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HomeMy WebLinkAbout0049 HENRY F LORING ROAD y `. t . t -j .? 06 Town of Barnstable Permit# � Q Expires 6 months from issue date Regulatory Services Fee • BARNSTABLE, KAM Thomas F. Geiler,Director Building Division V Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPMT APPLICATION RESIDENTIAL ONLY y p Not Valid without Red X-Press Imprint Map/parcel Number t 1 Property Address ( .l n r� `©r:i 11 ou fir' i Residential Value of Work 7 ,— Minimum fee of$35.00 for work under$6000.00 CL Owner's Name&Address `'M F m� �� d Jar b�� �� 9b2 ' ��ya Contractor's Name Tel hone.Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)' 7 b b ❑Worlanan's Compensation Insurance X-11'R ES S PERMIT Check one: ❑ I am a sole proprietor DEC 12 2012 I am the Homeowner 'I have Worker's Compensation Insurance Insurance Company Name ► )-e 5 TOWN OF BARNSTABLE Workman's Comp. Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side `l #of doors [� Replacement Windows/doors/sliders.U-Value V; 3 a (maximum.35)#of windows F-1 Smoke/Carbon Monoxide detectors 4 floor plans marked with.red S and.inspections required. Separate Electrical&Fire Permits required. - *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,,etc. 4 ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is nrequired. SIGNATURE: Q:IWPFILES\FORMS\building permit formsT)TRESS.doa .�- 1ne uommon)lweaan uj Zriaxsauritcst;i -\ Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston MA 02111 ivww.mass.gov/dies Workers' Compensataon:Insurance' Affidavit:.Builders/Contractors/Elec ricians/Flumbers Applicant Inforliiation Please Print Legibly Name(Business/Organization/Iudividu �`e ✓ Address:,SSAeS �'� f City/State/Zip: Phone.#: Are you an employer?Check the appropriate boz: :Type of project(required): 1.❑ I am a employer with 4• I am a general contractor,and I . 6. 0 New construction . employees (fall and/orr part-time).* have hired the stab contractors 2:❑ I am a-sole proprietor or partner- listed•on the-attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g• ❑Demolition . employees and have workers' addition capacity. Buil i an9. - working forme.m y ❑ ding co insurance. [No workers' comp.insurance. .. -- � _ 5:�❑,We area corporation,and its 10.0•Electrical repairs or additions required.] •' officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing aII work .. . myself. [No workers' comp. right of exemption per'MGL 12.0 Roof repairs. insurance re ed t c..152, §1(4),and we have no 4 ] 110:0ther employees:[No workers . comp.insurance required.] . *Any applicant that checks box#1 must aiso ffU out the section below showing their workers'compensation Wlicy 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 states whether,or not those entities have employees. If the sub-contracton have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site. information Insurance Company Name: Policy#or Self ins.Lic.# . Expiration Date: Job Site Address: City/State/Zip; - Attach a copy of the workers' compensation policy declaration page-(showing the policy number and expiration date). . Failure•to secure coverage as required under Section 25A of MCTL c. 152 can lead to the imposition ofcriminal:penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine : of up to$250.00 a day against the violator..Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pai-ns•and4enalties ofperjuty that the informationprovided above is true and cvrrecL: Je t a; av a Si ature: �"1 S'" Date: Phone#: Official use only: Do<not write in this area,ib be completed by city.or town official City or Town. Pei mit/License# Issuing Authority(circle one). J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S Plumbiug,Inspector 6.Other Contact Person: : Pho ne#: • . -.. ,. .