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Town of Barnstable Building
uld'n
rWMnur 4IL
Post This Card so That rts Visible From`the Street.-Approved'Plan's Must be'xRetained on Job andahrs Cartl Must be Kept
63a � ' Posted Until Final Inspection Has'Been Made Permit
ym�+
Where a Certificate of Occu`panc Requ ed;such Building shall Notgbe Oceupied,until a FinalFlnspection;ha been made 4.�1 111 1
Permit No. B-19-2191, Applicant Name Stephen Dickinson Approvals
Date Issued: 08/28/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/28/2020 Foundation:
Location: 159 GREEN DUNES DRIVE CENTERVILLE Map/Lot 245-013-002 Zoning District: RD-1 Sheathing:
Owner on Record: .FREISHTAT, HARVEY W& BRENDA G TRS Contractor Name` NSSTEPHEN T DICKINSON Framing: 1
Address: 85 WILLISTON ROAD Contractor,License: CS`=081843 2
BROOKLINE, MA 02445-2144
Est: Project Cost: $4;984.00 Chimney:
Description: Same for same, replacing 3 double hung windows•u factor 0.29, no 1 Permit Fee: $35.00
j _ Insulation:
structural changes r
Fee Paid:;f $35.00
f ,�
Project Review Req: Date: 8/28/2019 Final:
Plumbing/Gas
i Rough Plumbing:
m -. ui in icia
This permit shall be deemed abandoned and invalid unless the work authorized-by this permit is commenced within six months after issuan Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
.All construction,alterations and changes of use of any building and structures shall`be in compliance with the local zoning by-laws aril codes. Rough Gas:
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. (' Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building.and Fire Officials are-provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Service:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough`
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection .
5.Prior to Covering Structural Members(Frame Inspection) Final:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Rough:
'Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage.Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �,.
� Final:
17 V �
Town of Barnstable IT
200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: B-17-2765 Date Recieved: 8/11/2017
Job Location: 159 GREEN DUNES DRIVE,CENTERVILLE
Permit For: Building-Siding/Windows/Roof/Doors
Contractor's Name: STEPHEN T DICKINSON State Lic. No: CS-081843
a
Address: MERRIMAC, MA 01860 - Applicant Phone: (508) 676-6820
(Home)Owner's Name: FREISHTAT,HARVEY W&BRENDA G Phone: (617)739-1959
TRS
(Home)Owner's Address: 85 WILLISTON ROAD, BROOKLINE,MA 02445-2144
Work Description: 9 replacement windows r 1
--
Total Value Of Work To Be Performed: $15,991.00 01-
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). .
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am,the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,•regardless of what might be shown or omitted on the submitted plans,and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Stephen Dickinson 8/11/2017 (508)676-6820
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost: $15,991.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $81.55 8/11/2017 $81.55 X)=-)D=-)D=- Credit Card
7597
._.............................................:............._..._................._.........................._....__......_...........................:........................................... ..:.........................................................,......
Total Permit Fee Paid: $81.55
C4
oFt soh, Town of Barnstable *Permit#� 2 +
~��, Expires 6 months from issue date
BARMAsr,E, = Regulatory Services Fee_ o?f'
v , : Thomas F.Geiler,Director
e
ArED�,,t� Building Division X-PRESS PERT
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 NOV . 4 2003
Office: 508-862-4038
Fax: 508-790-6230 TOWN OF BARNSTAB E
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
nn Not Valid without Red%Press Imprint
Map/parcel Number ����� �1/R
Property Address 1 �m V.e e n y S.
[]Residential Value of Work 95 60- Q
Owner's Name&Address �z>'OQAR
Contractor's Name Ql��L e �� Telephone Number �(p R 1�
Home Improvement Contractor License#(if applicable) L to LA
Construction Supervisor's License#(if applicable) LA'�,' 6_4 L.
!L
�orkman's Compensation Insurance .
