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0564 MAIN STREET (COTUIT)
771- Town of BarnstableBuilding ; .�, �#`�'"''.r ., rWw. ... . `n Job and this Cd Nlus �bet Post.Th�s.Card So That it is;1/isible„From;the Street Approved, Plans,.Must be Reta, ,edo,,,, p 9APIMAgLL, . ,m r a"x r2. "# :r,,. �"`,. ,1. � s :''�., `r 'ra.; E't :Yu •, 4, , a S;`V .. Ins ,..Fti'o' Has Been,Made % .;, s Posted UntilFinal spec n� ,e . .�_aS' _ v"s,. r=,3.A';,;+rt, ': .r "�' . sn'-: .n..> > ,. �� ,,.r,g'r' ,., d = ,, n Permit Where a>Cert�ficateof Oeca ancy�s Required,such Buld�ng�shall Not be Occupied wnt�l aF�at-Inspectwn,has been made: �. ... .� :�.. ` :� ✓.-. ==Xs 'a :,..,.� .. " a. ?' , � .: .. `^ra... _x.3t .., �.� - Permit No. B-18-1630 Applicant Name: INSULATE 2 SAVE, INC. Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/23/2018 Foundation: Location: 564 MAIN STREET(COTUIT),COTUIT Map/Lot 036 021 Zoning District: RF Sheathing: Owner on Record: RENNIE,EDMUND D&GAEL P Contrac or=NameF,INSULATE 2 SAVE, INC. Framing: 1 Address: P O BOX 764` Contractor'License. 80747 2 COTUIT, MA 02635 Est Project Cost: $3,738.20 Chimney: Description: INSULATION/WEATHRIZATION Permit Fee: $85.00 i Insulation: Fee Paid $85.00 Project Review Req: Date 1, 5/23/2018 Final: F � F - Plumbing/Gas u Rough Plumbing: - Building Official ����� Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author e�d�by this permit is commenced within six Ainths Aer issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and theFapproved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by lavers and codes. Final Gas: ��� �y This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open four public inspection for the entire duration of the work until the completion of the same. r p i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and,Fire Officials are prod ded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work , . Rough: 1.Foundation or Footing 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. 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 6,t:sEl<�'•T f 7.V I3! it.t.:; 3��'d y•� - PWM ® .i.T'Nils s 4 - •V3 LV���). �•2�l.Fts: - -:!;_:. _ _ _ �•• -Mr7' 1c;t:Y vt 'dR - Il .t a.�.'.tt•'i37 !i i ->j- - eE ^a_sc a 9atat2 osa � - s dt)• •. � tlr," -t:,a�3 - �;s_a saa a SO 3 m{)t fi•t a3i: $es ? 76 i . Q aC 016do- e rc�� bse l Section 6-Proms.Sc Q Wriag Q Oil Tack Storage Q Smoke Dteetors QPlumbing �� { Q Gas Q Fire Suppression Q;Pleating System ❑ Masonry Chinmy E]Addheiocate.-b Water Supply Q Public f Private Sev�age:Disposal ❑ Municipal 0.She : historic.District Q Hyannis historic District i Q Old K ay, i Debris sal Facilit y: ,� v ' using a crane � Yes c�U zx d 7a D Section 7-Flood zont Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes j❑ No Section 8-Zoning ' Zoe District Proposed Use i Lot.Area .Ft. Total,Frontage Percentage of Lot Coverage #of Dwelling:U (on sue) Setbacks Frost Yard Required_ Reap Yard RtgWred Side Yard Required _Prop* i s erty lad relief from the Zoni4g.Board in.thepast? Yes No Sect 9—.Construpow.- Tel N �'a r AOq= �CO�'ho v�� 1'� r city eor _ �Lkem-Nwber License Type Coft'ac ors,:Email A sal4111fu�Q�`�dso u�.4e-)6, # ^p F- 3.)- 48 undw turtles an NOW=forte C ,.. .. SM g Code. I tie sae a by 780 CUR ad the Town:of Bamsud)k.Ate a' of y�r Sje � Die /s�� Sectim 10 Home C Ro 1berEVfixtionDate lald- 1j*dm;pOny.reVonst�''dies under fe mles and taus for Home IpM CAR tssacset BmIft I�d fat cow a by }C2� .oypaofy HZC... D - 11,,-Home.O Te"Number fo r-�d -4��'O-Cell or W N ; I my t es.0 s the rules gmd re im fan'L #fie s Site B g.Co&— i d d: € p by.'78s C11 sod the T'owii of$fable. �i€fie. JeeDaW PP ICNT $ �� N 60 -6" 17^ nth Dement Zoning Board(if required) rl Historic District Q Site Plar Review(if requft-ed) . Fire DVaftent C7 Conservation QI l For.co rcW work,pk=t to yp' pim n 13—Owner's $ as Comer th authorize G e }rapes hereby to m . act on Viers remove to wow,ato • by b� Y.b' Wn for. (Address o€job) Sigma of Owner UN me low . � - Page 1 of 2 Customer Name:Gael Rennie CONTRACT ........_.................. ....F-.,. _.................. Email:Not provided Phone:508-428-9050 _:....... Premise Address:564 Main Street,Cotuit,MA 02635 Project ID: Date:Mayy 7,201818 E1 GINEE SING I RISE EngineeNng 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description ATTIGDOOR:INSULATE&WS 1 each $110.00 $27.50 AIR SEALING 5 hr $400.00 $0.00 ATTIC FLAT-5"FLOORED R-16 DENSE CELLULOSE 461 SF $866.68 $216.67 COMMON WALL:FG BATT+2 RIGID 40 SF $210.00 . .$52.50' ATTIC FLAT-10"OPEN R-37 CELLULOSE 200 SF $3.12.00 $78.00.'' SLOPE-6"DENSE R-19 CELLULOSE 161 SF $338.27 $63.32 COMMON WALL:2"RIGID BOARD 84 SF $323.40. CRAWLSPACE:MAKE ACCESS DOOR 1 each _$250.00 :$62;50 12"X 12"WOOD GABLE VENT 1 each $1.14.00 $28 50: INSULATED BATH EXHAUST HOSE 1 each $60.06 $151b0 VENTILATION CHUTES 40 each $139.60 $34.90 CRAWLSPACE:10 MIL GROUND COVER 200 SF $194.00 .$0.00, . CRAWLSPACE.WALL R10 RIGID BOARD 105 SF $425.25 $106.31 Total: $31738.26 Program Incentive: . $2,.952.15. Customer Total:. $786:65 { WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF *`•Seven.Hundred And Eighty-Six And 051100 Dollars $786 05 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN TULL..INTEREST OF .1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATlb ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. I DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES le00000"L ..r� RISE RepresentaW Cu mer Signature G Sign Date. i TO T � � 8. _. ' Gael Rennie 144, ... . s 564 M a i n Street :Cot u it : .. f AM r w ,p � . , ':: .. ... ...... ....... ....................... ..................... ...... ... .. ...... ..................... The.Commonwealth of Massachusetts Department o,f Industrial Accidents I Congress Street,Suite 160 t Boston,MA 02114-1017 rvrvw mass Ovldia. workers'CoMpensation Insurance Affidavit:l3piiders/Contractors/Iriectricians/i'Itimbers. TO BE FILED WITHTHE:PERMITTING AUTHORITY. Applicant Information " Please.Priti .Ledbiy. Name(Business/Organization/tndividual): Insulate2Save Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone# 508-567-6706 Are you an employer?Cheek the appropriate boxy Type of project(required). J IZ,i am a"employer with 20 ' employees(full and/or part-time)" 7. ❑.New construction 2.E]i am a sole proprietor or partnership and have no.employees working for me in 8. Q Remodeling any capacity.(No workers'camp.insurance required.] 3.01 am a homeowner doinkali work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 0-Building addition 4.0 1 am a Homeowner and will be hiring contractors to conduct all work on1my property, I wi13 ensurc that all contractors cithcr:have workers to insurance or are sole 11.Q. 2octrical repairs or additions proprietors u tit no erripioyees 12. ].Piumbing,repairs'or additions 5.