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F
o�TME�y, Town of Barnstable � o3Cp�
a Permit#
Regulatory Services " 6m°n8crfr°°'isrne °
spa to Fee
, 039�- h Thomas F. Geiler,Director
Building Division elc f
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 A--Press Imprint
Map/parcel Number ( QZC
Property Address
(Residential Value of Work 7 S Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
v
/.5 1%1,4 0._c/7p
Contractor's Name Cjvt�q or,,,
Telephone Number �br 3 oS7
Home Improvement Contractor License#(if applicable)
construction Supervisor's License#(if applicable) GS,
0 3�a a,•
]Workman's Compensation Insurance
Check one:
KA
I am a sole proprietor i'_j L 3 I Q 1
Tam the Homeowner
❑ I have Worker's Compensation Insurance TO' VVN OF BARN.STABLE
tsurance Company Name Lib m L�� f
'orkman's Comp.Policy# h/GA — 3/s —
opy of Insurance Compliance Certificate must accompany each permit.
.rmit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑,Re-roof(not stripping. Going over existing layers of roofl
Re-side
❑ Replacement Windows/doors/sliders. U-Value #of doors
(maximum .44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
4ATURE:
wK.
I
The Commonwealth of Massachusetts
,� Department oflndusirialAccidents. ^
Office of Investigations
411:1; 600 Washington Street
a Boston,MA 02h71
r www.massgovhdia
Workers' Compensation Insurance Affidavit: Btulders/Contractors!Electricians/PInmbers
Applicant Information Please Print Legibly
Name (Business/Organion/Individua]): t�j�iaa,.�
Address: ;�6 -5'yo s 19 e Pl���•�m.,: t, r►7,4 0-LA5'0
City/State/Zip: Phone #:
E
an employer?Check the appropriate'box: T e of yp project(required):
a employer with � � 4. ❑ I am a general contractor and Iloyees(full and/or part-time).* have hired the sub-eontraciors 6••❑New construction a sole proprietor or partner- listed on the attached sheet t; 7• ❑Remodeling and have no employees These sub-contractorshave 8. ❑ Demolitioning forme in any capacity. workers' comp, insurance. g ❑Building additionworkers' comp. insurance 5 ❑ We are a corporation and itsired.] officers have exercised their L0•❑Electrical repairs or additionsa homeowner doing all work, right of exemption per MGL 11.❑Plumbing repairs or additions
lf.[No workers'comp. c. 152, §1(4), and we have no ]2,❑ Roof repairs . .ance required.] t employees,(No workers'
comp. insurance required.] 13.�Other �a S �
*Any applicant that checks box 11 must also fill out the section below showing theirworicers'compensation policy information,t Homeowners who submit this affidavit indicating they am 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 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.#: Expiration Data:
Job Site Address: City/State/Zip
Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition:of criminal penalties of a
. fine up to$1,500.00 and/orr 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 -
Invekigaiions of the DIA for.insurance coverage verification.
l do hereby certify under the pains and penabxes of perjury that the information provided above is true and correct
3i atnn-e: Date 7///�//
'hone
Official use only. Do not wrt7e in this area to be completed by city or town Official
City or Town: - Permit/License# .
�z
Issuing Authority(circle one):
J
Information and Instructions
Massachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs-persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." .
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant wbo has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is-required. Be advised that this affidavit may be submitted to the Department
artm nt o y p f Industrial
Accidents for conformation 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 m the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hle to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call. .
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations' '
600 Washington Street
Boston,-MA 02111
� �
Office of Consumer Affairs and usiness Regulation
- 10 Park Plaza- Suite 5170
Boston, Massachusetts 021`16
Home Improvement Contractor Registration
< .m
Registration: 165785
Type: DBA
Expiration: 3/25/2012 Tr#.295045
KING CONSTRUCTION & RENOVATION r ,y
GREGORY KING
26 SUNRISE AVE.
PLYMOUTH, MA 02360
Update Address and return card.Mark reason for change.