Check one: r
❑ I am a sole proprietor
❑ I am the Homeowner
[-I have Worker's Compensation Insurance
Insurance Company Name -
w r,
Workman's Comp.Policy# to a o -\a) Lf[ (a
<
Permit Request(check box) C- ;I
CD y
Re-roof(stripping old shingles) All construction debris will be taken to ,n►1 A A
❑Re-roof(not stripping. Going over existing layers of roof) W
m
❑ Re-side
El Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property 0 er m t si roperty Owner Letter of Permission.
ome ve t actors License is required.
Signature
Q:Forms:expmtrg
Revise053003
Cs
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MARK 171E ST
35 Peep Toad Rd.
Centerville MA 02632
(508) 420-6216
PROPOSAL SUBMITTED TO: WORK PERFORMED AT:
Tom Riley
159 Green Dunes SAME
MA 0264-2-,q5b 7,1
508-775-6276
':herby propose to furnish the materials and perform the labor necessary for the
r, t`t completion of the following;
Remove existing thing s
�Irastall8'driD edge
Install tee&water shield at edge & in val�v areas
InMall I Slb'�. t pal2er
yy
f tIY Y iY T
Please fill i
; �f radg�& anstalZ cobra vent
. 1plum bing flanges. t ;,
{ •Y�'^
d
" cn br as Cleaned -
Prtce ancludes m � 1, jn -�e-d. pc
All ma#erial as Parnateed"to be as specified and above work to performed in
K accordance witspecificatrons submitted for above, and completed in a substantial
workman]�ke trianner for the: X.,
,7
Dollar 97M with a j ents as foll ws 1/2
t ) P Y!n o , start w/maternal on sate,full - t r r t
_} balance due�upon completrorc. K T:- r, r
An allterat�on s from,above i
r
y O evolving extra costs wilfbe added unde_r'`written
{� agreement; and become eft a over and above signed estimate/agreement
A � � RESPECTFULL .S<
Signature...r
ACCEPTANCE OF PROPOSAL
Y
The above-prices specification &conditions are satisfactory,we herby accept
you are authorize to do the wor. an ayments will be as specified above.
Signatu e(s
Date:
* This proposal may be withdrawn li said company if not acceptedewithm 430 days
r
BOARDDF'BUILDING REGUtAT10MS j
License CONSTRUCTION SUPERVISOR
NumberCS 048546
Bltthaate01t27/1953
,z Expose 01/27/2Q04 Tr.no: 2926 1
Restricted ;00,
I
MARK D HERBS!' _
35 PEET TOAD RD ,
CENTERVILLE, MA 02632 «..iI, i.
Administrator
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7,.
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ard of B
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HO Regulations;and
Staridands
ME IMPROVEjjgENT
Reglstrations. CONTRACTOR.
i Ez i �s2fi480
1 p ration
MARK HERBST ndrvidual
MARK HERBST
35 PEEP TOAD RD.
CENTERVILLE .
MA 026327-11
a' Adm,ntstrat r
RIDGE VENT �2"
�_� �' • _ 12
RUBBER ROOF I 128
IX8 FASICA !
i
I.XB SOFFIT �+
UM.GUTTERS (.
IX6 FRIEZE BOARD
IXS COFNER BOARDS
WHITE CEDAR SHINGLES
ISERGLASS SHINGLES I�
3442 5942 I I
AREA OF eROVOSEQADDIT.ION
Ll
CREAR VIEW ELEVATION LEFT SIDE VIEW ELEVATION
\" (INSULATION/FIBERGLASS 2 x 10 RIDGE
CEILINGS -9"
WALLS - 3'1/2" EXTEND RAMPS
STQRAGE
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2u J" 2XS JOIST 16 O.C. (Ex15TING '
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NEW WALL '
BEDROOM (EXISTING)
,FRA MlNlG,,,•DETAIL
PROPOSED DORMER ADDITION
159 GREEN DUN ES DR. "
WEST HYANNIS PORT M 1
FLOOR PLAN MR. &MRS.THOMAS REILLY
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`OF,NE Tpk� The Town of Barnstable
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9 BARNSTABLE.9` Department of Health Safety and Environmental Services
MASS. 0
i6yq. �0
pTFD,�a+" Building Division
367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection Y` '
Location t(' All re Q� Permit Number ��
Owned LEI Builder
V
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
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12� 'R A.-Ft elfz_ S;QLC(;�Aa
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Please call: 508-790-6227 for reeinspection.
