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HomeMy WebLinkAbout0250 LITTLE RIVER ROAD c,2 e .3 6 3 `1 IKE Town of Barnstable *Permit# Expires 6 months rom issue date �+ Regulatory Services Fee _57j�f`) BnarrsrnBi E i "3y. A,�' Thomas F.Geiler,Director. X-PRESS PERMIT. fD Mpl Building Division Tom Perry,CBO, Building Commissioner MAY 2 9 2013 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 -Q EXPRESS PERMIT APPLICATION - RESIDES � 01�TLY � N t Valid without Red X-Press Imprint Map/parcel Number 01' jj�� Property AddressAkyu- V 1 V��� ✓'e, Residential Value of Work 4S7410 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address '616 �(, 1 (45 tin _ ZO L4-tom- Rl � 1 %i e0m,+ n4A Contractor's Name C�j �/,�'/,� CY{t�.yV Telephone Number Home Improvement Contractor License#(if applicable) / 0 3&S�- Construction Supervisor's License#(if applicable) `��= ❑Workman's Compensation Insurance Vk one: am a sole proprietor ❑ I am the Homeowner K3'I have Worker's Compensation Insurance Insurance Company Name r/�G!l /940L Workman's Comp.Policy# IyO a !38'R1<4-" ,0.2Q 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 pio S 4e—isa4 f ^ � /❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. . ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: I C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 r 114E T * * BARNSrABLS. Town of Barnstable RFD MA'S A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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, x�sea (1 GSM 1'n 1� ,as Owner of the subject property hereby authorize ;�(��� IAA to act on my behalf, in all matters relative to work authorized by this building permit application for: U 1r i (Address of Job) O . L-t-/ Signature f Owner Date �i ? Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Office of Consumer Affairs&Business Regulatioe 7 #OME IMPROVEMENT CONTRACTOR � e istration: l'•_ _ 9 170365 TYPE a, expiration: 10/13/2013 LLC CHASE COMPANY CONTRACTORS, LLC EDWARD CHASE 188 WHITTING ST g HINGHAM,MA 02043 Undersecretary 9 ma Sac 7u a Cnnstructiom Sup0r1 kor I .\ ' Fartril� c2nse: CSFA-100984 EDWARD E CHASE 16 HILL ST Cohasset MA-02025 ,. 1 110 5/2 0 1 3 P. bp ` � }fir a� wyirr 4 lz Sri£� " a*,... ��✓�,� sr<°r >� v,eA4 c,� ., `id \3 � '„.�„ 0,?/9 rr, � o d $ ryr � ru���� � �� �5 �„ ` r v � ssr�r,3�✓/N, h,�l�/yi/vG �%i� .:. ', y - 209wwww ra/fin ,w Tlae Cornmornrr�ealtla of Massadiusetts Depaphnent ofln&strial Accidents Office of Invesligations 600 Waskington Street Boston,MA02111 fvrvn.rrat gov,1dia Workers' Compensation Insurance Affidavit: Builders/' ntractors/Et tricians/Plumbers Appl Information Please Print •b Name(BusinessKhgau zationtlndividual)_ a 0 t Address: / City/State/Zip- IM A.L Phone#: q! 0 C1 I Are you an employer?Check he appropriate box: TIype of project.(required): 1 I am a employer with L_1 4. ❑ I am a general contractor and I employees(full and/or part-time. : have hired the sub-contractors 6- ❑New construction listed on:the attached sheet. 2. ❑Remodeling 2.El I am a sole proprietor or partner- i ship and have no employees These sub-contractors have g- ❑Demolition. working ffiY c for me.in employees and have workers' t23`'- Y 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 afficers have exercised their 11_❑Plumbing,repairs or additions myself[No workers'comp. right of exemption per MGL 12. of repairs insurance required-]B c.152, +§1(4),and sT have no employs.[No workers' 13-❑Other comp.insurance required-]', "Any applicant that checks box#1 must also fill ant the section below showing their wmkers'compensatio-n policy infnamateaiL Eloaaeoa mers who submit this affidavit indicating they axe doing all waA and dun hire outside contractors mwst submit a nen*affidavit indicating such. ZContracmrs that check this.#war must artached an addidonat sheet showing the nsme of the nib-contmcto-rs and state whether or mot those enti[ies have employees. If the sub-contractors have employees,they must provide.their workers'comp.policy number- 1 am an oinployer tleatis proWding sirorkeps'congmivadon irrsurauce for rrty enrplo},ees. Below is the policy and job site information. Insurance Company blame_ �+ 'j q Policy 'or Self-ins-Lic.#: (�Z ..J 5- p N _v Expiration Date: W 0 —v— Job Site Address: CitylStateMp�cbw,-V MIS Q 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 S 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 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. Ida hereby carttfy under tlt pains atedpenrrlties of petjaery that the irtfarvrantiote ptsavrdeclrtboine is trite and correct gna / C Date: 5_1 20�� Phone ik I 6 () OU V O,f Ceial use only. Do not write in this area,to be completed by city or town afficial City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.C t}frown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I .WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE �,ibert POLICY Mutual. AR INFORMATION PAGE Liberty Mutual Group 175 Berkeley Street Boston,MA 02117 Issued by LIBERTY MUTUAL FIRE INSURANCE 16586 Policy Number WC2-31S-388144-022 Issuing Office 181 NEW BUSINESS NEW Issue Date 12-12-12 Account Number 1-3 8 814 4 Sub Account 0000 FEIN 273378293 1. Insured and Mailing Address THE CHASE COMPANY CONTRACTORS LLC RISK ID 426465 188 WHITING ST HINGHAM,MA 02043 Status 46 LIMITED LIABILITY CO Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE 2. Policy Period:The policy period is from 12-17-2 012 to 12-17-2 013 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0, 0 0 0 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 10 0, 0 0 0 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE. 