HomeMy WebLinkAbout0150 FOX HILL ROAD ` „a;�:. t`• .; �„{', �4� '.'�� .� a��a {�`Te �3+ `ta re``1 }t� .:'v �� �} r .' '�'� 'tr.'� a �t�f' to - '.� ,�.- is'i - -- - :��+ :��� �• ,� �n �, ,
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Town of BarnstableBuilding
> >
a Post This Card So That it is Visible From the Street Approved Plans Must be Retained on lob and -Card:,,Must be Kept
> Posted Until Final,lnspection Has-1
as Been Made ; ���m 1
63Sa ][Permit
• Where.a Certificate;of Occupancy is'Requii'ed;.such Building shall Not 6e°Occupied until a Final Inspection has been made _
Permit No. B-20-1099 Applicant Name: BRIAN DENNISON Approvals
Current Use: Structure
Date Issued: 04/28/2020
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/28/2020 Foundation:
Location: 150 FOX HILL ROAD,CENTERVILLE p/�- 9-053 Zoning District: RC Sheathing:
Ma Lot 18
Owner on Record: KELLY, DIANNE L Contractor Name`;SOUTHERN NEW ENGLAND Framing: 1
,.
q = WINDOWS LLC
Address: 150 FOX HILL ROAD 2
Contractor License: 173245
CENTERVILLE, MA 02632 Chimney:
Description: INSTALL(8) REPLACEMENT WINDOWS NO STRUCTURAL Est Project Cost: $ 14;467.00
e Insulation:
Permit Fee: $73.78
Project Review Re GLAZING REPLACED IN HAZARDOUS LOCATIONS AS DEFINED
1 4 ° Final:
� Fee Paid': $73.78
IN 780 CMR MUST BE TEMPERED.OR EQUAL.
Date. 4/28/2020
s a Plumbing/Gas
ry.
Rough Plumbing:
Building Official Final Plumbing:
Rough Gas:
a
g
ssuance.
This permit-shall be deemed abandoned.and invalid unless the work authonzed fby this permit is commenced.within six months after
All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted.
►. Final Gas:
h local zoning by-laws and codes.
alterations and changes of use of an building and structures shall be in compliance with the g y
All construction, g Y ,
This permit shall be displayed in a location clearly visible from access street or road'and shall be maintained open.for public inspection for the entire duration of the
work until the completion of the same.
Electrical
r' Service:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are,provided.on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Rough:
1.Foundation or Footing -;- •� -e - W " � §
2.Sheathing Inspection Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Final:
Work shall not proceed until the Inspector has approved the various stages of construction.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
0 414 157
a o I 5�(pCGSS
PERM'TTOwm of Barnstable *Pernxit&
h I His R gakto y Sei-lees rFee F--.i— j
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72 95 W�
Fraser Construction, LLC .
31 Bowd6in Rd. Mashpee, MA 02649
Email: infogfraserconstructioncapecod.com
- www.fraserconstructioncapecod.com
FAX 1-508-428-0123/ PHONE 1-508-428-2292
HICL#112536 CS#97668
RE-ROOFING PROPOSAL
Date 7 29 2015
Name Diane Kell
Email dkkell ca e mail.com - LfiuCaZ�
Phone 508-775-2958 _
Job Address 150 Fox Hill Rd Centerville MA 02632 �o
FRASER CONSTRUCTION hereby proposes to perform the following services in a
neat, professional manner..in accordance with the manufacturer's specifications.and q
local building ode.c . ,
CertainTeed Shingle Options ' s,
Good Better Best
Shingles Landmark ' _ Landmark Pro Landmark TL
Algae Resistant '10 years 15 years . 15 ` ears .
Wind Warrant _130 MPH 130 MPH 130 MPH
Weight/square 240 lbs 260-270 lbs 305 lbs
-Shingle design Two-Piece Two-Piece Three-Piece
Color Palate . Standard Max Definition Max Definition
Valleys Closed cut . Closed cut Open copper
Investment $7,600 $8,100 $13,050
Above price is for'A18 sq..Below is a breakdown of the main house and sun
room r..