Inspected by '11-,
Date , lo
To
Date Time
WHILE YOU WERE OUT . ,
M
of �.
Phone
Area Code Number Extension
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU URGENT.
RETURNED YOUR.CALL
Message
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AMPAD 23-021 •200 SETS
EFFICIENCY® 23-421 -400SETS CARBONLESS
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DATE PEItraIT I s SUEE"D
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ID AT E C0MPLIAMCE ISSUED -,
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map -6f Parcel 0 � Application #
Health Division Date Issued Z �1
Conservation Division Application Fe
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address 15 Ll 6 r 69- Dr Ile
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Village Lv
Owner e.0 E�4-A Address l$01 (7✓�-�-�1 /�r � j
Telephone i
Permit Request l /Yt�A �� ,�'1 P/F -eGO�I . [.0 >6 if L
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Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District , Flood Plain Groundwater Overlay
Project Valuation r 0 0 V 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 tKo On Old King's Highway: ❑Yes IVINo
Basement Type: )U*rull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: _ existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:7 -�
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w'
;
.d
Commercial ❑Yes ❑ No If yes, site plan review# :-
Current Use � � Proposed Use kf
�- c
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name12M;:� '4AA( i4.,— Telephone Number 2_
Address N � 0 -0 19 S. k &ice`�lg- License # '7 0 0 F(
Home Improvement Contractor# %Z
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��/I��-I e
SIGNATURE DATE
FOR AFFICIAL USE ONLY
r APPLICATION#
DATE ISSUED
MAP/PARCEL N0.
ADDRESS - VILLAGE
OWNER _
,
t' DATE OF INSPECTION: ;
FOUNDATION
FRAME
INSULATION -
r
FIREPLACE t
t. ELECTRICAL: ROUGH FINAL
r /
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE-CLOSED OUT
ASSOCIATION PLAN NO.
,
The Commonwealth of Massachusetts ,-
i l Department of Industrial Accidents
Office of Investigations
9`Zfl�, 600 Washington Street,
t+ j Boston,,MA 02111
www.mass.gov1dia
Workers' Compensation_'Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: a p L�
City/State/Zip: S i�/'P/�i Phone ��
Are you an employer?Chec f6e appropriate box: Type of.project(required):.
1. I am a employer with 4 I am a general contractor and I
6. New construciion
employees(full and/or part-time).* have hired the sub-contractors
2•. ❑ I am a sole proprietor or partner-
listed on the attached sheet. # 7. Remodeling .
ship'and have no"employees These'sub=contractors have 8. 0 Demolition
Workers' comp. insurance.- --9. 0 Building addition
working forme in any capacity.
[No workers' comp. insurance S. .O We are a corporation and its 10.0 Electrical repairs or additions
required officers have exercised their
3.0 I am a homeowner doing all work right of exemption per MGL '°11.0 Plumbing,repairs or.additions
myself, [No.workers' comp. - c. 152, §1(4), and we have.no 12.0 Roof repairs `
insurance required.].t. employees. [No workers' 13.0 Other°
comp..insurance required.] ,
*Any applicant that checks box 41 must also fill out the section below showing their workers''compensation policy information.'"
t Homeowners who submit this affidavit indicating they are.doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet.showing the name of the sub-contractors and their workers'comp.policy-information.
I am an employer that is providing workers'compensation insurance for my employees. Below'-isVie policy and job site
information.
Insurance Company Name: . C . . �45
Policy#or Self ins. Lic. wy Expiration=Date: (�
Job Site Address: 4. City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .
