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0538 LUMBERT MILL ROAD
, P li r m v n a , r o a F Wk•-'±-v .-..,x.vs...» ...._,.M..r ......ate.,. r.- .., . n_ TOWN OErRARNSTABLE BUILDING PERMIT APPLICATION' Map �" Parcel _Ts�_' Application #� Health Division � A ��1 Date Issued Conservation Division TOWN OF i3ARNSTABI-E Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis a6 Project Street Address u:f-r� Village_C,.,f 4Z tulle Owner_,i�.Z eX , ,1 MY Address Telephone_ Permit Request /,!/J%�� G, Z� .!& ,9/.? y JD /ClL� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /70 6 D Construction Type ✓ �J �lJ 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 C,1Q o 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 6L��� Cf�l�y/�7TokJ Telephone Number Address J,F 10Z"Z,0_Lo G'6.� License #I/ yy1A&awD uyy. Home Improvement Contractor# Email Worker's Compensation # �,�/�C-`mod ALL CONSTRUCTION DEBRIS RESULTI G FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE kWNER ' a DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL y FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. "r ray Town of Biilrnstabi�� rt '' Regulatory Services RicLard V.Scah,Dim ia: BUHdi g Division- 'ram Perry,Bl uitding CommissbMtr 200 f&iu Suaer. XA 02601 N-•w AQwn.barnsiable.ma-us Office: 50$-862.039 ati: `.b8 79G-b23fi Property Cvocri I wt Compi�w and Sign This his Section jf V ing A BuiW: Cape Cad insulation r hcmbyvzhove _....� cw-Wt nM rl,^:.�Chajf, in:�E► +ttc cu��tisc tc�wi�rit autFiariu bR tizm bust&?,permit avpiica k iOr: g38 Lumbert Mill Road Centerville.MA 0263Z 3'•• olfCIIa- and Aaii s are 1L '.iF3ansfJllltt%of 1h: iIUaC:mr poilj� Clo'L EO tw Umi crruiA�1)-fine feACe l5 ImialWLI anj Al It pet rnu 3f� F3�-f(3arm I and atc LpLrt__ ri3 di L—ner iyUai71rG G a'��;Y�1C:+i �.tal r'laCtk: L � • �;KjFtyJ$•.^.1i�;•Jl;i•«'r.�?.f i�$iCIN�CJ:)LC ' Massachusetts,,Department of Public Safety ` -`*Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY` 1 8 SHED ROWr WEST YARMOU�H ^^� l Expiration: Commissioner 11/.11/2017 -\ Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home .Improvement Cft,tractor Registration Registration: 153567 Type: Private Corporation " Expiratlon: .12/1512016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE - SO. YARMOUTH, MA 02664 Update,Address and return card,Mark reason for change, ` KA 1 ',5 20M-05/11 Address Renewal E] Employment Lost Card �ce o�nr�>ao�racue�rLG/o�C�/�luao�rc/ccde� -Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT'CONTRACTOR before the expiration date, If found return to: egistration: =1:53567 Type: Office of Consumer Affairs and Business Regulation j xpiration; ;A':F1:16/201.6 Private Corporation 10 Park Plaza-Suite 5170 , Boston,MA 02116 CAPE COD INSULATION INC HENRY CASSIDY 18 REARDON CIRCLE S0. YARMOUTH, MA 02664 Undersecretary 9- v id wi tit sign } ' The Commonwealth of Massachusetts epartment of Industrial Accidents , sJ '� Office of Investigations 600 Washington Street I' Boston Mf4 02111 r� �} www,muss.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Jnformation Please Print Legibly Name (Business/Organizatiorvindividual): ter Address: �� � � C i�i ✓ City/State/Zip: ' A,- " � ' � b Phone #: v d tom I�lu Are you an.employer? Check th appropriate box; Type of project (required): 1 I. .I am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors 6, ❑ New construction employees(full and/or part-time). .• 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7, ❑ Remodeling These sub-contractors have ship and have no employees 8, ❑ Demolition . working for me in any capacity, employees and have'workers' insurance,$ 9.. ❑ Building addition [No workers com comp. insurance p, required] S, ❑ We are a corporation and its 10.0 Electrical repairs or additions 3,❑ 1 am a homeowner doing all work officers have exercised their l;❑.Plumbing repairs or additions myself, [No workers' comp,, right of exemption per MGL 12,❑ Roof repairs insurance required,) t c, 152, §1(4), and we have no employees, [No workers' 13, ] Other o comp, insurance required.] l *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information, r Homeowners who submit this afrZiNit indicating they are doing all work and then We outside contractors must submii 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. [nsurance Company Name; �,u vv, R Policy # or Self-ins, Lic, #: Expiration Date; ' ZG3z Job Site Address;s 3L ,i�/N-t/3t'/L¢ /VJ,�� / City/State/Zip; �! �J� _yyty, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a Fine up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurar4 coverage verification, I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct, a: Sign at re: Date' - Phone.#: �L Official use only, Do not,write in this area, to be completed by city or town official, City or Town: Permit/License# Issuing Authority (circle one): 1, Board of Health 2, Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6, Other CAPECOD-27 TQUIRK ACORO" CERTIFICATE OF LIABILITY INSURANCE FDATD/YYYY,— `--�' a/27/2z71zo1 s 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(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No E A/c No):(877)816-2156 South Dennis,MA 02660 E-MAIL mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURERS:Safety Insurance Company 39454 Cape Cod Insulation,Inc.. INSURER C,Endurance American Specialty Ins.Co. 18 Reardon Circle INSURERD:Atlantic Charter Insurance Group South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. L R TYPE OF INSURANCE POLICY EFF POLICYEXP LTR INSI) WVD POLICY NUMBER MMIDDlYYYY MMlOD/YYW LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I A I OCCUR CBP8263063 04/0112016 04/01/2017 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- F LOC JECT , PRODUCTS-COMP/OPAGG $ 2,000,000 MOTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT " Ea accident $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OS X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LA CLAIMS-MADE R/O EXCI0006635000 04/0112016 04/01/2017 AGGREGATE $ DIED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER OT AND EMPLOYERS'LIABILITY YIN STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431901. 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEP$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bill Swanson Builder THE EXPIRATION- DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS, Brewster,MA 02631 AUTHORIZED REPRESENTATIVE • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141/01) The ACORD.name and logo are registered marks of ACORD OW. ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 VI l0 Parcel V Application # Health Division "U/44NO _ Date Issued 2 �� ��► Conservation Division �A 4)" P 'Application Fee 576 dt Planning Dept. �'®W � �� ' Permit Fee 35-0 6 Date Definitive Plan Approved by Planning Board N pF�q . r �, 1 �5 Historic - OKH _ Preservation/ Hyannis Project Street Address 5b L U M I LL Village C�1�2: ( wE 4A 0,7_ 2 Owner •2020-f5 I X P;AU,-j Address 2-q khff, PZ Telephone �,0 �9b1 Permit Request A 40frX o` tee I tuho�J I KJ boal kJ&t L J+_ :Square feet: 1 st floor: existing-proposed "W CAi4 �~g p p nd floor: existing proposed Total_new 2oning.District Flood Plain Groundwater Overlay Project Valuation kf-013W 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) ame 6!gk- -1 w 1 %- ..Telephone Number Address 2-� License# 4(V) Home Improvement Contractor# :Email. 