�I am a general contractor and[have hired the sub.:-contractors listed on the attached sheet; 13.❑Roof repairs These sub-contractorshave,employees.aad have workers'.cotnp.insurance.+ 6.Q We area corporation and its officers have exercised their right.of exemption per MGL c. 14.QX Other Insulation' . 152..4 l(4),.and we have no employees.(No workers'eontp;insurance required.) "Any appkicant that chccks box#I must also fill out the section below showing their workers'compensation policy information, r homeowners who submit thisaffsdavit indicating they are.doing all work and then hire outside.contxactors must submit anew affidavit'indicating such. +Contractors that check this.box-must attached an additionat.shect showing the name of the sub contractors and:stateWhether ornot those entities have employees: If the sub-contractors have empioyeesi theytnus providc.their workers'comp.policy number. T am an employer that is providing workers'compensation insurance for my employees .Below is the policy and job site information. r Insurance Company Name;®Liberty Mutual Insurance Policy#or Self4ns.Lic.#: XWS 56418741 Expiration Date:. 12/10/2018 kb Site Address, ° / �vr c City/StatelZip:( lift: tX Ylf+t dot to Attach a copy of the workers' nsation policy declaration+page(showing the poli exp cy number and iration date}. compensation . Failure to secure coverage as required under MGL c. 1:52,§25A.is a criminal violation punishable by a fide up to$1500.00 and/or one;year imprisonment;as well as civii:penalties in the form of a STOP WORK ORDER and a fine of up:to S250:00.a day.against the violator.A copy of this statement:may be forwarded to the Office of Investigations of the:DlA for insurance coverage.verification. a.. .. I do hereby certify under the' s �iy that the i»forwadon,provided above.is true and correct. Signature Date: ����� Phone#: 508-567-6706 Official use only. bo not write in this area,to be completed by city or town official' City or Town Permit/License#. issuing Authority(circle one): 1.Board of Health 2`.Budding.DepsetMent:3.City/Town Clerk 4.Electrical inspector 5.PluMbing inspector 6.Other I Contact Person: Phone#: i ,_ ._... office of Consumer.Affairs and Business'Regulation 10 Pare Plaza-:Suite 5170 Boston, Mag iusetts 42110 Home lrnrovemtractor Registration Type: corporaton INSULATE 2 SAVE , INC. � :yam � , 4 Registration. 180747 � �A:. '� EarQiration ' 12/28/2018 . 410 Grove St Fallriver, MA 0272O x Update Address and return card. Mark reason for change. >CA 1 0 20M-Mil l T. .. ....._._............. _._._ _._ .._ ._ �._.,.__....._..L1 Ad;: rttsss... 1_Re11gwal;.Q Emp.19wert.0 Lost Card .,�.�,�ll, d„t77tT.?f7,t�la,.dZlLii7d�t fi�� b�'C£C.FLBl6fl1� _ . (Mal of.Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration vain far Individwl;use only. T`lP£;Ctl anon before the.expiration data.. If`fourld retum to: `' Office of onsumst Affairs artd..Buslness Regulation on lai£8ir�tlS2[! 10 Park Plaza-Suite 5170 1212$l2018 $oston;MA 02116 INSULATE 2 S J Roland Lange*,,A' 410 clove S# Failrtver,MA {121 ;,.,: Undersecretary . Not Valid without signature Commonwealth.of Massacftusetts Division of professional Unsure - Board of ff;i#ding Regulations and Standards i i cs-IOU61 .ire 4 .1 ,9 ROLAWt3 FALL WErL,MAm - 03 s Commissioner ,4Co/tcP CERTIFICATE OF LIA LITY LMSURANCE °A�`�"'°'""'"' 0-V0,7118 THIS CERTI ICATE tS ISSUED AS:A-MATTER OF INFORMATtION ONLY AND CONFERS Np'.-MHT-S UPON TF CE ICAfE;kIOL{3ER_.Tf(tS;: :: CERTIFICATE DOES-NOT AFFiRMATNELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGEAFFORDED13Y THE POUCIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE tSSUENG ItStiRfR{S);'At1T#it3RIZED' REPRESENTATN :OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If-the certificate1older,is an ONAL INSURED,the poliicy(es):must have AD€[TtONALINSUR�..provisions or be:endorsed.. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require:an endorsement. A, on' this:certificate does not confer:rights to the certificate holder in lieu of Such endoisement(s� PRODUCER: -NANFEi Anthony f Cordeiro Insurance PHONN : 508-677-Q407 Na 508�677.0409 171 Pleasant Street - Falk River;MA 02721 ADDRESS: � ndeiroinsurance.c om INSURER($};AFFORDtNG COVERAGE :NAIG f INSURERA: LiberW Mut4ofrIStR"dhCe INSURED INSURER B: Insulate 2 Save,Inc. INSURER C: 410 Grove St. aasuRER D Fall River,:MA 02720 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REWSION, g THISIS TO CERTIFYTHAT THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED.NAMED'ABOYE TIiEI'FI3R OUCY:PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER'DOCUMENT WITH:RESPECT Tb WHiC1i THIS CERTWICATE.MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY.PAID CLAIMS. 17R. TYPE OF INSURANCE I POLICY NUMBER POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $" A.000 000: CLAIMSMADE' ❑X OCCUR . . .PRERAISES'Ea-ocamencei $ OMo. '. MED.EXP one-PersoriP $' S.00Q A Y Y BKS 56418741 12/10/17 12/10/18. PERSONAL&ADV INJURY 'S 1,Xf8@:00Q<',- GEN'L AGGREGATE.LIMIT APPLIES PER GENEOLAGGREGATE' $ 2,OtItl,ti00 X POLICY �� ED LOC PRODUCTS COMPJOP.A66 $ 2,110�000 OTHER; $ AUTOMOBILE LIABILITY aeadentUMT $ 1,OE��80. ANY AUTO BODILY INJURY(Per person) .$.:. . OWNED v SCHEDULED A AUTOS-ON Ly !� AUTOS y y SAA 56418741 1211 DH7 12/10H 8` :BODILY INJURY(Per accident) $' HIRED` NON-OWNED X AUTOS ONLY. x AUTOS ONLY .$" X'UMBRELIA WAS ^ OCCUR, EACH OCCURRENCE $ T OOQ OQOt;' A. Exct ss.uAs cLAIMS.MADE Y Y USO 56418741 12/10i17 12/10/18 'AGGREGATE DED RETENTION$ $: wotacERstPEHSATION XrUT� E°AND EMPLOYERS'LJABILITY ANY.PROPRIETORIPARTNER/FCUTIVE YIN L EACHACCOENT $ 500,00D: A or+10ER/MEMBEREXCLUDED? 0 MIA XWS 56418741 12/10/17 12110/18 'I- MR n "m•NNi' E L DISEASE:-EA EMPLOY $ deseitibe'tmder . OMMOFOPERATIONSbelow ELDISEA$E=POLICYLILIHT $ .. `S�,000s.. DESCIiIPnON OF OPERATlONu!LOCATIONS.!VEHICLES:(ACORD 101,AdcNanal Remarks Schedule,may be attached it mo►e sDaca isreQuired) CER71RCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE:DESCR16Eti POLICIES SE CANCEL LID BEFORE THE EXPIRATION DATE THEREOF:HOTIGE VdLL BE DEWBRED-iN. Proof of insurance ACCORDANsrEN1IIT Et THE POLIC1r:PROYlS"ONS. AUTHORIZED REPRES 2015 ACORD CE>ttPORATTtaN Awn, �eserxred-; AC( 25(204&03) The ACORD name and logo are registered marks of ACORD 0*1HE - AN., -Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee IAMSTABLE, ► Thomas F.Geiler,Director Mass. Building Division rFD MA't A Tom.Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 568-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY C Not Valid without Red X-Press Imprint Map/parcel Number 03 to Property Address Residential Value of Work 5 J Minimum fee of$25.00 for-work under$6000.00 r, s � Owner's Name&Address 0^yjyc�ri Contractor's Named �t °�"� �"�,+ +r*fI Telephone Number 7? Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance.` PRESS. PERMIT Check one: " + ❑ I am a sole proprietor 2008 ❑ I am the Homeowner JUN 2. 3 [ ' I have Worker's Compensation Insurance - TOWN OF BARNSTABLE Insurance Company Name 4CA I J mc Workman's Comp.Policy#_ U.A 72 6 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken.to �0 (10111-� + ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/slider`s.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 co of the Home Improvement Contractors License is re ed RQ:< copy P q. '.." �K 6Z :Z SIGNATURE: G 3.18 /m,�!+ I V I'1. -in WPFILES\FORMS\building permit forms EXPRESS.doc Q:\WPFILES\F0RMS\building The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information /- Please Print LeEribly Name(Business/Organization/Individud): o<lexo A r,4 Address: j6 41-116 cam• ti - City/State/Zip: S /47 09- Phone.#: `7 7 f d mil' Are you an employer? Check the appropriate box: Type of project(required): 1.91�1 am a employer with 4. 0 I am a general contractor and I 6. ❑New construction . employees(full and/or part time).* have hired the stab-contractors 2.❑ I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 Builder addition [NO workers' comp.•insurance comp-insrnanceJ required..] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or,addifi= myself[No workers' comp. - right bf exemption per MGL 12,[?Rnof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] . *Any applicant that checlm box*1.nnist also fill out the section blow showing their workcra'compensation policy information- t Hommownes who submit this aSdavit indicating tbey are doing all work and then him outside contractors must submit a near affidavit indicating such. Tcontractors that check this box nrist attached an additional sheet showing the name of the sub•conh actors and state whether or not those entities have employees. If the sub-contractors have employees,they must ptflvidt their worla:rs'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees Below is the polity aced job site information. Insurance Company Name Policy#or Self-ins.Lie.#: 2® Expiration Date: ' Job Site Address* Y ✓ � "` City/StatrJZip:t�t��url-r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to soctue coverage as required under Section 25A of MGL c. 152 can lead to the imposition of erimifid penalties of a fins tip 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 tine violator. Be advised that a copy of this stakmeik may be forwarded tD the Office of _ Investinfions of the WA for insurance coverage verification. I do hereby certify under the pains•and enalties of perjury that the information provided above is true and correct Si e: Date: C, Phone# �77 0 Off:clal use only. Do not write in this area,to be completed by city or Iowa officlaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 representative's 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 binding 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( )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 compliznce with the inmi ance 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,it 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-instnzd 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 u to fill out in the event the Office of Investigations• has to contact you re the applicant. you Y �� aPP Please be sure to fill in the permittlicense number which will be used"as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year,need only subunit ono 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 (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete:this affidavit The Office of Investigations would hie to thank you in advance for your cooperation and should you have any questions, please do not hesitate t6 give us a call The Department's address,tzlephone•and fax number. ,The G6mmonwealth of Massachusetts Department of Industrial Accidents Qface of Investigations 600 Vdashk&ton Street Boston,MA 02111 W. #617-727-4900 ext 4-06 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia °FVE►� Town of Barnstable Regulatory Services HARN� AS KASS. Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder 1 '666" s1cl IM17 i-e _ , as Owner of the subject property hereby authorize el C ri. (1/,- 167-11 to act on my behalf, in all,matters relative to work authorized by this building permit application for: 576 (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. Town of Barnstable �oF the Tp� Regulatory Services " � Thomas F.Geiler,Director t saxrlsrwsr.>:, � Building Division Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 yr ww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HON EOWNER 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 dwellinl?s 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 perfomvng 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 air unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules Bc 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 can t amend and adopt such a form/certification for use in your community. 06/23/2008 09:31 FAX _508 775 3821 uLL� �nrn wv „ � n xa lvva — PRODUCER TEilS CERTIFICATE-tS 1SSU7=C7 AS A MATTER f?F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,E}CTI=ND OR Qlda CapgCcd ins AI3cy Inc ALTER THlr COVERAGE AF>=R042=BY THE POLICIES BELOW 296 V4her Street Hyannis,MA 02601 GOenPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY F SURED lanl Corr�wion Inc 8a 892 ertrtisport,MA t72672-0000 I THIS 15 TO CERTIFY THAT THE pOLJCtES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR TI'tE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TEF+M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WCTH RF3P>=C+T TO WHCH THS CI:KrIFICATE MAY BE ISSUED ORMAY Mf;VAIN,THE INSURANCE AFFORDED THE pO�ES DE4CRIBED REIN IS SUBJECT TO ALLTHETE M .K=LU510NS ANp CONDITIONS OF SUCH POLICIES-LV�AITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co ExPRATIDN VA LTit TYPE Of P1BU P+SL ICV NUMBER Nd l @PPEmm DATE A scommNSAT LIMITS D EMPLDYERO'LV48� t+FROPRp MTNERSIMe1rTVE ATUTORYI RIAs l(U!RSARE: .t3272044 .4ID112005 4/01/2009 NCL C}E>U� • � g 100, MWAPOmotaVAOpadwst)*y $ 500,R10 L4t:P9E FOLIC,Y LYw $ 100 00 BacaEMPLVVM t ESCR Q OPERAi1R7 SNEHICL6S15 tfE1lII5 i cEFtt1> CATS Hot: CANCr:LLATION CEI taFOAFEHoLLE SHOULDIINYOF THE ABOVEDEWAIBEDPCLOESBECPNMLLEDDEP0W"t BUILDING OF BAP1 E%PIS'AjkON DAZE THEREOF.YHE=UNG=P��FGbrAVOR TO MAI m �7 MAIN DA"W2FTFA NOTGE TO THE MTPICATE NDLDER NAMED TO THE LEFT,BUr 367 MAI$, T 028G1 FAILtM TO MAIL SUCH NDTIL`E liftL PIPOSE NO GaWAT WN ORL,t4BRRv OF ANY KIND UPON THE COMPANY,ITS A6E"s CA REPRESENTATNEs. AVTKORMED REpFtMl5NTATIVE i ✓lie �o�rwrrcooU�recc� o��/f/�aaaacc«uaeC�a �_---�,._ _ r.