Ticensa or permit to operate m bossiness or to constr'act bMIWngs in file commonwealth for any 2 alicantwrho has not pradnced acceptable evidence of compliance wifTi the insurance coverage req¢ired-" Ada&naIlY,M(ff chapter 152,§25C(7)statss aWeifber the corn nar wnM nor;�ny ofits political subdvi_sions shaTI eaitpr into any contract for ib a per�oe ofpublic wmk u�acceptable evidence of cou pliancewifh$ie n,m„�ce. e sof-fatschapteshaveBeenpreseatedfn the aant�.anthoiiiy:' Applicants Please fill oil the worker''compeaMbDn affidavit coaigletely,by chug the boxes inat apply to your siinaiion and,if n=MSS23:y,S'OPPIY s)name;(s), ad& s(e s)and Phone numbers)along with their=t[Ecafe(s)oOf than the inset-Mce- LimifedLiabiy Compames(ILC)or Limited LiabfiiipParfne iFs(IMP) no eanpIoYeess members or parfneas,are not r-eq=Md to Cary worm coZIPensaficm.msM7ance_ If an LLC or LLP does bane eanpIoyCCs,apolicyisre * Be advisedthattbisafSdaYit maybe mbmRfudtotheDepar(mentoflndusfrial Accidents mr Confrm�n of ice coverage. Also be score to sign and date+�ie affidavit The affidavit should b eretomed to the city or town that tie appfiraiion fn=thei pema or license is being regesb,not file D r arffrne nt of ITdi* tdsI A-c:d w—t- q ouldy.On have any gnestions re garding the law or ifyou are regaird to obtain.awollan, 0ompetnsation Ppfiey,Please can the Department at the number Iisiad below: Sedf- uredins companies should eater their self i[ �mce Iic,=se nmaber on the aPpiolaiafn line. City or Town Of Facials . Please be sate that fiie affidavit is complete andpriofedlegihIy. The Deparfmaathas provided a space at fae botfr m of the affidavit for you to f M out in the event the Office of Iuvms�=has to Confar-tyOuregardingthLo applicant. ; Please:be srn e to f17]in iiie peuni�t/Iiceuse number which.wM be used as a refesemce naimben In addition,an applicant �t must sab=t mubiple pe�iccen sse reputations is any given Yew,need only submit one affidavit mdi cafng cm�t policy mfornati an(if necessary)and under"Tob�e Amass"the,apple should write"aU locations in (aLy or of the•affidavitfbathas been officially stamped or m ±e;dbythe city or town maybe provided to the . town)."A copy tbat a valid affidavit is on file fur fufm a permits or licenses: Anew affidavitxoust be:fi71ed out era ch applicant as groof Year..gere lh &home owner or eifi=ais obtain a ing liee are or permitnotrelated!n any business or commercial vtnd=r, (ie_adoglicenseorpe�ittnbumleaves etc.)saidpersonisl�IOTrequiredtn completes S fd Vit Tb.e Office of ayesEgaticM would Mce to thank you im advance for your cooperatian and shouldyou have any questions, please do nothesif to gimus a mlL The Department's address,telephone and fax - T1 f:aI=MMWW h of M h fi4 Woman Ta 4 GIT- -4900 cist 4.06 or 1-M MSS FE Fax#617 727 7M Kevised -VIC R CAZEA ROOFING & REPAIRS PROPOSAL Proposal No. 17-3179 March 6,2017 To: Gary Winkler Work to be performed at 978 Bumps River Rd Centerville MA ti We hereby propose to furinish the materials and erforim the labor necessary for the completion of,:" ` NSW ROOF 1. Remove existing shingle roof 2. Install drip edge 3. Ice&Water barrier first 2t all skylights and penetrations 4. Cover roof with 15 lb felt 5. -Re=roof with 30 yr architectural shingle r 6. Install ridge vent 7. Flash all pipes and penetrations 8. Remove all rubbish from project Labor and Materials$9,300 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Nine Thousand and Three Hundred Dollars$9,300 with payment as follows: Four Thousand Six Hundred and Fifty Dollars$4,650 with acceptance of proposal and Four Thousand Six Hundred and Fifty Dollars$4,650 due upon Completion Respec y Richar P. C t,Jr. HIC# 168607 GSL#100393 198 Five Corners Road Workman Compand Liability with Centerville,MA 02632 Leonard Ins of Ost (508)420-5482 Acceptance of Propo al No. 17-3179 e ve prices,s e cations and conditions are satisfactory and are hereby accepted. ou autho the work as specified. a ent is outlined above. 7 Si tune Date _ f /">•C40RE>� � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYY)02/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and oondibons of the policy,certain policies may require and endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Leonard Insurance Agency Inc NAME: Berkley Assigned Risk Services 683 Main St B PHONE FAX (ac.we.Ext.): (888)548-7431 (A/C.No.): (866) 215-8118 Osterville, MA02655 . EMPJL ADDRESS:PolicyServices@berkleyrisk.