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1611 MAIN STREET (COTUIT)
s 7r U " Town of Barnstable * ermit# Fpires 6 months from issue date Regulatory Services Fee 11MMSTast e, Richard V.Scali,Director �® 3. PERMIT • i639 1 RFD MA'S A Building Division Tom Perry,CBO,Building Commissioner, JUN 0 9 2015 200 Main Street,Hyannis,MA o2�q�WN OF BARNS-TABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 17 L-) S Property Address Hall ►YIjqiN -ST. COT U I T' M Pf� ©a G3S J ❑Residential Value of Work$_ 5. 6 7—S , 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ?�SSfI "TTZ(dST CARL Contractor's Nam ¢ Telephone Number 6266 1177— 96 9 Home Improvement Contractor.License#(if applicable) /®46 al 7 Email: Construction Supervisor's License#(if applicable) S o 41.0 C� ^� ❑Workman's Compensation Insurance 4Cck one: P-: 1 I am a sole proprietor A I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. , Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) , ❑ Re-side �ZLReplacement Windows/doors/sliders.U-Value o,a—7 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Im ment ontract rs ense&Constr n Supervisors i ense is required SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Tempor ternet Files\Conten. utlook\2PIOIDH SS.doc Revised 040215 I f 1 * RAM aTABLE r 1639- ,� Town of Barnstable FDA Regulatory Services Richard V.Scali,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 'T: 1ZAP� CsttRsS�.N i -n2 us Y - I, CM L SQN/ -Mli S'T-Q 4 - ,as Owner of the subject property, hereby authorize f ��'7/FIlle als` `�O�S �lal is ,� to act on my behalf, in all matters relative to work authorized by this building permit application for: , 1 1I m4i4 ST. cc)TUi T, AM ' OZ633' (Address of Job) • .ram . Signature of Own Date C'4 e,� S' l , Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the " reverse side. - C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.outtook\2PIOlDHR\EXPRESS.doc Revised 040215 ne Co kk ofMb=chwse9F'. y �Dejvm�rer�t o,f I�ttccid�s _ O Of Invasktvns 600 l whington Sit Boston,MA 02111 • tivrvramasxxg�ov��a ' . ` Workwe Campensation Inn wince A bass Applicant tformation Please Print Nam Address: t- . 1"04-1.. S . Are y an employer?Check the appropriate buc Type of project(required); I-El am employerwA 4- El ansageund c m ackw and i o cfn11 andlorpact�me�* Lehicediire avb ads 6. p New aooatnction 2-oia4m a sole proprietor arparbw listed asthe attached rhea 7- ❑ ship and Lave no emplcTm Time svb-c�cs have t£ ❑Denioliiim wdddm fotnoe m- employees aadhave masker ' t3' insmauml 9_ Bullizig addda io [No wadmis'comp-msuza= c requitfl 5. p We aze a cmponitim and its 14❑Electric repairs cr additions 3_❑ Lama Lam'doing-allwaA o aCrabavedwased 1I_[]Phinbingzepairs oraddW= nTwH[No '.cwV- rightofmmgdcnpermGL l-❑ itaffiWam insuiance ]t c 15Z 11(41 and we linetno gip -[No wo*e& 13.❑Odcer coup.numcmm -] . 'i�rappTr�tBatitcbed�shm�lam�ta�oSIIoaitheee�mbeDoivTtu��ad��a�tianPo�croa_ � HomeoaoMs wbu&l.ds aMR Imit a may aiNdaat mdicatug Bach Zoma knilwclmrYlkkboK==.stwj lmaddttimdsheetd mrfgthewmeoitkesob-aomafa0ocsudswvwbetberw notthoseMahe Iftlsesab rs�eemQ3s�ec„1�u�y�ctpm�vldtdw&wooke ''o-PelkToozodm I am an exiph),w that ispravidEng 'coegrsnsafiapt i rraece for cry empiq l v is!be pokey aped job nobs: inforpeaiian. _ . , hisunme Company Name: Pdky#or Self ins.I C # : Job S&Addmw /&& (WO t J s t_ Attach a copy of the workere compmwdenporicy declaration gage(AwrIng the policy amber and egmation date). Failure to secure coverage as required wader Section 25A of hMM c. 152 can lead to the iuvosifm of criminal penalties of a Sae up to$U0O00 andloe one-ymimpdscamenk as welt as civil penalties is the fans of a STOP WORE ORDERand a fine ofvp to$250,00.a day against die violdar_ Be advised that a copy of this statement may be f vwded to the Office of Investigabiods of�e