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Permit No. B-19-1445 Applicant Name: brien Langill Approvals Date Issued: 05/20/2019 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 11/20/2019 Foundation: Location: 180 HIGHLAND DRIVE,CENTERVILLE Map/Lot: 190-131 Zoning District: RC Sheathing: Owner on Record: CALLAHAN,TRACY L Contctor Name:j'€ BRIEN LANGILL Framing: 1 ra Contractor License: CS-106675 Address: 180 HIGHLAND DRIVE i 2 CENTERVILLE, MA 02632 Est, Project Cost: $ 14,322.00 Chimney: Description: Installation of roof mounted photovoltaic solar systems 6.51kw 21 Permit Fee: $ 123.04 Insulation: Panels i Fee Paidc $ 123.04 Project Review Req: - Date. 5/20/2019 Final: Plumbing/Gas a. Rough Plumbing: I ` a z buildin icia This permit shall be deemed abandoned and invalid unless the work authorized by this permit ism comenced`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 and 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 n. "'` Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy '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" (as set 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 QJvI.j.�c/tZ Final: Town of Barnstable - ? nee $ Post This Card So That.it is Visible From the Street-Approved Plans Must be Retained on Job.and this Card,Must'be Kept Building' Posted Until Final Inspection Has Been Made. el�'lfl ° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection-has been made. ' li llll Permit No. B-16-2277 - Applicant Name: CALLAHAN,TRACY L Map/Lot: 190-131 C Date Issued: 08/10/2016 Current Use: Zoning District: R Permit Type: Conversion Expiration Date: 02/10/2017 Contractor Name: Location: 180HIGHLAND DRIVE,CENTERVILLE Est. Project Cost: $ 18,000.00 Contractor License: Owner on.Record: ..CALLAHAN,.TRACY L Permit fee: $0.00 Address:: 180 HIGHLAND DRIVE Fee Paid: `•.$0.00 - CENTERVILLE, MA 02632 - ; Date: ti 8/10/2016 Description: RE-CREATING PERMIT IN MUNIS NUMBER 201101605 REMODEL KITCHEN & BATHROOM r` Project Review Req : RE-CREATING PERMIT IN MUNIS NUMBER 201101605 REMODEL KITCHEN &BATHROOM Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. 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,'alte ratio ns and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 ofthe work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing ! 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flu F p p e lining is installed- 4.Wiring&Plumbing Inspections to be completed prior to,Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations: Work shall not proceed until the Inspector has approved the various stages of construction. n. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). ' Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT J OWN OF BARNSTABLE Buildin tHE Tp� g 201, 101605 BARNSTABLE, * Issue Date: 04/11/11 Permit 9 MASS. �p 1639• Applicant: MARTINS CRISTYANE ?Fp�•l A Permit Number: B 20110695 Proposed Use: SINGLE FAMILY HOME 09 1 1 Expiration Date. 1 0/ / p Location 180 HIGHLAND DRIVE Zoning District RC 1 Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 190131 Permit Fee$ 92.09 Contractor PROPERTY OWNER Village CENTERVILLE App Fee$ 50.00 License Num OWNER Est Construction Cost$ 18,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REMODEL KITCHEN&BATHROOM THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: MARTINS,CRISTYANE BUILDING SHALL NOT BE OCCUPIED UNTIL A FINALI Address: 888 EAST WALNUT STREET INSPECTION HAS BEEN MADE. PASADENA,CA 91101 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEL40RARILY O N ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUabING CODE,MUST BB APPROVED BY THE JURISDICTION, STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF,THIS PERMIT DOES NOT•RELEASETHE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. f 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY, WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. ; PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL o,142A). gm ' 0 R BUILDING INSPECTION APPROVALS - .PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 4PR-^ 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health �- e� l •—���Ysee.a ' Town of Barnstable 8)4 1 1: ,ckTM��►q,�t► Regulatory Services Richard V. Sc*Interim Director & ' Building Division 6 