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HomeMy WebLinkAbout0216 POPONESSETT ROAD �I lI popo� SSA ' Car-o'r' TOWN OF BARSTABLE, MASS.- No #a I THIS IS TO CE IFY THAT A PER I BY GRANTED-TO ; --- + ROPERTY OWNER) '- ,. (ADDRESS) TO ABUIY L ALTER REPAIR --- ---.... . --.. .-- --..�- - -�- ... e '� " '(TYPED BO ILDIN (AP IMA jt V L"OCATION z REET AND NUMB ) '� (VILLAGE) # NAME OF BUILDER OR CONTRACTOR.----- sA : [� PPROXIMATE:-COST - -2 .. ... ---- . y -'I HEREBY AGREE TO .CONFORM TOY ALLTHE,,,RULES AND REGULATIONS OF;«THEtr TOWN OF BARNSTABLE. .REGARDING THE%ABOVE, CONSTRUCTION - - y... ('CO NTRACTOR)- . BUILDING INSPECTOR: Town of Barnstable - "• `_ OF Tp� � v P� SHE do Assessing Division 367 Main Street;Hyannis,MA 02601 BARNSTABLE, www.townofbarnstable.mams y MASS. , zG39• �� ATFD MAC A Office:508-8624022 Edward F.O'Neil,MAA FAX: 508-862-4722 Director of Assessing 7 RESEARCHREOUEST (,�cR�►� (Zo 2- YOUR NAME: A 00) LEASE PRINT YOUR PHONE# ADDRESS YOU'RE REQUESTING RESEARCH ON: PARCEL ID (IF KNOWN): OOla PROPERTY OWNER FOR THE RESEARCH YEAR(S) REQUESTED: INFORMATION YOU ARE LOOKING TO OBTAIN FROM THIS RESEARCH (TRY TO-BE SPECIFIC): .� ce_ 4z FEE: FIRST TWO HOURS $ 0.00/$ 22.32 per hour thereafter and .05¢ per copy. OUR nGr4kT1UR2E - DXTE RESIDENTIAL PROPERTY MAP NO. LOT NO. `_ FIRE DISTRICT SUMMARY STREET 2�IPo-ooneSS@tt Rd. Cotuit 19 67 C 3 LAND BLOCS. 3/9So OWNER aCd- .. 7�.Gt'w-mot. TOTAL -.5,0 0 0 LAND RECORD OF TRANSFER DATE BK PG LR.S. REMARKS: Lot 191 BLOCS. Wallace Loran E. 9 2g 5o 764 497 TOTAL LAND / , Ol BLDGS. TOTAL LAND O) BLOCS. • • w/R TOTAL LAND BLOCS. TOTAL LAND 0 BLDGS. TOTAL LAND 0) BLOCS. TOTAL LAND INTERIOR INSPECTED: /� BLDGS. ►�c1r� TOTAL DATE: �y�_ Z �.2 V , �� =r �, AND ACREAGE COMPUTATIONS BLDGS• LAND TYPE OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT /Or L ''S 3 iZ' /D 9.T o ��� /D O u LAND CLEARED FRONT ZojOtZ 124CCOA47 Pogo P O 3 v BLOCS. REAR TOTAL WOODS 6 SPROUT FRONT LAND REAR 01 BLOCS. WASTE FRONT TOTAL REAR LAND BLOCS. TOTAL LAND S-V A 4, tY BLOCS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. IMF. VALUE HILLY TOWN SEWER LAND 3/ ROUGH TOWN WATER 0 BLOCS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. G BLDCS. TOTAL Cone.Blk.Walls Bsmt.Ree.Room v 3 Co 4� BLDG.COST Cone.Slab Bsmt.Garage St.Shower Bath Bsmt. _ i Brick Wails St. Shower Ezt. walls PURCH. DATE Attic FI.&Stain Toilet Room PURCH.PRICE. Stone Wells Fin.Attie Roof RENT Two Fist.Bath / Piers INTERIOR FINISH Lavatory Extra Floors Bsmt. F 1' 2 s� 3 Sink Plaster Water Cio.Extra Attie EXTERIOR WALLS Knotty Pine Z water only Double Siding Plywood No Plumbing Bsmt.Fin. 1 Single Siding Plasterboard Int.Fin. Shingles TILING /tJ2j F.P. Conc.Blk. 57ar G F P Beth FI. Heat Face Brk.On Int.Layout Bath FI.&Wains. Veneer Int.Cond. Auto Ht.Unit �a e Bath FI.✓L Wells Fireplace Com.Brk.On HEATING Toilet Rm.FI. Solid Com.Brk. Hot Air Plumbing __G✓ Toilet Rm.FI.&Wains. __ Steam Toilet Rm.FI.&Walls Tiling Blanket Ins. Hot Water St.Shower Roof Ins. Air Cord. Tub Area Total 3� Floor Furn. ROOFING COMPUTATIONS . Asph.Shingle Pipaless Furn. S.F. Wood Shingle -- No Heat S.F. Asbs.Shingle Oil Burner 8 J O Slate Coal Stoker S.F. Tile Gas S.F. �/ ROOF TYPE Electric S.F. OUTBUILDINGS 6abla Flat S.F. 1 2--3-4 5 6 7 8 9 10 1 2 3 '4 5 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S.F. Pier Found. Gambrel Fireplace Stack - 11d, Floor Wall Fou ' FLOORS Fireplace 0.H.Door Conc. LIGHTING Sgie.Sdg. Roll Roofing LISTED Earth No Elect. Dble.Sd g• Shingle Roof Pins Shingle Walls Plumbing DATE Hardwood ROOMS Cament Blk. Electric 6�ZC�-7a Asph.Tile Bsmt. 1st -ts//� TOTAL Brick/J G 7 3 - F Single 2nd 3rd FACTOR Int.Finish PRICED �/- REPLACEMENT OCCUPANCY CONSTRUCTION S1ZE AREA CLASS[' AGE REMOD. COND. REPL.'VAL. Ph De y p• PHYS. .VALUE Fund,Dep. ACTUAL VAL. 1 - � � G ✓�7 !� � �� /�1Pao z 3 4 5 6 7 B 9 10 TOTAL fJ RESIDENTIAL PROPERTY MAP NO.' LOT NO. FIRE DISTRICT SUMMARY STREET 73 LAND — 19 67 C 0m SLOGS. 7/Sc� OWNER TOTAL LAND RECORD OF TRANSFER DATE SK PG I.R.S. REMARKS: BLDGS. CI Wallace T,orw E. 9 28 50 T64 497 g TOTAL LAND VC r Ci:: ) .5 G BLDGS. TOTAL LAND ' BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND. BLDGS. TOTAL 'LAND INTERIOR INSPECTED: BLDGS. TOTAL DATE: ;20— 2 . LAND ACRrEAGE COMPUTATIONS BLDGS. LAND TYPE OF ACRES PRICE TOTAL DEPR. VALUE ' TOTAL HOUSE LOT LAND CLEARED FRONT SLOGS. REAR TOTAL WOODS A SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND •BLDGS. TOTAL LAND SLOGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER G BLDGS. HIGH GRAVEL RD. TOTS LOW DIRT RD. LAND SWAMPY NO RD. G BLDGS. TOTAL Conc.Well Fin.Bsmt Aree Bath Room LAND COST Conc.Bill.Walls Bsmt.Rec.Room Bay / 9 `f I BLDG.COST St.Shower Bath Bsmt. i Cone.Stab Bsmt.Garage St.Shower Est. a PURCH. DATE Brick Walls Attic FI.