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Home My WebLink About0042 NYES NECK RD EAST C� J� �,� C � l ► `� .��_` LAC � _T��' C-�`�'T-�, �' ._ �` ._ . . .. w ,. .. ti ��. .. ., ., ,�� a ,: r .. :, 5, ` �, ,. i ♦ .. n ��. - ... r..� � ., _ ,. ... x, :. .. 'r ,.. c .. �. �. .. . .. .. r ,. ., ., ,_ .. .. ;. - .. .,,, „_ ,. ., � � J � _ � �. �. .0 .. �{� .. - -t - .. .. .. «. .. .. .... a '..� .,. i .' .- .. -. � .. �; �' -'. ;, .' F ... ... .. �� .r' r _ ,... � .. ,t. _ ,� n v; , '� ,. _ -.�. .. ,.. 5�.:, .. 't .. ,.. -��. r _ .. -,. i. "+" n ,; .. �, . .. .. s. ,. _, �, ,.. �< ,. �. .. �, c .. .z w , .. .. ,;, ,, ,,.. .., ,. . r :� n ,. r �� t x. J 's+ i , .., ... ., .., ,,a , .. ,�.. _ �; .A ;o ...�. _ .n '� a n. .: i F E ,. _ .,. ._ � _ .. M ... � ,. c.*� ..' M1. :� a .:� y -. . . .. 4l ,. .` _ � � + . 1 ... � , .. µ.. :' � G .. ., f _ � _ ._ .' � i .. � :� .. i ..., .. .. .. _ �.� �. ., ,. :. ...� � '.�.. fi .� .. � � .. r .. ,, . � .. a a ,. _, .. e. - .. �. .. .- � :. � Town of BarnstablePermit: ZOM b(0q q cg Regulatory Services ate: Richard V. Scali,Interim Director Building Division ` MAM ' Tom Perry, Building Commissioner p�a� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: 1 OTIC a GrecAe_-, Phone: 501 Install at: wes ¢-LL ill. Village:& �uq At Map/Parcel: Date: I 0 t q Stove A. ew Used B. ype: Radiant Circulatin ^/ C. Manufacturer: �0 e_ Lab.No. //� C D. Model No.: /AZO 0 Chimney �. A. New xis�tin-- If existing,please note date of last cleanings 0 � t�f B. Flue Size C. Are other appliances attached to Flue? J D. Pre-fab Type and Manufacturer _/A E. Masonry: _ . Lined/Unlined rc Hearth Sr •a3 �:�1�� A. Materials: B. Sub Floor Construction: Installer Cii t M Name: SCC) S Y'1. c_/�� C CV l� Address: /`� �l J`l L U m Q AT Phone: 5b$' LtaO-COLCaPecs Location of Installation: 14d- 14( C5 !JC C-K AD `CQ'1tU'A14� Aq+ 6 a(03 H.I.0 Registration# C 55 L- - 10,50 a Co Construction Supervisor# v OR check_Homeowner Installing,no license uired t . P�b LICENSED INSTALLERS SIGNATURE: " APPLICANTS SIG URE• 1 . va APPROVED BY: 'Please make the s payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 11/4/13 s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations Y 1 Congress Street'Suite 100 Boston,MA 02114-2017 5� www.massgov/dda Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name (Business/organization/Individual): Chimney Care Address:7 Captain Lumbert Lane "v City/State/Zip:Centerville, MA 02632 Phone#:508-420-9261 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. [] I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [N mp.insurance comp.insurance. 9. ❑Building addition o workers co required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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 wood insert install 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. hContractors 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:AIM Policy#or Self-ins. Lic.#:awc-400-7024208-2014a Expiration Date:4/27/15 Job Site Address: 42 Nyes Neck Rd. EA5+ '; City/State/Zip:Centerville MA 02632 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder pains and penalties of perjury that the information provided above is true and correct 10/8/14 , Si mature: Phone#: 568-4 -9261 Offw l use only. Do not write in this area,to be completed by city or town offlciaL 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#: ' Town of Barnstable Regulatory ServicesBARNSTAB . 9 rEg` Richard V.Scali,Director �iOTEOµpI�`� 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 Owner Must Complete and Sign This Section If Usine A Builder as Owner of the subject property hereby authorize t I M n �WLe to act-on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) 9, L, 1 ,"'Pool fences and alarms are the responsibility of the applicant. Pools , are not to be filled or utilized before fence is installed and all final inspections are performed and accepted.