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HomeMy WebLinkAbout0055 JUNIPER ROAD 2 a . 4 t 5 .. Town of Barnstable U11d1I1 SARNS pp _Post This Card So That it iSVisible From the Street=A roved Plans"Must be.Retained on Joband,this Card Must be Kept u aR s e Permit Posted Until Final Inspection Has Been"Made ..: Where,a Certificateof Occupancyis Requited;"suchBuildmg shall Notbe Occupied untda Final Inspection has been"made - . Permit No. B-19-4011 Applicant Name: steve spengler Approvals Date Issued: 01/09/2020 Current Use: Structure Permit Type:M Building-Solar Panel-Residential Expiration Date: 07/09/2020 Foundation: Location: 55 JUNIPER ROAD,CENTERVILLE Map/Lot: 210-114 Zoning District: RD-1 Sheathing: Owner on Record: MCEVOY,JAMES Contractor Name .STEPHEN J SPENGLER Framing: 1 Address: 55 JUNIPER ROAD Contractor License: CS=071546 2 CENTERVILLE, MA 02632 Est�P'roject Cost: $3,520.00 Chimney: t Description: Installation of roof mounted photovoltaic solar systems.B.Okw 25 _­Permit Fee: $85.00 Panels Insulation: Fee Paid:. $85.00 Project Review Req: - R " Date: .+" . 1/9/2020 Final Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced"withinsiz months after iss an iCia 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 incompliance with the local zoning by-lawsla`nd 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 Final Gas: 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. Electrical Minimum of Five Call Inspections Required for All Construction Work: #" 1.Foundation or Footing Service: r. Inspection 2.Sheat hin g .n Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed" _®w 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 - Low Voltage Final:. 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. 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: QW>_�E ti Town of Barnstable ttPermit# I �•p Expires 6 rrwnt/rs frorrr issue date Regulatory Services Fee t WANSMBM MASS. Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner S 200 Main Street,Hyannis,MA� �y�P �1 �011 www.town.bamstable.ma. Al OF pI Office: 508-862-4038 R,uST 5p&7-90-6230 EXPRESS PEr APPLICATION - RESIDENTIAL ONLY f 0 Not Valid without Red X-Press Imprint Map/parcel Number Property'Address Ce;, (er✓i /l am (Residential Value of Work$ I 2 ( Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address _��(' 0n4-,-l3'\Orr C7 el " cIII oX e,,4e6✓i I �e A 3 Contractor's Name'1' G p7 aS-- t 2 Telephone Number 40F7141-d 3 J Home Improvement Contractor License n(if applicable) //Z 78 S Email: Construction Supervisor's License#(if applicable) _0_70 D 7: [�Workriian's Compensation Insurance 66 � Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name /�/�T�/��L tiL 1V e8 AJ Workman's Comp.Policy# U) Copy of Insurance Compliance Certificate must accompany each p mit. Y 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 - [v� eplacement Windows/doors/sliders.U Value •3a (maximum'35).A of windows m, of doors: - - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. '4[rheie required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. O *`-Note: Pope weer must sign Property Owner Letter of Permission. o y f the Home Improvement Contractors License&Construction Supervisors License is it SIGNATURE:, Q e iced 613 U:) SIbuilding pe f XP��.dgc Revised 0613li !, rJ^ �j Home Depot Contractor License Numbers: MA: 107774, 112785 Salesperson Name and Registration Number: Janice Campbell : R-1-073-13-00016 Home Improvement Agreement Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Pat Montimurro [New England South 10340239 First Name Last Name Branch Name Lead# 55 Juniper Rd CENTERVILLE MA 02632 Customer Address City State Zip (508) 361-0919 F E Home Phone# Work Phone# Cell Phone montikeen@gmail.