Failure to secure coverage as required under Section 25A of MGL c. 152.canlead to the imposition of criminal penalties of a
fine up to$1,500.06 and/or one-year imprisonment, as well as civil penalties'in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
-Investigations of the DIA for insurance coverage verification.
1 do herebycerti
nfy under the pains and penalties of perjury`lhat the information provided above is true,and correct
Signature:, Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town:. Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing.Inspector
6.Other
Contact Person: __ Phone#:
02/08/2011 10: 11 FAX 5085835587 ' MURRAV&MACDONALD fa001/001
.a►co CERTIFICATE OF LIABILITY INSURANCEF2/8/2011°ATe`MM,°°"""''
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement a.
PRODUCER Zaah LynkiawiC2
Murray & MacDonald Insurance 9ervicea I . Iao, ,A "E (508)$40-2400 FAx leas>2es-alit
550 MacArthur Blvd. DD-MAIL
PRODUCERCURTOMPIR In 1.00014460
Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC11
INSURED INSURER A Yi.reman I s Fund Ins Co
-IN*U.RERQiS&f8tY InCISMnitX 33618
Kendall & Welch Construction Inc INSURERCAce Pro pert & Casualty ins
S74 Main Street IN R RD•
PO Box 490 INSURER E:
osterville MA 02655 INSURER P:
COVERAGES CERTIFICATE NUMBER:10-11 Nuater GL REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED NELOW 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 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EPP POLICY EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE 4 11000,000
X COMMERCIAL GENERAL LIABILITY 1 50,000
A X CLAIMS-MADE OCCUR LN310000343' 6/13/2010 6/13/20ii MED EXP tAny one arson S 51000
PERSONAL&ADV INJURY S 1,000,D00
_ GENERAL AGGREGATE S 2,000,000
GEN•L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGO 1 1,000,000
X1 POLICY 7 JER& 7 LOC ° S
AUTOMOBILE LIABILITY COMBINED SINOLE UMIT $ 1,000,000
(Fe accident)
ANY AUTO
B AIL OWNED AUTOS 6207210 B/4/2010, 9/4/2011 BODILY INJURY(Par parson)
BODILY INJURY(Per accident)
R SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (Per accident) $
X NON•OWNEO AUTOS PIP•<jaAo 9 9,000
Underineured molorlet BI eplk $ ' 250,000
UNBR@LLA LIAR OCCUR EACH OCCURRENCE. 9
BXCESS LIAe CLAIMS-MADE AGGREGATE is
DEDUCTIBLE S
RETENTION
C WORKERS COMPEN8ATION I WC STATU• I OTH-
AND EMPLOYERS'LIABILITY.
YIN TORY LIMITS FIR
ANY PROPRIETORIPARTN6RpECUTIVE NIA E,L.EACH ACCIDENT s 500 000
OFFICER/MEMBER EXCLUDED? �46252512 /6/201112 /6/201212(Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 500,000
Ifi n desamw under
DESCRIPTION OF OPERATIONS below I EL.DISEASE-POLICY LIMIT S 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addlllenal RemaM,a Schedule,I1 more space Is required)
CERTIFICATE HOLDER CANCELLATION
(508)759-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.
Huildincj Dept AUTWORIZED REPRESENTATIVE
200 Main at
Hyannis, MA 02601
S Harrington, CIC/SLlai '"`r'
ACORD 25(2009109) 01988-2009 ACORD CORPORATION. All rights reserved.
