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HomeMy WebLinkAbout0006 GLENWOOD AVENUE • �ih , a� a n , e, r , t _ y 0 { , e, , r t a G , r .1 a i i d I , t e , ti , - Town of Barnstable *Permit# .. �' Expires 6 mon o issa µ IMIT Regulatory Services Fee o } anaiv&r"LF, „ Ar 9.:A` Thomas F.Geiler,Director l0 OF BARNS 'ABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 l VJ Property Address G to 1'1 VV ooA Ave Cen+p-r-y i ( �e MA 0.2(c:)32 []/Residential Value of Work S . 00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address f"t.t �(t c e n� &,,r Contractor's Name s Se.,r C�nS+r-uc�—��n,n, L C.0 Telephone Number 660R yaa-��c1 oZ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 9 7(06 8 ffWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance. I . Insurance Company Name No�Ti on 0. U n�o r, (: f e `r)S ur ,n C'2 C O . Workman's Comp.Policy# V\) C- Od 9 9 SO(o d 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) dRe-roof(stripping old shingles) All construction debris will be taken to ❑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 o Hom pr ement Contractors License&Construction Supervisors License is re ed. , SIGNATURE: QAWPHLESTORMSlbuilding permit formslEXPRESS.do Revised 090809 *YL Fraser ConstructionCONSTRUCTION , LLC P.O. Box 1845, Cotuit MA. 02635 ROOFING . , ` SIDING Email: fraser_construction@verizon.net 5�8-42$-�292 www.fraserroofin .com FAX 1-5 HICL#112536 CS#c 8-0123� �l V D RE-ROOFING PROPOSAL DATE: January.6, 2011 PHONE: 508-790-8229 NAME: Millicent Earls MAIL ADDRESS: 6 Glenwood Ave Centerville MA 02632 JOB ADDRESS: Same FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Fraser Construction will include a 4 Star Upgraded warranty with the A selection of any 30 year shingles or any Lifetime shingles. CertainTeed SureStart Plus- The extra measure of protection when a credentialed company installs an Integrity Roof System. 4 Star warranties have a 20 year Non-Prorated Coverage on any.30 year shingles with a 50 year Non-Prorated Coverage for any lifetime shingles, . which will cover incase of any in warranty repair, Labor and Materials, any Tear-Off, and any Disposal Fees. Upgraded wind warranty available on the following products when special application methods are used. See description below and in the CertainTeed SureStart plus brochure enclosed. Supply and Install-CERTAINTEED XT AR-25: 25 - Year Warranty, 5 Year Sure Start Protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self- Sealing, 3-Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10 Year Warranty against ALGAE Containment. r F. Color: PRICE- $7,875.00 Initial + a Supply and Install CERTAINTEED XT AR- 30: 30 Year Warranty, 5 ye sure start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self , Sealing, 3 -Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE Containment. 1 Color: PRICE- $7, 00 / Initial Supply and Install - CERTAINTEED LANDMARK /WOODS E AR 30: 30 - Year Warranty, 5 year Sure Start Protection, CLASS A FIRE RATE , ALGAE Resistant, . Extra Heavy Weight, Self Sealing, Multi- Layered, Architectur Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/ ERAMIC Stones with a Full 10 Year Warranty against ALGAE Containment. 5 year 1 0 mph wind- resistance warranty with six nails in common bond area, Fr ser construction includes six nails in common bond area at NO additional c t. See actual warranty for specific details and limitations. Color: V Ci� '/'�i� PRICE- $7,795.00 Initial Supply and Install - CERTAINTEE DMARK / DSCAPE PREMIUM: Limited Lifetime Warranty, 10 year sure s o ection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self Sealing, Multi-Layered, Laminated Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE Containment. 