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (.10). BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN-SHIPMENT AT--- HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. 71� d by: 09/05/2017 c stomer's signature - Date 1' f 370077 AS ,UUAR TE 2 A co*. _ �Xlti3£?ii �r Y- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia_ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �d Address: 15 City/State/Zi 026-7 / Phone#: '7 766 Are you an employer?Check the appropriate box: _ Type of project(required): L❑ 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. El New construction 2.Qf�I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ` `ship and have no employees These sub-contractors have g. M Demolition working for me in any capacity. employees and have workers' comp.insurance. 9. Building addition [No workers comp.insurance p• required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing'all work officers have exercised their. I L[]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.�Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1.3.❑ Other 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. $Contractors 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: 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 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$250.00 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 cer ' unde the pain�znd penalties of perjury that the information provided above is true and correct. l D y'- 20 --17 . Phnne#: 6 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#: The Commonwealth of Massachusetts _ Department of IndustrialAccidents _ll Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidm it: Builders/Contractors/Electricians/Plumbers Please Print Legibly Applicant Information The Home Depot At-Home Services Tame (Business/Organization/Individual): Address: 908 BOSTON TPK City/State/Zip: SHREWSBURY, MA 01545 Phone#: (508) 942-6942 Are you an employer? Check the appropri to x: 11 Type of project(required): ].~_..1 am a employer with 200+ 4. I am a general contractor and 1 6 New construction employees (full and/or part-time).* have hired the sub-contractors Remodeling listed on the attached sheet. 7. 2.❑ 1 am a sole proprietor or partner- These sub-contractors have g. Demolition ship and have no employees employees and have workers' 9 Building addition n any working for me i capacity. comp insurance.: [No workers' comp. insurance 10.❑Electrical repairs or additions 5. We are a corporation and its required.] officers have exercised their I I.[]Pltunbing repairs or additions 1 am a homeowner doing all work right of exemption per MGL 12.EI of repairs myself. [No workers' comp. c. 152, §1(4),and we have no insurance required.] ' 13. Other �✓Jn a"� I L employees. [No workers t P �ac �Pn 7 Icomp. insurance required.] 'Any applicant that checks box#1 must also fill out the section belowshowing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must a Cached additional s an :they must provide their work heet showing the erse o'comp.spol c�n �d see whether or not those entities have number. employees. If the sub-contractors P 'compensation insurance for my employees. Below is the polio'and job site I am an employer that is providing workers information. Insurance Company Name:NATIONAL UNION FIRE INSURANCE COMPANY 03/01/2018 Policy#or Self-ins. Lic. #: XWC 65831 45 (QSI) Expiration Date: J Job Site Address: 5 U''�`6�e'{ City/State/Zip: ( P �!e MA er and expiration date). Attach a copy of the workers' compensation poh 2aA of MGL eclaration page I52 can (showing d t h the oimpositionlicy of criminal penalties of a Failure to secure coverage as required under Section 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 aga' a violator. Be advised that a copy of this statement