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HomeMy WebLinkAbout0028 LIETRIM CIRCLE ~ a , w e _ , TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION Map Parcel Application # �� f O ((`i Health Division Z. Date Issued. Conservation Division Application Fee Planning Dept. Permit Fee.J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ZJ!� U\ Q_A`CLr n C:\Y-CA_-P_ Village C=�,e n'c 2YV� \Vle-- Owner CYl Address 1=� `ryL� C NYC),- , Telephone�'��SLnl� Permit Request �,Y-tQ Square feet: 1st floor: existing l proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valua it on Construction Type Lot Size . 33 0,C.Y-e_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure x rS Historic House: ❑Yes XNo On Old King's Highway: ❑Yes )/No Basement Type: Y Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 9 5C4_ Number of Baths: Full: existing 1 new 1 Half: existing new Number of Bedrooms: Z..-. existing —new Total Room Count (not including baths): existing new First Floor Room Count S Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Z -_ Central Air: Yes ❑ No Fireplaces: Existing 1 New Existing wood/coal stove:'O Yes. UNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0$existing 0-hew;size_ �a Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1aC4ie OL f ,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 Telephone Number Address C,\r L License # Home Improvement Contractor# Email ��1c�c'YIP�l�3�/#-A VV a J-icb0 u)rn Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ _ .=DATE �J 0 r FOR OFFICIAL USE ONLY APPLICATION # t DATE ISSUED MAP/ PARCEL NO. r ADDRESS VILLAGE • s OWNER 'f cj DATE OF INSPECTION: FOUNDATION ` FRAME 19 IG r , 7 INSULATION Q Ig 44 6V 3 It fa t FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. i A ne Conuno.-rivealth of rssachuseds Deparhrierrt of r4dushzal Accidents Office of lwestigatfons h ,3 600 Washizigton Street y Boston,.-41A 02111 iv►vivauam.govIdia Nrarkers' Compensafion Insurance Affidavit:Builders(Contractors/ElectriciansTlumbers Applicant Infar nation Please Print Legibly C` -Name ame qusinesslorganizationlfn l)- Yi W o— L n- a o on s Address: -City/State Zip,: Phone I Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer urith 4. ❑ I am a general contractor and I loyees(full andlor part-time). * have lured.the sub-contractors 6. ❑New construction s 2.-Ts am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling hi and have no em 1 ees These sub-contractors have P, P �' $_ ❑Demolition wo 3ung fcc me in any capacity. employees and have worke:,rs' 9. Buildingaddition k' [No w orlaers' comp.insurance comp.insuranml ❑ required_] 5. ❑ re We a a corporation and its 10❑Electrical repairs or additions 3.❑ I am a homeoumer doing all work officers have exercised their 1 L❑Plumbing repairs or additions mysel€ [No workers'O'p_ tight of exemption per MGL 12.❑Roofregairs insurance required.]i; c.152,§1(4),and we have no - 1 employees.[No workers' 110 Other comp.insurance required.]' #Any applicant: ut checks box K mast also fill out the section below showing their wodce&compensation policy information. I homeowners who submit this affidavit indLCating they an doing all wcd and then him outside contractors umst submit anew affidavit indicating sacTi 'Contractors that On this boat must attached as addid W sheet dmrmg fire nuae of the sub-contmcbars anal state whether or not those eaddes have employees.Ifthe sub-contractors have employees,theyamtsiprmdde their worker'-camp.policy number. I aril au etrtptoyer tliatisprot,iditrg workers'conipe-risadaii insurance for my eniplay'ees. Beloiv is the policy and job site . inforrnatiom Insurance Company Name: Policy,4 or Self-ins.Lic.-4 E Tiration Date: Job Site Address: City/StatelZtp: Attach a copy of the workers'compensation policy declaration page(sha ring the policy number and expiration date). Failure to secure coverage as required finder Section 25A of NfGL a 152 can lead to the imposition of criminal penalties of a fine up to S 1,50a 00 andfor 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 D.TA for insurance coverage verification. I do Hereby .e fj�njtder t e ' andpenalties ofpedut}the informationpm i&d abmre is true and correct l Sitsrature. 1 Dater 7 Cd Official use only. Do not write in this urea,to be completed by city oriown ofciat City or Tan= PermitUcense# Issuing A.uthor ity(thrle one): 1.Board of Health 2.Building Department 3.City/Town Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Othen• Contact Person: Phone#: I ' Information .and Inst-uefions Massachusetts General Laws chapter 152 reg us all employers to provide workers'compensation for their employees. p tc)this statute-,an emTkyeze is defined as."