1Xx S T� ' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r DATE /� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE 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. Town of Barnstable Regulatory Services r � Richard V.Saab,Director Ru ldnzg Division. t F 'Tom Perry,Bmildmg Commisdoner 200 Main Hyaa:dsa MA M601 . �ED� wee'aPtown.barncial,T�in3.IIS . Office: 50 8-862-403 8 _ gag: 508-790-6230 HOMEOWI R r rrx�ISE EI�FI=ON IOB LOCATIOR S-39) Z-v 040f4C7- A '1 W-- t nr m cc VM2P t CUMEI-a MAIL19G ADDRESS- _ ee[tyltapen ! 1 up code The current exemption for`homeowners"was extended to include owner-occ�ied dweIImas of sip units or Less and fn aIIoW homeowners to engage an individual for hire who does notpossms a license,provided that the owner acts as supervisor. DEMON ORHOMMWNMR 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, aiiached or detached strnctnres accessory to such use and/or farm studies. A person who constmcts more than one home in a two-year period shall mtbe considrred•ahomeowner. Such`homeowner".shall submittn the Bmi dmg Official on a form acceptable to the Bm�OfficK thathr./she shaIl be responsible for all such wow Re-formed under the bm7dina permit (Section 109.L1) The uadcrsigned`.`homeowner"acemnec responsiblTdy for compliance wititthe Stafn Bffi7cling Code and ocher applicable codes, bylaws,roles and regulations. - The 'geed-homeownea:'cert�es tbathe/she umde > nay the Towu ofBmnsfable BmIffig Depaztraent mspmim pro and req ir= nents and that he/she WM comply with said procedures and reqqiremeufs. : s Si atom ofHommvncC t Approval nfBm7d"mgOfFFdal Note: Three-faauZy dwellings containing 35,000 cubic feet or larger wiIlbe requiredto comply with the State BuIdmg Code Seddon 1:27.0 Car stmction Control HOMEOWNE'8'S FXtlON The Code states that aAny homeowner performing worst for which a building permit is required shall be exempt from the provisions of this section(Section 109_U-Licensitrg of constradion Sup.ervisors);provided that if the.homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor» M2ny homeowners who use this e=mpton are unaware.that they are assuming the responsffimtles of a supervisor (see Appendix Q,Rules&RegmIations for Licensing Construction Sipervisors,Section 215) This lark of awareness of= r results.in serious problems,parficularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas if would with a licensed Supervisor_ The homeowner acting as,Supervisor is ulfonately responmMe To ensure that the homeowner is fully aware of his/her responsrffiM des,many commm aifies regQ'se,as part of fhe permit application,fbat the homeowner certify that he/she understands the re$ponsibiM es of a Supervisor. On the last Page of this issue is a form cnrrentiy tse bp,s Ter-eI towns. You may rare t amend and adopt such a formlccr �n for use is your cammunify. - KG Ravised 061313 ti . . ll• l ' ofTosy Town of Barnstable Regulatory Services ' E Si�57NCPIRrP. f ' MAM $► Rl hard°Q.Smlti Edred nr m Building Division TomPerry,Emldmg Comndnioner 200 Main Street;Hy=jjs,MA 02601 www fownbarnstable_ma_us Office: 508-862-4038 Fay 508-790-6230 Property Owner Must Complete and Sign Tbis Section If US ing A.Builder as Owner of the subject property hC=b3r 2Ld10ZiZ5 to act on my behalf in all matters relative to work aufborized.bythis budding pewit application for. . (A,dd=ss of Job) 'Pool fences and alarms are the responsibia7 of the applicant Pools are not to be filled or utgized before fence is installed and all final inspections.are performed and accepted. S;RM='re of Owner Signatare of Applicant Print Name: ` Pant Name Bare . QF01Is:0wrERFE MISMM7Poors ' The ComrnorrrreaIIIz ojf-Vassach"Setts DepartinejitoflndrtsftialAccideras Q -e of lnws'tigadons 600 Washington Street, R y Boston,M4 02111 a impi# 7Nass.,govIdIa Nrarkersr Cumpensatian Insurance Affidavit:Pmldez—.lCunta actors/EIectricians/Phunbers Applicant Inf6rmatian Please Print Legibly' • -Name(Bush mMTZm]izationad n I)- A6X 4 �2y _ �j V� 1 �/L7. MA ,0 y 6l V q _�lt�1��t3t��1p 91/5 N7'IgPhcnetr_ Lire you an employer?Check the appropriate box: Type of project(required).: 1.❑ I.am a employer with 4. I am a general contractor and I 6. New construction. employees(full anNor part-time).* have lured.the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2..❑ I am a sole proprietor or partner- . ship and have sib-contractors have have no employees. 9- F Demolition woding fume in any capacity, employees and have workers' a [No n;orlmrs'comp.insurance: comp_insurance.l 9. ❑Building additioII,Y rewired.] �- ❑,°fie are a corporation and its 10.El Electrical repairs or additions' r 3.>kI.am a homeowner doing all work officers Have exercised their 11.0 Plumb ngrepairs or additions Myself [No workers'camp- . h right of exemption per MGL . 17:0 Roaf repair s insurance •- 152, 1 4 and we have no required.]i � c. � ( � � - eixtplogees.[No workers' 13.❑Other camp-Insurance required_]! •tlaY appHcznr(fist checks box PI must also fill ovt the section beIaw showing tLeu worke&compensatiouporicyinformation. I Homeowners who submit ibis af5dat ft indicating they are daing all wat and then hie outside contractors most submit anew affidavit indicating sadi fC'aiL=ctorsthat rhea this lbox m=attached sn additional sheet showing the nzine,of the sub-camirvctm and state whether or not those entitieshave employees.Ifthesub-contractorshave employees,they amtstpmv"ide their worken'romp.paHcy number.' I am an employer thatispror.Rdrng it�prkers'congwiiafion iiLuiraizce,for,rrzy e.urpigyees Below is they policy,and job sufe inf orinadotl. r Insurance Company Name: r = g Policy�A,or self-ins..Lic_g: FiTirati'on Date: Job Site Address: � ~ CitylState/4: Attach a copy of the wort-ers'compensationpolicg declaration page(showing the policy number.and expiration date).' Failure to secure coverage as.required.under Section 25A of 1MvIGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,SQ0.d0 andror one-year imprisorm-tent as well as chril penalties.in the form of a STOP WORK ORDER and.a fine of up to$250-DO a day against the-violator. Be ad,,iced that a copy of this statement may.be forwarded to the Office of, Investigations ofthe DIA for insurance coverage verification. I do Hereby cerfi' r ider fire paints andpenalties ofpeefaily f urtthe inforirzatiazr prmrldied aboi x true arty!correct +� -- ��.-... ...,._ -e:.. ;. Sit�szatur Date: / 2� _ t� c?fficial use Dilly. ,Da not writ;in th&area,to be.compWa by city artairn o•daL � City,or Town: a PermitUcease# Issuing Authority(drele floe): ti r 1.Board-of Ifealth 2.Building Depai-tment 3.'CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspec or G.Other contact Person:. Phone 9: - Lifarmafian and lai.strnWt Massachusetts Geberal Laws chapter 152 requires all employers to provide workers'compensation for their employees. parsTanttD this statute,an employee is defined as."