D7A for iaauanct cav�erage tine: I do&pushy cmd thspazrrs pmab es ofperjxq tbet the&forat prvPi&d&h ws is bare and cavrrect Phone Z 2`2 t) ciat use only. Do pat write in d* to be wmp by clip w tea m afficini City or To enc PermwLieease# Issuing AaAorRy(drele one): 1.Bm d of Health L BmlftDqwbmmt.3.Chy/rown Clerk L.Elechical 1wgxx for 3.Plumbing Inspector 6.WNW Contact Person: Phow if: . __ 7 P�l�ssachti3efts-DEpartmen#Cf Putl�c Safety * - - = Board.of Buildiiag R to## ns..antl Sfantlar s ` r e��c��z � rru�c�r�lf'n sr cfiJ s©ffiee of Goasumer Affairs&Supi6ess R i my og onstrucpon Super►isar OME tl1( AGVEMENT CONTRACTOR License; CS-0858.. i. etraUon t02827 Type gis y _ xpiraUon 7/2/201f DBA 5 MAIN ST " EL FLOWS BUILDING&HOME i .PROUEMEtJT � I MASHPEE MA 61b49- �� ' " } t , f,_ JamesG Fellows � ' .' 5 Main! J.,`.► j = XPITatlof Mash ee°MA 0264g ° Gomriussaoner 09/30/2015 P Eioderseeketary f { 2 { _._ k f; ROOM xvlvu� MEMO 1 jig y"�No scow vfyj�jjf, AN ; 010.44"Sly on.its A shoot Qq ._ MAN A two f t ' KIM zoo 000 KIN _ $ - _ 5 ANTS WAIT SA? AMA � 4 � LK s f MW boost 0% VON- was -lay JQV, T I ] A now 1 IN k 4 r w 4. hVAN v o Y f eJ MINK, 1.1 pan TJ U OWN son _ TWO.- Ion 14 Qtjn r ' ROT Tow fit {}t - - .I §i $u%x vw++"M ..1.,,.�>.x, y.xY2�::...+•.xw...:...�..n..a-.a><.... 1_�,.�_. ......R,-..<a.... .r .r._,....v,..+.,..�,...,.e_....e.Y._`.. ..aww.«_. ..x-n.,di..w,. >..o s„,..,1-,..w.a.(w .m.,.r..m ,... ac .�.a.a« ,..,....«,ted s...:w. F-..ry5a�aa.-..«.�.w..��e_k..x-. 7_7,,.�. s 7_. ,..,., .. ., unrestrlde'd-hiiildtngs of any use group which C 3., ' 3 t.icense otr re stration valid for indw�dut use only contain less than 35,000 cubic-feet(991m )of �' beTore the expiration date; If found return'to + A enCl`Osed Space pffice=,of Gonsgrrer Affairs and Bpsiness ltegulatioo ,10 Park Plaza"Suite s o46 , Boston.4"'02.116 ' f # A° > failure to possess a"current edition of the Massachusetts:" s State t3uildi Code iscause for revocation of this hcense: 4 - . Not vaid w�tTioot signs ire _� " �: F,a?605 Licensing information wsit: www.Mass Gov(DPS , . . k s w �; >a y S y k t k - F f - r - WAA _ - - e [ ,l t k $ f ! _ V ',€. - s B } pp 1 ' gr ry 3 _ n { s _ k Sj F t R i M. t - { {q 4 b! I j. 1 J - } c N t a� 1 - -.y 3 g no kr a MIT) UYS j p d? }�� � f' Hs fi f ' {,- F - :.Y € ! _ 3 x s - j s) t F _ f k - , p [ L 1 �, 3 X f1to f cG - , - is w 4 Fk r e Kh My"A rL`3k as m� r .:; ? sac: �. Q14`" � c x r .� a r .'N. ,` a 4 sia its e 4 # zy k + qA .' v bYly a i. .� 2 'r ; s * Town of Barnstable Permit Expires 6 months. om is e d Regulatory Services Fee SA 1N TABLE 9 Mass Richard V.Scali,Director TFO.39. A Co- Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number D 0 Not Valid without Red X-Press Imprint Troperty Address c6f . � I vl Residential Value of Work$ r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number pot M Home Improvement Contractor License#(if applicable) _ R P IT Construction Supervisor's License#(if applicable) Str ❑Workman's Compensation Insurance �o,A'N ®C BnRNc�p�1 C Check one: UU f A J /1 LC ❑ Jffffi a sole proprietor -I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ' U/Replacement Windows/doors/sliders.U-Value D t (maximum.35)#of windows - #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S_ and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. r ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvem ontractors License&Construction Supervisors License is required. I-. .SIGNATUREZS�\ Q:\WPFILES\FOl ng permit forms\EXPRESS.doc Revised 06131i3 w YTm Ctrrtsynurtf€t--�of MaEsachuseffs Depwfinent of hu&shizd Accidents - OKWe of AMWsaga ions 600 Washington Street Bgstan,,MA a-211I tvFtII rrrrrss:gOu/dia Workers' CompensatianInmrance Affidavit.Eu Tders/,aIItra_ctors/EL-ctriciauMumbers . AppEcant Infarmafion Pease Print ,ibly Name() s3JOFganiza iou&ayidu : !C { tyfstai2IZ.i = Phoneme Are you an employer?Check the appropriate box r of o ect :r �-. I am a.e�ez-a1 contractor and'I Y� � J ����- 1_❑ I am a employer with ❑ $. 