may be forwarded to the Office of D Investigations of the r in mce coverage verification. I do hereby certify un he aims a d f perjury that the information provided above is true and correct Signature: Phone#: - Official use only. Do not write in this area,to be completed by city or town official. Permit/License# City or Town: issuing Authority (circle one): t 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1.Board of Health 2. Building Departmen 6.other Phone#: Contact Person: --A moo= > Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement_Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 0412-1201 g 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑Renewal ❑ Employment ❑ Lost Card office of Consumer Affairs&Business Regulation _. HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only =' TYPE:SuoDlement Card before the expiration date. If found return to: RegistrationExp iration , Office of Consumer Affairs and Business Regulation ..:` 112785 04,122/201Q ?G Park Plaza-Suite 5170 Boston,MA 02116 HOME DEP0 i USA INC J ANDREW SWEET f\ � 2455 PACES FERRY,RD C-11 HSC .� d ithou signature ATl-ANTA,GA 3033-Q Undersecretary CERTIFICATE OF LIABILITY INSURANCE Do i21117 YYY) 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 CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER aCC,No I ac No): 1 3560 LENOX ROAD,SUITE 24DO E-MAIL ATLANTA,GA.30326 ADDRESS: iNSURERIS)AFFORDING COVERAGE I NAIC 9 100492-HomeD-CAW-17-18 INSURER A:OW REPUb6C lnsnrance CD 124147 INSURED I THE HOME DEPOT,INC. INSURER e:Agri Generalm Insurance Company j42757 HOME DEPOT U.S.A.,INC. INSURER c c New Hampshire Ins Co I2?841 2455 PACES FERRY ROAD INSURER D: BUILDING G20 AILANTA,GA 3D339 INSURER E: - INSURER F: I COVERAGES CERTIFICATE NUMBER: IATL-003746387-14 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL-THE-IEP.MS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSPILTR TYPE OF INSURANCE Ia0 I BRI POLICY NUMBER I POLICY OMIUDCDY� PMMMDNW I LmtrTZ LTr A X I COMMERCIAL GENERAL LIABILITY IMWZ`(310022 I0310112017 031012018 I EACH OCCURRENCE I S 9,000,006 I DAMAGE TO RE3NnED I I I CL41rt5+`ADE X OCCUR ?REMISES Ea omlrrenrP) I c i,000,00() �— iLIMTTS OF POLICY XS E(CLUD .V,ED EXP IAny one Person) i S ED ! IOF SIR:S 1 M PER OCC i PERSONAL 8 ADV INJURY 15 9,000:ODv _ f iGEN'L AGGREGATE UM;T APPLIES PER GENERAL s 9, 00,001, i�POLICY_ P CT LOC i I i PRODU -COMFIOFAGG 5 9,00D,000 OTHER: I I I I S A I AUTOMOBILE LIABILITY ( IMWTB131D021 - 01012017 0310112018 CIDem SINED SINGLE LIMIT I S i,000,DOP IIIttLX���III (E�adenl ANY AUTO ! I BODILY INJURY(Per person) I S HALL OWNED SCHEDULED I SELF INSURED AUTO P.IY D,MG BODILY INJURY(Pel a�peft s AUTOS R11 ON-0WNED fPROPERTY DAMAGE i S HIRED AUTOS AUTOS I I I iPeracideM IS rUMBRELLA UAB I i OCCU,- l I I , I EACH OCCURRENCE S EXCESS LAB I I CLAIMS-MADEI I ! AGGREGATE I c I DEC I I RETENTIONS I 1 I S E. I WORKERS COMPENSATION I VJ'LR C491123OD{TN) 0310i2017 03101018 I X I T-aTUT ! I EP I I C AND,EMPDOYERS'LU1BILnY Y/N WC 023102423(AK,NH,NJ,VT) I0310112017 031D1/2U18 I 1,Q17D,Dir I ;ANY PP.O.RIEfCRIPARTNERrcXECUnVE I EL EACi ACCID3� 5 I r I OFRCERIMEMBER EXCLUDED- �I N IA I I(Mandatory in NH) I WC 023i02424(WI) `031D12017 D31Di12O18 EEL DISEASE EA EMPLOYEE a i3OD0,OC {ii yes.describe under + Cenlinued pn Additional Pape II L l I c I CESCRIFTION OF O?ERATIONS belo. I !E DISEASE-POLICY LIMB, I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additiorei Remarks Schedule,they be attached it more apace Is required) EVIDENCE OF INSURANCE t l CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE LANCE LED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLAN TA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of rdarsh USA Inc, Manashi Mukheriee I ©1988-2014 ACORD CORPORATION. All