HomeMy WebLinkAbout0062 FERNBROOK LANE C�o� �e�nTb�k I.�e ® ;
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0/`f Application # d OV00)
Health Division Date Issued O
If n
Conservation Division Application Fee
Planning Dept. Permit Fee 3
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation / Hyannis V
Project Street Address J:�/� �aRM�k /fA/19
Village VGA/�g ��!`.1���c
Owner �al�A/ "�'1 �^J aelU Address 37-T rOXCPd , 144"Ai4 !!My
Telephone b7 " 7 sJ z3S/
r
Permit Request /i W -��1� t, ! t
. o
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ® Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) C7 R N
Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highway:,❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) �T�o Basement Unfinished Area (sq.ft
Number of Baths: Full: existing new �� Half: existing nev 0
Number of Bedrooms: existing new
J�
Total Room Count (not including bath 3): existing new First Floor Room Count
Heat Type and Fuel: C kGas ❑ Oil ❑ Electric ❑ Other
Central Air: Xes ❑ No Fireplaces: Existing New �_ Existing wood/coal stove: ❑Yes�No
Detached garage: ❑ existing ❑ new size_Pool:Xexisting ❑ 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 Number
Address �� da License
Home Improvement Contractor# l�SsZ 9
Worker's Compensation # U,gs 3fS- 3(fll0'j d!7—
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJ CT ILL BE TAKEN TO
SIGNATUR %Z DATE �' 2-7- — ;- 613
1
5
FOR OFFICIAL USE ONLY
APPLICATION# _
DATE ISSUED
MAP PARCEL NO. '
E '
. ADDRESS VILLAGE
yi
OWNER
y.
4' DATE OF INSPECTION:
b .•FOUNDATION _
FRAME
t
INSULATION
FIREPLACE
r
ELECTRICAL: ROUGH FINAL
i
PLUMBING: ROUGH FINAL '
4
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
t
600 Washingtotz Street
Bo stvrt;MA 02111;
www:massgov/dra
Workers'Compensation Insurance Affidavit Builders/Contractors/Electndans/Plwmbers
AUUlicant Information Please Pant Legibly c
Name(Business/Organization/Indvidual):
Address:,
City/State/Zip: MIA 1� � 1Phone#:
Are you an employer? Check the apiatebog ect(required
Tpt, )
4. :I am a general contractor and I
1. am a employer with� 0 6 0 New construction :
employees (full and/or part lime) * have hired the sub-contractors
2.El.I am a-sole proprietor or partner- lis1.ted•on the'attached sheet 7: LYM
Remodeling
ship and have no employees These sub-contraciors,have -8. (]Demolition '
wo for me.in an ca aci employees and have workers'
rking . y P t3' 9. ❑Building addition
[No workers' comp.insurance comp mcnrance.f
re ed 5.. �:We are a corporation and its 10.E Electrical repairs or additions _
4� . ] {Y . .
3.� I am a homeowner-doing 0 work officers have exercised.theii 1 L❑Plnmbmg repairs or additions
myself [No workers' comp rig f exemption per M ht oGL. 12.0Roof repairs;
insurance re ed t c..152,§1(4),and we have no
q . .] 13.❑ Other '
employees.IN, workers'
comp.insurance required.] :
*Any applicant licant that checks box#1 must also fill out the section below showingtheir workers'co ensaon policy information. t t
.. � ti P Y
t Homeowners who submit this a$idavit.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 hale emiployees,they must providb:their workers'comp:policy number.
I am an employer that isproviding workers compensation insurance for my employees. Below is thepolicy and job site
information
Insurance Company Name:
-�
'o ate:Expiration D
Policyor Self ins Lic. :�. . � III
Job Site Address: 6� "City/State/Zip:
Attach a copy of the workers' compensation policy.declaration page'(showingahe 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 statemerit:may be forwarded to the Office of
Iuyestitrations of the DIA for insurance coverage verification.'
