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0047 LEWIS POND ROAD
f _ _- _ _ __ _ _ _ - - � Town of Barnstable gg Building ,- �`J.<,• nt,.. .., ` .;;;� ..fir, .s,-v,.� :a y .a« gx ..z�= +. ,',�...-- r". � sa; ` `- ,: -"X' ".;-tee:va'' 'S_r'j;»�r^,'s Permit ePost�This.Card'So That�t'as�V�sible`from:th'e Street" A ,"'.roved--�Plans;Mustbe=Retain.ed on.Job antlxh�s=Card;MwstLbe.Ke t �' Where a�Certificate:of Occu anc ,,s,Re uired,;suchB�ildm .sh'all Notbe�Occu ied until,a Final�anspect�on,has�been;made Permit NO. B-18-3109 Applicant.Name: Mike McMahon Approvals Date Issued: 09/20/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/20/2019 Foundation: Location: 47 LEWIS POND ROAD,COTUIT Map/Lot 020 021 Zoning District: RF Sheathing:. 71 Owner on Record: HARVEY,JANE M TR n� Contractor Name = .MICHAELT MCMAHON Framing: . 1 Address: 47 LEWIS POND ROAD. �'r Contractor license, CS 068111 2 COTUIT, MA 02635 � a� � EstPrfoject Cost: $4,700.00 Chimney`. Description: Weatherization,air sealing,weather strippingan&15516wn cellulose Permit Fee: $85.00 - Insulation: , Project Review Req: VALID CSL CONFIRMED THROUGH STATE Tee Paid- $85.00 Date 9/20/2018 Final: � . . - ,�, ;,Y dry Plumbing/Gas � � .. Rough Plumbing: �•al ; w r Z, �4 � ; Building Official.- �� . '.�., . .' Final Plumbing: X , This permit shall be deemed abandoned and invalid unless the work aiithonzed by this permit is commenced within sam'onths aft suance. Rough Gas: All work authorized by this permit shall conform to the approved appliitation and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structure&sna%pe in compliance with the local zornng by 71 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 forpubhc�nsT.pect�on for the entire duration of the work until the completion of the same. K x ril:lr Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildmgkand Fire ,khi f;Jals are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: a _x 1.Foundation or Footing Rough: 2.Sheathing Inspection ,�. . T, .. . M -. .,.,.. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Finaf 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:', 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set 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 pprLS.w�� Ew+,4se.. 3Ei�'T' Town of Barnstable Building )Post This.Card So That it s,Visible From the Street:Approved Plans Must"be Retained on Job and this Card Must be Kept '�" Posted Until Final Inspection Has Been Made g X . � y _ . , . Lr Permit Where;a Certificate of Occupancy is wired such�Building shall Not be Occupied untifa,Final Inspection had bey de "' Permit No. -B-16-2313 Applicant Name: HARVEY,JANE M TR Map/Lot: 020-021 Date Issued: -08/18/2016 Current Use: Zoning District: RF Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 02/18/2017 Contractor Name: Location: 47LEWIS POND ROAD,COTUIT Est Project Cost: $0.00 Contractor License: Owner on Record: HARVEY,JANE M TR =Permit`Fee: $35.00 Address: 47 LEWIS POND ROAD Fee Paid $35.00 2C0TU IT, MA 02635 s} - '" Date: 8/18/2016 Description: 10 x 14 shed ` /� - e'-� Its✓ �- Project Review Req : 10 x 14 shed iU Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit.is commenced within six:rnonths after issuance. All work authorized by this permit shall conform to the approved applicationand the=approved construction which this permit has been granted. All construction,alterations and changes of use of any building and str�uctures-shall be-in compliance with the local zoning by-la%A s and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open`for public inspection for the entire duration_of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work A 1.Foundation or Footing I Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is insta116d 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy - Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. . Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in'MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED.RECIPIENT EA Town of Barnstable . oFTME�a�, Regulatory Servicft/LD/ I� Richard V.Scali,Interim Director �G DFp r MAOt Building Division AUG ?0�6 6 39. Tom Perry,Building Comivsioner 200 Main Street, Hyannis,MA 9YQF gA www.town.barnstable.ma.us RNSTABL� Office: 508=862-4038 Fax: 508-790-6230 PERMIT# J 'c2,313 FEE: s 3.S , SHED REGISTRATION J RESIDENTIAL ONLY 200 square feet or less Location of shed(address) Village Property owner's name Telephone number A0 x /y o/tea i Size of Shed Map/Parc # ,4,e Z7/D-020/� zannis a Date Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,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 7 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 Q-forms-shedreg REV:110413 } GJ LEWIS POND ROAD EDGE OF PA���-- 42.42 .-- -i42.82 , 42.82 42.65 8 /' b� 6 U T 0.00' 43.48 SHELL PARKING I 14 SHELL DRIVEWAY J43 3 08 43.63 1 42.93 �3.13 9 SHELL PARKMGi�': £� -4.2 81 77 2 4.5 I x 42.32 15.1 � x 42.39 7 2.84 GAS METER PATIO EXISTING 3 BR DWELLING m " TOP FNDN. pD BH EL 43.1' F14.8 42.2 m ;v p D 411.7i ___., 30 1 O y v --- 1 l 0 co p 41.53 o I 41.12 SHED O O > 41.43 N PORCH O m x 4 41 v x 40.92 EXIST. 1000 GAL Z 14" TREE O ' (APPROX. LOCATIC rn 39 x 40.16 40 x 39.7 LP x 39.61 EXIST. LEACH PIT x 39.51 (APPROX. LOCATK N CARD UNCLEAR) —+ 0 D 39 m PARCEL 1 9 00 SF D - z (0.22 AC) i r� 80.00 38.02 �. 319 rig x--j-8-13--x--CHAIN LINK FENCE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel '�`(n Application �� ` Health Division Date Issued Conservation Division Application Fee Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �� �-2�.J 3 -J Q - Village (� Owner �.,�, � ('Jai Address V a I Telephone Permit Request �' C� lei 9n 'R P Jr,�ti � o,lx Square feet: 1 st floor: existing�(00 proposed _(Z 2nd floor: existing proposed D Total news O Zoning District Flood Plain Groundwater Overlay Project Valuation l Construction Type �? Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s .porting ddcum tatioh. Dwelling Type: Single Family Ll� Two Family ❑ Multi-Family (# units) --- Age of Existing Structure J-~"N Historic House: ❑Yes ❑ No On Old King's I Iighway:CJ Yes2❑ No w Basement Type: dFull R/Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) L9 Number of Baths: Full: existing 0 new Half: existing d new Number of Bedrooms: o� existing V-new Total Room Count (not including baths): existing �new 5� First Floor Room Count Heat Type and Fuel: 01"Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Lill/No Fireplaces: Existing k New Existing wood/coal stove: ❑Yes O No Detached gage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached gage: ❑ existing ❑ new size_Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes LYVo If yes, As_ite plan review # Current Use 51�S�t ►�5 tG�(��i Proposed Use 1;0^"t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Afkq '1 QsW.91VV5 mac" Telephone Number OVA �S0 ''aZ�� Address License # D S 3 5� omt r Home Improvement Contractor# S7 0- Email 'W e n2, .A �AC• Q Worker's Compensation # Aut- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAK N TO x SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS - _ VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION f � FIREPLACE f ` ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH w FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT AS PLAN NO. - The CanumompeaM ofMassachuyeas D4arhumt of laid uh idAcdde7z1s -- �• e of�nt�tigu�rrs �, 600 WashingtonStreet Bost==M4 t?2111 rttt�m�c�gr�e�/din - MFurkers' Compensation Iusewance davit$BmiMers/Conti a-cfmrslElectician&(pl tmb rs licant Information. CA Please Pit hl_Name�s,�P ���Fndieidoal7: P� '1U M M ✓t l_Q 15 Address: Lam r City/St,teJzip: A 9onhd tApg . 000 sae 9-- QK5� Act l Ar an employer?Check the a ropriate.ba 1 am a employer vJith ❑ Tye of px aject(required);: _ I a gearal contractor and I employees(full and/or part-time)-* have hired the subcontractors 6- ❑free camsamdiba 2.