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual . Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ 500 Premium will be billed ANNUAL Producer 0004-020960 JOHN J FLYNN INSURANCE AGENCY INC 818 CENTRAL AVE DOVER NH 03820 Sales Representative 3000 Sales Office Name WESTON ©1987 National Council on Compensation Insurance,lnc. WC 00 00 01 A All Rights Reserved Ed. 07/01/2011 Insured Copy Town of-Bainstable *Permit# 0 I — qq Expires 6 the from issue date Regulatory Services Fee i639• �� Thomas F.Geiler,Director 2 Building Division Tom Perr y,CBO, Building Commissioner QV 200 Main Street,Hyannis,MA 02601 AL T OF PA www.town.barnstable.ma.us Office: 508-8 --40 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f Not Valid without Red X-Press Imwrint Map/parcel Number Property yAddress V�51 S c (lee C G,4* W/y NW • . YResidentiial Value of Work .51 j O' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �!�C /�• 9G f �yr G/,¢ �f�/�E/'SPY Contractor's Name ivy �U�/�9 ✓L Telephone Number ��� �l Sze G / 00 7Y Home Improvement Contractor License#(if applicable) / Construction Supervisor's License#(if applicable) C 5 ❑JdVorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [Vr I have Worker's Compensation Insurance , Insurance Company Name Workman's Comp.Policy# V V C C rd/0 � 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors r/IEN�ta �✓D! j [Replacement Windows/doors/sliders:U-Value (maximum.35)#of windows '9 p 0 1/ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 equi SIGNATURE: C:\Users\decolU ta\I al crosoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Client#:47298 CAPIHOM ' '�. DATE(NBA DDffYYY)) ACORD. CERTIFICATE OF LIABILITY INSURANCE � € 12 W(112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATt LHOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,E)CTENT)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(les)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 CONTACT PRODUCER Walther Rogers&Gray Ins.-So.Dennis PHONE Ert: wo.877-816-2156 434 Route 134 EdANL D ESS South Dennis,MA 02660-1601 INSURE )AFFORDINGCOVERAGE NAIC9 508 398-7980 INSURER A:Main Street America Assurance C INSURED INSURER B:Associated Employers Insurance - Capizzi Home Improvement,Inc. INSURER C Caplzd Enterprises,Inc. INSURER D•1645 Newtown Road - INSURER E. . Cotait,MA 0205 • INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 04SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR 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. L RR TYPE OF INSURANCE OL POLICY NUMBER POLICY EFF POLICY EXP LIAM A GENERALUAeIIITY MPB1075H 6/08/2012 0610812013 EppAAemoEECTcumuiNcE $1,000000 X COMMERCIAL GENERAL LIABILITY PREMISES° am�� $500,000 CLA3MSAIIADE Fx]OCCUR MEO EXP are ) $1 O 000 PERSONAL a ADV NXRY 31,000,000 GENERAL AGGREGATE 8 000,000 G8?L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-compi7PAGG $2,000,000 , POLICY1:1 PRO-JECT LOC $ - A AUTOMOBILE LIABILITY MIM28044' 6/08/2012 06/08/201 cMotJnI L51NGLEtJMIr $500,000 ANY AUTO BMQIN.Y m Qwpw") $ ALL OWNED X SCHEDULED BODILY INJURY(Per S AUTOS AUTOS ; X HIR[�A IT OS X AUDAMAGE TN° W ED - _ PROPERTY $ X rive Oth Car $ A X UDMBREU A LIAR OCCUR CUB1076H Draf08=12 06108M3 EAcHoccuRREmcE s5,000.000 EXCESS LJAB HCLAIMS-MADE _ AGGREGATE $5 000 000 DED X RETENROH$10000 $ . B WORKERS COMPENSAWN WCC5010547012012 12125120121212MO1 X IrWart> I IER AND EMPLOYERS L IABR1TY ANY PROPRfEfOR/PARTNER7 YEN ELE'ACHA�DENT $1 000,000 OFFICER/MEMBEREXCLUDED? 11l NIA (MandWAry in NH) E.L.DaEASE-EAEMPLOYEE$1 000,000 ° d under OF OPERan�cewa L.EDMEASE-POUCYLMrT 31,000,000 oEscR�iloN . DESCRIPnON OF OPBtAT INNS I U=TMSI VEMCLES tAtfmb ACORD 781,AddOorM Remarks Sdu dula.N more sPaee Is repaired) . **Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER• CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WRL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601. AUTLIORRED REPRESENTATME ®198 -2010 ACORD CORPORATION.Ali rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S91859/M91856 TI-H , i use group which of an � Y _Buildings Unrestricted contain less than 35,000 cubic feet(991M )of enclosed space. Massachusetts -Department of Public SafetY Board of Building Regulations and Standards Construction Supervisor License: CS-074640 Failure to possess a current edition of the Massachusetts _ 11 ", . 