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Home My WebLink About0038 MAIN STREET (COTUIT) �� rm cu CSC . i'� r _ oEs , Town of Barnstable *Permit# ?60 1033 Q� Expires 6 months from issue date Regulatory Services Fee r anatasrnBi.e. Thomas F.Geiler,Director ` Fokw RESS PER I-Puilding Division Y, Tom Perry,CBO, Building Commissioner r� AUG -- g 2008 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8TP-WN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �```J�//ll Not Valid without Red X-Press Imprint, Map/parcel Number o2� Property Address IF) L� Residential Value of Work oS�(1., Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name JOR A.) �/ �' 21C' Telephone Number'72 Y--Z3�s"o�s�y Home Improvement Contractor License#(if applicable) �;r_workman's Compensation Insurance . Chec e: I am a sole proprietor ❑ I a the Homeowner have Worker's Compensation Insurance Insurance Company Name �/ H/l /} i r� nf�'�14 1`P1 Workman's Comp.Policy# �+-3 Copy of Insurance Compliance Certificate must be on file. (copy A#nel #�/) Permit Request(check box) Re-roof(stripping old shingles) All construction debris will betaken to / !+✓ / � ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note; Property Owner.must sign Property Owner Letter of Permission. A cop .of the Home Improvemen Contractors License is required. SIGNATURE: G t Q:Eotras:build ingperm its/express Revised 1231G7.. . . : Town of Barnstable BAMSTABI& MASS � Regulatory Services Mfd p 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 W� IAZif,C�l to act on my behalf, in all matters relative to work authorized by this building permit application for: 0,1,k) Co' -ry I T— (Address of Job Signature of Owner ate Print Name Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations. ' d 600 Washington Street �< Boston,MA 02111 wWv.mass.gov/dia ' Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information rr ii Please Print Le ibl Name (Business/Organization/Individual): . ;�M j o Address: City/State/Zip: Phone.#: 77 / 93 0 / Are you an employer? Check the appropriate box: .Type of project(required):. lam a employer with '� 4. [� I am a general contractor and I 6. []New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers' comp,insurance comp. insurance. 5 [] We are a corporation and its 10:❑Blectrical repairs or additions . required.] ' 3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers' comp right of exemption per MGL 12 0o repairs insurance.required.]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Tam an employer that is providing workers'compensation insurance for my employees.. Below is.the policy and job site information. Insurance Company Name; {� t U► Policy#or Self-ins,Lic.it: 7001 w ?J Expiration Date: ; Job Site Address: City/State/Zip: �O TGt/7 D'? 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 maybe forwarded to the Office of Investi ations of the DIA for insurance coverage verification, I�do hereby ce der t s•a d enalges of perjury that the information provided above is true and correct. Si ature: Date: Phone#: 71ssuing only. Do not write in this area, to be completed by,city or town official wn: Permit/License# thority(circle one): .1.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6..Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an.employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced;acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL ehapter_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 evident&ofcomplianee with:flie 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-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers',compensation insurance. If an LLC or LLP does have, employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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 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 tc give us a call. The Department's address,telephone-and fax number;. The,,Cenunonweedth ofMmsa.chusetts , Department of Industrial A.ccidmts . Office of Ingest gat ons 604 Washington Street Boston,.MA 02111 TeL#617-727 4500 ext 40,6 or 1-877-M.ASSAFE #617-727-7749 Revised 11-22-06 � Fax w.mass.gov/dia �,� ,�a,,,;n,00zulea/� a�✓�a4d"�uCd r ►straflon valid for individul"use only Board of Building Regulations and Standards License or xp IMPROVEMENT CONTRACTOR before the expiration date. If found return to: HOME IM..