10 year 110 mph wind-resistance warranty Wind warranty upgrade to 130 mph when CertainTeed starter & CertainTeed hip & ridge are used. See actual warranty for specific details and limitations. Fraser construction includes six nails in common bond area at NO additional cost. Color: PRICE- $8,560.00 Initial Note: Prices are partial. Not including rubber. Product & Installation Details Supply 8a Install - (Soffit Venting) Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge with existing soffit vents. Protection against damage to the roofing materials and structure. The most effective system is a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is equalized from top to bottom, supplying a uniform air flow along the entire•underside of the roof deck. Supply 8s Install - CertainTeed Winter - Guard: (ice & water shield) Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, wails, and skylights) Supply & Install - DiamondDeck Underlayment Paper: (30 lb synthetic high strength underlayment) . manufactured to provide best-in-class performance in terms of both weather protection and contractor safety. DiamondDeck is a synthetic, scrim-reinforced, water-resistant underlayment that can be used beneath shingle, shake, metal or slate roofing. It has exceptional dimensional stability compared to standard felt underlayment. 2 (As recommended by CertainTeed) Supply & Install- CertainTeed Swift Start- With self- adhering asphalt starter course on all eves, and rake edges. CertainTeed requires this product for Integrity Roof Systems and upgraded wind warranties. Supply 8s Install -Aluminum & Neopiane Soil Pipe Flashing Suyplp & Install- Ridge Vent - Shingle Vent II (as recommended by CertainTeed) Supply & Install - Pre-Cut CertainTeed Hip & Ridge shingles Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of underlayment, shingles, accessory products and ventilation all working together. The Integrity Roof System is designed to provide optimum performance--no matter how bad the weather conditions are. (As recommended by CertainTeed) Clean 8a Remove - Debris from work area daily. 2% Discount if paid by check ' e a upon c mpletion Init' 1 'L NO MONEY DOWN- NO Pa nt at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA- AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1.5%for every 30 days the payment is late. 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 8v 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$60.00 per hour,.plus 15% mark-up materials FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. 3 CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shing.le-that was purchased. 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 fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. r FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: Homeowner Fraser Cons r ction, LLC For coMpanu use onIX. Date Received Date Started: Date Completed Job estimate: Dean/Mike # of squares: Billed- Material ordered Extras Paid Available Discounts 4 Massachusetfs-bepau-tment of Public'Safety Board of Building Regulations and Standards C'r6notrudfion Supervisor License . License: CS 97666 �; t ,-,t x DEAN FRAR :A 104 TWINN /1iEWr' NE EAST FALM�J UTH MA 02536 r Expiration: 6/7/2013 C'onunissione'r' Tr#: 16692 - I Office of Consumer Affairs andVUSness Regulation 10 Park Plaza - Suite 5170 Boston, Massachisetts 02116 Home Improvement ContrN.ptor Registration Registration: 112536 r 7 Type, DBA Expiration: 3/23/2013 Tr# 209024 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 `<. . Update Address and return card.Mark reason for change. E] Address Renewal Employment Lost Card DPS-CAI 0 50M-04/04-GIO1216 —Tok' 9:"I wIffir"�B� a License or registration.valid for individul use only Office o onsumer airs mess e n a on. 'before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 112536 Type: 10 Park Plaza-Suite 5170 Expiration: 3123N,013 DBA Boston,MA 02116 F R CONSTRQCTION Cb. DEAN FRASER 104 TWINN VIEW NE 6j� E FALMOUTH,MA(1'z�\536 Undersecretary of vale wit ut si re. ' � g CERTIFICATE OF FRAscoN-01 MOW PRODUCER LIABILITY INSURANCE DATEIMMrDaY,yT,I . 