_.every person in the service of another under any contract of hire, express or implied,oral or writtuen_" An ernplvyer 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 Iegal representatives of a deceased employer,or the receiver or trustee of an individual,partamship,association or other legal entity,employing employees. However the owner of a dweIIing house having not more tiraa three apartments and who resides therein,or the occupant of the - dwelIing house of another who employs persons to do maintenance,construction or repair work on such dweIliag house or on the grounds or bmldung appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25CP also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor nay ofits political subdivisions shall enter Into any contract for the p erformance ofpublic work until acceptable evidence of compliance with the iumn-an ce. requirements of this chapter have been presented to the contractarg aufhority." Applicanfs Please fill out the worker' compensation affidavit completely,by checking&e boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers) along with their certificates)of has-c=ce. Limited Liability Companies(LLC)or Limited Liability-Parfnerships(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.. B e advised that this affidavit may be submit-d to the Department of Industrial Accidents for confirmation of iasuran ce coverage. Also be sure to sign and date the affidavit. The affidavit should be retomed to the city or town that the application for the permit or license is being requested,not the Deparim.enf of Industrial Accidents. Should you have any questions regarding the Iaw or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-wed companies should enter their self_fi surance Iiceuse number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed Iegzbly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pm ait/licrose mmnber which wrll be used as a reference number. In addition,an applicant that must subunit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if n(-,cessary)and under"Job Site A dml re&'th e applicant should write"all locations in (cif'or town)--A copy of the-affidavit that has been officially stamped or marked by the city or tows may be provided to the applicant as proof that a valid affidavit is on file for futm e permits or licenses. A new affidavit must be filled out each year.There a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT regained to complete this affidavit The Office of Investigations would at to blank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number The Cc-mMaaWeajtlj of Masaahuttts Depaztinmt of Ii Iust iak Accidents Qfriiice of fve&tintimui 644 wasu oll st=t Bost MA G21.11 T(,-L 4 617 727-4,9GO(�xt 406 or 1,3-77-MA.S E Fagg 617-727-7749 Revised 4-24-07 r JOB LOCATION: 538 LBJfl Bert Mill Road Centerville,MA 02632 01 as, )" u 4�,{y I z 5 LABELS: SPECIFICATIONS: 1.Install emergency Window Egress System. 2.dicount 3.window allowance CONTRACTOR WILL: 1.Clean up all job related debris and remove from property upon completion_2.Maintain Liability and Workers'Compensation Insurance 3.hail warranty to customer upon completion and final payment CUSTOMER WILL: 1.Be responsible for building permit.- w, ADDITIONAL NOTES: -. •� 'ner will provide window to be installed l w • PAGE 2 OF 6 r M 38setglDgm Known best for using better! ' 3 Brit otrcler, t-02324 rrr r a sr 'Tias,R'' =-, FAX(5D8)8?2 2770 s •` MA#057572 RM31473 c - _ :) PROPOSALDATE: 0*90 1NIS BVIAIL aHW@n=x9panxam SUBMr7TEDT0: A08X311191y HOME: 401-7 ADDRESS: 5s'W Lunthiart No Road Cetrtervilta M&02M WORV- — ,� JOB LOCATION: 538 Lumbett @ltifi Road Centerville MA 02632 CF1L — systent Features FAX:.; — Evedast Perimeter wan System 0 u 2'ray to Florescent Light APPROX.INSTALLATION DATE. � ' Evert-ast Partition Wall w/Metal Studs Nevada Window APPROX.COMPLETION DATE: fr�eather6mata�ts prgm ) H - EverLast Insulated Partition Wall System Wall Surface Mounted Handrail One Side - ' Everl-ast Non-insulated Wag Open Mahogany Stair Railing-White ZenWali Hall wadi I r; Basement to Beautiful Panels Structural Permit&Electrical Permit t t k Eved-ast wall Restoration Basement Rip-out up to 700 sq.It. 13 6 Panel Printed Door-Knobs Dumpster s , Louvered Door-Knobs Access Parfetlip . • Bi-Fold Door-Knobs Decorative Post Surrounds F Exterior Door Knobs Modify Existing Ductwork � --'r �• Prestige Ceiling 2'a 2 E7ecdriml Baseboard Heat 20D sq.ft. Finished linen CCeigng 2'x 2' SaniDry XP Air Sydeet +.Box-out Ducts/Girders FloodRing Painted Ceiling u FloodChek Hoses s Everiast Basement window Ll traSump Battery Backup Pump _. € Egress Window System 1 Full Bathroom Package X SunHouse Basement Window Hall Bathroom Package x Everl-ast Window insert Sewage EJecitorinstanation — DETAMEDDRAVMaATTACKED Base Electrical ThermalDry Carpeted Flooring-Charcoal SERVICES NOT INCLUDED Electrical Sub Panel ' ThermalDry Tiled Flooring-Sandstone 1.Multi of D , w _g rams,Gas Lines or(hl Line ,• Outlets,Switches&Jack MinCreek Flooring-Mahogany 3 Mode guars m mHg D foruriry Systems(Unless Specaie 4 Ca Electrical Smoke Alarms Plain T tlennalDry IWateay orggCloset Shaletn '. 8.Work riequihred by Bugd'mg Officials not fisted herein Recessed Can Lights 7.Any items or nark rot . _ fly lisp)herein A "sl The basement wrap and finishing system is not a basement waterproofing system_Water prot)tems are the responsibility of the Buyer.Mold,ndtde=x,and fungal growth can occur under certain conditions.While the materials used in the basement wan system are mold Total Contract Price $. mo.00 resistant,the Contractor cannot control the conditions under which they occur.There are no Deposit With Order 30 a/o $' 2040.00 warranties against mold,mildew,and fungal growth by the Contractor or Manufacturer Payment on measure %'$ other than the Manufacturers warranties,if any,provided with the products installed under payment on Start % $ this Agreement The majority of the components of this basement finishing system are — constructed from mold resistant materials to eliminate a large part of the food source that Balance Due on promotes mold growth.This system is mold,water,stain,and fire resistant.Bayer hereby Substantial Completion % $ requests,and Contractor,an independently owned and operated dealer,agrees to install Total Amount of r the products and perform the services at Buyees address provided herein.Buyer agrees to Balance to be Financed $ sign a compliarm certificate upon completion of the services and installation of the products.THE TERMS AND CONDITIONS ON THE ATTACHED ADDENDUM ARE _ armenced' ly rya per O1—marchl'ry ay said mvits of appmxirnetety$ permmdh:Otynereyil(pay said INCORPORATED HEREIN IN FULL.BY SIGNING BELOW,BUYER AGREES TO THE amorau such interest and credit service charga of lending J institutionpayabtadirerriygiBralVM§i instWtimrtoantrrgsuch i TERMS AND CONDITIONS OUTLINED ABOVE AND ON THE ATTACHED ADDENDUM maribsto O�met and till mecum a f�amu kmml6nsm obG�gation and aq dacumots required by such tending Institution t, TO THIS AGREEMENT. n camrera�wear saw loan. i , d Authorized signature: ; Date Acceptance of Proposal.The above System Features,prices,specifications,terms and conditions,and Customer has received a copy of the X attached Addendum are satisfactory and are hereby accepted by Buyer. Contractor is hereby "Basement Finishing Science"book 3 authorized to do the work as specified herein.Payment will be made as outlined above. , 3 Customer is ewer@ of ttt4 Temis and X Conditions. A Tdp)aSale Pumping System was. X recommended ry Vil Customer is aware of warranly X f Signature X: Date r a r= - V. PAGE 1 OF 6 25 b 411 ©r IrEL ILD . . Cal Zj Iry Lu LU jc� LL LU LU lu KJ LU 'm w w w LU ul Ll- rm o C _ . F:�-sfi F�od� Pl^a nS rt L' SQ r `z- S.ecar.Gf � I av r � - � I joB iocxnom,536 Lumbert Mill Road Centerville,MA 02632 ------------- 411 i 3 i '� 11 5 -.a=3r-w S•�"--'-ter" .. ' - 3 - 48 0' EgrwW1ndrAn r LABELS: SPECIFICATIONS: 1.Install emergency Window Egress System. 