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HomeMy WebLinkAbout0480 NOTTINGHAM DRIVE �/iy► o n 0 0 t, o ,. � b j �5!� -1 :�'� - �.--- v ,. a ..: n.� � .. .a �. ,., �� } � � - .. - _ � - 1 , �� - , . '� �� <, ,. :�� i i ���� -� ao � �' y i I o e �� i � � j t "2..-� ""� � 'I . . --�- �"'" '� _ j �. �' sil .;1 i _ i i j '1 'So 33-7 6 Town of Barnstable *Permit Fapir ocssue date Regulatory Services Fe Thomas F.Geiler,Director �b,,r�" ,, "CP►BI:E - BuildingDivision5��'��s RNS �wyN OF $p Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable ma us I Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number NOT \ Property Address cPRd /YQTnLV �-I (►'� (Z �� ��c residential Value of Workfr).QZ0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �4rLA/FMA.�oit6cS T( C o tdf u-s-rzi t� Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) .Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name ra d.. Workman's Comp.Policy# r ; e f--Fe s-t l-c. p4i-"sA 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 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 re uir d. SIGNATURE: it irld ORSMOKE DETECT REVIEWED z i I i 'g /'/� J✓y�.. /�/J� _ ( f f.. f BARNSNG DEPT. ! I ABLLIUI i f CARBON MONOXIDE A t LARM� I ° MUST E IN TALLEO PER � � ��` ` ,• � �� I i _ I RYMEN�T MASSACHUS�TTS 6 WING Cop �1 ! PAT E , i ; ; i j ; D ATURES ARE REQUIRED FoRIPERMITTING " I - --- - -" f_. t �_.__r_ ._i .. i ..i --y- - -�- -- - .t. ._ _ - 4 I I I j -E � f� 1 I i I •i r it i l i ' - , I I f I f _ t j I i , , I� ! 1 1 _ -r I rk- 17t { - I { i i i . . I • `` y 1 , f• i , II ' , , _`•(`- ,. I r ;.. :_. t. ..- i � .,._. ,.._! �.__ —h—._.� _._ �...... ._ I s — _— a ___ _._.. —.. _. �... _r:- ,__I ..j_ } __ � .. i i }.. . I ! 1 • 1 : I t : t 1 ! ' k ft L ..__ ! '(" !r i[ III �. ! 1 � � i , I .i • , 1 ( I � I ! t �.. . , r , : t ! 1p . I t , fi L 1 i 1 t t I i I �_ ir _ - - - -- I f ; j , 11 , aco CERTIFICATE OF LIABILITY INSURANCE 0507/ ' �4.� 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 CONA E:NTACT PHONE PAYCHEX INSURANCE AGENCY INC A/C No Ext: 877 362-6785 A/C No): 877 677-0447 150 SAWGRASS DR E-MAIL ROCHESTER,NY 14620 ADD E chex@travelers.com PRODUCER (877)362-6785 • 3001YA171 SV996 70A INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER ATHE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT TOTTEN, MICHAEL INSURER B: DBA MICHAEL TOTTEN ELECTRIC INSURER C: 228 STONEY CLIFF RD INSURER D: CENTERVILLE,MA 02632 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 44391 931 5501 721 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADDL SUBR POLICY EFF POLICY EXP LIMITS TR TYPE OF INSURANCE INSR POLICY NUMBER MM/p MM/p GENERAL LIABITTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAPREMISESS MAGE (Ea occur RENTED rence) $ CLAIMS-MADE 0OCCUR MED EXP(Any one arson $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ PRO- POLICY JECT LOC $ COMBINED AUTOMOBILE LIABILITY (Ea accidet)INGLE LIMB $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ $ NON-OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WA UB-9C350353-13 03/01/2013 03/01/2014 X TORv LIMITS OR AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $10O 000 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICERIMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $100,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOTTEN,MICHAEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DBA MICHAEL TOTTEN ELECTRIC EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 228 STONEY CLIFF RD WITH THE POLICY PROVISIONS. CENTERVILLE,MA 02632 AUTHORIZED REPRESENTATIVE (%' ATTN KEN ELLIOTT �� ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered.marks of ACORD The aCownronirenith of Massachusetts � e arbr of Fndustrid Acridenft - t- O,f zce of investigidions 600 Washington Street :Boston,H4 42111 . www.jnas&gvv1dia workers' compensatialn I1as�ce Affidavit: BuflderstCon#ractors/BecEric.anstPhunbers Applicant Infennatian Please Pent Leek b Name mu�tioalludiviclaao: M i e—L-tt.j F`az n e Address: 22b 5pn.e:�-4 ck A+ CitytStar,&2�p: cw. .,•1 M� P} ne# gas- ZXO .3 5'ro Are you an employer?Cherk the appropriate box T of project r ,--,/ 4. ❑ I aaas.a scmtractor and I Type P J (required): 1.L� 1 am a employer with I 6_ ❑Ids*construcf m employees(full andforpart-ttme)_* havebirec3 the sub-xM#actoss 2.