I do hereby certify u der a pains•and penalties of perjury That the information provided above is true and correct
F
oo
Simattire. Date:
Phone#: Z&O
Official use:only. Do not wnte.in this area, to be completed by.city.or fawn of
City or Town: Permit/t:icense#
Issuing Authority(circle on
:1.Board of Health:2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person. Phone# _ -
_ Massachusetts General'Laws chapter 152 requires.all employers to provide workers'cpensation.for their employees.
Pursuant to.thus statate,an-employee is defined as"...eery person in the.ser_vice 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 anytwo.or niore
of the foregoing engaged in a-jomt ente prise,and iachiding the legal representatives of a deceased employer,or.the.
receiver or trustee-of an individual,partnership, association or oilier.egal 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 to persons to do maintenance,consirnction or repair work on such dwelling house
� mP Ys P ,
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
applicanfwho'has notprodnced•acceptable evidence of compliance with ihe.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 vrith 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-contiractor(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 retained 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 cumber 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/lieense 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 mnstbe:tilled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(Le.a dog license or permit to bum leaves-etc.)said person,is NOT.required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us.a call t
The Department's address,.telephone-and fax number:
•Thc CQmm'dim-al ofMa=cht i
U�pmlmmt of Jhdus al Acoi&ait .
Office Of,luve!%desks
600 Washingtar Sit
- �.ostc�4, I�tA€1�111
Tel.#617-727-4 ext 406 or 1-M—MASSAkE
fax##617-74
Revised 11-22-06
3/11!2013 6:24:12 PN_ PST (GMT-3) FROM: 100005-TO: 15084206856
Page: 2 of 2
• •,•acoRv® CERTIFICATE
OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRM OR NEGATNELY 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 eertpte holder is an AD
the terms and conditions of the oll DITcies INSURED,the policy(ias)moat be endorsed B SUBROGATION ii WAND subject to
P cy,certain Polities may require an endorsement. A statement on this Certificate does not confer rights to the
certificate holder in lieu of such endorsemen s.
PRODUCER DOWLING&O'NEIL INSURANCE AGENCY
973 IYANNOUGH RD CONTACT NAME:
HYANNIS, MA 02601 PHONE
E MAL All
Ill C N
N8U 9 AFFORID 000VERAGE
INSURER A: NAIC N
nsurall
J J DELANEY INC Nate:
20 RASCALLY RABBIT ROAD UNIT 2
MARSTON MILLS MA 02648 ""E"�
Nat D:
INSURER E:
COVERAGES CERTIFICATE NUMBER: Nsu F
THIS IS TO CERTIFY THAT THE POLICIES UI INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENAIMEDNABO EB OR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RE4UIRENENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
rCL"A
E OF INSURANCE EFF POLICY IMP
WTY POLICY NUMBER
LrMr is
AL GENERAL LIABILITY EACH OCCURRENCE $
3�,AM,E OCCUR PREMISE3 aoccunence ;
MED EXP(Any one pemon) $
------------- PERSONAL 3 ACV INJURY $
GENLAGGRE(ZATELIMRAPPLIE3PER: GENERALAGGREGATE ;
PQLICY LOC PRCDUCTS•Coll AGG $
ALITOMUMLE UABIm $
AN'AUTO e e enCl $
ALL OWNED SChEDUUD SOCILYINJURY;Perpar9on)AUTOS $
HIRED AUTOS NON-0 iPsr WrED BOCILY INJURY acritlnn() $
AUTOS RR
PPsrae'ertt A E $
$
IFLL48 OCCUR $
B CLAN"ACE EACHOCCURRENCERETENTION$ AGGREGATE $
$
$
A AllEE L��e„m", wcs-31 sue,at o1-01Z $
AAYTOR/PARTNERIEXECUTIVE YlN 1 /Z/Z01Z 11/2/2013 WC ATU. ��}.�OFFBEREXCLUDED? ®, NlA ElifNia NH) E.L.EACH ACCIDENT $ 500000
Il Ye under E.L.DISEASE•EA EMPLOYEE $S OF OPERATIONS baby 50000a
E.L.DISEASE•POLICY L MIT $ 500000
DEt7=
/YEIDCE8 fArtachACORD 101,Adtlitbnel Remerke Schedule M mere
apse la reqlred)Wverage applies only to the workers compensation laws of the state of Ill
7UERTI Holl
TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
BUILDING DEPT THE EXPIRATION DATE THEREOF, CANCELLED BEFORE
NOTICE YV BE DELIVERED IN
200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS.
