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" " 1��,f_` ,� , 1 ""�" `�,,�', ,,;4;�,;�iil �,,,,,,�,,,i5�,�(���i%.4v��,��".""� �."f�--,�",i�.�,"'�-.!",���l�,,��,,,��",.";��i�,�-.�,,,,_�",L��;'-'� , , - - ,�f��,��l��,�,,,,,��(,'i�"4��,���i'�,?"��'�" , 'i "i.1111�.drli","�". iiL`kitC - I i­�L;1. 111', � , -_,.;:-,,-��,�',,:� ��� l, _ ��. , IPL�-, ��f'L.�� !" "., ,�, _ij, ��_ 1.L-I � !,j � � - I .......�._.l�_ 'a L"z!'Ll L-Ldi2l'��,,ii,I,�.,,,t z'�_�.".-.I,�,"I2,i,_,"'IL�:�.", ; u,�,_,,.`;!� ��,��L',,,�f"'2,,,�:,,,,,, ""'6i ,,- Town of Barnstable ld Pos Thi `Car So That it is.Vistble From#tie Street=A rovedrPla s Mu t be'Retained�oriJob°andthis Card Mus �� � � + xsrwps t. s d pp st be Kept Posted Unt l;Final Inspect ontiHasi,Been Made ,� u���fi :.� �� ,� ' 5� �� ­°; 1°1 'tiEa:ryu►r` Where,a Certificate'of Oecupancyis Required,'such Building.shall Not be.Occupied until a final Inspection has been made Permft Permit NO. B-20-1597 Applicant Name: carlos Figueiroa Approvals Date Issued: 07/16/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/16/2021 Foundation: Location: 15 LIMERICK COURT,CENTERVILLE Map/Lot: 169-079 Zoning District: RC Sheathing: Owner on Record: BITTNER, BRYAN ALF Contractor Name., Framing: 1 Address: 15 LIMERICK COURT Contractor License. 2 CENTERVILLE, MA 02632 Est. Project Cost: $5,500.00 Perm it Fe�: 35.00 Chimney: Description: remove old roof and replace it with a Architect shingles $ remove front and right side siding. Fee Paid; $35.00 Insulation: Project Review Req: Date 7/16/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced-wiihih six months after issuance. 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 Final Gas: work until the completion of the same. i 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: rf 1.Foundation or Footing. .J Service: 2.Sheathing Inspections 3.All Fireplaces must be inspected at the throat level before firest flue`linmg is installed � � 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: Q w i..i.,.•�F" Town of Barnstable 200 Main Street Tel. 508 862-4038 Mnss a AiEOMA�A�`� INSPECTION REPORT Permit: Addition/Alteration - Residential Use. Date: 7/16/1997 12:00 AM Inspector: Permit Number : B-24156 Name: KONIGSBURG, DAVID Address: 15 LIMERICK COURT, CENTERVILLE Unit No. Inspection Type Inspection Item Status Comment Building Foundation A- Inspection Results PASS TPER: Inspection Overall Comment: Overall Inspection Status: Re-Inspection Date: Date: 8/12/1997 12:00 AM Inspector: Permit Number: B-24156 Name: KONIGSBURG, DAVID Address: 15 LIMERICK COURT, CENTERVILLE Unit No. Inspection Type Inspection Item Status Comment . Building Insulation A- Inspection Results PASS TPER: Inspection Overall Comment: Overall Inspection Status: Re-Inspection Date: x Inspector Signature Owner Signature Total Score: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION qq 7 c '<< F '.i Map b l Parcel 0 7- _ Ap�p9j Health Division r. - Datq Issued Conservation Division Application Fee Planning Dept. £,=v: Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1 5 L i m P r i r. �1 C G t+ Village Cenieny- CIP, Owner David On j�IR Address SSA #10 �1 J Telephone 50 139 6 5900 Permit Request �a d �'i 9 a�� �'38 Celkwlo)e +0 -V .j a� c. AJ� k-3$ -�;bwlw to t�e a-Wr , EI J pu l 116er$ 1A3J - At WemPni box s;II P r 5-eAl Ae .4k, VLne, and laseMenf w I A O_kndi , `t-aAMa Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5 p 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl . ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ,(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � II Nt'a���111Nn1 �ke CA kve, n.c t-Telephone Number Address 7 - 4 e_. License #_ J—C- 10a 34 6 0 6 Home Improvement Contractor# 1 8 Email Worker's Compensation # �, W� C 313 6 ag cl ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Y0.rmpy�� SIGNATURE DATE Ll l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED -r. MAP/PARCEL NO. I � � ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING -- , .DATE CLOSED OUT ASSOCIATION PLAN NO. t n - The Commonwealth of Massachusetts Department of Industrial Accidents d 1 Congress Street,Suite 1.00 Boston,MA 02I14 2017 wwwmass gov/da AN{orkers'Compensation:Insurance Affidavit:Builders/Contractors/Electrieians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY.. Applicant Information Please Print Legibly Name(Business/Organization/Individual):'Cape Save Inc Address:7-D Huntington Avenue City/State/Zip;South Yarmouth, MA 02664 Phone#;508-398-0398 Are you an employer?Check the appropriate box: ;tTi Type of project(required): 1;❑✓ I am a employer with 20 employees(full and/or part-time):* .7. New.construction. 2. I am a sole proprietor or partnership and have no employees working for me 0 8. 0 Remodeling any capacity.[No workers'comp.insurance required:] 3.�I am a homeowner doing all work myself:[No workers'comp.Insurance required `. 9. Demolition 10 0 Building addition 4tM I am:a homeowner and will be hiring contractors to.conduct all work on.my property. I will ensure that all contractors either haveworkers'compensation:insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 1:2.❑Plumbing:repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 ❑ROOf repairs These sub-contractors have employees and'.have workers'comp.insurance:( 6.❑We are a corporation:and its officers have exerciseditheir right of exemption.perMGL;c; 14. Other Insulation 152,§1(4),.and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box.#1 must also fill:oiit the section below showing their.workers'compensation,policy information. t Homeowners who submit this affidavit indicat ng:they are.doing all work and then'hire.outside contractors must submit a new_affidavit indicatingsuch. 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:Wesco Insurance Company t Policy#or Self ins.Lic.