12010 Viveiros Insurance Agency,Inc. � �� � ONLY CERD 11111 N IS ISSUED AS A MATTER OF INFO 1RMATION 375 Airport Road HOLD AND O� NO RIGHTS UPON THE CERTIFICATE Fall River,NIA 02720 ALTER THE TE DOES NOT AMEND DOR COVERAGE AFFORDED BY THE POLICIES 6 LOyy INSURED Fraser Construction LLC INSURERS 1.AFFORDING COVERAGE P.O.Box 1846 INSURER a National Unlon Fire Insurance COm NAIC 0 Cotult,MA 0205. INSURER B: INSURER G INSURER D COVERAGES INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY NUMBI PO GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR PREMISESIII accumnoe $ MED EXP(Arty one pel $ PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 79 LOC PRODUCTS-COMP/OP AGO $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB $ ALL OWNED AUTOS ddmQ SCHEDULED AUTOS BODILY INJURY $ HIREDAUTOS NON474VNEDAUTOS (BODILY O'add INJURY $ PROPERTY DAMAGE GE LWBILITY (Perecddel $GARA Al AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LUUHLITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY .. $ A ANY PRO ARTNHt/E�CUTIVE YIN FD � .�1O X STATU yMeeaa�Ian E)CLUDED? + 930r01 9=2011 EL EACH ACCIDENT $ 50010 SPECIAL PRO OSI06 below E L DISEASE-EA EMPLOYE S 500,00 OTHER EL.DISEASE-POLICY LIMIT $ 500;00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/MMU MONS ADDED BY ENDORSEMENT/WEpAL PROVIEONg CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THEABOVESC DERIBED POUOES BE CANCFJJ ED BEFORE THE EVIRATION Fraser Construction,LLC PO BOX DATE THEREOF,THE ISSURdG INSURER Will ENDEAVOR TO MAIL 30 DAYS WRITTEN To THE CMMFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE To Do SO SHALL Colt,MA A 02635- IMPOSE NO 013UGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR®R�ENTATNE ACORD 25(2009/01) ©19W2009 ACORD CORPORATION. AJI rights reserved. The ACORD name and logo are registered marks of ACORD Tke Conumpawealth off Massackusd& 11�p�btte�rt oflmdt�tr�ahq�� OJjrce OfInva4'awous 600 WaskkVwa,S)Ipgw ! Bostn HA 02111 wwwjwS goy/dza Workers'Compensation Insurance davit;�ders/Contractors/Eieetzi �1 Iicaat Information raans/Piwmtbers i Name t'BosiaesstOtgani : Please Print L •b r�Se r Ca ns�4r'u C - o L L L Address: 5. i+ City/State/7 cif K� �63 A e orr an em Phone#: ��— y,2g ��`? plew Cheek tie appropriate boa: I.[�d Y am a employer with 4 I am a genet Type of project t and I (squired 2 ❑ employees(full an par dme)* have hired the m�a 6. New�� ' I am a sole proPrietar or paw_ j Shp and have no employ ❑Itemodelimg I working forme in any city empl sub-contra �� [No workers ohs and have wodcers' 8 ❑Demolition P insurance camp insurance t 9. Building ding addition 3.❑ I' homeowner�• 5: We are a won and its 10.[]Slec�rical mg all work officers have ecercised 1Vaim or additions myself�o workers' of 1 L[]Plumbing repairs or additions ]t c 152.§1(41 and ehaveno 12-C]Roofrepairs WPloye-[No workers, 13Q Other 'Any applicant mat checks boa et must aim sll oar me seotton bey,, msmaace regrared'] t tHomoownets wbo submit this al�davit' �9 any doing 8II wooubidecmftct=Policy boa emPlOYM ftmftd=tbatdbwkftb $a awl shcetsbowuig the—offlte mut sab�ta new affidavit had sash. I �foY that mastlsovide Qreh wadws•soup Pojioy no 6w.aud#rate whethwornottow ea rw have I am an erarloparOWIs PVFMW WMAM' Info"awou. coan�isatirin f�MY erf yeex Bdow is Se y aNdJots s&e o>7Q/ / Tnsmance Company Name: .0 Policy#or Self-in&L ic.#: (N C > tphation Date 3p ; : O Z Job site Address: woo � .�✓.e �• Attach a copy of the Workers'compensation �'� ;p:CPr'-��rvi(�_____(�i`�l q Failure to secrue coverage as P7 declaration page(showing the Policy number and expiration date), �Z i re9 d under Section 25A of MGL c 152 can lead to the imposition of criminal ) I fine up to$I,500.00 and/or one-yem imp as well as civr'i Peres of a of up to$250.Q0 a day against the violator. Be advised that a titre of a S IOP WORK ORDER and a#Bus Investigations of the DIA for in urmce verffi alien.coPY this may be fCrW8rded to the Ofoe of I I do her+¢by cert 'u p ofpa ywy that the Lvie> in s Prmdded above is true andcorreet, S' ' #' �2 � 9 - Offldduse onlp. Donut wise is this Dreg robe cofir&eaTby cfty or to rm Offld j i City or Town: j Pennwueewe Issuing Author iiy(circle one): 1..Board of Health 2.BwUding Department 3.Ciityllown Cleric 4, } 6 Other liilectxical IwPector Plumbing Inspector. Conact Person: Phone M ; i 1p .zn.accordance.Vqtl the ro . 