- Signature of Owner Signature of Applicant T6� CC CA (;me Print Name Print Name Date Q TO RM S:O W NERP ERMIS S IONP OO LS Town of Barnstable Regulatory Services 'ME TQ Richard V.Scali,Director , q t r Building Division t ynxMAS.nit Tom Perry,Building Commiss`oner 200 Main Street, Hyannis,MA 02601' www.town.barnstable. .us Office: 508-862-40 Fax: 508-790-6230 HOMEOWNER LICENSE MPTION• Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town \he/sherei j state zip code The current exemption for"homeowners"waso include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire t possess a license, rovided that the owner acts as supervisor. ION OF HOMEOWNER Person(s)who owns a parcel of land on whichi es.or intends to reside,on which there is, or is intended to be,a one or two- family dwelling, attached or detached structur such/use and/or farm structures. A person who constructs more than one home in a two-year period shall not be consideow r.f Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she ons s e for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for complian with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town o Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedure\recq=� d ints. Signature of Homeowner f . Approval of Building Official { Note: Three-family dwellings containing 35,000 cubic feet or larger 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 persons)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 wr`ith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully awire 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 formlcertification for use in !your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 - Office of Consumer Affairs and Bu iness Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 161642 Type: DBA Expiration: 11/12/2014 Trlt 233688 CHIMNEY CARE SCOTT SMITH P.O. BOX 202 MARSTONS MILLS, MA 02632 Update Address and return card.Mark reason for change. Address Renewal [].Employment [ Lost Card SCA 1 G 20M-05111 fin`•rn"" (fairs `de Regulation License or registration valid for individul use only Office of Coasunter Affairs&Busi ess Reguletioa g Y R ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: "3 Office of Consumer Affairs and Business Regulation _�egiatration: 161642 Type: g � 1x piratlon: 1.1/12/2014 DBA 10 Park Plaza-Suite 5170 k Boston,MA 02116 CHIMNEY CARE SCOTT SMITH 7 CAPTAIN LUMBERT LN CENTERVILLE,MA 02632 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supcn imnr Spccialth License: CSSL405026 , 1 I♦ ,/ SCOTT B SMITH= ' 7 CAPTAIN LUM1sER y :a Centerville MA 02632 .Jcoc. " "' Expiration Commissioner 08/12/2015 I YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain.the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI:, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: C h G A- Fill in please: APPLICANT'S YOUR NAME/S: c� r e n - t s Sao- r` r BUSINESS YOUR HOME ADDRESS: �� Q G i; F I rs �Y 3w r e�C_�A'fA-, -e-r\0((e---- 11R,-,uck r, c hL TELEPHONE # Home Telephone Number �Sr:, NAME:OF CORPORATION. '::C- e i r'l CG NANIE`OF NEW BUSINESS, TYPE OF BUSINESS IS THL$.,A H011/IE OCCUPATIONS U iYES NO ADDRESS OF BUSINESS SX: :... .JU r P �. MAP/PARCEL:NUMBER 6 3 �: � [Assessing):. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of ' Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1: BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has I) n infor d a y p mit requir ments that pertain to thl; tKp Df/NT jPPOGULATIONS, FAILURE TO Au k�oTized Sig at ** COMPLY MAY RESULT IN FINE : COMMENTS: ics 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** ~. COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel VO Application # '> Health Division Date Issued rated: Z Conservation Division Application Fee UK Planning Dept. Permit Fee J )' F Date Definitive Plan Approved by Planning Board Dk �ILoIjL Historic - OKH _ Preservation/Hyannis Project Street Address �? �� ,sZZ � �� Village Owner ,�r'�2 /C/A 6!: ee Address r� Telephone c1 DcP 1 G Z 9 Z % Permit Request /�1�y��;i a4� y C�/��5 / ��,��Jr� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation_ Construction Type �1 �G/✓ 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 9'I`o On Old King's Highway: �0 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 ' d 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:0 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 _ _.