❑ I am a sole proprietor or partner- listed an the attached sheet. 7. ❑Remodeling ship and have no employees These snb-catstrar ors have g_ ❑Demolition l and have wodwrs' wosiring forme in any capacity. �P°� g. ❑Building addition [No wod=s'coop.insurance comp_""" '"�l required.] 5. ❑ We we a corporation and.its 10.❑Electrical repairs or additions 3-❑ I an a homeowner doing all w mlt officers have exercised thew 1 I_❑Plumbing repairs or additions right of exemption per NIGL myself[No workers'camp. 17.0Roof repairs ms;*ra,cerec}uired.]T c.152,§1(1} andwe have no 13.E?Other 5t-4alci 41"w-5, employees_[No worker' comp.insurance required.}. '�i`Wpllcaad that checks box#1 roost also fill out tine section belaw showing their vote&campe-ation policy inf6unat:am- I Homeovniers who submit this sffidxwxt indicating they mdomg an rack and thea hire oumde con=mxs oust mbmii a new affidavit mdica9 mg such . lConmc ms that cbecic this bwc mast attached an additiaaai street showing the name of ibe sub-amtrxton and We Ahetbu or not tense entities have employees. If the smb-coatmams have employee.%they,mutpuaide their *WkeKe camp.policy amber. Iran art eMplo;1sr iiiat is prsvt'ding.workers'campewa dvn icasa rmce for miy aurple} BeJ aiv is tiro pokey*and jah site information. . Insurance Company Name: 1 o J U o.y jr�' PA f_A Policy-g of.Self-ins.Lie. ;r'} A- t4 e,l�s� Expuatioa Date: Job Site Address: q T 0 NO 4+f l t(n ( )J_ city/S#ateizip.: : ch a copy of the workers'compensation policy declaration page(showing the policy munber and expiration date). Failure to setae coverage as required under Secticn.25A of MGL c- 152 can lead to the imposition of criminal penalties of a tine up to S 1,500_00 and/or one-year impriso mea�as wets as civR 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 Immstig&cros of the DIA for insa-mce cmwage vetiffica#icn- I do hereby cer6ft carder thepaians andBenaWgs of pedi"7 Ant the informat&n praW ded abava is and correct 01 r7� Date: Z 10, phone#: Official use only. Do not write in this arm,to be ampleted by cio or tmm official . City or Town: PermitUcense# Esuiug Authority(condo one): . 1..Board.of Bealtlh 2.Budding DeparUtaent 3.Catyffown Clerk d.Electrical Inspector 5.Phunbing.lnspeCtor . . 6 Other.. Phone 9 r °elm rqy� - • sexxsrasc,E, • "i"� s639• Town of Barnstable ��� - . Regulatory Services Thomas F.Geiler,Director. Building Division Thomas Perry, CBO i Building Commissioner j 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us I I Office: 508-862-4038 Fax: 508-790-6230 Property Owner' Must Complete and Sign This Section If Using A Builder I• 1,6(�M as Owner of the subject property hereb authorize \ y ��� �L�C�I�C. to act on my behalf, in. all matters relative to work authorized by this building permit application for: q7 0 A)orr_��, 144inn, 6 L-L (Address of Job) V Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form onjhe - reverse side. Q:IWPFILESTORMS16uilding permit formslEXPRESS.doC _ b �oF"ME r Town of Barnstable 0 Regulatory Services ti SA SLiti MASS ` Thomas F. Geiler,Director yQ 1639. M� ATEU +A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE TION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name ome phone# work phone# CURRENT MAILING ADDRESS: city/town \wner-occupied tate zip code The current exemption for"homeowners"was