1 Neer p 'Mons of 40 of m a P eer y Iioensed sohd w that the de"� anti of Pert* ; drspos�.I,� �'.k shaDl be• . • � debris � as �ed�bY.RqGL c. � �°� t be a*osed df fa: - , s. IMA- (�ocaifon of Facfy) �uatm a of Pau t App�it Date ' I i I`A D . SM, USAD a &'�''� i r . TOWN OF;BARNSTABLE„BUILDING PERMIT APPLICATION_.,.. Map Parcel //Cv 'Application # Health Division Date Issued 65 -2 .05 Conservation Division ,.Application { Planning Dept: ,.Permit Fee, c Date Definitive'Plan Approved by Planning Board , t Historic = OKH — Preservation /Hyannis Project Street Address G/P.-UC,vCI0 �� �s Village -r-t=Kyf L Ls Ls Owners 1l/ �s�7 �� Address Telephone S-;o'?P Permit Request -7ar�e-z��' s ; e Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Toil new Zoning District, Flood Plain Groundwater Overlay , ' s; Project Valuation kfZb Construction TypeG` Lof Size Grandfathered: ❑Yes ❑ No If yes, attach sup rting Fcun station. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) o Age of Existing Structure Historic House: ❑Yes �lo On Old King's Hi. hway: ❑Yes 0lo - Basement Type: W(ull ❑ 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 o Heat Type and Fuel: d Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes U o Detached garage: ❑existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: O existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 1114o If yes, site plan review# - i Current Use �A/ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _ /��� C��(� � Telephone Number Address (5D4 ���r�i ��� License# 0-5 t eq6 0/ l Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��e P SIGNATURE " - � DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: r FOUNDATION FRAME INSULATION f: FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL _.GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ,Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.go v/dia Workers' Compensation Lasurance Affidavit: Builders/Contractors(EIectri dansRIumbers A Uumt Information Please Print Le 1 . Name (Business/organizatidn/IndividuaI):• � / �� • Address: �� "��T�t �use,�� - • City/Statdz' v l� CI of Phone.#: Are you an employer? Check the appropriate box:. Type of project(required): [9- .El am a employer with 4. ❑ 1 am a general contractor and I 6 New construction ' ployces(full and/or part-tint).* havc hired the Sub-contractors 7. ❑. 12emodeling aI am a sole proprietor or partncz- listed on the attached sheet - ship and have no employees These nib-contractors have g. �Dcmolitiozl employees and have workers' working for me in any capacity. t 9. El Building addition [No workers' comp.-insr=Gr . COS"insurance' 5. [� We arc a corporation and its 10_Q Electrical zepaus or additions rbgtur�] officers have exercised their 11.0 Plnmbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself[No workers comp. c. 152, §1(4), and.we havbno �- incrTrance required_] t -13. l'Other PAL&1 C--V•Lf ro employees. [No workers comp.insurance rcgvircd.] *Any applimnt that checks box-NI must also fill out the section below showing their workcrr,mmp=m ion policy inforrmiion t Homeowners who submit this a$davit indicating they arc doing all work and then hire outside contractors mast 6ubTnit a new aMdavit indicating such. TContmactors that ebcck this box must attacbcd an additional sbmt gbowing the name of the sub-contract and state wbctha or not those aitities bavc anployar. If the sub�ontraetors have=Tip)oycca,they must providtr their workers'comp.pobrY number. I am an employer that is providing workers'compensation insurance for my employees. Belaw is the policy and job site • inform-anon. Insurance Company Name: Policy#or Sclf--ins.Lic. #: Expiration Date: Job Sitc Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to scare roveragc as rcquircd tmdcr Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fins 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 find of up to$250.00 a day against the violator. Be a.dviscd that a copy-of this statement may be forwarded to the Office