,�,nwww.______. TAw AP•ADA w.,ww+w,l Iwww��w�nwinMwa wl.w-.Lo w6 AP11DA
t
ofrH�r Town of Barnstable
Regulatory Services
IAWSTABLE,
v Muss. $ Thomas F. Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstabie.ma.us
Office: 508-8624038 x Fax: 508-790-62
Property Owner Must
Complete and Sign This Section
If Using A Builder
A'Rv �Y U1,
I, r FIP,� I S WT A T • — , as Owner of the subject property
hereby authorize ka E '} ' �. �— (N� �C to act on my behalf,.
in all matters relative to work authorized by this,building permit application for:
l5q GeE j DgN ._ DRiyE. W l-)yann1Sp�RT`
.(Address of Job)
i
Signature o er Date
�aRv�Y. W, FR�is�i i�T
Print Name
If Property Owner is applying forpermitple 'se complete-the
Homeowners License.Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
of THe Town of Barnstable
H try
ywP o Regulatory Services
BARNSTABLE, Thomas F. Geiler,Director
MASS.
Q, ,.b)r9. ,m Building Division
/FDA 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
DA TE:
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 dwellin>?s of six units or less and
to allow homeowners to engage an individual for hire.who-does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building,permit.'(Section 109:1.1)
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 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such 7
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supenrisor(see Appendix Q;
Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care tamend and adopt such a forn✓certification for use in your community.
e ulat ons an�tan ar s
"uiBoar oin g g .
One Ashburton Place - Room 1301
Boston, Massachusetts 021.08
Home Improvement Contractor Registration
Registration: 128405
Type:. Partnership
Expiration: 4/5/2011 Tr# 282001
KENDALL & WELCH CONSTRUCTION --
DAMON KENDALL
P.O.
BOX 490 --- -----
OSTERVILLE, MA 02655
Update Address and return card.Mark reason for change.
Address. ❑ Renewal . Employment f-7 Lost Card
S-CA1 0 40M-08/08-DBSLIFORRMCA1 08 2120 08
��lce -Voowrrea�raure� o /l�Ooaac�rtae�l6
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT
before the expiration date, If found return to:
jv
�
Board of Building Regulations and Standards
Registrati.onc 128405. One Ashburton Place Rm 1301
Expiration 4/5/2011 Tr# 282001 Boston,Ma.02108
Type Partnership
KENDALL&WELCH CONSTRUCTION
DAMON KENDALL
54 KOMPASS DR
Not valid without signature
FALMOUTH,MA 02536 _-' Administrator
Board of Building Regula/ions and Standards
One Ashburton Place - Room 1301
-Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 128405
Type: Supplement Card
Expiration: 4/5/2011
KENDALL & WELCH CONSTRUCTION
RONALD WELCH
54 KOMPASS DR.
FALMOUTH, MA.02536 Update Address and return card.Mark reason for change.
Address Renewal ; — Employment j Lost Card
:-CA1 ss,50M-04/04-GGV101216p
1. L40i17?/IYlOOu!/P.2LLiL O��i%�(.Qddd LUQP. 6...
Board of Building Regulations and Standards. License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR- before the expiration date. If found return to:
Board of Building Regulations and Standards
Registratlon 128405 , One Ashburton Place Rim 1301
Expiration 4l5/2011 Boston,Ma.02108
Type 'Supplement Card
KENDALL&WELCH CQNSTRUCT
^"� `�
i
lViass<►ellils,tts= Bcpiu ta►tcnt(A 1'tilti c Satct�
Board ofBuildin„ Rc„Tu!ations and.SYandar,�ls.� .
Construction Supervisor Licensee
License; CS 83484
RONALDV WELCH
85 BRIGANI INE CA
HATCHVILLE3 MA 02536, µg
C�
� - xpiration :7/11Y2012,
('innnutisinnc� Tr#: 29231 .{*
Mass:►cl►iitictts'- Urji<urtittcnt ot_t'utilir Safety
Boa d,of...Building Rclk;ulat►ons and;Standards 1,
Construction Superv.isor'License.
License: CS" 70086
DAMON L XK -NDAL'L r
48 KOMPA55-'0R - a
FALMOUTH ,MA 02536
Expiration: 11/21/2012`e �-
(`ommiwione Tr#; 9525
fi.
