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0415 ELLIOTT ROAD
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'+rrs ��r. . �n _,ulbrue:�A. .k rP��'.�E.' a.}?I��..J,�'`P. ...t,tF' f�4'"':�'i�;Il.na. N�•. ,y DEC 1 .4, TOWN OF BARNSTABLE � � � � CATION Map 4,1- 1, Parcel Application # (J Vl Health Division Date Issued Conservation Division � - Application F Planning Dept. l Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address O VtC44- Village C,_el.ev U',(t Owner s r-'a,n CZ Ue i 1 Address �{� � t '� . �Q�e'��✓u a Telephone -77 3'7° Ffa o 01632 Permit Request�Zes�6(c -�o S i�s(e Fv.,Ih l✓ kb np c Q^A CD h V eV Square feet: 1st floor: existing)j_proposed 0 2nd floor: existing B,.q proposed�� Total new \'7 Zoning District �,�+ Flood Plain IV Groundwater Overlay Project Valuatiorf' V�, n!l�,/ Construction Type was$ Lot Size Q oq r4ctj Grandfathered: ❑Yes C<o If yes, attach supporting documentation. Dwelling Type: Single Family D-"" Two Family ❑ Multi-Family (# units) Age of Existing Structure L t; Historic House: ❑Yes U4 b On Old King's Highway: ❑Yes D-N-b Basement Type: Wrl!5'ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) D Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 0 Half: existing D new 0 Number of Bedrooms: 1!2__ existing D new Total Room Count (not including baths): existing n new c�, First Floor Room Count Heat Type and Fuel: [was ❑ Oil ❑ Electric ❑ Other Central Air: Wl es ❑ No Fireplaces: Existing New _' Existing wood/coal stove: ❑Yes D-No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: sting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Urf o If yes, site plan review# Current Use & kc Proposed Use b fhc D eC APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name (V C"o Ut- ` Telephone Number gL Address ( Litt b "Zd License # cepAvu LJ,it V 't 32- Home Improvement Contractor# Email -6':- ✓ ea� f4e_��no I'ti�� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1'�)6 is K C ►SIGNATURE DATE S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION FRAME t . ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s DATE CLOSED OUT ASSOCIATION PLAN NO. Y JL V••ii Vi A.Fsax ilV{""JLV ` �1"E,b' . Regulatory Services 1 G� c� Richard V. Scali,Director Building Division 1639. ,0$' Thomas Perry, CBO �fD"1Pr� Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 RESTORE TO A SINGLE FAMILY n Map/parcel number II Building Permit Application to be completed. Approval Sign-offs from: II Health Department(8:00—9:30AM&3:30-4:30PM) n Tax Collector II Treasurer n Owner's name &address ] Project valuation must be entered Q Builders Information n Signature l Two sets of floor plans showing entire house with rooms identified. n Workman's Compensation Insurance Affiidavit State form must be completed and a copy of Insurance Compliance Certificate must be submitted. II Construction Supervisors License &Home Improvement Contractor's License OR n Homeowner License Exemption Form must be submitted if homeowner is acting as.general contractor or builder for the project.. El Property Owner must sign Property Owner Letter of Permission. n A NON-REFUNDABLE Application.Fee must be paid upon receipt of application.. All checks should be made payable to the Town of Barnstable. MA r2M -��-��{''�m�r�aa,�rfsrss Tir�rrr-anrfs � ETsf•�`��,r���t�:..:--r,�lP�m,��r�a Area in m3pIoyer7 Chhe&thx _ ziaJL-bo- r I❑ Ia=a aenZployCrti 4--'El Isotsge=Icar=ffI ' * l�1iu��•€�e s - � �IETe� ❑ I aiu a sole mar argazfner- Iiste�on The Etta 3 sh 7- []R mn l,4mg sbipmudhave na=3plo7ces T ors ha-vs g-,❑ a workingme M.any capanjLy a la7ees aa$ba�re tvoE�s' �I j_ ❑ '47e are a corpara9imLaIId ifs 1O Viral r2p�nt id ai. s_ I rah doing aIIwos�� affirrsshie -*zed I14:]pig=FMM Dr adcR!ions 152, 1(4� ad• $aofregaas I 13�C)a= =p-msnrancerequa-t l ��IIj aYpb $tom 36ar�Ihmsti mf.ac tthzmcfinab9Owsha dngffi 7rVUaZ M=O E4�67013 LEC�-h 'H1`it CTl^SY th'.L �" Eabig Ni:r.uzdm'�CrY„t,-vrnncym�sr�hct�Baar Rn7�'ic�LID �_ bazmgststt�hed�y,zd�it;�,,,TshseYt�n�ofEieam3statatche��r�cnnt� fi.� ID�?1ap�s_If73zn�hc �h.- e�7rrse ML7 Igmaidethy-wins'r=g.puEry=mber- :' �P�� �F � rrorkers'r- nN=ng.•r,•* t,fir tad rsrnyEss ��vtv is theg� asd3vb r �aC7LetL a T. - '� ,j• _ TV=iry'rp C{-Mp-iIYNMjz f AttzchM• upynft-7vto-rkers`rn�easa•banpaUcydxc�rstianpage(ShOWh3g6MP°BE3' oa��e}: FaIlum to set=t-1 Sec&EL2 5A o£MM c M CB:n lead iu tb2 imposifiva uFraminI pea flies of a -t'fF'I P ap��L.50Q O6 a_udlor os�yearim R3�1�CR7Z gesalfi�is tfie�6€a S�1'�3RI€�$.TaF$and a� c f Bp•o,S250.00 a day apaiud fhe vmhtar_ Be advised lhd a copy of ffiiz maybe ceded to-tit Offica of Fiona of ff 3eDIA for in n=cage •tfcs rip arrpfhat$t� pnrcpravid€daezrlruarmd srf Datp S ' �scsa azrF� IYc root tgrii�i�t fur tg"ectf.a bg urarpie�'��cdp aF frr�c u,}�c�L Cry or Tor= L Bo2rd efH,,Fth 2. ngIqt2a:l t CaL IFUWa a=k ILEI=tdcalh-peciur 6.P r W qm=l Laws thaptcr I52 recj==all emplopras tD prav>tie wor3mrs'cca"P=L Dn far tb�employees pums,�a this,-t f an��P�is dcimed as=_X=y p==n-is fne scavice.of-add=MCiea any ca*��of hQe, em2rss or iimplied, anal ar Wdt= , : assD tan,crffparati�or ot3ia Icgal eddy,or my tvto or more An arzplTer is defined as >ndxvidrr F of a deceased eaPloyq-Cr the of ffie,foregging engaged m B jaiht mferprise,and iMlUrl d' legal re m receivEs cir�e,of an.d aal,pact=bip,assoc� m or other legal e�y,emPIDYiag employees Hover ffie o4tner of a�ghDMeehaviugnDtmore,than.ffz=apartrneafs and who resides ffieaGin,CIEthe Dccapaat of fhe . d welling J�trse of another whn. joys p zscw to do ,construction,or repay woi3c on such ciwefii ag house or an the r?