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HomeMy WebLinkAbout0024 HORATIO LANE .+ � �.. �,, _ v�Jt� �e, � ,. :.} + 3 a. � �:. �ar. rTd�� _. !- r�.} d`ae'.� r 41,.. - - _ �t.`. � r�N d .. � < .a. � � r 4 . r ,. t�, iY. y.. '�1 a 96 �. � f a � � t 1-�� ... � .� T .:» ..- r � .�F ��, ,',+ �,•. 7. ° �n s � ., .„ .. .. ;... _, .; -,:, _' __ ^+ �r a.: it � v_..:'_., �: ,___ ,:...... :.. ,. , r -- � .� a o .. � o o a � e � . ,. ., u, - - .. r. - � ry _ .. .r o. .. i � - o Y .. �. _ � � � ,. .. _ �- ,. - ,_ .. .s _ a �. - - �.. ... :. .. .. ,. �� .. .. -.. � e .. c. .. r ter° Town of Barnstable _ ]Building_ . z srA�t Post This Card So That it is Visib,! from the Street-Approved Plans Must be Retained on'Job and this Card Must be Kept MASS. ,Q, �,>'.: xt,-'.''_ •,..h,. G� i - wzt'y`�'�,�" r^ C am{ ` - • i63� Posted UntiLFinal Inspection Has Been Made. �`" y k,. _ '� "; ��� �� Where a Certificate of Occupancyis Required,such Building shall Not be Occupied until a Final Inspection has been made. _ ._ Permit No. B-20-1154 Applicant Name: Renato Da Silva Approvals Date Issued: 05/18/2020 Current Use: - Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/18/2020 Foundation: Location: 24 HORATIO LANE,CENTERVILLE Map/Lot: 228-142-001 Zoning District: RD-1 Sheathing: Owner on Record: TAYLOR,JOHN W&NANCY W Contractor Name: RENATO SILVA Framing: 1 Address: 1 JENNINGS ROAD t Contractor License: CS-098849 2 WESTBOROUGH, MA 01581 Est. Project Cost: $;10,000.00 Chimney: Description: Demo existing greenhouse and build a wood frame,structuralPermit Fee: $ 101.00 similar size. Insulation: Fee Paid:' $ 101.00 0tA- Project Review Req: ', Date: �`f 5/18/2020 _�/>� Final: o� Plumbing/Gas �— Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months efte�l�Mf�'e.Official 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. I Final Gas: r 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_instalied„ Rough:. 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 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 Final: S i 3,01 qo" s — �' Town.of Barnstable *Permit# g 0,M,T Expires 6 monthsfrom issue date Regulatory Services Fee BARNszAB C 02 2014 • Richard V.Scali,Director OF BARNSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I;a�y Not Valid without Red X-Press Imprint Map/parcel Number.' 1e� b Property Address (o 1 �nP �n*x\1 Residential Value of Work$ Op'o _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �06 I tAs,1109 �o,Lfio Line Cr 'ii v;�`e Contractor's Name Ca Iunci11 -32 NCr— Telephone Number 5 Home Improvement Contractor License#(if applicable) \10oU S Email:L,L� lc>`,cx. (�b Y4mco Cct.A\ Con truction Supervisor's License#(if applicable) Q. 09 t-sao s Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �I am the Homeowner I have Worker's Compensation Insuranc Insurance Company Name g al n tf OctI��} ��--� � M Xf kt J p y v Workman's Comp.Policy# INIc - S D ��� ' f✓ y Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ c(check box) 0'Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken t<�&, m ❑Re-roof(hurricane nailed)(not stripping. Going over 3— existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (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 required. SIGNATURE: Q:\WPFILES\FORMS\building permit fo�Fss .doc Revised 061313 5 FIRS`[' CLASS CONSTRUCTION LLC **ROOFING 160 Baker Street (781)251-0710 Bus. Walpole,AIA 02081 (508)596-9478 Cell (508)660-7075 Fax MA