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Town of Barnstable RE Pr
KASS 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: TB-16-3220 Date Recieved: 11/2/2016
Job Location: 1293 BUMPS RIVER ROAD,CENTERVILLE
Permit For: Building-Solar Panel-Residential
Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572
Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508) 640-5839
MARLBOROUGH, MA 01752
.(Home)Owner's Name: BOULANGER,RICHARD& MARJORIE Phone: (607)760-0023
(Home)Owner's Address: DOMMER VAN POLDERSUELDTWEG 3F, NETHERLANDS,. .
Work Description: Install solar electric panels on roof of existing house with any upgrades,when applicable,specified by
Design; To be interconnected with home electrical system. JB-0263377 5.46KW 21 Panels
CO
Eon-
Total Value Of Work To Be Performed: $8,000.00 � t
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require�proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Nathan Tissot 11/2/2016 (508)640-5839
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $8,000.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $90.80 11/2/2016 $90.80 , XXXX XXXX XXXX Credit Card ,
_ 5477
Total Permit Fee Paid: $90.80
.i
Town of Barnstable
`• Post This Gard So That"�t�shVisible From;the.5treet.-.A.y roved:Plans;Mustbe:<:Reta�ned;onJob and#his Gard.Must;be Ke t -
*- BAIi.t3CA$LE .•
bPu
6" PostedUntil Final Inspection Has;Been Made
° =W,here a°Certificate of-.Occu anc-.is Re aired°_s�ch Bu��ldm shall;Not be`Oecu iedrun#iLa Final Ins' ection "'" er It
p. y q g p p has been made
Permit No. B-16-3322 -Applicant Name: Cheryl Gruenstern. Approvals
Date Issued: 12/14/2016 Current Use: Structure
Permit Type: Building-Solar Panel-Residential Expiration Date` 06/14/2017 Foundation:.
Location: .1293 BUMPS RIVER ROAD,CENTERVILLE Map/Lot 188=073 Zoning District: RD-1 Sheathing:
Owner on Record: BOULANGER,RICHARD& MARJORIE kv, 4, SOLAR CITY CORPORATION Framing: 1
r
Address: DOMMER VAN POLDERSUELDTWEG 3F Contractor License. 168572_ 2
NETHfRLANDS,: .. � lkr���
Est Profect Cost: $1,800.00 Chimney:
Description:. Install five 5 additional solar panels to roof of existinghouse,with R
P O p Permit F'ee: $90.00
any upgrades, if applicable,as specified by PE h Design;To be Insulation:
interconnected with home electrical system. �,In conJunction with Fee Paid: $90.00 Final:
TB-16-3220&.TE-16-2253- Revised System Size 6 76 kW,26 Panels Date 12/14/2016
Total
Plumbing/Gas
Rough.Plumbing:
Project Review Req: Install five(5)additional solar panels to roof of exist ng house, ,
with any upgrades,if applicable,as specified byPE in Design;TO wilding Official final Plumbing:
be interconnected with home electricaRsystem In conjunction .
Rough Gas'.
with TB-16-3220&TE-16-2253- Revised System Size: 6.76 kW
Q
26 Panels Total Final Gas:
f <4
This permit shall be deemed abandoned and invalid unless the work author ied by this permit is commenced within six months after issuance. Electrical
All work authorized by this permit shall conform to the approved application andA.e�approved construction do uments;for which this permit has been granted.
Service:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and'codes.
This permit shall be displayed in a location clearly visible from access street or road ands hs all be rnamt ned open for public"inspection for the entire duration of the Rough:
work until the completion of the same. -• .'-�, - ' '
Final:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Low Voltage Rough:
1.Foundation or Footing
2.Sheathing Inspection Low Voltage Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Health
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Final'
7.Final Inspection before Occupancy
Fire Department
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final:
Work shall not.proceed until the Inspector has approved the various stages of construction.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). EmAO,-L S ?'
Town of Barnstable !ROW
�X 200 Main Street, Hyannis MA 02601 508-862-4038
i �' �
Application for Building Permit
Application No: TB-16-3322 Date Recieved: 11/10/2016' "
Job Location: 1293 BUMPS RIVER ROAD,CENTERVILLE P"'
M
Permit For: Building-Solar Panel-Residential
Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572'
Address: 24 ST MARTIN STREET BLD 2UNIT 11, -Applicant Phone: .(508) 640-5397
MARLBOROUGH, MA 01752
(Home)Owner's Name: BOULANGER,RICHARD& MARJORIE Phone: (607)760-0023 l
(Home)Owner's Address: DOMMER VAN POLDERSUELDTWEG 3F, NETHERLANDS,. .
