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"� Cir -vl' Y _ ::p,. r _ — r T a, r s _ . 7 L• '� �+ of y +Y r w n .. .a - _ L « s ti w s ^ _ ec 6"= A A ti 14 , S �h s A W p r w 9 �• .. - -_ x .. - y - -d -q- � •-.`,�' - � � ti �-- -mac h r'' AIY- oFtHt:,�, Town of Barnstable *Permit# 10 Etpires 6 months from issue dote Jl Regulatory Services Fee , * BAMSTABLE 9 b 9 $' Thomas F.Geiler,Director o Building Division Tom Perry,C.BO, Building Commissioner NAY.2.6`2016 200 Main Street,Hyannis,MA 02601 s ' www.lown.barnstable.ma.us' TO N OF BARNSTABL Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. Not Valid without Red X--Press Imprint Map/parcel Number o0 f7 — O Q S Property Address 6 0 y A ZI Residential Value of Work oy q e Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_�'J.g►�i f t� c�� o� I ,o _c?`� I^ '7 G 3. 1 CIA? L�� lit L( 3 Z Contractor's Name_ h e__/ k,°"!5: L Telephone Number `J K- S D-5- 7 7 Home Improvement Contractor License#(if applicable) 41 4&11 r l Construction Supervisor's License#(if applicable) E I W orkman's Compensation Insurance Check one: I am a sole proprietor i�Iam the Homeowner have Worker's Compensation Insurance . Insurance Company Name IYOMIS`lum, r-/V; cad• Workman's Comp. Policy# WC015-j-19A19 if- )(WC 6-Y 30 q3. 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 1, y ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value 0 , �6 (maximum.35)#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 . regtdred. SIGNATURE: no C:\Users\decollik\AppData\Local\ icrosoft\Windowffemporaiy lnteniet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 y a * EARNSTABIX, • ii MASS. Town ®f Barnstable 1639. Al®� Ep� Regulatory Services Thomas E.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us j Office: 508-862-4038 tax: 508-790-6230 I s c Property Owner Must Complete and. Sign This Section f. If Using.A. Builder - I as (hvtier of the subject property hereby authorize ✓ to act on my be W all matters relative to work authorized bithis buil&ig permit application for: Address of Job) I i ✓sz x 'e of Own r bate-, Ma i Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption on the reverse side. i C:`,Useis\decolliklAppData!Local\Microsoft\Windows\Teinporary.lnternct Files\Content.Outlook\DDV87AAZ\EXPRESS.doc I i Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.n:ass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelzibly Name (Business/Organization/Individual): Z e we,5 Nme Celz tl-,f Address: M 06 A d tP eY City/State/Zip: ^11W Ille /t'/6 eWf/7 Phone #: Are you an employer? Check the appropriate bo Type of project(required): 1.0 I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees T 8. ❑ Demolition working for me in any capacity. employees and have workers' 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 I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[ Other � �� �Q�f comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providiztg fvorkers'contpeztsation insurance for nzy employees. Belo iv is the policy and job site information. ' Insurance Company Name: le' lfd`tdyl�JUS" C Policy#or Self-ins. Lic. #: X WC- &5'9'30,Y3 Expiration Date: �� Za 17 Job Site Address: l 1 �O r./r S� City/State/Zip:Cci'I,*llvC/l-(-o //(ifI W-6 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 th pa' s and pe to ies of per'zry that the information provided above is trite and correct. Signature. Date: .S" Z(0-/ Phone#: Official use only. Do not write in this area,to be completed by-city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other .. Contact Person: Phone#: A� CERTIFICATE OF LIABILITYn DAT THI 7��R S CERTIFICATE IS I INSU�R'� SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NGE CERtiFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON UPON THE CERTIFICATE HOREPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDERTA CONTRACT BETWEEN THE ISSUING INSURER(S), A IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the li ies must have ADDITIONAL INSIJRED SUBROGATION IS WAIVED,subject to the tenTs and conditions of the Policy.certain policies ma r certificate does not confer rights to the certificate holder in lieu of such endoyseertain ). Previsions or to endorsed.if s Y squire an endorsement.A statement on this w PRODUCER Aon Risk Services South, Inc. CONTACT G Charlotte NC Office NnME. • P 1111 metropolitan Avenue, Suite 400 (NC.No.Ext): C866) 283-7122 FAX (800) 363-oios Charlotte NC 28204 USA E-MAIL Ate•NO-' • ADDRESS: O 2 N"ED" INSURERS)AFFORDING COVERAGE Lowe's canDanies, Inc. - INSURER A: Steadfast Insurance Company NAIC and its Lowes Boulevard subsidiaries 26387 1000 Lo NSURERe: National union Fire Ins Co of Pittsburgh 19445 ' Mooresville NC 28117 USA NSURERc: New Hampshire Ins co NSURER D: 23841 INSURER E: COVERAGES CERTIFICATE NUMBER:570061530649lRER F. 