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I!t i r k p °f t ,� 1 t r I I j •,� t� ,r t{. , r a �`� t• ;} + .3 •'.Al t �- , J ,IJ •! j SS � , 'Ja 1 f '1 r' I. i 7 1 it t• r 1 •�r , i 1 i r W 1 1 t'�l �; •;t•t 4t' r a { .l 1 lilt, . a •� .�, 1�.,: l{� { ,�� ,4� C,i{ §§ , �i 1 I� } � 1�1� I = '• • ,�,? 1, � � ' t :.# 1�, ,, x 1 ., ',� 4' G+�y,, �� � tt.� , J ,i�' r>1 k ,�.. �j, 1 �; 7� �., ,l{i ,t a Ji t 1 j•rlg iri j t r. .1 �,, t !t I � - t �.a f , t ,,. r� �i rs t, t ld:,�x 1� t, . ,�{ 7, ,�: ,,� �r=t1 1 .f f � t IY.'Ii •I � � l 4 �. 1• s� j r +�` I 4� I' , I ; 4 -`,�: Y, k�k {� ' �, !• r .1 r ,i 1 4 , t �;• , 1' I 1 r 1 fill l { •.�• c , ar I { I y t f r� I 1� •�S � � , •�s �� t:d+ i. }: ,{� ��7<. �I, ,t 6� ,� , s t' :{ � t I: i } f d t, i. 1 �1. I I 7 { P. .I kk r ( �i i. Lj{[y •r /J}r t l '>, ,i=�� ,7, ( � 1� �.�{",•�-nri t i.� .�>< 1�! E ��}l , ,' ;< l � { }�` ;��� � ' �;' 'err .� i• t,l 1' � i`�� 9- 4-.l� �k:., , .G� ! t � J h, 4 } S., �2 .( IA .� t . - ,�'1� t"��� E i iii �,,} t(' ; �{ 7 1 ':I t, 1 ,d: ,dr �' � •�J• r' d' , �.I r9° I ' ��tt 1 � l fd� ', 1 i� ,�•i 1 , _J. ,{, .1, � , I. 1 � 1 •� : { (. - •i' +' �� rt}i �� I� E I Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 06/28/13 Town of Barnstable w ZE Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 w T RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 1110 Craigville Beach Road,Centerville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-28.8 Thermax in cathedral ceilings. Walls: R-13 dense pack cellulose Basement: R-19 fiberglass in.box sill. Floor: R-19 fiberglass+R-5 rigid board ; All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V b Parcel _ Application o/0 0 ?96_/ Health Division Date Issued a- �c.2 ► Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board /2ItG112 Historic - OKH _ Preservation/ Hyannis i Project Street Address l 1 0 C f �Q V IMP, yLC ?.o CJ Village C nip v Y ► 1,e, Owner �n n« n? Address S OLM G Telephone SOB- :1 3:1- ' g + 1 Permit Request �' 9 cellwlye -k-o 4e, ot*Ac. +r -F�e basemen- �0n Sl�` AJ ce:111n4. Dck;e back the w"113 .i4 Z - Q cellAl®if► � r basem�n�' U�� �xDa �ns �Vkm. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation S 5 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure `� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑,Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat 7,,ype and Fuel: �9 Gas ❑ Oil ❑ Electric ❑ Other C.a Central Air: ❑Yes A No Fireplaces: Existing New Existing wood/ca tove: a- es C�No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ rib-W Sig Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: N �' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes X No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 4 Name 1 ' �rGIUAd�i /roe & v±lKTelephone Number SOB 398 ' 03 I Address "D qik Ai 4o License # C 10 t b Jo h d��1 Home Improvement Contractor# l 3 7 Worker's Compensation # 7WC 33 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YafmAU�� SIGNATURE DATE C g FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t — . ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION 5 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. , b - 1 �D'Test R3a�n Street OUsil - - � g-. .- Hyannis,'L&k02601.3698 1 Assistance T �598)771-9M F�M)T5-7�113� on all lines Corporation HOME OWNER WEATHERIZAMN WORK PERMIT&FUEL RELEASE, PIXASE FILL OUT AND.SIGN TES TO.RM IF YOU ARE THE APPLICANT HOME OWNER hereby consent to and agree that weaffin nation-work maybe done by the Weathetization Program of Housing Assistance Corporation ( herein after referred as "Agency") on the property located at R4, - The weathe ization work done will be based on pro tic prioxities.and av-axlAb hty of fending and it map include all or some of the following measures: Weather-stripplsg&canUd3ig of windows and doors,insulation of attics,_-sidewalls basements,attic and other ventilation measures andyossibly replacement of badly deteriorated windows_In consideration of the weatherization work to be done at my home I agree to the followi-Ug: 1. 1 give permission to the "Agencyp its.agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said prveriy_ 2_ The Housing Assistance Corpo-ration reserves the right to inspect the feel or utility bill.for the weatherized unit on an ongoing basis for no more t1mn five (5)years after the weatherization work is completed I have read the provisions of agreement as listed and freely give my consent Home Owner.