Work Description: Install five(5)additional solar panels to roof of existing house,with any upgrades,if applicable,as specified
by PE in Design;To be interconnected with home electrical system. In conjunction with TB-16-3220&
TE-16-2253- Revised System Size: 6.76 kW 26 Panels Total
Total Value Of Work To Be Performed: $1,800.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Cheryl Gruenstern 11/10/2016 (508)640-5397 b.
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $1,800.00 Date Paid ? . Amount Paid Check#or CC# Pay Type
Total Permit Fee: $90.00 11/10/2016 $90.00 x)oIX-7DOOC-7{�}IX-1 Credit Card
8975
Total Permit Fee Paid: $90.00
• �� �� � �TuIS���S �TC1T r��PE� IT � �°
Town of BarnstableBuild In
; •., ,,,;.; ,; '.: .y,. „a +' .. aw,-, -,fix- �, ,; „"� , t ,.�,,. a,,.�: '.,
- Post�T is�CardSo That�ts.�s,U�sible�Frorn the;S.treet..A roved,Plans Must beRetamed on"lob and�th�s Card.Mustbe,K,e t� _�
E!A$�'fA3i1.E,- '�^.`., ° .t "�, .,�,T�'b^.,�::s �,..� ��-.�::� � .x:.,r� ✓..:1°' '� ,a s:-_` � -�'`,`'s '9,�,�, 'r . i g�^-'�
°
° Where a".Gentificate-ofOcu anc Is Re u�red such�Buiidm shall Not be:Occu ied'until a.F�naC Ins ectwn�has�been made �� lt.
Permit No. B-16-2364 Applicant Name: Douglas Mullen Map/Lot: . 188-073
Date Issued: 09/01/2016
Current Use: Zoning District:.. =RD-1
Permit Type: .Building-Addition/Alteration-Residential -Expiration Date:. 03/01/2017 Contractor Name: DOUGLAS W MULLEN
Location: 1293BUMPS RIVER ROAD,CENTERVILLE - Este Project Cost: $114,189.00 Contractor. -
� ontractor License CS 081995
Owner on Record: BOULANGER, RICHARD&MARJORIE Permit F e $632.36
�c
Address: DOMMER VAN POLDERSUELDTWEG 3F FeePa d` $632.36
NETHERLANDS, . Date •ny 9/1/2016
Description: Kitchen and.bathroom remodel.. Re roof house Changi slider. Move interior non structural walls to accommodate
larger bath: z �� �
Project Review Reci : Kitchen and bathroom remodel l Re roof'house Change slider Move interior nonstructural walls to
accommodate larger bath ;- 4
R BuildingOfficial
r
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is?commenced withq su�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.
All construction,alterations and changes of use of any building and st ucturesshall b'e in compliance with the local zoning byws nd codes.
This permit shall be displayed in a location clearly visible from access street or-road and shall be maintained open for public mspection for the entire duration of the work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by�the 6'uilding and Fire Officials are provided on this permit.
Xj
Minimum of Five Call Inspections Required for All Construction Work'U , ,
1.Foundation or Footing '
2.Sheathing Inspection r' ` y
3.All Fireplaces must be inspected at the throat level before firest flueammg isa nstalled �
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
7.Final Inspection before Occupancy
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.
"Persons.contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A):
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
i
/essor's Office(1st floor) Map Lot �� ermit# _
Conservation Office(4th floor) Date Issue
a.
Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) .
,/ngineering Dept.`(3rd floor) House#1
d�
Planning Dept.(1st floor/School Admin. Bldg.) `
_ • RARNSPABLE.
Definitive Plan Approved by Planning Board 19EO,u+'��
TOWN OF BARNSTABLE l
Building Permit Application
Project Street Address la 93
Village (�_6 ) LL t.