#:WWC3136274 Expiration.Date:04/09/2016 Job Site Address: 15 L% rne.r1G k Cev r+- City/state/Zip;: CeM+erYl I.I1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure.coverage as required•under.MGL c,:.152,§25A is a criminal violation punishable by a fine up to$1,50000 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 A copy of this statement may be forwarded to the Office of Investigations.of the DIA for insurance' coverage verification. 1 do hereby certify under th .pains and Penalties of perjury that the information provided above is true and_correct Date: 1,5 ` Phone#:608-39.8-.0398 Official use only. Do°not:write in this area,to.be completed bycity.or towm0ficial •City or Town. fermifticense Issuing.Authority(circle one): f L Board of Health, 2.Building Department 3.City/Town Clerk 4.Electrical,;Inspector 5...Plumbing Inspector 6.Other Contact Person: Phone#: A� CERTIFICATE DATE(MM7DDlYYYn �,.. OF LIABILITY INSURANCE Az4/2u15 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 INSURERS) AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, WPORTANT:' If Itze.eeMficate,holder.;is an ADDITIONAL INSURED,the poll cY(Ws.).must 13e endorsed. It Sl18ROGATdON°15 fttkAll/ED,subject to the terms and conditions of the policy,certain olicies may require an endorsement, A statement on this certitcate does not confer rights to the certificate holder in lieu ofsuch endorsement(s). PRODUCER ruME, Colleen Crowley Risk Strategies" CO®painy PHONE �781)986-4400 FA o t7811963-AA20 Eim, /C 15 Pacella Park Drive I ADORE -strategies.com Suite 240 INSURE s AFFORDI NG COVERAGE NAIC# �u d*Iph 1 A t3 ;358 IIsuRERA:Sel.ectiVO 'Ins. meriaa r INSURED INSURERBAlimriCa rivaucia1 A11ianoe 10212 Cape Save, Inc INsuRERe-Wesea Insurance an 7 D Huntington Ave . INSURER D: INSURERE South Yamefith ! a2`664 INSURER F:; COVERAGES CERTIFICATE NUMBER:CL15 32 4 915 0 1 REVISION NUMBER. THIS IS TO Cf�RnfY IN Ttif POiiC1ES t3F TAISt iiAii(Cf LISTED BELOW HAVE BfEEi ISS(iED'TO THE`fNSUREO'NAMED:ABOVE`FOR THE'PCILICY PERIOD` WDICATED. Nil'wiTHSTANG9 G ANY REQUIREMENT TERM<3R dONDITION'`OF ANY CCNTRACT OR QTHER DOCUMENT.WITH:RESPECT TO YtiMiCH THIS CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN;THE INSURANCE,AFFORDED BY THE POLICIES DESCRIBED.HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONt)ITIONSOF SUCH POLICIES.LIMITS,SHOWN MAY HAVE BEEN REDUCED BY PAIDCL4IMS'. NURS POLICY:EFF POLICY EXP MMIMNYYYI TR _ TYPE OF INSURANCE.: POLICY NUMBER MMI POLICY LIMITS GENERAL.LIABILIN , € EACH OCCURRENCE $ 1,000,000 X. COMMERCIAL GENERAL LIABILITY E N PRFUv11SES Ea ocxiurrence $ 100,000 A CLAIMS ADE �OCCUR 1994U0 0/16/2014 0/15/2015'`MED ,(Any one person) $ 10,000 PSRSOMALBADVIN,ILL,?Y s 1,:OQ0,4.Q0 GENERAL AGGREGATE' $ 2,000,000- GEN AGGREGATE LIM1T`APP.LIES PER' [PRODUCTS,COMP[OP AGG $ 2,000,000 JECTPOLICY X PRO-. X LOC $ AUTOMOBI.E'1IA131LITY Eaawiderrt_ Ij 1 000 000 B ANY AUTO BODILY INJURY(Per parson) $ AL L SCHEDULED46796600 1/6/2014 1/6/2015 SODILY INJURY(Per aeadent) $ X HIRED AUTOS NOILONMIED AUTOS PR�DPER�Y DAMAGE X' PercldanF $ X UMBRELLA UAJ13 X OCCUR EACH OCCURRENCE $ 1,,000,.000' A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION IZI 51994460 4/16/2014 o/1Gl2o=� WO.R $ C KERSCOAS'LtAuT ffie ps Iaeliideci for v�csrarli oTH_AND EMPLOYERS'UA9ILITY X ANY PROPRIETORIPARSNERfEKECU%IVE YIN ra e S R '— OMCEPJMEMBER DCLLIEIEC? N !NIA E;L.EACH ACCIDENT $ 500,OOO (Mandefory in NHI 1:36n4 /9/2015 /9/207 S E:L DISEASE-EA EMPL{JY If.yes,desaiba under DESCRIPT10 OF OPERATIONSbeldw EL.DISFJSE:-POLICY LIMIT $ $QQ QQQ DESCRIPTION OFOPEmnONSILOCATIONS!VEHICLES Issued (At#ufiACORD404,AddiflonatRemarks:Schedule,ifmorespaceisrequinxq as evidence of insura nce. Thielsch Engineering, Inc. :is listed as additional insured.as respects General Liabilaty':as sequixresl }i3r writt;naCt,: CERTIFICATE HOLDER _ CANCELLATION El£IDng@CapE17 i : .t?rtJ SHOULID AWY OP'THE ABOVE DiESC1 18ED IrbLTCiE$$E CANCELLED BEFORE THE EXPIRATION DATE *EREOF, NOTICE WILL 9E DELIVERED IN Cape Light COVpact ACCORDANCE WITM THE POLICY PROVISIONS. Attn: Margaret Sonq... &'0 $OX 427/3Gti AUTHORIZEDREpI ESENrATIVE 3195 Main Street Barnstable►:_MA. U2630 chael ChrstianfCLC . ACORE?'2S{Zb Ip/05 Q'ISM2010 ACt'3R,0 CORI>{?RATfOPf �61I r gh4e reees d.1NSp25(zotoos).Q1 The ACORD name and logo are registered marks of AC©RD . v Housing Assistance Corporation Cape cod HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE . _ \ THE APPLICANT HOME OWNER. I '; `�. \<C,\ CA4��-AX^ 0, hereby consent to and agree that weatherization work m y be don by the Weatherization Program of Housing Assistance-- rporat..' ( herein after referred as "Agency" ) on -the property located at: \ The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1.. I give permission to the "Agency " its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for 'no More than five (5) years after the weatherization work is complted. y 4 h F I have read the provi 3.0LS of �hiq ag eement as listed and freely give, my consent. 't Home Owner: (Signature) `.. Date: �, �� , '`�,�"`�-C. 1 f ' Agent: (signature) Date: - ..; i '�' •��ie- ��am�n,���c.�ec����. o1i Ci����Jc��c�����" , , a� Office of Consumer Affairs and'Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation tt t 4 t � Expiration: 3/1.4/201.6 Tr# 249649 CAPE SAVE INC. ` WILLIAM McCLUSKEY —!- 7-D HUNTINGTON AVENUE . p T ' SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. sCa 1 C. 20k4-05r1 1 Address [] Renewal E] Employment Lost Card �%w'�aorurrarWtauxtcl.C�ryf;:���jf�rrcr�r��eC/' w Office of Consumer Affairs&Business Regulation License or registration valid for individul use only TOME IMPROVEMENT CONTRACTOR k before the expiration date. If found return to: egistratlon: 3$0 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 _- Expiration 3/14/2016: Corporation Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY ;' 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 62664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety Board of Building Reg:ui.ations and Standards Constr-uction Supentisor Specialty t_icense:; CSSL-102776 'r. WILLIAM J MC C-LUS 1' r 37 NAUSET ROAD NS West Yarmouth A 02 :7 `4— JJ w ,1 F,1 ''> Expiration Commissioner 06/28/2015 C 5AL �- Cape Save Inc. , 7-D Huntington Avenue �''j South