� or bulldog app> na t3irreto.ShaIlnDthiecamse of snch emplcyme�be deemed to be an enrployc;r." l�i(sL chapter I52, §25C(6)also sfadm tbat aeverystR±e,or Iocal l c asrng agency slim WitTlhoId flit issuance or r-eueWRI Elf a Iice4se,gr Pip mit to operate a:hnaness or to construed bmTdnig ia,the mmmoawr-91th for airy apgficaat l lzo,has IIDt'prridtrced arrPptable eYi ce of po�apliah'c��f}i;fhe TaS�auc�coverage required A tidT±j many,MGL chapter L52,§25C(7)stag=Neifher f=coIDIDDn hwte- tenor auy of tSpolltical&3bffivisims shall enL:r into any coaizaot for the plan ce of public walk�1 acceptable uvide ice of compliance vairh the;n��ce r-e,T r ents of thus chapter have been presented fn t�contracting arch arity' if e hers' easafion affidavit completely,by the ,the boxes the apply to your si and, PI ease flI D wo camp _ and numbel(s)along wii'h then ces�]i (s) of necessazy, s¢pply sob-contracinr{s)name(s)�addresses) phi ,eS office the iab " antes or Lmm�dLiab2*Partnerships(I I P)ono emplc ;,,cm ante_ I:imitEci L ila9 Came (I LC) have members or parta=s,are notrequred to carry work= compenssiion i 3131 nee_ If as TLC orLL do s employees;a policy is required- B c advised that this affidavitmay be submitted to the Department of Industrial Accidents for conf m atiDn ofmYOIEnce tovmmgs. Also be sure to sign.and date the affidavit The affidavit should be rrtrmed to the city or town that the application far tilt permit or license is being rrgae;ste;d,not the Depal n eat of Indus'izial Accidents. Should you have any gargdr ms regarEma th c law or if you am rego i ed to obtain a v*orkers' eompemsafionpoEcy;please callthe Department atthe number below. Self-iusured conpanizs should'enter their sell;,,.s¢c-ante license n=l5cr on the appropriate Ime. - City or Town Ofticials ` . Please be sure f�the affidavit is coroplete andp ci leg�ly'The Depadmmt'has provided a space at,'he brit m of the affidavit for you to fill out is the event the Office of inywfigatiots has to confact.yon regaFdmg ffie applicant Please be sine fill.in the pe�itllieense ntanber vdlich be used as arefemnce n=bez In addition,an applicant•. that must sobmit mnlfiple pennielicense aPpli�nns k any given yew,need only mhmif one affidavit indicating cut eat ' policy informal+nn(if necessary)and under'Tob Site A ±=ss'the app)lc t should write 6aIl loeaiions in. (crty or town)"A cagy of the affidavit thathas been officially stamped or ma[ked by the city or town maybe provided t the applicant as proof that a valid affidavit is on Ell;for futmreperroits or licenses kacw-afdavit must be filed out each year_Where a home owner or feu is obtaining a license or permit notreIaird to•any business or commercial venture Cie.a dog license or permitt o b=leaves dr,.)said person is NOTregohed to completes this affidaiZt The Office of lape�gations would I77re to•thankyou in advance ffiryour caDp�on and shouldy. have any-gj�stions, • please do n:ot hest'��give us a call. :. • The Departnie 's eddrPss,telephone acid fagnumber aF eo 1a Of Mass s - D nt t fafInd�alA _ Revised.4-24-07 '. G, �trgti Town of Barnstable a� ` Regulatory Services } } MASS. '$ Richard V.Scali,Director E1.19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmb arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and'Sign This Section If Using A Builder ; as Owner of the subject property . hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) "'."Pool fences and alarms are the responsibility of the applicant. Pools ` are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner, Signature of Applicant Print Name Print Name ry Date ^ QTORM&O WNERPERMiSSIONPOOLS Town of Barnstable ' Regulatory Services Y4ppTHE rp Richard V.Scali,Director Building Division RARNC-4331 Tom Perry,Building Commissioner 1 9. ��� 200 Main Street; Hyannis,MA 02601 prED � www.town.bamstable.ma.us _ Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION a®' PIease Print DATE: JOB LOCATI0K number street village �HOI�owN>:x:�jr`�r, ��Ve �� �6�5 •� 3� • g ��g S a/�.� name — home phone# work phone# CURRENT MAILING ADDRESS: —f 1 6 ` ` . I . � 0�a l�.e. M4 city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINITION OR HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws;rules and regulaf ons_ - The undersigned"homeowner"certifies that he/she understands the Town ofBarnstable Building Department minimum inspection procedures and requirements,and that he/she will comply with said procedures and requirements. (? �� CA,)--k I Sign 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-IJ-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,RuIes&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 formlcertification for use in your community. Q:\VRFIl:ESTORMS\building permit fnrms=RESS.doc Revised 061313 Town of-Barnstable _ Regulatory Services ,aaxsr;A^7 i Th om as F, Geil er,bixectnr 19. BaUdhig Divisign Thomas PErry,-CB0,13uE din g Conl miss]0nPET 200 Main Stret, Hy.annis,MA 02601 • , , ww�.tawn•harnstahle.ma.us . o : sos-s62 o3s ' Fax: 508-790=6230. - 1'LAN RE VTE Owner: Map/parcel: �Z� 07 Project Address CIS eL4"La1'T.•!�D Builder: The following items sere noted on reviewing:. - S tnotic� A� cra2 i2 .-r Ar&Vc G �3 F-I g.VAOE4 $E!��D 1.4J A4.. . S�t4►r'c►o.•� GlD,r1r►PL'� W 1 Zu 1't. ��GEC Reeyi awzd by: r (its Et\ 1 t> 0 �le ON't A o C, j q o a �1 M G' Y SMOKE DETECTORS REVIEWED A�IL MA7 BUILDING DEPT. DATE FIRE DEPARTMENT DATE e BOTH SIGNATURES ARE REQUIRED FOR PERMITTING a 318dISM9 J0 N MOI �dOZ 8 T 330 O�LC a 1 Ck cc_u 1� �cl.--1 a CP Ai M P O I c � D 1 Z ?U�l t . C- if ���a a apge 4 ,6 (Dbch i g OP d� 0 c.e..;�cfA�, YhA o2-632- � s n vli � COU¢ l� VA- _ o 6'G � s �9 Town of Barnstable *Permit# P� p Expires 6 months from issue date Regulatory Services Fee ---- BARNSPABLE. r 639 � Thomas F.Geiler,Director �ArEO MA'I� v ]Building Division X-PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 APR 2 � Z010 www.town.bamstable.ma.us (, � � ���� Office: 508-862-4038 k,� ''90-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number. I A) Property Address M �( J Residential Value of Work s_SKsa Minimum fee of$25.'00 for work under$6000.00 Owner's Name&Address Contractor's Name Co S .��� Telephone Number ,4 ✓1_96 — Home Improvement Contractor License#(if applicable) K,2 '2 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 3 Y 2 it-) `- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) E2(Re-roof(stripping old shingles) "All construction debris will be taken to _S"'j }C(t7 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (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 require SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doC Revised 090809 AC Libertx ISSUING OFFICE .181 Mu INFORMATION Wormers Compensation mid PAGE Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group/Boston 1-342421 0000 LIBERTY MUTUAL INSURANCE CO 1-%28 POLICY NO. TD/CD SALES OFFICE CODE SALES CODE 1 T/1 1S' WCI-31S-342421-020 XX X WESTON 102 REPRESENTATIVE 3000 2 'YEA R ASSIGNED _ 2.003 Item 1.Name of CRESWELL CONSTRUCTION CO INC Insured FEIN 73-1641054 Address 195 PINE STREET CENTE.RVILLE,MA 02632 RISK ID 0134545 Status 03- CORPORATION Other workplaces not shown above: SEE ITEM 4 Mo.Day Year - Mo.Day Year. —— Item 2. Policy Period: From 04-19-2010 to 04-19-2011 12:01 AM standard time-at the address of the insured as stated herein. Item 3. Coverage A. .Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily.Injury by Accident 50.0,000 each accident Bodily Injury by.Disease 500,000 policy limit Bodily Injury by Disease 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any, listed here: SEE END WC 21?03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Iteni 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating- Pla is. All information reyuired below is subject to verification and change by audit.. Premium Basis Rates NE 110 Per$100 Estimated i.I Code Estimated of RE-ClassificationsAnnual No. Total Annual Premiums muneration SEE EXTENSION OF INFORMATION PAGE Premiums Minimum Premium $ 500 ( MA ) Total Estimated Annual Premium Interim adlustment of premium shall be made: ANNUALThis policy,including all endorsements issued therewith,is hereby countersigned by Authorized Re resentative Date 04-19-10 ^ C,oc:Codz Term: Oper. Audit Basis Periodic Payment Rating Basis P.I.H.G. Home,State . Dividend RENEWAH� OF: 04-19-10 NR MA WCl-31S-342421.-029 iPo 4030 RL. Copyright 1987 National Council on Compensation Insurance WC.000001,A Insured Copy aan;eu2ls;nor _ Inl � I �1:> suchusetts Delmi t.m.enf of Public SutetN t• U u(s..lolti dII StnI, ;. Bol•d of Building Rcrlat s0IZ0 UN°uo;so 4>� Construction Supervisor License ��, IOfI m aae S.' �mac; Sptepue;S Pug suol a n�a Id u9;�nggSV an0 u License: cS 76536 J.1 23$ui In aa�� I'k�Y. t fi :off u rn as PI. 8 Jo p.leo� n; # r t ` v PunoJ JI .'a;dp uogealdxa a Restricted to 00 y 'Cluo asn 1nP1eI ul Jo 9t.a oJaq { . fa P J P9en uol;ea;s► a I�o asuaalZ STEPHEN W `CRESWELL 195 PINE STREET CENTERVILLE MA 02632 _ Expiration: 8/27/2011 t'onunisiuncr Tr#: 2900 - t i0 a Board of Building Regulations and Standards r , '� ` HOME IMPROVEMENT.,CONTRA CONTRACTOR, P ya h c Registration 160627 Tr# 272337 }I 2010 4 tto 8/ 1�. P n 8l Type Indiv-idual STEPHEN W CRESWELL�' S CRESINELL TEPHEN 195 PINE ST f Adnn �lnist� oa , ., CENTERVILLE,MA 02632 f The Commonwealth of Massachusetts Department of Industrial Accidents ►' Office of Investigations 600 Washington Street -' 1 Boston, MA 02111 rvww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel4ibly l Name (Business/organization/Individual): Address: ` �f� � City/State/Zip: i � t," Phone #: Are ou an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 4. ❑ I am a general contractor and 1. 6. ❑New construction employees(full and/or part-time). have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a'corporation and its 101:1 Electrical repairs or additions 3111 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 1311 Other comp.insurance required.] *Any applicant that checks box 41 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy# or Self-ins.Lic.#: ���/ )1 -3 V%z�2® ' � 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$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that,a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. 'Signature: Date: Phone# Official use only. Do,not write in.this 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 Contact Person: Phone#: 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 of hire, express or implied, oral or written." er i An employer defined as"an individual,partnership, corporation artnershi , association, co oration or other legal entity, or any two or more P Y of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the g en g g JP 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,constriction 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 who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the conunonwealth 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-contractor(s)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 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. 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 . www.mass.gov/dia DIME T Town of Barnstable Regulatory Services L4 Thomas F. Geiler,Director Mass. A.`0� 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 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize l,�:a �'cLl L. to act on my behalf, in all matters relative to work authorized by this building permit application for., (Address of Job) hrAv Signature of Owner Date n IoLoo V"// Print Name b 4 If Property Owner is applying-for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION _ Town of Barnstable of t►+e rqt, Regulatory Services x =AxxsrAsr.E, Thomas F. Geiler,Director MASS. 019. A,m� Building Division TFn 'r 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 DATE: JOB LOCATION: 7 1-- J number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: i city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) I 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 Homeowner I I 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 io 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:\WPFILES\FOPMS\homeexempt.DOC ��►' rzl t t�rz TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OW Maps Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village C&f(k ��'^) (zl �-1J Owner ��� v�it/I Address Telephone T;� ' 0 Permit Request �- We Z 7fc),/ - ! 41 V. t /I k, 3% tot" � (ate, b fv � wc✓�,� o �5hu Z„�K c� 'v ►� � Iwo i�,�c,J. �� � �(� � .�, � --{ ME Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total nv Zoning District Flood Plain Groundwater Overlay 4! Project Valuation Construction Typel WW'-� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supp ;rting dodt'menion. / sv e— Dwelling Type: Single Family tf 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 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 `(BUILDEROR HOMEOWNER) Name��� ��� � Td�/ Telephone Number �-- Address/ /79�i��'��i,/� License i Home Improvement Contractor# ICJ Worker's Compensation # Cl/�,��✓�©/. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ���j�U �✓ lira. SIGNATURE DATE ' `b�' 2� tILI- 1' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i MAP/PARCEL NO. i t _ .t ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION z FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL 4� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 - _ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement CCh6bictor Registration V Registration: 153567 Type: Private Corporation i.iLr Expiration: 12/15/2b14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE { jkwy SO. YARMOUTH, MA 02664 } Y y pdate Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 0 20M-05/11 s mer Affairs&Bu Regulation u��eCta License or registration valid for individul use only. Office of Consumer Affairs&Business Regulation g Y. OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: fegistration: ;:l`b3567 Type: Office of Consumer Affairs and Business Regulation xpiration:z.1_.5 2Q1.4 Private Corporation10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION- HENRY CASSIDY 18 REARDON CIRCLE,". SO.YARMOUTH,MA 02ii6 Undersecretary Ivot val witho t nat re _ —_:: ✓ 1C 10 Park Plaza - Suite* 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY - . 455 YARMOUTH RD. ------------ HYANNIS, MA 02601 -.Update Address and return card. Mark reason for change. v l l Address [] Renewal l ) Employment Lost Card PS-CAI 0 50M-04104-G101216 ' (flficc.«/t'ui auwer Affa1 Bus ne: Regulation License or registration valid for i;.lividu!use cn! HOME(NfP �� f nlVf ACTC7 Z,.& before the expiration date. if found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation .' Expiration: 12/15/2012 Private Corporation l0 Park Plaza-Suite 5170 Boston,MA 02116 r. aOD INSULATION,INC HENRY CASSIDY 455 YARMOUTH RD. Atalid HYANNIS,MA 02601Undersecretary ith t si ture ' �,la„a:husctts-TIcpartn►ent of Puhlic Satct% Board 11t l3 itdin!g Rel!ulations and Stan(lar(Is Construction Supervisor License Licen��•: CS 100988 #A + '. HENRY CASSIDY 8 SHED ROW WEST�ARMOUTH, MA 02673 Expiration: 11/11/2013 ( uuwih.i„ilrr Tr#: 7620 ou'l, [, 2v i 2 3 : l /'N No, 1605 P. 1 Client#:4597 CCINSUL ACORN,,, CERTIFICATE OF LIABILITY INSURANCE °AT/02/2°'YYY'' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 07/R.THIS 2 CERTIFICATE ICATE HOLDER.THIS CERTIFICATE DOES NOT AI FIRMA TIVELY 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 18 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsamenl.A statement on this certificate does not confer rights to the certificate holder in lieu Of such endorsement(s). PRODUCER Rogers&GrayIns.-So.Dennis NAME: Mai' aret Young PHONE 508-760-4602 F 877-816.2156 434 Route 134 AIC No Exl: Arc Nd E-MAIL South Dennis,MA 02660-1601 500 398-7980 INBURER(B)AFFORDINU COVERAGE NAIL 8 INSURED INSURERA r Peerless Insurance 18333 Cape Cod Insulation Inc INSURERB:Evanston Insurance Company .- 455 Yarmouth Road INSURERC:Atlantic Charter Insurance Hyannis,MA 02601 IN3URERD:Commerce Insurance Company 34754 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 'rHE POLICIES OF INSURANCE LISTED BLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED eY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. TIT AND CONDITIONS OF SUCH POLICIES."LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EX Au POLICYNUMBER MWODIYyYY MMIODNM LIMITS A GENERAL LIABILITY CBP8263063 4/01/2012 04/01/201 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY ENTEq �fi � sT eecurrence $100 000 CLAIMS-MADE OCCUR MEO EXP(Any one pereon) $$000 PER80NAL r1 ADV INJURY S 1 000 000 a ENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPL168Pl;R: PRODUCTS-COMPIOPAGG $2000000 POLICY %R T LOC $_ p AUTOMOBILE LIABILITY - 12MMBCKVMIt 410112012 04/01/201 COMBINED SINGLE LIMIT Ea arcidrnt 1000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per a xidant) S .X HIRED AUTOS }( NON-OWNED PROPERTY AUTOS g denti 8 )( UMeftf=LLALIAB OCCUR XONJ453512 4101/2012 04/01/201 EACH OCCURRENCE - $1 O0O O0O EXC!_$5 Llge CLAIMS-MADE AGGREGATE $1 QQQ QQQ OEO X RETENTION 10000 WORKERS COMPIENBATION $ C AND EMPLOYERS'LIABILITY YrN WCA00525902 6/30/2012 06/30/201 X WCSTATU. OTIi. ANY PER/ , 7O Pq�TME ECUTIVE E,L,EACN ACCIDENT 1 000_LO OFFICE ory id NH)E?(CI UO � I N J A I(fY90, Cory id and E.L.DISEASE-EA EMPLOYEE $1 1060,000 If yes,oescAOe under pESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddIIIDna1 Rq.w ks SChodulq,It Mors ap6IC919 rggUlrqd) "Workers Comp Information Included Officers or Proprietors Certificate Holder is included as an additional insured undor General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod InBUlatioll,inc SHOULD ANY OF THE ABOVE DEscRIBEO POLICIES BE CANCELLED 13EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROV1310N3. AUTHORIZED REPRESENTATIVE Q 18B -2010 ACORD CORPORATION,All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo aro registered marks of ACORD #$83849/M83848 MEY The Common I i ,f11h of Massachusetts Department lialustrial Accidents Offict' ,,l.l a vestigations 600 Vir,i.�-!'lirtgton Street IA 02111 Bos \• . -= Worker's colllpellsation Insurance Aftiti.,:ii:Builders/Conti•actors/E;lectriciarts/.Ir'ltirul►er, �Ltl)liratlt f.nfurrti�ttittn Please Print Legibly mnc �Iit.Isiu� s/pr FUlIL. f101"tIJ.[1CI1V11�11111�: C f Pdi i Clone#: AI C vuu all eltlllloyct•? Ctleck the appropriiite box; Type of project(required): ILAN [.ill a C.utl)Il,yt t' With... ?0 '1 alll il_•rtit i:d,:ontractoc and I have 6. New construction - -- r.1ilployrc-s (full anti/or palt-titlle.).'r hired Ili �uii contractors listed on 7. Renludeliug theauadw,.I hcet.1 I an,.,sole; I:,roprietor oh partnership These sul,....,oaiacturs have 8• Detluilitiorl and havc: nt.,clttployucs workirn for employe—,:iuJ have•workers' comp. 9. F Buihaing addition nlr In any ca[acity. [No workers' insuraut,,. 10, El Fl4'CCrtl ilI l'61)i{ll5 11r U ihhlllls iullll) It1.1tlCiltll:C rCtllllrClL�- b `5.f]-Wedre:i-,-ij;oiation:and!its r I officers li:tt, exercised their right of I 1 I❑ Plurrlbing repairs ur additions .urt a hollicowllchr doing; all work exemp wit I,,i NIGL e. 152§(4),and 12. Root repairs my,clf INN workcrs' comp. � we havc n ,ulployees:[No workers" /�/ � 13. Other LuCC���1 rl zcr�tCil ursut.ul e rciluilyd.� .I. CUnlp. iu tii.uaC riqu)t'etl:J - y,pinaw that chucks box #1 must also fill out the section below showim.1,d it workers'cornpansaiion policy information. mc,wucis will,ulnnit this affidavit indicating they are doing all woiI,,w..l d.,a hire outside cono'acwrs muss submit a naw affidavit indica(ing such. ,,'•.ma:ijt,is that check this box must attach an additional sheet showing th, ic��u.:of the sub-contractors and state whether or not.those entities have employee.; ll' <xd,rtnn,actors have wnployccs, they roust provide their workers'couq- r,.I.,� ❑umber. t tilt,all employer that is provithrig workers'compensation iusnnrnc'e for my employees. Below is tFtg.policy alai fort Site mfurmutiory III<ul;ulcr'Company Mail,: � ( ���-I _t i�j(]fC�h(���� �,A t r -- Policy tI Expiration Date: lull Juc ,\ddress: .