-- _ _ r Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� D /�y ��d Telephone Number ��,��i%Z/5� Address 0i &, Z'/jz License # A b 6 Home Improvement Contractor#/rS.� ' Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE 1i t FOR OFFICIAL USE ONLY -APPLICATION# -T DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER s DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL S FINAL BUILDING d r 7 DATE CLOSED OUT ASSOCIATION PLAN NO. r 1 OWNER AUTHORIZATION FORM 1, oc�r-Le i a AGre e.vi.e (Owner's Name) owner of the property located at (Property Address) %/ (Property Address) hereby authorize e tJ (Subcont or) lki-s an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date i gwie&mmtmu ,s )GAOL 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY --- - - - - 455 YARMOUTH RD. HYANNIS, MA 02601 a - -Update Address and return card. Mark reason for change. L Address E] Renewal I I Employment Lost Card )P6-CAI <; 50re-04iO4-G10121s J I tyteg L.:iccose or registration valid for individu! ^:!; l)fticc.' ui sumo Affairs 13us nc,'c Regulation g �- 01 HOME I�p b� iflf`f�`f�� f A u'hru�eCG� before the expiration date. If found return to:' Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite-5170 P P Boston,MA 02116 fOD INSULATION, INC HENRY CASSIDY 455 YARMOUTH R.D. HYANNIS, MA 02601 Undersecretary Ata ith t si tulle '- �l;t,,arlutscUs-Depamnent of Public Safeth B„aril of Building Regulations and stand:u ds' 4.onstruction Supervisor License Licen CS 100988 HENRY CASSIDY 8 SHED ROW WEST YARMOUTH, MA 02673 G- �"'�" Expiration: 11/11/2013 ('uuuui.,; i i'�- • Tr/#: 7620 t , �� I� lfivl No. 16Ua P. I Client#:4597 CCINSUL ACORD,,, CERTIFICATE OF UABILITY INSURANCE DATE(MMIODNYYY) THIS - — 07/0212012 CEk'rtl ICATE 1 S IS SUED AS A CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES S BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS rl'i UTE A CONTRACT BETWEEN THE 1$$UING INSURER(5),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPQRTANT:If the cerHflcate holder is an ADDITIONAL tNSURED.the poli4l[ies)must be endorsed.If SUBROGATION 13 WAIVED,subject to the terms and conditions of the policy,certain policies may ruquln,an endorsement.A 6tatement on this certificate does not confer rights to(fie celtlflcate holder in lieu of such endorsement(s). PRODUCER 'ONTAIRogers&Grayhis.-So.Dennis NAME: Mar aret Youn Fnu 434 Route 134 aC No EXI:508-760-4602 aG N EMAIL oY 877-816.215E South Dennis, MA 02600-1601 SOB 398-7980 _iNBUKR(5)AFFORDING COVERAGE NAIC N wsuREo __.._ INSURI=RA:Peerless Insurance 111333 Cape Cod Insulation Inc INSURERB:Evanston Insurance Company 455 Yarmouth Road INSURER C:Atlantic Charter Insurance Hyannis, MA 02G01 INSUReRD,Commerce Insurance Company _3,1754 INSURER E: _ 11,16URER IF: COVERAGES CERTIFICATE NUMBER: _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 11CLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RGDUCED BY PAID CLAIMS. GR TYPE OF INSURANCE ADO SUER POLICY EFF POLICY Ell 1�R POLIcr ryil hro[R MM1DWYYYY MMIODNYYY v LIMITS A GENERAL LIA91LI7Y CBP8263063 U41011120112 04/011201 EACH OCCURRENCE $1 QQQ 000 X COMMERCIAL GENERAL LIABILITY ELATED 151 PREMISES anccurrenc 9:100 OOU CLAIMS-MADE OCCUR MEOEXP(AIIY one pereon) $5000 PER80NAl,&AOV INJURY $1 000 000 GENERALAQQReQATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES P✓;R: PRODUCTS-COMPIOP AGG $2 00U 000 POLICY M PRO LOC _ a p AUT0MOAILEuA61LITY 12MMBCKV10i< 4/01/2012 04101/201 eOMBI�EDSINGLELIMIT 1 OOOOOO ANY AUTO _ BODILY INJURY(P.,person) $ 4AUTOSAUT'03 CHEDULED ._.