8 State Building Code is cause for revocation of this license. GARY GUSTAFSO For DPS Licensing information visit: www.Mass.Gov/DPS 8 SHORT WAY ~_ SANDWICH MA70256�3 1,sV Expiration Commissioner 11/29/2014 ominzaru� Office of Consumer Affairs&B sinesy s�ula Regulation� � ���� � a�o��d for� ��� �� � Kara the dale. If found ret eta: OME IMPROVEMENT CONTRACTOR Mace ofC•iutsaxfterAffairS and Rwkw�pla iatfon. 3 Registration -f00740 Type; 110 a Ex iratioit P B723/2014_ Supplement( , CAPIZZI HOME1MPl3OVEMENTr'NC. GARY GUSTAFSON:._.r= 1645 Newton Rd :.otuit,MA 02635 Undersecretary Department oflndustrialAecidents Office of Investigations I Congress Street,.Suite 100 ; Boston,lflA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/organization/Individual):Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA-02648 Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1'.❑✓ I am a employer with 40+ 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 shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' ' No workers' comp.insurance comp.insurance.t 9. ❑Building.addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.[] I am a homeowner doingall work officers have exercised their 11.0 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' 13Other fir _ comp.insurance required.] *Any applicant that che4dl box#1 must also fill out the section below shov4ng their workers' ompensation policy information.' '* fill omeownets who submit this affidavit indicating they are doing all work.aW then hire outside contractors*nt�t submit anew affidavit indicating such. 1C.ontialn That check this box must'attached an additio aal sheet showin�t�e name of the suh-contractors and state whether or not those entities have employees. If the sub-eontractors have employees,they must provide their workers'comp,policy number. I:aiii an employer that is providing workers compensation insurance foi my employees, Below is the policy and job site . anformahom Tusurance Company Name:Associated Employers Insurance Company Policy#or.Self-ins.Lic.#:WCC5010 547012011. 12/2512012 /� C� r Expiration.Date: Job Site Address: / / City/State/Zip: &ro t Attach a copy of the workers' compensation policy declaration page(shoving 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 thepakis and penalties,of perjury that the information provided above is true and correct' .Si ature: �Date�.- Phone#:508-428-9518 Official use only. Do not write in this area,to be completed by city or towE:- : City or Town: Permit/LicensIssuing Authority(circle one): I:Board,of Health 2.Building Department 3..City/Town Clerk -4.Ele5.Plumbing Inspector 6.Other Contact Person: Phon Page 7 of 7 Capizzi Home Improvement Inc. ,,. i, Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE, ERIC &PATRICIA SCHAEFER, OWN THE PROPERTY LOCATED AT 44 SCREECHAM WAY IN COTUIT, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. ' SIGNATURE OF OWNER: �.` C OWNER'S ADDRESS: 44 SCREECHAM WAY,.COTUIT, MA 02635 OWNER'S TELEPHONE: 508-428-0956 - LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: a APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635. APPLICANT'S TELEPHONE: , 508-428-9518- RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: 4 RESPONSIBLE OFFICER TELEPHONE: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-05HParcel w A pp lica ion # I Health Division Date Issued 3d Conservation Division Application Fee Planning Dept. y Permit Fee Q Date Definitive Plan Approved by Planning Board I� Historic - OKH _ Preservation / Hyannis Project Street Address Z-90 L-A W2 1 2k��� !!�. Village L Ownerj� G�, �� �� /�t�Z� Address f Telephone F2i 21GH <' 05 0,0w4► ozos— Permit Request � f1 e/ �. in �` ✓� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 7� Flood Plain Groundwater Overlay Project ValuatiJ Construction Type Lot SizeT� / _ 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: ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) _ Basement Unfinished Area(sq.ft) � Number of Baths: Full: existing 21 new _41— Half: existing Z new Number of Bedrooms: existing 0new Total Room Count (not including baths): existing (l new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garag existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn*xisting ❑ new size_ Attached garageXexisting ❑ new size _Sh xisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # _ T Current-Use_ r � - _ - _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name LTelephone Number Address � ,� l License# C�J Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r` `'�SIGNATURE DATE I I *: FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS j VILLAGE OWNER` 4 DATE OF INSPECTION: FOUNDATION i FRAME INSULATION FIREPLACE P 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 of fnvestigatioirs -600 Washington Street' _ Boston,MA 02111 .Uv www.mass gov/dia ' Workers' Compensation Insurance Affidavit Sunders/Contractors/Illectricians/Plurnbers Applicant Information Please Print Le�bl� Name(Bhsiness/org ntztiion/jndivich4: .%a . - 'C(A&N ' ' Address: Gl Vt4C �\ City/State/Zip: Phone.# Are you an employer? Check the appropriate bow Type of project(required):: 1.❑ I an a employer with .4. ❑ I am a general contractor and I . employees(full and/or past time). „ have hired the sub-contractors 6 ❑New construction • 2.