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HomeMy WebLinkAbout0055 CROSBY CIRCLE vr�S- Csb Cl " r ool 01 H 1 o v } is r • r- � Y.� „ v r � ��� h��� ��� i � � i � _ - Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 10/4/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 17-3267 Dear Mr. Perry This affidavit is to certify that all work completed for 55 Crosby Circle, Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey 4%ZC®/ To�� I°10 � OFB ®,� BL. II Town of Barnstable Bli11C11i1 his,Cacd ®Tilat:At 15 UIs1�7I'": ,rom the Street �1 rovedPlans ustm a Retainer n]qb and tfiis lard Mustbe Ke t e' MA88:- •: .�.�. .. ':f t .= "; ' 1 b�ss�R,®g.:° 'UIolhseterec�aU nC�teirl tFifinieaaFt i n=ospf.eOccficioun aHna-s=Bse eRne„M-aairdeed. s " � r , s Permit ..+ Permit No. B-17-3267 Applicant Name: William McCluskey Approvals Date Issued: 09/28/2017 Current Use: Structure Permit Type: Building—Insulation-Residential Expiration Date: 03/28/2018 Foundation: Location: 55 CROSBY CIRCLE,CENTERVILLE Map/Lot 188-062 Zoning District: RD-1 Sheathing: Owner on Record: WILLIAMS,BRUCE C&KIMBERLY K � x Contractor Name WILLIAM J MCCLUSKEY Framing: 1 , Address: PO BOX 51 E Contractor°license CSSL-102776 2 CENTERVILLE,MA 02632 is st Pr ect Cost:. $3,700.00 Chimney: Description: Add R-19 fiberglass to the attic.Air seal the attic plane with fit Fee: $8500 expanding foam.-General weatherization. �° Insulation: liN fee Paid S 85.00 Project Review Req: Date 9/28/2017 Final: Plumbing/Gas - Rough Plumbing: ng This permit shall be deemed abandoned and invalid unless the work aia field by this permit is commenced withal s moh'- ss after ssl ain eOfficiaf final Plumbing: p � NIM All work authorized by this permit shall conform to the approved application and th approved construction documents'Iforw,hich this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zoning b laws and codes. .� Final Gas: This permit shall be displayed in a location clearly visible from access.strr�t�or roadIaiid shall be maintained open for public mspect�on for the entire duration of the. a""3b31 work until the completion of the same. Electrical. The Certificate of Occupancy will not be issued until all applicable signature Ay the Sutldmg and Fire Officials re provided cn th s�permit.' Minimum of Five Call Inspections Required for All Construction Work: y Service: 1.Foundation or Footing ' Rough: 2.Sheathing Inspection . ,. ...: ,.. ....: ..... 3.All Fireplaces must be inspected at the throat level before fi rest:fluelining is installed "Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame'Inspection 5.Prior to Covering Structural Members(Frame Inspection) - Low Voltage Rough:. 6.Insulation _ 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: °"Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). . Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: f 71 Town of Barnstable RECEIPT ,, 200 Main Street, Hyannis MA 02601 508-862-4038 Ch lint Application for Building Permit Application.No: TB-17-3267 Date Recieved: 9/22/2017 Job Location: 55 CROSBY CIRCLE,CENTERVILLE Permit For: Building-Insulation-Residential ' Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: WILLIAMS,BRUCE C&KIMBERLY K Phone: (617)999-9766 (Home)Owner's Address: PO BOX 51 , CENTERVILLE,MA.02632. Work Description: Add R-19 fiberglass to the attic.Air seal the attic plane with expanding foam. General weatherization. Total Value Of Work To Be Performed: $3,700.00 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: William McCluskey,, 9/22/2017 (508)398-0398 Applicant Date Telephone No Estimated Construction Costs/Permit Fees Total Project Cost: $3,700.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 9/22/2017 $35.00 XXXX-XXXX-X3DIX- Credit Card 0299 Total Permit Fee Paid: $85.00 i 9/22/2017 $50.00 XXXX-XXXX-XXXX- Credit Card 0299 ' T' I$IkS �S T,rA�PEgIT� " : . 4 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee I Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Addre s Vill g C'C'1!J'FP.