� _ UT03 BODILY INJURY(Per Awidenl) $ XON-OWNEDROPERTY DAMA(k - T, $ I3 X OCCUR XONJ453512 4/01/2012 04/01/201 EACHOCCURRENCE $1 000000 CLAIMS-MADE AGGREGATE $1000 000 DED X RETENTION 10000 C WORKER$COMPENSATION $ ---- AND EMPLOYERS'uAaalrr WCAOp529J02 6/30/2012 06/30/201 X WGSTATU» OTIT ANY PROPy2IErO�P,aR E I ecurlva Y I" rt OFFICMR MBER kX0 PIR a NIA E.L.NCH ACCIDENT $1,000,000 nd IMe das Y in nd er E.L.DISEASE-EA EMPLOYEE $1 000 000 MI It Yee, e,deacnee a u DESCRIPTION OF OPERATIONS below E.L.DISEASE,POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS I VENICLES(Allauh ACORD 101,Addido—I R-inrYs Srhgdulp,l(more apace le requil'ed) "Workers Comp Information 11 Included Officers or Proprietors Certificate Holder is included as an additional insured unclor General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cud Insulation,ine SHOULD ANY of THE ABOVE DESCRIBEO POLICIES BE CANCELLEU REFORL THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVEkED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR28PNTATIVG C 198 -2010 ACORD CORPORATION.All right-9 reseryotl. ACORD 25(2010/05) 1 of 1 The ACORD name and 1000 arD regls(ered marks of ACORD #883849/M83848 MEY The Common I t :1/01 of Massachusetts _ --- Department ,, industrial Accidents ' 0jfic.c / I1 t vests �ttions L SUU Vk illilngton Stree t AM 02111 C' WYv)l .c:.INS.govI ill "`o -Icir's curnpCIISMiou Insurance Attic,.., d: Builders/Contractors/l:lectricitt►�ti/.1''tun.il►�r ppliratllt Information Please Print Legibly A taut' IILniuc.�s/Orbcttli.�. Llii.>tt/Irtdividutlll; c. ( � — � c Y D__ 4` .. Z ' j' t(:You an Clupluyer'? Check tilt; appropriate box; Type of project (FC(ILlirVd): I. l.till tl r.ulployer With J`I ❑ I am a u,.c contractor and l have 6. ❑ Mew construction --t � — rult)IO)'0CS (full and/or l,zu'I:-tirrae.).* hired d .id. coiataetors listed on 7. Remodeling —� aua�il,tl .hrct.I auu<L sulL l.)roprietoi the oil,partnership these sui,.,:�.ultactors have 8. ❑ Dernoliti0li tilt.(Itavr nu c:lnployizes working for employe,:, have workers' comp. 9. ❑ Building addition ntC In any capacity. [No workers' insurau .; l0, ❑ Electrical mpalrs Or addiliuus rump iusuruu:e rr.tluirecC.] 5. We arc:I,oi1loiation and its 11. Plumbing ors u lilitiuus officers il:n: ;.�c rcised their right of ❑ � rc[` rzl houlcwwlaer duing all work exemplium I„i iVIGL c. 152 5(4),and 12. Roof repairs nlysr,lt [No workers' comp. we have Ilk' Ini)loyees. [No workers' 1 ` , 13. Othar >C�`t'�)f'rl?CT�(Cl nuurtulrc rr.iluirrd.1 .r C0111p, ul,ul:1i1re required.) F lu;:q)pllr;uu lhat r�hecks box it must also fill out the section below shoe w_•lll;-ir workers'compensalion policy information. it ma•.vuc,z Mi"slllmlit LhiN affidavit irldicat'ing thoy a-C doing all wu,l,,ltjJ ill,o Iliie out5lde comidctots 111U.)t submit a lmw affidavit i«dicauug ziuch. ([tilt chick this box must anilch an additional sheet showing ti. ,c lo,of the sub-contractors and state whether or not those entities have enlpinyrrs.it litc„Ill.wntak:Lo,n have Cntpioyccs, 1.11Cy I111.13r 1)rQVide thCil'WQI-kegs-caligi I .I„ aanlbrr. our tilt employer that is providitig workers'compensation i)r"onutce for my employees.Below is the policy and job site ^— — ntlur'nutfiva. lu}ut,.inCr.t.O (((tally hlitrl'LBi K�t t r�d�� i C_ �CJ� � ( .'. t 5 1 (.K Y`� J, full ti n L)l .�cll-iris, l_ic. it: Expiration Date: .�� lull Sur ,\ddw',s: .._-_ City/State/Zip: altaih it copy ut the workers' conipensation policy declaration pat;, i.,t)raving the policy number and expiration date). (�aillar lU sCc111C CUVcrkk8C a6 re(.jUifCd llrldof Section 25A of MGL c. I l..i.ul tuild to 1110 imposition of Cnnlltlal penalhGJ Of a f111C Up LO 1�500.00 i[tll.VU[ ,)llC-YCdl nul)rlsuuLLlcnt,as well as civil penalties in the form of a STOP Gv(W'I:ORDER and a fine of up to$250.00 a day against the viulatur.Be advised but r„py i-if Ulk sLatanlcrlt lit a c forwarded to the Office of Investi ,m,d6 of the DIA for insurance coverage verification, t do hMcuntler the iris ant. penalties of'peri'my that the information provideed above is true and correct,it u u rc ; �i' J q/ 019%ir4111 use 1-4. 