HYANNIS MA 02601
. AUT ill REPR�ENFATNE
/,LC ,r.,
JeffEldri e
EAiCORD 251�(2010105) 079'88-2�n The Ad1CeORD name and logo are registered mark ofA�OR�RD CORPORATION. All rights reserved.
S`li;isd ceiti 7cat=cancels'aids supe °tides°qA'L 1' ous 0'30 AN p�4e I o� L
prev ]?y issue cer i icat_S.
AWE ,,, Town of Barnstable
Regulatory Services
BAMSTAIU* ' t Thomas R Geiler,Director z
MAS&.
163¢
'°�Fn► +". Building Division .: x
Tom Perry,Building Commissioner
200 Main Street,Hyannis,.MA 02601
www:torvn.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 to.act on my behalf,
in all matters reladve'to work authorized by this building permit
- (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 ignatute of Applicant
z
Print Name
:Print Name..
Date
Q:FORMS:OWNERPERMISSIONPOOLS 6/2012
4
�'fl�E
Town of Barnstable
Regulatory Services
sniwsznsr,E Thomas.F.Geiler,Director
nmss 1639.
ArmBuilding Division:.
Tom.Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508 862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:.
JOB LOCATION: "
number street. village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state - zip code
The current exemption for"homeowners"was extended to include owner-occupied'dwellinngs 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 buildingpermit (Section log.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
requirements.
Signature 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.i -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such P
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. s,
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
I
✓sae 1eem�mzanu�eall/.a�✓aaaac�ivaalld
Otficeiof Consumer Affairs°&Bp mess Regula�on�� �,
HOME IMPRQ VIEN7 CONT.MCTOR;
` ,Re9i`s�tiAn:, �5529 'fYl�es
ExpiationQ14 indroiduai
JOHN',DELANEI(
271"PLU4ST
W BARKTABl E Q 4 Undersecretary.
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License:CS-009961
vSET•rs o
JOHN J DR Y
271 PLUM S
.r y
,-. J'�""'. �L ,�,ana Expiration
Commissioner 04114/2014
License or registration vglid,for,individ uT use only
beforeahe esp ration date. If foundireturato:.
Office of Consumer Affarrs and`Buslness.Regulation j
I&Y'Ark Plaza-Suite 5170' '
B.oston,:MA.021=16 I
x.
Not vaLd:wittout signature
Unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet(991m)of
enclosed space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Ucersing information visit: www.Mass.Gov/DPS
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application �l C(
Health Division _X�_ cv/g 2- 00 Aev _ Date Issued 1 C;, 0 6'Z
Conservation Division f � ' ° -"� Application Fee
Planning Dept. Permit Fee %Q1 'S
Date Definitive Plan Approved by Planning Board 0� /� Lae-
Historic - OKH _ Preservation / Hyannis
Project Street Address 02-
Village
Owner 50 AAddress
Telephone
Permit Request T15jZA ® (2 - LAJ0 V-k-- 0t,. I
S)0MIR(X�
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning Districts Flood Plain Groundwater Overlay
Project Valuation d Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ff) i -?
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
Fv� ► k7�L �,�L-�/L:S (BUILDER OR HOMEOWNER)
Name (..tlr�5t -- �h-�Q... r�Tele hone Number �'� aO �^33®
_ p ' � 1
Address to � Ol- License # W6
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOkr
v,
sr 6 4?-Of KTDU 3 t4 H
SIGNATURE + sDATE___
`t
C;t
t
FOR OFFICIAL USE ONLY
.F
li =y APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION +
t FIREPLACE
T
{
y ELECTRICAL: ROUGH FINAL
f PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT,,
ASSOCIATION PLAN NO.