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.LTR TYPE OF WSURANCE Lllrllt3 NSD POLICY NUMBER Shown are as regUCSECd COMMERCIAL GENERAL LIABILnY rLew LIMITS CLAIMS-MADE X❑OCCUR EACH 00--URRENCE MA PREMISES Ea occurrence MED EXP(Any one person) GENL AGGREGATE LIMIT APPLIES PER: - PERSONAL&ADv INJURY PRO- POUCV JECT LOC - GENERAL AGGREGATE o PRODUCTS. - OTHER- � 8 AUTOMOBILE LIABILITY Y V _ O CA 1861270 04/01/2016 04/01/2017 COMBINED SNGLE LIMB C AOS Fa rt SS,000,000 X ANVAUTO Y Y CA 1861269 OWNED SCHEDULED 04/01/2016 04/01/2017 BODILYINUURY(Perperson) B AUTOS O AUTOS ONLY Y IOREDAuros Y CA 1861271 80DILY INJURY(Per acddent) Z at+ly NON-0WNED 04/01/2016 04/01/2017 0 AUTOS ONLY VA PROPERTY DAMAGE tp �. eraxiderd to A UMBRELLA LIAR X OCCUR Y Y IPR379230101 04/01/2014 04/01/2017 EACH OCCJRRENCE X EXCESS LIAR CLAIMS-MADE 510,000,000 U DED RETENTION AGGREGATE S101000,000 C WORKERS COMPENSATION AND EMPLOYERS'LIABIL" Y WC 15519219 04 01 201 0 01 017 ANY PROPRIETOR I PARTNER I EXECUTIVE YIN N AOS X PER STATUTE OTH- OFFICERNFL48ER EXCLUDED? N NIA SIR applies R (Madat"in NH) PP per Policy to s & condi ions E.L.EACHACCIDEN7 f2,000,000 If yes.desuibe under OESCRUn ION OF OPERATIONS Debw E.L.DISEASE-EA EMPLOYEE S2,000,O00 8 Excess wC Y XWC6583043 E.L.DISEASE-POLICY LIMIT 04/O1/2016 04/01/2017 EL Each Accident $2,000,000_ AOS 53,000,000 SIR applies per Policy terlis & conditions EL Disease - Policy 13,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 8c 101 ls,Additional RemllA EL Disease - Ea Emil Commercial General Liability is Self-insure d. hedule may Ee attached if more apace Is Mquued) CERTIFICATE HOLDER CANCELLATION tI1L.l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVER N ACCORDANCE WITH THE Lowe's Companies, Inc. POLICY PROVISIONS. and its subsidiaries [A 1000 1000 Lowe's Boulevard Mooresville NC 28117-8520 USA ACORD 25(2016103) The ACORD name and logo are registered marks of ACORDRD CORPORATION.All rig hts reserved. Office of Consumer AffairZj 10 Park plazas S 4BUS iness Regulation Suite 5170 Boston, MassachuSe Home Improvement tts 021for R Contrac 16 egistration LOWERS HOMES CENT Registration: 148688 ERS CRYSTAL ALLENDE LLC. Type Supplement Card 136 TURNPIKE RD SUITE 100 Expiration: 10/18/2017 SOUTHBOROUGH, MA 01772 SCA 1 Ci 2oM•0s/11 Update Address and return card. �e �On:'�tartec�errl!,��,v ❑ Address Mark reason for change. kfotwi e of Consumer ` `r�'rrc�ruett ❑ Renewal ❑ Emplo Affairs&Business Regulation yment ❑ Lost Card ME IMPROVEMENT C License or re gistration: CONTRACTOR before the ex registration valid for in 148688 expiration date, d return ul use only Expiration: 10/18/2017 Type: Office of ConsumerIf found return to: LOWE,S HOMES10 Park Plaza-Suit Affairs and Business CENTERS LLC. Supplement Card -Suite 5170 Regulation Boston,MA 02116 -RYSTAL ALLENDE 000 LOWES BLVD IOORESVILLE,NC 28117 Undersecretary of valid without Msignature i' 1 f Massachusetts DePartment of Public Safety of sYIlY1T• e �•...: _ y eyu iauvi-s ai.0 vtandaiuS $upe-�- License:cS4y75153 .."x Wit:r :S ijA- nxeow sWeeden Plaw j l 1.. 9 Fovea MA SP/19 It's.' EXPiration Commissioner 01/12/�p17 The Commonwealth of M=sachus Department oflndust WAccidents ' I Congress Street,Suite I00 Boston MA 02114-2017 Workers,Compensation Insataace A,ffidSviv BmUders/CoTO BE FILED WITH THE PERMMITTTIIN�GAUTHORIRITY ������ hcant Information �. Please Print 1 Name(Business/ �ganiaation/Individual .��f y sus,L_ 't-l`� K e-,.jy,4 LL Address: ,� 'tr ,[1J,c- to City/State/Zip: �ia�-t JIL A C.N/ s Phone#: SU8 Are yO°i°employer Check the appropriate box: 1-D 1 am a employer with employees(full andVor * Type Of project(required): 2 Putt-time)• am a sole proprietor or pap and have no 7. ❑New construction any capacity [No workers-comp, re9 employees wad�g for me in Remodeling 301 am a homeowner doing all work myself[No workers'comp. �, ], 9. ❑Demolition 4❑l am a ermae homeowner,and will be hiringmoors to conduct all work on my property. I will 10❑Building addition contractors either have workers•tnrnpertsation ice am sole Proprietors with no employees- I.❑Electrical repairs or additions 5�1 am a general contractor and i have hind the ors listed on the attached shed 12. Plumbing repairss or additions Thesesub-c�orshave employees and have workers' ❑ �•�maau,ce_: 13.❑Roofrepaurs 6-❑we are a corporation and its offi 152.§1(4).and we have no orx have exercised their right Of urexemption per MGL c. I4.��/>Z��t`•�1� e+�loyees.[No workers'com op.nnce .] *Any applic=that checks box#I must alsot Homeowners;who submit this affidavit uidt fill out the section below showing they workers•compensation policy information- Ors that check this box must attached s1 afirig they we doing all work and then hire outside contractors�rst submit a new affidavit indicating employees if the have esm eY t�provide ir we name of the soh,-conftetors umber a�state whether or not those entities have I asr an a off' Policy number. mployer drat is prv.UA -orkers,co uifarmai�ion. a+Pson ursrrrance for rrsy enrployiee& Below rs Tlse policy and job sue Insurance Company Name: Policy#or Self-ins.Lic.#: ,�j Expiration Date: Job Site Address: _/q6 ! Amin s7fj Attach a copy of the workers'coin City/State/Zip: 7,- Pensation policy declaration page(showing Fatln x to secure coverage as wing the policy number and expiration date), and/or one-year nm �under MGL Itc. 1s §25A is a criminal violation punishable by a fine to$1 e>n,as well as civil penalties in the form of a STOP WORK ORDER and a fine of $ .�a day against the violator.A copy of this statement may be the to the Office of Investigations Of the DM for insurance coverage verification. I do hereby cerZ�ry under the P s alyd Si pe�1 olPn'! 