Yarmouth, MA 02664 11 a,.. rABZE Tel: 508-398-0398 Fax: 508-398-0399 i � 5/19/15 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St.Hyannis,MA 02601 z RE: Building Permit#201501876 TO: Building Inspector(s), This affidavit is to certify that all work completed for 15 Limerick Court,Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey t �} n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, Parcel 0 Application Health Division Date Issued 23 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH _ Preservation/ Hyannis Project Street Address/ J� {. v,� IcVillage � Ile g ��dq, ail �' Owner 14 c Address 1 L,4 44-e-4- INC )9' 0a Telephone O �' $ Permit Request I S L�e Square feet: 1 st floor: existing 13�O proposed 13 2nd floor: existing proposed Total new Zoning District Flood Plain A10 _Groundwater Overlay Project Valuation S Construction Type t.Vcl® Lot Size m Grandfathered: ❑Yes ❑ No If yes, attach supportq99 dogmentation. 21 Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) cn r o Age of Existing Structure Historic House: ❑Yes Url o On Old ri 's Highwy: aes 1` o o� �� Basement Type: &Full Ga'Crawl ❑Walkout ❑ Other x' Basement Finished Area (sq.ft.) (ti Basement Unfinished Area ( ( ft) i_ 044j to Number of Baths: Full: existingnew Half: existing ew Number of Bedrooms: existing _new Total Room Count (not incl ding baths): existing ��new First Floor Room Count Heat Type and Fu I: ZGas ❑ Oil ❑ Electric ❑ Other Central Air: ' Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: existing ❑ new sighed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Oo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 2n,,y�J_ ���,? Telephone Number --qr Address 47A License # C S O 0 41 CCI11" O ),(D Home Improvement Contractor# t i 1 Email � .z 9 O c l Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I q r z FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED MAP/PARCEL N0: ; ADDRESS - VILLAGE I OWNER DATE OF INSPECTION: ; FOUNDATION FRAME �, ~ INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y DATE CLOSED OUT ASSOCIATION PLAN NO. r - 27w Commoannwalth of f'Massachuseftr .l�eporttf+�f frulrrst�at�4Ec-�r�errts Q&e of nvesaga ions 600 Wkykington Street . Bastan,hA 02L11 nwiv.mass:goVdia Workers' CcampensationInsuranceAffidavit:$ui.Tders/Contraactors/Mectricians/Numbers k p]cant Information Ptease Print Leib . Na=(ism°wlO onffadivi&4: Cc.,M 1 7 � Address-- /�s Iz4.0 l —� CityfStat;rlZip: p Phone -7 7 ! - --._Are.you an,-employer? fh"kthue�appmpriatebasv--------•- 1_-❑ I am a em to er with 4. ❑ I air.a,gene al contractor anal 1 employees{full and/or part-time)* have Tired the sub-contractors 6- =deling lion 2__ I am a sole proprietor orgarfner- listed on the attached sheep �- ship oral have no employees These snub-contractors have g_ ❑Dem,olitiou working for me many capa.citl�. and have workers' ❑Building addition [No,workers'comp.msuranre camp_insurance-1 10_ Electrical r or additions required j 5-❑ '%Te are a corporationand its ❑ s 3-❑ I am a homeowner doing all work of have exercised their I1❑Plumbing repairs or additions myself[No workers'conip_ right of emmption per MGL I2-0 Roof repalf and.we��no g i nr cane required-]1 c-15Z§1(4), 13_0 O.thec employees-[Na workers' comp insurance mquire -j "'Anyappti utthatchedzsbox#InmstslsofMoutthesectionbelo-sbaceingfheIrworken,compensaionpoliu l Sov,,wners vd,submut this affidavif uxUc tiug they ate doing all vat and than hire outside couttactnrs nmsi subocit a nMR sffjdarst mcbrsting mrh- =Coatnctors tbat rhea this box must sttadhed sa additional sheet sho Ping the name of the salt-co 3cynss and state vrhether ocnot these Mdlies have t'pluyees- If the MT.-cont mom have empicyee-%they mist provide their—'—''comp.policy mmmber. I am arc empZo}w that ispro�liditr�tt'orke-n'caniperisation uesurance far rrr}r Rrrrp7Oyees. Iie�atr is i3tegaTicy artd fob site informat&rL Insurance Company Name: Policy#or self ins_Li--a Expiration Date: 1 / Job Sits Address:/S . ' M:C.P� k GCS Citgf5tatt=1Zip:1/� /1 z AffacIt a copy of the workers'compensation polies der-hratiou page(showing the policy number and elation 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 1,500-0D and/or one-year impri as well as civil peaslties in the farm of a STOP WORK ORDER and a fine ofup to$250-00 a day against the.violator- Be advised that a copy of this statement maybe florwarded to the Office of Investigations of the DIA for insz re coverage 4�cation_ I do hereby certify rr tyre its and enalties ofp dwy that the information pravided abaue fs truce and correct S<imature: Date: Phone if: owzd-al use only. Do not write in this area,to be completed by diov or town ofic&L City or Town:. Nru idUcense it Issuing Authority(circle one).: 1.Board of Ilealtfn ?.Building Department 3.City/Town Clerk 4.Electrical Ynspector S.P'iumbi g inspector 6.Other ff- Contact Person: phQIIe : 6• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hir(,-, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other Iegal 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 of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sus that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the corirrnonwealth or a)2y 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 cer'aficate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Lie advised that this affidavit maybe submitted to the Dep u--went 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 Deparment 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. Sells 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 nH 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 add-tics,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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be idled 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. nI$ Commonwealth of M ssachmeitts Depaxtme t of Industrial Accidents Office of kves4igafioAs FQQ Washington Street Boston,IAA G2I I I T6L A 6I7 727- 900 W 406 or I-9 MASWE Revised 4-24-07 Fax#617-727-7 749 vivm.mas&gav/dla r - ± Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-004650 ` EARL E BROWN 76 HOLLY Lh1 CENTERVILLE CIA 8 . 