►V, Owner Address 2k d'V eLuA2 et Telephone----,-1f -7Ra TZVBr�� 311460.V ZYe.� C,04 T-itee.. �....�-_ph�n?---- CPermit•Request '�*e'- :�.., a��......�..-.z ,� " -' Are&J a*f STK D 'ho 41 YW14 ow it dMi -►phy-M w t . Z)`'Z ;440 GR t fH Ae ev-r~ /mot ► N 1+�0 IN 4V?$ !N o�o Square feet: 1 st floor: existing 14Z proposed fA►aC. 2nd floor: existin N proposed Total new Zoning District Flood Plain Groundwater Overlay Project,Valuation`—Fi Construction Type Lot Size AtKaS Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family X11, Two Family ❑ Multi-Family (# units) Age of Existing Structure 3 Hi oric House: ❑Yes to On Old King's Highway: ❑Yes No Basement Type: )(Full ❑Crawl Walkout ❑Other Basement Finished Area (sq.ft. M#64;*J0 400 Basement Unfinished Area (sq.ft) `7 Lo Z Number of Baths: Full: existing ON ne N Half: existing70 PA /2. Number of Bedrooms: Z existing _6�9N o CW"V S) Total Room Count (not including bathe): existing new N060#`acfirst Floor Room Count Heat Type and Fuel:.,<Gas ❑Oil ❑ Electric ❑ Other �ee oveAdvia Central Air: ❑Yes $grNo Fireplaces: Existing New Existing wood/coal stove: Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing Tm..0 nezy size_ Attached garage: existing ❑ new size _ hed: ❑ existing ❑ new size _ Other'. I! Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 4 Commercial ❑Yes No If yes, site plan review # ` Current-Use- Ninb4 Q_ _(rj 4,Vo posed Use !/ c7J�.0/k�Q__ �Sl�'P •�Y) rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Y (/ Y C�Name � t ��%tttR w �q ephone.Number� A� ress ' � �UQC�N �tO���--- License # Home Improvement Contractor# AA A:- � 7 �r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO TIC. V SIGNATURE- % D TA E Q Z - /c-f Z— FOR OFFICIAL USE ONLY !APPLICATION# " r , F DATE ISSUED = t � MAP/PARCEL N0. t ' ADDRESS VILLAGE OWNER `s DATE OF INSPECTION: a •FOUNDATION FRAMEa INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I + GAS: ROUGH -FINAL FINAL BUILDING ll mllfths113k4ny DATE CLOSED OUT ASSOCIATION PLAN NO. — — �,r r .0 Q T)" of B' -L&Ze � -�egulafo�y >�`er�ces T7zamart F. Ceg ;Director Building Diyi 'on En h� I b a�aa Perrpr•.CB 0,•Bmuding Cam,;,i.�ri❑aer 20o Main Sit-64 ffYnis, hiA 0Z60 .fowl bamstablarna-trs Offitxc 508-862-�038 -Fax: 509-790- M* uL PLAN W .t<c�( �L-'i �' .S. ' Ma /P.arccl: � `�O d �' �' • • �r.� ��s Q � C f�; Builder: .� � �c � � . `Pmjcct Address �-ma er- no regz wzn 'IThefo-IIowing it W • . g- '.. ; . + t Retie F�ed by: i )ate - Lligton 600 mash' Street Boston,MA.02111:; .... rsnvtv.mass gov/dza Workers' CompensationInsurpr-e-Affidavit Builders7Contractors/Elecfridans/Plumbers Applicant Inf6r oration Please Print Ledo .. Name(Bminess/Orgamzationdndividual) Address:'- - C( 1.� :0�r00`I�O�cS"!, Cit tat&/y/S C`�-J' 1 yi�� �2b0L Phone#' B 7�i Are you an employer? Check the appropriate•bog: :Type of pro)ect(req.nir d)* 4. I am a general contractor and I 1.❑ I am a employer with` 0 .: 6 New construction employees (full and/oi part- * have h r the stab-_contractors t� • listed:on the atfiached sheet 7. �Remodeling 4DA:� "' 2:❑ I am a'ole proprietor orpartaer- K ship and have no employees These sub-contractors have 8._.0 Demolition . ems. workingfor in an bap?-city.aci employees and have workers' C Y P t3'• 9. ❑Building addition [No workers' comp.insurance comp'mstlrance:$ re ed : 5. 0 We are a corporation and its 10:❑Electrical repairs or addrtions _ . ] � - '3. am a homeowner•doing aIl work officers have exercised their 11.❑Plumbing repairs or additions right 6f exemption per MGL. Myself [No workers' camp 12:❑Roofrepairs insurance required-]t c:.152, §1(4), and we have no 13:N Other ,�t5'Ao�`t.: . employees. [No workers' eomp mcrm,�„ce required] . r&A0�"l yJ Rrt!