❑ I am a stile proprietor or partner- listed on.the attached sheet. 7: Remodeling and have no.employees These sub-contractors bane ' � �p y 8_ ❑I3enaolitirm WCA-ing for arse in any capacity- employees and.havre workers' [No n;orhU3,comp_insurance comp-�u�e X �- ❑Budding addition required] 5_ ❑ We are a corporation and its l4.0 Electrical repairs or additions officers have exercised their 3_❑ I and a homeowner doing all work I1_0 Plumbing repairs or additions Myself o wofke rs' ri-g t of exemption per MGL � - 12-0 Roof repairs. insurance required-]t c.1.52,§1(4),and we have no employees_[No workefs' 13-0 tither comp_insurance required_] - *,Aziy aopficm&that checks boa#1 umst also fill out the section below shosvitrg the workere«pe s stun poaT ing=uzH= T Snmeoctmem who submit this affldacrir mating tbey are doing a1I wak and then hire outside cmuRco3m mast submit a new 25dxeit indicating such Cantractrus thst check this box must attached:aQ additinual shut shoering the name of the sub-ccuuaem and state whether orvnt those euatizs hne eraplayees Ifthe sub-cz==,ars have emp.Ioyees,they must prn-ide ter svnrkess'camp.policy number_ I am an ettipIos'er thtd isproriding xvorkers'compensation inuirance for my emrpios-ees. Below is the poUcy and job site informatiom In-surance Company Nam: A M yyJ ,, Pd1icy:9 or Seff iris_Lic-;ff-:�fi ( ,^q W - W liW 0 1 - 20 0t4 Expiration Date: (0 l(�1& lob Site Address: K� `-�t/✓� n (� /`� eity/Statetzrp: A ttsch a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required-under Section 25Ai of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andfor one-year imprisonment as well as civil penalties in the form of a STOP W.ORK ORDER and a fine ofup to$250-00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Imestigati,ons.of the DIA for insurance coveiag5 verification I des hereby cerkfy uir a pains am&periaIties of p ijroy that the irtformafionpratzded above is truew and correct e: Date: J S Phone ik Official use artyy. Dv not write in finis area,to be canipleta by city or taws offl a£ City:or Town: PerMitUC.0 rse IssuingAazthority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk- 4:Electrical Inspector 5.Plumbmg Inspector 6,tither Contact Person: Phone 9-- BARNMBM 16.19. 1e� Town of Barnstable lEn,r,�►r• . Regulatory Services Richard Scall,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma,us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . I, C , as Owner of the subject property, hereby authorize r 1 D✓I to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) S a e of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the, reverse side. QAWPFMESIFORMSIbuilding permit formAsmokecarbondetectors.doc. Revised 050412 Town of Barnstable Regulatory Services pF� Richard V.Scali, Director Building Division `* a►xxsMr.E. t Tom Perry,Building Commissioner 163F9. $' 200 Main Street, Hyannis,MA 02601 iOrEc�'� www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) , 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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. Acc wp CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/13/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01627-001 CONTACT NAME: Fair&Yeager Insurance Agency Pv"c°."ry.EXt; (608)663-3131 AIc.No.: (608)661-0128 10 Main Street - EMAIL Natick,MA 01760.0165 ADDRESS: INSURERISI AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 26168 INSURED - INSURER B Soderholm Custom Builders Inc INSURER C 28 Leach Lane Natick,MA 01760 INSURER D: INSURERE: - 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 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. ILTR TYPE OF INSURANCE ANSR S, VD POLICY NUMBER POLICY MM/DD/YYXYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - - DAMAGE TO RENTED $ - PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY ECOT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO r BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OVVNED