Owner AO)JF m Address A(?)J C
Telephone
'Permit Request
.Total 1 Story Area(include 1 story.garages&decks) square feet
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $J ®G
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
NameAwpg ?_b Telephone Number
Address Z-,5- -g License#
W Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��✓�
SIGNATURE DATE
BUILDING PERMIT WNIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. 10522
DATE ISSUED Sept 22, 1995
t
MAP/PARCEL NO. 188.073
ADDRESS 1293 Bumps River Road VILLAGE Centerville, MA 02632
OWNER Richard & Anne Clarke '
4
DATE OF INSPECTION:
FOUNDATION
FRAME F
INSULATION {
FIREPLACE i
ELECTRICAL: ROUGH FINAL
j
PLUMBING:-- ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING '
i
DATE CLOSED OUT ® ' -Z - '
• 1
ASSOCIATION PLAN NO.
t
a, '
The Town of Barnstable - =�
NAMP Department of Health Safety and Environmental Services
Building Division
367 Main Strut,Hyannis MA 02601
Office: 508-790�ZZ7 Ralph Crosna
Buildimg Commisscoi
Face 508 775-33"
For office use only
Permit no.__
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"n=nstruction,alterations;renovation,rtpair;modernirauon,conversion,
improvement,.remotal, demolition, or construction of an addition to any► Pre cdsdng ownff owed
building mntaining at least one but not more than four"Idling units or to stitacnnzs which are adjacent
to such residence or building be done by registered contractors,with cegm exceptions,along with other
requiretneats.
Type of Work: Est Cost
Address of Work:
ner.Name: NNC /rm R n. c1
Date of Permit Applicatio • 9�yi��
I hereby certify that:
Registration is not required for the following reason(s):
Work cmduded by law
Job wader S1,000
Building not aw=-orpied
oa
Oww pulling oam permit
Notice is hereby gh=that:
NTRACTORS
OWNERS PULLING THEIR OWN PERMIT
WORICG DO NOT HAS S 't'O THE
FOR APPLICABLE HOME VP
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•.
Date Co
ntractor name Registration No.
OR
w
The Commonwealth of fassac%#setts
t;: Department of Industrial Accidents
011leeV1JJNesUgat/ons
:..• 60// !1<'ashin„tun Street
J. Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
,�ppircant Information• - Please PRINT lebr ply �aa= - � ;
namet 15"b FD �l,c>>iEr�
lac•Jtion•
w 2A) 11� z.4 nhtmc#3 b Z— �72,
1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
....': -..`�w��*L'*T�^M�,,,f�p""-�.�..'.,w:srwa�.r —X, �_ °+�lqa-s-.-• -i... -.::.iaLa,ri- .:._.� r a..,_:,....� _ _
M. -.. --lam an employer providing workers' compensation for my employees working on this job.
compinv name: -
address: — --
city: phone#:
incur n e o
a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the ollowing workers' compensation polices:
compare,name•
address:
city. phone#:
insurnnee co policy#
�...r..:rek .:" - ,,•Crs•x r..+:.::,�•v,_a-r�T=..,+.x;Me.: •7- -;•�F•-;++tt ,7K"'.'�gm,e='y1' - `"'
company name: -
address:
cih• phone#:
insurance co policy#
Attac ai`s_hsdditionhcetifnecessa _
Fuilurc to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP R'ORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Otficc of Investigations of the DIA for coverage verification.
I do herehr certifj•under the pains and penalties of perjurt•that the information provided above is true and correct.
/-"Signature
Date
Print name G 1J'oUE1J o Phone#Sb� - 362
OM62Luse onh• do not write in this area to be completed by city or town official
city or town: permiL4icense# r•IBuil7an
Lice
check if immediate response is required Selec
�liealcontact person phone#• r'IOthc
4
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Ireraed 3,195 P1A)
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Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an etnpl({t,ee is defined as every person in the service ofanother under any
contract of hire, express or implied, oral or written.
An empinrer 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,em p I over. or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dweiling house having not more than three apartments and who resides therein, or the occupant of the
dwcllin�(, house of another who employs persons to do maintenance construction or repair work on such dwelling house
or oil the -rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that 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, 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.
^''i%• ; •x. .1 Yi" �' ai:!, y.,9
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance 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.
....._..�• .:p!.{iS,lTa'',.:•.-.e• ...e+•:,t..s.�r..I'.i aer�s Y s -
.. -... <sw 0 .. - - ...
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Cite or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of lnvestiaations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
v'-ew,�•.-v..•r•.,.....-.yam•.-•—••v�.r .....•„r.,w'S,o. .e
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The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375