- • . I forma ®n and I s$ru ion 1vlassachusetts:General Laws chapter 152 requires.all employers to provide workers'compensation.for their employees Punsaant to.this statufe,an employee is defined as"...every person in.the service of another under any contact of bite, express-or implied,oral or-Written.. An ern la er is defined as"an individual,Partnership,ass iation,corporation or other legal entity,or any two or more P Y oc of empa ed m a•oint ente rise and including the legal representatives of a deceased einployer,;or the the-foregoing Wig.. receiver or trustee-of an individual,.PartaersluP,association or other egal entity,emP oying elm oyees.. owever e owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of tune horse dwelling house of anothei who employs persons to do mailitenance,construction or repair work on such dwelling or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing_agency shall withhold the issuance or renewal of a license.or permit to*,operate a business or to construct buildings in the commonwealth for applicant who has not produeed•acceptable evidence of compliance with the.insurauce coverage requu ed. � Additionally,MGL chapter 152, §25C(n states"Neither the commonwealth nor any of its political subdivisions shall an contract for.the erfornmance of public work until-acceptable-evidence of compliance with.the instance enter into y P requirements of this chapter have been pres ented•to the contracting authority. APpficants . Please fill out the workers'.compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)name(s),address(es) and phone numbers) along with their certificate(s)of in s rrance. Limited Liability Companies(LLC)or Limited'Liability Partaerships,(LLP)with no employees other than the partners,are not re d to casy workers'compensation insurance. If an LLC or LLP does have members or p require employees,a to olic is ed. Be advised that this affidavit may be submitted to the Department of Industrial. policy . required. 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'ensation. olic lease call the Department at the number listed below. Self-insured companies should enter their co R P comp ens self-insurance license number on the appropriatE line. . City or Town Officials.'. Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant ' Please be sure to fill in the pe>mit/license number which will.be used as a reference number. In addition,an applicant given year,need only submit one affidavit indicating current 'ors in an , Y that must submit multiple permit/license applications y gi Y . Policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or Y e town)."A copy of the affidavit that has been officially stamped or marked by the city or town may provided to th applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each . year:Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to blim leaves tetc.)said person is NOT required to complete this affidavit would like,to tbankk you in advance for your cooperation and should you have any-questions, The Office of Investigations please do not hesitate to give us a caIL ' ,d The Department's address,.telephone-and fax number: n6 f:E}=ouwle th o I chose (D mqut of hdtl��t al A cezd its `. COo Bo�an,1 .02111 'I - Fax#:617-727-V4•9 Revised 11-22-06 .ma s Q Idi 063-3.