&Stairs Toilet Room Walls PURCH.PRICE. Stone Walls Fin.Attic Roof RENT / Two Fist.Bath Piers Floors INTERIOR FINISH Lavatory Extra • Bsmt. F 1' 2 3 Sink % 1/s Plaster Water Cie.Extra Attie EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int.Fin. toed jD Shingles • A � TILING L i /0 .7�0 �� I.tJ.Di J>i Conc.Blk. G F P Bath F. Heat Face Brk.On Int.Layout Bat F1.&Wains. Veneer Auto Ht.Unit Int.Cond. Bath Fi.&Walls -o ^/ Fireplace Com.Brk.On HEATING Toilet Rm.FL Solid Com.Brk. Plumbing aFurn. , _ Toilet Rm.Fl.&Wains.Toilet Rm.Fi.&Walls Tiling 3 J 8bnket Ina. r St.Shower. Tub Area Total n.ROOFING COMPUTATIONSAsph.Shingle Furn. S.F.Wood Shingle S.F.Asbs.Shin le H r S.F. Slate Coal Stoker S•F: Tile Gas ROOF TYPE Electric S.F' OUTBUILDINGS Gable Flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S.F. - PlerFound. Floor Gambrel i fireplace Slack Wall Found, 0.H.Door FLO RS Fireplace Stile.Sdg, Roll Roofing LISTED Cont. LIGHTI G Drth No Eled. Dbld.Sdg. Shingle Root 2Tila Shingle Walls - DATE Plumbing ROOMS Cement Blk Electric !/ Bsmt. is r TOTAL U 0 . Brick Int.Finish PRICED 2nd �• 3rd FACTOR - A - REPLACEMENT P T OCCUPANCY - CONSTRUCTION SIZE SIZE AREA CLASS . . AGE REMODCOND. REPL. VAL. Phy.DeD• "PHYS. VALUE Funct.DeD• ACTUAL VAL. 1 P ecso a o a G o O o •S / /SUU 2 - 3 4 5 6 7. - - 9 9 - w. 10 TOTAL AFsessor�e map and lot number .........!.. ......... ... ................. ��.���i/ /fir / "�/'O f T E TO Sewage Permit number . .. ..... ( .w............................ SEPTIC SYSTEKWUST=BE INSTALLED Ifd;COMPLIA-NCE 13AWSTADLE, � WITS! ARTICLE II STAT' '' oo "639 ��. House number ............ .... . .. .....:........ � '�; 9,o� SANITARY CODE 46 TOWN 'EaMAI TOWN OF BA�RI�91 -Ift", t BUILDING JNSPECTOW" L , APPLICATION FOR PERMIT'TO i .............. .........6.............�. ... .................................... TYPEOF CONSTRUCTION ..........Y.!. :........................................................................................................... ...... 1 :,(..... .............19.2 `j TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according ,tto?the following information: � J Location ......4e.r..�..` .. - ..../.....' /��i..G.. sr�. !•..1.. .. lF:',a..... /..f.? Y ............� ProposedUse .......L/.�s�'. .. � .................................................................................................................................... Zoning District ................. . ....................................................tFire District ... 1h...1..4........................................ Name of Owner }�/ ; �l �%7eS �dd/� Address ' d�/ �ff�.. /r�-mot ���s=vrJr /�� :........°...-........... ......................../ ..... ......... ........ .. �.......... .......:.... :.r.... -17 Name of Builder a !G'✓�=G• ..-��.�.':..i c ..L A. .......... Address .t! !��'. ./..lc.���. ... 6 ;�/.z °% ./�� C. d l d �O�.�.Address G[r F> /.............................._ Name of Architect r...�.... ✓f....."...... ...Sl,� e r.............�... . .�1� Number of Rooms 7 .�!�,Qd � Foundation ..... G�c` ................... ... ............�.............. .................................................... Exterior .... ..:...................................................................Roofing ...J.... . :............ Floors .......... 1�1/........................................................Interior .................................................................................... AK— Heating ...........................Plumbing �`� -..... .. ...................................... ............................................................... 41 Fireplace ........J4�4 ............................................................Approximate Cost ���... ... .d..10....................................... ..... i s. . Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ........................ J�............... ti Diagram of Lot and Building with Dimensions Fee 69 SUBJECT TO APPROVAL OF BOARD OF HEALTH y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Connolly, Mr. & Mrs. James A=19-71 ft w No 21373 Permit for . 1 Z...s,t©ry••dwelling. `t ' ............................................................................ Location � Owner .....�ij�.o..& Pis ••.James••Gonnolly..... Y Type of Construction .......... ' Wood. ..................... ............................................................................... , Plot ........................ Lot ................................ Permit Granted ....................June•••,.•13••19 79 Date of Inspection .........19 ` ............................. . e Date Completed 19 Q. PERMIT REFUSED .................................................................. 19 ..... .. ... ... ... n.l........................................ ................. f f Approved ..........................................:..... 19 ............................................................................... ..........:.................................................................... Assessors map and lot number r /�G//�,' �� �J -y STHE Sewage Permit number ;.................................. .................................. t SANSTABU, i House number ............ ....Y`./.`!:�............................. yO mum C 039. O WIN a' TOWN OF BARNSTABLE BUILDING INSPECTOR . APPLICATION FOR PERMIT TO ........../...!�;!;��J�f ..........�1.,-:�.... ..........................:......... TYPEOF CONSTRUCTION ...........(X�/ I. ........................................................................................................... /...... .7.............19 . . ... , TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according two the following in�,f/ormation: .. Location ..... 6 ..1�6 ,/� 6 c -1��. / O„D s�.l. �. 7....:���( ......:' r�r�`/r�. ,: (F.. �`..... ProposedUse .........:'1../ '..�°t.. .................................................................................................................................... Zoning District .............. �.....................................................Fire District ... Name of Owner ...��A G.S...6,0 /r`1i....Address �,&?�- �Z/l Aa�tf ��re s't�/;l�Q0/„% . Name of Builder : ? .................Address 7 ;'.......G� Name of Architect ../..�:.�GA/ l/�,r.l h,�,/�•.�jc,� .Address ........... '.. ��r l� 9Ee �� ? 5:4..................... ....... �. .... Numberof Rooms ..................................................................Foundation ....:. .......,./...../..................................................... 'Ale Exterior ... .... ...................................................................Roofing r x.:.� ....!�l..t i✓!<.- !� >.1�:�.............. Floors ........................................................Interior ....................................................................... .. ...,.. / -?'•'ice Heating .... ................................... .Plumbing !� 2J !J r9.� Fireplace i��i�. ..................................Approximate Cost ? �,O )o !`� ...................... Definitive Plan Approved by Planning Board ________________________________19________. Area ....�............................ Diagram of Lot and Building with Dimensions Fee CID ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Off • V+ I hereby agree to conform to all the Rule andRegulations of the Town of'Barnstable regarding the above construction. ��- � �- J. ��-^��1................Name .....:......... ....... :....... .... .. Connolly, Mr.. & Mrs. James A=19-71 ► 13.7..3......... Permit for 7.4..s.t.E)r ...dWe.j•1•ing ............................................................................... Location ...Lcat..#.j66A..&...1.66$......................... ....216:.P.op©n,-sse•tt••Rd•:• .Eo�tuit................. Owner ..Mr•.•.&•�Irs, .T •Eornoflp........ x . 4 Type'of Construction ... .....Wood........................ ................................... ........................................... Plot ...................... Lot Permit Granted ..................... Me....1319 79 Date of Inspection ............ ......................19 Date Completed .......... ....:...................... 19 PENT REFUSED ~ ..... ................ 19 ......... .. ............................ nw .................... . .................................... ............................................................................... Approved .......:........................................ 19 r` s ............................................................................... ............................................................................... �• . TOWN OF BARNSTABLE 2is i 3 Permit No. t - »n.