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HomeMy WebLinkAbout0023 TOMAHAWK DRIVE �: f O.mGi,�CZu��. �� . �; , � . .. . h y w .. �!' _ _. - _ �'� ,. � 'F v - � .. a ` Town of Barnstable BLi1ld111 ,6 PoosstteTd Uis nPhaCWhe �C.t ailr dFinSao l TIkn.h.saptettc tisio Vnp�sH�.b,a lsXe B,Fe_rgaxeo nm.,qM4;t�h.aede5 t'reet ApFproved_,P,l ans Must,be Rse tamedonJob a.nd thts:Caar d Must be:Ke t Permit r b" da•I4.. Mwt$W.ww..,.,. '."s...._ - e..'�'� . .,...ii r.'«�.�...n YR.r'. .. < ,.._.+ ,-a"4ir. n: .. '.V Permit No. B-18-1758 Applicant Name: MALONE,CHRISTOPHER B&THERESA J Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 12/08/2018 Foundation: Location: 23 TOMAHAWK DRIVE,CENTERVILLE Map/Lot _190 016 Zoning District: RC Sheathing: Owner on Record: MALONE CHRISTOPHER B&THERESAJ'9 Contractor Named Framing: 1 Contractor ucense Address: 23 TOMAHAWK DR X 2 £ Est Pro CENTERVILLE, MA 02632 3 Project Cost: $0.00 Chimney: Description: 10x12 shed J x P..errn�t Fee: $35.00 i Insulation: Project Review Req: l FeePaida $35.00 a Date 6/8/2018 Final R h Plumbing/Gas um b Rough Plumbing: iiaBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within simonths after issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl ci ati6h1bnd the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structur se shall be in compliance with the local zon ng I y laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public uispection for the entire duration of the work until the completion of the same. _ Electrical The Certificate of Occupancy will not be issued until all applicable sign t6himby}thet uildmg and FireOfficials are prov,ded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing .. Rough: 2.Sheathing Inspection 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 Low Voltage Final: 7.Final Inspection before Occupancy g 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 forth 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 THE r Building Department Services t Brian Florence,CBO 0 RAnxsrAate. • Building Commissioner i639 ��� 200 Main Street, Hyannis,MA 02601 prED ,, www.town.barnstable.ma.us Office: 508-862-4038 BULCANG DEP. . Fax: 508-790-6230 MAY' 3 12018 PERNIIT �l 011VN OF,3ARNSTABOPEE: $35.00 SE EA REGISTRATION RESIDENTIAL ONLY 200 square feet or less Q3 I omn Location of shed(address) Village a Property ownef s name Telephone number �0 k I) be k/0� 9 © 01 Size of Shed Map/Parcel# 5-12 Signature Date Hyannis Main Street Waterfront Historic District? n U Old King's Highway Historic District Commission jurisdiction? O You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Worm -shedreg REV:08/6/17 gr r • MORN RF l 19Q924 1900' F 20 .13 1991023 / #34 s 3 190015 w , r „fir s 190012'. 19066. 190017 C 033 `A 19,0011 1} : #191 19491 ', #43 199019: #14 } T196Q0r y 24 .. This ma is for illustration purposes only.It is not Parcel lines shown on this ma are only graphic Map printed on: 'S/31/2oi8 P P rP Y P y!�' P adequate for legal boundary determination or representations of Assessor's tax parcels.They ar Feet regulatory interpretation.This map does not represent not true property boundaries and do not represer 0 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the r 0. reflect current conditions,and may contain such as building locations. Approx.Scale: i inch 42 feet cartographic errors or omissions. . y r i q r TOWN i9F BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel b Application # Health Division Date Issued 5 Conservation Division BUILDING DEpT. Application Fee Planning Dept. MAY 032017, Permit Fee Date Definitive Plan Approved by Planning Board r ry _ Historic - OKH _ Preservation/Hyannis BA rA-ISLE; Project Street Address Village Z:e-,�����;��� Owner ?/h% /0'Ve- Address ✓l�e�i Telephone 35�S zzg PL7 3 Permit Request // 2!fJ I l�j�' u�/-'�G�� > ��.G��fi' l`�/®�.G��✓� /mod l,2G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /3Do; Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ;No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ' ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� ��� ��/i9�®� Telephone Number J� ��✓��� I Address License# /G� v� Home Improvement Contractor# Email/04A&�_ jt �� ,�r, (0 Worker's Compensation #A2 <'� ,,Pd �� j f, Z- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE —S��//7 FOR OFFICIAL USE ONLY FAPPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 •i f " �rz he ¢ Y4 !. sa li egulatory Services s•, �� • � ; Y11 . 