-079 43-43 DH Vinyl l ,Viniio NFRC 6100 product Doub12—Hung ! VQntana d4 dobLa guillotiaa Argon/Progolar l Argon/?ro3olar • NationalFenestralion 3f32" Glaist 1 2.38 mm Vidrio Rating Councils No Laminatad Claa9 I gin vidrio sbi ,ado No Grid9 I gin rajillas ENERGY PERFORMANCE RATINGS EVALUACION DE RENDIMIENTO ENERGETICO . U-Factor Solar Heat Gain Coefficient Factor-U Coefidente:Gananda de Energia Solar 0 2 9 lusaal lrrsn ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDIMIENTO Visible Transmittance Transmision de l mVisible 0 . 52 Manufacburer stipulates that these ratings conform to applicable NFRC procedures for deterrdning whole product pedonnance.NFRC . ratings are deterrNned for a fixed set of environmental conditions and a specttic product size.MM does not recommend any product and does not warrant the a t ilk of any product for any specific use.ConsuR manufacturer's literature for other product peftmance ' Inlorrnation www.rdrem Este tabrlcarrte estiputa que estos valoree cumplen con los procedlmlenbs aplicables de NFRC Para deteaniny el rendimlento tetai del producto.Los valores usados par NFRC son determinados par un conjunto filo de conditions ambientales y un tarnano de pmducto especilico.NFRC no recomlmda ningun producto y no gaWUza que el producto sea adecuado para un use espedflco.Comub con el folieto del fabricante pars elluso aproplado de este producto.www.rdre org• Unit quaLifi¢sh for ENERGY STAR r¢gion(s : Northar4, North' C¢ntaal, South Cgntral; Southaen. La unidad caLiiica ,paaa la(a) SNERt31'STAR s iu� a r¢giCn(aa) ENERGY �TA.R: Norta, NOrta C¢ntrai, Sur`:C¢ntral; Sur. ._ IND: Rain 00/Glaik2 3/32"/H—R43 T¢9t¢d Size:: 36" x 63" IND: ftafuar:o 00/Vidrio 2.38 mm/H-R43 DP : +4 5)1—4 5 Tina probado p 91.4 'emx 160 cm tvr;4 �S�f Qt 40773 HS Hoffman 2931120 Keep this label for possible ENERGY STAR®rebates.To loam more visit www.oneqift.gov Guarde esia efiqueta ppra posrbles reembolsos ENERGY STAR®Para conocer trios acerca de esto,visits www.ener mr.gov. C1 earninza�uuea/ o�C-/�iraaac«uaella oil ce of Consumer Affairs&Business Regulation License ol•registration valid for individul use only EIMPROV NT CONTRACTOR before the expiration date. If found return to; Office of Consumer:Affairs and Business Regulationgistrati Type. 10 Park Plaza-Suite.5170 Expir i Supplement :wd Boston,MA 02116 The Home Depot MARK NIADNA 2690 CUMBERLAND. S A`�'[3ifJi,GA 30339 Undersecretary of val�witiut signature J I _ I2612012 8:30.17 A34 ;%ST (e4T-8; FROM: 1001005-2 : -151 f :302086 page.: 2 of 2 AC40 ate® CiERTIFICATE OF LIABILITY INSURANCE A 42RM3 THIS CERTIFICATE IS ISSUED A5 A MATTER OF MIFORiAAT*0 ONLY AND COWERS No RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFUtMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TiIE COVERAGE A ORDER BY THE POLIO S BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESEWATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoiden is an ADDRIOMAL INSURED,the policy(les)must be sndarsed. H SUBROGATION IS It/AWED,subject to the teams and conditions of the policy,certain policies Array requite an endorsement. A staW meat on this cenificate does not confer rights to the i certificate holder in lieu of such endomew*2281. PRODUCER PAUL 6 SULLIVAN INS AGCY INC r T 1467 S MAIN ST PNONE FALL RIVER, MA 02724 amm RFfORDM COVERAGE NAIC e NSURER A; E43URER e mum BA J$ REMODELING JOHN DALEY waSWriRC: 15 WILSON WAY rASU D: MIDDLEBOROUGH MA 02346 resuaERE: . R COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MISLRRED NAMED ABOVE FOR THE POLICY PERTHIS IOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT:TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 3ECT TO ALL THE TERMS, M , CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED Rf THE POLICIES DESCRIBED HEREIN IS SUB EXCLUSIONS AND CONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMPS. LOAn3 