Address ❑ Renewal 'E] Employment C Lost Card
DPS-CA1 0 SOM W04-G101216
Oftic30*0i-=r aif�1suSines�aS"on" License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration -165785 Type: Office of Consumer Affairs and Business Regulation
r.- Expiration 3/25,Q012 DBA .10 Park Plaza-Suite 5170
- Boston,MA 02116
KI CONSTRUCTIONWREtJOVATION f
GREGORY KING ,
26 SUNRISE AVE.
PLYMOUTH,MA 02360 Undersecretary slid without signature
2 ,
Bbarii' # atiltl3n� 3€ tatriirt� I na
� OstrtC2p3n St3rQr; aCt3t� r�,
i _
GREGORY KING ..
26 SUNRISE AVENUE .
PLYl1hOUTH;MA M60 3 1
Expiration: 6/3/2013 X" 6 �
C`Errnm�aioner Tr#:,.103202•
k CSL: 103202
HIC: 165785
Gregory King
26 Sunrise Ave.
Plymouth,MA 02360
508-269-3057
k.cn�C:011 4ruction Renovation gkirig3057@gmall.Com
Proposal
5/16/11
Annette & Steve Romagna
44 Brookside Ave
Belmont,MA 02478
617-489-7007
Proposed Work Address:
72 Crosby Circle
Centerville,MA
Job Description: Remove and replace cedar side-wall shingles on back of the house
and behind the garage,replace(1)3-foot window sill, fix outside shower door, fix/replace
aluminum behind upper right gutter on the back of the house.
Details:
Lower Back side: 22' x 8' $1200*
Upper Back side: 34' x 6' $1425*
Back of Garage: 25' x 3' $600*
* Price includes removal and disposal of existing shingles. New side-wall
shingles will be SBC resquared and rebutted#1 white cedar extras, natural finish.
a. Tyvek house wrap underlayment.installed
b. Course spacing to match existing house siding
I -
CSL: 103202
MC: 165785
Gregory King
26 Sunrise Ave.
Plymouth,MA 02360
508-269-3057
'Kine, C onatrue.ion & Renovation gking3057@gmail.COm
Shower door rebuild/fix: $175
Window sill replacement: .$125
Aluminum Removal/Fix: $250
Total Proposed Price: $3775.00
Payment Schedule:
Deposit(40%): $1510.00 First day of job
Final(60%) $2265.00 -After Completion(Last Day)
Above prices do not include permit fees, painting, or wood rot replacement. If lead paint
is present 15%will be added to the overall job price.
King Construction&Renovation is responsible for satisfying all local and state
permit and inspectional needs. All work will be completed in accordance to all updated
Massachusetts Building Codes (780 CMR7th Edition). "All work shall be conducted,
installed and completed in a workmanlike.and acceptable manner, and in accordance with
manufacturer recommendations,so as to secure the results intended by 780 CUR 5 1.00
through 99.00"in the Massachusetts State Building Codes. -
King Construction&Renovation is not responsible for any utility bills during or
after proposed work and property damage due to natural disasters.
This proposed price for the work outlined above will be guaranteed for<30> days.
Additional work, changes, or unforeseen problems will be billed at a rate according to
our labor scale and will include materials.required. Current Basic.Labor Rate is
S45.00 per hour`
* Contractors warranty is good for l year from the completion of the job.
6
4 CSL: 103202
MC: 165785
Gregory King
26 Sunrise Ave.
Plymouth,MA 02360
508-269-3057
kill,-, construction R,enavatron gking3057@gmaii.com
I,the undersigned,accept all prices;specifications, and term of this proposal. I authorize
Gregory King,DBA"King Construction&Renovation"..to perform the work as specified
above, and agree to make payment as payment schedule is outlined above.:
Homeowner:
Print Name ; Signature Date
Gregory King
"King Construction'&Renovation"
Sign Date
+ n
s
s.