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 PERMIT# A(50 y�D FEE: $,s�5 za SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less A1Qh,(6AAJkL1�) t fi-) Location of shed( ess) V' ge Property ownerk name Telephone number 00 Size f S ed 'Map/Parcel# e Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? /k)b.. If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN P • Q-foris-shedmg REV:110413 Town of Barnstable �1ME Regulatory Services p �•Richard V. Scali,Director 1ARN3IABLE ; Building Division BARNSTABLE _ canna s�is�'w-�v�iiiFCOvas�i'"nux�sue� 1639. ,� Thomas Perry, CBO 1639-2914 ATFD 1A0�A Building Commissioner - 575 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mams Office: 508-862-4038 Fax: 508-790-6230 M July 2, 2015 Tracy Callahan 180 Highland Dr. Centerville, Ma. 02632 RE: 180 Highland Dr., Coiuit, Map: 190 Parcel: 131 1 Dear Property Owner, This letter is in response to application number 201502677 submitted to add a shed at the above referenced address. As previously discussed on the phone, the application can not be approved at this time because of the following: 1) The location of the shed in relation to the property lines is not shown on the construction documents submitted. Additionally, the property is the subject of an open building permit(application number 201101605). Final building, plumbing, electric, and gas inspections are required. Please do not hesitate to contact this office with any questions., Respectfully, L: Lauzon Local Inspector jeffrey.la-Liz6n@town.barnstable.ma.us (508) 862-4034 4 F . Town of Barnstable Geographic Information System August 5,2015. �za 190123 #189 40* w� 190132 Q i—et ram! #168 " CA f C M 190131 #180 190122 #190 190139 , #60 190140 050 0 13 F t 190121 #40 • Co-Owner: DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:190 Parcel:131 � - e. Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of CALLAHAN,TRACY L Total Assessed Value:$233100 1'=100'may not meet established map accuracy standards. The parcel lines on this map C - are only graphic representations of Assessor's tax parcels. They are not true property Co-owner: Acreage:0.35 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:180 HIGHLAND DRIVE-, such as building locations. Buffer ��'; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 06 Parcel /31 Application # C26u Health Division Date Issued Conservation Division Application Fee r� Planning Dept. ': , ; Permit Fee 09 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street dress 96 c%C. Village ✓//4el , L Owner e Address Telephone a (/ `0��.0 Permit Request allnewell P Square feet: 1 st floor: existing V000,proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o� Project Valuation Construction Type Lot Size a 35 ae,.eA Grandfathered: ❑Yes &�o If yes, attach supporting documentation. Dwell' Type: Sin le amily Z Two Family ❑ Multi-FaY units) z. ,9 LLA ._ A 'Existing Struct •6. Historic House: ❑Yes On Old Kin 's Hi hwa : ❑Yes:'Wl o 9e0 g 9 :g Y �w Basement Type: /Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) V 06all Z�w"' Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 13 existing _new Total Room Count (not iZas' ing baths): existing new First Floor Room Count CO Heat Type and Fuel: � ❑ Oil ❑ Electric ❑ Other Central Air: ❑ C!Yes No Fireplaces: Existing /New Existing wood/coal stove: ❑Yes O No Detached garage: ❑Jp existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Coexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � G ( "( G Telephone Number Addre s 4�v �7 � r' License # 42-&3Z Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCT N D B 4ESULTI FRO THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9/�( r FOR OFFICIAL USE ONLY r APPLICATION# x DATE ISSUED 4 r MAP/PARCEL NO. 4 ADDRESS VILLAGE - OWNER DATE OF INSPECTION: , FOUNDATION r. FRAME 1 INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL t' PLUMBING: ROUGH FINAL !f GAS: ROUGH FINAL ;r , 'r FINAL BUILDING r 4. x DATE CLOSED'OUT ASSOCIATION PLAN NO. u The Commonwealth of Massachusetts Department of Industrial Accidents 11 Office of Investigations 600 Washington Street Boston, MA 02111 �. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Oda) City/State/Zip: � 3Phone #: ��'i -bi35 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer.with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- Misted on the attached sheet. 