- Price for Main house
Landmark- $6,200 . r
Landmark`Pr'o-F$6,500 Geed -
Landmark TL $10,600 4
Price for sun roof t oh
Landmark- $1,400
Landmark Pro- $1,600
Landmark TL- $ 2,450
* All above shingles quoted with CertainTeed 50 year non prorated 4-Star'
warranty
Xf
Shingle Selection: _ �� I ,oaAI1 Color: I Initial: - "
A f
Frame and dr ywall existing interior Aylicht holes
nvestment:. $600 Initial:,
Ironclad, Lowest Investment Guar 3 antee
Any contractor can price your roof for less by cutting corners and utilizing cheap
materials and unskilled labor. It's important to know what is and,isn't included in the
roof you choose for your home. You don't want to be left with an inferior roof built by an
untrained labor force. That's why Fraser Construction offers the Ironclad, Lowest
Investment Guarantee. Not only do you receive a,state-of-the-art roof built by highly-
skilled craftsmen, you also'receive peace of mind knowing you obtained your roof for the
lowest investment possible: If you later discover a comparable roof for less money than.
the one we constructed for your home, we,will pay you the difference plus a $50 bonus. .
All we ask is the comparison be "apples-to-apples:"
"We have no quarrels with the man with lower prices,for he knows what`his
product is worth."
PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. '
1/3 initial payment, remainder to be paid upon completion
Payments accepted are:
CASH CHECK MASTERCARD -VISA- AMERICAN EXPRESS
Any payments ediately paid upon job completion will be charged 0.005%for every day after the
given 5 day grace period upon day of job completion.
* Please note that"roof prices reflect removal of(1) layer of existing roof unless
A
otherwise indicated in contract. If additional layer or layers are removed
additional charges will be assessed.
Possible Extra-After the shingles are removed from the roof; we will lift one sheet of .
plywood to make sure that the insulation is not up against the plywood sheathing
. -
preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be
installed by; removing the plywood sheathing, installing the panels, turning the
plywood over and then re-installing the plywood. If needed, this would-be charged for
as an extra at the rate of.$6.00 per panel including Materials & Labor. There are 6
Panels per sheet of plywood.
Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing,
lead flashing, or other carpentry needing replacement will be done and charged for as
an extra at the rate of$75.00 per hour,plus 20% mark-up materials.
FRASER CONSTRUCTION guarantees the labor for LIFETIME of roof.
FRASER CONSTRUCTION guarantees the shingles against Blow-Offs for 15 years.
Please note that all pricing is contingent upon current market pricing. If contract is
not accepted within thirty days of date of proposal,,change in price may occur due to
deviation in material price.
Any deviation or alteration,from above specification will be executed upon written
orders and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays are beyond our control. Owner should
carry necessary insurance,upon the above work. We, if not accepted within thirty.,,
days may withdraw this proposal.
FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public
Liability Insurance on the above work, certificate available upon request. e
DATE OF ACCEPTANCE:
Homeowner Fraser Construction, LLC
1
FRASC Oil-Q, PAAS
�... CERTIFICATE OF LIABILITY INSURANCE $nM o>
THIS CERTIFICATE 13 ISSUED AS A:1AA71'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS _
14
CERTIFICATE ROES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND,OR AI-TER 714E COVERAGE AFFORDED 5f THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TF5 ISSUING INSURER(S), AUTHORIZER
REPRESENTATIVE OR PRODUCER,PND THE CERTIFICATE HOLDER.
JMPORT_4NT: If the certificate holder is an ADDITIONAL INSURED,the poGc i'l must be endorsed. If SU BROGATION IS WAIVED,subject to
the terms and conditions ofthe Policy,certain POltcies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemerrt(s).