1'A&the injornialion provided above is true and correct - Phone#. Date: 0fflczO use only. Do not write in this area,to be COMP/eted bJ'city or town o City or Town: Issuing Anthority(circle one): Permit/Iacense# 1.Board of Health 2.B 6.Other Oiler Department 3.City/Town Clerk 4.Electrical Inspecto r 5-Plumhaing Inspector Contact Person. Phone#: 2376-IMOO oirm 4 : i 42, I r� G I ; :54\e- 7 i e i f ofTME Town of Barest QD 103�Barnstable Permit# Regulatory Services FVi'6montiufrom issue date s i ' ` r a, : Fee CMASS �c � 0.79. �e� Thomas F.Geiler,Director t r��`/ r. Building Division qk, Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstabid.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 . Pr erty Address N I' Ul tJ �+ l} Residential Value of Work O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,44 Contractor's Name (} Telephone Nuffiber_lzq_�4q 712(� Home Improvement Contractor License#(if applicable) 'j �,1 0 _' Construction Supervisor's License#(if applicable) n ]Workman's Compensation Insurance c Famone: asoleproprietor "` -PRESS PERMIT ❑ I am the Homeowner❑ J l-1 L i? i l-i 1 .:I have Worker's Compensation Insurance isurance Company Name TOW!~ OF BARNSI r NS U/ ABLE `� � ,v �� lorkman's Comp. Policy#_ Q ! opy of Insurance Compliance Certificate must accompany each permit. :rmit Requ (check box) Re-roof(stripping old shingles) All construction debris will be taken to ►J/( ;�f'(� [` �//__ ❑Re-roof not stripping.( ppmg. Going over existing layers of r000 ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (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. NATURE: PFILESTORMSIbuilding permit formslE)PRESS.doc I" sed 0701I0 The"Common wealth ofMassachusetts f Department oflndustrialAccidents EI 7 Office of Investigations 1 ililh �� 600 Washington Street w / Boston, MA 02111 1} r www.mass.gov/d"id Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):^ �i /L� nit I ye � 60rV41: Vd l oj,) Address: ; t� City/State/Zip: 0 Phone #: : Are you an employer?Check the appropriate box: Type of project(required): I.❑ a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. Lam a sole proprietor or partner- listed on the attached sheet t ?•. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working forme in any capacity. workers' comp. insurance. g. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no �2•❑ Roof repairs . insurance required.] t employees..[No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that u providing workers'compensation insurance for my employees. Below is the policy and job site information. \ r Insurance Company Name: A. Policy#or Self-ins.Lic.#: Expiration Date a Job Site Address: n�}� t n/ LC� ��/gtate/Zip: Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,300.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. 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 cer/t�if(y under the pains anrd penalties of perjury that the information provided above is true and correct Sip-nature: f- A A A l \ Date fYI r t� d' Phone#: rFl�ssuffig nly. Do not write in this area;to be completed by city or town bfficiaC : - Permit/License# ority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Information and Instructions Massachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees. 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." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority;" Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for conformation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the Iaw or if you are.required to'obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: City or Town Officials Please be sure that the-affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out iii the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' 600 Washington Street Boston, MA 02111 Tel_ # 617-727-4900 ext406 or 1-877-MASSAFE Fax# 617-727-7749 E�MAR LIMA, EpUARD© FRANGC7 \� P.O. Box 1062 CENTERViLLE MA, 02632 1/� 774-268.9724 L A fft*Ltv 15 "IVENaft Construction Job Location: 466 South Main St,Centerville,Ma Owner ,- Maria Eftimiades Description of the job: Replace existing shingles with new 30 years architect roof shingles: Shingles will be install with 6 nails minimum as required by code, ice water guard and felt paper will be use as need to cover entire roof. Charges: (this price includes labor and installation as needed for removing old and install new shingles.) . -Main house/15 s uarefeet x $375.00 = $5,625.00. q • - Garage/9 square feet x $375.00 $3,375.00. Total = $9,000.00 (disposal and permit fee is include on price above.) Payments: $4,500.00for down payment. $4,500.00 is due when job is completed cgrSee to :pay Black River Construction all of the charges above on'the designated dates. If fail to pay on due'dates a late fee of $100.00 will be added to the total of the bill for each additional day that it exceed the due date. ature 0f cl' Dat •+ t ✓�iLe nsumrnXrtetrc e-,i,'%,A,Wg-u �i P License or registration valid for individul use only Oftice o onsumer T 6 s,neT egu a on before the expiration date. If found return to; �j � HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards �( Registration: .._.159506 Type: One Ashburton Place `� Expiration 5/2/2012 Individual Boston,Ma.02108 1301 II� BK RIVER CONSTRUCTION - EDMAR LIMA i 193 FAWCPT LN HYANNIS, MA 02610 Not valid without signature f Undersecretary Mr,- -:, 1! M.us;ichusctts- 'Department of Public SafetN Board of Building- Red-ulations and Standards Construction Supervisor License License: CS 103199 i Restricted.to-00 EDMAR LIMA j tires, i 68 ABBOTT ROAD` SOUTH,YARMOUTH, MA 02664 l-- - �s Expiration: 10/17/2012 Commissioner- Tr#: 103199 _ I y � i '- aIOME .IMPROVEMENT CONTRACTORS REGISTRATION ' Board of Building Regulations and standards One Ashburton Place — Room 1301 :Boston, Massachusetts 02108 - j s • I HOME IMPROVEMENT CONTRACTOR -L-- "-----_ "--- "--- ------- Registration 100740 Expiration 06/23/98 Type - PRIVATE CORPORATION I HOME IMPROVEMENT CONTRACTOR I I. Registration 100740 CAPIZZI HOME IMPROVEMENT, INC. I Type - PRIVATE CORPORATION Thomas Capizzi , Sr . Expiration 06/23/98 1645 Newton Rd . I Cotuit MA 02635• CAPIZZI HOME IMPROVEMENT, INC Thoeas Capizzi, Sr. 4� Newton Rd. ADMINISTRATOR Cotuit MA 02635 -- •w� ; ►;r„ .' • DEPARTMENT ONE AS14BUR ....... DOSTUN, •RUC_TIOW'SUPERVISOR LICENSE" 4:�r� { Expires: . 