PROPERTY DAMAGE $ AUTOS v - Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE. $ TH- VypI DEERDgCpM ERNETpENNTIIONN $ $ AND EMPLOYERS'LIABILRY X OC STATUS ER TORY LIMITS ER o Icy A�Z��� ECUTIVE YIN E.LEACH ACCIDENT $ 500,000.00A � N/A AWC400-7020004-2013A 10/18/2013 10/18/2014 — (Mandatory In NH) E.L.,DISEASE-EA EMPLOYEE $ 500,000.00 DESCRIPTION OF OPERATIONS below - • - E.L.DISEASE-POLICY LIMIT $ - 600,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Jane Harvey 47 Lewis Pond Road' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cotuit,MA 02636 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD -------� -- ---- ----- pp Massachusetts - Department of Public Safety Of6ce �od�Rf1'� ge¢ � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction Super�isor s" c Registration 172570 Type: License: CS-058535 f:. Expiration 6/226/2014 Private Corpotatio';, ��` , , ` KENNETH R SODMRHO ' HOLM CUSTOM BUILDERS„INC. 28 LEACH LN ,F,_ r � NATICK MA 011i60 1 KENNETH SOLDE HOLM 28 LEACH LANE NATICK, MA 01760 - � � j+ J,,�,,, tJ Expiration Undersecretary Commissioner 11/29/2015 i' J: License.or registration valid for individul use only before-the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. 10 Park Plaza,Suite 5.170 Boston,MA 02116 3 3� Not valid without signature TOWN Of cc Y7 , ca �►� ��- �tNCY . Z�`6 �`li�;�►.Sb ,..�� R \`t �� �i�orS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C e 0 Parcel' 0- I .'Application # ;1 -7`� , Health Division Date Issued J A ( 1 Conservation Division `` Application Fee Planning Dept. Permit Feed• d: Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Le&ws Village (6 Aa 1-4- Owner Scoff J_,iNc dsisve Address y Lewis Po vk 2oacA Telephone Permit Request Re"Sc Ciefinc !h &Vr5A,001 , k t rA(ic i� C� c,4a Ci.F.,I Square feet: 1 st floor: existing proposed 2nd floor:'existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $,G60 Construction Type Pe,o 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: A Full Crawl ❑Walkout ❑ Other l Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ' < Number of Baths: Full: existing 2 new Half: existing new Number of Bedrooms: 3 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 L-No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Oho ijj Detached garage: ❑ existing LJ 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 LA No If yes, site plan review# Current Use BPS �r^��� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name PZsL r� ® elephone Number Address /-9ci��TS� License# "Z, mae&& d"p.S�;c Home Improvement Contractor# AD 7 3 0 Worker's Compensation # !F1/6 9/N 6 27-fO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO za, SIGNATU DATE %� ,C FOR OFFICIAL USE ONLY t • APPLICATION# DATE ISSUED 3 MAP./PARCEL NO. ADDRESS VILLAGE - OWNER j DATE OF INSPECTION: J ?; FOUNDATION � s t FRAME d ere* oT a /sre('' INSULATION ' 7 FIREPLACE ELECTRICAL: ROUGH FINAL :F PLUMBING: ROUGH FINAL tp GAS 47>> *S :ROUGH :` FINAL � "IF NAL,BU:ILDfNG Fl.11j o .-,2 '7 l! OUT DATE CLOSED F ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department oflndustrialAccidents I Y•� 1~ r Office of Investigations Sri i 600 Washington Street Boston, MA 02111 z-Y www.mass.g ov/dia Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers Atplicant Information Please Print LeLyibly Kane (Business/Organization/Individual): -Fic1110 vi 1411S Address: Z8aArtll �'D ��cc C i tl/State/Zip: (,/l kar�Et n , fI a eg},ri Phone #: ,go;- 7q7- 1�7 z 0 Are Iou an employer?Check the appropriate box: Type of project(required): L PA I am a employer with Z 4.. ❑..I am a general contractor and I 6. El New construction I mployees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• EA Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity, workers'comp. insurance. 9, Building addition [No workers' comp. insurance 5. '❑ We are a corporation and its P nquired.