---r- - ----------- ------------ ` Board of Building Regulations and Standards License or registration valid for individul us HOME IMPROVEMENT CONTRAC e only TOR before the expiration date. If found return to: Re istration 9� 128560 . Board of Building Regulations and Standards ' Expiration 4/21/2009 Tr/E T31711 One Ashburton Place Rm 1301, 4- " Boston,,'YIa.02108 6 Type Individual F �rl RICHARD VILLANI ' I RICHARD VILLANI,,`F 3I `:; F' 109 WAGON LANE�_'��" HYANNIS,MA.026.01 �r i'iunist( r- Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _ 0- Map ,F Parcel Permit# � Health Division J04 q3 - /b k• t-Date Issued Conservation Division a a / /�!© r ►v i Application Fee Tax Collector Permit Fee Treasurer 1 �~�' `:,f r;s;`' -EXISTING SEPTIC SYSTEM Planning Dept. UMREDTiD OF 8WR00MS Date Definitive Plan Approved by Planning Board �cw2n ,isd v,-i�-rfe-017� LL Historic-OKH Preservation/Hyannis Project Street Address M a!n S 4r-eeT Village Owner ��d `� �ae1 I�+enniP Address Telephone So 5 — 42 9- 1 p SD Permit Request / K /6 13,47 1 Square feet: 1st floor: existing-------.,- proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /P/sf� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: O 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 g g g g �211`new size 12.)46 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION I I Name-- a V r d Tree m e T Telephone Number" 5 U o — 77 S-01-(Z tt r Address _ t 7 Fe r m d a lie K a�{ License# 012228 s' a.n t1 t S �'lQ 0 Z6O ` Home Improvement Contractor# 2 CD-7 Worker's Compensation# V WC 600 32 S 6 2 Z ooq l ALL CONSTRUCTION DEBR IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6 — 0'{ FOR OFFICIAL USE ONLY PERMIT NO.' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE �~ OWNER ' DATE'OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGT FINAL'-' GAS: ROUC� A FINAL FINAL BUILDING s ;�, ATA6M4 Cr ivi DATE CLOSED OUT •� IR ASSOCIATION PLAN NO. ' 00 it n � • The Commonwealth of Massachusetts Department of olndustrial Accidents es efMMVW8x 60o fT,ashin;ton Street c Boston,Mass. 02111 Workers' COMP ensation Insurance AffidavitGeneral Busin es //��// / // Elms address: ' zi hose# state: work site location d address: Restaurant/Bar/Eating Establishment I am a sole proprietor and have no one Business Type: Retail 0 Office[]Sales(including Real Estate,Autos etc,) worlang in any capacity. []I am an e�m�j/loy'a with eiz 1 es(full& art tim�. El / �•%/ %10 providing employees worldng on this job. �I ��F �.7 es comTMUY, *,�.,: Y•; ; • ;'•' t ':{'..'1 • .•a :•ti' ,'S� r .ft. S t,J.L ::+!'`••..' �y ,Y.•(�J'°•11.�� •:•.•J" !1.'1 {t BadTEBS" :• ,•M,,;,:; ,'�.i�I .�`.• :,; .• : .•..''''� :.�Se�•��'n„1` �P"•�" .' ,'��'' I bone#• ' :. . ` ''' .'. .s!�'�$" '�&`T'kl.• olic.'•#'.'1� / / i // I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: Xr ,;• ..�: J.,r ,gin: .••j'. .,:..•+ 't:: •�.•:a:• address �.;,�.: .' , ;' y:.:,'• .�, t. hone#! 1. t: •J.:; '•'. J .• •.�y 1. •/ ///////// /�� J•1. � •. •• ,�r;J:', t,:,,,'r�. .1.••J..''OI1CV+# 'Y' �/�/•/ • insurance co • . ::;. _ Y. „ 011 cam'eii a address; : • w. 71' ;'I:1`l .'L. - •fit . - . hone ' 1'' Cfii�:' .. �r . a{ .9.r.t• ••(•• .�. ti.:A• •'.` 't�•.: ,•A..• � .1•, - ',. 0.00 .....;••., y f:1• • •1 • •1 • >:•'.f:,•I' S.',,'./.•'�t5•'.•Ir �• o�1CY•i�raJ �:':i.a .1'••� .,1 .•.�• �' •. , .n MUMosition ye0ure to secure coverage as requiredednr S om in tl?e$formboia STOP'wORK 0 Rc 152 can lead to the pand a fine vfi$10�00ea d y against me" I uaa�atand:that pr one years'imprisonment as well as ry p ded to the Office of Investigations of the DlAfor coverage verification copy of this statement ma be I do hereby certify under a par s andpenaliies of perjury that the tnj�ormation provided above is true correct Date T' 5igaature / / �! d -77 37 rel'1 Phone# S Print name .. g.official we only do not write in this area to be completed by city or town official ❑Building Department permJtn1cease city or town; ❑I,icensiag Board_ ❑Selectmen's Office ❑check if immediate response is required ❑EcalthDepartment , phone#1 00ther contact person: (revered Sept 10D3) • .I4 < Information and Instructions Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the law, an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged is 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 apartnimts 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 section 25 also states that every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buddingsIn the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of.its political subdivisions shall enter into any contract for the performance ofpublic•work until he•insurance requirements of this chapter have been presented to the contracting acceptable evidence.of compliance with t authority. } Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. PIease supply compgny name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the-"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listedbelow. City or Towns Please be sure.that the affidavit is complete and printed legibly. The Department bas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe retumed to ., the Department by nail.or FAX unless other arrangements havebeenmade. The Office of Investigations would like to thank ybu in.advance for you cooperation and should you have any questions, e i please do nothesitatto give us a call. ME The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents M of Imsflgadons 600 Washington Street ' Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext.406 oF�e t� Town of Barnstable Regulatory ator Services Z BAWSrasrE, Thomas F.Geller,Director XAM 9�A 16 9. �� Building Division TED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4088 Permit no. Date AFFIDAVIT HOME JMPROVEMENT 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. // Estimated Cost 6 G a Q — Type of Work: S�Address of Work: a/a. S-7 ee y M Owner's Name: /e ae/ /ten n . Date of Application: /2 -- r(e -o I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law []job Under$1,000 OBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUAR,&.NTv FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: / /�! /2 G70.7 -� �avi4 �c T Date Contractor Name Registration No. OR Date Owner's Name Q..fotms:homeafFidav Town of Barnstable ti Regulatory Services Bnxxsras Thomas F.Geller,Director 16 � Building Division Tom Perry, Building commissioner 200 Main Street, Hyannis,MA 02601 vvww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ' Property Owner Must Complete lete and Sign This Sec tion If UsingBuilder / n t ,as owner of the subject property hereby authorize �a��c1 �e.'''' �e f t to act on my behalf, k authorized b this building permit application for. . in all matters relative to work y (Address of Job) ' Signature of Owner Date Print Name O:FORMS:OWNERFERMISSION 'I ' w •:/ate"(Opoyvrreaiturea.