•e -t 0: *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 sheetshowing the name.of the sub-contractors and state whether or not those entities have employees. If the sub-contractors bare 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 workers'compensation policy.declaration page'(showing the policy number`and expiration.date). , Failure;to secure coverage as iequired under Section 25A.of MUL 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$250.00 a day against the violator.:.Be advised that a copy of this statement may be forwarded to.the Office of Investigations of the DIA for insurance coverage verif cation I do hereby certi under hasp penaties of perjury fhat theme farmation provided above is true and correct Si ature e Dat�'� ( 2,.�f t{ t L (Phone# .3 -7 �-09- 04 ) Offt use anLy. Do not write in this area, to be completedbyc.g.or town offciaL City or Town: PermitUcense# Issuing Authority(circle one) J.Board of Health 2.Building Department 3.Cify/Town"Clerk .4.Electrical.lnspector 5.Plumbing Inspector 6.Other Contact Person: . Phone# ow Massachusetts General'Laws c ter 152 es. :. hap - requn all employers to provide'workers' compensafian:for iiieii employees Pu smant to this statgt a an employee is defined as".:.every person in the sereice of another IInder any contract of hire, express or implied,oral orwritfnn." An employer is defined as"an individual,partaersl,association,corporation or other legal entity,or any two;or more of the foregoing engaged m a joint enteipnse,and mchiding the legal representatives of a deceased employer,or the.__ receiver or trastee=of'an'intiividual;phrinership;`assocY0oti df other'egal>eiitdy,emp"o emp ogees. owever e owner of a.dwelling house having not more$ian'three�.parh eats and who resides,therein,or the occupant of the . 'dwelling house of anothef who employs persons to do mainteIIaiice;copstru�t 6, i repairwork on shch dwelling house or on the grounds or building apptutenant thereto shall not because of such er�pjoyment lie 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 constrnet,buildings in the commonwealth for any applicantKho has notprodnced•acceptable evidence of compliance with the.insurance coverage required." h'ept-er,,152, §25C()states'Neither the comm mmoawealth noz any of its political subdivisions shall Add i4naIlp A enter ii fi4 apy cj,*,-ac`l r.the performance of public worm until-acceptable tvidence of compliance adth the in==mince requae'zeiifs'of this chapter Have been presented to the contracting authozity." Applicants ' Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti-actor(s)name(s),address(es) and phone numbe(s)along with their certificates)of insurance In i sited Liabihty(©mp nies(LLC):or Limited Liability Partnerships(LLP)with no employees other than the Inerobeq Qtpartners,are not`wija ryed tq car7.Tor�kers'compensation insurance. If an.LLC or LLP does have employee's;a po'lrcy is'tequired Be advised tlift'flns 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 t-o obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: City or Town Officials Please be sure that the affidavit is complete;and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant . • Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pemsit/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'ia (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where.a home owner or citizen is obtaining a license or permit not related to any business'or commercial veatuxe (Le. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call ;, The Department's address,telephone-and fax number: . .. - i+..aV�FV"{�.{[14V'� Q��c?4hd+iK��, �..-ay %j i•;'�-.1% �- ��4 4 DTarfmft of lz ftsUid Amid=-t� 0 ce,Of li]ve� txons Bost in,ILIA€12111 I ' 11.9 617,' 27-•4W ext 406 w 1-M.-MASSAFE F*#G17772T-7749 Revised 11-22-06 VMMM Town`of Barnstable v�7HME .T 'F r Regulatory Services } six srnB Thoinas F.Geiler,Director:. irrass. _ v� 1639 10$ Bull[IlIIg�1V1S10Il _ . . .Tom Perry,.Building Commissioner 200;Main Street,'Hyannis;MA 02601 www.town.barnstable.ma.us. Office: 508-862-4.038. Fax: 508=790-6230' HOMEOWNER LICENSE EXEMPTION Please Print JOB LOCATION:_ SS daW y Cike number street. village ;°HOMEOWNER ,31&KC0 /!