'j j4A Expiration Commissioner 04/13/2016 r49\— Office of Consumer Affairs&Busihess Regulation OM'E IMPROVEMENT CONTRACTOR o egistration f,al i l Type x iration 4-> Individual r � IN EARL BROWN ,,} (:`f EL- '> EARL BROWN f' ' 76 HOLLY LANE \4 CENTERVILLE,MA 026�2i'=} Undersecretary { i / July 7, 2014 ' Barnstable Building Division 200 Main Street Hyannis, Ma.02601 Dr.Sir, We hereby give Earl Brown permission to act on our behave in all matters pertaining to this building per it application and remodeling project. R pe fully avid& Helen on 15 Limerick Court Centerville, Ma.02632 . - � V I✓�WWWW 2'-6,0000" 4' • 7.0000" 4, 4'-7.0000" TOWN•bE-EARNSTABLE —4444 rJ - DIVISION jexistong bedroom 0 o o o i, w r 0 I i r= d 4 � 0 r f" 1 1'-8.00001, i E 5` 8-0000" 3'-0,0000" 3'-OMOW I i � f -_;- rt 4 - 1 1�<7500" KO.0000' io 0 0 _ u m p o � 2' f•z_z O N wi G O i O D - CU 11'•8.5000" L sT� l o Ito �T�r Town.of Barnstable `Permit Expires 6 months fm n Regulatory Services Fee BARNSTABLE, 9� MASS. `e$ Richard V.Scali,Director 6k /y�,y AIFA MA't A illy din — I Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PENT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number- Property Address / 5 /.- j/!% I C.1� �IJ9(i1�0� -� �t?/�1� I I IP 4 JV< esidential Value of Work$ n O• CMG Minimum fee of$35.00 for work under$6000.00 knOwner's Name&Address yt e ---1/�" 1 Contractor's Name �^c,>� l� f�C9 C"'o _ Telephone Number :7 7 7 Home Improvement Contractor License#(if applicable) Email: E (13 . Construction Supervisor's License#(if applicable) C_s o 5� ro ❑Workman's Compensation Insurance Chec e: am a sole proprietor SEP 2 2014 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance. Insurance Company Name TOWN OF BARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to r . ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) �-side >' Zeplacement Windows/doors/sliders.U-Value o (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is e uire SIGNATURE: -�—� Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 I r o . e Ct�rrtr�ro�x€ t7a r� assr�er�ses Depivhneut of hulustr.ial Accidents offi��of-hga o s b, - Boston,,M,4 0211I H�FC'}1J 7riuss:gof�ilie� ' ' .mars' CampensafianLasuranceAffidavit:Builders/Conh-actorsfE•.ectricianMumbers AppEca-n t Infarmation Please Prim;Legibly Flame(k,,,, IOrgadzation8adividaal)_ t:�OV.P tj c_.� ` a CiwStatz zip: it t, _ Phone 4: C Are rau.an employer: Check tare appropriate ate: T •. of. o rem r t 4_ ❑ I am a g1 contractor and I }� �' � ����- I.❑�ai=ssofe plover wah 6- ❑New oons.a,-oazs(hill and/or gar#-ime)* ve hire i t e s fi contEacfors.2_ ` propr%etor or partner- listed on the attached sheet 7- �o��g sbip and have no e:mployess T1x�s:e sub-coatrar_tors have g_ ❑Demoliiiaa working ?orme in any cc-�r_.+ e In}yes and have worirers' y � � 9_ ❑Budd-mg ad'difion fro �roriteis' C.otilp_iSiQ7irtane e, F comp-insurance_ 5_❑ We are a corporationand ifs 14_[]Electrical repairs cr additions 3.❑ I am a homoownez doing all wO& offsreas/save exercised fh'ek I I--❑Piambing repairs ar additions. Myself [No wormers'comp_ right of exjmptionper MGL 12_]Roof repairs ii��zt�so s rezluu�d_�F c_ 152,g 1(4} and we have no, employees'-[No��' 13_.❑4tbes I omp_insm—cce squired-j. -Any appi o ac that decks box fl must also f1 our the section below rh�i'&laorkars"eompensadon RQUEY mfO t ne s wb--�r Lit ibis aLgidsvii j&r�w-y are�omg:n z+adc a d�t�hum o�tsid co�hacmrs�sY s absait a a davit.��cE.n�socFi ' 11�CtI3L5 t+�4i rF+xk ihts brat R rhnt7 as s[3diunnsl sheet shozemy the nape of the r.&�Xmd SLMM-chetiec ornnt those amities have Employees- Ifthe SUB-Cont actors have empIapees,they—p—de tb=r—kers'comp.poRcy nwnber_ I agi an.er:pZoyer that ispmidiug work ers'coPipLzrrsrthn iimiravc-a for rny mr W&yeem Hetaty is fat&poLic}arid}ob aitc i�z�`ctmalia;� • I�r�rance Gornpa Name: Polikj 4,cr Self itrs_Lif—�P- ExpirationDzte: Job Sit- Address: CifyFState/Ztp: Affach a copy of fhb workers'compen~satiou policy dedaration page(slro'a�the policy number and expsatien date). Failure to secare coV brave as sequzred under Seciioa 25-k of MGL c. 152 can lead to the iinposition of climiaal peraIties of a fine up to$1,500.00 and/or one-year imprivonment,as weJU as civil genatties in tie farm of a STOP'V.7ORK ORDER and a fiat of up to�250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office-of lm estiga6oa-s of gie DIA for insm-azace coverage verifiaatim- Idd hereby 4 thapcuns widpsng�iss 4:fP�xr'f#at rFfprrraufiQn pran�dabaw-is bars tend correct q Simatvze: [/ - /' Phone '� ( 7 V 8 K €I f Eci rL use anly- Dtr rtoi twits in t)ris ureR, a Its cuuapieted b}cifj ar fin n a iciaL City or T own: Permitucense# Esning Antharity(drde one): 1.$aaxd of He-Tth 2.$uilldug Department !GitFY-awn:Clerk 4.Electrical Inspector S.Plumhing Inspector 6.O4hex- CoSt.kct Peman: 6 1 information and tu-structions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto his 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,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`hereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sites that"every state or local licensing agency shal_I withhold the issuance or renewal of a License or permit to operate a business or to construct buildings,in the commonwealth for hay applicant who has not produced acceptable evidence of compliance with the insurance.coverage requiree." Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the pt ormance of public work until acceptable evidence of compli.o_nce vrih 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 situa on and,if necessary,supply sub-contractors)namt(s), addresses)and phone za be,-(s) along with then cerbific;sc(s)of insurance. Limited.Liability Companies(LLC)or Limited Liability Pau-toex-,l ys(i-.LP)vvith.no employ�ts other than the members or partners,are not re-qui_ed to carry workers' compensation insi,,ance_ if an LL.0 or LLP does have employees, a policy is requ1-ed_ fie advised that this affidavit may be subm ifted to the Depa,-mc-Tlt of indusfuu al Accidents for confrmation of,ems, Once!7,ovean e. Also be sure to sign and date the aEa-davit. Jl?e affidavit sho,?d be returned to the city or town that he application for the permit or license is being requested, not the Departyient of Industrial Accidents_ Should you have any questions regarding the law or if you are required to obiipliri a workers' compensation policy,please call'i ie Depaftmcat at the number listed below. Self-insured companies si.oild enter their self-;nc,trance license number on e arpropriate line. City or Town Ofia-ciaLs Please be sure that:the affidavit is u?mplete and printed legibly. The Deparulent has provided a space at he bottom of the affidavit for you to fill out he event the Office of Investigations has to contact you regarding the applicant_ Please be sure to fill in the permtjhcense number which will be used as a reference number. In addition-an appLcaut that must submit multiple penraiJLcense applications in any given year,need only submit one alldavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should v>rrite"all locations in __(city or town)."A copy of the affidavit hat has be--a officially stamped or marked by thecity or town may be provided to he applicant as proof that a valid affidavit is on file for fut me permits or Lcenses. .A new affidavit must lac tilled out each year.Where a home owner or cif eu 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 afTadwirit The Office of Investigations would juice to thank you in advance for your coope_i-adou and sho-uldyos have any questions, please do not hesitate to give us a call. The Department's address,telephone and ax number: Thh��Commnnwman of ifassachuse Dr--partraent of lndustdal Aecideats €?ff[c-e of avestigat%o-n! 600 washes an sft�-,et Boston_MA 02111 TtL,4 6I 7 727-4900 W 4€6 or I-a777?%L-kSSfiFE Revised 4-24--07 Fax T 617-7`7-77 A9 V LIV 1 LI1V ILLL, IYIr1 VLVJG t#.. ti— .�� l r � Update Address and i t' ► ❑ Address Ren, SCA 1 G 20M-05/11" , a Vlae'�arr�maruueaC�i�C�/f/�aaauc/zr.�aeltt:. Office of Consumer Affairs&Business Regulation License or registration valid for individ OME IMPROVEMENT CONTRACTOR before the expiration date. If found ret VEXp1ratiorf:--------'9): egistration:;,)�t7. 111 Type: Office of Consumer Affairs and Busine: j—& Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 EARL BROWN s� ` EARL BROWN, 76 HOLLY LANE t• CENTERVILLE,MA 02632 Undersecretary '-Not valid without signature Massachusetts -p P . + epartrri I Board ofi Suildin ent of Public`Safety . :. 9 Regulations and Standards Construction Supers isor License,CS-004650 . ,1• EARL E BROWNy; 76 HOLLY LNi ; CENTERMLE RA Q, u. Co Expiration 'v rmmissioner 04/13/2016 e� 4; OFSNE Tp� « saaxsrAJMJIK. 9$ MASS. Town of Barnstable t Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO - Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 . ____ Property Owner Must - Complete and Sign This Section If Using A. Builder as Owner of the subject property hereby authorize —c4N to act on my behalf, in all matters relative to work authorized by this building permit application for: 1 G,'-P,�,, l� (Address of Job) Signatute of O t Date y O S`)`Ar Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 061313 , Town of Barnstable Regulatory Services P�oFtt+e Taiyy Richard V.Scali,Director Building Division * snxxsrnBLF. Tom Perry,Building Commissioner - hLAS& v� 1639• 200 Main Street, Hyannis,MA 02601 ArED � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": ' *- •-—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 Procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner 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. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 e TMEr° The Town of Barnstable Department of Health, Safety and Environmental Services MASS Building Division er 039' � � 367 Main Street,Hyannis MA 02601 Fa�� Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: \ �� Name: �V u b 1'\QG� �—� L\Nhone#: —1 A �" � a�.1� Address:\'S C� Village: �\.� 2y y', a Type of Business:\—, -I\\Q Map/Lot: 1 INTENT: It is the intent of this section to allow the residents of the Town-of Barnstable to operate a home occupation - within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual '� Y alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: ` • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. - • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. . • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I, un signed, ve red and agree with the above restrictions for my home occupation I am registering. Applicant. Date 1 ` ` Homeoc.doc TO ALL NEW BUSINESS OWNERS Please Fill in: APPLICANT'S NAME: oN OME� TELEPHONE NUMBER: � O C7 (Please give us a number where you can be reached) NAME OF NEW BUSINESS. eci. r�a�S, v'�, TYPE OF BUSINESS .r�ro 'L i i V, s� IS T�IIS A_HOME.00CUPATION? ADDRESS OF BUSINESS "� N. [ PIPARCE NUMBER , When startinga new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable- This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). 1. GO TO BUILDING IN PECTORIS OFFICE (4TH FLOOR TOWN HALL) This individual has d,010y permit require ents that pertain to this type of business. t rued Sign e COMMENTS: 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individual has been informed of the permit.requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMINISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature fr COMMENTS: After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost $20.00 for e in the town of Barnstable - it does not give you permission to operate -you years). A business certificate ONLY registers your nam must get that through completion of the processes from the various departments involved. ti t Engineering.De t. (3rd'floor) Map Parcel # 2 is CP House# Date Issued 72 Board of Health(3r®or)(8:15 -9:30/1:00-4:30) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) / Planning Dept. (1st floor/School Admin. Bldg.) ST BE Definitive Plan Approved by Planning Board 19 INSTALLE�� NCE ENVIRONM 9 "AND TOWN OF BARNSTABLE TOWN AE TIONS _ Building Permit Application Project Street Address `✓ L� V Village _ Owner 6 Address 4,Ll— Lev Telephone Permit Request ��7�+ G�JG i/ G/L/v I i L r �N Z' v ✓ First Floor O x l 2 square feet Second Floor square feet Construction Type wpvr Estimated Project Cost Zoning District Flood Plain /J19 Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family)-ISL Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes No On Old King's Highway ❑Yes IxNo Basement Type: ❑Full ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing ' New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) _ Other Detached Structures: ❑Pool(size) --XAttached(size) )C ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use fr �� Builder Information Name -�1r3 , f�itj F-J Telephone Number bs-.04 Address - ! � License#���?'� Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ✓l.�" DATE BUILDING PERMIT DE qIEFOR THE FOLLOWA REASON(S) ei FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED ' MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION FRAME ` INSULATION FIREPLACE ELECTRICAL: ' ROUGH FINAL I PLUMBING: ROUGHS FINAL - GAS: { RO;UGfl':;� FINAL , FINAL BUILDING., e ' "'"' r °f DATE CLOSED OlfT�` s .t ` ASSOCIATION PL`4 0. = 0 : . . : The Tow_ n ,of Barnstable ASS g. Department of Health Safety and Environmental Services • Eon Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW _ SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: 'F 1��Z Est.Cost f2 ig 0 Address of Work: mo l, Owner's Name� t'1,7 LP t►J G5115 fZ-Le;:) Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as th age of th n Date Contractor Name Registration No. OR Date Owner's Name Tht, Conrtttottirealth of Massachusetts u:►! - ---:_.t;_.- Dc partauttt of lndttstrial.4ccidews �3 1. • F Office of/nyestigatians , 6(1(1 ff'oshirrrtutr Street Balton, A1ast. (12111 Workers' Compensation Insurance Affidavit 1liniic:iritiriformatirin• ^� Please PRINTIebi�jv�"`"-' "'�•-• •�� ��_—�-+ ��- _ name* Incatinn� 61N. G -`&my I UV 1 nhtme# I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workings in any capacity ' ._ -.T-•...-.....__��..'.1�....•. wtAST•"w.11^1T!+.!f!.^iI',.w...!+w..�•!A'P���.�w..�.�..�.�'�w`•!S., w. '1M..+-r...___•-•.. Cj I am an emplover providing workers' compensation for my employees working on this job. cnm tarn• narne: address: 14 - cirw: nhnnc#• insurance cn. nnlicv# ,/)(1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below u•ho ha—v the following workers rcompensation polices: m m n a n v n n m c: AM-g-'7At 6/ ei�. !'?ti 49 ` cin•;_- nhnnc�• inctirancc rn nnlicv emmnanv name: atltlresc: rite nhnnc#• insurance co policy 0 Attach additional sheet if necess ary : - _ fir' -•~ � _�"�•• •.y���� -���- —� Failure to securr coverage:ts required under Section:SA of 111GL M can lead to the imposition of criminal penalties of a line up to SI.500.00 andiur une t cars• imprisonment ns swell as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a dad•against me. 1 understand that a cope of this.statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do herebt•certift•tinder be pain rid pen tic o perjure•that the information provided above is true and correct. Si_^azure ~ Datc Print name WA.)tJ Phone# nflicial use oni1• do not write in this area to be cumpleted by tiny or town official ` ' city or town: permit/license a# riBuilding Department C3Liccnsing Board M check if immediate response is required Selectmen's Office C311c211h Department contact person: phone it: rj0fhcr s, r information and Instructions' Massachusetts Genera Laws chapter 152 section 25 requires all employers to provide workers' compensation for 11 employees. As quoted from the "fall all emplitree is defined as every person in the service of another under an\• contract of hire. express or implied. oral or written. An etnplorer is defined as an individual. partnership. association. corporation or other legal entity. or ally two or in. the foregoing cngaucd in a joint enterprise. and including the le 'al representatives of a deceased employer, or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However owner of a dwelling_ hcnuse having not more than three apartments and'who resides therein. dr the occupant of the d11!cl link, house of another who employs persons to do maintenance , construction or repair work on such dwelling, or out the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio. MGL chapter 152 section 25 also states that every state or local licensing nbency shall witlihold 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 insuranee coverage required. Additionally. 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 been presented to the contracting authority. Applicants Please fill in the workers compensation affidavit completely, by checking the box that applies to your situation anc supplying=company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile 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 requir: to obtain a %vorkers' compensation policy. please call the Department at the number listed below. . City or r011'n5 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investibations has to contact you regarding the applicant. P1 be sure to full in the permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to give.us a call. I Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents A Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 i phone =`: (617) 727-4900 ext. 406, 409 or 375 f JLMZ 9.;UMMUL4Wk:AL.TH Ur' hL4M*AU1UbiKJ-JS Board of Building Regulations and Standards Transaction No. One Ashburton Place-Room 1301 Boston,Massachusetts 02108 Registration No. Application for Registration as a Home Improvement Contractor or Subcontractor Effective Date MGL Chapter 142A4 CMR 780-6 Expiration Date FOR OFFICE USE ONLY Date I. Name Print the name of the individual or business applying for the registration(not both) Z Mailing Address -��i 3 at, State ?!p �/f 0 Area Code tit Telephone Number ��.��1 ,�/YY�- 4. Street Address(if different) �(! 