_.every person M_ the service of another under any contract of hire, express or implied,oral or written" An anproyer is defined as"an individnal,partnership,association,corporation or other legal entity,or an:Y two or more of the foregoing engaged is a Jomt entm?rlse,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 tie - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or but ding appuitenaut thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also sues 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 bu.gdh igs in the commonwealth for any o con fiance with the insurance coverage required applicant Who has not produced acceptable evidence f p _ PP P ^- Additionally,MGL chapt e 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with.the incrrrance. requirements of this chapter have been presented to the contzacting authority." Applicants , Please fill out the wodcers' compensation affidavit completely,by check the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their ceriifacate(s)of in �ance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the ct members or partners,are not required to carry woikers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submit[nd to the Depar m en t of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be reb=Dd to the city or town that the application fur the permit or license is being requested,not the Department of LnAustrial 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 lime. City or Town O$ciaLs t Please be sure that the affidavit is complete and printed legibly- The Departmenthas 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 pen oitdicense applications in any given year,need only submit one.affidavit indicating current policy information(if necessary)and under"Job Site Q ddress"the applicant should write"aII locations in (�'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 ' oofthat 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 permitnot related to any business or commercial veniise (Le. a dog license or permit to bun leaves etc.)said person is NOT required to complete this affidavit The Office of Investigation would like to tbaatc 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. Ike CaMMMWt a1ft of Massachusi-Itts IIepai invent of Iudu,-taat Aaeitjeuts , Gfice of JiLvesdgatio.� ' �QQ�asbingtau Sit ,• - . Bash MA G�Iif T�1.#GI'- 7-49QG ext 4-06 ar I-,a ILIASSAFB Fax-617 727-774 Revised 4-24-07 W mass gavf dia TONM of Barnstable n ' R%ula-tory Services TtM r Richard V.Scali,Director o . � . . � . . 3uffdmg Dzvisian . - • t F�� Tom Ferry,Duildmg Commissioner. 16tia� 200 Mafia Sftw4 Hyannis,MA 02601 �Ep µ www;town-barnstahIe-matrs ' Office_ 508-862-4038 _ Fay'508-790-6230 F HOMEOWNER LICENSE EXEIY=OBI a.,.• . P[czsePrint . ' DATE: JOB LO=OK-- Y „ nnmbcr"` �• sir=t: _ �. v�1ag� x � , •�roMEoW :__ 1. O v�o l�to S 08 • 3 9 . name ` homcphonc# CURRENTMAILIDIGADDRESS: 2 city/town zip cock The current exemption for`homeowners"was extended to include owner-0c ied dwellings of six units'or less and to allow homeowners to engage an individual for hire.-who does notpossess a license,provided that the owner acts as supervisor_ : AEFI MON OFMhMOWNER Persons)who oyes a parcel of land on which he/she resides or intends to reside,oa which there is,or is intended to be,a one or two- family dwelling, attached or detached stzuctares accessory to such use and/or farm structures_ A person who contracts more than one Home in a.two-year period shall not be considered,ahomeowner. Such`homeownee'shall submitto the Building Official on a form acceptable to the BmIdmg Official,thathelshe shall be responsible for all mchworkperformed underthebufldmg permit (Section 1D9.L1) y . The undersigned`-`homeownef'assumes responsibility for compliance withthc Staid Building Code and other applicable codes, bylaws,roles and regulations_ - The undersigned`fio eowner"certifies thathelshe undemtands the.Tova ofB=e-ble Building Department�imum inspection pro es and re ents dthaat he/she onply wn said procedures and reqcicemenfs. • -$i a4�of Hum cr F. ,�. '- ,,% •. - 1 .;. •: ,. Appm'ai ofSmld"mgOffiC f b Note_ Tfi=4m3ily dwellings confaihi g 35,000 cubic feet or larger will be recited to comply with the State Bm ing Code Section 127.0 Consintcdon Control HonoWNM'S EXMr2xION t The Code states that: aAuyhomeowner performing work for}which