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Acadia Insurance Co 31325 Richard Cazeault Jr INSURER B: 198 Five Corners Road Centerville,MA 02632 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR WVD (MM/DD/YYYY) (MM/DO/YYYY) WORKERS COMPENSATION AND ®WC STATU- ❑OTHER EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT $500,000 A, EXECUTIVE EXCLUDED?(Y/N;FJMEMBER Y� N/A ❑ MAARP300886 02/04/2017 02/04/2018 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below. ❑ ❑ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Election Category Election Status Name Effective Expiration All Insured Entity Sole ropne or Excluded RichardzeauJr Richard Cazeauk Jr Risk Location 198 Five Comers Road,Centerville MA 02632 COMMENTS ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED.POLICIES BE CANCELLED BEFORE THE Housing Assistance Corporation(HAC)on Cape Cod EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 460 West Main Street POLICY PROVISIONS. a - Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE. ignature: ACORD 25(2010/05) BRAC 3139 :5,= O/f[CB Of GOA3UAtEf AHa1FS&B1tSfifE$S� --• HOMEIfUlPRt)`✓E1iAENTCO Regulat}on - NTRACTOR - TYPE IndnirQual i onvaird for indh4qual use onl R on rana irat►o `ate: N found returnumer Of Cons to: 168607_- 70Park aza--Suite jprs a Business RegWavn RICHARD P C st. AZE,4C TJR Boston,MA 02116 DB/A R CazeauItAo ng&Repairs RICHARD CAZEA(1LT�R 198 five Comers Rd v�9 Centerville,MA Ondersei> (Not valid ._ _. signature Massachusettst3epartment of Public Safety ulati©ns-and Standards License: CS400393 Construction supervisor R{CHARD P CAZEAULT JR 198 FNE CORNERS ROAD CVXM tVILLE MA 02632 r�z r Expiration _ mmisSiOne; . 00� fi993. 'r __. U S pepartrrent of i aWr • �- s��v�� tOccupatr6nas Safety antl Heafd*AdmuuSiraUe.� • • � t �Icital'1f� �Ig�t 3z E - honal Safie aria Heattfi� �� ,ry -�-ha�Su.G�ftltfyC'J?.�er'd'a1Eh't6llr'Q� _ Y _ ,�"�. m T a�r�rgCoursE m Ganstruction Sx�etKl3Health l ..p � �iras•teri � r , i oFTr+ergy� Town of Barnstable *Permit Expires 6 mont/i roi issue to Regulatory Services Fee • BgRYSfABLE, i "V 659. � Thomas F. Geiler,Director Building Division V Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office. 508-862-4033 Fax: 508-790-6230 .EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address_ G� A tA i'S U __ Ko CE—ij-mzv I LL(.;. t P'1 0 0 LJC�3 Z. .Residential. Value of Work S O 0® Minimum fee of$35:00 for work under$6000.00 Owner's Name & Address G FJR4 i �j 141,C.�' i 0 -bq ULN N4ZK� Njj 07035 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ` ARE PER MIT Check one: ❑ I am a sole proprietor AUG 2 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) '❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not.stripping. Going over existing layers of roof)" Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.35)#of windows *Where required: issuance of this permit does not exempt compliance with other town department'regu fat ions,i.e.Historic,Conservation,etc. ***Note:, Property Owner must sign Property Owner Letter of Permission. A copy of the Ho a Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: X6AWPFlLES\F0RMSq\buildinermit fo s\EXPRESS.doc Revised 072110 . Tice Cori monjvc al'th oaf Marssarclrusetts Deparrti ent of-Indaistria l AccinTen&, fffwe oflni estigat oos 600 Wtullingion Street Boston,M4 02111 ii.'cm}niaiss&gmldia N%%*ers' Compensation"Insurance Affidavit Builders/Contractors/Electric aus,/Plumbers' 4 Applic- mt Information s Please hint Ably Name (siwsslchgauizationIndividuao: 'W) U Ie.I,C=1� C wstat^./Zi 0Z"3 Phone#_ Are you am employer?Check the appropriate boa.: Type of project(.required). l..❑ I ain.ae3nployer with 4. � I am s general contractor and I • e mplo/ees(fa and/or part-tirnej.* have hired the stub-contractors 6- ❑New construction 2.❑ I am.asole proprietor orpartner- listed on the attached sheet 7. Remodeling ship.and have no embpiayees These sub-contractors have $ Demolition urorkiig for me in any capacity- , , employees and have workers' [No markers'comp.insurance comp- -insurance.:Y 9. ❑.Building addition 3.Irequired:] 5. We are a corporation and its 10-❑Electrical repairs or additions 'I.am a lwmeowner do all work' e exercised their� k officers have idh . 11.:[]Plumbing repairs or additions myself[No workers'camp. right of exemption per NfGL insuranee required.]