2.dicount 3 window allowance ` { CONTRACTOR VVILL 1.Clean up all job related debris and remove from property upon completion 2.Maintain Liability and Workers'Compensation Insurance,3.Mail . warranty to customer upon completion and final payment CUSTOMER WILL r 1.Be responsible for building permit ADDITIONAL NOTES: ` 5'IIgH ner will provide wrindow to be installed PAGE 2OF6 ' �. 5 , 00vZone Basement Systems Known best for being betters „�1 ! `; 1150 Bedford St- €5 _ Bridgewater,MA 0=4 " FAX:(SM)M-2770 3..;` MA#057572RI#31473 a t g - n n �4 t PROPOSALDATE DE/92=6 - EMAlL a0wermXsParizam A SUBMITTED TO: RBeX($afl¢f 1400E 401-749460- s= xa ADDRESS: WS Lumbert MII Road CeraervRb WA OM2 WORK- JOB LOCATION: SSW Lumbert MID Road Centervalle VAA 02632 CELL m ' system Eeshme FAX: e Evert.ast Perimeter Wall System Tx 2'Lay to Florescent Light APPROX.iNSTALLATION DATE: EverLast Partition Wall uv/Metal Studs Nevada Window APPROX.COMPLETION DATE:: � 'E EverLast Insulated Partition Wall System Wall Surface Mounted Handrail One Side EverLast Non-Insulated Wall Open Mahogany ) i ti Stair Raining-White ZenWalt tied Watt ` Basement to Beautiful Panels Structural Permit&Electrical Permit• € ' Everi.ast Wall Restoration Basement Rip-out up to 700 sq.It i7 6 Panel Finned Door-Knobs Dumpster It Louvered Door-Knobs Access Panel BI-Fold Door-Knots Decorative Post Surrounds , _ M - Exterior Door Knobs Modify Existing Duetwodr t � Prestige Ceiling 2'x 2 Bechical Baseboard Heat 20D sq.It Finished Linen Ceiling 2'x 2' SanUry R Air System Box-out Ducts/Girders FloodRing i � Painted Ceiling FloadChek Hoses Everlast Basement Window UmraSump Battery Backup Pump ' Egress Window System 1 Full Bathroom Package-. z SunHota a Basement Window Half Bathroom Package EverLast Window insert, Sewage Ejector Installation aaeaAREDDRA%MGATTACHED Base Bectrical ThermaiDry Carpeted Flooring-Charcoal SERVICES NOT INCLUDED Electrical Sub Panel ThemiaiDry Tiled Rooring-Sandstone 1.Mwing of Drains,Gas Lines or 00 Line 2 Painting or staining Unless tN Outlets,Switches&Jacks MdlCreek Flooring-Mahogany 3.Mirdnasttons to Hag Duc�or SaScurity Systems(unless Specdre' `< 4.Carperrhy or Closet Shelvin Electrical Smoke Alarms Plain ThemtalDry 5.Wa4e roo9kr Unless ad Recessed Can Lights s•Wodc r�equ�by RMIng Off%tiis not fisted herein g 7.Any items or work not specifically listed hereln : (i The basemerd wag and finishing system is not a basement waterproofing system_Water a problems are the responsibility of the Buyer.Mold,mildew,and fungal growth can occur i under certain conditions.While the materials used in the basement wall system are mold Total Contract Price $ S800-GO resistant,the Contractor cannot control the conditions under which they occur.There are no DepositIflrtth Order 30 % $ 20 .68 11 warranties against mold,mildew,and fungal growth by the Contractor or Manufacturer Payment on Mrg I other than the Manufacturers warranties,ff any,provided with the products installed under payment on Start % $ this Agreement.The majority of the components of this basement finishing system are — -' constructed from mold resistant materials to eliminate a large part of the food source that Balance®tte on - promotes mold growth.This system is mold,water,stain,and fire resistant.Buyer hereby Substantial Completion % $ requests.and Contractor,an independently owned and operated dealer,agrees to install Total Amount of. a the products and perform the services at Buyer's address provided herein.Buyer agrees to Balance to be Financed,. $ sign a completion certificate upon completion of the services and installation of the I x twd. �Is paya6te in_morn,1v Installments o6 products.THE TERMS AND CONDITIONS ON THE ATTACHED ADDENDUM ARE approximatelys per month.Omar av7rpay said INCORPORATED HEREIN IN FULLBY SIGNING BELOW,BUYER AGREES TO THE amormt such and credit service charge of tI n-c 'vrstiardon payable dhecil Ira the randy irrs[itutinn baring sudr TERMS AND CONDITIONS OUTLINED ABOVE AND ON THE ATTACHED ADDENDUM man as is Owner and v�ill execute a tteml irstaMtsm TO THIS AGREEMENT. " obAgat[ori grid city docmrr�required by suds lending inswwon n b cormecnaar wrfi said loan. Authorized signature: Date ri Acceptance of Proposal.The above System Features,prices,specifications,terms and conditions,and Customer has received a copy of the X- ' attached Addendum are sati fac co y and are hereby accepted by&ryer. Contractor is hereby _ "Basement Finishing Science"track - q auVarizad to do the work as specified herein.Payment will be made as outlined above. customer is ware of the Term and X Conditions. hr A Tri l edeSe d Ong m was Xreco t date s Customer is aware of warranty l( Signature X: Date N lz .8 1� -PAGE 1 OF 6 Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee BARlvs1'ABLE, Richard V.Scali,Director Building Division ISIon Tom Perry,CBO,Building Commissioner ®PRESS �N- 200 Main Street,Hyannis,MA 02601 oC� 2 Q 2015 www.town.barnstable.ma.us ' � Office: 508-862-4038 ��N O fFaoxh ��OT-62�3p E EXPRESS PERMIT APPLICATION - RESIDENTRAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ' Property Address d esidential Value of Work$ O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ( uf,* ! 1 Contractor's Name Baker&Associates, Inc Telephone Number 508-362-2445 Home Improvement Contractor License#(if applicable) 162600 Email: info@bakercape.com Construction Supervisor's License#(if applicable) 009714 OWorkman's Compensation Insurance. Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Rj I have Worker's Compensation Insurance , Insurance Company Name Associated Employers Insurance Workman's Comp.Policy# WCCa99a9A24a4291rti e m 11 Copy of Insurance Compliance Ceficatust accompany each permit. Permit Request(check box) , ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-s'de O eplacement Windows/doors/sliders.,U-Value (maximum.32)#of windows ' G #of doors: pia ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand 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 re u' ed. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary I met Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 i The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 0-7114 201? www.mass.govldia N orkers' Compensation Insurance Affidavit:Buildens/Contractors/Electricians!Plumbers. TO BE FILED WITH THE PERMITTING AtITHORITY. AD ylica.nt Information PIease Print Lerihiv Name (Business/Organization/individual):_ Address: itvlstatelZip: A� 0 �13 2- Phone#: j B 3�o� a4 S Are you an employer?Check the appropriate box: Type of project(required). l. am a employer with I employees(fill and/or part-time),* 7. Frew'constzvc*aon ?.t-j=am a sole proprietor or partnership and have no employees working for re in8. Remodeling any capacity.