6_ ❑Neu coal in oa employees(full andlorpart time}* havehrr the sub contractors. 2_❑ I asn a sole proprietor or partner '�listed on the attached sheet 7_ ❑Rearodelizg ship and h nTe.no employees T1 e sub-contractors have g_ ❑Demolition werkma, forme in any capacity- empla5�and have warirers' Y � 9_ ❑EuiIding adiiifion TNO, _ ' comp:in¢�iraiia-e.. - CoaT1p_insnran" �] 5_.❑ hie are a corgoratioaand its IGTJ Electrical repairs cr additions officers hati�e eKercised their 1 t_. Plumbin airs or a4dditioss 3_ s am a homeowner doing all wort= ❑ �ref' right.of e: .doaper MGL �y�seI£ [No uror�rs'comp- l?.❑Roof repairs, at,c�xAa,�e repaired_]f c-152,§1(4),audwe hxve na employees [No Workers' 13_0 other Comp_msmmce reg6red:j I hny appIdcmE txt checks box fl-,mst also fill o--rt thee secdua beleve-d wing ih&woilere comatmadoa poEry info 1 A�.,,ar cm�tsmn sub�rt ffiis afi�dsci['**�`�tney ale�iniag�tsr�c�.ei then h>�uutiide cn�tracton mtrsi s-r�s�at s ae�z.�dsrst mcfir�:.�snrF* , 4"C'.t�ix�cton iry4t cT.xlc this b�c mgst sVached sa a ts�irionsI sfiezt sh�crmg iT�nssm;of die srtu-ass omd stst$uhet�[ecnn:those e2uifies brut EmplIIyees- if ih°sub-cCMtMctffM h.-ee Mployees,&V must pxuride Ih-r worki--s'comp policy number_ -Tani arz a ripicryer thatis pros idirzg r4rori erg'compgturtiv.n irminwcaformy emp&yygm He..Tntr is thepoEcy artdiob s6a Insurance C.onspafrYl�£asne: , Policy fr or Self. UcAk FxpirationDate: Job Site Address_ Ciiyo'StatelZrp: AttaxcIr a copy of the workers'comp eusatiou policy declaration pab(showing th+e policy number 2 d expiration date). Failure to secure coverage as regisireduuder Section 259 o€MGL c- 152 can lead to the imposition of-criminal peaalties of a fine up to$1,5 MOD and/or one-year imluivonment,as welt as civil penalties in ihe fates of a STOP'rQRK ORDER and a$ne of up.to�250-0.0 a day a&unst the violator_ Be advised that a cam*of this st$tesueul maybe farwarded to the Office of Iares(igatio�s of tip for Tnstrancff,coverage verification_ I dd hereby c fy rFaui�r the pcun nd pSnaL es�fetfhs is rMation praiidRd abos e is bzcs and corxBcE ` e spit` �� EJff-tirirL use arrF}. Ia not ivritg in this areaP to ba wmpLeted by cif}v ar town officiaL { City or Town: Permit/Liceuse# Issuing Authority(circle oae): ' 1.Board of$ezl'th .$ceding Department I CitFfFdwa Clerk 4_Electrical Inspector S.Plumbing Inspector .&Other Contact Person: Phone#r 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iegal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other Iegal 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 suc'n 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 th�I"every state or In cal 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 n.y applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally,MGL chapter 152, §25C(7)sees"Neither the commoawe-a h nor any of its political subdivisions shall enter into any contract for the pe-iormance of public work until acceptable evidence of compliance vith the insurance requirements of this chapter have been presented to the contracting authority." Applicants — Please fill out the workers' comp. pensation ar�7i davit completely,by chtclkc rg the boxes that apply to ycur s-ta.atien and,i.f necessary,supply sub-contractors)nlne(s), address(es)and phone=- ,ber(s)a.long with their ceri:nc e:(s) of insurance. Limited Liability Compaq es(LLC)or Limited Liability PartDer,laifs(LLP)vvithno en-grloy�ts other tan ube members or partners,are not re-gv red to carry workers' compensation ,sir Qnce_ if as LLC or LLP does have employees, a policy is requ=-e1 Be advised that this affidavit may be s bz iited:o the Depari:ment of indiizu-al Accidents for