'OOZ 0'W !/`�1�� - 00�0 Print street and Number(P.O.Box not acceptable) (Sty State Tip 5. Applicant type: Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation (See instructions on back regarding enclosing a city or town registration under the DBA or"fictitious name"law-MGL c 110,ss S tit 6) 6. - ` • (see instructions) )�,,,7. Number of Employees 8 Individual responsible for Home Improvement Contracts2 (a i'0 ► U2, Last First Mi 9. Title of individual responsible for Home Improvement Contracts i VvA L, 1 10. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? ❑ If yes,complete the table below. Use additional papa if necessary. Yes No Type license or registration Issued By License or Expiration Name of License Holder registration number Date 11. List all partners, trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary.(See instructions on back) Check here if you wish to receive an application for additional ID cards for fey persons.❑ Last First. Middle initial Title in Applicant Business %Owner Address 12 Is the applicant claiming exemption from the registration fee? (See the instructions on the back) ❑ If yes,include a copy of a current Construction Supervisor license or motor vehicle repair shop license or registration. Yes No I& Registration fee enclosed:S Guaranty Fund fee enclosed:S Include two separate certified checks or money orders-one marked"Registration Fee' one marked"Guaranty Fund". ALL APPLICANTS MUST INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE Ste instructions on back for amount of fees. Make all certified checks or money orders payable to"Commonwealth of Massachusetts" Pursuant to Massachusetts General Laws Chapter 62C section 49A,I eerilty under the penalties of perjury that 1, my t lmowl belief,have filed all state tax returns and paid all state taxes required under law. , J 7 (/ Signature of ppl� nt or appli reptesenta ' Title hdld with a plicant A false a to any question in this application constilutss grounds for suspension or revocation of the applicant's registration 7120/92 APPLICATION FOR REGISTRATION AS A HOME MOROVEMENT CONTRACTOR OR SUBCONTRACTOR Who Mast Register? All persons,individuals,proprieorships,partnerships,corporations who solicit,bid on,or perform home lmpmements as a contractor or subcontract . on an existing one to four unit owner-occupied residential building and accessory buildings.Complete rules and regulations on registration cad enforcar e actions(780CMR-6).are available from the State'Bookstore,Room 116,State House,Boston,MA 021A Td.(617)727-2834. F xempdons from registration include:workers who work for contractors or subcontractors for a wage; in general,all licensed`profcmon#or tradesmen, when they ate working solely within the scope of their license,such as architects, dearicians, plumbers (except for construction supervisors); the Commonwealth or its subdivisions;schools offering voced courses or training in home construction or improvements;pawns building their own home or personalty doing their own renovations;what aggregate sum of payments for any bona-fide single job is undo S1,000; part-time contractors or subcontractors whose gross revenue is less than S5,000 in the previous 12 months;persons enrolled as a full-time student for the last and next academic terms,and Zr3 of whose employees art so enrolled,and whose gross revenue is anticipated to be or has been under SS,000;persons who install air-conditioning systems,central heating,energy conservation devices,provide conservation services on behalf of a public utility,landscaping,interior painting,paper hanging,finished floor covering,tile,fencing,freestanding masonry walls,aboveground swimming pools, shutters,awnings,patios,driveways. Instructions for Application Fill out front side of application printing with pen or typewrite.Item No.refers to Question No. PLEASE READ CAREFULLY!APPLICATIONS NOT COMPLETE WILL BE RETURNED WITH ATTENDANT DELAY! ITEM L Applicant:The applicant name must be the name in which you door plan to do business. S. Applicant type:If applicant is not a corporation and at least the surname of the principal or one of the partners is not included in the company name(c name),a copy of the"fictitious name"certificate filed with the city or town clerk must be.induded with the application. 6. Applicant partnerships and corporations must show a Federal ID number.Applicant individuals should show a Federal ID number if they have employ. (in addition to the owner). 7. Number of employees:For the purposes of this application and 780CMR-6,the number of employees shall include all construction related employees w worked 20 or mots hours on the payroll in the weekly pay period prior to date of application. 8. Responsible individual:If the applicant in Question 1 is other than an individual(Le,a corporation,partnership,etc)the name of the individual pen responsible for the home improvement contracting work of the applicant entity must be entered hat. If the person so named holds a construct. supervisor's license and owns 10%or more of the applicant entity,the applicant entity is exempt from the registration jee.Enter license and owners: data in Question 11,and check"Yes"in Question 12 if claiming cx=ption from the registration fee. 11. _Corporations or partnerships may include any official document which lists the requited information, such as pertinent sections of the Articles Incorporation,current Annual Report,registration as a foreign corporation as filed with the MA Secretary of State,or a copy of the current partners. agreement in lieu of listing the required information on names of partners, trustees,officers, directors,and major owners.Organizations other tt corporations must submit copies of any business certificates filed in cities and towns pursuant to MGL Chapter 110,Section S.