19600 , .-- 6X74L"..GAP.IZiI'jJR � lkS BL;t ,,y hA`•'0266a 4 The Commonwealth of Massachusetts Department of Industrial Accidents 21 `x I flce011" 91199Ois 600 Washington Street }44i: ' Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: na MC7y V 42 &Ar I ocati city C..d'Ta,L� OZ&e 3S phone am a homeowner performing all work myself. am a sole proprietor and have no Qne %%orkin2 in am capacity I am an employer providing workers' compensation for my employees working on this job. 4 company name address: city: pphone#: insurance co Ab polity# ao AdzBfii_�Z3w I am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed below %%ho have the following workers compensation polices: company name: address: S—h :,. phone'#: insurance co policy N company name: a dress city' phone N• insurance co policy# Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a time rip to S1,500.00 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 against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the D1A for coverage verification. /do herebj,certifj•under t ins an a aities of perjury that the information provided above is true and coned G�/ Signature Date Print name :5"�/�" �Phone N 1 2 �� —� � official use only do not write in this area to be completed by city or town official s j City or town: ` _ - _ __ permit/license N . nBuilding Department 0LicCnsiDg Board' O check if immediate response is required oSelectmen's Office pHealth Department , contact person: +�` phone N:_ _ flOther • to Ue,ised tros PJAt A - _ 71 e Town of Barnstable z Department of Health Safety and Envu onmental Services ` Building Division 367 Main StreCk Hyatmis MA 02601 Ttaiph Crosses . ew i= 508-790-6227 Brag Commission Fa�c SOS-775-3344 For cmcc use only - Permit no. Date ^���� AFFIDAVIT ROME DWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c 142A requires that the mcanstraction,alte:atroas;renovation,npair, °n,.- imprcve:nent..rratrnal, demolition. or oonsa of an addition to'clay F Cdsemg cner o=giied building containing at least one but not more than four dwelling units or to m ester to such residence or building be done by regi urd.vonuact M with certain==Oons,along with ashy tequirc:mc= ` Type of Work- /S �'�3 �36 1`� r9y� Est Cosh�� Address of Work: 0%mcr Name: .�f7��7/Z 4 Date of Permit Application: I her&;%certify that: Registration is not required for the following rtason(s): Work excluded by law ob trader S1,000 " Building not cw=-oocupied owner pnIIing°a'u pezmst Notice is hereby gh-en that: OR OWNERS PULLING TIMR OWN PERMIT DEALING WITH CONTRACTORS , _ fOR APPLICABLE HOIE DOROVEMENT WORK DO NOT SA ME ARBITRATION PROGRAM OR GUARANTY FUND UNDER,mM c I42A SIGNED UNDER PENALTIES OF PERJURY, as cv►-ner: _ " I hcrcby apply for a permit the agent of the .-a® 7 Date name Ration Na 'fi 1 MLS Page 1 of 3 Listing Summary Listing#20711946 446 South Main St, Centerville, MA 02632 Pending (12/14/07) DOM/CDOM:46/46 $389,900 (LP) Beds: 3 Baths: 2 (1 1) (FH) Sq Ft: 1475 Lot Sz: 0.600ac Town: Barn Yr: 1900 1-� F2emarks Picture � ocated in the heart of Centerville steps to Craigville Beach, Four - ' Seasons Ice Cream, library...This delightful 3 bdrm renovated anti ue4ti gambrel/cape on .60 acre private,�ot ! south of 28 has a detached 2 cdr with possible living garage P g g�Zart�.rs overhead.....main house has°v�iood & tile flooring, updated kitchen has granite counter tops built ins- kitchen ; pantry-fireplace dining room -walkalm `s ' Additional PicturesLAI. {p�q CC f x �� j4IIM II ?t j, 4 •'' --- t it IltTlllr III, - r Pictures( ). Virtual Media: See Map Agent Janice L Merrill (ID:U2S8)Cellular.508-292-5267 Office CENTURY 21 Cobb Real Estate(ID:C21 E)Phone:508-775-2121,FAX:508-771-8089 Property Type Single Family Property Subtype(s) Single Family Status Pending(12/14/07) Estimated Selling Date 01/10/08 Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 0% 3% 3% No Facilitator Comm 3% Listing Type Excl. Right to Sell Owner Name Owner of Record County Barnstable Tax ID 207005 Beds 3 Baths (FH) 2(1 1) Approx Square Feet 1475 Sq Ft Source Field Card Lot Sq Ft(approx) 26136 Lot Acres(approx) 0.600 Lot Size Source (Field Card) Year Built 1900 Publish To Internet Yes 6 Listing Date 10/29/07 All Office Remarks 1%of sale price referral/management fee to be split between co-broke and list office.vacant-on lockbox -call listing agent for code Jan 508-292-5267 Directions to Property South on Main through Centerville Village to lights,take left onto South Main to#446(next to Long Dell Inn) Pending Date 12/14/07 Listing Page Commission-Other REFERRAL Showing Instructions Call Listing Agent,Lockbox,Yard Sign http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 