#, Board of Building Regulations and Standards Registrat n 157407 One Ashburton Place Rm 1301 Expiration t0/1/2009 Trl� 259757 Boston,Ma.0210 t lug a , Type D8A? / r J.P.CUSTOM BUILDING - JOHN DALTERIO�JR,�- ; 112 CAPTAIN SAMADRUS RD of valid without si nature Adnunistrator COTUIT,MA 02635 _ AUG-05-2008 12:39 From:MARK SYLUI4 IhL 6084209227 To:588 429 6928 P.1/1 I ' •', � ;. VERTIFIC-ATE OF LIABILITY INSURA : � I - I Say'lal1 10255Q TyIS CERTIFICATE 13 ISSUED AS A MA-,TER0 INFORMATION IVIAI314 Yl vIA INS!!!?ANG�E.P.G�Eid6Y ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 771 MAIM STREET ALTER THE COVERAGE AFFOR ED BY THE POLICIES BELOW. •I �gTIw I{/Ii.L.E.MA 02666 I I AEI.':a0 ,ate-0440 FAX, oioa�za.s2 !N$UR€RS AFFORDING COlVEPAGE NAIC4 I R{I uRQo . ...... INSURER FARM FAMILY CASLIAI..TY INSURANCE CO i JOhIN DA�LTERIQ INSURER O: i 112 CAPTAIN'S$AMADRAS ROAD INIAiRP•R C. i GOT r,MA 02836 INAuRf'R D: tNSURUR E: 00VERAOES. ........ ...'7He POLICIES OF•INSURANCE LISTED FLOW HAW 91EMN ISSUED TO THE INSURIED NAMwO ABOVE MA THE POLICY PERK INDI!"AT6D.NOTWITHSTANDINGi ANY RIaQUTA0M6PI',PERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE MSUED OR I MAY PERTAIN,THE MURANCE AFFORWO BY THI+POLICES DESCRISeD HeREIN IS SUBJECT TO AL6 THE TERMS, EX(n USIONO AND CONDITIONS OF SUCH t P01LICiES,AGM 190ATG I.IRfd'i`S GHOWfq MAY HAVE BEEN REDtjC.ED OY PAID CLAIMS. I ... T.VFC 6P INSURANCE POur7Y NUMBER .... CONCRAL LIABILITY' CACH 0MURAMCE Is 9 p00 GGG 61 :k COMGif3PPAI,Oet.MRALLlAs,.rrY 2001X0587 09t1Sr20Q7 08/1®12008 � . CaAIMS M11fa �•.�,Cv'CUR MI;D'EXP A C00 onn nntan i PCRBONAL&ADV INJURY S. OFNP.RAL ACIMFOATP S. 2,000 CDC 1.QEN'6 A44Rl=2AT5 UMrr APPLIM Pam. PRODUS -CWPl0P AI$d I B 2 000000 . t'OI.IC1` LOC . UTOM00.90 VA01UTY COM91NG0 1IINGLE UMfr LK. ANY AUTO ALL OVJNCD AUTOS Cll9PILY INJURY 8CHH6ULED AI.Rg6 4P4r Pam?) I g MIRK AUFO6 90PILY INJURY NON 4WNf?0 AUTO9 flaw mmiAgnu P OPKR'l gAMAOI? I g 0' RA�k 6UABILITY` AUTO ONLY-IAA ACr%D4?Pff. S' ANY AUTO OTHER THAN rp ACC ffi AUT-GONLY A6co S OEt 1ur!10R 61�uA816i i Y PA04 OWURRPWCE 5 bCCVF.. CLA1MSMADZI AGGRP-aATR Iffi PlaDLICTPU.: $ .".'. RE�T6INTIONI 3 g ::: `WDFtK61111CO(APBNSATIONAN) 2001we3es 09/17f2t)07 09M7f2008 K R L'd4Pf: ,gR8'-41AOILITY EL• GFI ACeIG 100,000 ANY pl2oPRlbfi0}ARTN IPJtf:CUTIVE o�ICliRnaQm9Cr�Excui R4dt s c2a!fir,-CA AMPLOYFU' 100 OOL� Ityyed dascriba undm :. tiFCaIAL PROVISION6 eelew "++iJivG,PO OY LI'uIT S 590 000 paP.RPimoN qP ADDED BY E1490ROW111MMMIA4 PROVIBIO A CARENTRY i cbHN DALTERIQ IS NOT COVIrRED ON 1 HIS WORKERS COMPENSATION POLICY CERTIFICATE H 0ER CANCELLATION WOULD ANY OF THU A110VE OUGAIMID PUUO ZS RC CANGRI-4f.0 QE.aOfke tealT.D. RATiDN TOWN Q�I3ARNa�"r1 LE DATE THEREOF,TMU It4UN0 tNSURilR WILL ENDEAVOR TO MAII,,.�,.�DAYSL":RMI ON BUILDING CbEPT NOTICE TO THE.CERZIAIOATF.HCLWA NAMED TO THIi[.0 i3L i gAIWRE To DO 50 SMALL 200 MAIN STREET BMIPOSC NO OIAIGATION OR LIA1501Y OP ANY WND UPON THIE imsURGR:ITS AWNTM OR Fkn 6LWATIVES HYANNIS, AAA 02901 AUTHORt$Q REPR CNTATP/5 FAiX;IiNSURF.0, 50"28.028 DEBS `. 'ACORO 2d(200110% 0 ACO 4:0170R 10N 1589 Assessor's. map and, lot number ... ..� � . .:... P��F ropy a - Ks SEPTIC E o THE f Sewage Permit number ....� ............ C SYSTEM MUST B c� INSTALLED IN COMPLIANCE i BJS33T11DLE. : 4 House number .... .�........::. WITH'A?TICLE II 'STATE 'oo�b 9 � .... TE SANITARY CODE AND TOWN 3 �0 p YpY 0r• v :{ ;TOWN OF BAR �TAsLE I-;- In u f� BUILDING INSPECTOR APPLICATION FOR} PERMIT TO .................... 1 ..ram TYPE OF CONSTRUCTION .................. ........�, ....19...7P TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin o the following information: he Location .... ...... dt� ��"' ...................... ................................................................................................................... � ,Q Proposed Use ! 