1)u itut write in this area, to be completed m.,ill,Of'town official , City or'town: I'ermit/License# lssuillg rlutllority (circle unr:): 1. ljuarLi o I'll ealth 2. .Buildiug Department 3.CRY/ olru Clerk 4.Electrical Inspector S.Plumbing Inspector 0.t)tt1L:r Contact Person: Phone#: O 1oJ24�iZ C� c PE cOO OF BARNSTAME I N S U L AT I P7rtCT tq ffl11: 39 FIBER OEASS SEAMLESS SPRAT FOAM 9YSPENOFO' _ _ BATTS GUTTERS INSUTAtION - 1-800-696-6611VISI€N Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: 10/17// �-- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village (;� e , ° Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( X) ( 13 ) (X) ( ) ,,O100 Sincerely He y E C sidy , President Cape Cod nsulation, Inc. °FT ,°►�. Town: of Barnstable *Permit# Expires 6 monthsfran issue date Regulatory Services Fee + BARNSTABLEr q MAC $ Thomas F. Geiler,Director rEDMAyA /��`2 Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Re - s Imprint, Map/parcel Number �,` p� (� 0 CA Sri o.J �'Q.J L Property Address Lil `V��S "SEC Residential Value of Work o2=i6 0 Minimum,fee of$25.00 for work under$6000.00 Owner's Name &Address �+�R c-rp-» e Contractor's Name u.Gu xi Telephone Numberp Home.Improvement.Contractor License#(if applicable) Construction Supervisor's License#(if aPPlicable) '0161 b7 MIT �w-- - - ❑Workman's Compensation Insurance. Check one: JUL 23 201Z _I,am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Lr ✓�� '""`'�A L' Workman's Comp.Policy IS 33 3 F® Y .D ZI Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) , �e-roof(stripping old shingles) All construction debris will be taken to c>trh V� Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors. ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *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\EXPRESS.doC i Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbeirs Applicant Information g� Please Print Legibly Name(Business/Organization/Individual): D Cc t 0 Addresses 1�0 ozw City/State/Zip: pLia MA �,t71i Phone#: 5o% Scoot %t ids j Are youan employer?Check the appropriate boa: Type of project(required): 1.L�'1 1 am a employer with. 4. 0 I am a general contractor and I employees(full and/or part-time).. have hired the sub-contractors 6. Q 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. Q Demolition working for me in any capacity. employees and have workers' P 1: 9. ❑Building addition [No workers'comp. insurance comp.insurance. required.] 5. We are a corporation and its- 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions. e L myself. o workers co right of exemption per MG Y � comp. 12.[j 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. TContractors that check this box must attached anadditional 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: Ll0-,iz-a`M MAj-cuA--e Policy#or Self-ins.Lic.#: J2S 1. 04 02J Expiration Dates UL 7-b`24 i �2 > o Job Site Address: does A,C 4,se City%State/Z a—M-Te2ei//4W e_ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this 'statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: � 6� Official use only. 'Do not write in this area,tabe completed by city or town offciat 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#: F 01/06/2012 FRI 11:05 FAI 508 7781218 DOWLING I O'NRIL INS 001/001 1/6/2012 9:52237 AM PST (G4T-8) FMMt iMUr4ncmv3s10rw.com-T0s 15097781210 Pages 3 of 3 CERTIFICATE OF LIABILITY INSURANCE THIS CWMFMTE tB 1 UJID AS A YATTBR OF INFDRYATION ONLY AND CONIMM NO RMMS UPON TH8 CCf'THWATY MOLDML 7HM CMt I PIOATE Dabs MOT AR AMATNELY OR NEOATN6LY At OM%MMMb Olt ATM THE OOYERAM AFMRt}1tD BY THE POLICIES "LOW. I MS Ct:R►lP"Iff OF IMSYRAMM DOM NOT CONMMU'rM A COMRACT SSTWM THK IitMN6 MBNtWM AVrrj0MM RfIPRMENTATNE,OR PROt UMNI AND THE CERTIFICATE"DWE L an ADO ED."pal ) be andwasc 