(No workers'comp, insurance required.} �- i 9. Demolition 3.[:]1 am a homeowner doing all work mysei"'No workers'comp. insurance required.,t - I azn a homeowner and vrii4 be Kirin contractors to conduct all work on m ro will 10 1....:Building addition. �. g y p per;3 t . ens are that all contractors either have wari:ers`compensation insurance or are sole 11.[ Elecµ ical repairs or additions proprietors with no employees. 1 7 1 .$�Plumbing repairs or additionx 5.171 am a general contractor and I have hired the sub-connectors lasted on the attached sheer. �? These sub-canractms have employees and have workers'camp.insurance.: 13.[7 Roof repairs 6.,7 We aye a corporation and its officers have exercised their right of exemption pe;MGI 4. 14. er 152, 1(4),and we have no employees. INo workers'comp.insurance required.] *A?V applicant that ehecl s box#I must also fill out the section below showing their workers'compensation policy infor;nation Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suc L Contractors that check Lhis box must attached an additional sheet showing the,name of the sub-contractors and state whether or not those ennties have empioyees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurancefor my eWlvyees. Below is the policy and job site information. Insurance Company frame: Polity#or Self-ins.Lie, 1 Expiration Date: k)j �e .lob Site Address: 536 LLuM6 \- S -City tatate ip: 02(II q2 Attach a COPY of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as rewired under MGL c. 152, §25A is a criminal violation punishable by a fine tap to S1,500.00 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify Ader the pains andpenaldes o,f per urir that the information provided above is true and correct 71Ji?.. —t �Signature: :"Dale: / Phone#: F use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Client#:9742 2BAKERAS ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(AIWDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE� 015 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(les)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 A Dowling&O'Neil NAMe: Insurance Agency PA//CCM. :508 775-1620 1 A/C,No):5087781218 973 Iyannough.Rd., PO Box 1990 ADDRESS' Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIc r INSURED INSURER A:National Grange Mutual Insuranc Baker&Associates,lnc. 'INSURER a:Associated Employers Insurance P 0 Box 923 INSURER C: Centerville,MA 02632-0071 INSURER D: INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSLTR ADDL UBR TYPE OF INSURANCE P pY EFF P�DY EXP UMn$ R NND POLICY NUMBER A GENERAL LIABILITY MPJ7223M 4/19/2015I 04/19/201 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY I I PREMISESOEa oYTED nce j$1,0 0,0 CLAIMS MADE X OCCUR ! MED EXP(Any one person) i$10 0O0 _ PERSONAL&ADV INJURY $1 000 000 — GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP A E 2,000,000 POLICY EIT1-7 LOC i AUTOMOBILE LIABILITY $ �— COMBINED SINGLE LIMIT Ea aeaderrt ANY AUTO ALL OWNED BODILY INJURY(Per person) is SCHEDULED I i _AUTOS =NO-O NON-OWNED I BODILY INJURY(Per accident) $ HIRED AUTOS _AUTOS I PROPERTY DAMAGE -- " I Per accident I$ UMBRELLA UAB $ F._.._ OCCUR EACH OCCURRENCE Is EXCESS LUU3 CLAIMS-MADE j DED I RETENTION$ AGGREGATE IsI � -- B iwDo r Lo UAa KERS COMPENSATION AND 1/ $ 01504/23/201 X TU OTH- 0ERTREORPAUD?ECUTNEY/N OFFICER/MEMBER DE — EXC N/A EL EACH ACCIDENT $50O 000 (Mandatory in NN) B Yes.desrnbe under E.L.DISEASE-EA EMPLOYEE $500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POUCY LIMB $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Reumft SchWuk,ti more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Orleans Town Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 19 School Rd ACCORDANCE WITH THE POLICY PROVISIONS. Orleans MA AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) 1 of 1 The ACORD name and logo are ID 1988-2010 ACORD CORPORATION.All rights reserved. #S149786/MI49785 9 registered marks of ACORD MER CS-009714 v RICHARD P.GARNEAV.!� PO BOX 476 3 West Barnstable MA M�6BE:��` 0410412016 o Office of Consumer Affairs Bufiiness Regulation w 10 Park :Plaza. - Suite 5170 . - Balton, Massachusetts 02116 Home Improvement,Contractor Registration Registration: 162600 Type: Supplement Card Expiration: 3/2612 0 1 7 BAKER & ASSOCIATES INC. RICHARD GARNEAU . a a P.O. BOX 923 _..__ CENTERVILLE, MA 02632 _._..___.._.._.._.__._........... Update Address and return carol.Mark reason for change. sca 1 0 20M-05rtt F Address Renewal Employment E Lost Card _ rArN of Consumer Affairs d&Business Regulation License or registration valid for individul use only . E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation eglstratior►:. 10 j TYPO: 10 Park Plaza-Suite 5170 Expitatlanz' 3612i}17 Supplement Curd Boston,MA 112116 BAKER&ASSOCIATES INC. RICHARD GARNEAt1 521 SHOOTFL.YING HILL RD VVI GENTERVILLE,MA 02832undersecretary id without signatu _ t i Authorization Form: I /� '8 , as owner of the subject property, hereby authorize Acker & Associates to act on my behalf, in all matters relative to work authorized by this building permit application for : Address of property: 538.Lumbert Mill Road Marston Mills, MA Signature of owner: (Pant Name: rDate TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel v "� Application # , r 2 615� � 4 Health Division Date Issued Conservation Division Application Fee ' 0 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 5 3 T Lurnbact 1—,' l Village Owner fEnc Cfs►. Address r-,'o (2-J i Telephone 7 7S-- 6a ti.a• Permit Request !J--eSA a(o to 5"Q i e ��r„ i� by h;4 _9en toter ieUe-l. Gc ✓Qr 1,r C, a �t�Q�rrr ;-l�e�/ bQ�(Ccr-,-F Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 100. oo 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 i✓ : C CGS h Telephone Number S a S 7 7S 6a Lld Address 4-1 6�/h A-2 0 License # 4-e-c Vt iIA2. /I-A b 63 a Home Improvement Contractor# Email �� r/er;2dn. rw Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE A la3 I �o is FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 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. Regulatory Services dFs� Richard V.Scali, Director Building Division s BAENSMM Tom Perry,Building Commissioner �m� 200 Main Street, Hyannis,MA 02601 rFD www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: VJ /_ I Z3 115 Please Print JOB LOCATION: /—: i i RJ (S& `l)i)i A number street village --xOlEOwr1ER!I: 5r,, c. C�Sk �i c,-ul,d cash bt'lS-tsn~ ��.v�S SG�s- 7S�6a �a name ` home phone/# work phone# CURRENT MAILING ADDRESS: Lt G w�:rr e G 4—Az- U�63a city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units of less and to allow homeowners to engage an individual fbi hire who does not possess a license,provided that the owner-acts as supervisor. DEFE14MON 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) r 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 