�p THE
The h Town of Barnstable
•
: Department of Health Safety and Environmental Services
1659
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
June 2,2000
Mrs.Riedell
72 Crosby Circle
Centerville,MA 02632
Dear Mrs.Riedell,
This letter is in regards to a visit that I conducted with you on May 9,2000. As I noted with you at the
house the only problem that stands out is the fact that the bathroom fan doesn't exit the attic area,but is
blowing into this area. If this is why there is so much moisture in the house it is tough to pin point because
we don't know what the moisture conditions were in the house before. As I stated at the house I suspected
that the ridge vent may be acting negatively and allowing moisture to be sucked back in,however,in talking
with your roofing contractor the vent that was used lwhich was recommended by the certified representative,
is designed so that this should not happen. As I said before,the problem is really tough to pin point. I've
discussed your situation with a number of builders and everyone is as perplexed as I am as to what the
problem is. The roofing contractor is trying to schedule another visit to the house and I have asked to be
there at that time. When this happens we will coordinate this with you.
Feel free to call if any more information comes up.
Sincerely,
Tom Perry
Building Inspector
Engineering Dept.(3rd floor) Map Parcel Ocr?R. Permit# (o �•'L'�
House#' ate• Date Issued Co�
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee
Conservation Office(4th floor)(8:30-930/1:00 ;2:00)
Planning Dept.(1st floor/School Admin. Bldg.) THE
Definitive Plan Approved by Planning Board ' 19 ;
BARNSTABLE.
' rE1639.
TOWN OF'BARNSTABLE
I Building Permit Application
Project Street Address ', csV 1.:9 i
Village
Ownerel Address F
.Telephone
Permit Request 7 -
i
First Floor 4P® square feet Second Floor square feet
Construction Type
Estimated Project Cost $ �(GG4D
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑. 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
No. 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size) -
c.� ❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name Telephone Number
Address f i972�C �"ci2 License#
Home Improvement Contractor,.#- 4&1-
Worker's Compensation#j�' P115 Y22)3,§6FA
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 / 9 / S
BUILDING PERMIT DENIED FOR TH OLLOWING REASON(S)
- � y
FOR OFFICIAL USE ONLY
PERMIT NO.
z;:t
DATE ISSUED
c
MAP/PARCEL NO.
ADDRESS ' VILLAGE
OWNER
' { F ; ems" 4 • w - I.
DATE OF INSPECTION: r
FOUNDATION } '
FRAME
INSULATION
FIREPLACE i • . ' +-r - .�' _ ,
ELECTRICAL: - ROUGH FINAL I!' -• t
PLUMBING: ROUGH FINAL _
GAS: ROUGH FINAL - y '
FINAL BUILDING a '„
DATE CLOSED OUT
ASSOCIATION PLAN NO.
THE rq�
The Town of Barnstable
Department of Health Safety and Environmental Services
79. Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commission
For office use only
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 occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: la Est.Cost jfC)O
Address of Work: 7( /!4-/l G C�
Owner's Name .
Date of Permit Application: e U I
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner 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.
/q/ VA-) --7—>r—ki-Ai C 1�rq C. SV7
Date Contractor Name Registration No.
OR
Tlic•'Conntron wealth of Afassac h usettt
Department of Industrial Accidents
7`z 1_ lei, 011iceal/nvesllgatlans
= ; 600 11 a.vhiar ton Street
��'•���.�- ;�:. Bustu►r. Afuss. OZI11
` Workers' Compensation Insurance Affidavit
-Alitilic:intintormatirin': Plc:tse P R I Ij]v
name �PGtM r� t�✓lGc���1
city t�) done#
i] 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working_ in any capacity
I am an employer providing workers compensation form} employees working on this job.
ennttt:trn• name: /-1lCA-4zA-*\I Ci
address
city' kl NI tJ ct.X nhnne#• .
insurance cn. nrtlicy 0/.t.l' l 13/,5
[j 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
comnany natnc:
addresc• �
cit... Shone#•
insurance rn. nniicv t!
cmmninv name:
addresc�
riry € Phone#:
insurance co. 0
Attach additional sheet if necesiary, - -+�• _ — _ � �'� • y-+--" _���=^�'�= �'--'
Failure to secure cuverace as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a lineup to 51.500.00 andiur
one%cars' imprisonment:is well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a
CUP) of this statcntent ma% be forwarded to the Once of Investigations of the DIA for coverage verification.