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ Iam a homeowner doing all work right of exemption per MGL- 11.0 Plumbing repairs or additions myself [No workers' comp. c. 152, §](4), and we have no 12,0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp:insurance required.] *Any appliant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractor that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -1fa✓e/`/-5 Policy #or Self-ins. Lic.#:__11=V 8 S 61 VIA g 210- Expiration Date: /�,Cl/ t Job Site Address: Y7 Levo 5 Po ap. City/State/Zip; 60 All r 9A 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 finder thepains andpenalties of perjuiy that the information provided above is true and correct. Sikhature: _' � �t�� Date:' I t M//6 Phone#: rf01" 7y7"5?w J 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. PlumbEInspect]or 1[6. Other Contact Pierson: Phone#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. tursuant 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 bF the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the nceiver 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 of 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-contractors)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 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 regarding the law 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 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. 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 like 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 ext 406 or 1-877-MASSAFE Fax # 617-.727-7749 Revised 5-26-05 www.mass.gov/dia y°FTHE r� Town of Barnstable Regulatory Services anarrsTasLE, y Wins. Thomas F.Geiler,Director Eo;w. & Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must - Complete and Sign This Section If Using A Builder I, Y o t P6Az '. , as Owner of the subject property hereby authorize to act om my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) l6 1 Signature of Owner _ w Da e Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. t , z .d QTORMS:OWNERPERMISSION �,%` Town of Barnstable �OFSHE Tp�� Regulatory Services BARNSTABt.E, _ Thomas F.Geiler, Director 9 MASS. g 1639. p,0 Building Division ,Foy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 _____ _ HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip.code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or idetached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 supenisor(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:forTnT s:horreexempt ado%e Cie ss � Ali awf opne f f ! f R rr f i I •j� 1 t i t i 1t` I OP ID: LB ACORO' DATE(MMIDDIYYW) CERTIFICATE OF LIABILITY INSURANCE 11/17/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s CONTACT PRODUCER 401-782-1800 - NAME Babcock and HelliWell,Inc.(A PHONE FAX 138 Main Street EMCI,E AIC Nor: Wakefield,RI 02879 ADDRESS: P ODUCER FREIBU1 Babcock&HelliWell,Inc. cusToM t INSURER(S)AFFORDING COVERAGE NAIC i INSURED Freitas Building Co Inc INSURER A:Travelers 10647 28Blanchard Place INSURERB: Wakefield,R102879 INSURER C INSURER D: - 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 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. 1 SR ADDL TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY M EFF MII CY EXP LTR D DIIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED - COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence $ CLAIMS MADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV tN URY $ - GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMWOP AGG $ POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY IN AIRY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTO S (Peraocident). $ NON-OWNED AUTOS $ $ UMBRELLA LIAB R OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE - - $ RETENTION $ $ WORKERS COMPENSATION OC STATU- OTH- AND EMPLOYERS'LIABILITY TRY LIMITS ER A ANY PROPRIETORIPARTNERIE)ECUTIVE Y I❑N N/A -IFUB8691 NS8710 08(08H0 08/06111 E.L.EACH ACCIDENT - $ 100,000 OFFICERIMEMBER