of Jnvesti ations of the DIA for insurance t;overa c verification. I do hereby certif under the pain—d penalties of perjury that the inforrma-don provided above Is true and corre4c:4 Phone#' S)—d 0 Q q OffzcW use only. Do not write in this area, to be completed by city or town offuiaL City or Town: Permit/Licenst,# = Issuing Authority (circle one): • 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their cmploy(,,cs: Pursuant to this statntc, an emPfcyee is defined as "...every person in the scrvice 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 foregoiag_engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rmciver or trustee of an individual,partnership, association or other Iegal 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 maintenancc,construction or repair work on such dwelling house )r an the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." vIGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or Tnewal 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." �dditiona.11y,MGL ohaptcr 152, §25C() states`Neither the commonwealth nor any of its political subdivisions shall :rater into any contract for the periormaucc of public work until acceptable evidence of compliance vd. them a-'ice cquircmcnts of this chapter have been presented to the contracting authority. ,pplicants lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to.your situation and, if eccssary, supply sib-confractor(s)mame(s), addmss(cs) and phone numbers) along with their certificate(s)of issuance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no-employees other than the iembers or partners, are not rcquircd to carry workers' compensation insurance. If an LLC or LLP does have nployecs, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ccidcnts for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should returned to the city or town that the application for the perruit or license is being requested, not the Department of idustrW Accidents. Should you have any questions regarding the law or if you arc rcq aired to obtain a workers' impensation policy,please call the Dcpartmcnf at the nungber listed below. Sclf-insured companies should enter their if kmn-anC0 license number on the appropriate line. ity,or Towl3 Offiirials ease be sure that the affidavit is complete and printed Icgibly. The D cpartmcnt has provided a space at the bottom ,the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant case be sure to fill in the permiVbcense number which will be used as a refcrcnce number. In addition, an applicant it must submit multiple permit/license applications in any given year, nred only submit onp affidavit indicating eurrcnt lacy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or Nn)."A copy of the a$davit that has been officially stamped or marked by the city or town may be provided to the plicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each 3.r.Wherr, a borne owner or citizen is obtaining a license or permit not related fo any business or commercial venture a dog license or permit to born Icaves etc.) said person is NOT required to complete this affidavit e Office of Investigations would h1m to than you in advance for your cooperation and should you have any questions, ase do not hesitate to give us a call Department's,address, tcicphone•and fax number. Tha C6mmonwea- th of Massachusetts Dcpartzmmt of ladustTial Accidents Office of InVestigatkt ns 6.00 Washingtaa Street Boston, MA 02111. Tel. # 617-727-490.0 ext 4.06 or 1-M-MASSAFB Fax# (517-727-774.9 11-22-06 www.mass.gov/dia Q Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR ` Regis 116609 Ezpieat�on _6%2912010 Tr# 268043 ijlpe IidNidual BILLY E GAUTHEN BILLY CAUTHEN 86 BETH LANE HYANNIS,MA 02601 - Administrator 7.7 �jie rir��3znta�rzuiQc�j� c�✓��avac�ar6e��6.Board of Building Regulattons and Standards Construction Supervisor License= 3 License CS 9975` • ,��',.�{ Expiration 8/13/2009; Tt# 2096 � , BILLS E CAUTHEN 1 • HYANNIS MA 02601 Commissioner vim' '•S`w�,� �,': - - ..-f 1 .,.