1/2/2008 MLS Page 2 of 3 General Page Zoning residential School District Barnstable Year Built Desc. Approximate Total Rooms 8 Total Levels 2.0 Basement Baths 0.0 Level 1 Baths 0.0 Level 2 Baths 0.0 Level 3 Baths 0.0 Basement Yes Basement Description Full,Walk Out Foundation Block,Concrete Foundation Width 25 Foundation Depth 37 Fndation Wing Width 0 Fndation Wing Depth 0 Irregular No Lot Depth 0 Lot Width 0 Topography/Lot Desc. Cleared;,Interior Association No Annual Assoc.Fee $0 " Assoc.Fee Year 0 Garage Yes #of Cars #2 Garage Description Detached Year Round Yes Separate Living Qtrs Yes Sep Living Qtrs Desc Detached Waterfront No Water View No Convenient To In Town Location,Marina,Shopping Miles to Beach .3-.5 Beach/Lake/Pond Craigville Beach Water Access Beach,Ocean Beach Description Ocean Beach Ownership None Street Description Paved,Public Interior Page Fireplace Yes Number of Fireplaces #0 Master Bedroom OxO Level:Second Floor Mstr Bdrm Features Built-Ins,Closet,Wood Floor Bedroom#2 OxO Level:Second Floor Bedroom#2 Features Built-Ins,Closet,Wood Floor Bedroom#3 Features Built-Ins,Closet,Wood Floor Foyer OxO Level:First Floor Laundry Room OxO Level Basement Living/Dining Combo No Living Room Features Wood Floor Dining Room OxO Level: First Floor Dining Room Features Built-ins, Fireplace,Wood Floor Kitchen/Dining Combo No Kitchen OxO Level: First Floor Kitchen Features Granite Countertops,Kitchen Island,Pantry,Upgraded Cabinets,Wood Floor Appliances Dishwasher,Dryer-Electric,Washer Floors Tile,Wood Exterior Style Cape Style Description Antique http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 1/2/2008 Remarks Located in the heart of Centerville, steps to Craigville Beach, Four Seasons Ice Cream, library...This delightful 3 bdrm renovated antique gambrel/cape on .60 acre private lot south of 28 has a detached 2 car garage with possible living quarters overhead.....main house has wood& the flooring, updated kitchen has granite counter tops built ins - kitchen pantry-fireplace dining room - walk out basement ....(possible) apartment has kitchen, living area, bedroom and bath.....Property being sold as is a single family with detached 2 car garage. Regarding possible apartment over garage, buyers will need to go for a town variance after the sale of the property. Buyers responsible to verify tax information, possible easement, legal property use and rooms sizes to satisfaction prior to purchase. This is on town field card as a 109-mulit-family. I it N`LS Page 3 of 3 Pool No Dock No Exterior Features Porch,Yard Roof Description Asphalt Siding Description Clapboard,Vinyl/Aluminium Mechanical Heating/Cooling Natural Gas,Hot Water Water/Sewer/Utility Private Sewerage,Electricity,Gas,Town Water Hot Water/Water Heat Natural Gas Legal/Tax Annual Tax $3099 Tax Year 2007 Land Assessments $187300 Improvement Asmt $4700 Other Assessments $310100 Total Assessments $502100 Annual Betterment $0.00 Unpaid Betterment $0.00 To Be Assessed Unknown Mass Use Code 101-Single Family Title Reference-Book 19158 Title Reference-Page 092 Land Court Cert# 0 Underground Fuel Tnk Unknown Lead Paint Unknown Asbestos Unknown Flood Zone Unknown The listing contract has not yet been validated by MLS Staff. Information has not been verified,is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2008 Rapattoni Corporation.All rights reserved. http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 1/2/2008 Parcel Detail Page 1 of 3 IT Logged In As: Pa rce I Detail Monday,3u Parcel Lookup Parcellnfo _. Developer ....... ........... ... ......._._ Parcel ID 207-005 Lot; Location 446 SOUTH MAIN STREET Pri Frontage 138 Sec Road; Sec Frontage ............ _...... ......... ................................. village-CENTERVILLE Fire District C-O-MM ........ _ ......... ......... ......... .. Sewer Acct I Road Index 1507 Interactive Map . Owner Info ." _._ .... .... owner s,TINORY, RICHARD F JR &CHRISTINA M Co-owner' ........ .................. ........ Streets 446 SOUTH MAIN ST Street2 City CENTERVILLE State I MA Zip,02632 Country US I Land Info ,-._ ...... ........... ... . _._ ... .... ......... .. ... ....... _ , ,..,.._ _ ......,. __... Acres 0 60 Use(Multi Hses MDL-01 Zone g RD1 ! Nghbd 0112 _......-.__.. Topography ILevel Road "Paved . . ...........__ _ ., .... ....... Utilities=Public Water,Gas,Septic Location"Rear Location Construction Info Building Year'1900 RoofGambrel Ext Vinyl Siding Built -. Struct Wall Effect _ _,. ... Roof _._ ..__ ..,.... AC Area '1617 Cover,Asph/F GIs/Cmp Type None ... g ...... Style lColonial # wal l Plastered Rooms 3 Bedrooms .. . Model Residential Int t Batty 1 Full + 1 H Floor= Rooms= .....�.,,,,...,",".._.�................� _.._._:. rotal Grade:Average Type Hot Water Rooms 8 Rooms http://issgl/intranet/propdata/ParcelDetail.aspx?ID=14487 7/16/2007 Parcel Detail Page 2 of 3 .......... ..........- ..........- Stories 11 3 4 Stories Heat I Gas Found- Poured Fuel ation Conc. Building 2 of 2 Year Roof .......... Built 11900 Struct 16able/Hip wall Ext Wood Shingle Effect -----------------................ Roof r-------- AC!....................... ........ 555 jAsph/F GIs/Cmp None Area Cover, Type Int Bed Style lGarage/Quarter wall ITypical Rooms2 Bedrooms V"MR ............