License#CS 91588 HIC#170068 Roof Contract: Will.do work as specified: John Taylor 24 Horatio Lane Centerville, Massachusetts 1-508-451-5858 Scope of Work: House Roof Roof: • Strip roof complete • Remove any rotted board • Replace rotted board (120 lineal feet allowance) • Install: Aec • ' ��a thielcJ-frem fasciabnacd_back ICe- • Tarpaper over remaining area • New pipe boots • 8 inch white aluminum drip edge around perimeter / • Shingle starter course - • 30 yr.architectural shingles by CertainTeed;color(owners preference) • Cobra vent • Shingle cap • ,Run magnet over property to clean all nails • Dispose all debris TotalMaterial and Labor: $8,500.00 4 *CONTRACTOR PAYS ALL PERMITTING FEES ASSOCIATED WITH THE CITY OF BARNSTABLE. r ' w � Fti _t • The Homeowner agrees that in the event the Homeowner breaches this agreement and legal action is commenced by the Contractor for the purpose of enforcing the terms of this agreement or collecting any sums due,in addition to any other sums the Contractor should be entitled to,the Owner shall pay for attorney's fees. • Cancellation: Homeowner may cancel within 3 days of execution of this contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Agreed: - Date: r ay r, Homeowner Date: Coleman Joyce,M geo First Class Construction, LLC 9b10£ :#al i,iui,issiwwo;) ZLOZ/LZ/L :uoi)endx3 r 680ZO VVY '3-10d'lVM � f 3oAo =1 MdW3-100. �` egg l6 So-:asuaji� ..; . .aSuaoij Josin.i.adnS uoilonijsuo0 =sp n•Pu�'1S puic suor►r.ln �� ;ui�rlin8 }�►{).krog �.� - ':• . �h�rrS ml(Ind.10 luauil.rr.did -sjl-)S.ny�rssrLU - ~� L ` � orr,e ore u �aaaecue2l , OME 1 ROV Affairs egistrat- EMENT CpNB°sines Regulation eC� xpiration; 1700s8 RACTOR 9/1 ' FIRST 2/2015 TYPe CLASS.C0N rr a` , STRON LLC r Q. LL J C�LEMAN i � C' ' BAKER STREET / wALPOLE, MA 02081 , r vadersecretar� _ . u;3t oylrn�p►1en loll a as -- 9tizo of i alms-ezeld K pLiS nsuoj 10 a�t330 I , . sale;;t�aaw., 3.1olay ri�ag ssaulsnq pus a; P uollealdxa aql uoilel ofuanlaa.p uolletlsl�aa xo asuaalri -3+ I . u - no;3I ry uipul lo;P►.ln^ Matiti rchuticat� Dc r u-tmcnt of Public S tt'et� n Bci rrd of BuiI�lin Regulations ttwnti rnii Standard , - ,�►no asn 1 P. .. u Constr ction Supervisor.License - License.: CS 91588 _ F COLEMAN F JOYCE 'k+ 160 BAKER..ST WALPOLE, MA 02081 Expiration: 7/27/2012 Cunmiissi,incr Tr#: 30146 . S �� O Details Page 1 of 1 ,Licensee Details ce see etas s Demographic Information Full Name: COLEMAN F JOYCE Gender: Owner Name: License Address Information Address: Address 2: City: Walpole State: MA Zipcode: 02081 ,Country: United States License Information License No: CS-091588 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 6/19/2014 Issue Date: Expiration Date: 7/27/2016 License Status: Active Today's Date: 12/1/2014 Secondary License: Doing Business As: Status Change: Prerequisite Information No Prerequisite Information Discipline No Discipline Information Documentum i http:Helicense.chs.state.ma.us/Verification/Details.aspx?agency_.. 12/1/N14 64 The Gmnz ann--a l of Massachus Deprrtnmt afhuNstrid Accident-v 0 �&d orstgrorrs 600 Wkyh-irigton,S`freet ast.aq MA 0-111 4 wft�t7J rraus�gof�drr� ' vrkers' CtlmpensatianInsurance davit:Builders/C-ontra:EEors(E.ectriciauMumbers AppHcant Information Piease Priuf Legibly Nam mo,or.s` o.. C3n� Ad&ess: 6 0 f sic City/tat—zip: \ w Phone b" Are you an.employer:-Check appropriate baTu Typ*of prof--t(required): d_ I a oeratl contractor and I l;_ I a_*n a emp toyer with ❑ am �e 6_ N rx employees(fall andorpart-time * have hired fbe sub-contiwim ❑ #orz listed on the attached sheet~ 7- model 2_❑ I^,�Tn a sole proprietor orparfner- ❑ g These sub-contrartbrs have shin and have e�ployeEs 8_ ❑Demolition working -for m e in art• caPa employeesci r_ employees and have wo&ers' Y c _ ❑Building addition �.'S� QrIT:e1S, C.oIIlp_rs�c�ir.