? c- 152, §l(4),and we have no 12.[].Roof repairs employees-[No workers' 13..❑Other ceanp- insurance required.] 'Any applicant thrt checks box#1:¢wst also 81l out the section belowshowing their workers,compeasafion policy information_ s #Homeowners w10 subunit this affidavit indicating they are doing all woo and then hire outside contractors must submit a new affidavit indicating such! IGontracmrs that cheek this bear mast attacked an additional"sheet showing the name of the sub-coutractoors and state whether or not those entities hixe employes. Ifthew-b-contractors have employees,they must provide their workers'comp. p policy ntmiber- I ain an empkvi,that....is providing Uvrkers'corrrpeirstrtit3ta irtstamrrae far my employm. Belo"is thepalic y and job site rr�fortnrctrcrtr. , Insurance Company Mamie: rr. Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: City/StatelZip: , Attach a copy of the workers'compensation policy declaration page(showing the policy rumber..and expiration date). Failure to secure coverage as required under Section 25A of IVIGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to$1„500.00 and/or one-year m3prison meat,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 foverage verification. I do here4, under#lie ins n nrlties oj',Iser'ury that the information provided above is re and correct Si �is Dare i2 f Phone#: O,frcial iise a tCy. Do not write in this area,to be completed by city or town official . City or Town: a Permit7License Issuing Authority(cime one): 1.Board of Health 2.Building.Depar'tment A City/Fomi Clerk 4.Electrical Inspector 5.Plumbing In 6.Other Contact Person: Phone tic 4 - 6 i yr. Trott Town of Barnstable Regulatory Services Ia^ ABLE JASa ' Thomas F. Geiler, Director ATB �A Building Division Tom.Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 518-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I Z 11 JOB LOCATION: 9�V 6UH PS PL�V EL kb c�T�R V t WE number �}.� street a c village "HOMEOWNER". Gam" I 601 Q Ia� {i s v SS l 8S 1s name home phone# work phone k CURRENT MAILNG ADDRESS: 10 U 0 D AB�� 0— city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The rsigned"homeow er ertifies that he/she understands the Town of Barnstable Building Department minimum inspection pr cedure and requi mq that he/she will comply with said procedures and requirements. Sig e o Homeov er 1 . pproval of Buildingofficial a -Note: Three-family dwellings containing 35;000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are,assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting a's Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of aSupervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 - i� of 1"E rosy snxxsrnei.s, i63� 19. �' Town of Barnstable ♦0 AlFO�r p Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Wice: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub)ect property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form qn the reverse side. QAWPHLESTORMS\building permit forms\EXPRESS.doc Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ( �$ Parcel Q4 Application # �ICP t Health Division Date Issuedi'f Conservation Division A plication Fee Planning Dept. r 'F �Mil Date Definitive Plan Approved by Planning Board d SEP ` �'. , Historic - OKH — Preservation/ Hyannis B a' �`GA Y I� Project Street Address g W MPS 2�v�fZ R►� Village CE.1\ ER\J I LLE- Owner GA W-4 UVI IJ KI Address, D Ll'Qb A CT 0 000W MgsZ _ , uq - Telephone C'1 3 - SSI- $St S Permit Request RE h o D EL G(l S%I N 6 Y_%T gAEtJ 4W I O M-M b o HIS ! Rep L.A C E ' NkeE caul&Zow : 4-00 W'raW ,Sly 610 G bo02 ; kePLA(1E EX1 ST1 G AEC.k1 Q G Square feet: 1 st floor: existingN0� proposed 2nd floor: existing 3S® proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z®O Q 0 Construction Type Lot Size 14a1 A CgE Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes XlNo On Old King's Highway: ❑Yes )(No Basement Type: )q Full ❑ Crawl Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) � Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing 9 new First Floor Room Count 7 Heat Type and Fuel: ,' Gas ❑Oil ❑ Electric ❑ Other Central Air: X Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes X 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 XNo If yes, site plan review# Current Use-. - — °-- _. _� Proposed Use.