41
i. .
r
E
1 s 70t--
3
Assessor's map ai'ld lot number .........:. .!�` ........./.3 ��' `1_ �5� d j��A/-
Y
3/ C S1�lBTEM IytUST
Sewage Permit number ...........................................:.............. BE
COMPUANCE
'• use �" I s"9 ¢' 5 fTNE'tp�4 ®WN OF BARcooE
T01" Pr-rllt. AND
13AUST"LE, i
"69
am BUILDING INSPECTOR . _.._.�.�. ..
PY a
/o� �e�lye//JG
APPLICATION FOR PERMIT TO .410 er6- �rT...��....1 ...........................................
TYPEOF CONSTRUCTION .....GUOC>.1�........ L�..........................................................................
.................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to th following information:
Location ,r�.0..T.........................:. 7` .t'?
Proposed Use ...... ..... � l/x YEG
2 � � A0-Ae4114.e_',6F�Zoning District ..... ...........................................................
.: .... ................................................
Name of Owner !/1WeV ......4,,.0 S415.1......................Address ...!/��SP'�dD/).....�j/}.......lJ.�DlO........
Name of Builder ` ............ ..Address GJ5 .......tG� �......................���GS 1�
Name of Architect .......... ..........................Address / a��
Uy L .............. ................................................
N
Number of Rooms � � ...........•...••.••••••••••••••••••Foundation ., 0.......
c12G�T ..................................
Exterior .`. . °..✓. GJ���. g .../r`�`5� ,/���a` .........................................
.....................Roofin
Floors ......................................................Interior /<..............................................
Fieating /•�./�T..1. .Z.....4��.. .....................Plumbing ..�............ ...................................:.......................
G
Fireplace ... ....-..... /��..f�`.':���".... f?X.................Approximate Cost ..... ....... .�...�. .............
!.� 193q
Definitive Plan Approved by Planning Board ________________________________19________. Area llZ......:... ® ...............
Diagram of Lot and Building with Dimensions Fee ............ ..........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
36
416A
rf
�r�2CGl� � ICU/✓G S 7]/2!�/L
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...../......`y... .. ........ ....................................
Permit for ....................................Single Family i
No ly
..............Dwglung................................................
Location .Lot„ ......1.59...Gre.e.n..Dunes..Drive
.... . ......
..................I ..Lenfl
Owner ...Walter......................Gorski..
i...................................Type of Construction ........Frame.......................
...........
................................................................................
Plot ............................. Lot ................................
Permit Granted ......January...1.8............1980
Date of Inspection ....................................19
Date Completed 6............ .19
PERMIT REFUSED
................................................................ 19
................ .........t....................................................
..........V...................................................................
........... .......................................................
...............................................................................
via ti
Approved ...... 19
.............. ,::............................................. ..............
. ...............................................................................
Assessor's map and lot number ...................................
Sewage Permit number .............`7
p Qy�FTHET��19TOWN OF BARNSTABLE
Z BARNSTAILE. i
"b 9 BUILDING INSPECTOR
fe
APPLICATION FOR PERMIT TO � '.
TYPE OF CONSTRUCTION ......CC'f��G�' .............'.......`:aG:` .........................................................................
................................i ................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according toj the following information:
Location .. ...?'.`.... . ................� i✓ ....�r/C'"�............ , . .. ! ..................................................
ProposedUse .:'�l..'rtG:..... ....r..r: .........!..c' .......=rVl��................................................. ..I.........................
Zoning District .........?.JJ.......................................................Fire District !l. ......Gr f .2 ...
Name of Owner . '!fi r. �r i251 / ....................Address ....fuG ..'''Lf1o111. . ... .........
Name of Builder �.t fi`�..'...... °:r. ....r ' ... Address / ..%=�,�.e✓..�Gr..... ,......?riZ.......... ... .Sj�........
Name of Architect ..:1 ."........................................Address ............/T , r..—
.................................................. �
Numberof Rooms .. :..............................................................Foundation ..,:...........................................................................