❑ I am a'sole proprietor or partner- listed an the-attached sheet 7. emodeTing ship and have no employees These sub-contractors have S: ❑Demolition working for me in:any capacity. employees.and have workers' [No workers' comp.insurance comp.?msmance.$' 9. []Bmldmg addition required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.Nq am a homeowner doing all-work • officers have exercised they 11.0 Plumbing repairs o' additions ' myself: [No workers' canes. right 6f exemption per MGL inanr-an e required.]t c.152, §1(4),and we have no 12.0 Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.] ' *Any applicant that cheeks box#1 must also fill oat the section below showing thew workers'compensation policy mfmmation. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors fhat check this box mast attached as additional sheet showing the name of the sub-contcactnis and statn:whotb=ornot those entities have employees. If the sub-confraotars have employees,$rey umstprovid'e their worlm a!comp.policynumber. , lam an employer that is providing workers'-compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: . Policy#or Self-ins.Lic.# Expiration Date: - Job Site Address: Gay/State/Zip: . Atfarh a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure• me to.sec coverage as rega red under Sectiion25A ofMGL c. 152 can lead to the imposition of armmmalpenalties of'a fine tip to$1,500.00 and/or one-year imprisonment, as weIl 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 Ida her ce under the pains and penalties of perjury that the information praUided ab �is true a d correct Si DatE: Phone# Official use only. Do not write in this area, tb be completed by city or town afficiaL7n City or Town:. PermitUcense# -Issuing Authority(circle one):. 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: -' Phone#: k tNME 1• Town of Barnstable Regulatory.Services ' BABNSTABLE, ' Thomas F.Geiler,Director 9 MASS. 1ezg & Building Division`` Eo l,�,or , Tom Perry,Building Commissioner r 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION it+,q�r7 Please Print , DATE: �U (�V1 1,(�1�C� �Q JOB LOCATION: number street � village "HOMEOW ]NER": V /e' 44/�(,{L'D_ name home phone# �- work phone# CURRENT MAILING ADDRESS:_�Y MIX =IC2426 cilyTtown 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) 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 pr cedure requirements and that he/she will comply with said procedures and requirements. S a meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State BuildingCode' 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:IWPFILESCFORMS\building permit forms\EXPRESS.doc Revised 051811 . ,. * snaxsTesr.E. • .039 Town of Barnstable i639 `fir A Regulatory Services Thomas F.Geiler,Director Building:Division Thomas Perry,CBO 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 as.Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doC Revised 051811 TOWN OF BARNSTABLE i r I,p y DIMS f, rl i lei r J Z 4 OF BARIMISTABLE Ay V� C--) QIVISTI . 1 :CJ 1 L�✓` f�1`� Mckechnie, Robert From: Peter Pattinson [ppattinson@tenebraellc.com] Sent: Friday, June 10, 2011 2:18 PM To: Mckechnie, Robert Subject: Re: 250 Little River Road Permits Hi Robert: Sorry to catch you so late in this process: We have gone ahead and got 'all' the electrics done to restore the house (Permiited under Tim Willman) and that has just been inspected and is all fine. We were going to go ahead and put up the board but 'have just '=discovered we need to get a different permit for that. . .. , It's my .ignorance that'.s limiting-me here, I guess. Is there a way we can get a permit (either on-line or through you) to do this quickly as we'd like to get the house up and running.again,, thanks, . P.eter , On Apr'11, 2011, at 5:35 AM, Mckechnie, Robert wrote > Good Morning Peter, y > > Thank you for responding to the card left in your door. The' > Massachusetts Building Code requires that- a: building permit be > obtained for any removal of sheetrock, insulation and related work. as:' > a result of water damage. In addition, .the .state may require a > notification if there is an explosionP of a boiler, expansion tank or > related failure. The restoration company should have obtained a permit. > around the time of the start of the work. I will contact them about > this issue also. li > Feel free to contact me at this office with any questions you might > have. > Robert McKechnie , > Local Inspector > 508-862-4033 > -----Original Message From: Peter Pattinson [mailto:ppattinson@tenebraellc:com] > Sent: Sunday, April 10, 2011 6:52 PM > To: Mckechnie, Robert > Subject: 250 Little River Road - Permits t > Hi Robert: . > I found your note in my back door today' - dated 4 .5.11 with`., it.s strict > injunction to call. within .24 hours. Sorry for the delay - I do not > use that door as my downstairs office is sealed off off for the duration. > > I am not exactly sure what I need a permit for, beyond having the- > dubious distinction of ':having dumpster ;parked.