a bu:Hdiag permit is `required shall be exempt from the provisions of this section(Section 109_I1-Licensing of 1.construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such Mork,that sneli Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsubrTiiies of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construcfon Supervisors,Section 21S) 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 if Would wifh a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. = To ensile that the homeowner is fuIIy aware of his/her responsrfrlities,many comratmifies require,as part of the permit appncatian,that the homeowner certify that he/she undersfands'fie responsiibMdes of a Supervisor. On the List page' of this issue is a form currently used by.seFeral towns. Yon may care t amend and adopt such a form/eertffim tan for use in your community. - Q1g1YFIIF5'lFOz2 f,**�tTmgprMitft=1EXFMS doc ' Revised 0613 13 To,yy Town of Barnstable . , aF Regulatory Services 'MA F Rl� IRT�! F Richard P.Sraii,Director.1659 k Building DIVMs 011 Tom rerry,Em gr Co oner 200 Main Street;Hyauais,MA 02601 www town-barnstable-rimus Office: 508-862•-4038 Fax: 508-790-6230 Property Owner Must , Complete and Sign This Section' : If-Usrng A B-rlder as Owner of the subject property herebyaurhonze to act on my-bJnl� in all matters relative to work authorized b7this binding pemait application for. ; (Address of Job) ` ``Pool fences and alarms are the responsibilityof the applicant~Pools s are not to be filled or teed befofe fence is installed.and all final " inspections_are pedored and accepted. S4=nr- of Owner Signature of Applicant Print Name Prime Name Date . QFORM5:OW1�tPIIt�SI01dP00IS � a Or FY>�•N : 4 r ,r a 4Ii P j i - j r C , 7 t _.1 'J��. .• _ .rlCoco f' 4W fill Zv C t ~U 4 t 1 i1 I mot , Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee * STAB . _ 9 Mass' Richard V.Scali Director 1639. 1� QED MA'S A Building Division MAR 10 2016 Tom Perry,CBO,Building Commissioner 20.0 Main Street,Hyannis,MA 02TOWN OF BARNSTABLF www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY ��� 5^ Not Valid without Red X-Press Imprint Map/parcel Number `� ' Property Address �-e U le 1-'\ C.��LCL i C, W esidential Value of Work$ �� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �!A-14 7 N `Z�j l_\%:-: i Q-t M C. k\C-t-� LLL_ M/h C97fo3Z Contractor's Name—'PA L) CA ztL A-U 1L7i—: -f-Sc�N_S' Telephone Number Home Improvement Contractor License#(if applicable) 03' Emaill C2 0 C_Ce 2 PGY e Lj`F. (ctir►.-, Construction Supervisor's License#.(if applicable) C S u g ( s 4- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner j lave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Vic, J - Z i S' 30, 166 -4-6" U 2 -'�7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to yAIMOO97} ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 L� The Commonwealth of Massachusetts � '.� Department of Industrial Aceidents Office of Investigations 600 N,`ashington Street Boston, MA 02111 wwm inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PAvL J_� CA 2'L__7 1-V UAJ Address: /V S City/State/Zip: 6S L-C- E NA Phone#: Are you a ..employer?Check the appropriate box: Type of project(required): 1 am a employer with/0 014-..171'1154. ❑ I am a general contractor and I 6 ❑New construction Pemployees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 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.❑ I_am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions in [No workers' comp. right of exemption per MGL 12•❑ Roof repairs insurance required.]t c. 152, §1(4),and,we have no ' 1 3.•�ther employees. [No workers' 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: 1/h S C-0 �� Policy#or Self-ins.Lie.#: G 6 '3/ — �� �-G 2 Expiration Date: �l 0/! Job Site Address: Z ,? L( L 'f72-���t �l/ZGLc. 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains aandpenalties o f perjury that the information provided above is true and correct. Date: S in� ature — Phone#: S7 � Official ctse only. Do not write in this area., to be completed by cith 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#: i f �^7 AC�® DATE(MMIDDIYYYY) �i CERTIFICATE OF LIABILITY INSURANCE 8/11/2015 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 DOWLING & O'NEIL INSURANCE AGENCY INC NAMEAOT 973 IYANNOUGH RD PHONE FAX PO BOX 1'990 A/c No.Ext: A/C No): HYANNIS, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC 1031 MAIN ST INSURER C: OSTERVILLE MA 02655 -INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25918664 REVISION