Exierior /.tl• -%,i�"ve-.t C Roofing .... .....r.! r ........!...........................................
.........../........
Floors 1.. ."` ........................Interior fa %�i'' �✓CF/ '
Heating ! . ,yn r, Plumbing ....�..f.i '... ...................................... - _.
Fireplace — -I�/.... 1- -oe" �v,+c'.................Approximate Cost oif�G?.6...0..................... ... ..................................................... Y
Definitive Plan Approved by Planning Board __________________________ dG�
-----19-------- . Area !r '-....................................
Diagram of Lot and Building with Dimensions Fee ............. °................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
} 2
�V
t
tr
qD
i
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Ndme ...........................
'.. ...........................
A=- 5-13-2
No -.Z.19,3.7— Permit for
---�—I�8�lIi��.-----.--.. ..............
~~
Location ... at..'#..�3..15y..�����.��V���..D�iva
/
------'
[wner --.Valter. __________
'
�
Type of Construction —�]rame............................ -
'
-
--------------------------'
P|
'
Permit
'
Granted Date of Inspectid....................................19
uo/a Completed 19
�
PERMIT RE ED
�
' .............. �
----\~.......—. -- / � ---'
....'..'....................''.............' ......................'......''
'
'-----''--------' ---~—~-----
.----------.---...----------.—
X
�
Approved ................................................. lg
�
�
-------'-------^^^^^------'--
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�( T6.1G OFFSET; IWOULI> LIOT Wr= U">cTMCm/uL �-oT L JS*. APPL►GAuT WALTE � C'3. aRSKi
Parcel /
L ZPermit#' J
Conservation Office(4th floor)(8:30-9:30/1:00:2:00) ` Z Date Issue,A 9
Board of Health 3rd floor 8:15 -9:30/1:00-4:45 00.0 1 / Fee,
Engineering Dept.(3rd floor) House#
SEPTIC S S'T EE t
INSTALLE IANC
- 19 WI
TOWN OFaBARNSTABLE
Building Permit Application
7Stres
Village MIt yo Ltz
Owner Address 42 v P_ Lu ft
Telephone Z Z.5--
Permit Request _04- JP muD '104/»1 Z7444
First Floor square feet
Second Floor - (�' square feet
Estimated Project Cost $ 12 ,000
Zoning District Flood Plain Water Protection
Lot Size ��, 3'� ,, Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use P_mi!�,e�sr?uz-- Proposed Use /yF—
Construction Type LDn,rt
Commercial Residential
Dwelling Type: Single Family Two Family Multi-;�Family
Age of Existing Structure 6/Basement Type: Finished Fy Lc. A0 t�
Historic House Unfinished
Old King's Highway
Number of Baths ; No.of Bedrooms
Total Room Count(not including baths) ell, First Floor �
Heat Type and Fuel a _ Central Air /,- Fireplaces
Garage: Detached Other Detached Structures: Pool bba Ae1r_=_,
Attached ='2 GoI--14_ Barn
None Sheds
Other
Builder Information
Name �c-� _ Telephone Number '271 Z 2
Address 6-92 yC�,�7�—/L UG License# g:�:: s
Home Improvement Contractor# /26
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
c
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
122 lY!
SIGNATURE DATE 2
BUILDING PER T DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY `
P MIT NO.
t
E ISSUED
P/PARCEL Nil
t r
DRESS ' , r VILLAGE
OWNERS
E I
t
DATE OF INSP CT
FOUNDATION
FRAME` ' ;J
INSULATION
FIREPLACE
. f -
ELECTRICAL:'} ROUGH '' FINAL -
PLUMBING:. ROUGH FINAL
GAS: ROUGH ' FINAL r
FINAL BUILDING
YL
DATE CLOSED OUT'' M. � r � � t •
ASSOCIATION PLAN NO. t 1 `
✓fie �a7z7�e� �� a����.aaa�uaeC�,t �;
DEPARTNBNT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires:
CS 036433 04/1L/1998 04/11/930
Restricted To: 00
x TYLER H FOSTER
.592 SCUDDER AVE PO BOX 564
HYANNISPORT, MA 02647
k
TIIe
HOME IMPROVEMENT CONTRACTOR r.