�n r•e. �1�-insruaute No . :W�l 3_❑ We area corporation a-adits 10-0 Electrical repairs cr additions 3'_❑ am a bs>m ,nor doing all Work' officers ha,.m exercised their 110 Plumbing repairs or additi� nrysel£ [2do tvofl-=,comp- right of e)mpfioaper MGL ift6n- ance r wined F c_152, §1(4} and we fiwm no L 1, r employees_[Na ori�s' 1 _.❑Other vz comp_insDra*+m seg6 md.l 'Any appldu-E that dfiacks boa rl rims#also fill o,A the sertion below shag ilieir taoffcee compensation policy info t H.NN, e s c"o sabmit ibis sfdx=Macytea,a iney sre&zO ap wcair and dicta hire outside contrwrors innst submit a new affi&T t mrl rA a sarfi_ tantnc Ears the rF,erk this box mist s�aclisd an xdditi in$sheet shoumt; hen of tlae sits its and sts3s crhere[rxnat Il se Mies fi emphDmfs_ Ifth°srb-coat xctors hive empIoyees,thi2y must pimide t _r workerO comp_policy mmmber I an an umpLoyer that is prmidfrrg workers'cooqmrurt&n irrrrtrance f or my,e- ygss. Hetow is tire•pogry arrd job sits infotmatio.,L /� Insurance Cornparr1Fl`iame:G Ck l %Mi a(��I Policy er self ins Lim .� -t y 10 - Expiration Elate: W-0"b j5 Iola Sites address: 1�c'� 4-0 W 1Q.:L 1 )14)t to Cify"StaWzip_a mQ(Vi f- moI Attach a_copy of the xeorkers'compensation policy deciarstion page(showing the policy-number• and expic-ation date). Failwe to secure coverage as retlnired under Sectioa 25A of It2GL c M can lead to the imposition ofcriminal penatfies of a fine up to S I_50UU andlar o=-year-imprivonment,as well as civil peaallies in The form of a:STOP WORK ORDER and a fine of up.tcx V50-00 a.day against the violator_ Be advised that a copy of this sbrtEaeat may be forwarded to the Office of hwegE gations of The DIA for amn—a.,ce coverage vetffication. I dd hgreiiy crttr uruLer tlrs pruns andpenuWas Df'pz ary that the inforrnu#ionprcnidegqdabm a is hus and correct Simatorz e: Bate._ Phone#: €Jff-rcia-f use wnly. Da not wiritg in th&area:,ta bs completed by city or town ofjiiiaL ` City or Town: Peratituceuse# Issuing Antharity{circle one}:: i.Board of$ealtls 2.Building Department '-K t itvjTa,?m Clerk 4.Electrical Inspector fi_Plumbing inspector 6,Other Cou-tact Person: Phone#r 6 Information and. Instructions Massachusetts Ueneral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statiste,an employee is defined as"__-every person in the service of another under any contract of hire, express or implied oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing 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 grounds or building appurtenant thereto shall not because ofsucli employment be deemed to be an employer." MGL chapter 152, §25C(6)also smies 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 commonfvealth for:lay applicant who has not produced acceptable evidence of cotnplia.uce vrZth the insurance.coverag--required." Additionally,MGL chapter 152, §25C(7)states"Neither he commonvrealth nor any of its political subdiviisions sha1.1 enter into any contract for the pt o_n pane of public work until acceptable e-�ridence of compliance w-iih the insurance requiremeats of this