EXCLUDED?. (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VENCLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Confirmation of coverage. CERTIFICATE HOLDER CANCELLATION TOWNBA3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable - ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE e 01998-2009 ACORD CORPORATION. All rights reserved. ACORD 25(20091109) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and 2USiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration T Registration: 107388 Type: DBA Expiration: 7/31/2012 Tr# 202844 MASS BAY CONSTRUCTION Margaret Freitas _.-----_��--�-- 1 LOCUST ST FALMOUTH, MA 02540 `a Update Address and return card.Mark reason-for change. Address n Renewal Ej Employment r Lost Card BPS-CAI t9 SOM-04104-GIO1216 Office v&ofumer"Xiratrs' �'Bie(i es�.0"on License or registration valid for individul use only — HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: .107388 Type: Office of Consumer Affairs and Business Regulation Expiration: .7/31L2012 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 BAY CONSTRUC-TION_:. ,,;; -- - t ? Margaret Freitas 1 Locust Sty, ' /f Falmouth;MA 02540 = Undersecretary f Not valid wit out signature f j, r - *- Massachusetts- Department of Public Safety Bom-d of Building-Red-ulations and Swndai-ds Construction Supervisor License License: CS 54103 Restricted..to;. 1 G. ... MARGARET A FREITAS T ~ 1 LOCUST,ST FALMOUTH MA 02540 Expiration: 10/3/2011 �'UR1111iSSi11nC3' Tr--: 22635 - SdQ/Ao0-sseyg-AVAM :01 Ja;ag asaaog slya;o aouwoeai io;asnea s► apoj au!pling a;iqS snasng3essl8W aq;;o aoUtpa;aazana B ssassod oa alnlls3 samola Sumea Z i-9T PaPuasatan -00 J t :ol PaPUPOt! Cotuit Fire Department ®T U, - .i Fire, Rescue & Emergency Services c°m'r Floe aisrnic-r 64 HIGH STREET— P.O. Box 1632 , 1926 COTUIT, MA 02635 RV CAPTAIN DAVID A. PIERCE PHONE 508-428-2210 FIRE PREVENTION FAX 508-428-0202 Ms. Livia Freitas 1 Locust Street O Falmouth, MA 02540 Dear Ms. Livia Freitas: On Thursday May 10, 2007 this department along with personnel from the building department and Zoning department conducted an inspection of your property located at 47 Lewis-P--ond Road-in:-Cotuit-3 There were a few items that will need to be corrected which are listed below. (1) There needs to be a hard wired smoke detector installed in the basement portion of the home interconnected to the first floor units. The backup batteries in all of the first floor smoke detectors need replacing per(Chapter 148 of the Massachusetts General Laws section 26E). (2) There needs to be Carbon Monoxide Detectors installed within(10)ten feet of all bedroom doors per(Board of Fire Prevention Regulation, section 527 CMR 31). Once the above mentioned items are completed, please contact this office so we can re-inspect your home. Sin rely, David A. Pierce Captain Fire Inspector MA!" y Y _. .,.11,�y•:.st i`�.;`.!_ ��s. 1.. ` ..,r ^.C.r '.A 5 w.3 •'�F ` ''�'.aY� '"' `w.. E "� �A°:ki".. 3. ll... L ,r�.J,.`f .e'` s S'. ! �.t t a "�� .,` .7� ,t� ..Ci��' ,r�v 4, pt,,j ' • 6�K 120E>t] PG293 12207 02-- 12-- 1999 e 01 200 I, ROBERT V. SULLIVAN, of 47 Lewis Pond Road, Barnstable (Cotuit), Barnstable County, Massachusetts 02635 in consideration. of One Hundred Twenty Thousand and 00/100 (SI20,000.00) Dollars paid grant to LIMA A.FREITAS, of 163 Remsen Street, Apt. 32, Brooklyn, Kings County, New York 11201, with QUITCLAIM COVENANTS that certain parcel of land,together with the buildings thereon, situated in that part of the Town and County of Barnstable known as Cotuit, and located on the Northerly side and off from Lake Stred, Cotuit, Massachusetts, and comprising the Northerly half of Lot 164 as shown and delineated on a plan entitled"Plan of Houselots,Cotuit,Offered for We by Charles L. Gifford,May, 1903", which said plan is duly filed in the Registry of Deeds for Barnstable County in Plan Book 26, Page 71, and said lot or parcel is more particularly bounded