7. Remodeling ship and-have no employees. These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9. ❑.Building addition No workers' comp. insurance comp. insurance. required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all Work officers have exercised their 11.0 Plumbing repairs or additions myself No workers' comp- right of exemption per MGL Y [ P• 12.❑,Roof repairs insurance required.] t c. 152,§1(4), and we have no employees. [No workers' 13.❑ Other w comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. /am an employer that is providing workers'compensation insurance for my employees.• Below is the policy andjob site information. Insurance Company Name: - Policy#or Self-iris. Lic. #: Expiration Date: . Job Site Address: City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy nu"er and expiration date). Failure to secure coverage as required under Section 25A of MGL.c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.0 a y agAn% the violator.,Be jd that a copy of this statement may,be forwarded to the Office of Investigatio of th D Armor surance c eragoertfi.cation. 1 do here b certi er t. pains d pen •tip of perjury that-the information provided above is true and correct. Si nature. Date: Phone#: ")`—(J f Official use only. Do n6t write in this area,to be•completed by'city or.town official City or Town:' Permit/Licertse# 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#: Information and Instructions. Massachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the servicey of another under an 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 foregoing engaged in a joint ente rise,and including the legal representatives of a deceased employer, or the g gJ rP receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However th e 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 deemed to be an employer." r on the grounds or building appurtenant thereto shall not because of such employmentbe 0 1; pp MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees; a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be 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. Self-insured companies should enter their 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 permit/license number which will.be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current . policy information(if decessary)'and under"Job Site Address"the applicant should write"all locations in (city or town)."A. copy of the affidavit that has been officially stamped or marked by the,city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a-homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Teo,9.617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable Of THE Regulatory Services " snwtsTeaLe Thomas F.Geiler,Director, nrnss. Building Division RFD 1i�y A Tom Perry,Building Commissioner 200'Main Street, Hyannis,MA 02601 „ www.town.barnstable.ma.us z - Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE.EXEMPTION Please Print DATE: �� x 10B LOCATION: ( T a_ypr�` / number / street village "HOMEOWNER": C' name home phone# work phone# CURRENT 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 homeowners to engage an individual for hire who does-riot 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 al 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-', e un ersi ed"homeow ifies that he/she understands the Town of Barnstable Building Department minimu a-tion. edures a requirements and that he/she will comply witlr•said procedures and re uir t S ture of Home err Approval of Building Official Note: Three-family dwellings containing 351000 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 perniit 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 - work,that such Homeowner shall act as supervisor.." Many homeowners'who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed person as`it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexirr pt r pF THE Tp� t RARNSTABLE. 