7i� lG 'k o ! .................................................................................. ZoningDistrict .....11.............:........... ...................................Fire District .......................................................... . Name of Owner .. �..". ' . dddress��J�i1`��/ � 0e11V J 's 7C�� AA ........... Name of Builder ........!.✓ .`.... ��✓ . .....5�� ...... ....... ........................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .......w ...............:...... ..........................Roofing ...... �. T............................................ Floors .Interior ......... Heating .................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------_------_------------19_______. Area 'I!lC? ..^.................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Wiseman, David - ' ! � . � 20350 dormerNo ................. Permit for .................................... � . ... . ----....----..----_---.----.. .. ' . � 38 Maim Street Location .--,---.—~---...--.______. ( ' cotit............................... .............................................. ' �a�� oeoas� Owner —.*-------..------.__---_ Type of Construction ---...f��------. ^-----^--^---------~-------'' ' ' - . plot -----...--. Lot ................................ ^ | . . June 29 7@ ^ | Permit ,Granted -------------.lA � Dote of Inspection lV ,~ ' ---.--.. . —. Date Completed ------.. lg ^ ` | PERMIT REFUSED ' - � i —'.--'~-----'^^^'------''/—'' i .............................................................*................ | _.._--.--..--'~^---~'--------r— ` —..--.—_.----.---^----~~—^--~'— /- . —.--~---~..—.--~~—.^—.—.~.---... 1 � � Approved ........................................� —.. lA ~ '. ----'---'-----''--^'----^—^^--�'' � | . � ----'r---^-----~--''--~'^^^—^''- / i^ - | Assessor's map and lot number ..................,...................... QyOF?N E • t Sewage Permit number ....,.�. .... �:....i�.`! ,..�:........ / / Z BARNSTABLE, i Housenumber .....-� ..�.......................................................... 9°o 2639 e t �O MAY a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... ..._ O ......................... ..... ..I. /y...... .......`.................. !' TYPE OF CONSTRUCTION �s../'..-` ✓"J ..................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according-to the following information: Location ...........�r...........!........... ...`.........-:....................................:1fr.. ....................................... ........................... ProposedUse ........................................................................... ................................................................................................. ZoningDistrict .....`.l.....................................................................Fire District ...............'.�............................................................. Name of Owner ....... �`�,�.... J: -1.��1 /,........Address .. ...................................../ / ................................./ T Name of Builder is /�✓/'P✓L� � r'dd .... .......A /;;�?�Q ............ Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. (C1� .... - - ...Roofing F�.+fr Zt Exterior ....................................t.. ........................................ ............ ...........:................................................. Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------_------___---------19_______. AreaP................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH _ 1 _ s 1 � t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ol 14 X Name".................................................................................. � W1mmoao" David,.',, 20350 ^ dormerNo ------ Permit for .................................... ' -------^---~^----------'---'' 38 Main Street Location ------.-------------__. �uocortframe ^ David Wiseman � '' ` J Permit Granted ' ' Dote Completed PERMIT REFUSED � ' / ` ^ =`' ..� —... . ^ . � ............... . . � . . .—.—... � Approved ............... ....... ....................... lQ ----------'---^'`-------~---'' -----------.---------.—..—.... ' � � -