- _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name G R R`{ W 1 N KL6P Telephone Number q TT -g S I" %S I S Address 10 LIMA Cr License # U UCA)W 4RI� UJ Q'7()3S Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO a SIGNATURE DATE _ o FOR OFFICIAL USE ONLY r' APPLICATION# ` DATE ISSUED a "MAP/PARCEL NO., r r ADDRESS VILLAGE t OWNER . j DATE OF INSPECTION: s FOUNDATION. ItaRm w 2j s' 0 FRAME c 11 e l`1 INSULATION_ ® Ao eg t FIREPLACE 't x ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS:- ;?s ROUGH ' FINAL k _-FINAL BUIL-'D.INGya , V t r DATE CLOSED OUT I w ASSOCIATION PLAN NO. t I IKE Town'-of.Barnstable, Regulatory Services SARNSTABLE• F r M $ Thomas F. Geiler,Director ��fD . ,Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.to w ri.b arns tab l e.m a,u s Office: 508-862 4038 Fax:, 508-790-6230 ` PropertyZer Must Complete and Sign This Section r. If Using A Build 7n,", r I, R`f la1N 1�1 of the subject property: hereby au 0A."i 1 fl V 1.�\ to act on my behalf, in all natters relativ ork authorized y building permit application for. CI18 By AMA- 0z432- (Andre frob) Sig tore of Owner ate Print Nune If Pro e Owiier is applying forpermit please complete the Homeow, ers License Exemp ion.Form on tlie'reverse side. ,er r Q:FORMS:OWNERPERMISS1011 Town of Barnstable Hof TKE rti . o Regulatory Services BARNsrwstF, Thomas F. Geiler,Director Mwss. -Building Division PrFv µay� Tom Perry,Building Commissioner 200 Main.Stre-et, Hyannis, MA 02601. _. Yrww.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOIN' OWWER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 91% SOWS 21VQ?_ P-b (ZtJ-17F ZU1Ll£ number strcat village "HOMEOWNER": name home phone# e work phone# CURRENT MAILING ADDRESS: i 0 U 11Yb C1 1A Nco I.A1 PAP,1r; kia city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINITION OF HOMEOWNER Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached siructures accessory to such use and/or farm structures. A person who constrycts more than one home in a two-year period shall not be considered a bome,owner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"ssumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. Ric undersigned "homeowner"certifies that,he/she understa .ds the Town of Barnstable Building Department um inspection procedures and requirements and that he/she will comply with said procedures and require• ents. Sign tore of Ho eowncr Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Section 1D.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pc sons)for hire to do such work,that such HOmeDWner shall act as supervisor." Many homeowners who use this exemption an unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rulcs&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bficn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot procccd against the unlicensed person as it would with a liecnscd Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitics,many communities require,as part of the permit application., that the homcovmcr certify that hdshe understands the responnbilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your Community. Q:forms:homccxcmpt The Commonwealeh.ofMassachrrsetts — — Department oflndustrialAccidents Office of Investigations 600 Washington Street t� Boston, MA 02111 sy www.mass.gov/dia .Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiordlndividual): GAR- NIMYLGR Address: ` � LtivD(} Cr o�p3s - City/State/Zip: L, 'NCD L.'� �A21� � Phone #: 9'�13 g�I- 8 S IS Are you an employer?.Check the appropriate box: Type of projecf(required): 4. I a a.general contractor and I 1.❑ I am a employer with � m . 6. [] New construction * have'hircd the sub.-Contractors.. . eiziployees (full and/or part-time). - - - - --- -' _ - listed on the attached sheet. 7. 2.❑ I am a sole proprietor.or partner- ❑ Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor mein an capacity. employees and have workers' y p ty• - 9.. [].Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. I am a bomeowner 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.]