chapter have been presented to the contracting avihority_" Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)namt(s), addresses)aad phone n,ber(s)a)ongwith then c ert:nc ?e(s) of insurance. Limited Liability Compa�ies(LLC) or Limited Liability Partoersl ps(7 7 P)ve-ith.no employees other than, u1e members or partners,are not requ ted to carry workers' compensation iaD ante- If an LLC or LLP does have employees, a policy is requil-ed, De advised that;his affidavit may be s,bi ifted to the Department of indus}sal Accidents for confirmation of ins-Lt--ar:ce nve_age. Also be sure to sign and date the affida- t. 'Ilae affidavit shol,ld 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;'-ae Deparbment at the number listed below. Jei insured companies sh.ould enter their selllmsurance license number on tie appropriate at, City or Town Officials Please be sure that the affidavit is uxaplete and printed legibly. The Department has provided a mace at the bottom of the affidavit for you to ill out in se event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which grill be used as a reference number. In addition—an applicant that must submit multiple permitihcense applications in any given year,need only submit one ofllddavit indicating current policy information (ifnecessax-y)and under"Job Site Address"the applicant should w,-iie"all locations is (city or town)."A copy of the affidavit that has been officially stamped or marked by the:city or town may be provided to e applicant as proof that a valid affidavit is on file for future permits or licenses_ A new affidavit mt1ct be:Eled out each year_Where a home owner or citizen is obtaining a license or permit not related to any bareness or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT reamed to complete this aifidw,-it_ The Office of Investigations would like to thank you in advance for your coopera.,'ion and shouldyou have any questions, please do not hesitate to give us a call_ The Departmcat's address,telephone and fax number: Tla,Co nmon�Y~ean of Massacliu.�!L-,s DAapaztLaent cif 1-idustcjal Qci_dr.;nts Qce ozf? t%Qn 600 Washingto-n 5 &as can_ 02111 T AIL 9 617 727-49-00 w 406 or I-i ce MASSAFE Revised 4-24-07 Fax T 617-727- 14-5 ACOP 11/03/03 CERTIFICATE OF LIABILITY INSURANCE DAT //2014 Y) 014 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 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 CONTANAME:CT Mark D.Souza Insurance Connection Agency,Inc. HONE o EXt: FAX,No):508-386-2298 P.O.Box 405 E-MAIL ADDRESS: Mansfield,MA 02048 PRODER CUST MC ERID#: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Ataln Specialty Ins.Co. First Class Construction, LLC INSURER B: Liberty Mutual Fire Ins. :' 160 Baker Street INSURER C Walpole,MA 02081 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: -THIS IS TO CERTIFY THAT.THF_ POLICIES OF.INSURANCE-LISTED,BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL EXP TR TYPE OF INSURANCE NR ADDL SUBR POLICY NUMBER MMIDD/YYYY MM D POLICY EFF YD/YYYY LIMITS A GENERAL LIABILITY 02/02/2014 02/02/2015 EACH OCCURRENCE $ 1,000,000 CIP199428 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: _. " """"" "PRODUCTS"COMP/OPAGG• '$ ' - ' � t �PRO--"! r.,_.ter",.,„�"•4.�..,.,. POLICY JECT LOC' �.. •..a•. .c a-: $ AUTOMOBILE,LIABILITY„C:. t ik., `COMBINED SINGLE LIMIT.0 , ;(Ea accident) ,! v $.x r•• sT t"c r rc ANY AUTO BODILY INJURY(Per person) $ �._ o o•_____._-____-_____- .