- ................... ........... .......... nt Model Residential Floor ................... Bath Rooms i:2 Full ........... t ................... Grade!Average Mii Hea lNone Total 13 Rooms' "IP Type L.. ............... Rooms M, - ' " ,�111-f,I "I � ..........-.-Ill.,................. - Stories 12 Stories Heat Gas Found- Stone Walls Fuel ation 1 Permit History..~.Y, .. ........... .. ........ ....... ...... Issue Date Purpose Permit# Amount Insp Date Comrr 2/10/2005 New Windows 82175 $6,000 12/6/2005 12:00:00 AM 8/26/1996 Remodel 17492 $2,000 7/28/1997 12:00:00 AM Rerooi - Visit History ......................... ..................... .................. .................................................................................... Date Who Purpose 12/6/2005 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 12/23/2003 12:00:00 AM Paul Matheson Meas/Listed 17/28/1997 12:00:00 AM 1 Lloyd Kurtz 1 Meas/Listed .......... ............. ............ Sales History Line Sale Date Owner Book/Page Sale P 1 10/21/2004 TINORY, RICHARD F JR&CHRISTINA M 19158/092 2 9/15/1996 WARDE, J SCOTT&SANDRA 10372/230 3 3/15/1996 CAPE COD BANK&TRUST EX P0118EPI 4 BAKER, DOROTHY A 2912/145 Assessment History ................................ ................................................111.......................... ..................- -..................... ..................... ............................................................................ .................................... ............. .................. .......... http://issql/intranet/propdata/ParcelDetail.aspx?ID=14487 7/16/2007 Parcel Detail Page 3 of 3 Save# Year Building Value XF Value ©IB Value Land Value Total Para 1 2007 $187,300 $4,700 $0 $310,100 2 2006 $156,000 $4,700 $0 $303,200 3 2005 $140,100 $4,400 $0 $341,100 4 2004 $139,600 $4,600 $0 $606,400 5 2003 $121,100 $4,600 $0 $136,000 6 2002 $131,800 $4,600 $0 $136,000 7 2001 $131,800 $4,800 $0 $136,000 8 2000 $79,800 $3,700 $0 $71,800 9 1999 $79,800 $3,700 $0 $71,900 10 1998 $79,800 $3,700 $0 $71,900 11 1997 $60,800 $0 $0 $71,800 12 1996 $60,800 $0 $0 $71,800 13 1995 $60,800 $0 $0 $71,800 14 1994 $66,200 $0 $0 $71,800 15 1993 $66,200 $0 $0 $71,800 16 1992 $75,500 $0 $0 $79,800 17 1991 $109,400 $0 $0 $95,800 18 1990 $109,400 $0 $0 $95,800 19 1989 $125,600 $0 $0 $95,800 20 1988 $97,300 $0 $0 $46,100 21 1987 $98,000 $0 $0 $46,100 22 1986 $111,100 $0 $0 $46,100 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=14487 7/16/2007 yST CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1926 1875 Route 28•Centerville, MA 02632-3117 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief Martin 01. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer December 21, 2007 Mr. Thomas Perry- Building Commissioner - Town of Barnstable 200 Main Street Hyannis,MA 02601 Dear Commissioner Perry: .Pursuant to MGL Chapter 148 Section 28A, I am making you aware and request your interpretation of an apartment without secondary means of egress at: -4_4b=S_outh_Main Street Centerville, MA _V, f". While on a sale and transfer inspection at this address, I observed an apartment over the detached garage. The apartment has a kitchen,bedroom, living room and bathroom. There is no secondary means of egress from`the unit as required by 780 CMR 3603.10.1. In addition, there was also an issue with fire alarm placement that we are addressing. J Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely, Francis M. Pulsifer Fire Prevention Officer cj ._j r Cc: Robin Giagregorio "Commitment to Our Community" r 1uST . CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT ( DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES. 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2375 x1 • FAX: 508-790-2385 John M. Farrington,Chief Martin O'L. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer December 21, 2007 Mr. Thomas Perry- Building Conunissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry:- Pursuant to MGL Chapter 148 Section 28A, I am malting you aware.and request your interpretation of an apartment without secondary means of egress at: 446 South Main Street Centerville, MA ' While on a sale and transfer inspection at this address, I observed an apartment over the detached garage. The apartment has a kitchen, bedroom, living room and bathroom. There is no secondary means of egress from the unit as required by 780 CMR 3603.10.1. In addition, there was also an issue with fire alarm placement that we are addressing. Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely, Francis M.Pulsifer C:) Fire Prevention Officer '` Cc: Robin Giagregorio S `'Commitment to Our Community" ;, f MLS Page 1 of 3 i r Listing Summary ' Listing #20704185 446 South Main St, Centerville, MA 02632 Active (04/12/07) DOM/CDOM:96/65 $525,000 (LP) Beds: 3 Baths: 2 (1 1) (FH) Sq Ft: 1475 Lot Sz: 0.600ac t I Town: Barn Yr: 1900 t Remarks Picture Step back to yesteryear and all the charm you could wish for... The y% charming three bedroom, one and a ' half bath main house has beautiful " x hardwood floors, walk-in pantry, !nooks, crannies and storage ' everywhere. Then there is a lovely Iiidpld one bedroom legal apartment with a kitchen, living room and full bath on 2nd floor of the detached Carriage House with separate utilities!!! In the main house the improvements include 200 amp electrical service, I WIF heating system, renovated kitchen l with professional stove/oven, granite I countertops and glass cabinets. All new Andersen windows in front. Live In the main house and rent they °� I apartment to help with your expenses... Craigville Beach, the country store, playground and 4 Seasl5' ( � Attached Docs Seem p' ..._..