! c. 152,§1(4), and we have no _ employees: [No workers' 1.3:❑ Ot6er,,, comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy# or Self-ins. Lic. #:` Expiration Date: Job.Site Address: City/State/Zip: Attach a copy of the worker`s' compensation policy declaration page (showing the policy•nurnber arid 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 her y cert tinder I e p 'n and penalties ofperjury that the information provided above is true and correct. Si natu e; Phone#: F Official a only. Do.not.wrile in this area, to be comp!eted by city or town officiaL,< � e City or Town; Permit/License# Issuing Authority (circle one): 1. Board of Health Z. Building Department 3. City/Town Clerk 4• Electrical Inspector 5 Plumbing Inspector b. Other Contact Person: Phone#: r 'I Massachusetts General Laws chapter 152 requires alJ employers to provide workers' compensation for their employees. Pursuant to this sta'ule, an employee is defined as ".,.every person in the service of another under any contract ofhire, 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 r the of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, o receiver or trustee of an individual partnership, associalion or other legal entity,employing employees. However the owner of a dwelling house having not more than Ihree apartments and who resides therein,.or the occupant of the house dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling 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) stales "Neither the commonwealth nor any of its political subdivisions shall 1. enter into any contract for the perfofthance ofpublic-work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely, by checking the boxes that apply to your s tion and, if necessary,supply sub-contractors) name(s), addresses)and phone narrnber(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, arc not required to carry workers' compensation insurance. 1f an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of lndustriaJ Accidents for confirmation of insurance coverage, Also be sure to sign and,date tb•e affidavit. The affidavit should be returned to the city or town th9at•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 Deparlmeni has provided a space at the; bottom of the a�dav-it for you to fill out in the event the Office of Investigations has to contact you regardi ng the applicant. Please be sure to fill in the pennit/]icense 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 affldavit indices tang 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 affidavilnust be flled put each year. Where a home owner or citizen is obtaining a license or permit not related to any busines or commerci a] Venture a dog license of permit to burn leaves etc.) said person is NOT requir ed to complete this a fi'davi£l. The Office of lnvestigah:)as wou�lik nnrralinr] and shou➢d y-0ufiaye 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 02 11 ] Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 9 617427-7749 Revised 4-24-07 www.mass.gov/dies y _ �w Assessor's map-and lot number A �Qj JS Sewage Permit number ........... STABLE, i ..! r 'House number EWAENTAL am �-° Tr^°*�•^; ,,; cps�639: \0m J MAv* TOWN OF BARNSTABLE BUILDING I"NSPECT0R APPLICATIONFOR PERMIT TO ......................................................................:...::..:..:........................................:.. TYPE OF CONSTRUCTION ............................... ...................................................................................................... ' .............................................. .19......... TO THE INSPECTOR OF BUILDINGS: The.lk'undersigned hereby applies or a ~permit,acc � thefj]II wininfor ation: Location .... ... .... . .......... rn .. ... o .....:............. y ..... J .:': ::................ ProposedUsed.��!.. .... .................... ................... ... ......... ........................... Zoning District .... I....`L' .......................Fire District ..��C1.1.�1�.1..11C.r..� ..0: VV bA�....... Name of Owner V.. ... ... �QAJ 1:1.�.. .i.t�,�:�A,ddress l.i... .....� �.. Yl ll� .l1 .......... Name of Builder , ............Address ... U. .... ... ........ .. . .Name of Architect .......:.................:.....................Address .......................,...................:....................................... Numberof Rooms .... .:. ...................................:...............Foundation .. ......:................................................ AExterior ....0 .,....Roofing ......... �t. 1 Floors ........... .. ...... 0-9.a. '....................Interior ........t.. Sl��.�1.(`�.............................................. Heating .....