110R TYPE OF NSURANCE Poucr NuMam - . LT,t EACHOCCURREt" S GENERALLIAaILITY is a accurrmce S COMMERCIAL GENERAL LIABILITY WED EW ene person) $ CIAIMS4AADE El OCCUR i PERSONAL S ADV INJURY $ GENERAL AGGREGATE S it PROOUCT3-COMPfOPAGG S . GENT.AGGREGATE LIMIT APPLIES PER: $ POLICY PRO LOC iwumLmlyS AUTOMON"LIABILITY aa� I BOOILY.tKlUF:Y{Per peuson). ANY AUTO BODILY NJURY(Per accaodil S ILL OWNED SGt1EOULEO AU, NONAWNPD eN S NIREO AUTOS �,�}AUTOS $ EACH OCCURKNCE i UMIROJA LOD .00CUR . • � wvcRECATE s 6G tsmI AO CLAANS.MADE I f OEO RETENTIONS 14 I S 212/2012 21212013 WCY I wGRfcExs >+PENSATIorA WC5-3tS38480p-012 M • A co mw awwww4EVIT Lmmu" 1Y--I N--y El.EAD4 ACCIOENIf ANY PROPRIETOA7PAATNEAIE%ECVTN£L� N!A Ex.DISEASE•EA EMPLOYEE S RI t O OFF ICE61EMSEa EXCLUDED? (Mandatori in NHt E.C.DISEASE•POLICY LIEgT S 50000 0 Tes,descs b under E TION OF OPERAT}ONS E2b_ DESCRIPTION OF ERATIONB f LOCAlU7N S f VENiCLE3(A11ash ACORO 161,Additional RamsrXs Sehet9rls,Nears space b requGPeO) Workers compensation instsance coverage applies only to the Workers compensation laws of the state of L4A. NO PARTNERS ARE COVERED 8Y�THE WORKERS COMPENSATION POLICY. EEWI&Woe C T AT NY OF THE ABOVE DE> RIBEA POLICIES CANCE4 f0 BEFORE TOWN OF BARNSTABLE wINn+DT1AtEpatcrPR*VtSI NOTICE WILL BE oELtvteaEn �+ 200 MAIN STREET HYANNIS MA 02601 EPRESEWATME ".Ut-2010 ACORa CORPORATION. All right's reserved• ACORD 25(2010A115) The ACORO name and logo ats mgWefW marks of ACORD 3:21Chic tto..eext livae22 me CLIENT and COPE- eedest1 pzevious l7c osuedl ceztlticat*$- nK Pa90 i of t 'fit •' ``� .w..,Aiaiwsa�le i U office of Consumer Affairs anid usiness Regulation 10 Park Plaza - Suitt; 5170 Boston, Massac41jsetts 02116 Nome Improvement Citractar Registration Registration: 132349 ;< � w,`;� •`-�... ... .' , ' Type: Partnership Expiration: 1/11/2013 Tr# 207392 J &J Remodeling Joseph Duarte - 15 Fall St. Wareham, ma 02571 Update'Address and return card.Mark reason for change. Address Renewal C3 Employment. Lost Card. )P"AR'G SOM-0006.0101216 uralo�4� ,ems• License or registration valid for I,ndividul use only Office o oasum a rs sloes e$u s oa HOME IMPROVEMENT CONTRACTOR before the expiration date: if found return to: HOME ..•132349 - Type: Office of Consumer Affairs and Business Regulation Regist10 Park Plaza -Suite 5170 Expiration: ':j/11t2013 Partnership Boston,MA 02116 Joseph Duarte ', '•.::a'''. '`� 15 Pall St. ithout signatureWareham,ma 02571< of va wt a �la"uchusett•- Depxlhment of Public'%:trct� 1 9our(1 of Buildim,, Redrul:ttiun5 aatl�uutdurd� Construction Supervisor License LicenSQ: CS 70077 JOSEPH C DUARTE 15 FALL ST WAREHAM.MA 02571 .. Expiration: j2j3o/2012 (..uu1J.<iiawP Tr#: 7048 s: 10 30ad Z9TtG6Z ES:Tz TIOUZO/Te M HOME•iPROVEMENT CONTRACT / r . PLEASE READ THIS J ' l �Prnished and installed by: Branch Name:'Boston Date: I` 'Z �' r THD At-Home Services,Inc. d/b/a The Horne Depot At-Homo Services + 908 Boston Turnpike,Unit 1,Shrewsbury.MA 01545 Toll Frcc(900)657-5182:fax(508)845-6017 Branch Number;31 Federal in#75-2698460;ME Lic#C 02439;.Rl Cont.Licit 16427 ' .�1r C'1 Lic#HICA565S22;MA Home Irtiproveinent Coim2ctor Reg:q 126893 Installation Address: 1�.. T 46 f I if Vi U11 Ci . State Zip Pur•chascr(s): Work Phone: Home Phone Cell Phone: t•^^ Cie Home Address: -- -,. — (If different from Ins4zllation Address) ' City ST, Zip E-mail Address(to receive project communications.and Home Depot updates): ❑1 DO NOT wish to receive any marketing ernails from The Home Depot Project Information: Undersigned("Customer),the owners of the property located at the above installation address,agrees to buy, i