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Town of BarnstableBuilding
IPost This Card So That it is Visible From the Street'-Approved Plans Must be Retained on Job and this Card Must be Kept
Posted Until Final Inspection Has Been Made. �� ��
„vcs Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection hasnlieenmade.
...�. _._...�.._.�... .��.,._._._ ._..,�..
Permit No. B-20-2254 Applicant Name: Ted Dow Approvals
Date Issued: 08/25/2020 ti Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/25/2021 Foundation:
Location: 283 OLD STAGE ROAD,CENTERVILLE Map/Lot: 189-135 Zoning District: RC Sheathing:
Owner on Record: LEES,VANESSA Contractor Name: TED D DOW Framing: 1
Address: 11 ENTERPRISE ROAD UNIT 16 ,J Contractor License: C5-097225 2
HYANNIS, MA 02601 Est.o Project Cost: $ 10,000.00 Chimney:
Description: Replacing 12 windows, no structural changes Permit Fee: $51.00
Insulation:
Project Review Req: Fee Paid:' $51.00
Date 8/25/2020 Final:
i Plumbing/Gas
Rough Plumbing:
_. g g
Building Official Final Plumbing: .
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection ' Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
' Final: '
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set for-th in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable Building
. . "L �
# � Post This Card So That it is Visible`From the Street .ApprHM oved Plans Must be on Job and.this Card Must be.Kept
1039 MAWL, , Posted.Until Final Inspection Has Been`Made ' Permit
Where a Certificate of.Occupancy is Required;such Building shall Not be Occupied"until a Final Inspection;has been made ,fig 1 ei ililt
Permit No. 13-20-499 Applicant Name: William McCluskey Approvals
Date Issued: 02/19/2020 Current Use: Structure
Permit'Type: Building-Insulation- Residential Expiration Date: 08/19/2020 Foundation: -
Location: 283 OLD STAGE ROAD,CENTERVILLE Map/Lot: 189-135 Zoning.District: RC Sheathing:
Owner on Record: LEES,VANESSA Contractor.Name:' ,William J McCluskley Framing: . 1
Address: 11 ENTERPRISE ROAD UNIT 16 Contractor License: 102776 -2
HYANNIS, MA 02601 Protect Cost: $3,200.00 Chimney:
71
Description: Add 280 sq ft.of R-10 rigid insulation to the crawlspace.Air,seal the Permit Fee: $85.00
crawlsp P ace with expanding foam. General weatheri2ation.
Insulation:
Fee Paid; $85:00
Project Review Re Final: 2,O
q: D 2/19/2020
Plumbing/Gas
�1
l Rough Plumbing:
'�—�-m-�- Official .
invalid nl h w rk h riz` hi . rmi i omm n withi ix months h e This permit shall be deemed abandoned and unless the o auto ed b t s a t s c a ced n s o t s afte l� f?�s pey p � Final Plumbing.
All work authorized by this permit shall conform to the approved application"and tli ;approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be' in compliance with the local zoning by-laws.and codes. Rough Gas:
This permit shall bedisplayed in a location clearly visible from access street or'road-abd shall be maintained open for public inspection for the entire duration of the
of the same. -.i' Final Gas:
work until the completion " ;�
ifi f "cu ancy will not be issued until all applicable signatures 6 the'Build'in _and-Fire-Officials are: rovided on this e`rmit.The Certificate o Oc
Pp g Y g p � B.
P Y _ i , � Electrical
Minimum of Five Call.lns ections Required for All Construction Work:
P q
1.Foundation or Footing F Service:
2.Sheathing Inspection ,
3.All Fireplaces must be inspected at the throat level before firest fluilimng is installed ..£ Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
S.Prior to Covering Structural Members(Frame Inspection) Final:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Rough:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Low Voltage Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Final:
Building plans are to be available on site �`- Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Final:
� a
Cape Save Inc.
7-1)Huntington Avenue BUILDING DEPT.
South Yarmouth,MA 02664
Tel: 508-398-0398 Fax: 508-398-0399 S E P 0.4 2020
T U`Y.,y ,,.Si�BtE
8/25/20
Brian Florence CBO
Town of Barnstable
Building Division
200 Main St.
Hyannis,MA 02601
RE:Insulation Permit 20-499
Dear Mr.Florence:
This affidavit is to certify that all work completed for 283 Old Stage Road,Centerville has been
inspected by a third party Certified Building Performance Institute(BPI)Inspector.
All work performed meets or exceeds Federal and State Requirements.