and described as follows: Beginning at the Northwesterly corner of the premises of the lot to be conveyed, y adjoining the Nothwasterly comer of Lot 167, as shown on said plan, on the Southerly side of Lewis Pond Road, so-called; thence running Easterly by Lewis Pond Road, so-called; eighty (80) feet to Lot Q163, as shown on said plan; thence Southerly by the Westerly boundary line of Lot 163 for a distance of one hundred twenty(120)feet to a point at the corner; thence turning and running Westerly by the remaining portion of Lot 164 eighty (80)feet to the Easterly boundary of Lot 166, all as shown on said plan; thence turning and running in a Northerly direction by Lot 166 thirty-four (34) feet and by Lot 167 for a distance of eighty-six (86) feet to the first mentioned ' bound and the point of beginning. For Grantor's title, see deed recorded at said Registry in Book 10912,Page 320. Executed as a sealed instrument this 1Z day of February, 1999. rt V. ullivan I BEC 120G0 P028 4 12207 COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. February /Z, 1999 Then personally appeared the above named Robert V. Sullivan and acknowledged the foregoing instrument to be his free act and deed,before me hart nahue, tart' blic My commission expires: 3/30/2001 BARNSTABLE C fNTY kEGISTkY OF DEEDS BARNSTABLE kEG 41 BARNSTA$LE COUNTY EXCISE TAX 02/12/99 ..X 92WELED TOTAL M•60 TAX 410.40 CHECK 273.63 CHCK 410.40 0056 840SA00o 13100 o0i aiiii 12:57 EXCISE TAX COUNTY EXCISE TAX BARNSTABLE REGISTRY OF DEEDS '�Zf03� Town of Barnstable *Permit# 733�3 Expires 6 months fsone issue date ,,,lWI X : Regulatory Services Fee `�Z s 0-0 v� MAN. ��� Thomas F.Geiler,Director ►��& Building Division Tom Perry, Building Commissioner X-PRESS PER-6' 7 200 Main Street, Hyannis,MA 02601 NOV- '? 6 2003 Office: 508-862-4038 Fax: 508 790-6230EXPRESS PERAUT APPLICATION - RESIDENTIAUMVF BARNSTABL hh Not Valid without Red%Press Imprint Map/parcel Number Property Address AL]Residential Value of Work Owner's Name&Address Contractor's Name ,-/ Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) - [�Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name workman's Comp.Policy# Permit Request(check box) ] Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side !�❑` Replacement Windows. U-Value (maximum.44) *where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prop e Owner must sign Property Owner Letter of Permission. 1 Improvement Contractors License is required. Signature Q:Forms:expmtrg —ReviseO53003 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Map Parcel Permit# '733 1y Health Division 31 2 //►►( 03 S Cvswtef"-e �oner� Date Issued ��2J03 Conservation Division ,� �j6/ 0 Application Fee Tax Collector Permit Fee 02) b C Treasurer Planning Dept. SEPTIC SYSTEM I,'UST C. INSTALLED IN COLIPLt:�,�CE Date Definitive Plan Approved by Planning Board VYITFs TITLE 5 DMIRONMENTAL CO_- Historic-OKH Preservation/Hyannis TOWNRECU `TIu Project Street Address Poid eW. Village �0� Owner Address w�S Telephone Permit Request �Si�'lliC—�dVl'l.(1dsgg C Square feet: 1 st floor: existing UU-� proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 60 fD Construction Type Fx I L irjor Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family tP Two Family ❑ Multi-Family(#units) Az Age of Existing Structure lq Historic House: ❑Yes .4 No On Old King's Highway: ❑Yes No Basement Type: ❑Full ❑Crawl ❑Walkout kOther 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 (d new First Floor Room Count Heat Type and Fuel: ❑Gas k Oil ❑Electric ❑Other . P- o Az Central Air: ❑Yes. Py No Fireplaces: Existing , New Existing wood/coal stove: ❑Yes X No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: / w fy� 7 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial- ❑Yes x No--1f yes, site-plan-review# _. _`> _ _� —- _- __-- _, "z `� Current Use Proposed Use tlo rr. // BUILDER INFORMATION y�a.frci7�S� Name Telephone Number � y Address GGU%S- fp )CY. License# r l 019-05!�- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO k1aA dl"�U SIGNATURE Z DATE l s FOR OFFICIAL USE ONLY . t . 4 PERMIT.NO. - ' DANE ISSUED � r , MAP[PARCEL NO. " y • - ADDRESS VILLAGE ` i OWNER ., DATE OF INSPECTION: FOUNDATION FRAME _ INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts Department of Industrial Accidents Office offayesiigatioos _ 600 Washington Street Boston,Mass.. 02111 Workers' Com ensation Insurance Affidavit /w/w/w/m/m/1, VIM MOM name: l I QL I,/ 70;d Adion: �"�- (fUl S • I am a homeowner performing all work myself. I am a sole etor and have no one working in a7 ca achy �n'din workers' compensation for mp em�la�ees working on this job. .•r +4,,, Y ,., th:•: 1 ram t1 h;..}l R'.';•,yM.,r tir,{:IX kT:{Yf,.t;h:;';:t:Ok,}:,vt•v\k?:;}F:ii~Y::?'r,';.i,} .. 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Faitu'e to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine np to S1,500.00 andlor one yes,imprisonment as wen a3 civil penalties in the form of a STOP WORK ORDER and a Sae of$100.00 a day against me: I understand that a copy of this statement may be formwaal to the Office of Investigations of the DIA for coverage verification. 1 do hereby c the pans and penalties of pedury that the information provided above is Si t cud rutted Date �� �jjli93 gna / Print name I);�'a 'U Phone# 5�� • L- zolallil ofncfal use only do not write in this area to be completed by city or town official permit/license#, []Building Department city or town: ❑Licensing Board once is required ❑Selectmen's Office ❑ mt checkifinediaferesp q. C]HealthDepartrnent contactperson: phone#; Other^ - • I Town of Barnstable FZME T� Regulatory Services • seaivsrnere. Thomas F.Geiler,Director 1639, Building Division 9 ,��' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ice: 508-8624038 Fax: 508-790-6230 HONOWNER LICENSE EXEMPTION Please Print DATE: l V 0-5 JOB LOCATION: 7 _ �e, 1S cyid f2d, ' tt I number street village 911ioIvMwNER^ Liyla �. e� S 5ai •.��8' l�Da S7>e 95 S�/DD name home phone# work phone# CURRENT MAILING ADDRESS: city/town state -zip code The current exemption for"homeowners"was extended to include owner-occiiDied 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 suvervisor. DEFINITION OF HOMEOWNER Person(s)who owns aparcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm.structures: A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under'the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules-and regulations_ The undersigned"homeowner"certifies that he/she understands.the Town.of Barnstable Building Department... inspectio procedures and requirements and that he/she will comply with said procedures and e ts. . Si of Isom er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Cod&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,maaycommunities require,as part of the pemsit application, that the homeowner certify that helshe 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 formlec tification for use in your community. Town of Barnstable ��°•� Regulatory Services vB i.E.$ Thomas F. Geller,Director 039. �,+ Building Division rfD MP't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 ' Fax: 508-790-6230 permit no. • Date /� �3 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 owAer-occupied building containing at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Y/YG( `S Estimated CostPOO& Type of Work- Address of Work: Owner's Name• / >7�S Date of Application: . -N/ 03 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law lob Under$1,000 Building 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 Ey2ROVEMENT WORK DO NOT HAVE ACCESS TO TEE 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: Date Contractor Name Registration No. OR I l a?r 03 D e 0 er's Nam : r i : . I i I r V e �oa� i , 1 � I / I i i t _.. ,n IV{��j//� 1 V Y /C ! /III t i 1 ..(. 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