�L-�CIWtt6 t.CY I�r��'h�7 S vp" name honle phone# work phone#,S' CURRENT MAILING ADDRESS: _ P= CS% �V•���` - Gam" OZ�O 3L . . 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 notpossess 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 of 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.,I.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 minimum inspection procedures and requirements and that he/she will c'mply with said procedures and OoO4 Signature of Homeowner. ..;`•��•,. - `' � .... ;,:. C 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.perforrriing 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, t Rules&'Regulations for'Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in'serious problems,particularly. when the horfieowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would-with,a licensed Supervisor.,Tlie 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 responsr-bilities of a Supervisor. On the last page of this-issue is al form currently,used by several`towns.0You may caret amend and adopt such a form/certification for use in your community. Q.forms,ahonreexempt, .. f THE Teti Town of Barnstable Regulato Services _ r3' KAM Thomas F.Geiler,Director 16596 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwwaown.barnstable.maxs Office: ,508-862-4038 Fax: - 508.790-623 0 - '; tom,r - .>,d :.✓. r _n :Y .. Property Owner Must 1.ss z Complete and=Sgi This Sec` oi If Using A Builder is , I, , as caner of the subject property hereby authorize to act on my behalf, in all matters.relative to work authorized by this b ding permit -( dress'of J ) #Pool fences and alarms are t e r ponsibility of the applicant. Pools are.not to be-filled or utilized b fore.fe e is installed and all,final ., inspections are performed an ace ted . � ..:F �' jig .�`.� �. . ♦.`Li Signature.of Owner Signature of App 'cant Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS'62Q 12 CUSTARD INSURANCE ADJUSTERS, INC. 1478 Atwood Avenue • Johnston, RI 02919 Telephone: (401) 272-8700 • Facsimile: (401) 272-2353 Building Department Town of Centerville Centerville, MA 02632 RE: Insured: Cynthia Burgess Property: 55 Crosby Circle Centerville, MA 02632 Date of Loss: 01/26/2007 (Water'Darnage) Insurer: Massachusetts Property Insurance Underwriting Our File: 132-380 Claim has been made involving a loss, damage or destruction of the above- captioned policy that may either exceed $1,000 or cause MASSACHUSETTS GENERAL LAWS Ch.139,46, to be applicable. If any notice under -MASSACHUSETTS GENERAL-.-LAWS ,Ch 1-39,�36,-,-is-appropriates please-direct- . it to the attention of the writer`and�include a`referenc to the captio insured, location, date of loss and our,file number. p, obert. lanag _ . . Manager gzK i 70 On this date, I caused copies of this notice to be sent to the persons+) named above at the indicated addresses by first- s mail. rQ (Signed) , ,(Date). ebru TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued f Conservation Division Application Fe ` Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board dK (oil h� Historic - OKH _Preservation/ Hyannis - Project Street Address .�S ef�OS/31/ t�G1lC( Village denrrMi 4� Owner k,'M Ulru r4JZ_S Address lb 6&&Ir LDi &1 &AZ=44d,_ Telephone CS-00 71'0 - 3 ula Permit Request REA44a 0L0 NGK- 9' X as Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach'supporting documentation. Dwelling Type: Single Family C' 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 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 ❑ No 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 Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Seaff 44 QyiLm Telephone Number 5--68-`17/- 02-41 Address 2V I S hjmy V 91# Z License # es 78000 t e-w-re 2yilk ILA 0 24,3y Home Improvement Contractor# 13,Z01 Worker's Compensation # ,VIA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE g-13 -f f c V FOR OFFICIAL USE ONLY 4 APPLICATION# DATE