• .� �"vW..... City/S[ate/Lip:CCK� V41 Yk4. - :mach a copy of the wolgGers' compensation policy declaration page wi,m iag the policy number and expiration date). I'�ilwr to secure iuvcrapc its required under Section 25A of MOL c. t i. c.n Iced to the imposition of ctinlinal penalties of a fiur up to$1,500.00 ilniVo, nr pe:u nupnsuntllent, as well its civil penalties in the form of a STOP V%1 jkK ORDER and a fine of up to$250.00 a day against cite violator. be advised ticu i a,py Of dtis,ituLenlcut im e forwarded to the Office of Investi,.:1. , ,i the DIA for itisurancC coverage verification, l do here c if' under the tns rind penalties ol't1er iiiy that the information pr Aided Gave is true nnri correct. tit: ualurc:; �� I� I'hllnr.11 Oj irial use only. Du riot write in this area, to be completed br cill,or town official City or'town: I'ermit/License# Issuiub;Authority (circle olte): I.HoartI of H eltlth 2. BuiltHug Departtrmit 3.Clt)-fro i Clerk 4,Electrical Inspector S.Plumbing Inspector 6:l)ther Phone#: I OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property A dress) Coo i-Pr v/Ili AA Cl 32 (Pro erty Address) C Ce fi� hereby authorize (Subcont ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. 0 er's Signature Date r r f ! 5 I r fit;¢ tj '. CAPE COD . INSULATION �r C%®r M P49M O5AS5 51AMLIS5 WAY F0 l SDSPANDPD SATTS OYTTigi 1NSD 'o- C51MG6 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, NIA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ?Y)a' 41y 6✓'e!/ y/� ��°off Cen krv�11 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( (JJ ) ( ) Slopes ( 0 CD P^$ ZE Floors Walls d(4m in Siel o1 He y E C sidy J , President Cape Cod nsulatlon, Inc. T 4r A °OW1s N S UAL A T I.O N `£1' ,CAPE COD 't 0 : 27 . f1i01t plASS i,AM w SPRAYMAM SUSPCND90 - KAM OUST6IIS INiULASIpN -CGUNG* • - - 1-800-696-6611 J'own of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below..Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work.has been inspected by a certified Building Performance.Institute (BP•I) inspector. All work preformed meets or exceeds Federal& State Requirements. Property Owner Property Address village J Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) { ) ( ) ( ) Floors ( ( ) ( ) ) ( ) Walls Aiy a ,doA4 Sincerely t , He ry I- Cas y Jr, President C; e Cod I - uIation, Inc. I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel A lication # pp Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address _ 14J,5 iFLL 9 oTr 12D. Village >r!;.�, ✓. /�e Owner Address Address Telephone � e;2 jr f ff Permit Request /2/ _��is� /�lie-z-�- G/ d f -!/✓fie✓' 9 4AZ-4� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /ti 11,. �j&Construction Type aJ 1u /j o� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family dJ"' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes allo 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 _ nevv:P Number of Bedrooms: existing —new ' n _Pt co . Total Room Count (not including bat[ existing new First Floor Room ount Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 4 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coa stove: Yes fTa 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 Telephone NumberD Address e e;,�,ev iLcense #,Ze Home Improvement Contractor# /J�✓L Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 'J��.f s" r FOR OFFICIAL USE ONLY ,. APPLICATION# DATE ISSUED MAP/PARCEL NO. i" ADDRESS VILLAGE OWNER �r ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s ` r` ? DATE CLOSED OUT- ASSOCIATION PLAN NO.' - h 1 _ NIANSachusetts - Department of Public 1:I1'etN Board of Buil(fin"y Rc,ulations and standards. ® Construption Supervisor License Licenr"-CSC 100988 i➢r T. HENRY CASSIDY 8 SHED ROW ,=d WENT 1€ARMOUTH., MA 02673 Expiration: 11/11/2013 (',nuwissi ,ner Trt#: 7620 v C�/ffla 1c�Cl2C��C� �2 Office of Consumer Affairs and Business Regulation -__-p 10 Park Plaza - Suite 5 17 0 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/21b14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE .. --- _ __.------------- SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. (� Address ❑ Renewal Employment host Card ,,� ���r �(nrrr.rrcrrr-cr.<ecz�r�n`C�<r:cr9Jrrr�uJe :a4\ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only .T OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation s xpiration: 12115/2014 Private Corporation 10 Park plaza-Suite 5170 Ln„ Boston,MA 02116 CAPE COD INSULATION,'-INC: HENRY CASSIDY 18 REARDON CIRCLESO.YARMOUTH,YARMOUTH, MA 02664 ---4val*Undersecretar5' ho t nat re The Commonwealth o 'Massachusetts Print Form ' Department of Industrial Accidents Office ofInvestigations I Congress Street, Suite 100 Boston MA 02114-2017 www.rnass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciatis/Plun►bers A p.tlicattt Information, Please Print Le ►ibl Manic. (ltusincss/Organization/Individual): a Phone #: "W I Z f Are 4otl an employer. Check t e appropriate box: Type of project (required): l. I Lulu a employer with 4• ❑ 1 am a general contractor and.L culployccs (I'ttll and/or part-time). * have hired the sub-contractors 6. ❑ New constt action I ,ill a solc propriee6r or partner- listed on the attached sheet. 7. ❑ Remodeling ship arld have no employees These sub-contractors have 8. ❑ Demolition working for mQ in any capacity. employees and have workers' 9. l3uildin � addition No workers' comp: insurance comp, insurance.t required.1 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ( ] I ant a homeowner doingall officers have exercised their ' work 1 1. Plurnbin repairs or ilddIU011S ❑ 1; P mysel I'. (No workers' com right of exemption per MGL p• 12.