PRODUCER 508 676-Q309 O0N cT
VJveiros Insurance Agency,Inc. NAIa ` Ash[e Patva
375Airport RDad AF N 0608-689-27'13
IAiC,N(o): 50 8t'24-4553
Fall River,MA C2720 Anomss.APaiva Vnreirosinsurance.cotn
INSURM45)AFFORDING COVERAGE NAIC
JNsuRED :INSURERA:Granite State Insurance Co
Fraser Construction LLC INSURER 3:
PO Box 1345 INsuR>Rc:
C.Otuit,MA 0263
INSURER D:
INSURcRE:
COVERAGE$ INSU.R F:
CERTIFICATE NUMBER. REVISION NUMBER:
THIS 1S TO CERTIFY THAT THE-POLCCI=S Or•INSURANCE LISTED BE:.'OLV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY F'eR1pD
INDICATED. NOI'Y BES SUED O ANY P.EQRTAN'cNT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUI�NT WJTH RES'EC-TO WHF^H THIS
CERTIFICATE 9hpY BE ISSUED OR MAY PERTAkV,-Y._ INSURANCE A=FORDED BY 7HE POLICIES DESCRIYD IiB2EIN IS SUBJECT T C ALL THE TERMS
PXCWS'ONb AND CONDITIONS OF SUCH POLICIES LIMITS SHOMIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �
sit
'
LTR TYPE OFINSURANCo INS WVO POLICY NUM6?=i - _'"
GENERALUAMUTr '�D .. L11OOrrYYY7 LAMS
? EACH OCCURRENC`e S
MW-4ERCbU.MERAL UABLIIY
CLAl0.1Sa,7A9E OCCUR I P.4EIAGES Eaocaurercel 's
:d:DeP(ArryMe�n) S I
PERSO(yV-B.ADVINJURY S
GEN'LACGR=�ATELMrAPPUEEFER -^-34EPALAGGREGATe ;S
POLIO. �FCT 7LOC ` I %RODUCTS-COMP10?ACC- S
S
AU70I14E1:-E L1A8ILITY
Es acatlentl L U
ANYAUiO - I
�0INED S
�� SODA_Y¢dJURY(P�D9150n) _
NON.OWN�C BCDILYmIAJRY(Par.=dwrr- S '
li E-'A'JFOS AUTOS r.�v
1 IF£RACn70ENT1 � ,'
I S
UN3RMLAUA3 OCCUR
EXCESS LAB - 'EACH OCCURRENCE
S.
C.AIAtS-MACE! A3GREGRTE !S
DED RETEMON $
WORKERS DOMPEN8ATI0N S
N�AND£ LOYERV L%ZB_r1Y :;Tx 70AY 6RS
A ANYPRAPE�pRtPAR7NER-EDC-CUrNE YIN =809930601IER
0f aa�'InNK DCCLUDIDs 0 MIA 9tz6rzOs4 3/25/2013 F-LEACHACCOEur S 500,0110
ISE-
ayes°esai�e¢ncer ( etfllSasE-=AaiPLo;EE S 500,000
OY CR1FT10N OF OPERATIONS t davr
SJ-DS54SE-PCL'C1LW S 5001000
I
DESCRIPIION OF OPERATIONS!L=-nDNSI VEHICL ES(Atmcb ACORD 10t,AddZOnol Rer: ft SehedUle,Ymac space Is tegwretl)
CERTIFICATE HOLDER CANCELLATION
SHOUL.DANY OFMIEASOVEDEScRlsEoPOLICIEESBECA?4f �6ErOF;E Town of Barnstable 6uitding Divisian THE ECPIRATLON DATE THERMOR XOTICE WILL SE DEL rve ED 114
200 UMn Street ACCORDANCE VATH TKE POLICY PROVISIONS
Hyannis,MA 02WI-
AUTAIOR¢ED RI�R£SENTAm'E
0. - - <71
O 1988-2010 ACORD CORPORA noM.All rights reserved.
ACORD 25(2040105) The ACORD name and logo are registered marks ofACORD
ne Comnzonwealth of Massachusetts
-�---- Department ofIndustridAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.rnass gov/dia
Workers' Compensation Insurance Affidavit.Bttildeas/Contractor-s/ElectriciansfPlnimr)ers
Applicant Information Please Print LeaiblY*
Name(Business/Organi on/Individual).
Address:
City/State/Zip: Phone :
Are y u an employer?Check he appropriate box:
I am,a employer with J 0 4- ❑I am a general contractor and I.
Type of project(required):
have 6. ❑Ne-w construction
employees(fult and/or part-time)-* hired the sub-contactors
2.❑ I am a sole proprietor or partner- listed on the attached shee, 7. L]Remodeling
ship and have no employees These sub-contractors have
g- Demolition
woi4dng for me ne.any capacity. employees and have workers' ❑
9_
[No workers'comp.insurance comp-insurance+ I]Binding addition
reed-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work of&cem have exercised their 11.0 Plumbing repairs or additions
myself.Woworkers'comp. right of exemptionperMGL 12.0 Roof repairs
insurance revired_]t c.152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp.insurance required.]