� u��/�pc/zuQel.� Board of Building Regulations and Standards f HOME IF�ROVEMENT CONTRACTOR Registriftl-n 120707 it} .�oa= �2/2006 } _-7,. Tel � a A E z :1 KD DESIGN&R`, WMEIzC `J I DAVID TREMBLE'T h, 17 FERNDALE HYANNIS,MA 02601 Administrator y A ,JO,,,,,,taruue TIONS Id SOAR OF SUILDIN.G REGULA" ONSTRUCTION SUPERVdSOR I L-icems-e ' NumbeY�S g 042228 B1 h at �rf49 v_. � j 005 Tr.no. 3778 Rest i i ENPF Er' ik I DAVGID 17 FERN DALE R � i 0260I Admimstirator HYANNIS, MA _ F ' t i 1 k I - i f �1 II as been rernoY ' �j arrl � b� home oc�n er has � i V:7r Oct c� AILLIAM a C, N r E 193;14,0 C p.T t F 1 ED P t.-O`(" Pl-.. 1 Getz Tl l= O AJ ► L e 6,Z& .J QO t \ �, \L..•4 r�. D� J p'-A R s F a Ze►Q Gam. W1T1-41l 7• 763A)(TME "Wo 5uev�:-Yo$V; C7,�T r1 :)STEZV%L.L-- oLjOT U A►-� ls.i°5►'T'�UR�E►.ir SUQve'f MAC v� yFr S'idoa'rw q° 4�1..1C.��.►JT j RO 2'2"xY5114" - i RO 63 3/4"x 6'10 12" urn Li C i Side View Back View Front View y. N � m o Q, S (n A .. 0 co A - Ul r " i 16'-0" I I I try I I I SHED I. 15,-5"x 11'-5" 4 I 2x6 j Bete 16'OC I' 1. I I I � I I I 2035 �� G068 �: 2035 LIVING AREA 192 sg ft O - x Scale 1/4"=1' Roofsyatem:2"x6"nft &-i1ing ;, t5 joist 16"o.c..112"plywood shcething y n .. 12 Pitch @ 3 tab aaplutt ehmglea to n . - - j match the style of the main house; / f is soffit.mke,and comer wns to . L' be pm?rimed pine. Wall System:2.x4 studs 16"o.c-double PP (V -to late sin le bottom P Iate back B stdea to be TI-11 siding ehee0wtg, xa3 ll tohave 12"plywood C o sheethin P vek house wrap,white cedu"Extra"shingles with 5"exposwe A ON 4 On n Q O\ T � .., to T-8 3l4"—,—� j iz- Floor System:2x6 Presstvc tn:ated joist and box frame, with 3/4"plywood f r,set on 6"concrete blocks on grade TOWN OF BARNSTABLE BUILDING PERMITAPPLICATION Map Parcel L5 off-/ Permit# " Health Division - Date Issued I - cc Conservation Division t Fee Tax Collector Treasurer ,a(o Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address v��� L�. Imo/ -1 Village Owner 2— G'e,11_1 ) t _X"\ r-n S E Address Telephone �1� Permit Request V v e s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new q g p p 9 p p Estimated Project 000st '1 006 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: O Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing ' new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 existing O new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:O existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use Proposed Use B ILDER INFORMATION U Name :Jv,�,ll c Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE J , FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. - -� ADDRESS VILLAGE OWNER DATE OF INSPECTI N: l r FOUNDATION FRAME .> INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' r' PLUMBING: ROUGH FINAL • f ` GAS: ROUGH FINAL FINAL BUILDING, d l/7/� 2)f2G& 21444 - ` e A` DATE CLOSED OUT fL ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents _-- -- Olflca ofl�estigstioos . ' - 600 Washington Street f Boston,Mass. 02111 Workers' Com ensation Insurance davit name: Ep T,� V-, location'............. hone# z cites - t� I am a h meowner performing all work myself am a sole etor and have no one workin in any �p%/�/r/' �i�0iiy�///O///O%/////%/////%/%%%///////%//////%////,%///%%//�, . . workin .on this ob.-........-.... comp .. .. .::•. . . ... . :.......... ; ;;:;:<.::. I am an Dyer ::.:::.:.......4.::.:::::•,....-h:=::.............:.:.......................:........:.:.,.:.............................. :.............. 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V Mani .. >� ss� .:........,................... . ..( ry, .. fir'4Y :. .. ...........:::.............:...�....:......t... .r:a..a .... .:::,..�- , . �., .. .:�#:.}}} :.: .< ,.;:.�<:.,:,,,.::.,,::::;,,,.�.::.:,:._>�:>::<':: ;::>::>:_:< .....:..::.::::.w.. :......:�:.:.}, vh....,..t. ,... .. it .... ..... ...........:::::.-v::::vv.:w:::;•i}:::.v•:•:r:v! .??•fi.`i}R•'. h• : vkk.+-...vr:{4}}lfi'•::::::'v'•• .-- -- ............................. .... ..........::..................... ..........,rt. ........ r..x... r v...........:.};,;....w:•ti::;;i:•:•:{vfi:}};�:.}:vi}}}}}}}:{•}}}:vi}}}:•:::{}:4}:;{•}}}i}}}^,;-i:;;4:{-}:;;.iii}:�i}}i:;vy::::::::::::.:.:: .... ..... ..,.. ..O .v. ..... }y•x::::.v:.v:..rfi:.:::::....:.. .{.;,r.:.......................................••x::::;....::.w.v.�.•::.....::•.F}}}}i:�i ..�:::::::.::{.;>:.::},:.:::::::::'::::.....::......::.:...:.r•... .....{{,..fir.:}:: ., :.... ..v.a:,.h..................-... ,:.,,.,.,.,..... . .......:.:.....}{.c{:?•7::•:^};.h.t.,.,.¢•},>::•r;}:.;.:..Y;::;;::::i�,fi,:•ywE4•' ;�?�a?::Y.°r'.t;': :y'°t -...t............... .....:,..:::::.:.:�::::::�:::::>:::�::::::::�::::•.,:�::::::�::::.,.... insurance••co:>::�::<:::>-;}:>;><,,.:::::.::,.}::.;w.,,.}.:.:. • Failure to eecm'e coverage as required nude.Secd=25A of M(M as b'sd to the of criminal. unities of a Sue uP to S1,S00.00 and/or one yeah'imprisonment as well as civil penalties the form of a STOP WORK ORDER and a Sue of S100.00 a day against um I understand that a copy of this statement may be forwarded to the Ofnee of Inver of&e DIA for coverage verItication I do hereby certify under the pans and pawltier ofpeVury&at ae information provided above is&a:mid correct Date _ Signature # Print name oindal use only do not write in this area to be completed by dry or town oMcW permitilicense# OBWbling Department city or town: ❑Licensing Board ❑Selectmen's Ofnce checkif immediate response is required ❑Health Department' phune#, ❑Other contact person: (teased 9/95 PJA) Information and Instructions ' Massachusetts General Laws chapter 152 section 25 requires all employers to Provide workers compensation for their employees. As quo ted from the an mployee 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a Incense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance,regiuremetns of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be and submitted to the Department of Industrial Accidents for confiz�n of insurance coverage. Also b t h date the affidavit. The affidavit should be to the city or town that the application for the permit or license is of Industrial Accidents. Should you have any questions regarding the"law"or if you being requested,not the Department ensation Policy,phi the Department at the member listed below. are required to obtain a workers' comp City or Towns Please be sure that the affidavit is complete and printed legibly The Department has provided a space at the bottom of the for to fill out in the event the Office of has to contact you regarding