lights reserved. ACORD 25(2014/01) The ACORD name and looD are registered marks of ACORD AGENCY CUSTOMER ID: 100492 LOC#: Atlanta AC0 ADDITIONAL REMARKS SCHEDULE ' Page 2 of NAMED INSURED AGENCY HONE DEPOT U.SA,INC. MARSH USA,INC. DIBIA THE HOME DEPOT POLICY NUMBEA 2455 PACES FERRY ROAD BUILDING C•20 ATLANTA GA 30339 CHARIER I NAIC CODE EFFECTNE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2� FORM TITLE certificate Of Liability Insurance Workers Compensation Continued: Cartier.Indem*Insurance Company of North Aron-- Poky Number.WLR C49112294(AL AR.FL.IC,IA,KS,KY,LA.MS,M0,NE,NM,ND,OK,SC,SD,WV,WY) Effective Date:031D1r2M i Expiration Date:0101016 (EL)Limit:51,DDD•00D Cartier.New Hampshire Insurance Company Policy Number.WC 023102422(DC,DE,HI,IN.MD.MN,MT,NY,RI) Y Effective Date:03101I2D17 Expiration DaM:U31012016 (tQ Limit:Si3OD0•DDD Cartier.ACE American Insurance Company Policv Number.WCU C49112282(OSI)(AZ,C,..IL,NC,OR,VA,WA) Effective Date:0 0112017 Expiration Date:OW.1201 E j (EL)Urnit 5,0M,00D I SIR'51,0DD,000 SIR for the Stales of AZ,CA,IL NC,0R.VA,WA Cartier.National Union Fire Insurance Company Policy Number.XWC 6583144(OS0(CO,CT,GA,ME,MI,NV,OH.PA.UT) Effeclve Date:030/2017 Expiration Date:030112D18 (EL)Limit:S 1.000.000 S,,00,000 SIR for the states of C0.ME,NV,Id1.OH,PA,UT S750.000 SIR for Ore state of GA ) S350,000 SIR forfhe state d CT Carver National Union Fire Insurance Company Polio Number.XWC 6583t451050(6AA) /� L y Effective Date:O'JD1r207 I/(�111 A Expiradon Dale:03f01/2D18 (EL)Limit:51,0m,00D t SIR S500.11M TX Employers XS Indemnity. CarrierUlvios Union Insurance Company Froiicy Number.TNS C48E13202(TX) Effective Dale:03/0112017 Expiration Date:03101/2018 (EL1 Limit:S10.000,M0 SIR S1,00D,000 I ACORD 101(2008101) ©2008 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD CA IT ,TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .r Map �f!U Parcel ;,{ t t >,; #: f Application# '" t Health Division Conservation Division I�"1/®6 �� . Permit# Q r a Tax Collector j _ Date Issued o 31 f� t a -4F+ i 3 �.f-.''-1 I ..6V Treasurer Application Fee Planning Dept. Permit Fee i 00 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis V Project Street Address '' �S� �JI V�+ Pie(- cc/- Village C P n10 C Q I l Q Owner Ix P,u 1 n LaA, 1 Address n fn<< 6�0/ Telephone .SC��_ 7`� _ (Q 3 } T Permit Request �v-�d� ec "l !c4 (/� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l Ol) 0 00— Construction Type Lot Size °1 . LI Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(#units) Age of Existing Structure 3o vc,; ? Historic House: ❑Yes JM On Old King's Highway: ❑Yes iMo Basement Type: W'5ull ❑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 Firstfloor Room Count 1 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 Aftached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization - D-Appeal# __ _-Recorded❑­ --- _--_ - - - —_ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name r��� .,A ( Telephone Number Address bI Qo Y4 d ��► V�-(, License# C S ( .e c,LA 2 Home Improvement Contractor# l )'ZKd Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL'USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO.; ADDRESS VILLAGE OWNER z 's z DATE OF INSPECTION: z h FOUNDATION rry. FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL Y. GAS: ROUGH FINAL s r FINAL BUILDING O !S 1 DATE CLOSED OUT ASSOCIATION PLAN NO. Board of Buildin � 4dac�tuQ g Regulations and Standards iM �ROVEMENT CONTRACTOR License or registration valid for Registration`: before the ea l individul use onl X 18030 p ration date. If found return to: Y i?Ir n Board of Building i;Regulations and Standards { Ohe Ashburton place ividuai Boston Rm 1301 SAWYER BOB � �° � � � � ,Ma. 02108 ROBERT SAWY ;Z�Mi 22 DOLLAR CENTERVILLE, Mq 02632 b Administrator Not valid without«;i gna re - --- --- .......... Bp L/CenSe qRp Opary 9e M4 sOjVST. tly, bE+ RUCT/O IQt=GU t>,) NrjO 0" 1 R S I FF21p ?4 SO 2O8ERT R��,` - kl �yb8 C t) Sq F/VT qR frY YBw ' r`;I Tr �-� no' 16j M,q�2 f' 82 t Town of Barnstable °* Regulatory Services Z = Thomas F.Gener,Director ' amass. ig ,,�o ,�•` ,r Building Division.