}��„�:p�;c�,rts p X 1 . < f � •.fv i ��' 5 } • at ��� ��,ry �' �• i i i � i a 4 ME, Lill „€ KA ��p; �' ,�95 •T- J2 '�`. _ eatk +NUJ t R+§`:v �• <�� � § r'r"Wyk eX qT Ig ta,. r � k •.. a� �'.�m a#, Sw� �'��t -f"'f's s r � p�"�Y ' Tr .: i,a AR Q ' Ir Town of Barnstable T Regulatory Services BARWMpQ LE Thomas F. Geiler,Director. lforM+nt 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 Sigh. This'Section If Using A:: Builder AQL , as Owner of the'subject property ' hereby authorize � LLB � } (..t �1 �(/� to act on my behalf, in all matters relative to work authorized by this building permit application for: UW D iq 0E- c lj on,L L--- (Address of Job) d-LiL 6Ake V Ct 0?404� Signature of Owner Date Ls Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption.Form on th:e reverse side. Town of Barnstable E op•tH Regulatory Services Thomas F. Geiler,Director MIIARNbTABLE, - "� Building Division p�plE1A~� Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 Y w` town.barnstable.ma.us fice: 508-862 4038 Fax: 508-790-6230 HOAfEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number Btrcet "HOMEOWNER": work phone# name home phone# CURRENT MAMING ADDRESS: city/town state zip code The current exemption for"homcdVMers"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. t DEMMON OF HOM ONVNER 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 iv✓o-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 responsMe for all such-work performed under the building pemu't. (Section 109.1.1) . "homeowner" assumes responsibility for compliance with the State Building Code and other The undersigned applicable codes, bylaws,rules and regulations. Me 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 -equirements. :ignaturr of Homeowner ,pproval of Building Official Note: •Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the tate Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for whidh a building permit is required shall be exempt from the provisions 'this section (Section 109.1.] -Licensing of evn;truetion Supervisors);provided that if the homeowner engages a person(s)for hire to do such )rl,that such Homeowner shall act as supervisor," Many homeowners who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, er Iles&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly un the homeowner hirrs unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would With a licensed pervisor. 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, i the homeowner testify that hrlshe unda stands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by reral towns, you may care t amend and adopt such a forn-Vrcrtification for use in your community. • 1. . �ra \tl` �x 4 y 6Ims < wf y 65. . Y r) Map; / /ny Parcel / Permit# Conservation Office(4th floor)(8.30-9:30/1:00,-2:00) I J\ �' G,_ Date Issued Board of Health(3rd floor)(8:15 -,9:30/1:00-4:45) Engineering Dept. 3rd floor House# c �' Fc SY "' T ' g. g' p ( � ) � �� CND dALLL �S a �� .. LJA�J�E g') = V118 - 19 �VCN9� DE AND 1��"� ➢ . ONS TOWN OF BARNSTABLE ' Building Permit Application i" t o'e reet Address ✓ Village. Q Owner A� �r ,15� � �✓ Address V t Te ephone ?/ Permit Request First Floor square feet Second Floor square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential .Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure 40 -t— Basement Type: Finished Historic House Afv Unfinished Old King's Highway A/0 Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Cau ff Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached ✓ J Barn None Sheds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE ASITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS f- ! PROPOSED STRUCTURES ON THE LOT. ' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE l DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PE MIT NO. D ISSUED /PARCEL NO. : ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: FOUNDATION FRAME- ,�; k C � t _ . # .. • ! 