9. qq Pich trd:V.Scali,.Directar. ':" 1 k t•2639, RWI ing Division , font Perry,I UH&ng'conunissianer + , 200 Nfitin Strti t H)-Annis,-3%AA;0260i . . + vvw v:tosrn:barnvtabIc.ma:ns- 14� of 'e: 508-862403'8 Fax: 608-79M2.3.0 `; Propexty Owner Must. {l Complete and s gn`'his Se ti.on 4=,: itq, If Usino—A.Builder Yl r� I C Pl as C?Tz�ner.raf the subject-prooeny 1 herebyuthc� e to act-Oh.-my,;elialf, in aU matte,s.eelauve.to'work authorized-by this buiIdin;pernaivapplication for o 23 � Gcw_<<Dr 0 (AddfesS Qf join.: s Paol fCh t.c&and aLu-zris are the iespansibItyof th,e applicant. Pbols are not.to-Ue'filled insta.:ed azid:all finai' ` { x' , iUsp zs_a e p.erf-onned and.accepted. , 5i lnanu e.r Signature of-Appl e.na.tAA a ; C 4 Q I slop*s fe, ACGNQ l's dame _� I'1anL Nairc� �e. t T - a, Date { ,pM to Q:FOLtMS:OCv?��F,RPr�1�tiSSIONPOU]S � r""�'�� -_, P Al �'... The Commonwealth of Massachusetts Department of Industrial Accidents OffBce of Investigations b 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aalnlicant Information Please Print Legibly Name (Business/Organization/Indlvidual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip:South Yarmouth, MA 02664 Phone M 508-775-1214 Are you an employer? Check the appropriate box:I.ME am a employer with 48 4. ❑ Type of protect(required);I am'a general contractor and I New construction employees(full and/or part-time),* have hired the sub-contractors 0 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' ❑ Building addition [No workers' comp. Insurance comp.Insurance.t 9' 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 1 l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherizatlon ,,. 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 affdavit 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 an additional sheet showing thts rfame 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. lam an employer that Jsproviding workers'compensation lnsurance for my employees, Below is Ilse policy and job site lnformatlop,,. Insurance Company Name;Atlantic Charter Policy#or Self-ins, Lie.#:WCE00431.902 Expiration Date;6/30/2017 Job Site Address: 02 3 ��i6I/1�kJ.�/ ,➢ �p � jj���� City/State/Zip: ✓ 4 z 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, 1 do hereby certify under the pains and penalties of perjury that-the lnformatlon provided above Is true and correct. Signature, Henry Cassidy , f•. Da Phone#: .508-775-1214 Offlclal use only, Do not write In flits area,to be completed by city or town offlclal, 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#; " I CAPECOD-27 KDOYLI ACORIt7" CERTIFICATE OF LIABILITY INSURANCE DATE 0 3/3 0/2 0 117 ' �" 03/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlficate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER ACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 INC,No Ext: A/C No; 877 816-2156 South Dennis,MA 02660 mall,@rogersgray.com INSURERS AFFORDING COVERAGE NAIC k INSURER :Peerless Insurance Company 24198 INSURED INSURER 8:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER c•Endurance American Specialty Insurance Company 41718 18 Reardon circle INSURER D:Atlantic Charter Insurance Compariv 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR.CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH'rHiS 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY'EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,001 CLAIMS-MADE =OCCUR R/0 CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RENTED rent 100,00( ISES 9 OCf:I MED EXP(Any one ereon 5,001 PERSONAL&ADV INJURY 1,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,00( X POLICY j LOC' PRODUCTS•COMP/OP AGO $ 2,000,00( OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ANY AUTO 6232707 COM 01 04/01/2017 04/01/2018 BODILY INJURY Per ereon Oy�ryED SCHEDULED AIURTEOES ONLY X AUpTNOpSy�NEp BODILY INJURY Per accident 1,000,00( X AVTOS ONLY X AUTOS OtJLY ���R��I AMAGE Co X UMBRELL•�1LIAB X OCCUR EACH OCCURRENCE 2,000,00( EXCESS LIAB CLAIMS-MADE R/O EXC10008635001 04/01/2017 04/01/2018 AGGREGATE CEO RETENTION$ Aggregate 2,000,001 D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N �( PER OTH- ANY PROPRIETORIPARTNER/EXECUTIVE WCE00431902 06/30/2016 OW30/2017 1,000,00( FIGE�2IM�MQ,�ft EXCLUDED? N/A E.L.EACH ACCIDENT If nde ory n n ) E.L.DISEASE•EA EMPLOYEE 1,000,00( Ryyes describe under 1,000,00( DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety ' 11VV Board o°f Building Regulations and Standards License: CS-100988 Constructlon Supervisor HENRY E CASSIDY, 8 SHED ROW WEST YARMOU•lH �1 if �•� l/�.