1' ,�� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 Sign This Section If Using A Builder ` 1> , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\4ppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 r � Ji77 7 l3 �, . - no, Ra* LlC1, 44, tj 41 - . . Vngineering Dept. (3rd floor) Map _ 1 4 o_ Parcel ' F.JS Permit# House# Date Issued 7 Board of Health(3rd floor)(8:15 -9:30/;1:00- o�S� 670 Conservation Office(4th floor)(8:30-9:30/1:00-�2:00) NO Planning Dept.(1st floor/School Admin.Bldg.) i SEPTIC SYST T BE r : INSTALLED 1 NCE Definitive Plan Approved by Planning Board 19 •- w/�TH e ENViRONME M ' TOWN OYBARNSTABLE� WN REG E AND Building Permit Application Project Street Address 3 VillageC'�I>T�'a2 Owner 1 Address /86 W4A'ZAQ Telephone '7 T Permit Request /i✓S? 7 .C�✓✓ 1 i First Floor square feet Second Floor 1 ' square feet Construction Type - Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes Ulo Dwelling Type: Single Family � Two Family ❑ Multi-Family #units) Age of Existing Structure Historic House ❑Yes IIfNo On Old King Highway's Hi hwa ❑Yes U14o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: - Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes M4 o If yes, site plan review# Current Use Proposed Use Builder Information Telephone Name hone Number p yZ� 1Sr/� Address License# O�Jo s 2— Home Improvement Contractor# AQB 7W �77 -�L_1�t � Worker's Compensation#00'1#135 Z. Z6Z NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS R SULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ✓ i DATE BUILDING PERMIT DENIED FOR THE FOLL ING REASON(S) 1 ' FOR OFFICIAL USE ONLY PERMIT NO. -1' e . .;#... DATE ISSUED.. - ., - : .. �- ' � + • i r ^ tea: � •s.. -.'.4 MAP/PARCEL NO. ADDRESS e . `I rY VILLAGE p t OWNER di DATE OF INSPECTION: FOUNDATION # r FRAME . , •;~ 1 ; ;F ;: t r . INSULATION -� _ t �� - � _- ., •f. �. w ,FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: r tkOUGH r ' FINAL. GAS: * 4 ROU H FINAL•' (�" i�� -• fir''. '• . - r FINAL BUILDIN45 r $ DATE CLOSED O `. oi• r ; + t ASSOCIATION Pfnl X O. Y tri 0 i if ,h �)I—1 ti F ARTHY T�gfayit ] 1 M➢9t 43 i t f .�.E RUCTIONO { ; fiat and Commercial Builder 141 V1 3 11. „�. 4 a W 'Sa S k 3 S fib; 1 :� T 12 ,. sP�ECIALIST;�� AL o s r D IS N a4 March 15,'2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201201374; Status A; Parcel 190131 at 109Highland Drive, Centerville, MA; Permit Type RADD and issued on 3/16/2012 has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction f - IT Town. of Barnstable _ *Permit# Regulatory Services Fee 6mon fro ' ue • BAtuvsrnat.e. • , 9 MASS. Thomas F.Geiler,Director i639. fp�6 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 IQ� l6 Not Valid without Red X-Press Imprint Map/parcel Number /yy�� (J Property Address Residential Value of Work$ 16'Q Minimum fee of$35.00 for work under$6000.00 ' Owner's Name&Address C a, A"'i 9 i ►L la44 t V-e-, Cj Contractor's NameJbtNl►tIw a YY jctr ht" ivt.(6s1J Telephone Number q0 `. 9�'66 l � Home Improvement Contractor License#(if applicable) 3 Email: Construction Supervisor's License# (if applicable) Q L [Workman's Compensation Insurance Check one:❑ I am a sole proprietor 40Ti4_,�� ❑^�I am the Homeowner �cJ'1 have.Worker's Compensation Insurance PEP Insurance Company Name . 5 NoV. Workman's Comp.Policy# f 3 cj;�_ 3 0 WZA Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to . ❑❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [e-side Replacement Windows/doors/sliders.U-Value 0 . O (maximum.35)#of windows #of doors: ❑ 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. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r­qquired. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 I Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -:Department'of Public Safety Board of Building Regulations andStandards Construction Supers isor License: CS-095707 BR1iAN D DENMSON f r 7 LAMBS POND EIRCL'E Charlton MA 0150Y1 J.�e•ar �11�6 >i 11i Expiration Commissioner 09/08/2014 � _cJfie �ptmrinumurea,�Gl d �Zc.+Q�a e - Office of Consumer Affairs�an Business Regulat�ion 10 Park Plaza-Suite 5170 Boston,Massachusetts 021,16 Home Improvement Contractor Registration Registration: 173245 - Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119/2014 DENNISON BRIAN " 1137 PARK EAST DRIVE' WOONSOCKET,RI 02895 ' Update Address and return card.Mark reason for change. . n,Address -Renewal 0 Employment D Lost Card , �*1/ `h..,,,,,,�, G/.,fry.