extended to incr-occu ied dwellin s of six units or less and to allow homeowners to engage an individual for.hire who does not ponse,provided that the owner acts as supervisor. DEFINITIOEO�VNER Person(s)who owns a parcel of land on which he/she resides oo reside,on which there is, or is intended to be,a one or two- family dwelling, attached or detached structures accessory to s or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowno eowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be res onl su work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for mpliance with th\Stae ilding Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she unde stands the Town of Barnstable uilding Department minimum inspection procedures and.requirements and that he/she will compl with said procedures and requir\work, ' Signature of Homeowner Approval of Building Official Note: Three-family dwellings containin 5,000 cubic feet or larger will be requwith the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfo ing work for which a building permit is required shaa provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provid that if the homeowner engages a person(s)for hire touch Homeowner shall act as supervisor." Many homeowners who use this exemption unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Thi lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlice d 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. , n.��i mr•rt nn,�rnn��c,L..a.7:_.-.,e._.:�F....�ILYDD RCC Anr - _. .. _ 14 12JJ Z 'Town of Barnstable *Permit#moo dF Expires 6 months om usue date Regulatory Services Fee s _ MAM Thomas F.Geiler,Director . Building Division Tom Perry,CBO, Building Commissioner 200 Main.Street,Hyannis,MA 02601 www.town.barnstable.ma.us r Office:..508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - i Not Valid without Red X-Press Imprint Map/parcel Number. /4-7 d f Property.Address b0 IV O7T1A[ H A M 00(L U I (LE 'Residential Value of Work1.9 S d Minimum fee of$35.00 for work under$6000 00 Owner's'Name&Address O(v lV n /yi P l Cc S 0 �1 S c ft Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) WIT ❑Workman's Compensation Insurance a -NOV 29 2012 Check one: ❑ ,I am a sole proprietor ❑ I am the Homeowner 1"01NRI ®�BARNSTABLE ' ker s CompensationInsurance I have Wo rker's Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) " m� � Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be to ❑Re-roof(hurricane.nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows. ❑,Smoke/Carbon Monoxide detectors.4 floor plans marked with red.S and inspections required. Separate Electrical&Fire Permits required. F *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:' Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement'Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E3�RESS.doc Revised 053012. r \��i The Commonwealthi of Massarchnsetts Deparrhnent Dice, Investigations . 600 Washington Street Boston,M,4 02111 . wnw:lnarss,gov/dia Workers, Compensation Insurance Affidavit Builders/Contrtctors/Elec#ricians/Pburibers Applicant Information Please Print Legibl Name(Bosime timIrtdividoai): Q tee N A M• i(LDS Address: 'f?® o✓6-777;_664 4An D(t- -i City/State/Zip-l;r l` t� MA C3 Phone# 2 Are you an employer?Check the app opriat+e box: Type of preject(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-cemtractoxs 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet �- ❑Reimodeling ship and have no employees 'These sob-contractors have 8. ❑Demolition-=- worlring forme in any capacity employees and have workers' ; 4. ❑Budding addition [No wodmrs'comp.insurance comp.insuramr I required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3%KI am a homeowner doing all work. _, officers have exercised their I I- Plumbing repairs or additions myself [No workers'comp. right of exemption per I41GL 12.