-in my driveway. There > is no construction going on what, you see in the dumpster is the > gutted' detritus of my basement which was ,destroyed in. a :boiler > blow-out approximately a month ago. > The insurance company brought in a firm called Disaster Specialists to > get the steam/water-logged materials out of there before the mildew > became too much of a problem. I will copy/forward them so that they > can contact you directly to get the appropriate permits and approvals: > Going forward they plan to do mildew remediation and then reconstruct > the basement exactly as it was before the blow-out. I imagine that we > will need to get a bunch of permits together for this project . > (electricians; plumbing; . etc. ) so please let me know what your needs > are so that I can be ahead of the curve. f > Please advise me directly if there are any other'permitting-issues > that surface - e-mail:ppattinson@tenebraellc.com „- I am local but. > travel in CA for extended periods. > Sincerely, > Peter > > Peter M. Pattinson > 781-934-6242 - Office > 617-417-6350 - Mobile > www.tenebraellc.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �Q �� Application 30 Health Division Date Issued b Conservation Division Application Fee Planning Dept. Permit Fee C Date Definitive Plan Approved by Planning Boardrip✓ - Historic - OKH _ Preservation / Hyannis ` - QA Project Streef�Address 2 � Owne`r_ �:-` f Address Tphones y ele Permit Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation--YO _ _.O Construction Type ram,, .4,a­, � ,a k..:::.� ,_,Ia Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) i 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) w c7 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/mal stove-_ ❑1 ❑ 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 O1i_H09EOWNER)1%_ .� �U ( � L' �" ie � sl1� /1 Telephone Number ress Q_t License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIG'NAT,URE ^, -f'v '` " DATE � - FOR OFFICIAL USE ONLY APPLICATION# A ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 7 DATE OF INSPECTION: FOUNDATION L FRAME f INSULATION !t)S dGJ (�� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL _ FINAL BUILDING DATE CLOSED OUT f ' ASSOCIATION PLAN NO. t i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 e=` www.mass gov/dia Y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/organizationdndividual): i � asiW1 Address:��///��� � .I�Jfll�l. �2j'l� • 'tVi/ /q�� Phone.#: z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t -7• ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. g. Building addition [No workers' comp. insurance 5. ElWe are a corporation and its - quired.] officers have exercised their. 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work *right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp.. c. 152, §1(4),`and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' comp. insurance required.] 13.❑ Other *Arty 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Dater Job Site Address: City/State/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$1,500.00 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 u de pains and penalties of perjury that the information provided above is true and correct ' Si "afore"--a. � Official use only. Do not write in this area,to be compleied by city or town official City or Town: Per-mit/License# Issuing Authority(circle one): 1. Board of Health 2, Building Department 3.City/Town CIerk 4. Electrical Inspector 5.PlumbinjInspector 6, Other Contact Person: Phone#: 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." c 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 =a 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'eompensation 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 e that-th affidavit is complete and printed legibly. The Department has provided a space ce 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 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 bum 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, '4, The Commonwealth of Massachusetts Department of Industrial Accidents G-Mce of Investigations 600 Washington Street Boston,MA 0211.1 Tel. # 617-727--4900 ext 406 or 1-$77-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.m,asa.gov/dia Town of BarnstaWeI Regulatory Services % ' Thomas F. Geiler, Director EI xtas-r Est t; Ojp- Building Division � Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.t6wn.barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print r—DATE..