(Also known as the D: or"fictitious name"law). If the applicant desires to have additional identification cards issued to key individuals(patinas,officers,eta)check the as noted to receive a supplementary application form. 12 If applicant or responsible individual is a licensed construction supervisor under MGL C.143,S.94(i)or a registered motor vehicle repair shop opera and is claiming exemption from the registration or renewal fee,check yes on Question 9,and include a copy of the current lieensdmgistration catific With this application.(See instructions for Question S,above). 13. Enclose a certified check or money order for the registration fee(if the applicant is not exempt),and a separate certified cheek or money order for: guaranty fund. Please note on the check(s)which is for the Registration,Fee and which is for the Guaranty Fund.Make checks and money orders paya to the Commonwealth of Massachusetts. ALL APPLICANTS MUST PAY THE GUARANTY FUND FEE EVEN IF EXEMPT FROM M REGISTRATION FEE! Mail completed application form,required documentation and certified check(s)or money orders to: Director, Contractor Registration State Board of Building Regulation and Standards One Ashburton Place - Room 1301 Boston, MA 02108 Registration Fee: $100.00 (Renewable every two years) Sec Note 1 Note 1: Individual Licensed Construction Supervisors in good standing under Chapter 143,Section 94 who register as an individual or as indicated in t instructions to Question 8,above,and individual motor repair shops registered in accordance with Chapter 100A,Section 2,are exempt from 1 registration fee only.To qualify for this exemption,the applicant must chexic'yres"in Question 12 and submit with this application a copy of t current license or registration certificate which shows the expiration date. Guaranty Fund Contribution: Zero to 3 employees $100.00 4-to 10 employees 200.00 11 to 30 employees 300.00 More than 30 employees 500.00 See Note 2 Note I The Guaranty Fund Fee is a one-time fee at initial registration unless the fund becomes deleted. In such a case,all registrants can be assessed' an additional contribution in accordance with 780CMR-6 and MGL a 142A. ALL APPLICANTS MUST SUBMIT THE GUARANTY FUND FE ,*THET��y� TOWN OF BARNSTABLE i BASH9TAIILE, i "° *t o BUILDING INSPECTOR � war a• APPLICATION FOR PERMIT TO .... ...... ... .................................... . .. .......... TYPE OF CONSTRUCTION ��{,/�.. „ ...............19.td. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .............`.. Location ���.....!�P� �.��w^J.�I�.C�...... G ............ .. ......... .. . ...................... ......................................... Proposed Use .,. ...... ... .:... ............ ....... .. ... ...... ..... ................ ........ as ..... .. .. �-� ..�..Zoning District ........................................................................Fire District .. . ®. ........... .............. Name of Owner . !.. .... .... .. . Address .. .:.M. ...................... Nameof Builder ....................................................................Address .................................................................................... /t if Nameof Architect ..................................................................Address ................................................................................ ... Number of Rooms ...... °'�................................................Foundation .....f. .......... ............ .......... ................... Exterior /�a�.� ..-'.�....... ........Roofing ........ "`O''�`� ..... .. .. .. ...... ... . Floors ...................................................................Interior .....d`.... ...... . ...... ......... ............................. Heating ..... .......F44A.......................................Plumbing ...........I..................................................................... Fireplace ...... ..........................................................................Approximate Cost ........ Difinitive Plan Approved by Planning Board ________________________________19-------- . / 1E? �. F � Diagram of Lot and Building with Dimensions ry .JUJI O U W O _ 0Q0 z ¢ u, , > LIJ ! = z 00 < m ne < �- Q II UJCL - OQ 0. o 0 (U) < � I— --: ¢- � - �UJI LLJZDW � � w _ _ ED W f, Uj ozv o U 3s , CL va LLJ w F=" Z I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 Name a44w.. � i Daomy* WiIIiam ]Q, Jr.� _^ ��� � � ��� � «�&~u' wv � p���� \ . ^ \ No —132+�---- .. Permit for ---one-- —story*---- -- _______. i single family dwelling " ~ Limerick Court Locpnon ---------------------. .....................���!��.�.����—.---------.. Owner ........l,,&IIiaou .E .�Iacey�_Jr�____ Type of Construction _--..f..��!....e------.. ' � > -----~--------------------. ^ ` � ' #62 Plot ---------. �� —....-..------'' �oI� Permit Granted --- l�—'r-��---..—.]p �O | ` i� Qota of Inspection . .. .����---lA 740 ! } Date Completed ...................................... y - PERMIT, REFUSED' -----_---------.----- lg ' \ . \ � --------------------------. / .. � . � -----.---~-------.-------.--. ` ' '---'-----'-----'--^---------' | � .—.--------------.--.-----_—. � . ` ^ � ' Approved .......................... lg � � ---------------~-------^--'' | ` .............................._________,__.__.^,,_ | ` | ' t LOT 56 A.M. 169/73 CENTER VILLE LOCUS o ��0 ssso A.M. 0D LOT 6 s LOT 55 00 A. M. 169/79 ' A.M. 169/72 AREA=15,966fS. F. ��� Q R0 UTE BULKHEAD Oo LOCUS MAP •• PLAN REF 223/139 0 ....,..,.... RES. ZONE. .RC IRON nj Qj PIPE HSE'\:;;' .PLOT PLAN OF LAND DECK . . .,, . , LOCA TED IN: CENTER VILLA MA, SHED ����:���ti� , LOT 54 PREPARED FOR. A.M. 169171 � ��' O ,�� DA VID KONINBERG JUNE 30, 1997 �'PROPOSED' /� ADDITION E. GRAPHIC SCALE �N OF tip' Qj� 20 0 70 20 40 80 PAtIL A. THEW MER{ o U �, H ( IN FEET ) No.32098 LOT 63 _ � I inch = 20 ft. �EcrSTEoN� A.M 169/80 YANKEE SURVEY CONSULTANTS UNIT 1, 40 INDUSTRY ROAD P. 0. BOX 265 MARSTONS MILLS, MASS. 02648 TEL: 428-0055 FAX 420-5553 J#51348 GGM i ff _ i i 4 rip 4N i SCALE: APPROVED BY: DRAWN BY DATE: REVISED DRAWING NUMBER IB X 24 MINTED ON NO.100011 CLAARMINT• IPA, el J� K-) _145 00, lot 0 SCALE: i y APPROV90 BY: DRAWN BY r DATE: RirvesLo AWING NUMBER Is x 24 PfdkTID 0#4 NO.I00011 CUEAAPPAW