❑Roof repairs insurance rewired.]T C.152,.§l(4),and we have no employees-[No worlms' 13.0 Other comp.insurancer+equired.) •Any applicant that checks base#1 mast also fad our the section behm showing their workers'compensation policy u farmatim i Homeowners who submit this af{dsyst imitating they are-doing att w a}and then bire outside contractors mast submit a new affidavit indicSting bitch. •'Contractors that check this WE must saacbed as additional sheet showing the nmae of the sub-comiractors and stare whether or not those entities have employees. If the sub-contractors have emplasees,they'must provide their Workers'romp.policy number. lam an employer that is praviding workers'conwensation in=rance for my engA&ynm BeIaty is the policy and,job site information. Insurance Company Dame: Policy it or Self ins.Lic.#: Expiration late: Job Site Address: City/StatelZig Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiresi under Sectim 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 r well as civil penalties in the form of a STOP WORK ORDER and a fine i of up to$250-00 a day against the violator., Be advised that a copy,of this statement may be forwarded tau the Office of Im-estigations of the DIA for insurance coverage verifYcatioa I do h by i y ander the s andpenaltiss ofpedk7 that the information provider/above is bye and correct Si tore:: i U Ntu Date: 2. Phone 9- 6kOy-1 q 4 Z► ®4 Official am only. Do not write in this area,to be compWod by do or t6ttwi official City or Town: PermitUcense# Issuing Authority,(circle one): 1..Board.of Health 2.Building Department 3.CityrPown Clerk.4.Electrical Inspector S.Plumbing Inspector 6.Other . Contact Person: .Phone#: � F tHE tp� * anxrrsrasrrr. 9� 039. ,�� Town of Barnstable ArfD MAC A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,M 2601 www.town.barnstable a.us Office: 508-862-4038 t #_ Fax: 508-790-6230 t' op& ner Must COmpl to and ign This=Section,M S, ::.I U s i g.X-Builder .., I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by s building ermit application for: (Address o Job) �({ Signature of Owner ate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption.Form on,the reverse side. Q:\WPFILESTORMS\building permit forms EXPRESS.doC r ; °FTME rati Town of Barnstable Regulatory Services snxrasTnsr Thomas F. Geiler,Director �q'Are1639. MASS Building Division Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 29 ' 1Z 7 JOB LOCATION: 1410 NOT7-tA16-144 N\ (Z. C_EM(Z✓/e_CX__ number street village "HOMEOWNER":1JdlVN/1 n'1 • 71 Z S Qo�- `l Ll name home phone# work phone# CURRENT MAILING ADDRESS:77 0 I CA5co yaq 9-7: 19y6-vg-rid C3Zd�Ce 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, " e that he/she understands the Town of Barnstable Building Department minimum inspection The undersigned homeowner certifies a g p p g prcv..edures and.requirements and that he/she will comply with said procedures and requirements. I let 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.I.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. 0:\WPFILES\FORMS\building permit forms\EXPRESS.doc Town of Barnstable *Permit# ° Expires 6 months from issue date X-PRESS PERM' regulatory Services Fee : 70 JUN 2 9 2006 Thomas F.Geiler,Director Building Division _OWN OF BARNSTaQ%f rry,CBO, Building Commissioner Uk jplZS/°b 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4dY0 A l&_77A/�01 � Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S/g71/ M14 /C/9��l Contractor's Name 61?We FRe,6 1101ne5.5 /NC, . Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) "OrIs Compensation Insurance Check one: ❑ I am a sole proprietor ❑ karn.the Homeowner I have Worker's'Compensation Insurance i Insurance Company Name t=� • �• Workman's Comp.Policy# LO l Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) . ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) side A ('11 ! . ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvem o s License is required. SIGNATURE: r Q:Forms:expmtrg� Revise071405 o�. e. Town of Barnstable Regulatory Services Thomas F.Geiler,Director . o � � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Ov;mer Must Complete and Sign This Section If Using A Builder as Owner of the subject property I hereby authorize—!LZJ! 4f ZL to act on my behalfy in all matters relative to work authorized by this building permit application for: /) 7&Wt11 6Z-& (Address of Job) Z y Signature of Owner Date r- Print Name, Q:F0RMS:0WNEUERM0SI0N J � ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 Worker's Compensation Insurance Affidavit licant Information PLEASE PRINT LEGIBLY Name: Location: �/ �/ y� City , 2 !/�% A f J - Phone# ❑[am a homeowner performing all woilk myself. ❑ am a Sole proprietor aad have ao oae wt),-:"e iu:+uy �;;APJLi Ly 1 am an employer providing workers'compensation for my employees working on this job. Company Name: T&AW A�2 Address: "f `•4ti7TZ.557-Z)a/ At'6457 City: 11� Phone# J®p7 7 ���G�_s/ Insurance Co. 4` �• �r Policy ❑ 1 am a sole proprietor,general contractor,or hommwoer(circle one)and have hired the contractors listed below who have the following workers'compensation policies: Company Name: Address: City. Phone# Insurance Co. Policy# Attach sddltlotaal Wt If Failure to secure coverage as required under Section:5A of>iGL 152 can lead to The imposition of criminal penalties of a Roe up to S1500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day agalust me. 1 understand that a copy of this statement may he forwarded to the Office of lovestigadoos of the D(A for coverage verification. l Do herch certify nder the poises and Penaldjjp4Kuty that the information provided above is true and correct Signature Date 2 Print, m M Ti f4 Phone#a)k� r ficial use only do not write in this area to he completed by city or town official ty or Town: PermittlAcense a Buildin ❑ ;lkpartment check if Immediate respostse is required ❑ Licensing Board ❑ Selectmen's Office ❑ Health Department Contact Person Phone a (�] Other (revised 3M PIA) It-, ���,��.r r :`.''i"..� .. ,.k` _-a ... - ..^'= ..... Mfg., -i� -. � .� , «.g::.*xq..T�Aah La 7�4�`` '4�;`•" �: y ,v c Client#: 105064 CAREFREEHO ES1 ACORD, CERTIFICATE OF LIABILITY INSURANCE 04/224/s°"Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Feitelberg Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222 Milliken Blvd. HOLDER. THIS CERTIFICATE DOES' NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 3220 Fall River,MA 02722 INSURERS AFFORDING COVERAGE INSURED INSURER A: Acadia Insurance Companies Care Free Homes,Inc. INsuRERB: American Home Assurance Company 239 Huttleson Avenue Fairhaven,MA 02719 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXP IRATION DATE IMMIDDfM DATE D LIMITS A GENERAL LIABILITY CPA016537'710 09/01/05 09/01106 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $250 000 CLAIMS MADE Ex-]OCCUR MEO EXP(Any one person) $5 0-00 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 1000,000 GEN'LAGGREGATELIMITAP(P'LIIEESPER: PRODUCTS-COMP/OPAGG s2,000,000 POLICY X f -IPc T I 1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS 80DILY INJURY $ i SCHEDULED.AUTOS..•.