ISSUED MAP/PARCEL NO. r ,h ADDRESS i VILLAGE OWNER ' t � _ ry DATE OF INSPECTION: FOUNDATION QW�Ssaas �a►� ���Srf 4 " r` 4, FRAME t INSULATION FIREPLACE �+ ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL l FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. i a' g. f! it The Commonwealth of Massachusetts. Department of Industrial Accidents n Office of Investigations' 600 Washington Street Boston, ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name(Business/OrganizationflndividuaJ): S Co4 A Qut LIOL Address: d4l 61Y"6kAxJt 14thl. City/State/Zip: &Ai towtIL M& oZb3Z Phone#: C5vY) -77/=02.!(j Are you an employer? Check the appropriate box:- Type,of project(required): 1.❑ I am a employer with 4. El am a general contractor and,I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. t ? []'Remodeling 2.[ZI am a sole proprietor or partner �' ship and have no employees These sub contractors have 8. ,❑ Demolition working forme in.any capacity. workers' comp. insurance. 9: ❑,Building addition [No workers' comp. insurance 5. ❑`W1 . e are a corporation and'its 10•D;Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 1.❑°Plumbing repairs or additions 4 , and we have'no' myself. [No workers' comp. P. 152, §1O 12.❑ Roof repairs insurance required]t employees, [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers"compensation policy information. 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 subcontractors and their workers'comp.policy information. 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. 4: 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 MOL c. 152 can jead 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 $250,00 a day against the violator. Be advised.that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the pains and pens o perjury that the information provided above is true;and correct SiEnature: 4 A Date: Phone 4-(6M) ii 1 O Z'i'1 Official use only. Do not write in this area, to be completed by city or town official City or Town: Perm it/License ft Issuing Authority (circle one): 1. Board of Health 1. Building Department 3. City/Town'Clerk 4. Electrical Inspector S.:;Pfumbing Inspector 6. Other Contact Person:, Phone : Town of Bain-stable ` Regulatory Services • fxAAWrest.e v MAML g Thomas F. Geiler,Director,' Eo ►.`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.b arnstabI e.ma.us Office: 509-962-4038 Fax: 509-790-6230 Property Owner Must Complete and Sign Ibis Section If Using A Builder I► Br2 U WILL(&M-S , as Owner of the subject property= hereby authorize S&Tr K QOk L--rs-i2:' to act on mybehalf, in all matters relative to work authorized by this building permit application for (Address.of.Job) PA Signature of Owner Date Print Name x If Property Owner is_applying. for permit pleaseµcomplete_�the Homeowners License,Exemption Form on the reverse side. Q:FORM$:o WNERPERMIS510N r Town of Barnstable CA ' 0 Regulatory Services Thomas F. Geiler,Director MAss. tasfl. ,�� Building Division Tom Perry,Building Commissioner 200 Main.Street,_Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER!" name. home phone# work phone# CURRENT MAILING ADDRESS: 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. DEFUA177(0,N OF HOMEOWNER "u 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 structures accessory to such use and/or farm structures. A person who constrticts 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 buzildin permit.