//, /.,u.2• flke ofCo r Ai4irs&Boaintn a<Q tali• - License or registration valid for indivldul use only .F before the expiration date.If found return to:OMEIIAPROVEMENT CONTRACTOR � � P - Office of Consumer Affairs and Business Regulation ' s _ Registration: 173245 - Type; IO Park Plera-Suite 5170 - - Expiration: 9/1SI2014. Supplement::ard Boston,MA 02116 • - SOUTHERN NEW ENGLAND WINDOWS LLC. • - RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK EAST.DRIVE WOONSOCKET.RI 02895' - Undersecretary - Not valid without signature - - ' The Commonwealdl of Massachusetts z; Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name(Business/Organization/Individual): ,E/V d LLG Address: o`Z (oaffiloAJ 90—a p v City/State/Zip: L 1AI6,0& , /<<�• AtSbS Phone#: 4101 ;P Are you an employer?Check the appropriate box: _Type of project(required): 1.[1 I am a employer with A l) 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roo rep 'rs insurance required.] t C. 152,§1(4),and we have no employees. [No workers' 13. ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Sill-QiItIC6,M,0"V14 Policy#or Self-ins.Lic.'#: 5 d 3 3 Expiration Date: 4 Job Site Address: 1 a '� �{1 �l City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). p yb Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true nat a t. and correct. Si ure: Date: �O tJ _ Phone#.. .q0 L o? a 9 — 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#: Client#:30124 SOUTNEW ACORDr. CERTIFICATE OF LIABILITY INSURANCE °8sw201-3 THtS 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 policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this.certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME Anita Little - Willis of New Jersey,Inc. PHONE g56 914-4660 F 856-914-1881 A/C No Ext: AIC No 1015 Briggs Road,PO Box 5005 EMAIL ADDRESS: anita.little@willis.com PO BOX 5005 1' INSURER(S)AFFORDING COVERAGE NAIC# Mount Laurel,NJ 08054 INSURER A.Selective Insurance Co of the S 39926 INSURED INSURER B Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER C,Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen INSURER D' 26 Albion Road INSURER E I ' Lincoln,RI 02865 INSURER F i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS UED 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. LIMITS SHOWN MAY HAVE BEEN Rk.DUCED BY PAID CLAIMS: LTR TYPE OF INSURANCE NSR SUBRI WVD POLICY NUMBER MM/LDIDY EFF MM/DDY EXP ' LIMITS A GENERAL LIABILITY S202945900 8/10/2013 68110/2014 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES FORUM occurrence) $100 000 CLAIMS-MADE OCCUR ' MED EXP(Any one person) $1 O 000 I PERSONAL&ADV INJURY $1,000000 I GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO- LOC A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/10/2014 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED _ BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS [ Per accident A X UMBRELLA UAB OCCUR S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE ,. AGGREGATE s5,000,000 DED RETENTION$____ $ C WORKERS COMPENSATION 0000068028-RI 8/2112013 08121/201 X WC STATUT. - orH- ER AND EMPLOYERS'LIABILITY Y I N B ANY PROPRIETOR/PARTNER/EXECUTIVE� AIC927818352394 8/F1/2013 08/21/201 E.L'EACH ACCIDENT $1 000 000 . OFFICER/MEMBER'EXCLUDED? nl NIA (Mandatory in NH) E.C.DISEASE-EA EMPLOYEE ,$1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below - - - E.L.DISEASE-POLICY LIMIT $1,000,000 ' I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS.' Lincoln,RI 02865 s. AUTHORIZED REPRESENTATIVE '_� F..• ~ _. r. , e? r,_~ *. .` `r ©1988-2010 ACORD CORPORATION.'All rights reserved. ' -cxr ACORD,25(2010/05)., ' 1 Hof 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL I , r X%CUCWAA UY&LU"W 7Caa VA ovuUmcraa LNCW l Xzwa w ;_�.-• CUSTOM WINDOW AND DOOR REMODELING AGREEMENT.. Buygr(y)Marne: — -TVALf L.- (2 4- e `t i Date oi e 9 U � ny u Buyers)Street Address.City State.and Z10 Code r PQ.Bmc u O H { E-MailAddrew Home Telephone Nunit'.1 � 27/ _ 6113�orkTelephone Number: Buyer s)hcreby joindy and severally agrees to purchase_the products and/or senices of Southern Ncw England'Nrindms,LLC d/b/a Renewal by Andersen.of Southern Nlcw EngIand.("ContractorI),in accordance with the terms and conditions described on the front and the reverse of this agreeinent and on the attachedspecifi6tion shcct(s)(collectively,this`Ageeeme'nt"). 