__ u ALL OWNED AUTOS' BODILY INJURY(Per accident) $ ._ SCHEDULED AUTOS .._...... . . ... . ........_..�. .,«.. _�_'...„ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB i I CLAIMS-MADE ❑❑ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION 01/20/2014 wCSTATU- X OTH- AND EMPLOYERS'LIABILITY Y/N WC2-31 S-601377-014 TORY LIMITS01/20/2015 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A ❑ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under�Prr.IAI PIP E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) i CERTIFICATE HOLDER CANCELLATION •' wsTown of,Braintree-Building Dept.j r SHOULD ANY OF THE ABOVE DESCRIBED. POLICIES BE CANCELLED BEFORE THE" ._ EXPIRATION DATE THEREOF NOTICE;WILL BE,DELIVEREQ IN ACCORDANCE WITH THE irI'.� POLICY PROVISIONS.—— .. _.,_. _. ATTM ERIC ERSKINE-Building Inspector , - -1 JFK Memorial Highway---; r AUTHORIZE EP T Braintree,,-MA 02184- ©198 - 9 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD vj ypFTHE Tp�, Town of Barnstable *Permit# 4 4 yP ti� Expires 6�e_� thsfrom issue date �HprtNS'TABI.E, • Regulatory Services Fee >� 9 MAW. Thomas F. Geiler,Director f L) ^/ � O Z� M Building Division X-PRESS PERMIT ' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 0 C Y 1 1 2002 Office: 508-862-4038 TOWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numbe O� Property Address ARA /! /'�r'AJZ?Z lJ I Ile i� 3 VResidential Value of Work ,20 0 Owner's Name&Address /�1 ® G z- ��- Contractor's N;;Tn l7 4Ilt- 7 e f d %? Telephone Number 67 Home Improvement Contractor License#(if applicable) /0 O f ea, Construction Supervisor's License#(if applicable) 9 / Cl ❑Workman's Compensation Insurance Check one: C) `~ EK'am a sole proprietor , ❑ I am the Homeowner -= a ❑ I have Worker's Compensation Insurance cz Insurance Company Name r~ Workman's Comp.Policy# Permit Request check box) Re-roof(stripping old shingles) All construction debris will be taken to 2ZL Ti3 _/R�fn/S�cl� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Fcrms:expmtrg Revised121901 \ .,The'Commonwealth of Massachusetts -- ,Department of Industrial Accidents _ - Office oflnYesfi9alfaJ7s . 60O Washington Street Boston, Mass. 02111 Workers' Com ensation Insurance Affidavi�gr / i naive; ✓�i Cr//�Z location: ..-- ' Ile myself �a homeowner performing all work U 1 am a sole ro rietor and have no one worlsin in ca achy i /G%�/%/%//% / %///%/% %/%/ / e1wr %/Gli%////��%/% /////////%%//// mp oY .x. r:.: 3 >M,r.,.�,:4Yir..t;t:��,.,s :�>._ rs compensation-for a{.}: :•.?}.r,'ty :2;4<fiiC.:c N ;:��Sy Y4.'%t t:}o;`.. b;•r,., $F.F,:3 4fitiiL;C r:•.;;t• rovidin works ,n :Ye.:•:::{C:}Yq:h•:: r-<fia{..::.SY.r.}{;.L.}a:.,•:,s w:•n 4:::•r.-54,•:l,v.y};}; {.} n...r'i<:;:3<i}..,,s:F;$.;,R 4;..r r:, e �rtver g !!vn}:?• .yt tir.x;..,,S:,C.. ..r.,,.}.,t•:. •4:nt,::kv: •'af. ., }. :s.,,.; ..{..,:':;•.• '++;? 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A:^. is,v:...:•..:+i. •. ::.. . ..:r rr.}:.::••:..:{.;y..]{.r,.}}.::.}i}}}•:{...:....n vi vv+,.^.. •.:n:.;.;.:,::+.i•}-tt-:::: n^:t;.!n•:}:.}•::{.?{.: ....•,........::::.:..::•::. :r.::.•n•::•..1.'i:}�$FS:::•{::+'?;3;�7{.}:rr::;�:%:i•r::::•::::::•........... :�TLlur$I2Ce G6: •`:•>%is;<:$•:7;?;ti•7f:rrt•}.: :.. enalties o!a$ttenp to 31,500.00 and/or Failure to secure wverate as required ender Section 25A of MGL 15i asno ad to the imposition Of eriininal p one years,imprisonment us '���penalties in the form of a�pa of the DIAja Sr`EcoRv�,gey eriilcatione of o0 a day againstme. Immdersfsmdt7ist a' . copy or a&statementmay be forwarded to the Office of Invesiig d 'es-of-perjury that-the- forniatian-prau enidedabnve ir�=rrQi_sd correct - Ida hereby.