S
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' A 600 Washington Street
Boston,MA 02111 -
www.massgov/dia
Workers' Compensation Insurance Affidavit: .Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLdbly
Name(Business/Organization/IndMdual):
.Address:
City/State/Zip: ( j Phone#: fool; 33P
an employer? Check the appropriate bog:
Type of project(required);
Ayou
I am a employer with er 4. [] I am a general.coatractor and I
employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction
2.❑ I am a.sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
shipand have no,em to ees These sub-contractors have
P Y 8• ,[�eemolition
working for me in any capacity, employees and have workers'
[No workers' comp.insurance comp, insurance,t 9., []Building addition
required.] 5. E] We are a corporation and its 10.[]Electrical repairs or additions
3.❑ 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.Q Roofrepairs
insurance required.}t c. 152, §1(4), and we have no
} employees, [No workers' 13.❑ Other
comp.insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contactors 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:, . C
Policy#or Self-ins.Lie.#: Expiration Date:.
Job Site Address:' bz— City/State/Zip: (F_ A
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$1,500.00and/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 unde the p d that the information provided above is true and correct
Signature: I?ate: ( ®(Z �.Z
Phone#: I C1 �^73 !�
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
CantP,ct Person:. Phone#:
10/5j/2012 1 :55 :41 PM 8935 (A 02/02
CERTIFICATE OF LIABILITY INSURANCE -
DATE(B�JDD/yyy�
10/05/2012
TaIB CBRTIMCATL Z8 ISSOBD a8 A HImm OP IiPOAmH'i0i OILY aaD COlPEBS !O RIeHTB iPOi 48R CHRTIrXCATB HOLD. 7=8 clamrZCam
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to the tense and eanditions of the policy, eertaln Polley(ies) moat he endorsed. If SOBROea4loi IS 9AIVHD, subleet
� tights to the certificate holder in lieu Of such endoraemnt(z an andaraeeleat. A atatemnt on this Oertlfipte does not
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51 bill Street umi.t 12
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CMMFICATE BOMBER:
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_ 09/29/2012 �09/29/2013
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CRRISTOPB6R ALMHOER IS NOT COVEM BY THE WOBIOSBS1ccw=SATI0B POLICY.
CERTIFICAM HOLDER r"CELLATICH
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Office of Consumer Affairs& Business Regulation- Mass.Gov Page 1 of 1
The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) fz= �
Consumer Affairs and Business Regulation
Home Consumer Home Improvement Contracting
HIC Registration Complaints
x
Registration# 152975
Home Improvement Contractor
Registrant MMA BUILDERS Registration Home Page
Name CHRISTOPHER ALEXANDER
Address 10 SCHOOL ST
City, State Zip HANOVER, MA 02339
Expiration Date 10/23/2014
Complaints Details
No complaints found for this registrant.
You can also view arbitration and Guaranty Fund history.
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I
http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=54149 10/30/2012
r � ✓12C U�O'I?9/I7Z0�?,ClIC2GCfL ,,pLCC6C�b r t._ `2s .
1 ice'se or're istration valid for�nd►vIdul use only x�
Office af,ConsumerAffairs;&.Business.Rcgulation g ,
befoe the expiration date. if found return-to .f
HOME IMPROVEMENT CONTRACTOR i
Registration i 952975 Type Offiq of Consumer Affairs and Business Regulation K
_ Ez matron: 10123/2012 DBA Y
10 P,rk Plaza Suite 5170
p t�`-- Bos n;MA 02116`-
r' MIC BUILDERS
1i ER Au
CHRISTOPH ��DE3
} 1 1 r
1OSCHOOL;ST
F,ANOVI=R MA 0233;3
Not valid.without signature
a Massachusetts Departm of Public Safety
Board of Building Regulations.and Standards
Cunstrtictiun-Supervisor:=
t License: CS-094651
-' CIMSTOPI3ER E AI EXANDFi .
10 SCHOOLTREETI
I1ANOVER MA 02339
.JNI ^ - -
Expiration `.