and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the rclorcnecd Spec Shcet(s),all of which are.incorporated into this Contract by this refcrcnre,along with any applicable State Supplement and Payment Surriinary attached hereto and any-Change Orders(collectively, "Contract")[ .. . Job#: (t"xromRa ) Products: s ecshee s #: Project Amount. // xx Roofing Siding'�LWindows ❑insulation ❑Gutters/Covers ❑Entry Doors ❑ $ - ❑Rooting []Siding Windows El insulation [jOutters/Covers ❑Entry Doors ❑ $ ❑Roofing ❑Siding Windows ❑Insulation- ❑Clutters/Covers ❑Entry boors❑ $ ❑Rooting OSiding Windows ❑insulation _ []Gutters/Covers [:]Entry Doors ❑ $ " Minimum 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount Maine Purchasers may not deposit more than one-third ofthe Contract Amount .Cistdmer agrees chat,immediately upon completion of the work for each Product, Customer will execuLc a Completion CcrtidQatc (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, cach`Customer under(his Contract agrees to be jointly and severally obligated and liable hereilnder: The.Home Depot reserves the right to issue a Change Order or terminate dais Contractor any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligatiorns due to a.structural. problem with the home,environmental hazards such as mold,asbestos or lead paint,other satiny concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary;r �� cJ included as part of this Contract, sets forth,thc total Contract amount and payments required for.the deposits and final payments by Product(as applicable)- NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note.: there is nne Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. It) the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the dale of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITIHI0LD AM0UNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DFPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement.bel.ween Customer and The Home Depot with regard w the Products and installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. ustomcr acknowledges and agrees that Customer has read;understiuids,voluntarily accepts the terms of and has received a copy t s Agreement. , Accemed by Sub ed by: 5 � x z5 r Custo ear/', a ore / Date Saks nsullanl's Signature Date a tf 1 rt 1�134 �� 1! Teleph eNo. Custome's Si}, t Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THiS (as applicably.) _ AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN,NOTICE TO THE ROME - x DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THiS AGREEMENT. THE ` STATE SUPPLEMENT ' ATTACHED HERETO CONTAINS A FORM TO USE 1F ONE IS SPECIFICALLY . PRESCRIBED . BY LAW 1N t -. CUSTOMER'S STATE. , I / NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSC SIDE AND ARE PAR r OF`l'II1S CONTRACT 05.10.12 White-Branch File Yellow--Customer , Td Wd9T:b 600E- ET .unf ° T2_=9£805: 'ON XUA PP6wp(': W021A 08-20-',12 06:09 FROM-THD PRODUCTION 5087559009 August 17, 2012 Barnstable Building Dept-. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres—CSSL#100546 HIC# 163528 Robert Reposa - CS#60526 HIC f# 147080 To`m_01hY-TKdi W-CS#51899 HIC# 152121 now Joseph Duarte. CS#70077 HIC#132349 . Douglas Szynal CSSL# 103950 HIC# 146142 Brian Laroche- CSSL#100478 HIC#152612 _ Joseph Mckeon - CSSL#98863 HIC# 132614 i if you have.any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S ce y, ussel Jo t Bran stallatioo'Manager._ THID At-Home UrdiCes,lno: 908'Boston Tumpik®- Unit 1•Shrewsbury,MA 01545 Phone:774+275.2/30•Fox.508.845.6076•Ton Free:600.657.5182 r I _. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION- Map Z Parcel b ! Permit# � Health Division GL�"� Date Issued _ 24 0-0 "W_Ic� Conservation Division Fee Tax Collector �'f � 'I ` � �YT � ��' I.'q' R a . Treasurer �'2-Pt,-1 L3,I Z�1 V91Th9 TITLE 5 Planning Dept. 01 Tdl!„ Date Definitive Plan Approved by Planning Board V` I Historic-OKH Preservation/Hyannis �Z Z c V. LOT 44, Project Street Address_ Village 6ptfv 2c�//yea t Owner L a&l'ce / { r Address Telephone y�0 t9/0it Permit Request 55ree4eel h D�K.l� - ��/���Z s��� = /'; X /� Il o �z� ��46 Square feet: 1st floor: existing/ N 1 proposed I S b 2nd floor: existing proposed .Total new Valuation t d� 600 Zoning District./ IC Cl Flood Plain Groundwater Overlay Construction Type 4)o&� Lot Size wo� Grandfathered: ❑Yes ❑No. If yes, attach supporting documentation. Dwelling Type: Single Family R7 Two Family ❑ Multi-Family(#units) Age of Existing Structure 71 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) `fir b Number of Baths: Full: existing o'L new Half: existing new Number of Bedrooms: existing a new Total Room Count(not including baths): existing 6 new First Floor Room Count Heat Type and Fuel: ❑Gas 0 Oil ❑ Electric ❑Other w Central Air: Ud YeS ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:&(existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use - Proposed Use BUILDER INFORMATION Name&kAj OW-A C Telephone Number 77s- 3 7' Address License# .0V0330 Home Improvement Contractor# IM 4 7 7 Worker's Compensation# �S 000 01-2 303�T— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rnS 1"l e JlM. d' ill SIGNATURE DATE -2 3/ 0-0 L FOR OFFICIAL USE ONLY . PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS " VILLAGE OWNER - DATE OF INSPECTION''y FOUNDATION :,'`-Y;,c; LP:+;,�`, r FRAME INSULATION FIREPLACE - a ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL • GAS: ROUGH FINAL - 3 FINAL BUILDING ` DATE C-LOSED,OUT ASSOCIATION PLAN NO. e Omn ot Barnstable ` � F4ABN5I'ARt c ' , 9 .� ���' Department of Health Safety and Environmental Services E� Building Division 367 Main Street,Hyannis MA 02601 Ofrice: 508-8624038 _. Raloh Crosse.-. Fax: 508-7 90-6230 BuiIdinz Cor 4-- Permit no. E t Date AFFIDAVIT HOME ZIPROVEMENT CONTRACTOR LAW SUPPLENIENTTO PERMIT'APPLICATION MGL c. 142A requires that the"recen=cdon,alflerations,reaovatim repair,modernization,conversion, improvement,removal,demolition,or consm cthm of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units onto stincmres which are adjacent to such residence or building be done by registered contractors,with camin exceptions,along with other requirements. Type of Work: : L LereeneLij Djrc.� " 4,*T, o,(1 e f Estimated Cost Address of Woric�� k�ehYa J` ori•�4 /Z�l C'e•��ee ki . Owner's Name:�t_ie )kr_(+� Date ofApplication: I hereby certify that: ; Registration is not required for the following reason(s): []Work excluded by law ❑Job UnderS1,000 []Building not owner6accupied []0wnerpul ingownpermit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR-GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent ofthe owner. g/a 3 0 r , Date Contractor Mimi Registration No. OR Date Owner's Name a::orms.Affidav f e °went of ln&uvid Acrichents . Depwye l'Ods =a ` t street 600 Washington �— <,ff OZlll Boston,Maser InsQrance davit Workers' Camamsation ►oc,,�cr. �f,+o� �,La l a hone! tie - Ol I-7fV p��v.,t1� ..•v �y/ rpnriirir,. i I am a hOm=O ��.++�+�"�'y all a= m an � . i I MMEMEMEMM=1 III am a sole groan_ zq=i form �� oathis job.MM K:- �. c= M . ..... ..„ ... {ry.(. ...,..........::::::.. .w.\• .- .. ... ....,.y:;, ..1.�{.{iryvr%}:•t}`{:{:$i}::::{i4}:}•:ti{j i I am IO_ '''�:4\4:•:wiii::Sji�ra.{{•:i:y;:.:y:v:: .............. :... ...:.. .. •.. �Yl�•:!