"Any applicant that checks box 41 must also fill out the section below showing theirworkecs'cornpemsatlon policy inform t!
Homeowners who submit this affidavit indicating they are doing all work and then lim outside contractors mast submit anew affidavit indicating si e:L
,Contractors that check this box r .roust attached an additional sheet showing the same o.thesub-contzctors and scare wtether or got t]:ose enhhcs have
employees- If
P the sulrconttzctors have employees,they must provicL-their wofsers'comp-Polity anther:
I am an employee that fs provzdfng workers'compensation insurance for my employees. Below is the policy and job si<e
infra matidiiL _
Insurance Company Name: :f�j I L � IfIaLcance r
0�
Policy#orSelf ins.Lic.#:Ar V 0"t �Mo_a i BxpirationDa U1.
lob Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(shoNdng the policy number and expiration date).
Failure to secure coverage as required imder Se„^tion 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to S1.500.00 and/or one-year imprisonment,as well as civilpenalties in the form of a,STOP STORK ORDER and a�e
of up to$250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage veri£cston_
I do hereby certify, under the pains and penalties ofpe jury that the information provii&d above is tt race and correct.
��Siguauare: Date: 7 /
Phone
Offzefal use only. Do not write bx this area,to be completed by city or town olowal
City or Town: PPsmitlLicense#
IssaimgAvthority(circle one):
1.Board of Health 2.Building Department 3.CCi tyMrn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persona Phone 0:
x' {� �leasnohusa{ta.!)opZlttmont n.r f.'uYiiie StcFc{y
8Os1M of RUIldhlg Rooidtitlnns anti$(Qnttp(Ct9
COIIStpitCfhfll Stij141'1'iettp
- {Jc9nss7 1 497c08 "`
� vts'riNt;T+itds�R ` ,�tsr 'r, ��i
BAST 1!A41
'LMaTI
(. Curnmtoslonor 00107/201,5
Office of Consumer Affairs and Business Reggah4 on
10 Park Plaza-Suite 5170
Boston,Massachtasetts 02€16
Home 1mprovemezt Contractor Regzstat on
Repistra cm: 112MB
Type: DBA
ExpPrafon: 3/231201i ir} 2635IS7
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
CO T UiT, M, A 02635
Update Address sad retem card-it2ar k reason zor change.
Sca'. []Address M iRemewal Ci V_=gloymant F�_ost Card
F��ie�pamomwr�zwaatG�a�PQ/l/�:xc�%aaeQ� .
Office of Consumer ASzzts&Bllsbzess Red nation 12c use or registration s alid for individul use only
= OPFEIMPROV—M akrj CONI ACTOR before the expiratzondare- IffonLdreturnto;
on: 112s36 Type: Office of Consumer Affairs atad Business Regulation
i:—ji atior: -U 2017 BSA 10 Paxk Ph=-Suite 5170
' •
FRASER CONSTRU=.ON CO. Boston,MA.021I6
DEAN FRASER
104TA INN VIEW LANE
E rALMOITi'K MA 02535 IIndersecramry biotvand without s gnat•.tre
� � I��iaS JcCi.1���:... - irj�.,^.^2�: Ci .,,,..•`.iC .�.iJ �:?•!