-. (Per person) HIRED.AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ _ $ DEDUCTIBLE $ RETENTION $ $ B EMPLOYERS'LIABILITY WORKERS COMPENSATION AND WC6812119 09/01/05 09/01/06 X WC STATU OTH- E.L.EACH ACCIDENT $500,000 E.L DISEASE-EA EMPLOYEE $500,000 E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS "Except 10 days notice in the event of cancellation for nonpayment of premium CERTIFICATE HOLDER ADDMONALINSURE0 INSUItERLETTER: CANCELLATION SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES B E CANCELLED BEFORE THE EXPIRATION Joan Morgan - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n* .DAYSWRITTEN 69 Brington Road NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL Brookline,MA 02445 IMPOSE NO OBLIGATION OR LtABILITYOF ANYKIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, AU ORIZED REPRESENTATIVE ACORD 25-S(7197)1 of 2 #S82441/M8796 DP3 0 ACORD CORPORATION 1980 f `V ✓fie �omvnwozureatlli a��/�aoaactuiaelta Board of Building Regulations and Standards License or registration valid for.individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date: If found return to Registration 100503 , _ Board of Building Regulations and Standards Exp�rafron 6l19/2008' One Ashbnrton place Rm 13UI ' a ; rG Boston,Ma.02108 1c! Type pplement Card CARE FREE HOIIVI,e JESSE MOTTA 239 Huttleston ave � fij Fairhaven, MA 02719 � ---r/ — — Administrator Not valid without sign ure aFt ro,,, Town of Barnstable *Permit#"3 Expires 6 months from issue date Regulatory Services Fee • ttnnrtsrnst.E, • / 9c6 MAN. Thomas F.Geiler,Director 0 2 t639. ♦ A,ED�,ta Building Division Peter F.DiMatteo, Building Commissioner 367 Main Street, Hyannis,MA 02601w . Office: 508-862-4038 X-PRESS PERMIT Fax- 508-790-6230 AUG 1 9 2002 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint OF BARNS T LE Map/parcel Number y'7 a TowN Property Address® 11a77-Ml6w-l" 655 r e V/ue R Residential OR ❑Commercial Value of Work Owner's Name&Address ��D NO%r7jy�fl 'I !�� • j eeAg 2ylu.E c Contractor's Name —Telephone Number 3-09-947171/11 Home Improvement Contractor License#(if applicable) /DD J 0 Construction Supervisor's License#(if applicable) MI(Orkman's Compensation Insurance Check one: ❑ I am a'sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Z yk INS " Workman's Comp.Policy# J -2` -8 / 16 15—E Permit Request(check box) ❑ Re-roof(stripping old shingles) 'VAN Ke-roof(nor stripping. Going over existing layers of roof) 'V ASV T P"F CO DE S'EC. 3665. 4. r ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit d n t exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg:rev-070601 ,.` •e TOWN OF BARNSTABLE Permit No. -_--------- I Building Inspector »>r.n .... Cash ------------------------ �O t6�0• 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 Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. .............................I.......................1 19...... .................................................................._............_......._ Building Inspector FROM TOWN OF BARNSTABLE Mr. Francis Lahteine BUILDING DEPARTMB " Town Clerk -67 MAIN STREET HYANNIS, MA Phone. 775-1120 SUBJECT:' FOLD HERE DATE - _ - November 14, l 84 M E S S A G'E . a Work has been completed under Building permit #22383, (P«F;D. Building Co.) Please release Bond. _ may/•/�� / .� - I ' - • SIG j DATE - - RE-PLY • • • SIGNED RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY - PRINTED.IN-U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. ` _ rj . os_r,P.1 D. DALUZ TELEPHONE: 775A120 _ABuilding.Commiuioner EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS. MASS. 02601 t August 4, 1983 Mr,. Paul Drouin - -- P. F. D. Building Co. , Inc. 153 Route 28 Hyannis, MA 02601 i Permit 2238 dated 7 31 80 Re: Building P rm # 3 / 1 Lot #38 480 Nottingham Drive, Centerville Dear Mr. Drouin: As per our telephone conversation, the following is the list of defects noted at 480 Nottingham Drive, Centerville: I Top cellar. stair rise is 9", maximum rise allowed is 72'. (2101.10.6) ; 1 Floor joists around fireplace hearth and cellar stairs require joist hangers. '(2105.2.4) 1 z - Additional fire stopping required in garage.at ceiling ' level, especially around chimney. (2101.9.2) Access hole to attic must be-.enlarged to 22" x 30". (2106.5) Ceiling joists and rafters