0 Historic E7 Condo 0 HOAR TotalJobAmount l 1 Estimated Starsing:Date: Method of'Nyment O Check ©Cash �Flnanced Deposit Received(33%}:- Credit Cards are accepted for deposit-only—maximum 113 of the Balance at Start of job(,33X):_�.Nl� project cost(,please see Credit Card Payment Foam)By signing this Esumaced Completion Dale: Agreement,you acknowledge that the Balance at Start of)ob and the Balance on Substantial _ w�L Balance on Subsrantal Completion of Job cannoi be made by cr edit Completion of Job.(33%): card and must be made by personal check.bank check,or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties; and that there are no verbal understandings changing any of the terms of-'this Agreement. Bdyer(s) acknowledges that Buyer(s) (1) has read this Agreement, understands the terms of this Agreement, and has received.a completed, signed, and'dated copy of this Agreement,.including the two attached Notices of Cancellation,oa the dateArstwritten above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Boyer..(1)Do not sign this.Agreement if any of the spaces' atended for"the agreed.terms to the extent of then available information are left blank.(2)You are entitled to a copy of-this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance'due under this Agreement,and in so doing,you.may be entitled to receive a partial rebate of the finance and insurance charges.(4)The'seller has no right to unlawfully enter your premises or commit any breach of the.peace to repossess,goods purchased under this Agreement.(5)You niay cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or'certified mail,which shall be posted not later than midnight of the third calendar day after the day on which t)ie buyer signs the�Agreeiiient,,exelnding.Sunday and any holiday on which regular mail deliveries are not made.See the accompanyingoodee of cancellation form for an explanation of buyer's rights. Buyer(,)received the consumer education materials provided by the R Is nd`C retractors . gistration Board: (Buyers bilials) Renewal by Anclersmi of Southern New England Buy r(s) -Buyer(s) By: G � Si hatuic Product Ma-pager i tiirc, Signature Prim Vame.of Product Manager Pnnt Nainc Print name YOU, THE BUYER(S), MAY CANCEL, THIS TRANSACTION,AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - � _ _ - - �- - - - - - - - - - 4c- - -.- - - -. - -. - - — —3 NOTICE OF AN 'LLATIO NOTICE OF CANCELLATION Date of Transaction 2 v .You may cancel l Date of Transaction .You may cancel this transaction, without''any en ty or'obligation,'within this transaction,without any penalty or obligation, within three business days from the above date.If you cancel,any 1 three business days from the above date.If you cancel,any property traded in,any payments made by you under the ( property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following: I by you will be returned within ten business days following receipt by the Seller of your cancellation notice, and any I receipt.by the Seller of your cancellation notice, and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.If you cancel;you must make available to the Seller I canceled.If you cancel,you must make,available to the Seller at your residence,in substantially as good condition as when ( at your residence,in substantially as good condition as when received.any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale;or you may,if you wish;comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at Seller's expense and risk.If you do make the goods available X Seller's expense and.risk.if you do make the goods available to the Seller and the Seller does not pick'them up within, I to the Seller and the Seller does.not pick them up within twenty days of the date of cancellation,you may retain or .I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without Any further obligation.If you fail to make the goods available to the Seller,or if you agree I fall to make the goods available to the Seller,'or if you agree to return the goods to the Seller and fail to do so;then you l to return the goods to the Seller and'fail to do so,then you remain liable for performance of all obligations under the remain liable for performance of all obligations under the Contract.To cancel this