(Signature) Da-te3-- Agent. (signature) Date_ HA.CaPFzoved Weaherizat on Company: --- Ca l Aber Bui dmg&Remodeling Cape Cod EMIlai ion: Cape Save Creswell Construction Frontier Energy Solutions Lola&Sons Peer Smith Resole i n Energy` Rock Solid Cowtmction All Cape Insula don The Commonwealth of Blassachusetts ➢epartinent of Industrial Accidents Office of Investigations 600 Washington Street Boston, h1A 02111 ivi w.niass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Oraanization/Individual): C n g &,ve, Address: - fl �Vulting+a� �yeeK,� City/State/Zip:,S,*'n. YQQMOu.-t� mA 02Q4 Phone#: 5 0$- 3 9 $ - O 3 9 B Are you an employer?Check th appropriate box: Type of project(required): 1. 0 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in:any capacity. employees and have workers' [Now comp.insurance comp.insurance. 9. ❑Building,;addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL C. 152, 12.❑Roof repairs insurance required.]t §1(4) and we have no }} employees.[No workers' 13.X Other__'r,, tp,1p��ion comp.insurance required.] *Any applicant that checks box R1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affida%rit indicating such. Contractors that check this box must attached an additional sheet shonzng the name of the sub-connectors and state whether or not those entities have employees. If the sub-contractors have emplovees,they must provide their workers'comp.policy number. lam an employer that is providing workers,compensation insurance for my employees. Below is the policy and job site information. 4 —r� Insurance Company Name: 7 eoh not 0 J.C� af%a t: C n Policy T or Self-ins.Lie. r: F W C 3 3 g 0 Expiration Date: y 9 13 Job Site Address: 1 l (AY:11Q, lack qJ C t City/StateJZip: Attach a copy of the workers'corYpensation 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 S1,500.00 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 Investisations of the DIA for insurance coverage verification. I do hereby certiij,under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone 3 a - — Official use onh� Do not rurite in skis 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 ID Contact Person: Phone r: r'® DATE(MM/DD/YYYY) A n CERTIFICATE OF LIABILITY INSURANCE 11/9/2012 THIS dtRTIFICATE 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 conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:ACT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 Fad o.(781)963-9420 15 Pacella Park Drive E URESS:ssperrazza@risk-strategies.com Suite 240 INSURE S AFFORDING COVERAGE NAIL# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance company 3618 Cape Save, Inc INSURER C.Technology Insurance Company 7 D Huntington Ave INSURER D INSURER E: South Yarmouth MA 02644 INSURER F:— —d COVERAGES CERTIFICATE NUMBER-.CL1211954576 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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 TYPE OF INSURANCE AD L SUER POLICY NUMBER PMIDDY EFF POLICY D EXP LIMITS LTR YYYI GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE To TED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) S A CLAIMS-MADE ,OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 X POLICY PRO- LOC $ COMBINED AUTOMOBILE LIABILITY Eaa accidentSINGLE LIMIT 1,000,000 BODILY INJURY(Per person) $ B ANY AUTO ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED (Per accident) S X HIRED AUTOS M AUTOS X Underinsured motorist Bis it $ 100,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE S 1,000,000 DED RETENTIONS 199448001 0/16/2012 0/16/2013 $ C WORKERS COMPENSATION Officers excluded X ORWC LIMIT O R AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE NIA FCm331,00, coverage E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBEREXCLUDED? /9/2012 /9/2013 E.LDISEASE-EAEMPLOYE S 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space,is required) Issued as evidence of insurance. •Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc. , Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, .MA 02630 Michael Christian/SMSyI' ACORD 25(2010/05) ©1g88-2010 ACORD CORPORATION. All rights reserved. INS025 rmrrnnm ni Tha Arnon noena anti Innn ora ranietarad rnorke of Ae npn tilas.acbusetis- Department of Public S;tfetN 9 Board i�f Building, Re�,ulatiuns and Standard . ConstruedJn Su ECvISOr Sj'l2Clalt.J License License: CS SL 102776 Restricted to: IC = j WILLIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 _yam Expiration: 6128/2013 Tr-:-: 102776 ( nuui.