-c" hey P lee Date signature • .:• .. ..... CiA-lit- Priat riante e ofScialu$e only do not write in this area to b e completed by city or town oMdal _ i artrnent permit/iicenae# i OLce sinzBo city or town: ❑Scect nen's Office c ontact p ers on: r Information and Instructions Z section 25 requires all employers to provide workers' compensation for their General Laws chapter 15 s Mwsachusetts defined as eve per on, ' the service of another under any contract loyoted from the `Law , an ernPloyee is every P .. In ees.._As qu ---------- ---- - -- _. III of hire,'express cr imp a or or An employer is defined as an individual, Partnersbip, asspciation, corporation or other legal entity, or any two or more of _ the foregoing engaged in a joint enterprise,'and including the Legal representatives of a deceased employer, or the receiver or ,partnership3 association or other legal entity, employing employees. However the owner.of a .. trustee of an individual and who resides therein; or the occupant of the dwelling house of dwelling house ha-Ving not more tl=three apartments another who employs persons to do maintenance, construction or repair work on such dwelling house or onthe groiiads or b g appurtenant thereto shall not because of such employment be deemed to bean employer. c c shall withhold the issuance 5r renewal MGL chapter'152 section 25 also states that every state or local licensing agency . of a license or permit.to operate a business or to construct buildings in the commonwealth edAdditionall Yppllca�at who neitherthe has •not produced acceptable evidence•of compliance with the insurance coverage required. � commonwealth•nor any of ifs political subdivisions shall enter into any contract for the performance of public work untr7 acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authoaty FE FEW 011 Applicants at affidavit completely,by checking the box that applies to your situation iacf Please fill in the vvbrkers' compens supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe ' submitted to the Department.of'Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and Y„ date the affidavit. 'I'lie'���should'be returned to the city or town that.the anapplication 1e az°�g�thor. �c'o �fyQa being requested,not the Department of Industrial Accidents. Should you have y questionsg btain a workeis' compensation policy,please call the Depaitmerit atthe nurnlier listed below:.' ate required,to o City or.Towns - Please be sure that the affidavit is complete and Printed legibly. The Department has provided a space at the bottom of_rthe to fill out a-vit event the Office of Investigations has to contact you regarding the applicant. Please,, ou ,.. = ~' affidavit for Y the.peunit �cense iiii�nber wliic}iwill beused as a reference num6er.�1fiie;affi�avits mayi'e'r .tp•,: be sure'. in unless other arrangements have beennmade ' •., 'b"mail of FAX the Dep � _ �. . .. .. .. -• ^� '�•' ' .. ., • ,. . . .. '�I ations would like to thank you in advance for you cooperation and should you have any�uestions, The Office of Investig. .