transaction.mail or deliver a sieved ( Contract.To cancel this transaction,mail or deliver a'signed TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN QFN T� LE MapO Parcel = Application m o 12 A, j f [. Health Division bZte Issued Conservation Division \Application Fee ' g pt. permit Fee Plannin De Date Definitive Plan Approved by Planning Board 3�/6/iL Historic - OKH Preservation / Hyannis Project Street Address �kG ��•1� Village C- ilt, Owner 1 y'ce.i - 4 �r. Address Telephone_ -0135 z Permit Request � ��� Ih C�/�d��,= �► ��- � Square feet: 1 st floor:-existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation$ � � Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U(/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing '❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _Current Use Proposed-Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name rdwe McCarthy Construction Telephone Number PO Boa 52 Address West DennK MA 02670 License# Cell (sue)280-6%4 - CRIAN33 HIrC-169393 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE S r FOR OFFICIAL USE ONLY 'APPLICATION# E DATE ISSUED ti MAP/PARCEL NO. ;q is ADDRESS VILLAGE OWNER DATE OF INSPECTION: } FOUNDATION ' `' 4 Y FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:- cv ROUGH FINAL -FINAL BUILDING- ., DATE CLOSED OUT r ASSOCIATION PLAN NO. R. The Commonwealth ofMassachusetts , DeparbnenfofIndustrialAccidents., k .. Office of Fnveskgadoirs -,t '660 Washington Street Boston,MA 02111 www.mass gov%iia Workers' Compensation insuranceAAf idavit•.Buhders/Contractors/Elect icians/Plumbers Applicant Information Please Print Lep-iblp Name Mike McCarthy_Construction PO'Bo8 52 , Address: West Den®is. MA Q2670 Celt (5 ) City/Statelz �4 P• CSI _4R6�3P _169 Are you an employer? Check the appropriate b6X: g 'Type of project(required): L❑ I an a employer with •4. ❑'I am a general contactor.and I �nployees(full and/or part-time) have hired the sub=com cactars 6_ ❑New construction Z. I am a'sole proprietor or partner- Ii&ted oii the'attached&heat . ' 7. []Remodeling; ship and have no employees These strb=comractars hate g, Demolition working far me azly capacity. employees snd hate wormers' [No workers comp.ms,==e ` COmp.in�tiranee,$`: 9: $uiI addition required.] 5 [] We are a corporation and its. M10.❑Electrical iepairs or addihons x. 3.❑ I am a homeowner doing aIl work officers,have exercised their: . 11:[]Plumbing rep airs.,ar addztione myself [No workers'Comp. right 6f exemption per I�ICL I2.[�Rnofrepairs` . insurance regtm�ed.J t c:152, §1(4), and we have no ., . employees.[No workers' M 1:•��er3,��z... comp.msur=e,regttired,] *Any appIicnnt that cheeks box#i must also ill out,the section below showing then workers'pompeasatioa policy infamratioii t Homeowners who subnat this affidavit indicating mey are doing all work and then hire outside cantracta s must subnit a new affidavit indicating such $Contractors that check this box must attached m additional sheet showing the naznc of�b sub-contracturs and state wheflur ar not those entities Bove , ernployees. If me sub-conhazt=have employees,they mustpravide their workers'.comp.poHcynumbcr.'' I am an employer that is providing x�orkers'compensation insurance fnr my employees. Below is the policy'and job:site._ information. Insane Company Name: ' Policy#or Self ins.Lie.# Expiration Date. lob Site Address: 7r-o ►�c��:.c� ] City/State/Zigt Cc•-,icr` [[< ?J7/� 4ttach a copy of the Workers' compensation policy declaration page-(showing the policy number and egp ra an'date} Faihire,tn sr,= coverage as required u 6.nder Section25A of CIL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisanmmrt as we.0 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,stateinerit may be forwarded to the,Office of Investigations of the MA far' ce covera a veIIficatian :.-. .r I do hereby certify un e p ns d penalties of perjury that the information provided ab ve i true and correct . Si tare: I?atE: 3 .