-�I: I2_6 t rJ06-IACATIO_N_t g— i ` a(1� �� �— numer street ^ village "HOMEOWNER": hoy, name,. home pho'ne�# work phone# CURRENT MAILING ADDRESS: �� n[y/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. DEFINITTON 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.detachad 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 lie 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 i ection procedures and requirements and that he/she will comply withrsaid procedures and require en . �Si a _:o _ omeowncr 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 EXEMPTTON The Code stairs that "Any hbrneowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.3.1-Liocnsing•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 czemption-am unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack ofawarcness often results in serious_problaru,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 hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may cart t amend and adopt such a for ✓ecrtifieation for use in your community. Q:fortns:homcczcmpt Of O < i LIBNSLI Ric Town of Barnstable Y PrED��� • Regulatory Serdces Thomas P. Geiler,Director Building Division Thomas Perry, CRO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arns to ble.m a.us Office: 508-862-403 8 Fax: 508-790-6230. Property Qwner Must Complete and Sign This Section If Using A Builder as Owner,Df the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property owner is applyingfor permit,please complete the Homeowners License Exemption Form on the reverse side. C;\Users\dccollik\AppData\Locai\Microsoft\Windows\Tcmporary fntcmet Filcs\Content.outlook\DDY87Ap,Z\EXPRESS.doc Revised 072110 Assessors offioe (1st floor): _�m �� EP L�D� y?NE Assessor's map and lot number 1 � �''q Board of Health (3rd floor): Q r.�� �� !I � Sewage Permit. number ../.... �................... ......... y �C .. y� 11�0� ITff T19TGDLE, a[ Engineering Department (3rd floor): Yo�V N7'A a House number ....................... APPLICATIONS PROCESSED 8:30-9:30. A.M. and 1:00.2:00 P.M. only, 8arnsrab,e PP A . . may ROVED TOWN OF - BA-RN _ �au°" � BUILDINGANSIPECTO = � APPLICATION FOR PERMIT TO ..... TYPE OF CONSTRUCTION .....:.. .W..0Qfi!.... �1- /`j. ......:........................................................................... } .....a..A./te........................19.q.1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Q..T.... /.Q....., I.7-7-z-�../PI.XFk...�J-..... C6.7e.,,1 7.....:.................................... Location nn J.... ,,,,,,,,,,,,,,,,,, Proposed Use .... ..........k M.f—.N.cz........ Zoning District ..1�� .............Fire District �oU. - 'Name of Owner .As.!..., AA W-4,+...W00h 4 CJ��......Address ... ��,///���,-L��J..M/Q'.�............................ j� Name of Builder ..: .�i�(�' .. /�. �..1/VCi......Address ......1�./97IDG!/l�/J?�J.. J .�............... . ....... Nameof Architect ................... <V. .........................:.........Address ................................................................................ r, Qom ^ Number of Rooms .....................6.......................:.................Foundation ....P0.0./ .... (�.c......................:..... n n Exterior ........... 6-L-t..........................Roofing ....... ....... Floors ........ -'..............:.......:...........Interior .......... /....W1.1Z..4:,........................................... Heating ..... .......... PlumbingS(/ Fireplace .....R`0.0h......,5-7-0..f............ ....................Approximate Cost ........�.�D. 7.9.......... ..� .,........ � Definitive Plan Approved by Planning Board ____ __ _,c✓___.. ___19___ a Area ..�� ............... .......... N o � rya. mod ple5 ) sse / Diagram of Lot and Building with Dimensions Fee ,�1�,. � SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License ......4�.Q. 1/ .. WOODLOCK., BRENDA ';No 3566.3.. Permit for ...1. ...StorY............. Single..Family..DWelling.......... Lot 10 250 Little River. Road r Location ................ ....... ....................................... Cotuit Owner ......Brenda Woodlock Type o.f Construction .F.... ` . ... ........................................................................ r Plot ............................ 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C_ C f to } ':. Y..'•... .,#�:L ....W. .- •..�.-...... h...�... ..y..ci...,...,<._....._Iw,y .{�.,...,,.....-;.yr..,=- k..yw: »� i 1 QU.2E/1'1Eit/TS Ord T.�/�', 7`oN/"Ve C C,4 7',EI> f�//Ty/�.✓4 T� � Gt�,oL,¢% 1 } �T p Z� � .1,J � 't_� � r,.I + , , h i • �LNRV ! _ �'-S/�9��� 3 t /.T��..� � - y 14 T - - r•'t BA,SE"O div.4it/ �2EG/STE.2EO ..CA.�� /NST SU.eY � �� OET�.�•/1I//�E .L�GT�.%t/�S� - .4r�ic'�./C�{/V/ /7" � e , DEPARTMENT OF PUBUC SAFETY _- COMMONWEALTH 1010 COMMONWEALTH AVE. OF BOSTON,MASS.02215 ENCLOSE CHECK OR MONEY ORDER MASSACHUSETTS L I C E N S E FOR REQUIRED FEE, CONSTR. SUPERVISOR EXPIRATION DATE P� MADE PAYABLE TO " 06/3D/1993 ` EFFECTIVE DATE LIC NO. "COMMISSIONER OF PUBLIC SAFETY" RESTRICTIONS o C t/3 0/1 1 0 C 55 C 2 NINE (DO NOT SEND CASH). mJOSEPH C POLCARO 417 TURTLE PACK RD ILLS MA 02E48 PLEASE NOTE FEE. INCREASE PHOTO(BLASTING ORR ONLY) FEE: E I-F E C T I V E F E 0. � / 1989 1oa.co HEIGHT. I N STAMPED UNTILOT VALID OR S SIGNATURE IGNED BY `IOF THE COMMISSIONER OFFICIALLY AND THIS DOCUMENT MUST BE SIGNATURE OF LICENSEE SIGN NAME IN FULL-ABOVE SIGNATURE LINE CARRIED ONMI". THE PERSON OF THE HOLDER WHEN ENGAG- k. COMMISSIONER OTHERS RIGHT TI-:VMB PRINT ED IN THIS OCCUP ATIOF E 20OM-2-87.81429 i } }st-I I �-.�_� :J•_1 ^r t� , .I. I'y :..,I I t - - -j,r.,._I _ IIr�,( .- .3.�C-.I.lb-r �. j. •..: E 4-}- ._� -, I .0 I.1 F�.r i T, � I .. r ,•: �_ ..t ....