__................... ......__ ....... .._. ... . ..... .__._.. _.._... —...�.---- ... ..... ...__ .... ._ ....... ......._ Agent Vivian F Nault M (ID:U19C)Primary:508-775-0158 Office Vivian's Real Estate(ID:VIVN)Phone:508-775-0158,FAX:508-775-5122 Property Type Single Family Property Subtype(s) Single Family Status Active(04/12/07) Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 0% 2.5% 0% No Facilitator Comm 2.5% Listing Type Excl.Right to Sell ? Owner Name Tinory County Barnstable Tax ID 207-005-0-0-BARN Beds 3 Baths (FH) 2(1 1) Approx Square Feet 1475 Sq Ft Source Field Card Lot Sq Ft(approx) 26136 Lot Acres(approx) 0.600 Lot Size Source (Tax Bill) Year Built 1900 Publish To Internet Yes Listing Date 04/12/07 Listing Page 1 Commission-Other none ( Showing Instructions Appointment Req.,Call Listing Office mm General Page Zoning Residential Year Built Desc. Approximate,Renovated I Total Rooms 8 Total Levels 2.0 http://ccimis.rapmis.com/scripts/mgrgispi.dll 7/16/2007 MLS Page 2 of 3 Basement Baths 0.0 Level 1 Baths 0.0 Level 2 Baths 0.0 Level 3 Baths 0.0 Basement Yes Basement Description Full,Interior Access,Walk Out Foundation Block,Brick,Concrete ? Foundation Width 25 Foundation Depth 37 (I Fndation Wing Width 0 ( Fndation Wing Depth 0 I Irregular Yes i Lot Depth 0 Lot Width 0 Association No f Annual Assoc.Fee $0 Assoc.Fee Year 0 Garage Yes i #of Cars #0 Garage Description Detached j Parking Description Carriage Shed I Year Round Yes Separate Living Qtrs Yes Sep Living Qtrs Desc Detached,Second Floor,Verif.Legal Aptmt I Waterfront No Water View No (' Convenient To House of Worship,Medical Facility,School,Shopping 1 Miles to Beach .5-1 z I[ Beach/Lake/Pond Craigville Beach Water Access Ocean,Public Beach Description Ocean j Beach Ownership Public ' street Description Public Interior Page f Fireplace Yes ' Number of Fireplaces #1 Appliances Dishwasher,Range-Gas Floors Tile,Wood Interior Features HU Cable TV,HU Washer,Pantry Exterior Style Cape Style Description Antique Pool No Dock No Exterior Features Exterior Lighting,Yard [ Roof Description Asphalt,Pitched Siding Description Shingle,Vinyl/Aluminium I Mechanical Heating/Cooling Natural Gas,Hot Water s Water/Sewer/Utility Private Sewerage,Cable,Electricity,Gas,Town Water Hot Water/Water Heat Tank j Legal/Tax Annual Tax $2856 Tax Year 2006 Land Assessments $310100 Improvement Asmt $192000 Other Assessments $0 I Total Assessments $502100 ] Annual Betterment $0.00 I http://ccimis.rapmis.com/scripts/mgrqispi.dll 7/16/2007 ' MLS Page 3 of 3 i Unpaid Betterment $0.00 To Be Assessed Unknown 1 Special Asmt Pending Unknown 13 Mass Use Code 109-Mutt Houses on P Title Reference-Book 19158 Title Reference-Page 092 1 Land Court Cert# 0 Underground Fuel Tnk Unknown Lead Paint Unknown Asbestos Unknown Flood Zone Unknown i _._ _. _._............. . Information has not been verified,is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2007 Rapattoni Corporation.All rights reserved. http://ccimis.rapmis.com/scripts/mgrqispi.dll 7/16/2007 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i _ Map �� Parcel o Permit# Health Division45 Date Issued _— d Conservation Division 4&S w Application F�' lJ Tax Collector 52 Permit Fee ? l ou Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANDTOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village 6n.;kg e.f. Owner C'C�AjG����°' ohm 1 i•'�3e'�t Address Telephone �—O?r— 7 ] s—i�,�� Permit Request s e, WA �-- Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Gad , Project Valuatio Construction Type k)v-el Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure h,0 Historic House: ❑Yes 5 No On Old King's Highway: ❑Yes �Oo j Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing a new n Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room County Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other ; ? Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: `O Yes Q No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION p 7 pi —I to Name G F4 rr Telephone Number Address Li 4 Q - S o.r,T{1 S)r License# 4 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE — �� FOR OFFICIAL USE ONLY PERMIT NO. , M DATE ISSUED MAP/PARCEL NO. ' ADDRESS_ VILLAGE OWNER , DATE OF INSPECTION: FOUNDATION FRAME ` INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL m co :s S GAS: ROUGH'S > }� FINAL ;e, 0 FINAL BUILDING m i i DATE CLOSED OUT S ASSOCIATION PLAN N0,j 5; Q Y Y S m� m The Commonwealth of Massachusefts _ - - Department of Industrial Accidents' t "• 600 Washington Street ' Boston,Mass. .02111 : Workers! Com ensation.•Insurance davit-General Businesses name: 1 1 address: J� �tv C�ntl lam_ statat e *bu 4 an phone work site location Out address): ❑ I am.a sole proprietor and have no one Business Type: ❑Retail[]'Restaurant/Bai/Bating Establishment working in any capacity. ❑Office❑ Sal'' (including Real Estate,Autos etc.) ❑I am an em to er with em to ees(full& art time.: ®Other /// � �/O%%%� % I am an employer providing workers' compensation for my employees working on this job.. company.name., Bd8TeBS:! >: .* Jj .it1Si1]'ance.car: .(: +L:•4• `jr '}it:'„�':.