>imcr • r` Office of Consumer Affairs and usiness Regulation j til 10 Park Plaza- Suite 5170 ,M Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 -- Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE - SOUTH YARMOUTH, MA 02664 _ Update Address and return card.Mark reason for change Address rl Renewal Employment ;; Lost Card PS-CAt is 5om-04/04-G101216 _. _ ,__.. —•- — �� License or registration valid for individul use only �/e�a�rvnza�craea a a ruae `i office of Consumer Affairs&B siness Regulation before the expiration date. If found return to: _-- „ HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation r.. ri Registration: 171380 Type' 10 Park Plaza-Suite 5170 ; Expiration: 3/14/2014 Corporation Boston,MA 02116 CAPS SAVE INC... WILLIAM MCCWSKEY: ; 7-D HUNTINGTON AVENUE Q- SOUTH YARMOUTH,MA'02664' Undersecretary Not valid wit o signa b g1ilb6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a LMap l Parcel Application# 6 �W-) Health Division Conservation Division Permit# Tax Collector - Date Issued00 g Treasurer Application Fee Planning Dept. Permit Fee 036,A Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �� (0 ct w(lVaig r�dJ T Village Owner � h(lam Address `� C 0 CA*()V l,C.tr 130t I _" Project 6'DT_-__Y2 -- 5M= 7 '7<'- T_ -� Permit Request - d F Alno . 9. 41RIO& ,-'e q`' �(u� /(nit`I I�Pe Se?O T�ot,a:l e,speC- 'o0' Square feet: 1 st floor:existing proposed 2nd floor:existing �/ pr posed T w Zoninggistric t Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting'documentation". Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 4CO On Old King'syHighway:_Q Yesv No Basement Type: ❑Full 415awl ❑Walkout ❑Other :Y. Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) h '— Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes VN Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage: existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial`❑Yes No If yes, site plan review# Current Us , Proposed Use i BUILDER INFORMMATTIION 7-37-- ?� ame a ephone Numbe '<3 6 � IL dress License# 'Ald r g Ul Li.� - - Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO KC&Uk)-" ISPO1> 'li §66ATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO.. ADDRESS ' VILLAGE A � • OWNER ; r DATE OF INSPECTION: FOUNDATION FRAME f j INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ; 1 L I he C.ommonwe.alm of juassacnuserrs Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston, MA 02111 " www.mas&gov/dia Workers' CompensationInsurance Affidavit: Builders/Contractors/lElectricians/P1uin hers. Applicant Infornaatibn Please Print Legibly Name (Business/Organization/Individual): P-AULbA.V, Address: J f(0 4A6lA.LW-,f 13 -- City/State/Zip: ' 1 Ij— Phone Are you an employer? Check the-appropriate bog: '. 3'ype 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. ❑New construction 2.❑ I am a sole proprietor or partner-. listed on the attached sheet$ ; 7• ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑-Demolition working for me in any capacity. workers' comp. insurance, g, El Building addition [No workers' romp.insurance 5. El We are a corporation and its I I t required.] officers have exercised their 10.❑ Electrical repairs or additions 3�I am a homeowner doing all work right of exemption per MGL 11.❑ Phlmbing repairs oar additions myself[No workers' comp. c.'152, §1(4),and we have no 12,❑ Roof repairs insurance required.] t . employees. (No workers' rti comp.insurance required.] 13� pther�L�-pG �e �-�a *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infoirnation. I am an employer that is providing workers'compensation insurance for.my employees. Below is the poldcy andjob site information. Inswance Company Name: . Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50Q.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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. ;Ido he certi nder the pains and penalties of perjury that the information provided above is true and correct afore: Date: � 7.(/ t3 Phone#: 7�57 71. Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitfLicense# Issuing Authority (Circle one): 1.Board of Realty 2.Building Department, 3.City/Town Clerk 4.Electricai inspector 5 6. Other ._Plunlbiag Inspector Contact Person: Phone#: CF SNE 1 ' Town of Barnstable Regulatory Services sn t'e'KA"M ' Thomas F.Geiler,Director Mass. .i63q ,0� iOrEo 39 Building Division _ Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition; or construction of an addition to- any pre-existing owner-occup-led 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. y}� Type of Work: 4- I Estimated Cost 4 ON Address of Work:_/j O CjAiC Jl_�—A[-14— P_-D Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 Building not owner-occupied 7'JQwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH 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: Date Contractor Signature Registration No. OR Date Owner's Signature Q mpfi les,forms:homeaffidav Rev: 060606 Town of Barnstable ��FTHE Tp�� yP Regulatory Services + swRNS1ABLE + Thomas F.Geiler,Director 9 MASS. 1619• .� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print D ATE: �/7� b JOB LOCATION: number y� streets^ �^7 village "HOMEOWNER": 9 I U name home phone# work phone# CURRENT MAII ING ADDRESS: �� -Fi000 1.�-toff- OZCo -3"Z city/town state zip code The current exemptionfor"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.Drovided 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 of 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 undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department um' pection procedures and requirements and that he/she will comply with said procedures and r uirem ts. Signatrc re of Homeowner 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 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)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 as 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 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:homeexempt s Assessor's map and lot:number .4�d�Z:/..c�� / :... THE T� Sewage:•Permit number ........................................................ 4 Z BARESTIIDLE, i Houser,-!?Umber .............. :........:...:.: ; ro rasa �4 039. tR x I 'Ea Nix Av TOWN ' OF B.ARNSTABLE' . BUILDING, INSPECTOR APPLICATION FOR PERMIT TO :°.................... ..................................... TYPE OF CONSTRUCTION .........................................1... .. ... ....... ..............:........ ... .............�X•4'�•••• ............19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ac ding to the following informa ion: Location .............1..11.�..........:. �1. .... `l� .l ...`... .........�l,�iA.. ............ ..� ...!............................................ ProposedUse .......................... ......... :!..:-";.......................................................................................................... .......... Zoning District .................�..............................................lire District Name of Owner .......... ..u'`.'?�?....................AddresS Nameof Builder' .......................................................:............Address .......................'............................................................. Name of Architect ................................... ........Address Number of Rooms ..... .........................................::.Foundation ,.... Y1 C2, .k ...Roofing Exterior ............................:............................. .. ... .... ..... .................................................. . . ..................... . d c Interior Floors r.- .!t Ll. .................:.. ............'. ................................................................ • mow:-•• Heatng ..:....-.... :. ....fi ...:..........::............. .........Plumbing ......... -:...... I Fireplace ..................................................................................Approximate Cost „� 0 V......" Definitive Plan Approved by Planning Board ---------------_---- /.:Q!! --- -19- ----- Area .. . ............... Diagram of Lot and Building with Dimensions (� 9 9 Fee ............ ... SUBJECT TO APPROVAL OF. BOARD OF HEALTH 13J �,d_ � YJ! • f�t5 OCCUPANCY PERMITS REQUIRED FOR.NEW DWELLINGS ` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...................... ................................................... TOBINS, BARRY No 24467 Permit fo&r�Bu-kld Garage r x ' S. gl. •_Family Dwelling............ Location ..1,�.�.9... X:aig:Ljjg..Beach Rd. ` ..... C�z3 �rv .�,�e................... .... of Owner .Barry ........................................i .......... t Type of Construction ....EXAM......................... ...................................... .... .............. .... Plot ............................ Lot .. ... y ........ .- : , Permit Granted October 15, 19 82 , { .............. Date of Inspection .......................... . .19 Date Completed ..19 • . 111 t Assessor's map and lot number .......... ENE Sewage Permit number S i BASBSTGBLE, i House number JI 9t63 '•FQ MAY pr• TOWN OF . BARNSTABLE BUILDING , INSPECTOR d APPLICATIONFOR PERMIT TO ............................... .., ...................................................................:.. TYPEOF CONSTRUCTION ........................ ! .... . ..... ........................................................................... t..Q C J.............19.. TO THE INSPECTOR OF BUILDINGS: 4 t t The undersigned hereby applies for a permit�f according to the following informs tion:�-----` Location ............. [A.b........... 1).f2w,) �1 ....... ' ..........(kv. ............ ?^ ;1,.,,r,........................................... e ProposedUse ........... ....... ,J,. ' -r "� .................................................