( .Ck.,�>.................................................................Plumbing ..........:e1ia.................................................................. Fireplace ...... ...................................Approximate Cost ....IS4.D.Q0............................. . Definitive Plan Approved by Planning Board ________________________________19 _______. Area .......... Diagram of Lot and Building with Dimensions �"'r Fee ............V-..........`.................. SUBJECT TO APPROVAL OF BOARD OF HEALTH -BOA)O. } i I hereby agree.to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1 Name :.� .0m.rWN. ...... .. 'l OPW3NGER, FRANK & M. A � . t No ..21.9. �... Permit for .Single..Family...... . . Dwelling. ............................................. . � ~ ,� r '1�cation ............ Centerville i ............................................................ r +l Owner ..F.rank..&•.Margaxetta••Si.nger......•• i Type of Construction .....FrAMP.............:............ i ....................... .. ................. EPlot ............................ Lot ................................ ter Permit Granted January 23, 19 80 Date of Inspection ........ 19 q!. Date Completed .. . ............19 a PERMIT REFUSED ' ................................... ........................ 19 . ............ ............. F ............................................................. t � . .. i Ared' .:.............................................. 19 # M Assessor's map and lot number ...................... (r... . 7 E Sewage Permit number - �..�..... ............ ......3....... Z 33AB.B9TADLE, i House number % rasa OYPYA• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �-- Location ........... :........................� }?:.'..k..i.� `�?..z ......1.+.'..�:. ........ !.r .a...................tY A •! =1--}t':^✓ 'C................. ProposedUse .......:�. ...::........... r ......................................................................................................................................... Zoning District ..............•:s.......................................................Fire District .0.(n Name of Owner ..! ..::. ff 7� ;�,l1f::..:�.�t�li::�Address ..��..��...... ... , .: ........... Name of Builder .# �rf•s�� � .`�#.1 ta.K.............Address ... 1�?' � .. c,r -�. '� 15....... ..far; f . V. .Name of Architect ... }.::..: ............................................... Address .......:............................................................................ ... Number of Rooms ....L..........................................................Foundation ..�1 �c;'�1. ,c•_,c;l........... Exterior ..... y....:..`......................�................................................Roofing ..........;.......:....``.,......,.....................................................: Floors .......... ...........1:.......... .f nc. ..................... Interior .............................................. Heating • .,�. - ..........................Plumbing ..........., ,.................................................................. . Fireplace m - .. ............................................................Approximate Cost ...: t..`.:...• rn r,,^, � ......................................................... l Definitive Plan Approved by Planning Board ________________________________19--------, Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �M I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..,.. .. ." `. ..........!..'...: ...... ......:!..!. .......... ' ....:._.- ......'+t.-.14...U.xnx.:.. ..�.n.. '.,...:u. tn.I c. ��.r:>`L�xiY. :a's..i.� ,_...Si.x.J�C u. ...I..li�iia..iL.. ��: a.r.�ali.t' wue...eti•_.N ix..L.. a.-..c..,r....t.......,.,,.�..f....-.,.. o......._s.M _..J.,. ........ ...... ...s...... _ A=168-96 2n 4 1 Single Family I NO' . ............. Permit for ............................... .... .............Dwel-lIng................................... ...... ...... Location ....L.O.t.1.4-978...Bumpa..Rivrer.. oad Centerville ............................................................................... Owner ......Znank... Type of Construction ...........Frame.................... .......................................... .................................... Plot ............................ Lot ................................ Permit Granted ........JiaAlAa!?Y.2�..........19 80 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ..................................... .... ................... 