-,(Section 109.1 1)4% ;wt 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowmcr Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to cor:Tly 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_(Seetion 1D9.1.1 -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. l4any homeowners who use this rxemption are unaware that they are assuming the responsibilities of a supervisor(set Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homcowncr hires unlicensed persons. In.this case,our Board cannot procccd against the unlicensed person as it would with a licensed Supervisor. The,horbrowner 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 fom-Jccrtification for use in your community. Q:fomis:homccxcmpt t e ✓!ie T�anvrreo�rzure¢l� o�✓�aoaac�i,.,�aelta � ,• ,. .I, Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: �32691 Type: Expiration 3/2 312 0 1 3 Individual SC QUILTER1\-it SCOTT QUILTER=\ _ 247 STRAWBERRY�lilr[,-RD,, CENTERVILLE,MA 02532== qg. Undersecretary . Massachusetts- DeP4_rtment of Public Safety Board of Building Regulations and Standards t Cor*;�ftuctiQn Supervisor,- _icense License: CS 78000 t MrV s Restricted to: 00 � , SCOTT H QUILTER RO BOX 727 °W HYANNiSPORT, MA 02 12 j Expiration: 2/3/2012 Commissioner Tr'#: 21477 l+ Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: ,<432691 Type: Expiration: :f23%2013 Individual SC. QUILTER} SCOTT QUILTER\,� 247 STRAWBERRY�HILL F3D CENTERVILLE,MA 0263Z Undersecretary " Massachusetts- Dcl)j,rtment of Public Safeti Board of Building Regulations and Standards Construction Supervisor. ;_icense License: CS 78000 Restricted_fo: 00 i* SCOTT H QUILTER $ "" PO BOX 727 ' W HYANNISPORT, MA 02672 Expiration: 2/3/2012 Commissioner Tr#: 21477 ainizu2is Inotl1im P!IVA Iou i I 9IIz0 vw`uo;sog i OLIS alInS-gzgla A-Iva Oi uol19ln2ag ssaulsng pug sa191JV aawnsu03;o a3two :01 uin;aa pun0;3I 'alvP uoijga.idza ay;aao3aq ,iluo asn Inp►nlpul�03 pggn u01;g.r 0aa J0 asua317 v Jti Massachusetts- Department of Public Safety Board of BuildinA, Regulatwns and Standards CC Sfructii?n Supervisor; _icense License: CS 78000 Restricted-to: 00 SCOTT H QUILTER "t y 7 4 A y PO BOX 727 ,1 V1/HYMNISRORT, MA 02672. Expiration: 2/3/2012 (ommissiirner Tr#: 21477 f t i' a , , i I I 1 CA;O ajn;eu;�rs;no ;!A+P.1 H f i. . gIIz0 vw`u0;s0g i OLiS a;!ns-ema ilea w uo!;gln;3ag ssau!sng pug s.l!e,!;V iawnsuo3 JO aatwp :o u l ;a.l n ;I •a;gp uo!;g.l!dxa aq;a.lo;aq p un0 3 .lo asua al Z uo 1 g.l sl�a ,.. ` ,Cluo asn!np►A!pu!.103 pggn .; 3 :.. 1 Massachusetts- Depa,rtment of Public Safe.tN Board of Building Regulations and Standards Conatruction Supervisor, :;-icense License: CS 78000 Restricted-to: 00 SCOTT H QUILTER ° PO BOX 727 W'HYAIVNISRORT, MA 02672 c Expiration: 2/3/2012 ° Commissioner Tr#: 21477 W O M CY, . COLn 01 to x, Y VJ �n COS i co:*00 3 r-I o N G N ko co00 O • y o v C v a❑ 0 10 a a. c y a a G m O'U Z AdEy° v 04 N N h a 0 G C A p 40 N O M ° d o 0 N O Ln °•8•os o :y CO ao �y A . N y 0'Z3 m E �Q^ O IN � rn v i VJ U w C rv. v `10� v � �oo �.°a vEN ,g Aw� �1 0 7 A'Id Ny .--I oD - x ca ap v 3 O ` s 0Na.S� voEa:.. p m 3 N A a N h G 00 00 y X OW 0 0 ven o c 5 E ❑ _ ° ° o °o � O `ra c- N ;y ❑O �'9 C7 a w ro v v b v ❑ `� v m m m oao v .' • vro. c x 33 A rs: v A d b a. v m 3 en Q ^cvl a� ;� o fA m o .'t � � b � b m v b A evo o v 'o •C v ¢h � m E m A W '°�v C INR `�i aFl $ W m 'C 7 LL a> d .A A A ro m C Ic C ro N c .N v N c, 0 0 o A. a a a d m 6 z A d 3 3 0 v a 7 a a cw 7 m C4 w c� x n v u q =0 ti m q 3 O Y ' c c on Y c QJ c DOES � �s ao0t j gofl , ox ®X- 0 � e,o *duo � � SFrv1 PSOA :I Ir r� p ; @ t I - k r T Lq&L�, (�ejj i -- -------- T _ EtY . .. DATE SUBJECT ....»......... ... ..,, ..,... .......,.,_ SHEETV NO. . OF CHtCqeDATE .. _.................. ...................... . ............. JOB NC3._..m....,..__,.w,...._............ ._ 4 1 i • �N u _.- '�� RICHMID BAXTF.8 ,w No 2 . �� ,�qs . ' �. _�EST► t�?:� i''�-�'�" tF�„�a.!� ' `tea; l u, d:� •� �v�l 22,1�7 GEN7 1 "f 7W4.7" 7W,�F "a* S�D4t/Af /����"tJN .t',:"+r�'}rs���"5 ' l�J/7''Y� 7"h�� �..0''t"' :�� -• �. ' J! ��� dry ` T�� 7"�W1�! �� •�L;. `��. �� (�G�. 1� 4^1S r.4 , 7�Ar' o V Ze, 1976 9 A14 WqF itx, Assessor's :map and lot number ......1 .... . e; SEPTIC S^yS t <' . r ;',.^ tc r, INSTALL , C kLIANCSewage•,-Permit-number .................... �� 1TH ARTI I i !! NIT S7ATE +� fs, fTHEro :� TOWN OFF BAIB . � . Z BAHH9TADLE•.i :.t ,� � , 'moo B*U1L�DING ; INSPECTOR 039. W� _ a a= APPLICATIONS FOR''PERMIT TO. ........kSA.JN'G1-C..... I:�..t4.�.L.. .......... f?!