° Zoning District .................:C ............................... ......Fire District ........... ..� ..v....... Name of Owner Y�11} ......... .Address .................................................4 f Nomeof Builder" ....................................................................Address .................................................................................... Name of Architect f... ..t.:.... ............*.....................Address ..............:.. _ ........................................ Number of Rooms ................ I;'..... ' ................................Foundation .... HIV �i . ............... Exterior ................. l.. .. .........................................Roofing .................!. 41• ........................................ . .... ..... ... . Floors (u�+ ' ...................................Interior '--�'_ ................. .. ...... . .................................................................................... Heating ..................................................................................Plumbing ............................................. �j .......I... Fireplace .........................::......................................................Approximate Cost .✓.� ..�.G .............. ............. Definitive Plan Approved by Planning Board ---------------____-----------19 . Area ...........,l.Q ..... ................. Diagram of Lot and Building_ with Dimensions -_Fee, SUBJECT TO APPROVAL OF BOARD OF HEALTH � GGAi2<V71 kD 17 ex ell t" L � _�A t. r e f, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all-the Rules and Regulations of the Toviin of Barnstable regarding the above construction. Name ........... .......... .................................................. TOBINS, BARRY A=206-91 24467 Build Gara, e No ................. Permit for Rr...... ................. ..... Single Family Dwelling ...................................................................... ........ Location 1110 Craigvill = Bea h Rd ......................................... .......... ........... Centerville Owner ..Barry...Tobins. ... .. ....... ..................................... Type of Construction Frame .......t. ..................................................................... Plot ............................ Lot ................................ r Permit G(ed . Oc ber 15, 19 82 { Date of ..... ................... ..........19 Date Co .... .................... ...........19 { lei L.P e • X'PRESS PE 'Town of Barnstable- *Perm 'it# 9 o 24 �T Expires 6 months fr Issue date DEC 8 - 2005 Regulatory Services Fee - 0� Thomas F.Geiler,Director TOWN OF SARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcelNumber � Property Address ilia Residential Value of Work Minimum fee of$25.00 foz rk der$6000.00 Owner's Name&Address A_?>44- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ am a sole proprietor I am the Homeowner , I have Worker's Compensation Insurance Insurance Company Name Cb wk(R•c. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to S/ 6ek41?/- ❑Re-roof(not stripping. Going over existing layers of roof) fZrRe-sideV ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this peraut does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ome Improvement Contractors License is required. SIGNATURE: QTorms:expmtrg Rtvise071405 Department of Iridastrial Accidents Office of Investigations` . 600 Washington Street Boston,MA 02111 /Y".mas&gov1dia Workers' Compensatlon Insurance Affidavit: Builders/Contractors/Electricians/Pluffibers Applicant information Please Print Eee'ibly Name (Business/Organization/Indmdual): -4>44— 77)& /4 Address: ZZ10 G City/State/Zip: A:Te—_&l % 4 kk.-A&J ,Thone#: S '7 7 C Are you an employer? Check the appropriate box:. Type of project(required):- 1.❑ 1 am a employer with . 4. ❑ I am a general contractor and I ' 6. ❑New construction employees (fall and/or part-time)-* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet$ 8• ❑ e Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or.additions .(- recquired-] . . 