>t Building Inspector RAIL Cash ' -'--'----- -' OCCUPANCY PERMIT Bond ____ _____ No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to i11r. & I-Irs, James Gonno11.y Address .orwocw :h ot,s 166A & 166P 216 Poponessett: Road, Ccltui 4: Wiring Inspector ' �`, Inspection date Plumbing Inspector Inspection date �— Gas Inspector Inspection date Engineering Department Inspection date 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. .............................................. 19...... ........................................................................_........................._._...._._ Building Inspector , i1 a o 4T 4 4L/�S V N s u r Ts r��, "}... r 'r .y'�f.`,� 1 �•!` . � ' tYJi�r t r� �'1 i •� r- �� (,� A •� s� M 1 4 166 - ` ✓i v 1 LF G?mTr t tom' L ej " (� �1 -117 Town of Barnstable *Permi Building Department Fees 6 ma s issue date t Brian Florence CBO • BARNSTABIX MASS' �' Building Commissioner 1639. �fD MP'I A 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Alb 17,0 f�o,��SS ell' /3tS' /Residential Value of Work ewe- Minimum fee of$35.60 for work under$6000.00 Owner's Name&Address 1VCA1j,- Ro 7r'r Contractor's Name_ Telephone Number C��)..G'"4 f�� %© ;1.��� /i/ G�/� '/ j Home Improvement Contractor License#(if applicable) I`f 7Z(0 Email: �� f3�°�,� �/l//li�lo:-l Construction Supervisor's License#(if applicable) �� ® "1 L►9 ❑Workman's Compensation Insurance 0 Checkpac. am a sole proprietor . ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance �C p T0141 / T232017 Insurance Company Name `t Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. A Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �s�► ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [r e-side [v]Replacement Windows/doors/sliders.U-Value 1 (maximum.32).#of windows A0 #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Ir C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 the CorYlTl o mveakh of sadiuS tty. jwOrwe af1M- giztitnts 600 Was ingtonstreet BastontM 02111 tvfvttLarcg�rvfa�irt. Workers' Ctmpensafttm Insurance Affidavt Emltders/CantractarsJF ectactanslPhomhers AEI Hcamt Infwxnaiinn / Please Print. y ItiT3SgariitFvdnalf/7 Address: A&"etl Div � glStatelg d"" j`3"' Phone Are you an employer?Checkthe appropriate bac T L❑ I am a 1 with 4. ❑I am a general confractor and I Y of Pro1eat{r�Y d}= ❑ o ees(filn an&Or part-time).* liave lured.tfxe sub-contmctors 6. Id oonsru iotc deling 2. ' I an a sole propdetar orpastuer- fisted Dottie arched sheep. L✓J ° ship and haves as employees Mese sub-cossti'acton hale 9-,Q DeuwliUou Working far�ae Sa e�layees and hire wodcers' orl b � i 9. 0 Building addii ca [No zv doom! camp,iusuonre COsnp_m¢rtrarrrrs l(�0 Flerfriral r oradc xoas recluized] 5_ ❑ We are a cmrporat flm.and its 3.0Iamahomeouxur doing all;worlC , . officers have 11-0Flumbiagrepaissoradditions• myself[No vrerlca S,comp_ Tight of exemption per MGL ' 12 0 Roofrepaim inetrias�reret�aiFed j F c.152,§I{4k andwe:haven employees-[IV'a woAess' 1311 Other cam-insumace���-1 •loyal=tchec1mIwaflmastaLaSIlauEthnsecBaabeIax theirtuor�cexs'rnmpe a�peri�gi�oemsao� #HameavaesswhD sob t sbis af#idaea mffct..z bey Rra dmas Rnwa x ad,Mea Vxz outside r=trz=rsamst mb=t a new XTL&V t io�-acids FCamznctois S�xt checYtlus bmc mmt sttache fi saadditinnsl shed shauwingtben=e of the sob-ccmu=ctomsnd sfdetcrhethec arnatfmre mid ieshare employees..ifthesnIrtont act=hn'e empicyea%theym¢srpmride•their wukecs'camp.pauu aumben I am an entpla} r t7i it pr4nzdir>r;markers'catirpertsrdiatt insuranca at•rrt}T empinyees $eIomv is f7te pa8ry•and job�� €nformatfnrt: hmamnce Compmy.'Name: Pricy 4.or Self-ins-Zic_-44, ExpirakonDate= Job RteAddre= Cry/StafeE.tp: AEtaCh a COPY of the warkere coompensatioitpoIky-declaration page(showing the policy number and expiration date). Fai kwe to secme coverage as regmred under Section.25A of MGL c-152 can lead to the irnpositiaa of cdmhnl penalties of a fine up to$l,54Q40 andlmr one-year impdw as well as dvil penalties in the form of a STdP WORK ORDERand.a free of up to$250-00 a dap against the violator. Be advised that a copy mf this statemed umy tie forwarded fn the Office of Inyestsgatiom of the DIA.for insurance coverage'aredficatiom 'Ida hereby carhf3�raardrr its prints a7td�penalties a.fFeZty f7rat fJte i;fart prmuled a€�at�i !rats acid arrrect Date:/4, % Phone ' �`� f. Qjkial use miry. Do not wrke in this area,to be-camplete.d by cafy artown oJoiciat C"ztj or'l awn: EermitlLicense9 Issning Anthorffy(robe