NUMBER: 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MMIDDIYYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE a OCCUR DAMAGES(TO RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY CEa M aOBINED SINGLE LIMITccident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ �DXED CESS LIAR CLAIMS-MADE AGGREGATE $ I I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-386670-025 8/10/2015 8/10/2016 �/ STATUTE _ ORH - AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN - E.L.EACH ACCIDENT $ 1000000 ❑N NIA A OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION PAUL CAZEAULT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 031 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25918664 1 1-386670 ) 15-16 WC I shankar.gadale@libertymutual.com 1 8/11/2015 4:45:09 AN (PDT) I Page 1 of 1 _��— €� ���/�€% .�)f1/1�'�ird�'?�c�-:fir:?'�°��%�:�'C%�r''(• f).�, ��+��d:J!�-��%�i�'li��i��'�d��- -�, Office of Consumer Affairs and Business Regulation 10 Park Plaza -- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card ::....: Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, ING:.' RUSSELL CAZEAULT ---- -- — 1031 MAIN ST -- OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. scA 1 Qp 2OM-05111 /��/ ❑ Address Renewal Employment Lost Card !� <�I70 Z(�Ci7YL/7EOY"U(JeaN?L�(i(/.11;l:lClC%llL''e�J Office of Consumer Affairs cos Business Regulation g License or registration valid for individul use only q)Nilm. =.nr, before the expiration date. If found return to: QME IMPROVIMEN7 CONTRACTOR pr;,; Office of Consumer Affairs and Business Regulation Re istratioij037 4 T e!% 9 4 yp 10 Park Plaza-Suite 5170 Expiration::-:'. 20.16: Supplement Ward pp Boston,MA 02116 PAUL J.CAZEAULT&:`SONS';1NC: RUSSELL CAZEA(JLT•, 1031 MAIN ST �— _ 'v OSTERVILLE,MA 02658 Undersecretary Not valid witho nature ulassachusetts -Department of Public Safety --r Board of Buiding Reguiations and Standards Construction Sullerrisor License: CS-108157 RUSSELL CAZEAULT:.-.,:, f 2071 MAIN STREET _'-- Brewster MA 0201 - •`iD,C•Mommi-s"siio n e'rr 1112312018 ,. a a' } -77 � . 4-4 - = 41 'sfb` #rn•.•-y,: "' �' ..e .�,,.�, fr.�-,3Sa' «`: �`s « -" y �. R :.. 4 ??+ - ,'i.,a:,F o-ram, r fit" Y➢ 6 z s ;` i ma.^ € � f j f pa 0- "S ,'...�' "�,p�,a.y `^`_'• '. _ , yg$ ,t , _ _ _ �• _ _ m— >'•'i IKF s x wo Property awnerMust Complete &jS1gn,Tfis�Form _ :-. 4 9 x If�Us�ng �Roafer� Bui1d®r 4 ° E � _ s x , VW Y �+ _ - - s+ $,. m _ as Owne of k f ,. •, Av ^ Y {, • a ��- u r ¢of fhe sub"ecti r hereb "authviiesPaulJ. CazeaultBSonsRoofinplc - : - -- rA fir' .-.. ..^s-..,., s ,�..... �wc»�s •I v .._ w �. �to acf onmr,behalf,rnall►naffersrelafrve #o`worl�,authorrzedb�flithuiltlin - " t . _ i We 'psi - � ' permifrapplrcation for: s ;_ �� ��:'a- �`-g t •�� � �'�� � � n ���jr ` r��s #a- ..,+,t " j � �,.,�,p `.t5�-�r " s . 5�`x -.,,;._ ,,. -_, � �-®.-.f-".'�,�,.�,- -_ -,�....-at°w--`Y --'•,��--.� _ ._ ,,. _ ��...,_ �-yr, -. _a fv V ' .r .,. `--• —>wi+»+em.r"G� � � '� _�_ q� ` �.e". .- .�. �€ �m 'Sf Ms '��.�.- �f4...' w _ $o-_s��tl° $ 9RA-� �i_k� �r *"_g�*� "�Z f 0wng "Marlin �ttltlress ofOwner t .r_, 1 �'-*��,Y € a ." E i� it AU, '. Aim- ,'3�t -:•.,,i try ay y `'"` # ria .: ,pit.= ., y. ra .,y j-:-. .t .a ,•; �,." `{'�-n- . `, $„pry • n` xy"=' S=.>s '�s x - ¢i �:.... .r :I P aase ret m this form t Pau1,J a zeau#t7R66flngiabng�rntli,your s.gned confract.7. i� A 1Et>Es Weeder!for us�t obtaf ihe;buldtngfpermit:requ�rediby your,towr to complete your oofing p�oJect•, ' ": r'`r`,� "t .'z°*�-- _ ¢ _`sue. .. ` - y�•. �,-",-. �, - '"- _ fa` #50$ 420�4555- x - office@cazeault corn. - d - ." "� r �w ';,:.« hi -P _ '-tea rA S � s t a AM r ,'.a�. a• a e--' - « *•. 'T. '„ a'ra, vA; •' 1 x. t , 4 L_ _ a t oFIME, Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services r Fee 3s 3ARNSTARM v , ; $ Richard V.Scali,Director rE0 MP'I A �� � a17 Building Division * � Tom Perry,CBO,Building Commissioner AR 1 5 9 200 Main Street,Hyannis,MA 02601 �t•Il .2016 www.town:barnstable.ma.us �p�n�Office: 508-862-4038 TOUVIu OAVO d 0.F -EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f q Not Valid without Red X-Press Imprint Map/parcel Number Property Address 2�('r%M -C.'