confirmation of=--ance coverage. Also be sure to sign and date the affidavA. Die afLdavit sbould. be returned to the city or town that he application for the permit or i cen.sc is being requested,not the Department of Industrial Accidents. Should you rave any questions regarding the law or if you are required to obtr-_iri a workers' compensation policy,please call ne Depaftment at he number lisp below. Self-nnzred comp�ies sn.o lld enter. i e r self-incitr211ce license number on to a_-ppropriate line. City or Town Officials Please be sure that the a idavit is cnmplete and printed legibly. Tne Depaz-mtrit has provided a space at the bouom of the affidavit for you to nll out he event the Office of Investigations has to contact you regarding he applcant Please be sure to fill in the perrait1 cease number which will be used as a reference number, In addition,as appLcant that must submit multiple pellmn.it/licence applications in any given year,need only submif one alffidavit mmcaung current policy information (if necessary) z�d under"Job Site Address"the applicant should v,gte"all locations in___(city or town)."A copy of the affidavit that has been officially stamped or marked by he city or town may be pro-,dded to the applicant as proof that a valid affid3Nrit is on file for future permits or Lcenses. A new affidavit must be tilled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial_venture - T (i.e.a dob license or permit to burn leaves etc.)said person is NOT requ�reri to compl ete ibis aihda�,at The Office of Investigations would li]kc to thank you in advance for your cooperation and shouldyou have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. Th4 Conrmonw-an of Massadaus-� D¢paruntnt cif Industrial Acci:d(�nbs Office Qz M-Vest gatiG's 600 Washhagtan Stt� Bostoa,I4 02111 1 EI, 61 7-727-45LOO Qxt 406 or I-97-INC,SS FE Revised 4-2447 Fax ft' 6r17-727-7`t4 .11 v FFCam..r r2,s, ,,gawcaa Town of Barnstable Regulatoiry Services oFIKE Totyy Richard V.ScaIi,Director ° Building Division t inxxsTnarE Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 prFO �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION , 1 Please Print ' DATE: J �U! vl � �j JOB LOCATION: 161 I I "/� a(0 5�. 0 n r street village "HOMEOVa\TER": Sy G l� �� �l l :Samf u y f - n e / home phone# work phone# 7 CURRENT MAILING ADDRESS: x / / /0 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. _ nr- ersigned"homeowner"ce es that he/she understands the Town of Barnstable Building Department minimum inspection nes and re ementsthat he/she wi comply with said procedures and requirements. of Hom caner Y Jr 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,RuIes &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 actirig as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fbnns\EXPRESS.doc Revised 061313 J THE rq�� Town of Barnstable * Regulatory Services - va M^M $ Richard V.Scali,Director 1639. iOrEnM Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) ,,',,'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:O WNERPERMISSIONPOOLS r Pa 8 Town of Barnstable Expir Regulatory Services Feees6monthsh°"`,ss�ate BARNSTABLL Thomas F.Geiler,Director MAss. 039. 39. Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 " www.town.bamstable.ma.us Office: 5087862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Q Property Address 161 M,+w 3T. (�t7fV ff f AAT V Resi&ntial Value of WoJ:�cc Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Gu'r�f . A Contractor's Name bg w Telephone Number ,5�67�,74 �� Home Improvement Contractor License#(if applicable) d d 8 st9 " 6AJ S7W.. "OC e V sf S V C) ❑Workman's Compensation Insurance `'6 7 k one: am a sole proprietor PERMIT ❑ I am the Homeowner [�I have Worker's Compensation Insurance Insurance Company Name R,+Ve L F leS MAY 1 2008 Workman's Comp.Policy# U%' 88/X 6 A.A Q 08 xoWN OF BARNSTABLE Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ' e R ide Replacement Windows/doors/sliders.U-Value a (maximum.44) � ^ - v,2k W1wS •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: On i Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 'Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationandividual): City/State/Zip: /I/i�I-SG �� Phone.