Registration 120963
Type - PRIVATE CORPORATION t
Expiration 03/25/98
T.H. FOSTER INC
G� TYLER H. FOSTER '
ADMINISTRATOR 92 SCUDDER AVE/PO BOX 564
HYANNISPORT MA 02647
The Town of Barnstable
Department of Health Safety and Environmental Services
M6 w� - BuiIding Division
367 Main Strut,Hyannis MA 02601
Office: 508-790-6227 Ralph Croce
F= 508 775-33" Building Commissio:
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires'that the"n=nstruction,alterations,renovation,ncpair,modernization,convem n,
improvement,removal, demolition, or construction of an addition to nay pm-adsting owner occupied
building containing at least one but not more than four dwelling units or to structures which are ad]ac cut
to such residence or building be done by registered contractors,with certain exceptions, along with other
mquirerne=
Type of Work: Dn PjzcrrbD 4 at Cost
Address of Work: 1 5-9 �'%"e 4 �'—
Ovner.Name. p L
Date of Permit Application:
I hereby certify that:
Registration is not required for the following remn(s):
Work excluded by law
Job under S1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THM OWN PERMIT OR DEALING WITH iEGI CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A
SICKED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
D e 7Contra�� Registration No.
OR
``nn`.'�' Tlm Commonwealth g0fassachuseas
-- yVl: tli
- Department of Industrial Accidents
„ n Street
� �: Boston,A1uss. 02111
Workers' Compensation Insurance AMdavit
— -
,eRnlic�n�n-fortnatton•,� u 119i PRiNT,e
name• Z �i✓ =X - S 7�
loc ion,
' g,,P—e,? // phone0
1 am a homeowner performing all work:myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
caml!nnx name_: Q cfe2d e4-'2V 0GT7/!5 -Al
address, Z/) v— 10,11097i?
coty: (f 2;73u �1/LLiL�L / phone#:
QT
am a sole proprietor general contract or homeowner(circle one)and have hired the contractors listed below who have
the following workers compensation polices:
SomnaO.y name: I
add SS: Bc, Z Z
c /d& , phone#:
cu nee co.
cz z/
ctimpanv name:
address:
city: phone#-
insur•mce co policy#
:Attachadditional'sheet Iftieceis •KY +"+'�' ''""*;:-""``'�`r`''" ""' "' " u rrs�
Failure to secure coverage as required under Section 25A of 111GL 152 an lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the OMce of Investigations of the D1A for cmvmge Verification.
I do herebr certify under the pains and penalties of perjury that the infornwtion provided abode is true and come
Signature
Print name_ L - �/� t phone
0 Icial use oniv do not write in this area to be completed by city or town official
city or town: penait/lieense# r'iBuilding Department
13Ucensing Board ti
check if immediate response is required QSeleetmea's Office
C)Ileaith Department
" contact person: phone 1710ther
1m—d 3.4)4 pld1
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* compensation for their
employces. As quoted from the "law an emplgvee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An emplinyer is defined as an individual, partnership,association. corporation or other ;;:gal entity, or any two or more o:
the forc,, engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling: house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling* house
or on the-rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 1'S2 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildinep
gs in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the in coverage required.
Additionally. neither tite commonwealth nor any of its political subdivisions shall enter into any contrast for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hav
been presented to the contracting authority.
.....-..+,mow •<. ... • .. {rlr . . `Y�r. �,,.7R:•n...n-r.p....--�.
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 affida�it. 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.
..-• -.ww.s�.wr�ois!M•►cna...+r 7L7, 7.77S� �''• 7„iti�;.: _. -
Citv or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
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 questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents mf,:
Office of Investigations
600 Washington Street
— Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
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