❑ Roof Fe ans irlsururlce required.j t c. 152, §1(4), and we have no ej ��� employees. [No workers' 13 Other comp. insurance required.] ':bus applt,aInl that check.5 box#I itust also fill out the section below showing their workers'compensation policy information. .1 I luni,;uwucrs who submit tltis A—Wavit indicating they are doing all work and then hire outside contractors must submit it new affidavit indicating such. �Contraclurs that check this box mull attached an additional sheet showing the name of the sub-convactons and state whether.or not dlose entities have cn,ployu:s. II'lhc;suh-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'cornpensation insurance for my employees. Below is the policy and job site ia�ur•nyiatiula' ��� �`` lilsurau��Coulpany Nrune:_ t�� Ci C�+itLhV I�--MV ao G� '' ,, rn� Policy 4or ticll-ins. LiC. tl: WGA oQ 2Zl? Expiration Date:--- —w- / 'lot)Silo: .Udress: - _ City/State/Zip: Aitach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). I ;inure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line up (o$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine ul'up to$250.00 a clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 du hereby cegt . ntler the wins-afld perr'ulties of erjury that the inforrnatiort provided above is trite and correct. �ItIIUUr'c:` Date: Uf/ichd u.ve only. Do not write in this area, to be completed by city or town official. Pity ol-Town: _ Permit/License# lssuiug Authority (circle one): 1, Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing; Inspector 6.Other t'ontuct l'ersun: Phone#: V GC I N,3 U L CERI-IFICATE OF t-jABILITY INSURANCE LII ':i A MIA I I L�lj 0F INFOTil�i-A- N,U-R(-U'T;�U P0 N T 1-112 C) I IoN(1040'ANI.)CONFM 7 Jill. 4 1 IVCLY 014 NEGA I i�Tc lit•lt_q I f; ("IF IW-AIRANCE,OOES NOTUjiq�jIl TL hl0,-UI*E NO OR AL11k TI-IL'QOVLRACI�- AFFORDIZ-1) QY TilU 11 It-A GUN I'IUCj'HhIWC.IzN I llt�liSUING It I Ic. T�I LI r�A'k I I'L I ANL) A AU I I i(jl�14L it ti',*:�, �- - -t. ...... J,)U�4 "all A)UI I'IDNAI, Icy, cclvu'�Ill ljoilcluti Allay 411,kill!, ION 13 VVjkIVC,:J),�jlkjl yll%i,I kt,11 . qi lwl Uoml(u Nihlh MaILI'llt:1 Yumill W ....... .......... 6 7 6 0 160 14AX kIJ ill -........ 41.1 ol N1 A 1,):, I,j Q I ij iioixo_C AdwitiQ ........... 3 it 1 ............ ..........i I,,It W.lr�; Cw F*v I I L)1`4 1\1 I I IM 1. "i,Wv 1,01111111. 1101-101- AJIT WIMACI OR 0111H4 DOCI-J&H.-Al IVVIJJJ %Nt! lal I Hit INSUM1,Ii:t ;j,1,jjcLjtD by-ftjF POIACICS DESCRIIA-D IS ;;UUJL 01 M At.l. Ili[, jjlchj:, 11,i Vp"LEN G� PAID CLAIM',-) KAI I 411,1112012 0410 11 NI-I lAt I,lAtIll.I PY X C W) I IL II II A), t 1,000,00t, 0 Ll 0.U00 kjDL1 1--,( 1H )I AGG 2 1, ('I It l2MMBCKWvj)\ 4,IU112012 I (I Ll U IJI 0 U I-A....... A NO I u X 0 N,I 45"1 1 Ab, I - U ��c-Tli ivfl I."It" IAIIII.I ly tILt M) F,L NIA ,LAPII :!-A I 1-,k(-I,,0k01LL ..........7— (,IIHIN i,L(WJ%IIUN%1 I A1 AiJ1 , . _ . IllylV#pKVoIq(III,yb...lit) lill'ollmilloll t.l.j Lill Oddill'U11d)IIIaLIIQUUIIkJuj (Mlluial LIJOIlity wholl ro(ILI(rod LAY wrMon CANCELLMICIN k-yo kl*od lI Ir.LJlzl(IcIII,iIIc MALIULL)ANY06 TllC ACKWI.;QI!jiiJflItI1U Oil-GAN(;I;I,LkII 1111 OHL IfIE EXPIRATION DATr TI-ICHIECIF, NOTICE WILL LIV, LII.LlVt:k (l N ACCOROANCL WITH THE f-CSI-ICY OROVILAIOWJ. -------------- -201IQ A0040 C0IV[1;If,')HA I KIN.All Ill I)I I(,,I I k-,,kit v At, o r. IOU0:it,,folik(wrod lurk6 OfACORD r OWNER AUTHORIZATION FORM:, (Owner's Name) owner of the property located at (Property Address) 01 '1 VXJ-le YrN R 0, (Property Address) �Gi CG .Yh 7i'�c hereby authorize. �, / , (Sub tractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. i Own s Signature Date E . 4 , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# �5"� Health Division Conservation Division '- Permit# Tax Collector Date Issued F 1611 Treasurer Application I# Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board c J 0/1/0-7 Historic-OKH Preservation/Hyannis Project Street Address "7 i 1 r�{-'E >b Village Owner c b u e l Address e Telephone J o ' '�3 TI °gIS So it Permit Request tJv dot �X` a n [ �9 X (e SSuYc l t ���e� EUN�-e"g, Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation U 0 • Construction Type 03 o o 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 )(No On Old King's Highway: ❑Yes '�Illlo Basement Type: Gk5`6`II ❑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 Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No f Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new, size.., i cam; a� Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: E Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ - Commercial ❑Yes ❑No If yes, site plan review# CD Current Use Proposed Use m )) BUILDER INFORMATION A _ Name r 1 G.Iti /1 Telephone Number Address I I ► License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE c DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ` z MAP/PARCEL NO. i -ADDRESS VILLAGE 1 , k OWNER DATE OF INSPECTION: FOUNDATION 6)36.10 c12 J /plat,�y. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING IF `r DATE CLOSED OUT r r ASSOCIATION PLAN NO. A r The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): p V,e Address: City/State/Zip: -eA-P-r C t 11r, Tt Phone A .3 Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction . . employees(full and/or part;time).* have hired the sub-contractors 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 workingfor mein.an capacity. employees and have workers' Y P tY 9. Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. 7 We are a corporation and its 10.❑Electrical repairs or additions 3C I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no d y �y. employees. [No workers' .13 ]Other 1� comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certLfm under the pains and penalties of perjury that the information provided abovet l is true and correct. Signature: Date: r 1 Phone#• 4-:7 613 '9 3 7 ' T7 S f� Official use only. Do not write in this 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 Contact Person: Phone#: 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 of hire, 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)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 in.�ance 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 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. 