#. 'EO ?? — Are you an employer? Check the appropriate bog: Type of project(required): 4. I am a general contractor and I 1.El I am a employer with � � 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors listed on the attached sheet 7. I am a sole proprietor or partner- .�odeling K�L ship and have m employees These sub-contractors have g, Demolition ' working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp.-insurance comp'insurance.$ ieq&ed.] , ., 5. F1 We are a corporation and its 10.❑Electrical repairs or additions 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required] 'Any applicant that checks box#1 trust also fill out the section below showing their workers'convcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t-_Mtmctors that check this box trust 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'corny.policy mmnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f Insurance Company Name: Policy#or Self-ins.Lic.M . Expiration Date: L Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. -- I do hereby certify under the pains-and pen ' o/�f perjury that the information provided above is true and correct. Signature: Phone# 6 Official use on Ty. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.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 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." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiVlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense 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 io any business or commercial venture (i.e. a dog license or permit to brim leaves etc.)said person is NOT required to complete this affidaviL vesti ations would like to thank you in advance for our cooperation and should you have anquestions, The Office of In y y p y y g please do not hesitate to give us a call The Department's address,telephone-and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 4-06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mamgov/dia lime Town of Barnstable • enaxsrnB[�. . 'bs9039 Regulatory Services p1 �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 I ,as Owner of the subject property hereby authorize ��°"' S ✓ - to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ignature of Owner Date J�M el Print Name 11 Q:Forms:buildingpermits/express Revised 123107 GTE 1° f Board of Building.Regulatioris and Standards HOME IM!- 10VEMENT CONTRACTOR RegistFati n,02827 P`NNQO2Q08 Ti# 1;26463 , �r - {A f FELLOWS BUILDtN&M—L—lGim1=1M ROVEMENT r James Fellows_ { a 5 Main Street. Mashpee,'MA0264"9 Admmstrator i a. t Se only ' -,�- individul u valid for to; a or registration If found retu Licenser iration date. nd Standards 'the exp Regulations a before'.of Building 1 shburOD place Board pne A Boitonl Ma.02108 S lai,1.0A tur j.. a e, `Notvalidwithoutsign. J� y l .. 5, I Lossesst, office (1st floor): Assessor's map and lot humberr ...map 17 , Lot 5 l �♦ Board of Health,(3rd floor): 8 7 749 Sewage Permit number MARISTGDLE, J .: Engi`neering,Department (3rd floor) I / .J MAC Sr. EI�iVI House number ....: ... ........... .. ............. ..... .:....................... T(.)VM REGULA Ara. Definitive Plan Approved by Planning Board -may _5 19 79 APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00•2:00 P.M. only TOWN OF BARNSTABLE A p p R 0 V ED : " ILDING [NSPECT0R Barnstabl :"vation C0111fttsucu ION FOR PERMl7� ....B�ii,1 d..a...s.ing.] e..:f.am.ily...dw.ela.l rtg. sign @d Date • Wood Frame, 1 ` TYPEOF CONSTRUCTION ............................................:........:..................................................... ..F.e:k�.r.u.a.