� .............................. c, TYPE OF ,CONSTRUCTION I 0'.0b......I':, 7. ... .... . ........ �19. TO, THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location lDT.�../. ... 1./ f?S. .Y:...C/.'RCI,�:...... mhass..........................r........,........... A .�.t!��a..1,, ........JCAm .,r 14a'.�h.a............................... Proposed. Use .............. . ... ............ Zoning District 1 ....................................Fire District ................C..`..... ............................ ..l .l..r....... ............................... Name of Owner MR.si. 7jRS...W.JI-L.0M119.1:.....Address Name of Builder .... .!' ..7.z..;".T...,814,t,5. t4.CAddress ......T)Ot..... .Q.. .. aa. f?919A�'S7'�/VS f %CLS° Name. of Architect .............. ..................................Address ............................V..,9.0.7.g...................................... Number of Rooms 1. .. .... ..1...............Foundation �� �'1 . F 'f Exterior ........... ,. ..tJ...... .`. .C7.. ..��..5...............Roofing .� 17 �. ...................................... Floors W./.q.L.L....To..... . A.L L..............Interior .............DRY.....WALL.................................. Heating' Jd ... .�.�. ......... .. .. ......C? i.Plumbing ........ ...� .�} ...WT. :... ..V.. (.,/7_ .1,4 F�®#3r . .�. Fireplace .............y.a. ....,....................................................Approximate Cost ...........Fa. y..Q.� ,..................... , Definitive Plan Approved by Planning Board -------------_------------------19________. Area /,� ..:.. ...../... O Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL.OF BOARD OF .HEALTH I `o� Lo r_—_ s i z_E_ of 17 MAI ►B�c7 r I � � 4 Mo I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �` Name ....�� 'JLK..t :.. ..... .....J..4..6?:!11:!,?+1..W?�`_ Lien, Mr. & Mrs. William 18070 one story, `" I t No ... ..... .Permit for ............................... single family dwelling J t �; Crosby Circle - -- Locate ......................... ► ti -=r Centerville .........`....... Mr. & Mrs.....William Lien..... {' i Owner r .,. —. :►- f came' ................................................................... `iwl :T>Ype of Construction .......................................... p •k-•- v'Z j.. _t ;`''a��- I�. .,,,,. i •...c r `s "♦ . t i 'Plot ................".......... Lot .............#15............ r'1 �+Y � Ir' v` � � rs, �`t November,26 75 - ' t.V ti -Permit Granted 19 "Date of Inspection /k.. .. i:. d '.:`".19 Date Completed ..Si 19 rM1 N--) ; PERMIT REFUSED G tom,-' ................. ..................................... ie .......................................... ;►y }.- M _51 ........................................................../............... ... .... ...........I... .......................... .. .......... . L7 r� "E s ✓ i .. � " � ✓ E,.,_ /'t'� --ter ! 1 y+ x 7 Approved ................ r I ............................................................................... +? tj:� ..................... ................................................... Assessor's map and -'lot number .•,•.ter,d '.. Sewage Permit number .... ............ Q ?"E.T°�° TOWN OF BARNSTABLE DAWSTADLE, i "b q A,• DUI�LDING INSPECTOR iOTE'G YFY ' � ; , t �. l r ....C�..✓1 =' APPLICATION"'FOR PERMIT TO ....................:.I...(.....:......:.....................:.................................................................. 10 TYPE OF CONSTRUCTION t AL N r,11 � ..................................................................................................................................... ................................................r!tt .. .... 19.!g. TO THE INSPECTOR OF BUILDINGS: Vie undersigned hereby applies for a permit according to the following information: Location ."...................r...........,� ....�::.:...r. -......... .....^'.�-'..?....�. +.:'-...../YIA:a................................................. Proposed Use . ► , ', i t=, ��t t 1 .!