\r C_\e L P r-&exyd \�Q__ ®Residential Value of Work$�Y,S p p Minimum fee of$35.00 for work•under$6000.00 " Owner's Name&Address' Y)gy(N`, - M nX-)Cn9V, - Z Ae�r'\m Xr .ke_ Contractor's Name - Telephone Number . Home Improvement Contractor License#(if applicable) Email: " Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor_ I am the Homeowner I have Worker's Compensation Insurance y Insurance Company Name (`(ill V—(J .y Q\R� Workman's Comp.Policy# L Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box)-., ❑,Re-roof(hurricane nailed)(stripping old shingles) All construction debris.will be taken to .'r ' , 1 . - ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side [� Replacement Windows/doors/sliders.U-Value. (maximum.32)#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: C:\Users\Decollik\AppData\Local\Microso \W• dows\Temporary IntemetFiles omen Outlook\2PI0IDHR\EXPRESS.doc Revised 040215 I Town'of Barnstable Regulatory Services oFIKE Richard V.Scali,Director Building Division � a BABNWABr e, ' Tom Perry,Building Commissioner 69• .m� 200 Main Street, Hyannis,MA 02601 rFDMAIp www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Z�I�O1�, l Please Print JOB LOCATION: R 1—.1<Z.tyhm (:am\V CA 2 pimtear Y%\,�2- number �,� street village �Y� "HOMEOWNER": -)Ckrc_ \ 1 1L�SlmoA sc& GJw�Q• \\.Q\. 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 not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) . The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection ocedures and r uirements and that he/she will comply with said procedures and requirements. g ature of m caner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. + HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such 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. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 i The Conutionivealth of Massad iusetts Department of Indusoial Accidents Office of Investigations 600 Washington Street Boston,1 02111 ►vw�ry inasmgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Numbers Applicant Information Please Print LegiblX Name(Businesslorgaiiintiontlndividnal): Address:Z.FS UN Q.-�ynm City/State/Zip: Ler Phone# Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer,with 4. ❑ I am a general contractor and I (full atLd!`Of part-time).** have hired the sub-contractors d ❑New construction employees( part-tun listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- , ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Building addition , required-] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.X I am a homeowner doing all work officers have exercised their 11.❑plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]l c.152,§1(4),and we have no employees.[No workers' 1319 Other i n comp.insurance required.] 'Any applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all wort:and then hire outside contractors trust submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the game of the sab-contractors and state whether or not those entities have employees. If the sub-contractors haae employees;they trust provide their workers'comp.policy number. I am art einployer that is'pmWditig it orkers'�congseltsatioii insnraiice for xty entplojwes: Belo_ w is the police ante job site information. Insurance.Company Name: Policy#or Sel€--ins.Lie.i#: Expiration Bate: Job Site Address: Cih,/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 S 1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine- of up to S250.00 a day againstthe.violator. Be advised that a copy of this statement may be forwarded to the Office:of Investigations of'the D1A for instuance:coverage verification. I do hereby certify under the pain and penalties of perjury that die infortnalion provided above is trite and correct Si true: Date: Phone#: Ufficial use only. Do not write in this area,to be completed by city,or lawn of cial City or Town: Permit/lAcense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector . G.Other Contact Person: Phone#: Assessor's map and lot'inumber ..: ......... :....................... TIC ...• i` SYSTEMINSTA MUST jZVI ►`� lNITH SLED IN COAgF BE S`'wage Perrrst number s. ..:�r�_���'��4'.�J:......... ARTICL LIANC� SANITARY.CODEII STATE F tNE T ..... r It U IC�ti ,, AND. TOy�/R1 °�♦o -; : w� TO•WNJ OF 'BARN S���'LE Z BAnsTeDLE, � M6 q � RUf3LDIN.G INSPECTOR o APPLICATION FO PERMIT TO men.....:............................. TYPE OF CONSTRUCTION i........... ... .................................................:.:.................................. -L-4W�- ......U7-'TA9........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�i.l. 