the applicant. Please affidavit o You .. be retnmed t_ be sure to fill in the pease number which will be used as a reference muiYiber. The affidavits may the Department by mail or FAX unless other arrangements have been made. to thank you m advance fur you cooperation and should you have any questions. The Office of Investigations would l 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 Otflce of 1=211®atlons 600 Washington Street Boston,Ma 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 40.6, 409 or 375 of THE The Town of Barnstable RAhMARM KAM Department of Health Safety. and Environmental Services �6 9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME II"ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT 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 twits 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: O 1� C Estimated Co 'T Address of Work: L5,6-A Owner's Name: 4 - 1-� Date of Application: ^ a ca I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERNIIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. F Date Contractor Name Registration No. t R , Date Owner's Name q:fonns:Affidav The Town. of Barnstable Ft roy�o Department of Health Safety and Environmental Services Building Division MUMSfAB14 ' 367 Main Street,Hyannis MA 02601 y NAs& g s63p. �0 AjPp MAC a Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: h /, 719 number street village "HOMEOWNER": N n G/-?,e�3- 9 b-S C7 name home phone# work phone# CURRENT MAILING ADDRESS: 7 V ��y 1 tj 1 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. St "ature 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN i � 1 S7 8� .\p M I i i - - i 4AVA41Z J N EXIST 4-1 1 ' ZI} i 1 I PREPARED FOR CER T/F/ED PL 0 T PL AN, LOCATION, T T SCAL E:1=_DATE: gTzcrz z/ �Z�i+ of M7 REFERENCE LOT 3-0it FL 00D ZONE: C' N0.3 I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. AND THAT/T Es CONFORM TO THE ZONING BY-LAWS OF THE TOWN Of- WHEN CONSTRUCTED WELLER & ASSOCIATES 714 AMIN S ££T — YARMOUTH, MASS. DATE 11:'02 '94 17:02 'C6177277122 DEPT IND ACCID T L,OIlUnoiz.WealtA ot iz�JachttjettJ aUaPaitnieat n�J'•ndu�t��✓dcci� 600 Wwknyloa.Sh, l James J.Campbell 916a tta 02f f Comm ss,b e. �M1lorkers' Compensation irtsnrance davit g (aoasscCIPUMim") with a principal place of business at: Gty/St"JZ10 do hereby terrify under the pains and penalties of perjury, that: () l am an employer providing workers' compensation coverage for my employees working c this job. insurance Company Policy Number O l am a sole proprietor and have no one working for me in any capacity. () i am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor insurance Company/Policy Number Contractor insurance Company/Policy Numbel Contractor insurance Company/Policy Numbei O I am a homeowner performing ail the work myself. 91 1. c � ' ,r< -c:-s:Z cc;y of&.:s s_;emEnt will be fo-v:zrad tc rf:e office of inveai�dons of d:e DIA for eom2ge verifitat;on and thy f�aure tc cevr;Cc s rec,:;:ed under.Scc::on 2�A of MGL 152 caa lead to the lnvcsition of criminal penalties eonsistine of a fine of up to S 1,500AO arcf, yea:z irnprucn:Ent -,5 well as civil penalties in the fora:cf a STOP WORK ORDER and 2 fine of 5100.00 a day ag<inst me_ Signed this day of. /21( 14 t5— rr Licensee/Permittee Building Department Licensing Board Selectmens ace Health Department TO V"PIF.,"•COVirP.AGE INE.ORMAT CN CALL: 617-727-4900 X403, 404, 405, 4,0,9, �75 The Town �„�„ of Barnstable MAW, g Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph C rossen Fn 509_775_31A2- Date AFMAVTT HOME 1MPROVENUMCONTRACPORLAW SUPPLEMENT TO PERNUAPPUCATTON MGL c. 142A requires that the"reconstruction,alterations,renovation,rcpat4 mod6mization,eonyemon, improvement, nemrnal, demolition, or construction of an addition to nay pre-posting owner occupied building containing at least one but not more than four dwelling units or to sUucW m which are adjacent to such residence or building be.done by registered contractors,with ariain=options,along with other requiretaentS. T of Work: ,, i 3� Est Cost 5 S'3=a Address of Work: Owner Name. Date of Permit Application: I here]%•certify that: Registration is not required for the folloKing reason(s): Work excluded by law Job under 51,000 Building not owner-ooarpicd Os«ta pulling own permit Ncticc is hcrcbN•givcn Lw;: OWNTERS PULLTNG i tiEIR OWN PERMIT OR DEALING I=UNREGISTERED CONTRACTORS FOR APPLICAELE HO'+IE MTROVE.M -?,,T WORK DO NOT HAVE ACCESS TO THE F .: TION' FTIC) �_',10.^, GUAFh.*M,Flj-zD 1 DER*„GL c_ 142— SIGNED UDDER PENALTIES OF PERJURY I hcrebti'apply for a permit as the agent of the owner.- - J 6 ° Datc Contractor me Registration No. OR ' Data Owner's n me � fie -� 0�.,2�aQaa�lucae�a ; HOME IMPROVEMENT CONTRACTORS REGISTRATION I oard of Building Regulations and Standards I One Ashburton Place — Room 1301 I Boston , Massachusetts .02108 I I HOME IMPROVEMENT CONTRACTOR Registration 100740 Expiration 06/23/96 Type — PRIVATE CORPORATION I I -HONE IMPROVEMENT CONIUCTOR..-.. <JtsOtatrattoa 400140 I Capizzi Home -Improvement , Inc . I Type -. PRIVATE CORPORATION- II Thomas Capizzi , Sr .. I E>spitatlon 06/23/96 1 1645 Newton Rd . Cotuit MA 02635 Capizzi Home Lprovelleat, Inc Thous Capizzi, Sr. (� w-?f ffL440 Newton Rd. I ADMISRATOR Cotait MA 02635 Restricted To: 10 Owl DEPARTMENT OF PUBLIC'SAFETY CONSTRUCTION SUPERVISOR LICENSE I 10 - Noet Rrober: . Expires: eirtldite: LA - Rssoory oily CS 116189 lOR II% 10/29/1148 16 - 1 a 2 Wily Holes Restricted To: 00 ,,�...L. DAVID N IEBB CowasaNm '100 PLUM HOLLON 10 E WHOUTH, RA 12536 t f. ssessor's Office` lst floor Ma —_ j Lot o2 Ig, Permit# '... i. /-., Conscrvation Office(4th floor) ! Y, Date Issued Board of Health Ord floor , C� t �( Engineering Dept. Ord floor House# Planning Dept. Ust floor/School Admin.Bldg t Definitive Plan Approved by Plifi Ling Board A )'cations rocessed_ :30-9:30 a.m. & 1:00-2:00 .m. f " 04 TOWN OF BARNSTABLE Building'Permit Application' Project Strcet Address y� Village Fire District „fir (honer e/A-Y.� Address `�,� -M % Telcphonc L1 � 5 d Permit Request: i Zoning District ' Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type t Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure Basement type Historic House Finished Old King s;Highway Unfinished Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached ' Other Detached Structures: Pool f Attached Barn None Sheds Other Builder Information Namc l� I— t ��2C7 Telephone number Address License# -12 LA (� a 5 Home Improvement Contractor# Worker's Compeusation # NEW CONSTRUCTION OR ADDITIONS REQUIRE. A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION:DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Project Cost Fee. SIGNATURE � DATE C' S— BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 6 Y& I ; BPERM T �• 5/15/95 -3-7-i9-5— 036.021 564 Main Street,Cotuit Owner: Ted & .Gail Rennie TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �j' , Map w Parcel lo_*,*)—/ Permit Health Division 13-5 6,6, Date Issued ^fy!AA®30L Conservation Division a �� �7 Application Fee Tax Collector Permit Fee �� °®® Treasurer 'd 6� SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by PlanningBoard WITH TITLE 5 VreservatiLoin/Hyannis ENVIRONMENTAL CODE AND Historic-OKH W TOWN REGULATIONS Project Street Address �yti S IVillage Owners M L..