18i1 BRD6A to thetsnne and aandltl w om pa w,gabtn Mod"tn1WngVbw wendaroWnWC A dfdmw It on fhb dow am oonrsrfilh a to dke ammkob hwd In Ron cm%HYA WRMS,% 601 vie U AG C N NAM NC M ftMA 02575 i GOVEMOES Ni"Rfb jN TN18 OF IN8URI1MpI L18riiR 06=NAVE BUN HUED TO THE WSURED NA M ARM FM a WDIG11T8R NDTWIMH8TANM"ANY RE0IARElNENT TERRA OR CONOtT M OF ANY ODWRAMT OR OTHER OOGUMW WIM R@BP W TO WHICH THO co"URCA"MAY a I68UED OR MAY PiIKTAtN�Tits NBURANCE WORM/1f THE F04i M DMMMED MMAN 18 SULMCr TO ALL THS TERM6, iKQW81CN8 QQNdt'M10N80F8UOIt "WHAYEBEENRECUC@DltifMCLAMM. on sus aaoiwsatisinr , , anura�,v, . OiAMIMM am 5 are •• s►aaomi+a.aaov 1E oea• ttMlfA!!t avrouoauatssocnr F NirAtlrO �•• eeeuV DUtBIrO'AP�dI aocarwnasrRaraeaaro MMAVM =R RACN06d�UliNfx 1< tiRC ', �itRfCIN: � ; s A AM'liiP10YlM{il�/arrl< rlss S3MatY1021 =WWI 42F"12 X=QmaMet NIA WOOD ,e •En a~ uaR aaw�pw � Workers tiaa,pr�Yan trannanef aoveng!saoRes orlt�►ia the wmt�ers oortBef�aeton laws of the amte tAti THB Wt]RK1liRS'COMPBNSIITIOR POLICY cm ROT PtRmIDE COVERAu FOR OLNSR KBLLY BHIMttD ANYORTNtAtidME IAQtXIIi IEQANC@tLEp tfEf� f TOWN OKYARMOUTH RIBfi " RATE TUIRM NOI'iCt3 WILL an tassmm >q TBL�JhiR YAEtMII MA 02684.44= A+ 0MAMM M,MSPottcve, . rr�r+rnre4rasansisrsrA,we - ®90"10 ACM CO!RRMPA' MON. All rfpMe sasioN@d e A{;Qlip�yu{(�muffi ) s oThaeoeeA�COM a6um antd bBo am wplstmd rmft of ACOIRD 1W wrsCi3Llisi e�xrzMAMM.WAV4»fir:.iMniv la:n«l/7ili.,�ii InliAi:OL M N0.4 of t i Office_ of Consumer Affairs and Business Regulation r 10 Park Plaza.- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 128957 Type: individual Expiration: 6/1412013 `r# 2 Oliver Kelly Oliver Kelly 8 Rhine Rd Yarmouthport, MA 02675 Update Address and return card.Mark reason .. C] Address E] Renewal [3 Employment [ SCA 1 0 20M Sn I �Ic trc�uurc.rtoenlN c,/�l�ti.;,;arftt,:C!!: Office of Consumer Affairs&Bust ess Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: n e. Office of Consumer Affairs and Business Regulation egistration: 128957 Type. ~ iratlon:_ 6/14/2013. Individual 10 Park Plaza-Suite 5170 _ - Boston,MA 02116 Oliver Kelly Oliver Kelly 8 Rhine Rd. Yarmouthport,MA 02675 Undersecretary Not valid without signature I \laa.arhuserts- Department rrr Public Sant.- 1 Bo:u•d rrf Buildin== Reglul ttions and Stand.ird • License: CS SL 99167 Restricted to: RF,WS -OLIVER KELLY 8 RHINE ROAD YARMOUTHPORT, MA 02675 Expiration: W8013 Couuni�si„nrr Tr-` 5155 �y KELLY ROOFING 8 RHINE ROAD YARMOUTHPORT PH 508,775 4498 MA. REG.# 128957 MA 02675 LIC.# 99167 Okelly52@comcast.net INSURED July 18,2012 , Proposal submitted to Pat Greene of 42 Nye's Neck Road East Centerville Ma. We propose to supply all materials and labor necessary to remove and replace the existing roof on the garage at the address above All debris to be removed to town transfer. 8"White Aluminum drip edge to be installed on all eaves. Ice and water damage protection membrane to be installed on first three feet of eaves. " Remainder of deck to be covered with#15 felt paper. . Limited lifetime warranty Architect style shingle to be installed. (Landmark, Brick Red) Protect all walls,windows,decks,plants and shrubs etc. during roof strip Obtaining of town permit. Complete clean up of site during and after completion of project, including all nails. At a total cost of$2500 Payment Schedule;balance upon completion. Respectfully submitted,Oliver Kelly Proposal accepted by, —Pa- Date 1�C3 /2012 If acceptable,please sign and return one copy and keep one for your records. This proposal is valid for 45 days from date above,please call to verify thereafter. i Town of Barnstable �9115 Approved Regulatory Services Fee Z, �, Thomas F.Geiler,Director Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038. Fax: 508-790-6230 Home Occupation Registration Date: +_AJV_AXq S. oM a Name: 1 cx+rCc_ o. A cc.e:n�9_ Phone#:�J�O�� 33bo1`�� Address: 1 e.cL Ci ZaS_� *` Village: s `2 Name of Business: (37re e-VI e. C(eQ n Type of Business: X f(1 q Map/Lot: a33 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. - • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up-truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed.indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: L�p/1itfL Date: 02 6 D Z Homeoc.doc Assessor's map and lot.number ....................0?. ...