f requirements. ! Signature o 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 personas 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 c 1 ,6 t amend, and adopt such a form/certification for use in your community. ,, - + n u v ..yam THE * o+ * BkAaN6TAW=X. • "ASS. 1639. Town of Barnstable 1�r Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601• . www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-623 0 Property O r Must mplete and Sig This Section If Using Builder I Owner of the subject property hereby authorize to act on my behalf, . in all matters relative to work authorized by this building t application for. (Address of Job) Signature of.Owner Date Print Name If Property Owner is applying for permit,please co plete the Homeowners License Exemption Form on the reverse side. Q.1WH MESTOR Wbuilding permit formslsmokecarbondetectors.doc Revised 050412 The Commonwealth of Massachusetts • Department of IndusbialAccidents far Office of Investigations 600 Washington Street ' Boston ALA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/In(Uvidual): G �A'cidress: 4/ City/State/Zip: ,Q ✓I I t,< f'Nti Phone#:• 77 S 9 D Li Are you an employer?Check the appropriate box: i Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I .employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- 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' [No workers' comp.insurance comp.insurance.: ' k 9. ❑Building addition r`equired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.VJ I,f m 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.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office.of Investigations of the DIA for insurance coverage verification. I o e eby certify under the pains and enalties of perjury that the information provided above is trace and correct ,Si afore: Date: 6/23 a,3 ks- Phone#: So 7 7S— a Li 0, `/ -4G 2 Offacial use only. Do not write in this area,to be completed by city or town official City or Town:' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 4.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' corn ensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of an er under any contract of hire, express or implied,oral or written." i 1 An employer is defined as"an individual,partnership,association,corporation or o _er legal entity,or any two or more II� of the g �g foregoing engaged in a joint enterprise,and including the legal representativ s of a deceased employer,or the g receiver or trustee of an individual,partnership,association or other legal entity, mploying employees. However the owner of a dwelling house having not more than three apartments and who resi es therein,or the occupant of the. dwelling house of another who employs persons to do maintenance,constru ' n or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such ployment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licens' agency shall withhold the issuance or renewal of a license or permit to operate business or to construct uildings in the commonwealth for any applicant who has not produced acceptab a evidence of complian with the insurance coverage required. Additionally,MGL chapter 152, §25C(7) tes"Neither the comm wealth nor any of its political subdivisions shall enter into any contract for the performance public work until ac eptable evidence of compliance with the insurance requirements of this chapter have been prese ted to the contrac ',g authority." Applicants Please fill out the workers' compensation affida ' comple ely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addr s(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or imi d Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry work s compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this davit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. o be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application.,or th permit or license is being requested,not the Department of Industrial Accidents. Should you have any questi ns re ding the law or if you are required to obtain a workers' compensation policy„please call the Department t the n ber listed below. Self-insured companies should enter their self-insurance license number on the appropriat line. City or Town Officials Please be sure that the affidavit is complete d printed legi ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the eve the Office of Ilvestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license her which will be used as a reference number. In addition,an applicant that must submit multiple permit/license plications in any given year,need only submit one affidavit indicating current policy information(if necessary)and un r"Job Site Addreis"the applicant should write"all locations in (city or town)."A copy of the affidavit that has een officially s"ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizeni obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum le es etc.)said person is NOT required to complete this affidavit. The Office of Investigations would a to thank you in advance for your cooperation and should you have any"- questions, please do not hesitate to give us a c - The Department's address,telephonj and fax number: The Common th of Massachusetts Department o Industrial Accidents Office. Investigations 600 ashington Street B n,MA 02111 Tel,#617-727-4 0 wd 406 or 1-877-MASSAFE R F #617-727-7749 Revised 4-24-07 www.mas&gov/dia G4�s,fi� vn Ge - � , t '� �,� �.®vim � � . � � . • � • a F:rs F Floor 53 ber t Ta 3.�car�d ,Ss d vo r ash � �7q rill rIc% r ioi510 t �® C �FIME� Town of Barnstable Regulatory,Services * snaxsrnaLE. � Mnss, g - Richard V. Scali,Director �p iG39• ♦� Teo�,ure 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 June 4, 2015 Laurence W. Cash 538 Lumbert Mill Road Centerville, MA 02632 Re: Basement Apartment Dear Mr. Cash, This letter is to inform you that you may currently be in violation of Barnstable Zoning Ordinance 240-11; any use other than a Single-Family home is prohibited. You must contact this office by June 24, 2015 to arrange to bring the above address into compliance or be subject to fines of$1.00.00 per violation, per day. Sincerely, Robin C..Anderson Zoning Enforcement Officer r , /blc C meering Dept' (3rd floor) Map y Parcel Permit# " t House#. Date Issue 6�— Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) = Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) IKE rq Definitive Plan Approved by Planning Board 19 _ RARN"ABLE, 6 9 TOWN OF BARNSTABLE' ` Building Permit Applic` ion Project Street Address �� , Village = Owner ,' Address ,Telephone — jo 17 i 'Permit Request First Floor square feet Second Floor square feet 'Construction Type Estimated Project Cost $ _�"�j oQ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other - Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size)' Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# v. Current Use Proposed Use Builder Information r� Name PTelephone Number Address FQ -� 6 License# J k9CD " 0 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 SIGNATUR 0DATE \ 13UILDING• PER ^ E FOLLOWING REASON(S)" ; a Ilk FOR OFFICIAL USE ONLY 3 Not PERMIT NO. - - DATE ISSUED MAP/PARCEL NO. ADDRESS + VILLAGE H r OWNER DATE OF-INSPECTION _ w ; FOUNDATION ` ' FRAME 4 _ - INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH } + FINAL GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. } - . of TMe rq�, Y . • .