% eo ?. Address :!�_6a ►������ �i Telephone S Z — Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic Houser ❑Yes -❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No- If yes, site plan review# Current Use %Proposed Use BUILDER INFORMATION Name v`n ' Telephone Number Address_� License# Home Improvement Contractor# Worker's Compensation((# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �Fiz.� SIGNATURE DATE �S ,//— t FOR OFFICIAL USE ONLY PERMIT NO DATE ISSUED L . MAP/PARCEL NO. ADDRESS VILLAGE f OWNER �r DATE OF INSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL M PLUMBING: ROUGH FINAL m GAS: ROUGH ts� > � FINAL _ < i U pG 0 FINAL BUILDING c i rn DATE CLOSED OUT ASSOCIATION PLAN NO. t" c r n N ' t f im C) / i ' :' , '' .. y. ,.. '• •to .. .. .: • .:`.,'•..r; •.f. ,y' r•Y, • •• The'Coriarrwnwealth 'of Massachusetts - aI'Accidents' Departm.ent of Inds ' __ •p�ICe Ifs �` 600 washington Street - Boston;Mass. . b2IZ Workers'.Com ensation.usurance Affidavit General Businesses /' eddress: 5•. • ' zi one# _ ' — state: _ . • . tlBai/Eating F�tablishmeot ork site iom icli address : . • on $as s tie, ❑Retail❑Restauranla ReaYEstate,Autos etc,)' abl.la.sole rietor and have no A [] Of.ce0 Sayer(in �g ywrking in aDf capaciiY ., 03her io er with•' etn'•lo•ees(full 8c' art time : ❑ an % %%/y%%�%%%//%%/////%%///%/�//%/%%/ on his' , r �E /%%% /%/%//a%%,11'er%%%// %/%/%/l/%cb Deasation for myeRl?Yees wor]ang 1 t eID�i)y providin yiorkefs t t.. t • t _ . , 4• J.�'�'+ ti .{ � •, '.. \ t+'�''.�,'•'::'.t•'r.''' 4:]•:, s; '+' .•t.,.,,+'r.15i•,...11 � '' -�• ,•-�' •• ' � .;• '�• :.ZJ •t}>=1'� ,'.'t': •• •��tt'Iii15 •Iij+ :�. :�. .•.�'. 1 y •,, .tI' i.••t'.?+:i '�y''+ 't!�; " . 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'r.: :t �.. .i�•t'r yC' ,.t':.'• '1.,t:',.�t• 71.-.4I' t`''•'+r. n�•'t di "I�i l•jt.t': ;+h.%' i JAI '2 ' ��• c t' ` ' /�/ i, t: - t rl•`' .•:r•• .',.t, r' .�.I.�I+I,tZ.: h'.li•Ia1'd1;iX:',•. l•. 011G / >. ;f•r{..y: ,� . followingvrorkers' t �Ce�o:" listed below•who have th ra '' the dependent contractors ' ,ELM a sole proprietor aud'have hired `• ; ' .:.. •. `,ttip t;t,' ,• :;;:'V4:;' .. Y mpensation polices* �' '' r-- S .�•p,• ... teyl� t;r •. ,t 'L.•..r•s;, '' S• t'Sf::'. t,t.:. ,�.L" 9n 'S18Il1 �... ! t?t+' ,;7i•1if' \t��r .'I"" 'l' .' t COID V ' .• ,'yf. '•'�t•u',, t •�.. r :fr t•..`., ir1:'•,..yll .i^�r• ,4, eadzess'.t' ••. •r ,t,M.'• ' . r: ::�� •r' �°',�;•''4:'S' hLl• '• `il'di10'ff. . .• .1•ZJ•:nyt. r' '. ''�� ' }' r;r' a 'tip' �Q't` rf�•.:,' �1.•'r•e,95P '' r:.•:bh;1,I.:•• •n r::' :'< :l: 1�r, f Cl r ' a l: i7:.• i y.4 rQ.t 1 rr y �\ tJ.ti.•,•'t` iB5111'fiIl � 1 , •' ie::i'ti •� 1,f.; : ,r. ,��;"'�,�., r r ••F,., +. �7:!t•��:ts+•. :J..,'vt,.� .C,•. 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'' � • cadres r:. t. �o . ,,�..r„+. .r• '.� } .'i,•'r •"., MATURE _ t,' .':1i•r,a:.;';%R.•.. }5.':•t5•.:1 •'l.,'`t•+. t .i,: • `' .!'.. t„' ,� ,', ', �• .f �'.n, p '•'.i.• a :s�i:• f,5 ':�'4Ytt: a,..+>1':�' ,'' f; '. ,}•C.�•irt,t.,4<'4,,i+ ,�`�. � °u+ • ._{:•t :rt,t2- ' :t:' 1't'n;.lr r<,f it',i"„•y' •,• 'i•t•�•' CI . .�•t'.;fit. r'1''':+t'„i.: +:1'`• r"t• ;t+ ' '�;s it r; r' I.I t,i;'yo'„l,i.• 0•]1C.' s••,L'.t•,^"' •t,,l r♦ - '' ri}'.. f�y' `:. f••4:a• I• t•::i+. •Y�•r. +.r:.:4ti,•,'tti.;•J •�, t. 4�'.. ••. r•Ji „ '• . 11 'it..Y:'y.t'::5.,: •y..: D to si,Souc an or insiirsnc8i{;i•:,,. • ' enaYries of a rw up Fallnre to secure cove nt asp eIl 1 e Penalties�a 23A of MGL TO can lead to the imp osition of crimfnalp the foi m o[a STOP WORK OtDEA and a fino of�100.00 a'day against me' I underetan t X one years'impris onm copy o f this statement maybe Well 21for crded to the Office of 7nvestigarioin of the DjAfor ooverage verificatioov is frue and corXec>~ i under ihepains and,penalties of perjury that the information provided a J/ D I do hereby f3' Dato Signature h phone#t;'+� L=� 7 • , print name _ de not write in this arm to be completed by city or town oftic14 ❑Building Department official w a only p ermitllicens e# ❑Licensing Board city or town: ❑Selectmen's Office �]HealthDepartmeat , [}•checkif 1mmeai-tc rrspowe is rcquired []Other phone contact pt r3o �,�yjsed5ep • ' • information and jAstructions• r ' al Laws chapter 152 section 25 requires all employers to pxovfdc Qvorker. eor eas lion for their. Massac,ji s f5 Gefler :. 6 .•t. employees, As gtroted'fromthe f`1sw", an employe is.defined as every person in the service oi'another under any contract of hire; express or iix 11ea;oral or written. . artners , association,co oration or other legal entity, or an two or rmgre of •pn,errcplvyer is defined� an individuak,p� hip � . the foregoes�gaged•in anoint enterprise,and including the legal i;epresentatives of a deeeased,employer, or the receiver or artaershi association or other legal entity, employing employees. 'Howevei•.the owner of a trustee.,Of au individual,p pj. �aot'inore than three apartments and-who resides therem, or the,occtrpant otbe;dwellinghgttse bf dwelling house haying,.,. . another who ibyspersbns to domaf Aenance, coast nption or repair work ozr such clwelIing fiou�e,6r on the grounds or errant thereto shall not because pf such;employment be'deemed tb be at.employer,••,.,. $ , building PPS •. . •;: . , . ' . • •.: MGL chapter'Y52 sectzbn 25 also'states that'every state or local licensing agency skill withhold the issuancb or renewal of a license or i?e1"n?'f to operate a business or to construct buildings in the.6ntimonwealth for any applicant who has not produced acceptable'evid,ence'of coinpliantie hall�e��o�Ce eontracgfar the perforrnavice of'pnblzc work unt�,q,'• cozxmo�v'�althn°r.any.of its political subdivisions s y liance with t�e insurance rbquh•ements of this chapter have been presented:to the contracting•. acceptable evidence of comp authority: . •., Applicants Please f tiZe workGrS'•eo en9a�affidavit completely,by checking the box that applies to your sfttiatiom,Please su ky company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted PP to the Depa��t•of �rrdustrial�,.ocidents•for co�nfixmation of insurance coverage. Also�be sure to sign and date the vit should b e xeturned'to the city or town