Commissioner 01117/2014
�,, wTA
FROM ;€D A_FXRNDER, IHRNOU€R, IMA ;PAX iNQ, , 9PIP6879-5 Oet, 03 2012 06 41AM P2
Town of Aara�bw
TAMP"1p,
Ocaner Must
comploe Ign TI ion
if uging - O
14,4 F ilk- u OWWA of Aug;w1m
c➢ *amy�..
>X $ Pt�eoal�s�fioSe Ptia�nsl as,We.
INVOICE
COLLEGIATE PACIFIC Page 1
P. 0. Box 300 Invoice# 337973
ROANOKE VA 24002 Invoice Date 07/30/08
Phone: 800-336-5996 Due Date 08/14/08
Fax: 540-981-0337 Customer# 31786
Bill : ship:
ELIZABETHTOWN COLLEGE BOOKSTORE Same as Billing Address
1 ALPHA DRIVE
ELIZABETHTOWN PA 17022
P.O.# 060608ECS11
Order# Requested Not Before Cancel Terms shipvia Phone Agent
647000 07/21/2008 07/28/2008 08/14/08 UPS GROUND 717-361-1516 622
Design/Sku Description --------- Size & Quantity --------- Total Price Extended
QTY
FV031790 ELIZABETHTOWN/COLLEGE/'SEAL /ELIZABETHTOWN,/PENSYLVANIA
7447C NVY 18X36 BAN-FLOCK PLUS/NAVY 24 24 13.00 312.00
COLORS: 10F, 16, 30, 16F
7447, 18X36 VERTICAL
NAVY FELT - GRY BORDER & LETTERING
WHT FELT - BLK BORDER & LETTERING
NOTE: PLEASE NOTE THE CORRECTED PRICING.
Subtotal 24 312.00
FREIGHT CHARGES 10.77
Total 322.77
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of Town of Barnstable
Regulatory Services
BAMSTi Y
issB ' * Thomas F.Geiler,Director
i639 ��
°i Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
February 15, 2013
Christopher Alexander
10 School St.
Hanover, Ma. 02339
RE: 62-Fernbrook Lane, Centerville,Map208 Parcel 085 014
Dear Mr. Alexander: ..
This letter shall serve as notice that building permit 201206092 issued by this office on.
October 30,2012 to remove sheetrock and insulation at the above referenced address has
not been paid for and therefore is not valid. Furthermore, it is the understanding of this
office that the.work has been completed. As the construction supervisor of record you are
in violation of 780 CMR and subject to penalties provided for in same. Penalties for
violations of 780 CMR include; but are not limited to, fines and/or suspension of
construction supervisor's license. Failure to resolve this issue by March 1, 2013 will
result in this office to pursue said penalties to the fullest extent as allowed by law. Thank
you for your immediate attention in this matter.
By Order, h
auzon
ocal Inspector
j effrey.lauzongtown.bamstable.ma.us
(508) 862-4034
Q:zoning5
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OP
op
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WILLIAM
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Foy Eaa. P C.SeTII=IEo I nor Po' .A V j
4No Su�`'y
ILOGATIOtJ G L. ".
:.s u T 11=%4 T f 4 AT T LI Ei Naw U
Q G o►.l GGy11�PL,YS W I TN .YL16 S t oE.�.I w6P ` �C c>r- 7
tb ,SETb$ACK , QEQUIREMELITS O� TWO /�'d ,t/ . O►� FEt'9Ss ,
V U o f a7,Id�/ST�3l A►.t Q I's ..._...:------• V-47W A of, /%Z
GA•TSO WITIAIti.1 FL001 tW .
TIc r ILE LA wo �Su I-V P—%(O ra
"_.Ig - C7LAW IS 1JOT BASE'S AW OS'YE�Vtt..l6s o. I�aSS,
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�c uSC.o To. iDe:TmP_MtyC LaT ILt4.