- . � The Town of Barnstable • s�arrsrnsce. • 9ebA � 10�' Department of Health Safety and Environmental Services rEc nwt" 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. dam' l Type of Work:&—l(I i f�dQ� \�hG��(j Est. Cost .�Address of Work: Owner's Name 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 hheye"by ap�p'l"y for a permit as he a ent of the owner: Date Con ctor Name Registration No. OR Date Owners Name r_4___ The Commonwealth of Massachusetts .f o Department De Industrial Accidents P OlfCV 01127YO tYOMPns = t 600 Washington Street Fs Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: 01 —S location: �� U city hone# ❑ I am a homeowner performing all work myself. I amiiiiliii have iiii one iiiicapaicitviiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiaii ❑ I am an emplo r providing w kers' compensation fo my empllo ees working on this job company:name. address. ' �/` ci hone#. ! f insurance co. olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnany name. address::: city: phone#. insurance ca .. ; oliev# camaanv address: - city shone#. insurance co. xx olic # i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do�h�ereby certify der t ains and penalties of perjury that the information provided above is�trjuo' d correct Signa_tue✓ Date / 1'91?v� 61 Print name Phone# i official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) v Information and Instructions . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 inmw ce requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance 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. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be red3rned to 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 questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts department of Industrial Accidents Otllce of InvesduaUons . 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 n ,ebring Dept. (3rd floor) Map Parcel = c�S ermit# t _ y House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4+36� - Fee ,,25 G d Conservation Office(4th floor)(8:30-9:30/1:00-2:00) �12. off Planning Dept.(1st floor/School Admin. Bldg.) TME Definitive Plan Approved by Planning Board 19 RNSTABLE, ` MASS. 16s9 TOWN OF,BARNSTABLE. 0 4 i 1 Building Permit Application Project Street Address ] Village G ,N? L/[.L/— Owner Address Telephone Gl 4 T Z/ , Permit Request �KF —/00"4 . First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 \fie Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name pA vL ��q z�,,q vc,T" /t r�0`i�c.(y Telephone Number �� //-,7 7 Address ;Y D X 230 tz2 5 77:�5 License# -,5 a S5 A-11,/ Home Improvement Contractor# U '16 Worker's Compensation# .4 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 DATE 31�- BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED u rx MAP/PARCEL NO. ADDRESS ( ! VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION ! t i , FRAME 1 INSULATION F FIREPLACE ELECTRICAL: . ROUGH FINAL , ' + PLUMBING: ROUGH 4 'FINAL ' GAS: ROUGH FINAL 4 i FINAL BUILDING , DATE CLOSED OUT t ASSOCIATION PLAN NO. i r. SR DR DATE(Mldi1DD/YY) ACORD CERTLFICATE OF LIAE3ILITY INSURA�ICAD 2' 05/04/98 -- PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOI! ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan & Crocker HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE David D Rust COMPANY Phone No. 508-255-3212 Fax No. A . Assurance Co. of Atperica INSURED COMPANY B Credit General Insurance Co. Paul J. Cazeault etal'DBA Paul COMPANY -._J. Cazeault & Sons Roofing C COMPANY D COVERAGES 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 THI`.: 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. POLICY EFFECTIVE POLICY EXPIRATION i t" COI TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DD/YY) LIMITS LTR i GENERAL LIABILITY {GENERAL AGGREGATE $ 1000000 A $j COMMERCIAL GENERAL LIABILITY CFP25552812 05/01/98 05/01/99 PRODUCTS-COMP/OPAGG $ 1000Q00 . i PERSONAL&ADV INJURY $ 500000 _—]CLAIMS CLAIMS MADE [g]OCCUR I OWNER'S&CONTRACTOR'SPROT EACH OCCURRENCE $ SOOOOO FIRE DAMAGE(Any one fire) $ 3000 U 0 MEDEXP(Any one person) $ 10000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ -I ANY AUTO -- ALL OWNED AUTOS BODILY INJURY Per $ i SCHEDULED AUTOS ( person) HIRED AUTOS BODILY INJURY, $ (Per accident) ---i NON.OWNED AUTOS - PROPERTY DAMAGE $ i GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY i EACH ACCIDENT $ —. . AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ — - -: i UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM _ $ i WORKERS COMPENSATION AND Ya ITORYLIM B WC STATU•S OTH -�— I En >` 1 i EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100000 THE PROPRIETOR/ INCL SWC17005901 08/09/97 08/09/98 EL DISEASE-POLICY LIMIT $ 500000 B PARTNERS/EXECUTIVE OFFICERS ARE: RXEXCL EL DISEASE-EA EMPLOYEE $ 1000 0 0 OTHER i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS Roofing, CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE a .�... t. -- EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I - 10 DAYS WRITTEN NOTICE 1.0 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND ON T E COMPANY,ITS AGENTS OR; PRESENTATIVE& ` AUTHORIZE EP ATIVE r �ACORD CORPORQ�'ION 1988 I ACORD 25-S(1/95) _ °F THE Y, The Town of Barnstable EARMAEM 9eb '1 Department of Health Safety and Environmental Services 'OrEo ' 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 r i 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: X� —/e 00/" Est. Cost ��do Address of Work: Owner's Name c 04-C2 / p Date of Permit Application: -7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' G�Lz AA4-L7- 50.E ����,� ro 71 y bate Contractor Name Registration No. OR Date Owner's Name S�y�sTM`r• TOWN OF BARNSTABLE Permit No --- C 814 t.�AP3TAU ' Builclzng Inspector _ Casl +- . 968.00 {bldr. � occuPANCY� PERMIT .Bond ``No building nor structure :shall be.-erected,- and no,land, building or structure shall'be used for .a -new, different, changed,_ or enlarged use .without a Building Permit therefor first having been obtained from the.Building.Inspector.-No building shall be-occupied until'a certificate of occupancy has.been issued by the.Building Inspector." Issued to jAwrence Wrt. ..Cash Address Box 166, West Hyannisport lot #t9 538 Lum-bert Mill Road, Centerville Wiring Inspector �'- e: ,� Inspection date Z,�Z7�& Plumbing Inspector Inspection date K P Gas Inspector Inspection date Engineering Department a, �^? . � Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 1 Building Inspector zel 4-4 9S'� , �tM OF 1lr,4$ LiE3 E►2'€"' , . . ram�..I`� 4� 'n+o�a, ti :moo' v�i i� E�. $ KI= ` IST ou Z H1:rMr18 1 ..KeLLEY CO,. rNGiNrEf'tS--'3UHvEYOR.S. 346 LONIG POj'N SOUTH YARM©Lrm'MAC. . Q�664 • CERTIFIED PLOT PLAN B! w r a LF SCALE .�.�.I.=. `��?. . DATE . .��'�'� . . . PLAN .REFERENCE . L PT.... . . . PLAN. . . .►N. . �+ srgt� .3�43Z, 3-co-72. . . . . . . . . . . . . .C .�zLs. .