• 'A.I. ��. .. - please do not hesitate to give us a call. mom The Department's address,telephone and fax , - ThCCommonwealth Of Massachusetts Department of of Industrial Accidents • Giflce of layestlgatlot►s • 600 Washington Street t Boston,Ma. 02111 fax ff: (617) 727.7749 06 409 or 375 .. . :;�;.,.,p �• f91 71 727-49 00 ext. 4 , 'TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'Map Parcel /Y,:;2-If J001 Permit# (� � Health Division �� c% Date Issued f 0 Z 4- Conservation Division Application Fee fl� Tax Collector /� /D/!/ Lo .)-- Permit Fee Treasurer �ie— l0 41116 Z I LTG ` Sa Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address c2 q A61 ICA j?Q 6A ez E Village - c Owner e"7f+1 2 G -E. P�jR(G E Address 62 i t 4.4 6 ? t Telephone '7 Permit Request ?�r�o�� si,vim Xg T1Ac&_ .617AAle. Op J1eW,_L77-+ 6j � o r ve7 O L Ldlulb bill, MuCCF-b Square feet: 1st floor: existing proposed J�fa 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 3`% Historic House: ❑Yes ®1Go On Old King's Highway: ❑Yes Gllo Basement Type: ❑ Full ❑Crawl ❑Walkout tether t"oL- ,3,a(�.�.Eti Basement Finished Area(sq.ft.) 'v��4 Basement Unfinished Area(sq.ft) k0© ' Number of Baths: Full: existing �_new Half:existing f Z i new1 Number of Bedrooms: existing new Gar Total Room Count(not including baths):existing '7 new �� First Floor Room C,unt_ + C11 W Heat Type and Fuel: ❑Gas W O ❑ Electric ❑Other `O m Central Air: ❑Yes a 0' Fireplaces: Existing I — Newt_ Existing wood/coal stove: ❑Yes 41,60 Detached garage:❑existing ❑new size !$Al Pool:O existing Cl new size'� Barn:❑existing ❑new size -ram Attached garage:dxisting ❑new size > )'a3. Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# �JIA Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# �VIAI Current Use Je-iU-7 A Proposed Use Am X , BUILDER INFORMATION io'vr^e 91-a2v 67 Name e�,4 9AI&A0 J R Telephone Number eell k✓fk-,< >>G- �7�? Address 4V01 t>DS[ i>C- /7o A r� License# L✓ A>Zit/S ✓�!� /��l�. Home Improvement Contractor# DO 6_3 clr.�l e-5T Worker's Compensation# 40,CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOZn/_ ��4 J ? A2 CT� S_1 %o A c (fS SIGNATURE DATE �-- - FOR OFFICIAL USE ONLY PERMIT NO. , r 4 , DATE ISSUED ;•�' , _ -' MAP/PARCEL NO. ADDRESS VILLAGE ` OWNER `! DATE OF INSPECTION: 1 FOUNDATION r ' - .FRAME -Z2- b f •� �l t! t r �. 1t Z INSULATION r. ' FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL-__ i _ s GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` 1 i 4 ASSOCIATION PLAN NO. ' t °*VE,° Town of Barnstable Regulatory Services '* saaxszea , * Thomas F.Geiler,Director 9 Mass• g 019. �� Building Division TED MAC Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 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:, rstimated Cost Address of Work: ,�� fly,7ATio A ���/�'�✓������ �'� Owner's Name: CZA/ Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACCESS TOT THE AR ITRATION PROGRAM OR GUARANTY FUND UNDER MGABLE HOME IMPROVEMENT WORK DO NOT L c 142A. ACCESS SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit the a ent the owner: R O RegistrationNo, " Contractor Name Date OR •Date Gwuer's'_varf_e s v 'r ! 1P1P1P t { t , { LLU Llij _..... tv- _ - o) AiZS 2 X R_R,47"tiZs 16" o,c., e . 3 ` t ,r'� .-:.�o ►.: .r _� tZT.... Fi2tj { n.u. q J+ -13 -, - 31r 7"t� 13oaZg SA _F11 — 2x 4" OR Tois�� I� 0C_ (i EX IS lit -� ;�� .,. .{ tAl Cr. { j PRICE 7L { i F �1 64, ca tom.. _ c? _ _ ... _ 1 - -- ma_+ w.vv.moos++.�-�e.:e..rvnw.s."e+,'.u�rxtw�++ne..s...vay.. �.r..s..x+-.'._eea•.e..+..�.ve..a.ur:.......+.. ..++nv..�= -w�.eve...:.ra+-,.—...e...e..�_m--.<v....6.-�..o.-..,�-+...::v+�.:n..e....... � � 4 �®�._.'m+_ -