> ... .. ..- ...-... .t,.a?:.4.�N:^}•::ti::::�tiv'is<:{;::tiiti•:i;}i::i:j;:;}::;:i}::$7:;:...:�: ... .. com�snv name.. 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LS. .....,v.v.•:r.}::a:!!+p.`Y.:.. �j..�.. „� �::.!. :,... .,40'lJYY96�J'A�" iit:P . ; tIl!4t'sT1Cc•tQ�: that a ___ ZsAnt�� ����Eg�sl�oeotS10Q00ada�'o���' raim'ctoaeemTrorrra� weII s3tfl ta�ato�otsi 1�It1�AAoo�ie onr years'lsnprssoraamz� s;s g ropy of Lhis statemeiu ffi7 beta to M=Qf it"P o � mfCl � _•1,t�OVt �COTfCd I do ntrcflv c�T�Y z�thtp�=d pa�allics jp J �l�"Daft ' la`3 -D p$ame# 771- 3700 lk e e� ����� u e only do not-rift in this sssesi to be �Buading Deparan�t aifl::zl wperm"Ce e —Oj,icensutg Boa ' ❑SdecuneII's OSSce cirr or town: �Health Depart"'t k if iinincai;Ltc response is se 4ui ciec red Qther�� plum 0 Information and Instrncfions =PIG.v=s to Provide workers* cC)MF--1srtlo: ` set 152 section 25 m4 as ever9 person is the service of another undo:nn�' �iassachuse:*.s General Laws chap Iv ee is defia�ed ,mDlot•ees. As quoted from the `Iaw ,an Prnp Y 3f hire. e�-pZess or implied, oral orwrittea. .: outer� • or any Two or mo.= - ned as an individual,Parmersh P, assoc:a�, �Po o�or of a deceased emPlo�•er. or :fin empl o}vet is de . including the�eves fio�.et er the cmi os th foregoing engaged in a Joint eaterPas�ssoc�or Giber le-al effit9' �PIG-M�o- - of the dv" =house rust,: of an individual,pazmershiP, and Who dw�,.or the occap house ling not maze than three. �vmk cn saeh dwelling house or on the �u•=-= dwelling ersons to do maiat=a=, eansau��� another who etaploys p shall not because of such empiopmrr�be Labe an employer• ouiiding appurte� o o-retie- �;1oeal�teens�S agency shall withhold the issuance • is the commonwealth for anv. applicant wizc ._ MGL chapter 152 section ZS also states that 'Y WOW Ad� o � ,�the ermit to operate a bnsiaess or to constraet of a license or p with��ce�F - public� ;��� not produced acceptable evident of fertbe p of Of its political sabdivLsu:ns sba3l-��0 �been eased za the cam== P� co:nmonjt e�1th nor tiny �h�ksu= - _ Rance tic•• table evidence of� IWO 01 113 :jpphcants ...-. dm=nd s ` ' f' tcatc ai" as an azaaa the warke1S' �� vrt vita may b.. r p, a n"il in nab address and mzmbets ikM9--" �o be sure to sign supplying comPany �"M df 0.-Tytrinsaid L :... the'acrnix dt :fed?O thZ DepaltM= bCI � P�toWIIt �PPrt � .. ,: , uI3W"Or'�. date the affidavit MW a A=MWILpoaha� _4d below. _ Cep reques+teed,not the Depattmeat r the D atlbe number W obtain a ���J T ,n..j► aze z�„�tuted ~- - - - City or Towns Space att�bottom o= - affidavit is cmapiete and p • ' . Y. no fh„app c'-�- thc e DSo,cam ., szue fiIl out intheevaztthe Off of �f°=m The affidavils may b..z�m.�a t" aavn roe y e amber WbichvMbe asedas ase� inthe �a9e iaadQ. be sure m n'1i P be�a Depara ='t-by mail or FAX rmirss,ad= •would Ike aperjd=and should you hBv'aa� m om of Inri_�oas ke to thank you.is advance �•voa c:o ` Tn.. Ofrce t hesitate to give us a call. e do no POP /%��' , a, 's address,telephone and fax number: The COMMOnwe2lth Of Massachusetts Department oflndustrid Accidents orrice of MoSti0aff 600 Washington Street gaston,Ma 02111 f=#: (617) 77.7-7749 _e MAP 2 182 o O 0 MAP 172 MAP 17, 1 3 100 # 49 o 172 ^� . # 110 MAP 172 180 # 59 \sitemaps\Public\m172p181.dgn 08/23/2000 08:43:32 AM a . } , � q+8 fir'• � �•> . �Y O -4 O . Y AOM c ka tN t� / l Tk - ✓bUlQdctC�Ude1, '"BOARD-OF-BUILDING"REGULATIONS. q"nse:,.gONSTRUdnON SUPERVISOR . Q48338 4 Blrtttx ,Q1/22/tl4 .. � _ �1122/2t2. Tr.no: 13450 105 HORSESHOE LAi�tE. CENTERVILLE; MA 02632 ~, Administrators ;VI ! 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