19 Ir / ................ ... .. . . .... . ...... . .......... l .......... ................. .............. ... ....... . ..... .................................... .......... .......................... ............................................................................... Approved ................................................ 19 ............................................................................... ............... ............................................................... J t p -- �— tf h ..�_.__ -_'L_..._ .... _. _ -.,."ma's -,.-'�- :c: � ..� y� •.i � �[ L - _ f i� pal r 'P Lb'T" t_oU�T►OI`I CC-.ft� .Ilf t.0 C6IZTIF-4 THAT T14l= To0oJr->AT7oQ 'S"owW N6QEc�►_3 GOAAPLVG WIT" T"G SIDE.LI► & AWE> SETSACVC VeQUI(ZEMcuTS OP TE•IC -town 4�= �s�f _ � 7' n�� . � ^ . L, PG DATE �ZEGtStttZLt� LAWID SUevcll'OzS This VLAW IS LJOT E54SE-V v►-1 Ad.i OSTEV-V%L-LG o /1rCaSS• U4. rQ(JMi=t.IT 5L) zVc-! ¢, T:,W-- UFC' �"�:-�11o!�w APrL.I C.A."T NC.1 e�G u3uo 1 A De rGZA{ta1�:_. LOT L_1i-t 'FTZ/ ��— '`T"`'p TOWN OF BARNSTABLE Permit No. -------------------- ' 1 ���� ; Building Inspector A YYL • Cash ------------—-------- ,639. OCCUPANCY PERMIT Bond ---- _---------- No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .....................................................1 19......__ ..................................................................._� ...___......._. .___ ___ Building Inspector 4 Assessor's ffice 1st floor Ma Lot Permit# � Conservation Office 4th floor �.-mac'..—1- o 42) . Date Issued I® Board of Health Ordfloor) L�_ �, `S $�� ut Engineering Dept. (3rd floor) House# Planning Dept. Ost floor/School Admin. Bldg.): RAMSTARM Definitive Plan Approved by Planning Board 19 (Applications processed 8:30-9:30 a.m.& 1':00-2:00 p.m.) Q(e�► )e ® - cl 0% TOWN OF BARNSTABL ®�� Building Permit Application Protect Street Address Villag Fire District ' fhvncr Address i/✓ Telephone H 2 ' q 9 915 Permit Request: +o �EAZoaM o�JFz ��.'rt-1-� :fin �NTst-.1 Zoning District ® ' Flood Plain 612 Water Protection Lot Size .49 ae e�— t a5' Kren Grandfathered Zoning Board of Appeals Authorization Recorded Current Use nfALE Pf'M;L Proposed Use SP,ME- Construction Type Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure (G$0 Basement ty�na,ey s*)o C,,ere v Historic House An Finished Old Kings Highway IA o Unfinished �S Number of Baths No.of Bedrooms Total Room Count not including baths First Floor Heat Type and Fuel E EA.A. G Central Air v\O Fireplaces l Garage: Detached -MF— Other Detached Structures: Pool inC'nV A ttached Barn None Sheds Other Builder Information Name it )n►.1A�D C. )+�-t v �, Telephone number 50 - 5b3 Address RD License# O G-(0 l S r, f d a 55(O Home Improvement Contractor# 1 i `7 6-4 3 Worker's Compensation # SSE PrL10• NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 41,,rn, L6 (,n,4o Project Cost 612jy. oz) Fee t, SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T 3-3FOR OFFICE USE ONLY 978 Bumps River Road Centerville ADDRESS VILLAGE 1 OWNER Margaretta Singer DATE OF INSPECTION: ! t r FOUNDATION i FRAME 4 l) ' INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL A . fi .:1 < s �`�'�� � ' GAS: ROUGH,"..- FINAL FINAL BUILDING'«`F d DATE CLOSED OUT: —,,"- A 1 UPL Y � � ASSOCIATE PLAN NO. "Z v{/ , a - a i "•'�.� ! 5 AS'"x .�.S� � 1 K�p.t*M1j � Y.W' �S �E :i � } i df,.•.^ { 4 .� 2 *�' E.xa4 �l . . .,} Jro k } .Z 1� `4 E { � •�:•. _ i 4 �`jEY 7t�`df y w l Zr c 4`+zj "•r t }�E v' RJ �: xj s � r� j .�� a s �� Y F� t �x� / S '4 J •y "f x>' • Y '1 t at•JF, r t »r < i VV 2 z P c*•`' Ix t+r'Y. •; 4 toms Y r n- .� w il at j D e a f f h l .a ti < ry S ao MM� r a t gfa8.✓$fi �� �' s M,,t32 ��,r���y�, n w4 .a I- �yN - := u r a tit r } at } { 4S F F .yn-.r'� .-§-+�$Jf✓-184icSt... FY .r �9f l -. ,q• .A'. 4 iC G•u E r 1 ♦ ,> z i J A LOCATION CEu-ITL.L�I c.r. / 45 C-A L C (L C T3 AT 1; ► � � l go C G 3<T t F 1( T N A-r T t-1 t= `DU 1�r 1 f_.'NJ 5 NO'41►J i 1-it:QEa�-� GovvlP�.�(S W tTN T�-16 SIUE.t.tu� LOT �F- AWD SETO-AGK VGQUljZEAcuTS ot= TNt~ U 4� /are-, 7r� J t 1. DATE: � Z7..(gp. �1(,,`fM-c�....•-•-..� � ' rz� L 1---�'-� � ��1.XTCtiZ �. �..lY� `� _ •s�:. QEGISt�ED 1...A.t.tt� SU2vcYoiZS TNIs at._AN !S L JOT BASES 0, Aft -v1LLL- o MASS. tWy��U�t/si=.�•!T SuQVcY �; T'. _UF�S��G '�i+� �� APPt_1 GAti1T tJGT': :E . `� j-t� D i T cz em'6i1C :L n T .IU.