Construction Suprn i+ur
CS-097668 _P
DEAN C FRASER
104 TWINN VIEW LANE:. _
EAST FALMOUTH•MA';&3;36
06/07/2017
Engineering Dept. (3rd floor) Map Parcel (j J Permit#�� 7 �i to
House# /J—U cQ,� Date Issued �7
Fee
�.1HE
19 '
&Projecreet
TOWN OF BARNSTABLE
Building Permitt Appliccation
ess J 57) Fox H, 17 �
Village Ce4l, 4--e-n
Owner Address
Telephone c-
Permit Request
First Floor square feet Second Floor square feet
Construction Type V c afK i
Estimated Project Cost $ ,24k5to
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name De kt sj F(Zy -SQ/) Telephone Number
Address 5/9-9 1m Q-n ` License#
n
C 4-tA A b Home Improvement Contractor# /f
Worker's Compensation# ' 13ZoA Y2a 30-61�
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE /,2 j
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
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The Co1111no1111'calth of AfassachusettS
tz- Department of Industrial Accidents
`
iiw oficeolittyestfgations
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6011 «ashinrtun Street
Boston, 31asx 0 111
Workers' Compensation Insurance Affidavit
Ilcant Information• Please PRINT
Apr ---....._..---
omen S-e/
JDcition• 7 !-�C/t'1 rl f/t
citv nhonc#
0 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working In any capacity
.ta.:...ew.Tr.•n.`nr--'T"�; pE7�.^!!'Ae��+r'n-'�71F7RKT�!T�Rv�^•I,�?^'•�*"'�'=r!"�vr�a*'�p�•• .�!•(`�'�'.r^'�"e'n!'f��"....,.,s•cv.
am an employer providing workers' compensation for my employees working on this job.
compiny name: LAC":, ¢
r. it
address:
city nhonc#•
insurance co. lie
I am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
compnny name:
address:
city- phone#•
insurance co policy#
. - ♦ ..... i.r..R!«' ':h,05 �•.^Y•r'•;'.'T•R'�vF^..RT".: rr•-+•!ct��.�;�-pT•r,�+,•�ww•- -=r.:.^,••+.fr,!;,c�q :::..r^+r►fro:a.�..c.....�—x�
enmriny n•tme•
address:
city 11hone#•
insur•nce co policy#
Attach additional sheet if necessary„• _f 3 a,-,��: air.*,-t*_ «. '^-" •�• =A--•»»�-• '..._--
Failure to secure coverage as requiredZL
under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur
one years' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do here ht c• u der the p td pen of peryun•ghat nc�injorntation provided above is true and correct.
Si=nature ��"� Date � g(
Print name �'� F-✓lLL t%_- M Phone
( ficialof use Iv do not write in this area to be compacted by city or town official y y�
city or town: permitAicense# riBuilding Department
C3Liccnsing hoard
check if immediate response is required O ffSeicetmen•s Oice
C3I1calth Department
contact person: phone#; rlOthcr <~
'd•
Irmised 3roi P1A)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an eynpinree is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An empinrer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more .
the foregoing-engaued 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 havin, 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_ hour
or on the `.,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that even-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 anv
applicant -*who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits 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 tite 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.
City or-ro-vwns
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. Pleas
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
�..�,. �......__. - _...v_...
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
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
"Q.' �TME
The Town of Barnstable
MASS Department of Health Safety and Environmental Services
65 h Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition,
olition 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: 24
Est.Cost O�G a O
Address of Work:
Owner's Name ✓�
Date of Permit Application: -) /1h
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
_
_ ob under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLEGUROVEMENT WORK DO ARANTY FUND UNDER MGLo 14ZA� i
ACCESS TO THE ARBITRATION PROGRAM OR
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
DiAe Contractor Name Registration No.
OR
Date Owner's Name
Assessor's map and lot nu r ................. .. . .... ..... THE
yoF toy
Sewagg Permit number ...
J" Z 33JHB9TIME.
Housenumber ....... .................:.................................. V
0 Ili C
TOWN OF BAR.NSTABLE
F
D UILDING INSPECTOR
APPLICATION FOR PERMIT TO ........... 1 /........40.0.t y........................................
TYPE OF CONSTRUCTION ....... �Q.0............. v '.. '.(... ..........................................
...............
.............. .. ....,9..
TO THE INSPECTOR OF BUILDINGS:
The undersigned/hereby applies for a permit according to the following information:
/
Location ..., v..v........ ....... Y ..�z...........5�11v1. ...... ...............................
ProposedUse . ...........:e ..................................................................................
c---
ZoningDistrict .......... .,.. ................................................Fire District ..........................................._
Name of Owner .. �1�,�........ 4. .........Address ,(i .... d!t....�lll.�r...if 4!:✓I;::
... .......
Name of Builder .... .....Address
Name of Architect .. / ............ .... ...........Address ... .. �--
Number of Rooms .F / 0�����
............ ....................................................Foundation x,S.. .. .... ...........�... ..... ........... .. ................
Exterior ... .........�i ...5���/ 1Roofing ....., 1 /•,f�......................................................