that the application for the permit or licros a is being The affidavit s affidavr arhme it o )hdustrial J•ccideuts. Should you have any questions regarding the `law' or if you are requested,not the DeQ o lain a.workers'•compensationpplicy,please call the I?epaTtmebt at the niunber listed�elovr. t required to $ . ., '. City or Towns • , M t the affidavit is cbmplete and primed legibly: The Aepartn=thas provided a space at the liott=a of the e sure tha Pleaseb oure ardln their hcant Please affidavit for you to fill oat in:'the event the Office of Investigations has to contact y g• g pp errrrit/license number t�rhich will be used as a referbnce number. .The affidavits maybe returnedtq. be•sure to fi11;m'the P �' ements have been ma.de,' •`•�:••..' . .. ;, ' ' f lap Aepartmeutb3.I�ail Or F.AX,unless other;arraug .. The Office of Investigations woukd hike to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a•cal1... , / moment's address,telephone and fax number: The Aep • - The Commonwealth Of Massachusetts D ep arbnent-of Industrial Accidents lie of ices ens 600 Washington Street Boston,MR. OZ111 fag#: (617)727-7749 Mrs . Christie Rennie :House 1959 Uprer :'a'.n St . , east side. { This house was built about 3B38-'70 by Owen Jones Lucretia' He was a builder and house mover. puny Cotuit houses were moved 'during his lifetime, so it was quite` a lucrative business . Summer residents"Mere buying land along the' water front and having the small houses` situated there removed: They adopted their neice, :Helen Harlow (iLrs . Rennie) after her mother dried. In 1895. Mrs . Jones ran a boarding house, Rooms and ?Teals $1. a day. Her husband at that time also ran a stable . " Yrs . uelen Harlow Rennie m. Christy Rennie m. Carl Burlingame . Her children: Lucretia Burlingame Berger married John Reid,Later 11r.B�i°_=. .1. Roger It `� mo ElizabeUh Linnell Thomas Rennie m. Sally P Bearse . . `r ncis Rennie unm. 46 _3 S •y 1. s f. e .t.ri•'' 4 ^ri .. :4 4 Barnstable Assessing Search Results Page 1 of 2 Add Home: Departments:Assessors Division: Property Assessment Search Results r9 564 MAIN4 STREET (CVd-%TUIT) Owner: S RENNIE, EDMUND D&GAEL P Property nd Map/Parcel/Parcel Extension 036 /021/ Mailing Address RENNIE, EDMUND D&GAEL P P 0 BOX 764 COTU IT, MA. 02635 2004 Assessed Values: Appraised Value Assessed Value Building Value: $140,806: $ 140,800 Extra Features: $2,400 $2,400 Outbuildings: $2,200 $2,200 Land Value: $ 154,700 $ 154,700 Interactive Property Map: ap requires Plug in: Totals:$300,100 $300,100 1 have visited the maps before Show Me The Mau April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: RENNIE, EDMUND D&GAEL P 7/15/1983 3801/046 $0 r t 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,983.66 Town Fire District Rates Other Rates I 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Cotuit FD Tax $456.15 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax .$59.51 Hyannis 2.03 t West Barnstable 1.36 Total: $2,409.32 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 5/11/2004 'f Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.65 Year Built 1900 Appraised Value $ 154,700 Living Area 2373 Assessed Value $ 154,700 Replacement Cost$ 176,004 Depreciation 20 Building Value 140,800 Construction Details Style Cape Cod Interior Floors Typical Model Residential Interior Walls Typical Grade Average Plus Heat Fuel Oil Stories 1 Story F A Heat Type Typical„ Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 1/2 Bathrms Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,400 $2,400 FGR2 Garage-Avg 288 $2,200 $2,200 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 5/11/2004 �' :iy vv�IrwvoVtL4i lJv'/�v��VL{l(I'Gv�[i ItAItNti'I)11IIIE. vo AIA.L, 0 230 South Street �A1i639%p`� Hyannis,Massachusetts 02601 TOWN 01' BAR11S l'11111•I, Notice of Intent to Demolish or Move an Historic Building/structure Print in Ink 1. Date of Application: A"�--�� 2. Building/Structure Add.rjess: ,@� {( ��c. `� `,� i1T-- .3. Assessor's Map and Lot 'Number: 4. Is building/structure located in a local or regional historic district: Y N If yes, Protection of Historic Properties Bylaw does not apply and it is not necessary. to complete the remainder of this form. 5• Is building/structure listed on the National Register of Historic Places or pending listing on the.National Register of Historic Placest T_______N�.-____.,__ 6. How old is the building/structuret/W t' Architectural style of building/structure, describe if not known iJ - , Is this building/structure associated with one or more- historic events or persons, name and description 7. Type of Building/Structure* and Proposed Work: L� C) o — y S/8. Zoning district: Fi.rc District } 9' Applicant's Name: CG'd v� Address: 10. Owner's Nan►e: C e e lam... ` Tel. Address: -. ,- Tel. N � 71 ?3 S'S • Contractor:7 sa>-T;-� ,, Address: JLxr� y 1 � Material of Building/Structure: 13' How is Building/Structure Occupied : _ No. of Stories: 14. Explanation of Lite proposed use. Lu be made. ul• Lite s1Le. � ��►c��t� f Diagram of Lot and Building/SLructure wi.Lh DinlcnGiuns : i I r < y, ,...�..� �` e 1 x-� L.g s,� A �'r .e � s>s�.� Sgn3�c�.a�'�� 'v �•� >a �'� � AL t� g � �✓ x � � "� � € .�.'4» ,,� 36 V'�#� .i, n'�� 3 �eX �. Y �.:v�� ,, `€t''s'�,��z �`^ r }�`�„r Y u x i k k 6 i i i' . ��• `i.�, CIVLItVtI'Gt,tit.GYi l'lV%!G%/frLfiUliV%G nnansr, 111Y. MASS, w 0 230 South Street OR, ��o,l•t679�% 14 Hyannis,Massachusetts 02601 :Ii'� .. 'icnrtl UF,li�R1151A111,1i ' Notice of Intent to Demolish or Move an Histori�6�Balldi-ngy8trUd-ts4re Print in Ink 1. Date of Application: � ) '03/ 1 2. Building/Structure Address: t (o .3. Assessor's Map and Lot Number: 4. Is building/structure located in a local or regional historic districti Y N� If yes, Protection of Historic Properties Bylaw does not apply and it is not necessary. to complete the remainder of this form. 5. Is building structure listed on the National Register of Historic Places or pending listing on the National Register of Historic Placest 6. How old is the building/structurei/ •t- Architectural style of building/structure, describe if not knowni,- Is this building/structure associated with one or more historic events or persons, name and description 7• Type of Building/Structure and Proposed Work: � ��� � j,:�, — 8. Zoning District: Fi.re District �' g 9' -,\ Applicant's _ Address: - // �± / <j 10. Owner's Name: C �.. �_.. ' TeX. 11 :� Address: � � Tel. 11. Contractor:'A sai Address: �. n J�%� 1 • Material of Building/Structure : 13' How is Building/Structure Occupicd : ldo. of Stories: 14• Explanation of the 1 i)ro posed use to be made ul' Lhe site: Diagram of Lot and Building/Structure with U.iatenGions: Ilamc - A � n it a d { t f { { t f , i f V