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 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:. The,Commonwealth of Massachusetts Department of lnfttrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-$77 MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.go-v/dia °F Er ti Town-of Barnstable u- °� Regulatory Services saxrrsrnn , $ Thomas F.Geiler,Director y Mnss Bitl$ ','t dangDlvision D MP Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date ' AFFIDAVIT HOME MROVEMENT 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 W O a � � ��� D Estimated Cost Address of Work: 5 1 t I�dt . CeA%c f U 0 owner's name: ' a�" 4' Date of Application: '(� I hereby certify that: Registration is not required for the following reason(s): i ❑Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied' '[Owner pulling own permit Notice is hereby given that: OWNERS PALLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME EUIPROVEMENT WORK DO NOT HAVE ACCESS TO TEE ARBITRATION PROGRAM OR GUARATY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERTURY I hereby apply far a permit as the agent of the owner: Date Contractor Name Registration No. l , a. Old Date % er's Name Q:fomshomeaf8"dav oFtHE r Town of Barnstable Regulatory Services x BARNSFABLE, : Thomas F. Geiler,Director 69. A.�� Building Division FO MA'1 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 DATE: ` -6 I ^— JOB LOCATION: 41 ,5 � 1 ( (IS 1� Roo,) (number /) street village ' "HOMEOWNER": �s r t ay- CO ViC ( f EO'�? '.17 3'77' Tt, name r 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. DEFINITION OF HOMEOWNER r Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws, rules and regulations. The 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 . requir ents. /1 ,, Signs 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 / 5 / 6 R 5h 0 -9 0 LOT 5 40,803 S.F. 66 2�0 ci9is r3. o0 Y� 0. i� !y 0 LOT 4 LOT s •o, G � gLo R� THIS DECLARATION IS ADDRESSED TO BANK UNITED OF TEXAS FSB FOR MORTGAGE PURPOSES ONLY. TO THE BEST OF OUR MORTGAGE PLOT PLAN — LOT 5 KNOWLEDGE,INFORMATION AND BELIEF,THE LOCATION OF THE STRUCTURES) SHOWN El ARE ❑ ARE NOT IN COMPLIANCE ELLIOT ROAD WITH THE LOCAL APPLICABLE ZONING BYLAWS IN WITH RESPECT TO HORIZONTAL DIMENSIONAL MEASUREMENTS, BARNSTABLE, MASSACHUSETTS FOR CONFIRMATION OF SAME SHOULD BE MADE BY AN ATTORNEY. BRIAN COVELL I CERTIFY THAT,TO THE BEST OF MY DATE DEED REFERENCE BY KNOWLEDGE,INFORMATION AND BELIEF,THIS �'` .; 5/23/94 BOOK 8576 PAGE 161 AL LOT ❑IS MIS NOT LOCATED WITHIN THE `=`:''";� _ 100 YEAR FLOOD ZONE AS DEFINED BY THE _ t' SCALE:1" — 50' JOB N0.1679/1679 F.E.M.A. FLOOD INSURANCE RATE MAP NO. ( i` 0 50 100 250001 0008 D DATED JULY 2, 1992. I CERTIFY THAT THE STRUCTURE(S) SHOWNbDREDGE & WAGNER ASSOCIATES INC. ON THIS PLAN ARE LOCATED ON THE GROUND AS INDICATED. 010M UMAPE MUMn eMW ID Ors ' 586 STRAWBERRY HILL RD. CENTERVILLE, MA 02632 to l,e .. to CerJ1t'e� T1 1 i l 1 L) �}c4l.NG t � r .y� a ck<- a 1, G J V sa a ORDER ' SHIPPED 'i ITE DESCRI ION PRICE AMOUNT PLEASE DEL 619(AMB6/8/12:37PM) *'*PAID-PAID""PAID'*' 5.001 5.00 PC LP021016 PT 2X10X16#1 25 ACQ PRESERVE 13.001 13.00 PC LP021012 PT 2X10X12#1 25 ACQ PRESERVE 1.00 1.00 PC LP020810 PT 2X8X10#1 .25 ACQ PRESERVE 4.OQ 4.00 PC LP021212 PT 2X12X12#1 25 ACQ PRESERVE 30.00 -. :,-.30.00 PC, LP540616 PT 5/4X6X16 PREMIUM25 ACQ PRESERVE PLUS 4.00 >-00 PC LP040408 PT 4X4X 8#1 .40 ACQ PRESERVE 26.00 26.00 EA LVH021012Z HANGER LUS210 2X10/12 SINGLE Z-MAX 1.00 1.00 BOX LNI0DJH5 NAILS N10HDG 1-1/2'J-HANG.GALV.5LB N10D51-DG 6/CTN 14.00 14.00 EA LNSBC3840OG CARRIAGE BOLT 3/8X4 W/NUT GALV 20.00 20.00 EA LNSB38000WG WASHER 3180 GALV 67PCSA B 6.00 6.00 EA LNSBC38600 CARRIAGE BOLT 3/8X6 W/NUT GALV 3.00 3.00 EA LVPOS44CP POST SUPPORT 4X4 COMPOSITE PLASTIC 1.00 1.00 BOX LNI6DGC05 NAILS 16D COMMON GALV 5LBS 6.00 6.00 EA LMEBLSL8816 BLOCK SOLID 4X8X16150 PER/PAL .. .] npi .-. LO i. `t ;Delivery instructions MAP PAGE 18 GRID K10 ROUTE 28 TOWEST MAIN ST.LEFT ON WEST MAIN TAKE RIGHT ON PINE ST,LEFT ON ELLIOT RD AMB 06(08/06 CONDrnONS OF SALE :Stock items returned in original condition within 30 days of purchase are subject to a minimum handling charge of 15%and must be accompanied TBP 845 by a copy oi*ds bill.Non-stock items may not be returned without special approval.Claims of shortage,damage or unsatisfactory conditn must be INVOICE made within M hours. 4 - Delivery Copy IIIIIII Hill oil 11111111[IIIIIIIIIII11111111MIIIIM MIIIIIIIIIIIIH11111111IN 0 0 U 6 E I 0 , • 1 yeti � / g / / (b - 10' 2 f9 Cb ^. LOT S 40,803 S.F. i 66O . 2"0,?ems LOT 4 LOT 6 a 'o.'10 Opp Z$oOpp R.g ROPE $LA'�O� 1 1/15 93 INITIAL ISSUE JEAL THIS PLAN IS NEITHER INTENDED NO.1 DATE DESCRIPTION ley FOR, NOR SHALL IT BE USED FOR AS-BUILT FOUNDATION PLAN-LOT 5 MORTGAGE LOAN PURPOSES. ELLIOT ROAD IN BARNSTABLE, MASSACHUSETTS FOR kA OW M,., BRIAN COVELL I CERTIFY THAT THE FOUNDATION SCALE: 1" = 50' JOB NO. 1679/1679 PLEV A. 4�,1 0 50 100 SHOWN ON THIS P AN IS LOCA D LEVY a N0. 10617 ;ONa>�E R0UN AS I CATED :S T'r.R LEVY, ELDREDGE & WAGNER ASSOCIATES INC. ENGINEERS LAMISCAPE ARCHITECTS PLANNERS LAND SURVEYORS DATE REGISTE ED LAND SURVEYOR 586 STRAWBERRY HILL RD. CENTERVILLE, MA 02632 COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ONE ASHBORTON PLACE OF BOSTON,MA 02108 MASSACHUSETTS _ CAUTION .:.. EXPIRATION DATE ` `' FOR PROTECTION AGAINST EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB PRINT IN APPROPRIATE y RESTRICTIONS o' o °I LASTING OPER ORS Z r OTO, T INCL HEIGHT. I . lty I • PHOTO(BLASTING OPR ONLY, FEE: .. - RRRq 4 ..�i I .. - NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY �� I Y _ F STAMPED-OR-SIGNATURE 9F Tf�E COMMISSIONER ��^�,•,_, n DOB: f f 1 SIGN NAME IN FULL ABOVE SIGNATURE LINE THIS DOCUMENT MUST BE St A RE OF LIC�•1SEE CARRIEDON THE PERSON OF JJ�� THE HOLDER WHEN EN- // COMMISSIONER OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION � - l o, The Town of Barnstable . a Conservation Department six i 367 Main Street, Hyannis, MA 02601 Office 508-790-6245 Robert W. Gatewood FAX 508-775-3344 Conservation Administrator T0: Joseph Daluz, Building Commissioner FROM: Robert Gatewood RE: Occupancy Permit/Final inspection DATE: y— The following project has been granted an Order of Conditions by the Conservation Commission. Applicants Project: 15 r O . Location: �, Map/Parcel: .1,2 7 o 7 Our Permit #: SE 3- a�p We would kindly ask that no Occupancy Permit or Fiz':al Inspection (as may apply) be granted by your department until a -Certificate of Compliance for' theproject has issued from the Conservation Commission. Your assistance is very much appreciated. ��� °•yew TOWN OF BARNSTABLE . BUILDING DEPARTMENT Z SADIST rua TOWN OFFICE BUILDING ., HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: t An Occupancy Permit has been issued for the building authorized by BuildingPermit $k...... .6..:5c.0 »...» ..........................................»