° THE o ;rSewage%Permit number ........................................... NAUSTODLE i ..............:.............................................. �V a`0� F�ouse number r� c yaY _ TOWN "OF BARNSTABLE BUILDING " INSPECTOR Al A APPLICATION FOR PERMIT TO .............. ......�"�.{.......... ........... .......................................... TYPEOF CONSTRUCTION ...:.... ................................. .. .............. ........................... . ............. .... ....:19..: 2. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby. applies for a permit accordin to the f oAo wing i-formation: Location .......... . . .... ...... r ................................................. e....... ...................... .............:....... ProposedUse ................. ..... .`L,. . .............................................................. . . .......................................... ZoningDistrict .......T).. ......................................................... ire District ................................................................. .............. Name of Owner�. /_� �.. ... 1.: �P/1/.. ...Address :... ..... . 1 .!!'.. .... ................... Name of Builder" ... ..1.. ................ / �l�/✓) .....Address'.....................................:....:......................................... Name of Architect ......... .. .................Address ........ Numberof Rooms ..................................................................Foundation ......:.. ............ .......... ..... ................,................. Exierior' ............. .�i .....................Roofing ........:... Floors .... r.. ................. ................:. .... ........................:..:........Interior .............:........................ Heating .............................................. .......... ................Plumbing .......... ............. .................................................. Fireplace ..��J.... .�..............................................Approximate Cost .........A.6b.�..`..C�..G ............... Definitive Plan Approved by Planning Board, -------------------_-----------19________. Area 'S Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL 'OF BOARD OF HEALTH -2--Z OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the .Rules and Regulations of the Tow P,16-f Barnstable r garding the above construction. Name # ....... ........................ Greene, Philip A 2-4 2 2 a*' Build G r ge No ................. Permit for .................... ............ Accessorto Dwelling........:................ ......... .......................................................... Locatidn;..1`!y Road &t&.4—............................. .................Centerville................................. -NJ .. .. .... .. .... .. .... ... 4 Owner ....Philip.. A. Greene, Jr. .......... ..........................I.................. 1 Type of Construction ...................Frame..... ...... ........... ........................................................................ Plot July 20 82 Permit Granted .........................f.............�19 Date of Inspection ........................ ... .......19 Date Completed .................rx" i 1 4n-eiY c. fr** Assessor's map and lot numbe ......................................... SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE WITH ARTICLE II STATE Sewage Permit number ..��C1l h, .......