1 do hereby cc unr r rr rims mrd r !lies of perjun•that the information provided above is true and correct.
1
Sicnature Date /011H�-7
Print name Phone#
official tise unly do not.write in this area to be completed by city or town oRcial
city or town: permit/license# r7tluilding Department
CLiccnsing Board
rt check if immediate response is required 0Seleetmen's Office
t. [311c2lth Department
contact person: phone#!; nUther t
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for
employees. As quoted from the "1aw an cnrpl( ree is defined as every person in the service of another under any
contract of hire, express or implied. oral or written.
An eynple rcr is defined as an individual. partnership, association. corporation or other legal entity, or anv two or inc.-
the foregoing enga�_ed in a joint enterprise. and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However
owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling_ he
or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioye-
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
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supp:= in`_ company names. address and phone numbers as all affidavits may be submitted to the Department of
lt�auarial Accidents for confirmation of insurance co\erage. Also be sure to sign and date the affidavit. Tice
a �,avit 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 ifyouu are requirecI
to obtain a workers* compensation policy. please call the Department at the number listed below.
City' or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o:
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple:
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
-the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any quesnor
please do not hesitate to :_ive us a ca11.
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The Department's address. telephone and fax number.
TIte Commonwealth Of Massachusetts
Department of Industrial Accidents
Office cf Investigations
600 Washington Street
Boston, Ma. 02111
fax 9: (617) 727-7749
'' phone #: (617) 727-4900 ext. 406. 409 or 37S
��QyOFTHE Tp�yn TOWN . OF BARNSTABLE
i EARBSTADLE, i
y MA®6 BUp 0 bC S� TO
Apo,1639. `00
'FO NPY a'
µ
APPLICATION FOR PERMIT TO .................... ........ ....... ....... ....
TYPE OF CONSTRUCTION ................Ae..e .✓.a.. ..... r... .......... ....... N!!. .................................
....... ....4C....19.w
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereb"applies f r a permit acc rding to the following information:
Location ......1...a....... .. .... ....... ...
ProposedUse .... .Q-�- . ....:.........................................................................................................................................
A T �r��
Zoning District ........ .s... !.....!d...e................. .............Fire District ...1 !'�. .... ..v` ......... ..........................
Name of Owner ...C ... ....� .............Address .. ,1 .
Name of Builder .... . . .. ..... .. 4'd?'d...Address ......C>.d....I.. .. . ... .... .... . . ....IJJ.�,..... ..... ......
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ........ ...............................................Foundation .. . ..................................................
Exterior `
Z3" "1.......................................Roofing
Floors .....'C ?? !►.........................................................Interior .....
. -4- -tv-L
Heating ...........................................................................Plumbing .............
�.. .'................................................. .....
Fireplace .......';,�.®::........................................................Approximate Cost ...... .�„ �0........................
Difinitive Plan Approved by Planning ______________________________19________.
Diagram of Lot and Building wit Dimensions N�e"f/ f
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hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ......1-%✓...e.... .. . . .. .........
French. Carson B:
DEC 31 1970
No 13.IO1 Permit for ..,•aocessR.X7
to dwellin
.............................. .- araPe...............................
Location ..72..Crosby..G`irele...........................
....................... .....
Centery U10................................
Owner ........Carson..B!t.. `Y'Sribl......................
Type of Construction ................
................................................................................
Plot ............................ Lot ................................
Permit Granted Q91Qb0r.,,5...................19 70
Date of Inspection ... �. . .....19 �®
f
Date Completed 19 70 i
PERMIT REFUSED
................................................................ 19
...............................................................................
................................................................................
.........................................:.....................................
...............................................................................
Approved ..............................I................. 19
...............................................................................