were.not sufficient'in size or spacing to span area. (2106.1 & 2106.6) Required spacing. fo3r. framing should be 2"° from outside SateriTeadcing(around''"ey. 41" x 41 " posts. supporting rear deck should have been treated. (2102.8.1) Peace, os ph D. D uz Building Commissioner JDD/gr i - A✓ 1 /S o o 3 In 73 6 X 1-5T, V $.4 (J 70 - i'1 11 M , CEPT PLOT PLPAJ A)sc:7v LE 4oAD L. D CAT/ On/: !yam KJT'�, a> (// �- (- E FRon, Ti ,-vG LOT SCA L E: l = 30' DATE; TUL4J REFERENCE: BEING LOT 38 AS SHOWN ON A PLAN RECORDED / w THE BARNSTABLE COUNTY DATE , REG /STRY OF DEEDS PLf} U BOOK .,.� � • c S? PA GE 31l / NEREBY CER7- 1F-Y THAT THE Fcu1,,1DA7-10n1 REG. L,4,VD 55ru--RVEYDR SHOW/V1JON ,THIS PLf4N / S LOCATED ON THE O RO LIND AS SHOWN HEREON ,AND y,. 7-HA 7- / 7- � O C ONF' ORM TO THE ,11 '1 7', BU/ LD/ NG SETBACK REQU1 RE"ENTS, OF THE TOWN OF , IOW,1R, I� E 0 ,q E L_ 0 K/ f{ N � r O . 9F p Lk Y A q -i -• GCFq-r M�? 5S, ' do !STE 1pf SUR 0- -�S <. ........... e/,�G0- '�' Assessors dnap and lot number ...� .............�•'•'•••• t SEPTIC SYSTEM MUST BE 4 INSTALLED IN COMPLIANCE �° - � �Sewage Permit number ...... ....................... ...............:....... WITH TITLE 5 ENVIRONMENTAL CODE AND �Qyo *THE ton, TOWN OF BARNSIb�CffLGEATIONS Z BA 3 ABLE. YAr. RUIL AG INSPECTOR : r APPLICATION FOR PERMIT TO ........ f .. .. ....... ...... ...... ....................... I TYPE OF CONSTRUCTION .... .tt.i7t-.rn ............. i ............... ..........19 . TO THE�INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit'accordi g to the fo lowing information: Location .....v . . .� ....... ........ .. .. ..................... ProposedUse .., 4 -C . ................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..........Address ...... .......`.........J;Z.S Nameif Builder ....� ..r...........................................Address ........... ........................................................................ r� Nameof Architect ..... L........................................Address .................................................................................... Number of Rooms ........ ........Foundation ..- ............................................................. Aj Exterior ....... Roofing ..................... ". ...... .................. Ftoors � i`.....Interior ..... ...... ...................... Heating ..... ................................Plumbing ..... ................................................... Fireplace ........... .`(.......................................... Approximate Cost .......?Qp .................... .... Definitive Plan Approved b Planning Board _______________________________19________. Area [� . ........... .. .......... ............ Diagram of Lot and Building with Dimensions Fee �L,Z�^ SUBJECT TO APPROVAL OF BOARD OF HEALTH6/v� �t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... i......f .... ..V. L _ <I P.F.D. Building Co. , Inc. No* Permit for one„stony........... e f �..,i� .. ' .. ......single...47.,4L ily-►'M-d 4l-1 ing................... Location .........4aQ.Nottingbm-Drive........... ........................Centerville..... ,± Owner ......:. - . � ., u) � ,� -� / A --� :-•`� , - P.,..F._..D....Bui r Type of Construction frame............... .......... ................................................................. Plot ...r ............... . . Lot ........... .38.............. Permit Granted July 31 r 80 P ��� � • Date of Inspection J. ... ........:::..........19 r Date Completed .. A&7 r 1 t �J PER.411T REFUSED } " 19 �.: .. .... ........................................................ a`�!� /''.� ✓ 1 "� .� - ' 4, ` in- f.. .... .......................................................... . Y' ....................................................... g,a Approved .. ... ............................... 19 .. 1 1 r n