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Assessor's map_and lot nurnber ............................................. uF THE To
SEPTIC SYSTEM MUST BE �Q�
Sewage Permit number
v` INSTALLED IN COMPLIANC
' WITH TITLE 5 Z EAWSTODLE,
House number ......................Q :..............t........:..............,.. rasa
. ENVIRONMENTAL CODE AND o�ay.a�0m
LATMNS
TOWN OF BARK LE
BURDING INSPECTOR
APPLICATION FOR PERMIT TO ?� i4�G� ....-..--.....��...................................................................
TYPE OF CONSTRUCTION ............ .................l.-4,0 e.....................................................
............... ....... 719.g;
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to/the following information:
Location /�. .! c,N ..........
........................................ ............................... .....
Proposed Use ................... kG/�����°�/:!.!?l�a................. .:�. ...................................................................................
Zoning District f .................................Fire District
Name of Owner ..... ........... �J4=.!..........Address ..4�"Q ..... ...� /. li✓
...... ................ ....................
Name of Builder ..xrr!. ....�i�irC%i✓ cQ /16 .......... jG!::........
...........................Address ............
Nameof Architect ..................................................................Address .....................................................................................
Numberof Rooms ........................Foundation ................................................................................... .....................................
Exlerior ...Roofing
.................................................................................. ....................................................................................
Floors ......................................................................................Interior ....................................................................................
Heating ..................................................................................Plumbing+ ..................................................................................
Fireplace .....Approximate Cost ...........*�z.........................................
Definitive Plan Approved by Planning Board ________________________________19________. Area .....:. .......
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi the. abo
construction.
Nam .. .. ............ .L....... .......... ...................
Co ction Supervisor's License ....... ��........
- — t
DAQF--Y-t4'BR1-AN-4
A208-085-14
No ..... Perrhit for ......accp-ssor.y..to....
.........dn��il�.g....(swimming...ppal).............. ...
Location
62 Fernbrook Lane
................................................... ... ........
C ent O.r.vil.l.e
. ...... . . ...... . ...
Owner .........Brian Dacey.......
...................... ..........................
...........................................
Type of Construction
................................................................................
Plot ............................ Lot .................................
Permit,JG ran',ed ..................�June...27.......1985
Date of Inspection ............................ .......19
Date Completec! ........................ ......I gla
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039.
TOWN.. OF BARNSTABLE
BUILDING INSPECTOR
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following informatiom.
Name of Builder Jg�.... ea ........
� ^ Diagram of Lot and Building with Dimensions Fee ___. ____
`
SUBJECT TO APPROVAL Of BOARD OF HEALTH l
'
`
`
|
'
~
'
'
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
|
| hereby agree to conform to all the Rube and Regulations of the Town of
construction.
~
' Name.-.,
[ohs�dcion Suporviao/s Licen»e -_���./���.....!��..
DACEY, BRIAN A208-085-14: e
No ..28111 ,A Permit for accessory to.........
dwellin (sw��!unin ool
....................g. P.......).............
Location 62 Fernbrook Lane
................................................ ......
.................Centerville
............................. ... ..........
Owner ..Brian Dacey.............................
Type of Construction ..........................................
............................................................................... '
Plot ............................ Lot ................................
Permit Granted ............Jung..27..............19 85 -
Date of Inspection ....................................19
Date Completed ......................................19
\V
Fw P
TOWN OF BARNSTABLE Permit No.
IIA"WAK Building Inspector
Cash -- --- ---------
OCCUPANCY PERMIT Bond ------
Issued to i3ayside Building Address
A
17, 2 'r—nbrc-,,,--)k Tj;!�n,�;, 0ent,�t!rvillp'k
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date Z'I 7
Engineering Department Inspection date
Board of Health
Inspection date
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.
................
.... . ........ ........... ---
................. ...... ............ 19 ............................. .............................