one): L Board-of I-rcdth 7.Buffd ng Department 3.City1rown Clerk 4.Electrical hispestcr S.Plsmbing Inspector 6.Other Contact P•ersoa: Phone 9: — -- - - - 6 Taformation an' d lastruefiolas �� e Gd3�Taws chEpt�r M req==all=q:Ioyeas'to PEE WOIkE rs'com?rusation for their employees_ gent-to this staff,as=17L*3 Me is defined m7. zvety Prawn k.ffie serPi=of anoth=under airy coarser ofhire, express ar implie-A oral or written.." An.employer is d�fined as'pan ind'rvidBal,pa��,associg an,corporation or other legal�3,�ffiY two or more of the foregoing engaged is aJo��P�@,and mclndmg the Legal seprese�aiives of a deceased�Ioyes,or r r=.Oim or trustee:of an individual,PMtlMS'i --associaldon or otherIegal entity,employing em lDYCM However the owner of a dwells house having not more than three EParEn"t"aMwho resides ffierciu,or the occopaut of the- dwelling house of anon who employs pas=to dD mai aft a cc,condructt on or repair work au.such dwelling hours" or on the grounds or bmIdmg appurfenautihereb shalln.otbecanse of such employmeattbe deem.edto be an employee MGM chapter 152,§25C(6)also states ffiA¢evMTsfa�or Loral licensing agencyshalI�eitbhDId ffie issuascce ar r-mew of a license or permit to opazte a business or to construct btrrldings in the c�mmon�ealth for any applicantw'h.o has notpro(Inced acceptable evidence of cdmpTianM With t7r-k=r=CA coverage required. Additionally.M(ff-chapte L52,§25dM states cNixither the nor guy Of its poIHcal subdivisions shall Enterintoanycontrad for theperfonnanaeofpublicwmkuahIacceptableevidenceofcompHa.nccvbiifh5b3S ere.. re,,==eUts of this chapira havr,been presenfediD the cofractiog.aufhozity." Applicants Please fill o: the wotl�'.compensation affidavit completely,by rhe�g the boxes�applY to your sitaation and,if necessary,supply sgb�ouEradtor(s)namets), addresses)andphane mmmber(s)along thcrr ceitificate(s)of the Zn IIce LuritsdLiab�tyCompames(LLC)orLnnitadTiabilityParfne�hiFs(LLY)withno euapIoyees members or partners, If an LLC or TTP does have are not rbq i ed to cagy worlr&compensation i nmtce: employees,apolicyisreq i Be advisedtbAthis affxda:y tmaybe snbmi,�dto the Departmeatof lndnstrial Accide.D.fs for conEM ati=of insurance covmmge ATsu be sure to sign and dafE to aidavit The affidavit should beretmned to the city or town that tiie application for the permit or license is being=quested,not thee-D eparimeut of L�sirial Aye T=ta. S.bauldyou have nay q estions=egardmg the IaW or ifyou are regret ed to obtain a workers' compensationpokey,Please call theDepmfineafat the numbealist.below: Self--R0nedcompanies should enter their s elf-msuran ce Iicense number on.&a appropriate line. City or Town OfEl als _ r PIease be sore that the affidavit is complete mdprinted.Iegfly. 'Ihe Departm.enthas provided a space at the bottom Df the affidavit for you to fIl out in thD event the Office oflnvmt gaff=has to contact yam regardmg am applicant Pleas a be sure to fill in the peamitlIicense number which will be used as a reference�bcr. In addition,an applicant that must submit ulhple peffitlIicense applit�.ons in any give<nyear,need only submit°ne affidavit indiratmg con�t policy mfomlatiaay if necessary)and under`lob 5$e Addime the applicait should Fall Iacaiims is (may or town)_"A copy of the affidavit. at has been officially stamped or marked by the city or tom may be provided to thee- applicant as prooftbat a valid affidavit is on file for futar penoits or licenses A new affidavitmxtst be fMed Dirt each year.Where a home owner or citizen is obtaining a license or permit not re<Iated in any business or commercial vftt= a dog license or pctmk to bum leaves etc.)said puree is NOT regmmd to e°raplete Ibis affidavit T1ie Office oflnvesdgati=would hike to tiiank you in advanco for your coOPwdian and.should you have any questions. please do nothesidato to givens a call The,Dep artmmfa address,telephone and faxnumber . ThD CaMMMTMttbE of Massaoh - �tc�ladA�d�nts ' Tf�1.:'617E-72749W cxt 4-06 Cx 1-977 Tv4A SAS Fax#617 727-7M Revised4-24--07 wWW.Tn tf � ��� � 1 �� � ; � s THE FOLLOWING IS/ARE THE -,BEST IMAGES FROMTOOR QUALITY ORIGINALS) im DATA THE COMMONWEALTH OF MASSACHUSETTS License Type: Construction supervisor Division of Professional Licensure 03429 License No: CS-1 Office of Public Safety and Inspections Expiration: CS-103429 One Ashburton Place; Room 1301 /2017 Status: Active Boston, MA 02108-1618 RENEWAL NOTICE PAUL Z ROMA ❑ Address Changes/Corrections: (Please Print) P.O. BOX 