• UI1 :}�'. �i. I am a sole proprietor and have hired the independent contractors listed belowwho have the following workers, compensation polices: :';: comPanv'aame= �t�• r.1 addre":. cityt. u&'one''# insurance co. - rz;.:; coin` nv n� OWN sadness.. : . • :: . . .',-•..•' '; .:. .',:. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that R copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u er the par an ti jury that the information provided above is free and correct Signature Date )L Print name Phone# official use only . do not write in this area to be completed by city or town official city or town: permAllicense# ❑Building Department ❑Licensing Board -check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: —__-_ phone#; ❑Outer (revised Sept 2003) Information and Instructions. Massachusetts General Laws chtapter�l,52 section 25 requires all employers.to provide workers' compensation for their.. employees: As quoted from.the 'law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mqre of the foregoing engaged in a�joint enterprise, and including the legal.representatives of a deceased,employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the.occupant of the.dwelling house of: another who.employs ' ons to do.maiutenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.,employment.bedeemed to be an employer: :•. : . .. MGL chapter 152 section 25 also states that every. state'or local licensing agency.shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned'to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents'. Should you have any questions regardinethe"law"or if you are required to obtain a-workers.'compensation policy,please call the Department at the number lists below. , City or Towns . Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for.you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill.:in the permit/license number.which will be used as a reference number. The.affidavits maybe returned to the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call.:-. 1 _ The Department's:address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents BMW of wesdgeons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 Town of Barnstable h �-� Regulatory Services HARNsrasi.E, Thomas F.Geiler,Director A 16 9. a � Building Division QED MAC( Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME L,4yROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied. building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): (]Work excluded by law ❑Job Under$1,000 �Building not owner-occupied Ownerpulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTEREDMENT WORK DO NOT HA .. CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAMOR GUARANTY FUND UNDER MGL cE.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply fora permit as the agent of the owner: Date Contr for Name Registration No. 0 Date F Owner's Name Q:forms:homeaffidav of1HE, Town of Barnstable Regulatory Services YAxtvsTAar KAss. 9� s6gg. aim - . .....•. ilding Division . ABED MA't Tom Perry;'Ruilding"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: ";,46 L/ JOB LOCATION: t L 4 le t,7 & ,kA S 7 number street village "HOMEOWNER": name home phone# work phone# Y CURRENT MAILING ADDRESS: `(qL -5-,7-A 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 Persons)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 riot 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 l09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum mspec ' n proc and re uir and that he/she will comply with said procedures and requirements. c Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required-to comply with the State Building Code Section 127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot.proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by -several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt _ hvnce- ,S"v4` _ 7 7 S' / S`3 •14�� �o'csS -- C(c.(4 SvvT i� /6►/}t� ST. �'Q/1/c�v� '//F - e4 T " . �P►9c� d�� r���t �o`�tG�$ c,A� , 1,.44 ' 7 tl��` p►�'K Pow— iA-cI-«sc �v �G T -S c X `s Lo `J iflit ST 'fix Q 1� Ott +ArcLO f;-- it • w f v ccI too" _ q , re ! r I _ Assessor's Office-(1st floor) Map �D Parcel 6 0,5 Permit# Conservation Office(4th floor)(8:30-9:30/1:00-.2:00) Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) N , ��� eeJ ,� 0 d Engineering Dept.(3rd floor) House# THE i Planning Dept or/School Admin. Bldg.) PEPTIC ���� M III STALLE . N A LIANCE Definitiv lan A rove by Planning Board 19 �/l 9° TOWN OF BARNSTABLE Building Permit,Application Project St dress {�!4 Village ► v, r/f t�LC /�/i� 'Owner /,J� Address ,Telephone ge !13R6 Permit Request t•da0 AIIA 'X_, ROOE 01JF,&W5 ;�i 0WZ- e Ix/ 1 4 3Ae/� o'r �h2�-� ens { First Floor _ square feet Second Floor square feet Estimated Project Cost $ s2 '&z" Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family il... Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House ;A Unfinished Old King's Highway ,tfa Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name ��Z y/L Telephone Number y2Z-j5F5--1;7 Address License# 4J-V 03 2 s Home Improvement Contractor# _y�ed70,0 t G¢ � Worker's Compensation# &,9 f,FO.OR- ld .. NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. _ } ADDRESS f } } VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME } INSULATION t ,- FIREPLACE` ELECTRICAL: ROUGH i FINAL , PLUMBING: 4 ROUGH t FINAL GAS: €-ROUGH FINAL - FINAL BUILDING ` DATE CLOSED OUT , } Jf i ? ♦ f } } ASSOCIATION PLAN NO. } I ul ; I