4 - INSULATION - FIREPLACE : .., a"~ _. �. __ i f ! ,i _� _• ELECTRICAL: ROUGH FINALOU PLUMBING: RGH FINAL GAS: ;ROUGH: FINAL 4 i Y FINAL BUILDIN:C DATE CLOSED Oi4l-f ri 0 ASSOCIATION,T NQd r t ` FYI{ � t }• i t ! ! � � � � { � �: r � d - P 4 i , T Aa25.00 ,QL 0 CIF 0 (v ep Q LOT 24 11 h�00 15, 128 SF. ti r y 12r 125. 01 N 55'51 '30"W PLOT PLAN OF LAND To THE BEST OF MY KNOWLEDGE, THE L OCA TED IN BUILDING SHOWN ON THIS PLf ;3,vl.S., CEN TER VIL L E - NIA SS. T ��{ IT ACTUALLY EXISTS ON DClN( '" _.. 41 PREPARED FOR U DATE' OCT.21. 1993 ROBERT K. 9 MIL L ICENT J. EAPL S R.L. ,,��. i' DATE.' OCT.21, 1993 SCALE.' 1 "=30 FT. FL DOD ZONE C (NON-HAZAAW' i CAPE 6 ISLANDS ENGINEERING . .�• D-50 `' MA SHPEE - MA SS. 0 er's Manual ' se I str cto s _ I ---- ------- / 7 FOUNDATION I I ,.Model L------(— PROOF OFPURCHASE —_----J ARROW 9 World's Leading Maker of Storage Buildings® 1 i yA I I i i I 6 I I I I r � ` G 705021093 NOTE: THIS KIT IS NOT SELF CAUTION:SOME PARTS HAVE SHARP EDGES.CARE SUPPORTING. SEE IMPORTANTMUST BE TAKEN WHEN HANDLING THE VARIOUS PIECES TO AVOID A MISHAP.FOR SAFETY SAKE,PLEASE READ INSTRUCTIONS ON SACK COVER SAFETY INFORMATION PROVIDED IN THIS MANUAL BEFORE BEGINNING CONSTRUCTION.WEAR GLOVES ® WHEN HANDLING METAL PARTS. ©Arrow Group Industries,Inc.1993 r :}4 .. n4.Y,..r..v/ r...,..x..........:....,I.....v.v........ .:.n•..v:.�:::.................................,.... ........................................�:.�::...::.:.:..::v::::v:::.v::::::::::.�::::::.:::.�::::nv;:::.:::i::Y'::?;. .. , r .r : Y »r/....... ., .,Y'l4Y•:n�::,v::::.v:::::{:.:.+.:Lv::;::»:+.v::..;v;;.�.}.::•::i�t Y.i.... .v .r... ..... .n.,..... .. .. ... ....::::::J}:.}.::..::::::::.�:n�:::v:....'.v}YS::}:i.ri:.�::::�:::::::::.}}:i.,:•};:•iY:.}}Y:::•»r;;•}:^ri}:�:'v'•r::.:.: ...............•...�..,:•.......+:Yo;r:;i4•.•.....:ii4::<::r�t:::;:pi�YYi.+.LLi;acs»i};>};:o:::.:�'.;...... , ...:..::�.:..i, t yrj; �f:Ls::•%.rY,�',ry r� >,.::••,:::;:,:;�:;•::•::»u::e�.•<e�io}s..;.t•,};>..:.:.........•.,..�.,.,......:, ....:............,,........ ,.... .,.. ... .. 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No. E El MNIUN D N-'10 8 E I H MI'l 08 3 Plu"',J1 0 8 El S 0 11 NW10' E Al Z5 VN108' El ® 70 6 8 5 3"8 El l e" Y P Far— • t ARROW 1 t World's Leading Maker of Storage Buiidings®. 5 , CAUTION:SOME PARTS HAVE SHARP EDGES.CARE MUST BE TAKEN WHEN HANDLING THE.VARIOUS PIECES TO AVOID A MISHAP.FOR SAFETY SAKE,PLEASE READ SAFETY INFORMATION PROVIDED IN THIS MANUAL �i 704661195 BEFORE BEGINNING CONSTRUCTION.WEAR GLOVES BUILDING DIMENSIONS *Size rounded off to the nearest foot o WHEN HANDLING METAL PARTS. Exterior Dimensions Interior Dimensions f Approx. Foundation Storage Area (Roof(Edge to Roof Edge) (Wall to Wall) -Size Size sq.Ft. Cu. Ft. Width Depth Height Width Depth Height 10'x 8' 121°x 92 3/4° 74 401 123 1/4° 95 1/.4' 70 7/8' 11.8 1/4' 90' 69 5/8' y vJ� 9y y�c�`�p 7� �1 70 <- - •` The Coninurnrrealth (!f Massachusetts _ f f_ P�'.�._� De• artment of Industrial Accidents 6111111 arldigpi)n Street rr x`; •c Biulan.Marx 02111 �- Workers' Compensation insurance•ARdavit MrMt . d-- -cift, vz 'it1 am a homeowner performing all work myself t am a sole proprietor and have no one working in any capacity IT ❑ 1 am an employer providing workers' compensation for my employees working on this job. comnnnv none• atidress• h•• phone ' insurance co nniiev# ❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who hav the following workers' compensation polices: Company n•one• - phone#- insurance co- Address- city- phone fh - .. policy>Y insurance co. additional'sheetittieeessa •- •�•--'tom-��'�-�+"'r"'�""r�.'�_.;�•�•t�..�r-' ,:.�F:��..�.'__M.----- -- _ .�.