142 COTUIT MA 02635 danaroma5@gmail.com t y Email: C a_ SCo_o u/.' wnt Renew Online - Construction Supervision(CS)only Specialty(CSSL)and 1 &2 Family'(CSFA)are not available at this time http://www.mass.gov/dpl Look for the OPSI page and click Online'Licensing. The website accepts Visa, MasterCard debit and credit cards with a 2.3% processing fee. There is a $1.95 fee for an electronic funds transfer from,a bank account. Renew by Mail: Office of Public Safety and Inspections Send this completed form,-,payment and P.O. Box 414376 all required docurbents'to: Boston, MA 02241-4376 ❑ Non--refundable renewal processing fee: $ 100.00 C - N I herebycertify under the pains and penalties of perjury that to the best of m knowledge ' _Color picture p P P 9 rY y g Is Plain background, and belief the information above is correct and that I have filed all state tax returns and paid I * Facing camera I all state taxes required by law and complied with all laws of the Commonwealth relative to Head and shoulders the withholding and payment of child support. I Square (height=width) ignature of Applicant Date Rev: 1000-3000 Amt:$100.00 RenID:695501 LicID:292359 y } ON-LINE-CLASSES CERTIFICATE OF COMPLETION Student Information: Paul Roma,PO Box 142, Cotuit,MA 02635 MA,Unrestricted Construction Supervisor, cs-103429 MA, Provider Information: On-line-Classes.com, 801 West Bay Dr. Ste 516,Largo,FL 33770 MA Coordinator Ids: CSL-CD-0079,CSL-CD-0124, CSL-CD-0125 Course Information: Date Complete Title Instructor Duration Credit Earned PDH 2017-09-15 Historic Preservation Id 409242 E-Learning Course Rebeca Boucher I Hour MA 1 (General Elective)#CS-7908 2017-09-15 OSHA Personal Protective Equipment Id 409193 E-Leaming Course Roy Terepka 1 Hour MA 1(Workplace Safety)#CS-7911 -----------------------------------------—--------------------------=-----------—----------—------------------------------------------- 2017-09-15 Wood-Based Composites 2 Id 409243 E-Learning Course Department of Agriculture(USDA) 1 Hour MA 1(General Elective)#CS-012503 -----------------------------------------—--------------------------------------------------------------------------------------------- 2017-09-15 MA Mechanical Properties of Wood Id 409257 E-Learning Course Department of Agriculture(USDA) 1 Hour MA 1(General Elective)#CS-012402 -----------------------------------------—---------------------------------------—--- -------------------------------------------------- 2017-09-15 MA Photovoltaics 2 Id 409261 E-Learning Course Alex Pesiridis 1 Hour MA 1 (General Elective)#CS-012406 2017-09-14 Construction Contracts Id 408557 E-Learning Course Charles Perry 1 Hour MA 1 (Business Practices)#CS-7905 -----------------------------------------—---------------------------------------------------------------------------------------------- 2017-09-14 Home Energy Efficiency Id 408558 E-Learning Course Lee Ellen Bell 1 Hour MA 1(Energy Efficiency)#CS-7906 2017-09-14 Wood-Based Composites 1 Id 409192 E-Learning Course Department of Agriculture(USDA) 1 Hour MA 1(General Elective)#CS-012502 --------------------—------------------------------------------------------------------------------------------------------------------- 2017-09-14 Fasteners For Wood Construction 1 Id 409191 E-Leaming Course Department of Agriculture(USDA) I Hour MA 1(General Elective)#CS-012410 2017-09-13 OSHA Fall Protection Id 408556 E-Learning Course Roy Terepka 1 Hour MA 1(Workplace Safety)#CS-7907 -----------------------------------------—---------------------------------------—------------------------------------------------------ 2017-09-08 MA.Residential Design&Building Code Id 408555 E-Learning Course Becky Boucher 1 Hour MA 1(Code Review)#CS-7904 2017-09-07 MA Lead Safety Id 408559 E-Learning Course Meredith Douthit 1 Hour. MA 1 (Lead Safe Practices)#CS-7909 Student Affidavit: I,Paul Roma,a licensed professional,herby swear under penalty of perjury,that I completed this continuing education course and personally fulfilled all mandated time and participation requirements,and that no other person acted on my behalf in fulfilling this obligation. Note:If you have any comments about this course offering,please mail them to the Board of Building Regulations and Standards atm:Education Coordinator,One Ashburton Place-Room 1301, Boston,MA 02108 " 172L137 Lp 78�: 83 23271 w —_-_- ' Check: 144 Amount:$52.00 Date:e9/18/2017�A`sm'�� Check 144 . I'?