--, .t.._,...:. _ ..,......._. . i. D ! �Pfl-C ._Ta � � .�,3-f-E-xl a7i I / _}~ J 1 �dpp o(J I I r ' �I IT ,Sip} I ;-�I -j 6ii1 : I I I _ � { I {—, 1 I �i I I I ' I i ( I �_, , i�—r-1-i , LI6N , �✓' I i ` , ., , r, I. �--I=- � r � 1 i..I. +A'�j i T f t } ; L ( I � I-i_1 I �.�. i •Y1 '� •1 .fl �� tr , �i. ; I Ell } I + ++ 1 t j .-I I I , z i —1 (--� -}- 1 -� ��-�-{ � ,.-I �-�i_I_'„1 .• _E �'�'l_-- H _ �J r _ i L.,; �_ �I ! I I I 1 1 i - .t_ � •!_ !_I IGN I�rh (,I _ I I i �, j I� - I. I j � � I-`t t I '_ � - � t � -!- � I � I ( I ,_ g��'t?�A I�'�"'( - • Tz t- ,� 1it Ir _.- ,. ,. ��-�.�. z ,_, ,�=1fl� ,L� � ter. �•t-� �-� , 1 �--� �-+F T r ._: �I TI I ; r , i I.at _ , r J • l It r' , t i 1 LoA VI;° I ( '-'! _T I �'' y i 1 ( T� j I I 1 I� ( r I ry✓I 2� I ' t" + Ix 77 I i t I I r• , i ��t ��1 r � �s, j �`r [ I: I I I� � �� I I r }-, —t: I i '— k 1 — ��n ! - �'-•ylr: � �I { � _ � EL'�� I # ' I� { °..�� t ) f I I r i I j - ! 1 I I .. - (, t I �'_ '- :.. �( !.��v If'. I � .. r.I , i , I1 T„- II i -I I -C--•_��I 1'� i 1�; r Y ,. r1 Cc_ `_ �J F�?t1- it -{ (--�-�' ' f 1 PI:.AN, aleE�, -I t e •:�� _a �aL�.. `_' t � 'I I � �1 I� i I -rt -- -1- i --(- � i ' '��+'-z I t ,I_� I I 1 �_ ;. ��` tv IJ�j�l� hl_.f.4GJ/N��..'�7� •.1� - GI r- I r Y 1-�1 �---I ' t'1-_.I .� ' 1, 1!'Q i:l'�( i i I i �'{-� � �r ��- .3�. L i;, , : I• I F:'� `n? f�-I � � r L'I � .�_ '� ._ (�_� bN prat 1 dart ;G �_ �Pa�t�L � ', , i I _ LIM, 11'. let r w I ' , f F�4►J IS NP1" t�J 'iTzAME�'t' r i I x r � r --_ u�cc�44 -�-ro I ;TQ'r�is(_��. I ,•-1°� L�.� ;�T� (- , ; I I r � I_I ;._E._�� ' -I - -r , d -' ;._.}N, A/fit �� �,_.' c A r r i 7 1 r w I I 1 ;-LL �j} 42 I14 4 f , IZ7 I , 1 � t 31 t } �( Z T , 3,Z-O,1 a r Al i � rt -Y (�V::t .y , }.. �•1• r � t .( , _ 1 2p 4 t _f �I e I r k - -- -_ wa OF 1 , iSUWVAR 72* 16 r i ! q ' t k P� 4tXP U J oA, s i a I ix 1 Ni MXTER w r f r V I � 1q +9 t of ��'.s !' �N� �' `� STAB r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^�c� C DATA -1���\ LI Vr�_..a.'1-�Y.•�. •�IMJYr.�. 1 .... i •� PE , FI x;i _ DATE ty(^ r iX.:; '�Csf�aV� .�' _ - _ -`19 3 PERMIT NO. APPLICANT - = =t 't ADDRESS Ll� %'MG'' - (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO - :� (< •,•:,- .,..+.:.-� F�1 STORY '" _,.s.t:1.1•.: _L�:.i1.';' L1'vJC:..il .a:c.I DWELLING UNITS(TYPE OF IMPROVEMENT) NO. j(PROPOSED USEI 3: 71 AT (LOCATION) .t:), ._.iU t'.Ii L'.- .£� i?I�,i c� _ _.,_i,;,a, L:��.i,Z_ ZONING (NO.) DISTRICT (STREET) BETWEEN AND (CROSS STREET) . (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR I• •� VOLUME -'. `s -a ESTIMATED COST $ PER FEE ...�.., ._ .. (CUBIC/SQUARE FEET) OWNER -� BUILDING DEPT. ADDRESS BY /- ✓ � (�%b,, f THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDSVISION RESTRICTIONS. - MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WERE APPL INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PEHRMITS AREICABLE SEPARATE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANI CAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS /y_z W9 or 3 — E ING)SPEI04,11PPROVAV., ENGI ERING P TMENT • B��ALTH r OTHER SITE PLAN REVIEW APPROVAL— WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. tMf TOWN OF BARNSTABLE 4 . 3 Permit No. .. ...5§.......... BUILDING DEPARTMENT I ""'� I TOWN OFFICE BUILDING Cash .... .Yl ,619 9'�reowl' HYANNIS,MASS.02601 Bond .....X......... CERTIFICATE OF USE AND OCCUPANCY Issued to Brenda Woodlock Address Lot #10, 250 Little River Road Cotuit, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON 'SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. August 12, 93 .... ...... 19................. ..................... Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING raa HYANNIS, MASS. 02601 �o rnr►' MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #........._ _ �lO-?» .»................._...........................................................................».......»......»»....... . .....»»»» issuedto ...... /1p t G1.../U ,Ar ...................................._..............................................»....».....................».. Please release the performance bond. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6s 4 Parcel 006—00 (n T 0 W N ,_ <<A aS 3 L E Permit# Health Division �� `,��� �t' Date Issued O 2 2002 J : Conservation Division , 2- QW -- Fee 2s-, 0 Tax Collector mi 0 f X� ���,��,,�1P MUST BE Treasurer ��?:�� /2/e,�� I�{:a:ED IN COMPLIANCE Planning Dept. R TITLE$ ONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Z SO k-,4�e Village Owner I J€ 4, Wooc" o c Address ZSo 8���(e ��e K ��,COAL Q111� Telephone (� Permit Request II., G 2A�� N . Square feet: 1st floor: existing proposed M_ 2nd floor: existing proposed Total new Nc(?