�. ].3.........:. � .19.6.9:. ` TO THE INSPECTOR OF `BUILDINGS: The undersi ned hereby a plies for a permit according to the following information: f611 rh l N S _r. , _ - Cotuit Location ..:..... ............................................................................. Proposed Use ....... , Residential Dwelling. . ................ . Zoning District ........R.F...........................................................Fire District '... C,otu•it........ ..... ....:.... Jessica Rapp Grassetti jName of.Owner .... a•r l•,„A•.....G r,a•s s e tt ,,,,,,,,,,,,,,,,,,,,,,Address ... . 1...... ,,•,C•o t u• t, m A 0 2 6 3.. Name of Builder Ca_r.l:•,A......Qra,sse,tti;;,,,,,,,,,; ,,,,,,,;,Address ..:.Bo•x 1,3,10,, C•otu•it•,• �IA•;.02.635..,;,•;....• Name of Architect D. A......in... Annino••,A.s.... ..: Addressl.5,9,••P•le,a•sa;nt • St•••, Attleboro, IAA Number of Rooms .....t.en....................::................................ Foundation ......Co;n;er.ete......:.......... :......... Exle for :._....Ced.ar.:.sh :n.91:eS:..:........................... Roofing ......:A.s.Ph.a.lt......... . Floors , ........Two... .::......:...:......'. _:..........Interior ......QT.y....lUal.�...... . .:. ... p.......:..... .... Heating .....G,a.s......�...... ..W. .�Ri...?.] F...................... .......Plumbing .....3....b.a.t.hS............................................................. Fireplace .....masonry........................ .......Approximate Cost ... .,1.78 , 000 .• U 'Fo •ndation 2 , 950 sq. - ft . Area Tat.aJ:. I.S.t....`&...2.rid...4 , 956. s Diagram of Loy and- Building with Dimensions Fee $265 50 q • f t Board of-, Health Sewage Permit Number 87=749 Q November. 12 , 1987 �2 13 Barnstable Conservation Commission Orders of Conditions recorded. Nov . 13 ,,. 1987 , Book 6020 , •Pg . • .093 Amended Orders of Conditions Recorded Jan . 19',.' l987.,;,Book . 6104 , Pg,. .322. OCCUPANCY PERMITS REOUIRED. FOR NEW DWELLINGS I hereby-agree to conform to all,the Rules and Regulations of.the'Town of Barnstable regarding the above construction. Carl A . G r a s s e t t i Name .... .. .. ... .............. ......... ..9..32 Construction' Supervisor's License .... . GRASSETTI , JESSICA RAPP & CARL A. :.. Permit for ....` .W to r.Y......... �. fir. .... .. � .... Single.Z mUy. .piael 1. n.g......... r Location 1.61.1...i"I .,I?..Stx�e.t..:................... j .. . ..........Co.tu . .......... .. -.......................... Owner .Jes,sica. Rapgf.& .Car�1..A..:..Grassetti` ' Type of Construction :..F.Rame..... ':.......... ; .. .... . .. ..... ................ Plot ............................ Lot b9................ ................. Permit Granted ........June...2 7...,........19 89 �. Date of Inspection .... ..........................19 Date Completed /..........., f(. /.[J...19 l Assessor's office (1st floor): Assessor's map and lot number ...Map 17„ L..t 5 THE of rot Board of Health (3rd floor): 87- c, 1��(J }' fO Sewage Permit number .....................7....49 EARBSTSDLE,MAS i Engineering Department (3rd floor): ",��� �-' ' 'oo 39• House number .................:................................`.,.........v....:.... _�9 o�pra Definitive Plan Approved by Planning Board _______y----_------------------19__'_____ - APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only _,.. TOWN OF BARNSTABLE � BUILDING INSPECTOR , AP P ION FOR PERMIT TO F3 u S.? ' 2 a-n c),� f r _� )A jo�11 n g Wood Frame TYPEOF CONSTRUCTION ....................................................... ...................................................i........................ F-ebri.' rY.. 3... ...... ....19.89 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for 'a permit according to the following information: Location � .CouVlt .............................'... .................................................................................................................................................... Proposed use Rosidential Dwelling ............................................................................................................................................................................. Zoning District RF ............................................................. ...........................Fire District ... %otui.t lessic.a...Rapp...Grassetti. Carl A . Grassetti Box: 13:1C , Cotuit . MA 02635 Nameof Owner ..............................................:.......................Address ......................... ...................::.................................... Name of Builder Carl A , :j . ... .rassett.......................Address Box - 1.310, Cotuit , MA 02635 ..........................I....... Name of Architect ........'.:nninc . Anninn i�ssec. .Addressl50 Fleas�.� i . , Attleboro, iylA ......................................................................... Number of Rooms ten Concrete ..................................................................Foundation ...............................: .......t..edai s`ting.'t.es Asphalt Ex1e for :>. ..........................................................................Roofing .................................................................................... Floors T`iv Ury Fall ......................................................................................Interior ............:. Heating Gas Tiz'ed w,:.,:m air ..........Plumbing :5 ha' hs .......................................................... ....................................................................... ............... Fireplace m``�c ..r.y...........................................................Approximate Cost `�1.7G ,000 .................. ................... rcundaatlon 2 ,950 sq. ft . Area TP._Lal....1.st.....&.......2d....4,95E n... $265 .§0 3U4. ft.. Diagram of Lot and Building with Dimensions Fee ....................................... ..... Board of n Heal 1 i;, Sebiaoe E'ermit Plumhpr R7-74S November 12 , 1987 Gai-,.St3�)1E Co.-,sei:vation Coi,imiysion Orders of Conditions recorded I10ki . 13 , 1967 , E:ook 6020, Pg. 093 Amended Orders of Conditions Pecorded Jan . 19 , 1937 , Bock 6104, Pg . 522 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding `the above construction. i arl A . Crassett:i Name . ..... .............X"Y 039032 Construction Supervisor's License .................................... GRASSETTI , JESSICA RAPP & CARL A. No 33016 Permit for ...Two Story........ Sincrle Family dwellilqq........... 1611 Main Street Location ................................................................ Cot .................................u...i...t ........................................ Owner ...... es.sic.a...Rapp & Carl A.. Grassetti ............. ... Type of Construction ..... r:a.T}Q......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ......June....... ..............19 89 Date of Inspection ....................................19 Date Completed ......................................19 7011 4,!,;yh6 PERMIT COMPLETED 1/1/-L 'Ile � � ! -rwE TOWN OF BARNSTABLE. Permit too. 3�6 BUILDING DEPARTMENT I Faun ($2 0 0.0 0) ................ I TOWN OFFICE BUILDING Cash i6SV. 9�our. HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Jessica Rapp & Carl A. Grassetti f Address 1611 Main Street Cotuit,Cotuit, Mijas. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. May 17, 19 9.0 Building Inspector �:d 'n"` ?',^z :,`?�'a"• .atil -, 01,111115RE1 µ', "�.' ' ,:ls ,s'�..,,.