-ACHARY ROMA L,LC -.Pff.54B.Yg4911 ss-luih��a -•..raarnclaz ' 146 W A4 A- $: " o ry o= �a t g n"i wmm O-- 2'i ls371078q 83. 2327 i58o 00 L1.22. IS Check: 146 Amount:$100.00 Date:9/22/2017 Check 146 o N_ �I t Town of Barnstable Regulatory Services t EAME'yEME, * Richard V.Scab,DirectorKAM - 1"9. �`� Building Division PaulRoma,BuDding Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 509-962-403 8 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subjectproper�ty hereby autfiorize J to act on my behalf; in all matters relative to work authorized by this building permit application for (Address of Job) **Pool fences and alarm 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 8 trite Applicant Y +>Irk t Cam. Z,7,,f A __ 217,411i "I Print Name Print Name Date . Q:FORW:OWNE"ERMISSIONPWIS �Tt r Town of Barnstable Permi I Expires 6 m nths om issue date Regulatory Services Fee '- i • BA2N9rABLE • 9cb arAss.1639. ��' Thomas F.Geiler,Director � PIED MA'I a Building Division 0 Tom Perry,CBO, Building Commissioner g 200 Main Street,Hyannis,.MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X,-Press Imprint Map/parcelNumber Oi D Property Address a214 A I'O iV ESS ET 1 a5 [TResidential Value of Work SCKDCS, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M O U 1 C 4 R n P lz .2a. P,PO AJESS EI T Rb C" icam'I'l Contractor's Name A',EN T ?F_R SS d(J Telephone Number SOS 96 Home Improvement Contractor License#(if applicable)' /O a 3lo 6-- Construction Supervisor's License#(if applicable) 9`7TO ®Workman's Compensation Insurance 4pf, Check one:❑ S I am a sole proprietor ❑ I am the Homeowner [+]I have Worker's Compensation Insurance MAY Insurance Company Name OF Workman's Comp.Policy# IAA:�— j!J `3e,3 iD BARNS-rABLE Copy of Insurance Compliance Certificate must accompany each permit: Permit Request(check box) Z'-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to „gC7OR, ul_ ❑Re-roof(hurricane nailed)(not stripping.. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt'compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: �� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 . Persson Construction, Inc.. 22 Colony Ave. Boume,.MA 02532 Phone: (508)759-8959 PROPOSAL SUBMITTED TO: PHONE: DATE: Monica Roper .781-235-0979 3/26/12 STREET: JOB NAME: ARCHITECT: 216 Popoessett CITY,STATE AND ZIP CODE: JOB LOCATION: DATE OF PLANS: Cotuit, MA We hereby submit specifications for: Strip off old roof shingles from entire roof and remove to the dump. Inspect roof deck. Install a layer of 30 lb. felt paper on entire roof deck: Install ice and water barrier on all eaves and in all valleys. Install new aluminum drip edge on all eaves, new flanges on all plumbing vents, and new,flashing where needed. Install new 30 year Tamko architect style roof shingles-on entire roof. Color will be .s,,,c. . C,s. C,)rrP„ t N_ . Co gr Install Shinglevent II ridge vents on all. ridges. Job site will be left clean, and all debris will be removed to the.dump. Start dateKM 3 a3�2 (weather permitting) finish dateb P d . MA HIC #102365 MA CSSL #99507 .YOU HAVE 3 BUSINESS DAYS TO CANCEL THIS CONTRACT We Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of. ($5,700.00) five thousand seven hundred dollars. Payment to be made as follows: $1,900.00 down,balance on completion My work preformed beyond the scope of this contract will be billed separately as extra work. This includes conditions which could not be foreseen by the Authorized Signature: contractor. yf /_c�z.f. ucapz Note:This proposal tna ith i f not accepted within 30 days. Acceptance of Proposal—the above prices, specification,and conditions are satisfactory and are Signature: hereby accepted. Payment will be made as outlined. Date of Acceptance: Signature: The Comrnonwah*of Massackasehts 3Jqrrrtntent o,,f Indasoial Acc deniis f 1,f ce of Inveslrgations 600 Washington Shwet Boston,MA 02111 womn mass gov/dia Workers' Compensation Insurance Affidavit:Bmlders/ContractorsfF ft4ric anslPlumbers Applicant Information Please Print Leat bly Name( + on&dividaal)_ e.1 T P,eroz S S O r._l Address_ 11-- (oLDO-1 AJf- City/state av - G).J W Phone# Are you you an employer?Check the appropriate box: Type of project(required): 1.L'_'f 1 am a employer with. 3 4- ❑ I am a:general contractor and i employees(full andlarpart-time)- s have hired the sub-contractors 6. ❑New construction 2 ❑ I am a sole pruprietor or partner- listed on the attached street. 