� SANITARY CODE AND TOWN REGULATIONS. ypfTNE.To�f TOWN OF BAR.NSTABLE Q EAMSTLDLE. i 039. BUILDhING INSPECTOR °'E'OypYa•e � � APPLICATION FOR PERMIT TO .................................................... ,>C:�4..... `�e ........................................... TYPEOF CONSTRUCTION ...................... �............................................................................................. !.•. ......... ...........19.�. �z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby, applies for a permit according ,to the following information: { Location ..................../. d�5.......r d?u ...........0 lsi/ �r✓J�l� ................- e4.C�S�. 1....t'....................... r' ProposedUse .............................................................................................................................................................................. Zoning District Fire District � i��'vi./�' .............................�........................................... ............. ............................................................... Name of Owner 4/.�� 3...f( ......... - Address ........ ��:, iY/ / ' �.� _ �. ... ........... ......... Name of Builder ...... ` .... �✓ ��e�... �...........Address .. ...... Name of Architect ........��..ram./..✓...`.�......................................Address ..........................................................,......................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ...................................I.................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. e Fireplace ........................................Approximate Cost 14 2 `� 6 ' ................��... + Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ......./ ........ ......... Diagram of Lot and Building with Dimensions Fee ............ ................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH f �+ 'J �v ` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ame ' .......... .� ..... .................... mreexma^ A. Jr. � Philip \ . � . � . , . � �� | c^ Lnconon'--... �-- �� -------.. | ' ` ----..--- --. � � Owner ---- �.�~_ � ----. -- . . � Type of Construction -----.. ----. ' .............'...,............................................................' � Plot ............................ Lot ................................ . ; Permit Granted ---.�q.tip J..........lg 73 | . Date of Inspection 19 ' ~~'~ Completed ^ ~ \ ^ � | � PERMIT REFUSED Y -----`-- ........................................ 19 . ` � '---------'---------^------''' Y...................... ......................................................... \ � . } � .------------------..—.—,.~-- . � ^ / .--------.~-------...—.----,— � / � Approved ....................... lQ - � ^ ------------------`-------' , ----------.--------,—~—....—. - ~ ' 11 h 1; fCTi (^y mo te£i3>i Pc^^kL li- 'y^ i-C- i -<" I )* V" •4M IrAvOf r *0 Assessor's office (1st floor): Assessor's map and lot number Board of Health (3rd floor): Sewage Permit number Engineering Department (3rd floor): House number APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ^..^.^1. TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS;.—_ The undersigned hereby applies for a permit according to the following information: Location Proposed Use . Fire District ddress Address ..-rrrS^P-•• Zoning District Nome of Owner Nome of Builder Nome of Architect Address Number of Rooms Foundofion Exterior Floors Interior Heating Plumbing Fireplace Approximote Cost Definitive Plan Approved by Plonning Boord 19 Diagrom of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH Areo Fee . BABJISTMILE ^c9 Cb CP OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of Bornstable regarding the above construction. Name Construction Supervisor's License ...r-NE,PATRICIA A. '*No Permit for Single Family Dwelling Location ....tlX®.®.:; Centerville Owner Type of Construction Plot Lot Permit Granted Sep.t 15.,19 86 Dote of Inspection 19 Date Completed 19 • ;? •.-t 'A- :V^: * y.-r: C3 /•< U- 4 ( •f*}. .'l •ej' if'- Ci . •tjyt •>'w'• :'-31] '--..it:?! i':i? •.kV ?r> ri^ u X T C •ry o •> 4^ J: c/ /.I >;