Bui1din'(*?**1'*-ii*spector
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No. 19334
C-SVMr-lev PLOT P:Olt-.QN
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LOC.ATIo)-J
Gt;RZ'tF�{ THAT THE �oUeV.PA7Su°Vu�
�-tt�Z tm o►J GoINtiPLYS W I TA TWG 51 trE.LI►-tE
� At.JL�•,SET�CK QEQUIRE,�tEI.t'T"S OF THE /�G_st•,t/ .F".D� FE�N8�C�9S
Tc w u . of aq�.✓STA3L� A,"t IS
�LoGAT�� ,: WtTt-tt� FLOOD I.� BAXTG.R. uYE' tUc.
bATa✓ -� REGISCUZ6b LAIWO 6UevE`(0Z,;
' OSTEiZVtl.l.� o Arta•SS�
THIS DLAW IS LJOT BASEv v AN
tj,J U"F-t.JT 5uevr--`( APPL.t C.A.IJ—T"
t.JG't' E3G ue>L To DeTcPM�Nc LpT IW�S_
n; �t►..IGt.� FAMtLY ^ � BEORooM _ N°. �� �
t-oW IIO X 3 = a3o G.PP I a.
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'To W N or- EMI-'9 A G W N a�T�� ,4irv�, /O�SZ•
LOCATED •WITNI 'T . .
DATE
R.EGISZ�Q6•D �u�5uevf�Y�eSI
?ut5 Pt_o.I.l l5 NOT• gt�51�p e0d AN os-rl=2VILLE
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APPLI
_ PG
°A&ssor's map and lof numbe PRO*,THE
Tp�y i
Sewage Permit number ........
f,, i BAEH$TAX
Housenumber• ...............ly.....................................................
'SEF_aaka ro aea.
SYSTEN4 MUST BE
fi t V. '. 0 N a'
x T O W N f.0 F = B-A . ;. ,,
� .� d�n f'F J�_rw tf�• td
BUILDING ;INSPECTOR
11
APPLICATION FOR PERMIT TO .;.:: .1.!'� L C .....`. !' .. . ......... .................. . .
TYPE OF CONSTRUCTION ..:!l.l... Y..... M-4! ........................ .............:.........:.:.......................................
r
. ; ,M /.7...............19.
TO THE INSPECTOR OF BUILDINGS: ..;'
The undersigned hereby applies for- a permit according fo the following information: 1
Location .....1-,. ?` ...... ...!.7......... AUf............ ,�...� I ...........:........
Proposed Use ....-�.t.I�..�'l.r...... i4!�^.1..�! ..................................................... .. ............... .... .. ..................
ZoningDistrict ..... .............................................................Fire District ................ .. V. ......................................
Name of Owner ..... .�.S..l.&�fr:.... `, . ....... ...AddressYL ................................
.... ..........................................
Name of Builder" .:.�!. ...........5�. .. !f..�.. �0� ...Address ............C.e ..:S!1.......................................... ..
Name of Architect ...... ... e......Address .......... ... ............................
Number of Rooms ........ ....... ..................................?......:..Foundation ........d. .9..,4?ut�!w..(0-t,K�e�.........
Exterior ......LG7 '� ............................................Roofing .......... ,$ (G(„ ............................ ......
If-
Floors .......... . ... ........ ... :... ............................Interior ......... nn . ...................................................
Heating' .....::...lT✓� .. ..................... ..........Plumbing ........(.. ...............................................
Fireplace .........60z[ck........ & k.............................Approximate Cost .................. ..................................
Definitive Plan Approved by Planning' Board ________________________________19___-___. Area a C
....................... ..................
Diagram of Lot and Building,with, Dimensions Fee . A-�
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
0
c
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...Z14K.. ..... ... ,. ^.........................
�/S—
BAYSIDE BUILDING CO.
r t
` 25139 112 Stor i
Ke .................... Permit for ...................... .......
Single Family Dwelling t
...... .. .................. �-
i
Location Lot 17, 6 2 Fernbrook Lane
.. y
t Centerville
' ...........................................................
Owner .ayside Building. Co.
y
Type/of Construction Frame
. ... � I
x
Plot ..r........................ Lot ................................
+ Permit Granted .. June...1.!. ................19 83
Date of Inspect' �Ia!?.'` ...lf..�v.... ....19
Date Com leted (./,•G�e/I. ...............19 t, -