't-;. ..... +:..,tCCEi.................................................................................................................... ProposedUse ......Y-AO.s'I4 Xt.1.G.4 2 L,........::................................................................................................................................ .......................:Fire District .............................................................................. Zoning District .....................................:.......... Name of Owner . t-.... .... O.T..'!.'.................Address ...2�.... "..... ........... .�kcuhti},,. 'ry 1 t, Name of Builder ...1 )r ... b�G.>�. ........ ........Address .. �... 5. ,,........ .�� . Nameof Architect .................................:................................Address :........................:........................................................... a Number of Rooms ......................... .�.............................Foundation ...16....... ....1.YA. `.........:.......................... Exterior ...... .��,,..... a.....................................Roofing ...h. .-.... j'h ....... Floors . e f- ,.... .Interior ...... /..•.� U. .................:............................... Heating ..................................................................................Plumbing................................................................................... .. Fireplace ..................................................................................Approximate Cost .....A.}Qlo ... ...................................,......... Definitive Plan Approved by Planning Board ________________________"_______19________. Area .....Jl ..... Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTH i �z $ I hereby: agree to conform .to all the Rules and Regulations of the Town of Barn ble regarding the above construction. Name .... ... `... ............... ............................... Brown, Ford No 1,9.767..... Permit for Additim................ ............................................ .................................. Location28 Lietrim Cir .................................................. ............. Centerville ...................................... .................... Owner J....rdo .............Brown....................: .. ....................................... ... Frame .Type of Construction .......................................... .................................................................I............ Plot ............................ Lot .........69 53 ....................... Nobember 21 77 4 Permit Granted ............ ................ `........19 Date of Inspection ..... 39 0 of Date Cotpleted 19... ....... PERMIURIEFUSED -'k ..........................................................Z...... 19 ............................................................................... . .................................................................................. ..... ......................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ................. ........................................................ Assessor's map and lot number ... y !�-wage Permit number .......................... .................... ........... 1. TOWN OF BARNSTABLE t 33ARNSTAki NAGL t639- a M Ar- BUILDING INSPECTOR A 1,1 111no— APPLICATION FOR PERMIT TO .................. ............................. .......................e................................................ TYPEOF CONSTRUCTION ........................... ................................................................................................. ................................. ........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........1'=-....... ............ ..................................................................................................................... Proposed Use .....to ............. ...... ........................................................................................................................................... ZoningDistrict .........................................................................Fire.District .............................................................................. Name of Owner M— t::� . .................Address ...14 1 -1 1,) I . ................ ...... .................. e-4 ,,L,i)� ............................ Name of Builder ..n)5.... .......Z...:................Address ........ ...................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .........................40'N—.............................Foundation .... ....... ...................................................... .....................................Roofing ... ol Exlerior ...... ....................r. .... ................................. ................................... Floors .....