�- Expiration: Commissioner 11/1112017 I Y 6 r Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Maft,tUSetts 02116 Home Im roveme., .'.C.©-i ractor Registration `;- )) Type: Corporation ?'.(f Registration: 153567 Cape Cod Insulation, Inc ,,, .�, ;` === Expiration: 12/14/2018 18 Reardon Circle So, Yarmouth, MA 02664 :''I '` r {•—SCA•j 20M•O6l11 Update Address and return card, Mark reason for change, <i stx ..._ ._....-•------._.._....�7r ..Q_�..._�..__..__...._.._,,..._---'___.._......._._.._.. __............_.._..... .(�_�1��::c.,t�...h..f1�ru+ar::�:_!1;".,�;;lo�y.mank_.Cl�•.os±.!^.ax�.... v/ae 1pa?lrmaa9acuoC��t�o���a4Jrrc�6uJeC�J• Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only i T.yOe; Corporation before the expiration date, if foun urn to; '""' Office of Consumer Affairs and sl as Regulation 10 Park Plaza a 8170 12/14/2018 i •`a:•'�: ,:- Boston MA 11 Cape Cod Insulatf`f1.,1'c'' '' • + Henry Cassidy'ra. �•' !,, 18 Reardon Circl, •:Yi So.Yarmouth,MAQf .iv" Undersecretary t al h& si atuy ,,t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-!' GIB Parcel of Permit# / `792Lf .w Health Division �® ! ABLE Date Issued Conservation Division U7/I k/C)`{ 9 `� `L 12 Ate 10: 21, Application Fee Tax Collector %f��,�o �f Permit Fee *qs:;=AAe 4%0.q.90 Treasurer ' fSdON___--- `17C JYvTEM MUST BE Planning Dept. t,—.,TA1_LE0 IN C011r9PUANCS •SAP;TrrLE 5 Date Definitive Plan Approved by Planning Board CODE AN. Historic-OKH Preservation/Hyannis Project Street Address d I� Village Owner Cor 1 { q fn Org Address 0 Telephone Permit Request C7 �6a � s::winToo� C'J 4\1 - Square feet: 1st floor: existing I d proposed� 2nd floor: existing propose Total new Zoning District Flood Plain Groundwater Overlay Project Valuation bah Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) y Age of Existing Structure `I— Historic House: ❑Yes ';1No On Old King's Highway: ❑Yes No Basement Type: Full ❑Crawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) n Basement Unfinished Area(sq.ft) Number of Baths: Full: existing o2 new 8 Half: existing new Number of Bedrooms: existing_ new Q Total Room Count(not including baths): existing qvr— new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric 0 Other Central Air: ❑Yes )5 No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes No Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:l existing 0 new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �W No If yes,site plan review# Current Use Proposed Use LDER INFORMATION Name e. Telephone Number SZS C �0 ;__UT Address �% tgck License# C 5 07 Y a CJ Ofy �Q' W-C sa6 a Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i�,Ar\(L SIGNATURE DATE /a LG L' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. t A + ADDRESS_ VILLAGE } �- '. OWNER- ,. DATE OF INSPECTION: 4 4� FOUNDATION FRAME INSULATION IG FIREPLACE ELECTRICAL: ROUGH J FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH + • FINAL FINAL BUILDING DATE CLOSED OUT, - ' • �` _ r , ASSOCIATION PLAN NO. Y A f The Commonwealth of Massachusetts -- Department of Industrial Accidents ' wee 61AffV~M 600 Washington Street e Boston,Mass. 02111 Workers',, Compensation.Insurance Affidavit-General Businesses name: address:. state: r1YA zip:C193 zz -hone# .6*'w work site location(full address): K�i►vl ►ll`t� III�` �G� V� ��3 _ ❑ I am'a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Eatii g'Establishment working in any capacity. ❑ Office❑ Sales(mcluding.Real Estate,Autos etc.) ❑I am an em toyer wt employees full& a t !net: ❑Other �%%% %//%%%% % am an employer pro 'ding workers' compensation for my employees working on this job.. — com an •name ' sadness= ..�t• ::�� ��. 't�,t'a,t(1�� .. � $..� ':_:;.,:. .phone.#:��':;' "• .��� ,V�:•. insiirarice.ca ' } ohc. •#:..4..:._.,. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: ctimpanynarire= - - address:. •'• �L;�� :::. _ '� ci! )sh one, #.: ''-?, is .?S.y ,;. •.Y:. ',i.,. ZZM .•r:s insuran - jW/k�///�j •:r.. :t•.i r'•6. •'9j' .':l.l':i:: conipeny n :a• _zs. ci1.y:. .n�tiriE�#c 'olic:' . #'}:is•:,' :•.;..i iiisuance�so: - �. Failure to secure coverage as required under Section 25A of MGL 152 can lead to.the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of this statement maybe fo . to the Office of Investigations of the DIA for coverage verification. I do hereb ee ify under th ains a aides of per hat the inform ation provided above is true an orre Signature Date � Phone# O� Print name i1 IL oircial use only do not write in this area to be completed by city or town official city or town: permit/license# -[]Buildingent ❑L ❑-check if.immediate response is required ❑Se CHicontact person: phone#; ❑O (revised Sept ZI103) Information and Instructions Massachusetts General Laws chapter 152 section 25.reguires all employers to provide workers' compensation for their. employees: As quoted from the 1`law", an employee is.defined as every person in the service-of another under any contract of hire, express or implied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint 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.cmployment.be deemed to be an employer. .. MGL chapter 152 section 25 also'states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required. Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the 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 Depar rent 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 lndustrial Accidents'. Should you have any questions regardii*the"law"or if you are required to.obtain a.workers' compensation policy,please call the Department at the number listedbelow. . City or Towns . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant Please be sure to fill.in the permit/license number.which will be used.as a reference number...The.affidavits.may:be.returned to; the Department by mail or FAX unless other•arrangements have been made. The Office of Investigations would hike to thank you in advance for you cooperation.and.should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents WIN of wesflgatfens . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 �FISE Tom, Town of Barnstable Regulatory Services snxivsTnstE, ' Thomas F.Geiler,Director 9� ' 039. `�� A, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: a e Estimated Cost 3 f Address of Work: ��®�n IV►��►.� �\ �- owner's Name: Date of Application: 7 A` I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ate Contractor Name Registration No. OR . ate Owner's Name Q:forms:homeaffidav Town of Barnstable pf(1iE TO�� Reg latory Services Thomas F.Geiler,Director XAM .09• p,� Building Division ArE0 MAy Tom Ferry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . -- aww:tawn:barnstable.ma.us Fax: 508-790-6230 office: 508.862-4038 - PY r usro e owne Sig Complete aid This S ection If Using A Builder —� ,as Owner of the subject property `�— to act on my behalf, hereby authorize matters relative to work authorized by this building Pe 't application for: (Address of Job) J Signature of er Date Print Name i 1 ° �a d fierya�i?ractrz o ✓�/�.aafcrc�uz ..« BOARD OF'BUILOING REGULATIONS ` License; CONSTRUCTION SUPERVISOR , Number CS 076820 { .. ''. B►rthdate 08/28/4965 Exp►res 081 8./2005 Tr.no: 371:5 !''` ,.. Restr►cfetl., 00 ! KENNETH O PERRY- ,,. j CEN.TERV.ILLE, MA 02632 i � Admiriist�ator 1 . .J�ZC �fb?flYJ1IY.GQ�Zl(lY,(LI./.✓L C�>..'4f.(ld.iaClLCI `. c25i *� Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Registration: 132282 Ezprration: 12/2.112004 Ty": DBA h K.P.REMODELING KENNETH PERRY 19 GUILDFORD RD. Centerville„ MA 02632 Administrator THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY, ORIGWAL (S) C� ,F- DATA Town of Barnstable *Permit# — ��FYHE Tpk� Expires 6 months fro►n issue date Fee � • �z Regulatory Services CD UP.NSTAaLE. MASS. $ Thomas F.Geiler,Director 9�'OrEo rM'ta,� Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main.