�d;;,�,n Failure to secure coverage as required under Section 25A of MGL 152 can lad to the imposition of criminal penaities of a fine up to$1.500.00 and/or One rears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand th'at a cop+•of this statement may be forwarded to the Oflice of Investigations of the DIA for coverage Te ilfatioo.4 Zad11herehr ccnifj•under the pains andpenalties ojpedurj•that the information provided aboveis true and con VLazutn ate 7 ® 9 71 Print name ��/� �� �-/�L S - Phone# 90� a Icial use only do not write in this area to be completed by city or town otileiai city or town: permitfileeme# nBuilding Department [3Ucensiag Board cheek if immediate response is required OSelectmen's Omce Otiaith Department • contact person: phone ft nOther ••Information and Instructions Massachusetts General Lacs chapter 152 section 25 requires all employers to provide workers' compensation for tlrei employees: As quoted from the"law".an emplm�ee is defined as every person in the,crvicc of another under any contract of hire.express or implied, oral or written. . j An emplitrer is defined as an individual. partnership.association.corporation or other :gal entity, orf any two or mori the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased cmplover.'or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However th( owner of a dwelling house having not more than three apartments and who resides therein.or the occupant of the d+vcliing house of another who employs persons to do maintenance,construction or repair work on such dwelling hot or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to be an employes MGL chapter 1'53 section 25 also states that evcry state • .or local licensing agency shall wititirold the issuance or. renewal of a license or permit to operate a business or to construct buildings in the commonw aith for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 1-. 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 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. ......•...,,... ... .. .:.:77 -:: ,a' ss:o777777 .,• she^ .�;s City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant• Pie. be sure to fill in the perm it/I icense number which will be used as a reference number. The affidavits may be returned i the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questior please do not hesitate to give us a call ,T The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Inestigations 600 Washington Street Boston,Ma 02111 fax#: (617)727-7749 •. phone#: (617) 7274900 ext. 406, 409 or 375 The Town of Barnstable KUM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosses Office: 508-790-6227 Building Comr F= 508-775-3344 For office use only P=7nit no._ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERKM APPLICATION MGL c. 14ZA requires that the-r=nstruction,alterations,'renovation,repair,modernization,eottvez=M iznprovement,.temo%%L demolition, or construction of an addition to nay pre-ddsting owner 00cupied Wilding containing at least one but not more than four dwelling units or to S=cm s which are adjacent to such residence or building be done by registered contractors,with certain eooeptions, along with other —uu=c- Type of Woric: Fzt-C.ost Address of Work: 01�, Owner.Name: Date of Permit Application: 7 9 I herzln certify that: Regisuation is not required for the following ttason(s): Work excluded by law Job under S1,000 Building not owner-occupiedd Owner polling own pe mft Notice is hereby given that: OWNERS PULLING TIMR OWN PERMIT OR DEALING wrm uNREGISI EM CONTRACTORS FOR APPLICABLE HOME RAPROVe ENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c I42A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the 0%71 r-. Date Contractor name Registration No. OR r Owner's name • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION �— Number Street address Section of town „HOMEOWNER" NameHome phone Work phone PRESENT 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attach/ed 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 Stat Building Code and other applicable codes, by-laws, 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 comp y ith saidprocedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. 1 HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a 'b"wilding permit is required shall be exempt from the provisions of this section (Section 109 . 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this . case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home 1,0 wner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community.