Sincerely,
William McCluskey
-- - SS PERMIT
ti X, .pRE
utu 16 2005 Town of Barnstable- *Permit# / 7 5
Expires 6 mon hs from issue date
TOWN OF BARNSTABLE .l
Regulatory Services Fee
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO; Building Commissioner
200 Main Street,Hyannis,MA 02601
www.townbamstable.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 Z J7 Old 6 , 14-
V
[Residential Value of Work ,::Do1P Minimum feg of$25.00 for work under$6000.00
Owner's Name&Address LA �" a `✓ /�
3
Contractor's Name V a .— /l. v/�C Telephone Number -5 —7 7/
Home Improvement Contractor License#(if applicable)
�,o riser's Liee$seapplicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
ara the Homeowner
❑ I have Worker's Compensation
Insurance
Insurance Company Name U Q-l/n�� /� °r` 'n
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) 1
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
❑ 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 Improvement Contractors License is required.
SIGNATURE: _
Q:Forms:expmtrg
Revise071405
Department of lridustrial Accidents
Office of Investigations' ' .
a 600 Washington Street
Boston,MA 02111
° y www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu>Qalbers
AppHeant Information ]Please Print Le 'bl
Name (Business/orP=ation/Individual)'
Address:
City/State/Zip: Phone#:
Are 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
employees (full'and/or part-time).* have hired the sub-contractors ❑ construction
2.El am a sole proprietor or partner- listed on the attached sheet $ �• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. g, ❑ Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
officers have exercised their i0.❑Electrical repairs or.additions
3Xrequired-]
I am a homeowner doing all work right of exemption per MGL ME]Plumbing repairs or additions
myself. [No workers' comp, c. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.]t 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 anew affidavit indicating such '
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
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/Stateat:
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 Qf 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 STOPVORK ORDER and a fine
of up to$250.00 a day*against the violator. Be advised that a copy of this statemed 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
Si ature_ Date:
Phone#: 7 l — . G 91
Official use only. Do not write in this area,to be completed by city.or town offices
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2..Building Department 3.City/Town Clerk 4..Eleetrical Inspector 5.Plumbing Inspector
6, Other
Contact Person: Phone#:
l .
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
f pursuant to this statute, an employee is defined as"...every person in the service-of another under any contract of hire,
express or implied, oral or written." r
'N :: oration or other legal ty,or any two or more
An employer is defined as"an}p�au,..partnegtip,:association,qwp . . g
of the foregoing•engaged in a Joint enterprise,and including the legal representatives of a de ased employer,or the
receiver or trustee of an individual,partnership, association or other legal entity, emplo ' employees. Hovrtov..er.-1 e
the occupant of the
owner°�f a dwelling house having not more than three apartments and who on orides
'woo kvn such dwelling house
dwelling house of another who employs persons to do maintenance, eP
or on the grounds or building a\urtenani.. thereto shall not because of such employm t be deemed to be an employer."
MGL chapter 152, §25C(6)alsat"every state or local licensing agency hall withhold the issuance or
renewal of a license or permite a business or to construct buildin uthezommonwealthforany
applicant who has not produtable evidence-of compliance with th insurance coverage required.Additionally,MGL chapter 15 states"Neither the commonwealth i any of its'political subdivisions shall
enter into any contract for the ce of public workuntil acceptable Hdence of comcpliance with the insurance
1equirements of this chapter haesented to the contracting autho
Applicants
Please fill out the workers' compensation .davit completely,by c cking the boxes that apply to your situation and,if.
necessary,supply sub-contractor(s)name(s), ,dress(es)and one umbers)along with their certificate(s)of
Companies C Limited Liab ' Partnerships(LLP)with no employees other than the
insurance. Limited Liabfiity Comp (I-L ) € lion insurance. If an LLC or LLP does have _ '
members orpartners; are not required to carry wo ers' comp
employees,a policy is required.. Be advised that this davit y be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. o be s e to sign and date the affidavit. The affidavit should
be it to the city confirmation
town that the application for th �p 't or license is being requested,not the Department of
Indusrial Accidents. Should you have any questions .eg the law or if you are required to obtain a workers'
comp_nsation policy,please call the Department at then listed below. ur
. Self-insed companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials .
Please be sure that the affidavit is complete and grin legibly. The D artment has provided a space at the b rottom
of the affidavit for you to fill out in the event the O ce of Investigations to contact you regarding the aPp applicant'
in the ermit/license number hich will be used as a re ence number. In addition, an
Please be sure to fill P
that must submit multiple permit(license applicati in any given year,need a submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant sho write"all locations in (city or
tom)"A copy of the•-affidavit that has been offilially stamped or marked by the ci or town may be provided to the
applicant as proof that.a valid affidavit is on file or:future permits•orliaenses..Au davitmustbe filled out.each
year.Where a homeowner or citizen is obtain inI a license or permit not related to any iness or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete is affidavit.
The Office of Investigations would like to thanI you in advance for your cooperation and sh uld you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and,fax number:
The Co onwealth of Massachusetts .
-. P}h ent of Industrial.Accidents
p..
. . .. .. 0 'ce Qf jkvestigations .
,. 600'washingfon Street .
Boston,MA 02111
Tel.#617-727-4900 ext 406 or-1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www.mass.gov/dia