-Street, Hyannis,MA 02601 MAY 1 3 2004 Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDEN'rIA���F B,4f�NSTi�BLE Not Valid witl:out Iced X Press Impruit a Map/parcel Number Property Address on Value of Work Residential Q O� 3� Owner's Name&Address Telephone Number Contractor's Name 1 �� Improvement Contractor License#(if applicable) cc�Home ® ((���2 0 Construction Supervisor's License#(if applicable) �d DWorkman's Compensation Insurance Check one: (] I am a sole proprietor �� � A k � I am the Homeowner CO 41 '�e �t I have Worker's Compensation Insurance � Insurance Company Name Workman's COMP-Policy# SJ Se57aOL_ d J Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to vR :. Re-roof(not stripping. Going over existing layers of roof). Re-side- C'a K-K ) - maximum. q►��Q2. v✓ Replacement Windows: U-Value- ( ) ��lGt 13ACI *Where required-Issuance of this permit does not exempt compliance with other tbt GTfie ,� p Board of Building Regulations and Standards ***Note: Property 0 i Property Owner Letti . Home Itripro t Con rs License is requir. NOMIE 1Mr kOVEMENT CONTRACTOR ReglstAo a� 1.32282 X3iE�t� f;2/2i1/2004 Signature , ��jrge A{> K.P.REMCigELIN l" Q-.Forms:expmtrg KENN,EN PERRY':' Revise053003 19 GUILDFORD ..�. c—t—Aiae nnn n�c�n �p�,HETph� Town of Barnstable Regulatory Services rr A Thomas F.Geiler,Director MASS- s6$9' p�m Building Division lED � Commissioner Tom Perry, Building 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize < Z'A• to act on my behalf, in all matters relative to work authorized by this building permit application for: 02`3 G YNI �1 qw �� '— (Address of Job) Signature f Owner ate e��a Print Name Q..FORMS,OWNERPERMISSION Assessors map and lot number ................... ................. 7 LOOA. ?�' Q�OFHEtO�y F 4i O Sewage Permit number .......��f,Qi1/1i.Lc....• .. . ..��� '�'' f�i0 LE, 41use number ....................:..................................................... \0 rs i' TOWN OF BARNS TAi co® :� 0 PCl?11t ,AIle- BUILDING "INSPECTOR APPLICATIONFOR PERMIT TO .....................................................::...................................................................... TYPEOF CONSTRUCTION ............................................:.............................................................................:........... ..11 19.22 TO THE INSPECTOR OF BUILDINGS: . ..� ..-{,. ... ... f ni,'.f•Y.sul'u"/...-rT):.'i' C.N, urJ i,. The undersigned hereby applies for a permit according to the following information: Location ........................../........... .... !e ..... .PN?..�iQVfL... ............................................................ y.. ProposedUse .... ..... 4r,.6. 1.: ..... L.i:........... .................................................................................... 9 Zoning District te'. .....Fire District ...&42 .. ............................... Name of Owner ?.....' .. 0. .�NC.� �OX £ ....Address < 4 Name of Builder . . . .................Address ?.Q7 e.p..751..�..�:�rrz,��� Name of Architect —1.4-42/.Y.►LC. .....................................Address . Number of Rooms .......................................! ........................Foundation .1. ....��f�,7`1.. ........................................... .. Exierior ............. ...Roofing --as. C... :uff sh ��QIS ....................................... Floors .2. .SZ. ..........................................................Interior . A.AI.II1('A1 ....%7jr �i F S.....4!.4 �...... HeatingA O.ASS.Q...............................................................Plumbing ............................................................... Fireplace o�V.d.AJ.e..................................................... ....Approximate Cost O a b 0 6 .........................'....�...... Definitive Plan Approved by Planning Board -------------------------------19--------. Area ........vl. k..... . .... ....... Diagram of Lot and Building with Dimensions Fee .... SUBJECT TO APPROVAL OF BOARD OF HEALTH kvq A 3 c�3 a� hn b a � rr , rl70pn'�1'�_.1 �rr7D Op oOV _ der(b.�'1 •� f�N�D!I S /v� \ l� I her agree rm to all the Rules and Regulations of the Town of.Barnstakle regarding the above so f c ructio Namedr ,G ..� �_:.... ............. I• K: Coye, Florence - A=190-16 ONo 2kS6.6 ...... Permit for ...... t ...........$inglP..Fami.l ..S�,trte I 1jXlg. ................. Location ..........23..T(=]:IaTA..AX....................... y, ....................... ente:u.Ul.e........ ................... Owner ..........FlAX:Qnce...CQy..e........................... Type cf Construction { • F ............................................................................... Plot .................... Lot ................................ ' 3 i Permit Granted ........................nne...12,..19 79 • y Date of Inspection ...... ............................19 DatelCompleted .')� f .................19 t r PERMIT REFUSED . ............... ....W. ............................... 19 .......... ... . ............................................ ........... �. .......................... ' ......... ......................................... .. ...................................... r t I A .............................. 19 �+ I Approve �_ • , . 7) f� Assessor's map and,-lot number.......I ......... ......... ram^ � / L LOQ�.� } �~ FTHE S�w.a a Permit number I Al ....i1 ... r ' Z BAHHSTADLE, i U louse number ........................................................................ 900 639 \0� c war a' TOWN OF BARNSTABLE BUILDING INSPECTOR . a APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ........................................................................................:............................................ rho :A......................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby�ap�,plies for a permit according;4o� the following information: t Location ...... ��.........'.` �'� ll r ........... "/1�T iC V/�.� ' ..................... .......... ............... Proposed Use ... ':c{z,n �? • :>..,...! t!..: t. .!... . .... .:.................................................................................................... . ... Zoning District ............P C...... r ........................... Fire District ... ............................... op Name of Owner ........ ..............................`::f...,.......:................Address ........................................................................,........:.. Name of Builder !Yli *. � !... ....:.,r:.:?- -.........Address :!..'.? Tr.c?�?... yli.... .: ! ilu ::".........:::.' s Name of Architect '� '^" ............Address �` '......................�.:..................... ::....:.................. Number of Rooms ........ ................................... ....................Foundation ........................................... IT ExteriorRoofing ........ ........,.,........................5....................................... Floors 7 /^ G' . �� n y�S .. r. ..m ��t Interior ..!C; r,��,�./i �ti ,./� �... S Heating c............ ....Plumbing;:.n.i.P. ..:.�'-............................ ................ Fireplace .............................. ..........................A.pp roximate Cost ..:a�;� �.d.a.'..u.�....................................... Definitive Plan Approved by Planning Board _______________________________19________. Area ...................`........... . ...... Diagram of Lot and Building with Dimensions Fee ~ SUBJECT TO APPROVAL OF BOARD OF HEALTH n o �r. Ito C� - ni' J I hereby agree ttd'conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. d� t Name Y��:%� -,r !, ; � Coye, Florence =190-16 No 2.1.366....... Permif` or ....Add._...to••por-ch.. jingleemi3y.. e�lit�g................::`... .. Location ....23• Tomftawk••Dry............. ........ .... ......Centervi.•13 e...................................... ... ..... Owner ....Florence..Cone................................. f` Type of Construction .... ... ................................ .. . ' Plot ............................ ot ................................ Permit Granted ................ ..Jut.......1219 79 Date of Inspection ....... ............................19 Date Completed ......................................19 PERMIT FUS ....... ... ... .... .. .......... . .. . .......................... .............................................. ............................ .... ................................. ..� .............................. ................................... .. ................................... Approved .............. ................ 19 = r ............................................................................... ; ..................... ............................................. ........ f i �' • Sh