- Valuation S.boo Zoning District Flood Plain DJ o Groundwater Overlay a N' Construction Type Lot Size C Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1A, Two Family ❑ Multi-Family(#units) Age of Existing Structure S 1 Z Historic House: ❑Yes Flo On Old King's Highway: ❑Yes �L& Basement Type: tFull ❑Crawl ❑Walkout ID Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing `Z new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: Cl 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 BUILDER INFORMATION Name P7 e- /"R- Telephone Number Address License# ` Home Improvement Contractor# Worker's Compensation# n ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN SIGNATURE � _�.Qc, -� �� L�c,d. DATE i - 23-tb2-. FOR OFFICIAL USE ONLY PERMIT NO. ri DATE ISSUED r MAP/PARCEL NO.. ADDRESS VILLAGE OWNER;• i DATE OF INSPECTION: j FOUNDATION ��1 a �'.._.� � � FRAME I I ,1► ��� I U y �� �� INSULATION FIREPLACE ELECTRICAL: ROU FINAL PLUMBING: ROU FINAL } FINAL GAS: ROUGI-��» �.� �-?s �': p FINAL BUILDING OW in r DATE CLOSED OUT _ r"• ASSOCIATION PLAN NO. a� _ I c. I~ RESIDENTIAL: SHEDS - POOLS -DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ >750 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ . i ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) mom PERMIT FEE $ �� r, Q:forms:dkcost eff:082301 off 1 ,� 11 11 11 LI •' 1 a 1.1• 1 11 1 1 /. 11 ' ■ /1 1 1 11 • � 1 1 1 1 1 1 1 1� ' 1 •,� 1 1 1 ✓.11. . 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I11 .all .1 off elllll /.•/ I-a / • ' OW�%///// 1 1 1 1 • U /1 •1 I•ay it • ' 1 �'•IIIU ..1 •11 1 • Illl�e ..•1 I 1 / •V. •11 ..al 1 / • e.I • •' •1 11 a • 1 •I11 • ♦ " tt • - 1 •1 • • %0 • 11 11 /1 .+al /1 � •• Y • 1 ' .� • 'I:la •11 / la v•IIIY. « ' • 1 ..•Y• •111 • 11 - r • •'%all 1 11 /• 0 11 11 •.I•tlll Vwa Ilalll 1 .• ° 1 1 I a �a .11.l .+1 111111 •.. 1 - t1 • la- 11 • •IIII -• / 1 • Iel.+11 / • 11 •i 111 • 11 ./' a .II • ..11..alA 1 •�.'1 11✓. a 1 1 tt • I 7 • •Y•la •1a '• ills bl. • 11 .11 • 11 I ' .11 Y • • 1 I.•• •.l ./• •II / I 1 • • • 1 •11 • / w • • •• 1 • I:�Y I Y.1 • •J to ✓• 1 - 1 - • rll till • r M • 1 •11 .1/ / Y•. 11 lel •.1 1 ttl 1 1 1 1 t 1 1 I I I 11111 a 1 � ♦ 1 1 1 / r 1 1 I 1 • 1 °F Inc rpm °� The Town of Barnstable 9 +sr��.g Regulatory Services Fo';- Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 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: 4 2.� �►�i�^� •a a Estimated cost 2 p! a Address of Work: Z S 0 t,A g- A AXN Owner's Nam A 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 Owner pulling own permit Notice is hereby given that: D. OWNERS PULLING THEIR OWN PERT OR DEALING WITH UNREGISTEREPERMIT CONTRACTOR OR APPLICABLE HOME ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGWORK DO NOT L c.142A. ACCESS TO SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. Date Owner's Name q:forms:Affidav:rev-070601 OF THE v The Town of Barnstable nstable 9 MASS. Regulatory Services COA i639• ♦0 rfp .�A Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 . ,ffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 2—so fl -�- number street village HOMEOWNER" ;Ze.+ IL0 0)47�—S� name ` home phone# work phone# CURRENT MAILING ADDRESS: ZG0 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) 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. Q:FORMS:EXEMPTN I ' f 1 { I } I1 r ' ' r 150•7I 1 J. I i • � �-7 p a { ► i.l i 36 I - Room , 24"S G , 7-,'/,477 TA�� .' ,CovN6A rioV 4C.4T/OIL/ Sh�O!-twit//7'E,2EOrC/CO%<'Iid.G YS Gt�/��/ CA/-G I� I � � 7`.v�S�/O.E�///� .gic/G��5'ETB.,4 C� ' •. . . '��QU/.E'EjLlE.t/T,S' O CA TE.G� Ty/� T �LG)4Z ,C:4 // y PA*rat, -Deg, (g., .fgQf SA XT.E+C s NY 7itlC. o,c,45'E?-.s'syc�.�.c%Y S.�vG.L� No• ';'' , l/.SE"1� 74 UE"T�,�iLl/�!/� .L•UT!��I ;. �PP',�../C,�/7' p �i �„o>G.oealo.,k rl g �Go►.iC.'L.c'�e I f X1o"o � C®Nc.va.e.$8 2XIO,11 , 6.0 ZX L SA ��A•1 Sa.otias c �q.�l Aµ�. \ Q Dt10W �eC�CJIG �, Yz d w i � E S ca FF- 6 X Z-- ,_ �oocJ� -� looms !b` 10 'k \2 SO-A�100,�. Z , Brenda Woodlock 250 Little River Road Cotuit, MA 02635 (508) 420-5774 January 2002 SPECIFICATIONS FOR ONE STALL HORSE BARN Size: 16 feet deep by 12 feet wide Foundation: 8" diameter concrete piers, min. 4'0" below grade. Anchor bolts V2"diameter X 10" on concrete piers. Conventional Framing: Sill 4 x 6 continuous. Walls 2 X 6 studs, 16" o.c. with 2 X 4 horizontal nailers for siding. Shed roof: Front to back slope of 12 feet to 7 feet. 2 x 10 rafters, 16 " o.c. Architectural asphalt shingles. Flooring: Stall area --Dirt floor. Hay storage area—wooden floor over 2 x 6", 12" o.c. floor joists Exterior: 1" X 8" Shiplap Pine with matching trim Door at southwest corner: 48"--split or "Dutch" door .x" Door at northwest side: 3 X 7 Windows east and west sides: 32" X 30" —six light sash. Hinged to lift like old fashioned storm windows and removable with screen replacements Interior stall area: 2X6" T&G Southern Yellow Pine horizontal planking to 7 feet oF��.kF,;P"tiN"",..i9� {rt �' 'M� r��':�� dr y{...r 4E"r yam.,. •i '. - I! t .yi�i � �� t' ` _ tS L�.��.F �T„k24..:kY}T..•�. y . � r,,1.[ j � i z V V k ^ k i, a� C'... k..'S,*,,x7 .�v.'^a x,,! ,.:.. .,., -•..-. �. ,� M � _ ..._. f--"'•---"-� � - _ .. ., ate. �, � • u y _ a. LLLL1111 ,r � I I Nad R FI czE. IZ& r- -r p !�r�(►' I - i u I i aq k --------— P 1 f- : I 3 I. V 1 - ._._II- •Co f o _ I r � II 1 W J I ♦ 1 i I . 0 " 11 j TANM( I . ..01.1. GE1L1 1 LS o r G U-�( z —-- -- oG J { i n I t W J i J� G R3 y 11