• Toia Perry, 'Building Commissioner 200 Main Street $yam h%MA b2601 WWW.town barnstable.ma.us )ff'ice: 508-862-4038 Fax; 508-790-6230 Property Owner Must Complete and Sign This Scctlon• -If Using .A Builder I, �C 2, La 1 ,as Owner of the subject propert3r hereby authorize e�� 2 r to act on m7 behalf, in all matters relative to work authorized by this building pe=h application for. n , ( dress of job) g/7 Signature of Owner Date Print Name Q:F0RMS:0WNWERMISS10W i ne t ommonweatrn of lvlassacnuaiettai Department of Industrial Accidents Office of Investigations 600'Washington Street �r Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pluaubers Applicant Information Please Print Legibly Name (Business/organizatiowhdividual) :gi Address: S`� `'� ��� l� v? City/State/zip: - C e N @ c J'\�l�2 1Y�� ox3 : Are you an employer? Check the-appropriate box: Type of project(required): 1.2 I am a employer with a 4. ❑ 1 am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors.have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs !!-- insurance required.] t employees. (No workers' 13.[9'0ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonmtion: t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy an` job site information. Insurance Company Name: R C, O C- Policy#or Self-ins.Lie• #: Z y_ Expiration Date: n / l Job Site Address: ),p C ! h City/5tate/Zip:f�„�#�1i G�T(j 3.2 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50Q.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 nd the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License#. Issuing Authority(circle one): 1_Board of Realt:h 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector � 6. Other Contact Persona: Phone#: y Information aid 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 service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,parmership, 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 hous a 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 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 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of i 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 necessary)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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner 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 Tel. #617-727-4900 ext 406 og 1-1077-MASSAFE rax# 617-727-7749 Revised 5-26-05 ywv,mass.4o gov/dia �tHer Town of Barnstable Regulatory ServicesBA"STAB g ry � 'MASS.IEg` Thomas F.Geiler,Director 039. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862- 038 Fax: 508-790-6230 Permit no Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 1 2A quires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improven ent,r moval,demolition,or construction of an addition to any pre-existing owner-occupied building c ontai 'ng at least one but not more than four dwelling units or to structures which are adjacent to such resk ence r building be done by registered contractors,with certain exceptions,along with other requireint nts. Type of ork: Qz-V JWi Estimated Cost 10 A00 Address cfWak. ,S S _75 y T( ���' C P[\A P co; -/ Doi G 32 Owner's Name t< t ) va ra 1 Date ofApplic tion: % —^7--d V I hereby c erti that: egis ration is not required for the following reason(s): OWork excluded-by law ❑Job Under$1,000 ❑Building not owner-occupied ElOwner pulling own permit Notice is here y given that: OWNEP S Pt LLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTR kCT, RS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESI, TO rHE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby pply for a permit a the gent of the owner: Q �1 a U I Igo Date on ignatur Registration No. 0 ( OR Date Owner's Signature Q:wpfiles.]Drms:: omeaffidav Rev: 060 6 30' Uj ItN I THREE INFILTRATORS EL 35.0' 35" STONE AT SIDES AND 45" AT ENDS Strip—out Note: vd = 330 gpd Required Flow Remove all unsuitable material 5' arc down to the "Cl" layer and replace w, granular sand per 310 CMR 1&255 (3, 10'W x 2' Eff/Depth and (6). C 2.0 = 160 s.f PROPOSED INFILTRATOR 42 0' TRENCH + 'otal Design Flow 41.3' t1216 + o N32'51'50"E 41.8' 41.6' . LA +/� 30.00 1 141.9' + 41.5' TP 1 0 1 + + LSS1�tZ I l 1 I 7' 131 4 •6 2 6 1 41A EXIST. PROPOSED + - �10 SHED 1500 GALLON O D/B 7 L F POLY LINER/ SEPTIC TANK - O -- + _ 0' -46 ----- I s 42. 0) C/) 41.6' + 2.0' rn 42.1' REMOVE o OP EL. 42.75' I BRICK °D FOUNDA T � ON _Q FULL I PAT10 GA �i QG BASEMENT I I EXISTING GARAGE 1 I 3 BEDROOM 1 D WELLING #55 1 i 3 42 00' 1 0 41.7' + I + I r t 42.1' i I DENOTES N + + z SPOT ELEV. cn 41.8' 42.3' I (�) o LOT 84 j EXISTING 1 42.1' 9,847±SQ.FT. j I PAVED I + I 1 I DRIVEWAY 1 EL 'MP BRB FND l 1 EL / I Fi'V. 4L 9tY' v9 I I DATUY GL9 ' I j 43.2' 1 I L=40.10 i + 43.7' 59.67 + N32'51'50'E I R=307.00 I . j BRB ------;< ----------L-----+ FOUND -- +--_-- 41.55' __---EDGE OF PAVE--- 41.56' 41.16' 41.03' fln z1 D IPER�IUN =±-----------------_------ GRAPHIC SCALE t Agen t: Mr.Desmarais 20 a 10 20 40 80 9a te: 07-27—06 'valuator' S. Doyle EL 41.6' TH #2 EL 41.6' ( IN FEET ) 2 MIN/INCH PERC G2 MIN/INCH 1 inch = 20 ft. � i I 0" 0, L 10YR 3/2 A SL JOYR 3/2 i _. Town of Barnstable Regulatory Services Thomas F.Geiler,Director * snaxsrnBM • 9� ' ��� Building Division ATEo►9. ° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ 00 SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number k. Size of Shed Map/Parcel# 3 I 6C� Signat6e Date Hyannis Main Street Waterfront Historic District? ' 0 Old King's Highway Historic District Commission jurisdiction? PV D Conservation Commission(signature required) Q 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 Q-forms-shedreg REV:121901 L C3 ATI O N O F JP RO P E RTY LI S AY E ^,eCOJKAL STANDARD LEGEND i 7 t NOTE:not all symbols will appear on a map f / GOLF COURSE FAIRWAY ❑ EDGE OF DECIDUOUS TREES f -•---—` - EDGE OF BRUSH • I rr j7, ORCHARD OR NURSERY MAP ".....ti....'Y.....;i EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER. ,.\ 65 , i =__= DIRT ROAD r r ` DRIVEWAY E--PARKING LOT PAVED ROAD DRAINAGE DITCH J PATH/TRAIL J � PARCEL LINE f M I 021 AP RCEL NUMBER #367 E HOUSE NUMBER t a \ 1 2 FOOT CONTOUR LINE r f MAP 1/0 E® 10 FOOT CONTOUR LINE /10 �` 0 0 L . _. •� # Elevation based on NGVD29 4 0 "" 5 " � MAP "a.9 SPOT ELEVATION ❑ FD c x x STONE WALL \ ❑ X--X- FENCE RETAINING WALL 4-� RAIL ROAD TRACK - STONE JETTY \ M f !P°° SWIMMING POOL PORCH/DECK BUILDING/STRUCTURE DOCK/PIER i . 1 j HYDRANT t i 6 VALVE O MANHOLE `ram O POST 0" FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T C,> � SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This ma is on enlargement of a **NOTE:The parcel lines are only graphic re resentatioas DATA SOURCES: Pianimetrics man-made features were interpreted from 1995 aerialphotographs b The James r P r9 P YDP P I I V =100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE a TOWER w E 0 20 40 National Ma Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetric,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=40 FEET* enlarged sco e. on the map. at a scale of 1"=10O`. Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax maps. -0 LIGHT POLE O ELECTRIC BOX c t l I etz 3 _ ksNVI G y 1 Oo