��-/177 Z Phone *' x Official use only.'Do not write in this are¢,to be completed by city or town.off ciaL:... City or Town: Permit/License#� h � Isstung AIIthority(circle'one): "A. 1.Bbard of.Health Z.Btulding Department 3 Citp/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone z. _ f li I - _ Office of Consumer`Affairs and usiness Regulation.. f 10 Park Plaza Surte-5170 ` nF Bosion Massachusetts'-02116 ` Home Improvement Contractor Registration ` w Registration: 169393 Type: Individual. <, Expiration: 6/16/2013 Tr# 213517 MICHAEL MCCARTHY ' , MICHAEL MCCARTHY - P.O. BOX 52 � � WEST DENNIS, MA 02670' `.Update Address and return card.Mark reason for change. Address' ❑ Renewal Employment Lost Card: DPS-CA1 is 50M-04/04-G101216 -------- _� ✓/C Consumer Affairs& °�'ess Regulation l� License o"r re istration`valid for individul use only Office of Consumer Affairs&B siness Regulation" g Y - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration ;}g969393 Type: Office of Consumer Affairs and Business Regulation t Expiration 6/16%2013 Individual 10 Park Plaza-Suite.5170 :. E Boston,MA 02116 MI AEL MCCARTHY MICHAEL MCCARTHY 6 RANGLEY LN. SOUTH DENNIS,MA 0266Q — Undersecretary t valid without signature ZLLSZ :#�1 Z L0Z/0 61tr OL9ZQV` 'SINN34 M Z9 Yoe Od t-, �` Wit- H LOIN 1?�dO�VV (' H e6 00 •01 papu;sa'd asua�1� aoSlAiadnS>uoilonj;suo0 .:SPai.Pu1 1S,P ur.tititiilr.ln-a� UIPI!n8 10 Ptro9 �1a}�cs �!14nd.4o luautlird�a Sllatinq�rtisr.W - : } . „y J r OWNER AUTHORIZATION FORM I f r-a (Owner's Name) owner of the property located at (Property Address) (Property Address) herebyauthorize �� u0 G , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my pro rty. w 's Signat re Date . .. °: The Town of Barnstable URMAM . 9e � ' . Department of Health Safety and Environmental Services TEo ram" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. / Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT•APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: hl✓>" ta� Est. Cost ­21 Z:A� Address of Work: _D" Lrrn-o'✓/ Owner's Namelid Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR 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 a ent of the o�: Date Co ractor N me Registration No. OR Date Owner's Name The Conrnronl+•cttlth of:1tassachusetts Department of Industrial Accidents ��.. Otlice ollnyestfgat/nos 6MJ Ma-vhin��tua Street Boston.Ala s. (12111 Workers' Compensation Insurance Affida-vit i iiin inf•rni itiri• --.. I,1- T, -�.•--�...,,`..._.r•--•r..—........^.,._.— ------ -- - �/y���2_v � � �r1t� mil'✓� Incntion• ril" ��/% /! i/ � �0 c am_ nhnnc if [j 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [I I am an employer providin_ workers compensation for my employees working on this job. cmmunov name: address. nhnnc ft• [� 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who ha%-: the Following workers' compensation polices: cmmrinny name, addresc• cir- nhnnc#• incurnncc rn nniic� # - • `�."- .-. �..:Y' � -- �ram_ -_� -�5••)!•.�w•y�'�� ��...-. . .�.-._..-.-. cmmnnnv nhnnc: addrecc- sin nhnnc#- insurance ce nnlic� # Attach additional sheet if necess ary Failure to secure covcrace:ts required under Section SA of NIGL 152 can lead to the imposition of criminal penalties 01•2 line up to SI.500.UU andiur unc years'imprisonment as w0l as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. i understand that a copy of this statement may be furwirded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjun•that the information provided above is true and correct. Si^_nature _Date Print name C�-- ��a� Phone official use unly du not write in this area to be completed by tiny or town official t� city or town: permit/license d r7Building Department CoUcensing hoard C C:check if immediate response is required 0Seleetmen's orrice t.. (:111calth Department contact person: phone#• r70thcr !I w I �7-- I ✓fie oll/�l��a.Qae� I I HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards i One Ashburton Place — Room 1301 i Boston , Massachusetts 02108 I HOME IMPROVEMENT CONTRACTOR - ------------------------------ -- Registration 100740 Expiration 06/23/60 Type — PRIVATE CORPORATION I HOME IMPROVEMENT CONTRACTOR I Registration 100740 CAPIZZI HOME IMPROVEMENT , INC . Type - PRIVATE CORPORATION Thomas Capizzi , Sr . I Expiration 06/23/00 1645 Newton Rd . Cotuit MA 02635 I CAPIZZI HOME IMPROVEMENT, INC hh as Capizzi, Sr. 1645 Newton Rd. ADMINISTRATOR Cotuit MA 02635 .. i DEPAP,TMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR 110ENSE Nutber: Expires: Restricted To: 11 TNOMAS X UPIZZI JR 286 PERCIVAI DR R BAR.NSi ABLE, MA 12668 III_