�� f I 1 II 1 , I ; a — C�568 428.6191 ` SKty 0.CCf'�`tiC TO I-CM 1,r.1y NC'✓+.`.___ _- U510M Aulu,t,,ta - a- es igns T --- — �— - s I All R nfs N s - Reserved . —T 5 _ _ C.l+1-r',cnrtry.�c w'cN w"ry C :-. cy , s Z maws®. C IayO U[1 by DC 0 dre fOr [ht use OI Ihtrr CultOmtrS Only,Any Other use it Srr�C[ly PrOhr Or[f �_ 7T7 I ---' —_ --'-- .. ..._. . — ' Tt .F •'t'Yf - r 2 114 41, .' .� te0' .teJ Ir.O no CID L '•I �� 2.,�•s wte n —` 1-..._ r•, _i-I-' II 0 f 508.428.6114 91 ;'_' I Ef IN - ;'�-- Levi i n j F. ;^— I.F. �. i',. � i @uStom ♦c;•'— t - � i -- + M1t« �..�L I designs j •'; t l I I f - All RghtS -A GRA1vL.'�.'/AC-E l { n� e •j - I �.F -p.*ur.cvac�a�r�v5 . - 7 t fiFf�CiC PLAN FUU4r)AT;ON P4.A 3 C ` plan•, and layouts by 0CD are FOt the use or their customers only Any Othn use'S Strictly Prone o-le 1 I ^ � .. y )lIlrO Ylt?. — — - t I .6 A6PS CAi.� ._JY E S. .r.; ,��,ii' ,, '''3•r r - 4 2CcPn.. _ �ta M sty kS � ' A s I r } fiIEETQOC3, - 777 s a 1lY#i:GsTit6 t 4 Owe�v/a It lusul. a f s ahc'o.eisGr:PLYkwon� may' It f f' c'mN Ilk, v 4 ` a . .. F Te.6191 k. m esigns Copyright 01994 All Rights t 4.. ;� _ r -'p _ k + ' f m PL —— I - � - CL Z -It �,. � * .R{t}IC:ECF4tCTtp��1 _ r S h3 0 • 4 - v C r pr elimrnary Dldns and layouts by DC D are for tnt use OI their customers only Any other use i5 s[riCtly PION:b�fe C _ COMMONWEALTH OF MASSACHUSETTS D EI'Alr:MT-NTT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET BOSTON, NiASSACHUSETTS 02111 fames.: Ca=Dei' -Ornrl!isiane, WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licensee/permincc) with a principal place of business/residencc at: (City/state/Zip) do hereby certify, under the pains and penalties of perjury, that: ( ) ] am an employer providing the following workcrs' compcnsation coverage for my employees working on this. job. Insurance Company Policy Number *, m a sole proprietor,and have no one working for me. I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below r?ho /have the following workers' compensation insurance policies: �,.s Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number D I am a homeowner performing all the work myself. VOTE- Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in wbieb the homeowner also resides or on the grounds appurtenant thereto arc not general])' considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for.eoveragc verification and that failure to secure coverage as required under Section 25A of MGL 152 can)cad to the imposition of-r,timinal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. Signed this c7 day of I U„ Lice scelPcrmirtcc Licensor/Permirtor THE The Town of Ba t IARNSrABIE, rn s a b l e a 9 b N Departnient of lie<ilth Safety _ and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph CYossen Fax: 508 715-3344 Bedding Commissioner For office use only Permit no. Date AFFIDAVIT s HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modemization,,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ADS tT'i o N Est.Cost Address of Work: 9'1 t�M(ems �: Efz �. ��.tTIt►��1� Owner Name: Date of Permit Application: Q—T. I q 9 y I herebv certifv that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWNT PEPUMIT OR DEALING N�TTH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: i g Oc--r. 1994i t otsAu� �;��r i ::sR 1 1 r15r•4 3 Date Contractor name Registration No. OR Date Owner's name sa -—!�LO MONWEAtftf ART-MENT OF-PUBLIC-SAFET-Y -. 7"rllys•re nxx�rr•rYrrrrrt OF ONE ASHBORTON PLACE <roascr'q rs otrrov'Ov l fts 9, MASSACHUSETTS BOSTON,MA02108 Coda labacsapq♦rodA�RrdlYh LICENSE of rh!a!!MOTION EXPIRATION DATE CONSTR. SUPERVISOR 4�O/-�4/1 996 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RES I ONS THEFT, PUT RIGHT THUMB NONE a 05/31 /1994 051015 o PRINT IN APPROPRIATE BOX ON LICENSE. P DONALD C UITTI JRq�u:�... z P COUNTY RD OC y ' ? llil STICLUDERPHD'To.RS � OCASSET MA 02559 PHOTO(BLASTING OPR ONLY) FEE- 100 00 �..OGT 94 • NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ��1 HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER r .I j I THIS DOCUMENT MUST BE ,� J�6 SIGN NAME IN FULL ABOVE SIGNATUFk CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. ve.� COrw1MISSIONER • � ✓'ie�orsvuwouaea�l�o��/�rauccluraella ^ HOME IMPROVEMENT CONTRACTOR Registration 117543 , a Type - INDIVIDUAL Expiration 10/17/96 DONALD C UITTI JR _ DONALD C. 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