3. m a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. o f repairs insurance required.]t employees, [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and than hire outside contractors must submit a new affidavit indicating such tContmctn that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an em information. - Insurance-Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratioin 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 STOPNORK ORDER and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statemenf may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify Arer the pains and penalties of perjury that the information provided above is true and correct. Si afore Date:. t 2- Phone#• �j�?l`7 -- 7YpJf Official use only. Do not write in this area,to be completed by city.or town offuial City or Town: Permut/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#: In form Ationand 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 ag"an i�elivi�lual,..part�e hrP�: sociation,parpoma on or other legal entity,or any two or more a joint enterprise,' and including the legal representatives of a deceased employer,oar the in engaged in ] . of the foregoing. How�er.tl1e receiver or trustee of an individual,partnership, association or other legal entity, employing employees. the re therein or.the occupant of owner of a dwelling house having not more than three apartments and who resides �P dwelling house of another who employs persons to do maintenance,construction or repair wo&on such dwelling house hall not because of such employment be deemed to be an employer." or on the grounds or building appurtenant thereto s 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 tommonwealth 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 iequirements 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 smb-contractors)name(s),address(es)and phone number(s)along with their certificates) of insurance. Limited Liability Companies(I.LC).or Limited Liability Partnerships(L•LP)with no employees other than the members orparmets; 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.ense number which will be used as a reference number. In addition,an applicant' Please be sure to fill in the permit/lic 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 on file for;future permits-or-licenses..Anew affidavit must be filled out.each applicant as proof that a valid affidavit is 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would lie to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents >. office Qf l uvestigations a r 500 Washington•Sreet� . Boston,MA 02111 Tel.#617_727-49 00 ex t 406 or•1-877 MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/din •.�'.1.1�45.>'`> `-� <.B......ILD<: <::ERVI�;:: ::B LDIN n,,,,..............................,.............................,.,....................,......,..................::.::::::::.:..........:::::...........::::.:. »> <A{<: >« . G +. ...:..;4. .{}RAy".� VILLE.�B,.y. 7 G 7 9 EACH..RD.yI.::: <;; :.: 1 ..:.:.......:...:.:.. ENT RVILLE, ,36 O .. <« x<::i:::t4i:>. RUNNING BUINESS FROM HOME— REPAIRING CARS. }> G U.WENT TO SITE_--REPAIR GOING ON MANY CARS IN YDOOS ARE AS FOLLOWS-----BAT 37637-9465AV---- 26546 -99545 B ALSO 2 BOATS.S. f i t i j . 10 R `'fto40 kf E IE ' ..: wg CAm q,ti! was lv t _.. ! � Lro / .L-� II5 ✓ _._ _ • * / / / �� CB/DH / Fnd Disturbed e0000' �.' `�� tea• �, `�.. .:R t�`ai C � \c'!• � aau �• � .d a Q'6 6v:e. � _� ��., A - \ �• d �. C FEMA Flood Zone Lines As Shown On FIRM Panel �6p' -' R��1 / \\ F •`' , �� r „�� a ♦ `• # 250001 0008 D ��F )(oKe -6 G172 o Sg�b%' 0 00 \\l a• L`Z'8igV1� s° u � OV//� po o�E'1 - pn \o pubitc Bpi Al Landt�g 4. �.rarer.,. _..7_r �_,..✓•.7 x. 49.9' \ oy � ,-' / � � ', - Locus Map _ .1 0 / Scale: 1 =2,000f Septic - �' CB/DH / Fnd Disturbed ASSESSORS REF.: Map 206 Parcel 091 // / o //""Or r Fnd \ �� / / f 1 Garage f / ,5 ' FLOOD ZONE: o g 15.0' s� g\ r Zone A10 (el 11) ° \ #1100 Op FMq ? 410(F Community Panel No. °ne #250001 0008 D O Hey OHW 1-112 Sty w1f , <Me< B July 2, 1992 '♦ °yW / 37.9' `:;��� rZc Dwelling ° Old Block µ. 30. OVERLAY DISTRICT: Steps F Foundation - {, F( / 1`�oa... Steps w �j °s\ / Proposed `'a'H� 'rO / f{ AP - Aquifer Protection District o .. ♦ 01 8'x26' Deck & \ C—Space Access �° ZONES: RD RD-1 NP£° co' °�� �y0 Area (min.) 87,120 SF (RPOD) Area (min.) 87,120 SF (RPOD) :m / f\° 6'0+�- °� 23.2' S ��•� Front Widtha((min)qe 520' Front Widtha(min) i12520' / �• / ! Setbacks: Setbacks: I- / �y� \ Fron t 30' Front 30' Side 15' Side 10' / \ o °/ 1F G(eec Rear 15' Rear 10' 0 6 \ �° `Je*o� Ron�tif'6166 NOTE. ,SwOF 9 0 ° 4 �' 1.) The structures shown were located on,the ground �o�� RICHARD 1:� by conventional survey methods on 14/JUL/06. R. S 0 $ IHEUREUX 03 312 i ss���Q i 0 5 10 15 20 30 40 FEET i Sheet # Title: PLOT.PLAN IN Prepared For: Notes/Revisions: Gape,Sury Scale: 1"=20' Saundra & Barry Tobins 1.) The property information shown hereon was 1 of y BARNSTABLE, Date: 111 o craigville Beacn Rd compiled from available record information. (Centerville) 7 Porker Rood 2O JUL 06 2.) This plan is not for recording and is not Osterville MA 02655 / / Centerville MA 02632 to be used for construction layout or deed MASS. (508)420-3994 (508)420-3995 fax Dwg• description purposes. copesurv@ccpecod.net C41 1_1 g 1 Y