� . . . . . . I CERTIFY-THAT THE . ...... ,/ SHOWN,ON THIS PLAN IS LOCATED ON THE GROUND L4ve.Lex, '• +� AS SHOWN HEREON AND THAT IT CONFORMS TO THE -� TRACK REQUIREMENTS, OF THE TOWN OF Di i� � �j' Arc'-►V_ WHEN CON STRUCTED. DATE �/' PETITIONER: S OR - AA s_ ses!or's map and lot numbe . LO........... . e, � OF THE TO IC SYSTEM MUST Sewage Permit number .... ..........6 ff..:................... °+► INSTALLED IN COMPLIAI:r;� WITH ARTICLE II STATE SAIU BLE, House number ........ .......... . r Maea ..... SANITARY CODE AND TO ° 039. GU IONS. OypY�'' TOWN OF BA.R.1�1�SL LE i I� DILDIN I 'S ; G , SPECTOR APPLICATION FOR PERMIT TO .....�." ��'� G`G'��,,:...................r.................. ................................................ 000 Flz�r f TYPE OF CONSTRUCTION ............... ..............................................�.....................:..........:................................. ......................1... ................9........ ..%,.0*_TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information• Location .............................................. �......."/................... .........:................:................................. ................................ Proposed Used`. .......................................................................................................................... Zoning District .0 1!'IGG % ...........Fire District V,C_ -%......................................... ...... cis Name of Owner ................................................,4vo Emsi ..Address x.../C��o... ... .........................Name of Builder -KA6 ,/ Qj.�M......./3CPa"fSAddress �C�...O/VV- A/0 -64'.... .:........� d cJ .... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ............................(9..................................Foundation Acf�2a � J�a�.... .................................................................. Exierior .� .:..� .7-F—........ l``�!`'P.. ^...............................Roofing ....a�..r`3..�..�............... c�.................... Floors r � L� ...................Interior ......��`-�� Heating ©`� �f ................................Plumbing.................................................. .................................................................................. p �ILI C`� Approximate Cost 44C -70 Fireplace .................................................................... ..........................(................................ . . ..... 5" s,t Definitive Plan Approved by Planning Board -----------__ D_____________19________. Area ...................��.J.... ......... .... Diagram of Lot and Building with Dimensions Fee 3 .. SUBJECT TO APPROVAL OF BOARD OF HEALTH '9 5 I hereby agree to conform to all the Rules and Regulations of the Tow of Barnstable regarding the above construction. z�a Name .......................................................`.. ................ I 1 ab, Lawrence W. � � 2OGI 1. 112 �-..����.. Pefh�i� 6m, ------..�.��'�_.. , -� single family dwelling ........... ` Location --'538.. ..Mill..Road _______.. lle__________.--------� ' ^ Owner ---. .���..Casb______.. ----�-- - -.�.�.. Type of Construction -----jl����----- � --------------------------. � 'Plot ---------' Lot ----'��----. �p� ' ^ 78 Permit Granted ---.��y��������.�..�^lp Date of Inspection ' lQ ~~~ Completed - z '- ' 19 . - ' - PERMIT REFUSED ~ ' lQ --~------.----.---.-.`.�..�../ --------'—r-----'' k -`�� ...................................................... ' ^ -..------.-.'......-.-..^--..-.--..,:- '-^---'^-^'--^---'-~^^'-''�-'---' / lV-Approved -_'----------..'�--. ^ | . ' . ..................... ' ^ .................................. - , Assessor's map and lot number 1.4.v. �... 5� /'_p 7- 0 . .... . ......... �Y� �pF THE T0� Sewage Permit number :I:�............................................ f� � Z BARNSTADLE. i House number ..........................". ............................................. roo MASS. 39 �0 Aii'p Mf1Y a. TOWN OF BARNSTABLE BUILD-IN'GIL IASPECTOR APPLICATION FOR PERMIT TO <c_.................�..'< TYPE OF CONSTRUCTION . d.d.0........ �'�......... ... ... ............................................................ ............................... 19.7 1 ................................................ ....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according ,ct..o�the following information: Location ...................................... G / 7 .........�...`..�.C- -r ..... �, .... .... c7tl � .I:..... ... Proosed Use ............�� r r C� 7.. ...... ........................... ........................... ................................. , Zoning District C .�2 /�/G �" ( �C &-t-F J. ... .............................................n........../.....Fire District ...........................�.I�. .... :.�� ......................... Name of Owner . .... '... /RS/� '..Address ... ... J. /'i�y✓!L/�S/"�. Name of Builder .�r� r M <3 t ��S G � �` A/3 ................................................................. Address ........................................................................ ........... Nameof Architect ..................................................................Address ..........�.......................................................................... Number of Rooms �..................................Foundation r� 0v1C� 4 �A/�E��— ............................... .............................................................................. Exterior ..T...........a: �...............................Roofing ....op..(`�....�... ......R`�/� 'L/� ............. ................................ Floors .......... ....................................................................Interior ......` ........................... ............................................. HeatingV/L'" ...........................Plumbing....................................................... .................................................................................. �`3�� tC �� � Fireplace ..:...............................................................................Approximate Cost .......................... ......................................... -----------------19--------. Area �Mr. Definitive Plan Approved by Planning Board -----------__ ...............................{„....., 7--,q— Diagram of Lot and Building with Dimensions Fee .........c.�..^...... ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH }k� 41$1t2 'o i v l�W I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................................................................. Cash, Lawrence Wj, ~ &=146~25 No � _2O8l4,i "___�� fo, ....I..���.. __. \/ | � siogIe family dwelling —^---'^---'--''---------^----- ' 538 Lu�bort Mill Road Location ------'-----------^---. Centerville -----------------^--------' Lawrence W. Cash ' vvvnrr Type of . ` Plot . No . Permit— Granted ........ Date of Inspection - Dote Completed PERMIT REFUSED � ' _ 19 ` ''' ....... ---- .................................... ... , . ..................... . o ............ . .... ............. ''m~----- �� ' ----.—...—.—.�--~—...—..—....---..-Approved � ---------------- l9 -------'-----^`—^----'—^^^'--~' � -------~^------'---~--'~—^^^— � ��