........................................................... .»».....»»». issued to ... r`�E�a »1!?..:�!»t..........»... . G?� ?.........» ........ < <_ �. .»-------.._-..-»!_ .��»....» »»»» i Please release the performance bond. i 1" TOWN OF BARNSTABLE 36324 PermitNo. ......:......... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash Y� pp �� 679• A �co+' HYANNIS.MASS.-02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to ROSEANNE GOLD Address lot #5 415 Elliot Road, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, .AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. j Mai 27 , 19....9.4......... - Buildin�g Inspector - f / .^•- -.cFf_a'�. -^:�".'��n: 3'?��`'-S '�`.�" ^'.f 'lt�.,� i^%'-r��L�v�s'�'y" s"..i ;� ,� Y�.�-r:: .. J� BARNSTABLE, MASSACHUSETTS BUILDING PERMIT A=227 107 November 15 �:93 EIR 2 t William Covell DATE '� e1e.1 T.P vllle'�1"ti t f,. V14 APPLICANT ADDRESS (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Build dwelling 2 Single fain-ily dwwelli-.-ig NUMBER OF w ( ) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) lot #5 415 Elliot Road, Centerville ZONING DISTRICT— RC (N0.) � (STREET) � - - BETWEEN - AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #93-515 i.. BOND AREA OR 1680 sq. Lt. 70,000 PERMIT �n 109.50 VOLUME - ESTIMATED COST $ FEE J (CUBIC/SQUARE FEET) OWNER Roseanne Gold ADDRESS 169 Whitehall Way, Hyannis, XA � � BUILDING DEPT. //`` BY / . V / FR'D'W O OIfilONS_-,_— OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL .APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2fO /J 3 HEATING SP CTION APPROVALS ENGINEERING DEPARTMENT -- ) BOARD OF HEALTH ER fSITE PL'A REVIEW APPROVAL � C14 �U L—O—c,�c,`'� -- WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. u e:�r',"n^,rr'. .e. y,,.c Z:F �.sr ,.,t t';iv -;5 Y`•� i t •.;'{;. 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I. f ,r: ?.. j.. — r r,F •-C S 1 art h: 6. a• ` y y®^� Ff�.�. 4 { +i i � s-3 s ! 4 r k JrI: d `? '? i, J f s i;. r 4 -i,f x- '. Jr� J + 'S �� a s t. .� ,s y f t't yl. fYY'�\ 7f^. y- 1 f -• 4 y ..: ':: .� Y v"'•[ ,<If J 1. .1e'-5 \Mir 3 F F ♦ f� ! _ ._t f ...G, f.'v { .. I t,e". .7' i 1. t. ,'. a 4 I. ;; t 1 T. 4 2 r tR - d 't + i f , _ 5 Y y 'fi s t % ,,:. -t t C f > + '? f ? ! j `+ r is-JA.' I -f ( ;! 'r. q>='n a } t ,; , r' ? r ,is t a E{ � 7 F�1 .1 r.ya.. - J i ,f. "•1 r :5 ;J .s.. .�N 46; t ? ,e) 4 l i t i.. t, /;1rr + t: s. ,, _ j 5 (.` tJ. l "`t I r, 1, } h �J y 4 t V,� h; .t. t IrF t.. . �( —'- " I "':a ) s i t ; t x- .� .r. Jr 4 t l d ': �aM a' b 1' i, f i r ":, 1 ur I 1' a '+ 1 e 7 f:: •• , ;P, m'.. i r:. \ v ,t { r a sf.l !. k r 7.'i '44, I ,. , !.�. e N a I I r y r ,.'. - t 'x - i, j a , '.� I I Ge l^f-y--t7Q ttQ J i I x , cq6¢f r.?4 .. Y - - `. '. .' G -fie•• . � / g�ic`e tr••.o� �} Y—� . . { l[,o� 7 \ Q. i _ - t; J `i % ' .. ,, f I- i ! I r d. t1111 r _-1 _--'-, i C 1 �� E5. 1l,, f ? .- .. - �. L .. .. , P __. `r ° � TA , Pt r st - t4,S,ty 4 1 b�o4 _ - - - . 6 .Ux LA 6 r . f R -fe�v �w�f . 11 ! .: - _ _ \ lti ` - g, , T o y r V i N t rt V i t f } ` t \ : l "...�.:� , .. ., , s % ..} v ".. - .7.r-- ..�...�._.�.,_..�.__..._.a. .:._. F'4i. � °B` a ; � >--- y�, ;� "N J� �J-h+'3'�:.�clY+� e'_• . , LAW OFFICES OF PHILIP M. BOUDREAU 396 NORTH STREET HYANNIS,MASSACHUSETTS 02601 (508) 775-1085 TELEFAX (508) 771-0722 PHILIP M. BOUDREAU PHILIP MICHAEL BOUDREAU MARK H. BOUDREAU September 29, 1993 Joseph DaLuz, Building Inspector Building Inspector ' s Office Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: Lot 5, Elliott Road/Salt Creek Ln. Centerville, Massachusetts Dear Mr. DeLuz: I have been requested by Roseanne Gold, the owner of Lot 5 (Plan Book 305, Page. 44) located on Elliott Road and Salt Creek Lane, Centerville with regard . to its buildability as a separate lot under the bylaws of the Town of Barnstable. Plan Book 305, Page 44, dated April 9, 1976, shows two lots abutting the subject lot , Lot 5, being Lots 4 and 6. Since 1977, Lot 6 has been held in ownership distinct from that . of both Lot 4` and Lot 5. Lots 4 and 5 were originally checkerboarded by the developers, Lot 4 being deeded out in 1985 to an individual. The ownership of said Lot 4 has remained distinct from that of Lot 5 ever since. Lot 5 contains 40, 803 square feet, of land. This letter is being written to indicate that from a zoning standpoint , Lot 5 is a grandfathered buildable lot which was held in separate ownership at the time the Town of Barnstable increased the lot size requirements for the residential zoning district in which the land lies. Should you require any additional information with regard to this property, please do not hesitate to contact me. SincerelyW Mark H. Boudreau MHB/AMB Assessor's office(1st Floor):,• SEPTIC SYSTEM MUST BE ' l Assessors map and lot number ' / 0 "'WALLED IN COMPLIANCE Conservation(4th Floor) WITH TITLE 5 Board of Health(3rd floor): ENVIRONMENTAL CODE AND 1Z ssai�r�nr Sewage Permit number 3— /15is ' Engineering Department(3rd floor): TOWN REGULATIONS` 4 � /' � +b)o•`\�a° House number 1 / o MCI Definitive Plan'Approved by Planning i8oard Y P / 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only �Y1L TOWN ' OF BAR ABLE BUILDING INSPECTOR APPLICATION:FOR PERMIT TO TYPE OFf CONSTRUCTION �Z 19 L_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follloowin information: { Location 7 f / Proposed Use ��h—s/ ►' �f—�-•`�X Zoning District N Al� Fire District �} Name of Owner Address Name of Builder rC Address G Z. Name of Architect S'Gr/ffca VT Sr su Address Number ` � t N mbe r o f Rooms Foundation u Exterior � ` Roofing Z 3:.� Floors �► 2,--�/ Li '``y ( Interior Heating Plumbing Z �L /Q 00 Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions C v(p Fee ` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abov nstructio Name Construction Siipervisor's License ` _ GOLD ROSEANNE '.AI-0 3 6 3 2 4 Permit For Two Story Single Family Dwelling _ Location Lot #5, 415 Elliot Road Centerville Owner` .Roseanne Gold r _ Type of Construction Frame- Plot "- —'Lot Permit Granted November 15 , 19 9 3 :,,.Date of Inspection: ;Frar . 19 I ;rye lnsat 19 • v..t e'O'r, s "`Felace 19 ' 'fc � . Daijej g eted Z 19 1 •