- AL71 . ...............................%..................;............ .......................................................... Zoning District '` .' ..........................................Fire District .............................. ...................................................................,........,. Name of Owner/..•%, ,�h . :5 i:l} ,/ 1 ?�r�? 6t=;A1 Address ....'.�,6i�...P�3pTl1.. P/,xj:N %-.`;It_ r,�11 Name of Builder ... ..............................................i)ri 1 T // l aA!lAddress ...... _.� �"5 .... ............................. .......................................... Name of Architect SA r= .................................Address �r....-�'/i'tC ................. ......... ........... .................................................... Number of Rooms Fr .. `�- /n�' �' .. ...c-. t' L; ................. Foundation ............... .............:..... .......... Exterior { ..�,) n U r� J i i ! P a...............Roofing .......................... �.................. V.I. ...............�.................... ............... Floors - 1 I � i .................Interior ................!........° ........ , " .......................................................... Heating ....f.. ... ... ...............Plumbing ................ ......... � .: I....................................... Fireplace ..................................................................................Approximate Cost ............. ..................................................... Definitive Plan Approved by Planning Board _______________=---------------19________. Area ''4 ''` ' Diagram of Lot and Building with Dimensions Fee .. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 _ ' f r, - ,"---- -„'�-..� .__ �..- .art-^.�� -���--'r. � ..�-+. -�. �... � -' �_�� � .- �• _..�^. .- -�`-- _.. _.. _ -_ _ .mow-.� I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. { y Name .........................1..: . / .....................................:.. + L - ` 4 Lien, Mr. & Mrs. William A=188-62 18070 one stor No ................. Permit for ....................... ..........s.ing.l.e...family... dwelling....... ... ......... _j . ...... . .. ... .... ... ...... . . ...... Location 65rosby. .........Circle.............. ............ .. . ...... .. Centerville • ............................................................................... Owner Mr. & Mrs; William Lien ............................... Type of Construction /frame ................................................................................ Plot ....... Lot .......f 15.................. Permit Granted ....November 26 .....19 75 Date of Inspection ....................................19 r Date Completed'-- . -. 19 PERMIT REFUSED ................ ............................................... 19 ............................... .......................... ............. ............................................................ ..... ..... ..... . ................... .... .......... ...... .............. . .................. ............... ............................... ....p1!:p ro v e.d. 6.........-..-.-..- - ......-19--. .... /7 .......... .......... ... . .... ...........Approved V 5 �C� apt., V\Aov �-S C C. BARB TEE-IL :0V nol �G v S 0 G 20 rI,e_ 2d c� 3 ` s S� f �o O v� A^'rN iq,•� c�dC 2 � h s `-'-e Z W iti a0uJ3 « 0 T S T101 FY(S 77"I C S ►N�- 7-0� r&ol 9 1-g 1, — T-6 112" 5'-2" T-0 112" 2'_6"x6=8"! 9'-0"x 3'-6" - ® Bruce and Kimberly Williams 55 Crosby Circle Centerville, MA Basement layroom Ren ation n T N Finish Ceiling Height- T-2" x i� M x n, N I Ma " Shower i 2X-0" I— `a d 4'-0"LxX' O"W N 6'-X N Paint exterior walls, new 2x4 stud and gypsum board interior walls, 2X2 Drop Ceiling with recessed lighting, VCT flooring. Update existing bathroom, add showe� Paint Floor and walls, t; 2X2 Drop Ceiling with Flourescent Lighting ° M v CO i`2'-6"x6'_8" Finish Ceiling Height- T-2" � o 9-8 112 w CV �. M 2T-0" s Unfinished space, b 19'-8"