7- ❑Remodeling strip and have no employees. These sob-contractors have g_ ❑Demolition working for me in any capacity- employees and have wodaws' [No workers'comp.insurance comp.inmumme.1 9- ❑Building addition required_] 5- ❑ We area corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all wodc officers have exercised fir 11.❑Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12.0loof repairs insurance ]t c.152, §1(4�and we have no to o workers'COMP. otherJam- con�p,insurance required-] Any apphc;mt that cbedcs bra#1 must also fill otu the section belaw shawmg their wuakeW compensat m poky iaformatiob Homww ms who submit this affidavit M&C3ting'they are doing all wak amp then hue outside Contractors= submit a new affd"indicating such_ ICantractm that:check tbis bra most attached as additional sheet showing the name of the sub-conttxim noel state whether arnot.ftse entities hwe empbres. If the soh-mantra cn bate emplbyms,they must provide th&workers'comp.policy number. I am an empkyer that is providing workers'congwusadon.inmMuce for my Below is the policy and job site infor madfotL Insurance Company Name: J,/M-k-N 1Mu TU44� Policy#or Self-ins-Lic.#: Gt1C2 3 3 b 3 /03 Expiration Date: 8 2 2-. Job Site Addr€ss: of/(a Citylstatei2ip: Attach a copy of the workers'compensation policy declaration page(show ng 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 andlor one-year imprisonmendt,as well as civil penalties in the farm of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator- Be advised that a copy of this statement may be farwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ca fj,under thepi ins andpenah'es ofpedury that the infor mat pt ov ded above is hue and correct Signatrtre: "su /� Date: �f/!z Phone# ofjft ial use only. Do not unite in this area,to be completed by city or town official' City or Town.: Permit/License# Issning.Authority(circle one).- 1.Board of Health 2.Building Department 3.City/Town Clerk 4AIectrical Inspector 5.Plumbing Inspector 6.t?ther Contact Person: Phone#: 6 AC© CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER G H DUNN INS AGCY INC - 9� MAIN ST CONTACT NAME: BUZZARDS BAY, MA 02532 rINSURER NE(A/C,No Ex : 508 759-3132 Fqx Alc No): 508 59- 1 7 E-MAIL—ADDRESS: INSURER(SLAFFORDING COVERAGE - NAIC p A:: LIB UTUALGROUP INSURED - - INSURER B: PERSSON CONSTRUCTION INC 22 COLONY AVE INSURER C: BOURNE MA 02532 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12724524 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS GENERAL LIABILITY - EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED PREMISES Ea occurrence S CLAIMS-MADE OCCUR - MED EXP(Any one person) S i i - PERSONAL&ADV INJURY S I � GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG S POLICY PRO- LOC $ 'AUTOMOBILE LIABILITY - Ea accident) COMBINED SINGLEINGLE LIMIT $ . ANY AUTO ._ BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) s HIRED AUTOS NON-OWNED - PROPERTY DAMAGE . AUTOS I Per accident S s S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS - g - - $ A WORKERS COMPENSATION WC2-31 S-363103-011 8/2/2011 8/2/2012 WC STATU- .1 GR- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE - E.L .EACH ACCIDENT S SOOOOO OFFICER/MEMBER EXCLUDED? `NIA (Mandatory In NH) E.L.DISEASE-Eq-EMPLGYEEI S If yes,describe under I _. 500000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMITS - 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation Insurance:Part One of the policy_applies only to the Workers'Compensation Laws of the State of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE. - Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD.25(2010/05) The ACORD name and logo are'registered marks of ACORD CERT NO.: 12724524 CLIENT CODE: 1287312 Maria Anderson 3/30/2012 9:40.12 AM Page 1 of 1 - -This certificate cancels and supersedes ALL previously issued certificates. — ✓fie �ara�nrar�u�PalC/ a�✓ aaaac�a.�aelta Office of Consumer Affairs&B smess Regulation License or registration valid for individul use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and-Business Regulation Registration: 102365 Type: x oratidn 10 Park Plaza-Suite 5170 Expiration: 7/1/201 Private Corpora p Boston,MA 02116 PE SON ROOFING ANU3SIDING'I:NC. 'U Kent Persson 22 COLONY AVE 1 BOURNE,MA 02532 :- Undersecretary Not valid without signature w• Department of Public Safety Massachusetts - gulations and Standards Board of Building Re Cunstructiun Super,isur 5 ' K License: CSSL-09907 KENT EPEE 22 COLONY BOURNE M 025V32 ( ' Expiration ; 01/02120U commissioner