}c' r— '-;•<,w-, 'gyp.' ' � f, m OF,BAIANSTABLE, MASSA4NUS�f � F yBUILDING 1�=17-5 C�d 19 —� PERMIT NO. APPLICANT_(� 1 ADDRESS. E RE 7 (CONTR'S LI CENSEI PERMIT TO t r• t ; NUMBER 'OF 1 TYPE OF, IMPRO MEN O 'STORY '.;rr i DWELLING UNITS 'N'O. IPROPOSE&USE) F AT (LOCATION 1 fib MAl 11 of Y'-�Fa{{� •ft1 77 ZONING • I (NO) DISTRICT._ .'BETWEEN EEH (GROSS ,STREET) AND - ,,...,,xy-.,. ,. (CROSS STREET.) SUBDIVISION*.. LOT LOT BLOCK SIZE - BUILDING,IS TO BE FT, WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE -'' USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS' G d @' �.7 UO , �I�ll`lI�y ; r "a .•a '(CUBIC/,SOUAR' FEET) ESTIMATED'COST' 1 J s V V d. FEEPERMIT � 'Z 65.�50 z"s O ADDS ro r BUILDING OEPTBy , ,THIS PERMf it - - -`0,E RM AN E!N TL } PRQ.VED BY TI FROM THE DEPARTMENT OF PUBLIC WORKS.�WT N'1=`155U OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. _._,w.._... MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON .1QB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED �-FOR ' A L L.,CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. I.. 3. FINAL INSPECTION BEFORE OCCUPANCY. E POST THIS CARD SO IT IS VISIBLE FROM STREET . ILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i �GJC P 65 1 2 irl - g o ✓ rn +a c 3 n A S+ HEATING INSPECTION APPROVALS ENGIN RIN DEPART NT s 17-96 OTHER ----___—_--_—._ --- BOARD OF HEALTH sld ci�T�D �4,� J hn A y "5 d Ir WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L:BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOTISTARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRIT, CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. I� •i.� 1 _ �Y N -7 PLA-t f31C S3'7 PL z�4 G O 3�-y e• . .�Z o ni it° n� 0 o.0 0 •o v o 0 Z 40" 40 9 - � I V•1 E TLA r,1D 12t=-Q r � a � m •� 23 � N �a � 1 I �2-� �4 J �►, I So 5. F , �Qa i f I ' � L15 CERTIFIED PLOT PLAN 29974 taa j �ssi c t�ao��,� A� MA-PMA 1IV i _ C1�lEtvT:ert4ssETrt = F-1 E T N A.T ELl_IS �"�--1Lll_.lN It�1C. ,Od ;�1p:86 Of8 Tk4E F-\",' \ON OV-A 'T\4 I tS- c_-c-yT, t :s, Psr s�N�wic,l-�it�iL.�0253� C4A �� INS I�oNUP �T HOWN 5�12'8�'1 _ POSTS GRADE BALE 70 BUTT • -TO&E-7 • ill p. I I g7D1JE L11ER ARoU1.!D S�GT101J 13 g ( PER 11--1E�ER OP PC�I,.1D I I I S�GTI01,1 A�L01J p 45' --- cOuPI.CR • OI 5o770M OF VFR�IAL PULID all x �' SZ AKt5 EACH GALE eIr \I'�R1�.J AL P0�.1D DEf Al L �II� PL ALl �I1 t1+J SEGTIow A SEGTIou g SIM (E2� ZNx -T0�1J OF PJAR1,�5>7RP5LE 411 S�GTIOIJS or ,— ----� ----------- tz SILT rz;u.011.000, to G� 1-IO-[E'. 70 � USl✓D UPERE Eu157\QG c-RooQD / / / (�A ,� -4 G, �� ��� FILcG-R �AgRIG SLOPES A�A`� FR�NI DOE o� -CI-IE EI�6AU1`1M�1�1T // I I �� PARCEL ✓ / ��� 40,111000 0i lLtVAl10L1 ,/ uPLAUD - (p1 . 5 t'q-r--T / 1 :,; _/ ,� 1JE-C1.F�1JD - ,CoIZ. ► �. F=G� � i DuT Q07 -'O SCALE % ��' % /� /� .` 150LAT�fl bJ�TLAUD �ILT�R PABRIC �/ \� \\ / �/ ��. 4.a . ►JOT TD 5tD15TURPp O TOE 1U MCT ;� .. O µOD"A" (o LI1--t1T OF U�15u�'TAC�L.1✓ � :,:,: � SEMOVA�,L E PEGIA UOTES i / Plop \ \ I �E ,fi EDGE of 0E7t,A\..ID 01-1 >�Att�T z) ' Ip' o '4 / P45ED \ z\o�JP' �`' / >✓s7AeL15HED o� 1 1 •M DRCj �� � ,� — \p� R'� ��n �.r OCT ZZ, M67. •Cs •• �C --lOu5E M A -\ - n :.Y Tot - )1J HcT1J►OD5 • � � zoo � L.. o � \ � � � � `F � � � ` 1JI1N S7A1�ED) NA`•SGALE'S I / i T.P. . \ �� PROPOSED I�A7�R ��RV IZ' (SEE DE-T All. � i �� � 1 1 \ � -- \ � �U�� 70 MU IJ►C 1 PAL 1J'VP-t�EU-p, 1 i NJ •'0000� / � O \ __ CS O cDv�� / � PRoPoSEt�' RESERVE EA � EAU \ tlTt -i'aR 9 �1-111ARn� K�C�D "�A'��► t�UT O�- 1 / \O \�lg IL\. FOR Ot✓R11..1G VEGG T A-T ED j ' tl LAUD V-107 -TO tE \b ILD REV ISED , LIO\,L Z, I�a1 ,70 CI--I P-QGE \&JETLAUDS t VE,R uw- POUD U)CRI JDU 70 faDD 1JORK LIM\T 1.1\.1E \�IT�-I S7A1''�iED 1-IA`�i�Al.ES. LtGtUD Slf� PLAI...l JOB NO. H Of qs� FF O k)OOD pogo M ^ c s FRE ��y V I-T- , 1JI ASS A C�-1��� T� ✓ ��_�O,. y DRAWING NO. o GIs <fsSP�NAIE '\�t DATE SCALE DRAWN DESIGN CHECKED 1 OF C. t„ 1��=w' LM� RR11, PRt