`- a a,) ................................................................................Interior ... .......................................................... Heating ..............................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ..... ............................................................ Definitive Plan Approved by Planning Board --------------------------------19--------- Area ....a4—t IL)LI ................................... Diagram of Lot and Building with Dimensions Fee ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH LIN C7 t- hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Brown, Ford i No ...9 ! Permit for ..Additon Location ..28 Lietrim Cir............................... ................................. ents. .J, ............. ........ F Owner ord..$r4.Wi1<............................... ................. Type of Construction .......Frame........................ ............................................................................. Plot ............................ Lot ............1.6.9....53.... Permit Granted November 2119 77 Date of Inspection ..... ............................19 , Date Completed ... ...............................19 FERMI RE D .............J. /. ....L . , r ........0.............. .....:............................................... ........... ......................0-........................ .....................................................0......0.................. Approved ................................................ 19 ..........................................................0.................... ....................................................0.......................... y�f TN E TD wy TOWN OF BARNSTABLE Z SAHHSTADLE, i "6 9 BUILDING INSPECTOR O MAY�. APPLICATION FOR PERMIT TO .. .................................... .... ............. ... .................. .... ........ . . TYPE OF CONSTRUCTION / ..... .... .. ..... ... . . ............. ....... .... ..... ..l ..........19,7. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord.ng to the following information: Location .�Q. .�P...... ... . .. .. . .. ProposedUse ! /1 .. ... . ..... ........ ... ...... . ....................................................................................................................... Zoning District ` V.. .... ... ...................................................Fire District -( Name of Owner r �/JA! ...... '!r'1. . ... .... ...#,A Address �. ....... .' 1..!.!a! r .,✓.1.0,4 Name of Builder .......Address Nameof Architect ...............................................................:..Address ............................................................................:....... Numberof Rooms ..........! ..-1.. .............................................Foundation ............... .............................................................. Exierior .(Ao ,t......Ck-d�..�..........................................Roofing ... ... .J� 0 Floors .0 .............................:......................................Interior ..... . Heating ... . .. --. ........ ..............................Plumbing ...../.......................................................................... Fireplace ....I............................................................................Approximate Cost ....../.. �. ............................ Difinitive Plan Approved by Planning Board ________________________________19________. So Diagram of Lot and Building with Dimensions AOO ' Y L .4 . 0 m a cn co }� \� W cn QC'" ® 0 0 0 m � djzi � 2W ( 00 .z S lfl (j } � W �1� LU ^�h 0' �C C7 V Z z' S� �S LR L q • �`� Ham ® =-' � < 1() o I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .A.. .... ............. ...�� ' 11 - [� Iacey* 11fiIIiazuE. Jr. «971 - ^~ 14O47 one otozv No ................. Permit for .................................... " - ^9 / � Location - --- - ---- / 0 � ----- ---- � � �Owner . ,`^ �____�������.---. `----. � . Typo of —..frana____.. � -----^--------------------'' ��� � Plot ---------. Lot ---?��................ \ � . ` \ Permit Granted .....JoI7..13------.lA7l | � Date of Inspection ------------l9 . Date Completed ..... ........ - ^^ � ' | ^ / ' V PERMIT REFUSED ( � � ______—_--.__--------.. lg } » � --------------------------' ^ -----------.--------------... ' ~ � --------------'-------'-----' x�y .------..------------.------...App,ove6 ,__------------.- lg ---------------.-----.~..--~— \� » ----^------^---------^^^---^' | _ .