Floors /...1 ......................Interior ....
Heating4,7.....................................Plumbing ..../.......... .................................................................
Fireplace .................�' .....................................................Approximate Cost ..��.I�GIC/........................ ..................
Definitive Plan Approved by Planning Board ______________________________19________. Area ../..l 1... ....:...............
Diagram of Lot and Building with Dimensions Fee �`�` S
SUBJECT TO APPROVAL OF BOARD OF HEALTH .
5
OCCUPANCY PERMITS REQUIRED OR NEW D
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ab Lee
construction.
/ Name . ..
Construction Supervisor's License ....................................
KELLY, FRANK A==189-53
;i No ...2.6$74. Permit f Addition to
....................................
single.ing.jf:�..,f ami I_v... ............
...... ........ ...
Location EP&JU.1,1...g44. .................
.................Centerville...............:..................
C
Owner ...........-Frank...Kel�y
............. ........ .............;...........
Type of Construction .................Fr.ame',-
..... ...... .
............
................................................................................
.
"Plot ............................ Lot ................................
Permit Granted .............19 84
Date of Ihspqction .......19
-Date.,Completed .//:n ..................... 19 Sr.
Assessor's map-and lot number .................. ✓ .... r -� �oFTHEto�►
f
SevJagre 'Permit number �... ....'C.{r.. {�.. ... ........
33A"STABLE, i
House.,number ....... 1/. ................................................... rb 9 ♦�
`0 MA
TOWN OF . BAR`NSTABLE
BUILDING INSPECTOR :T = t
v
�' ,APPLICATION FOR PERMIT TO 1 ,.h ........::. ..... .. . ....:............v ��..............................................
,> TYPE OF-CONSTRUCTION . q�.J eo............. . . ! ..........................................................19..
TO THE INSPECTOR hOF.BUILDINGS:'
The undersigned he��reb��y�� appliess for. a
� permit
-according to- the following.information:
Location .•. u ...... .1 .....7 � /.G'l..:........�...........
M
`f���� y � �1�
ProposedUse .......... .................. ..............................................................................................................
Zoning District .: ............Fire District �"/t'//. /�G,��l� ........
Name'of Owner ./47z .:....<..� ..::.....'..Address ,l .... d ..��1 .... /,/•..::.Zf:J..
•.
Name of Builder Address ,11�; � ��� ... ... ............`:......
A
Name', of Architect r 46 f� .���!/��...........Address .����/�1��/.!(//�s����•..•.,;%���f��-!
Number of. Rooms ............ .................................................Foundation ..... ...•. .......... �..
A
i.
Exlerior ... T'�/ �;•'•• l./ ..5,���Vy �:lloofing ..... �� .................................................
...Interior ....ti5/�'.•.r. ..... ..... 1 ..
Floors �� '—' ...:.. .; . .. . � .-.... ...:.....:....
z Heating � G _�,�� .....................................Plumbing ...:/..(�. .......:.........
.. ... .... . ..:
Fireplace .... .............r. . ..✓••..................................:................Approximate. Cost ..,f ��/�l)...................... ..........
Definitive Plan\Approved by Planning Board ________________________________10--------. Area ...... ..`..1�J.../....................
Diagram of Lot and Building with Dimensions 4 Fee '
SUBJECT TO APPROVAL OF BOARD OF HEALTH l
f
-17
�� -
X
OCCUPANCY PERMITS REQUIRED 'OR NEW D LI°�1G
r
s I hereby"dgree'jo conform to all the Rules and Regulations of the Town of Barnstable regarding the abole 4
,construction. .
-- A' Name . ..` ;Z.......................:.........
v Q� L�
e` Construction Supervisor's License..............................
KELLY, FRANK - A=189-53
No Permit for ..AdditiQll...t;Q....
sinqle family dwelling............
single...family...
Location .......l.5..0....Fox. ...Hill. 1...Ro.ad............
.. . . .... .. .. .. .... ..... ..... .
Centerville
...............................................................................
Owner ........Frank.........K l... .ly............... ....
.. .........
Type of Construction ......Frame........................
................................................................................
Plot ............................ Lot ................................
Permit Granted .......... ......19 84
Date of Inspection ....................................19
Date Completed ......................................19
j