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Home My WebLink About0304 POPONESSETT ROAD �� ~_-�-� P y 1 )c I t — I-�ouS� ARE K[TCN�N AJV-xT T 07of/fu� 1 Nb ��f9Y2[s-!<3T SrTI�GI.GTGIi��92- c�}/ytl¢6E. I P 1 , 1 i a wT n c 73 I 1 i I J1 I I 1 i I Ji I r JO • � o Town of Barnstable Building • aPost This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job-and this Card Must be Kept ,�$ ;Posted Until Final-Inspection Has Been Made. .. � � w,a+° {Where a Certificate of Occupancy is Required,such Building shall Not be Occ�upied`until a Final Inspection has been made Permit ml Permit NO. B-19-611 Applicant Name: William Callahan Approvals Date issued: 02/27/20.19 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: . 08/27/2019 Foundation: Location: 304 POPONESSETT ROAD,COTUIT Map/Lot: 019-059 Zoning District: RF Sheathing: Owner on Record: KRAMER,MARK&CHERYL Contractor Name: WILLIAM CALLAHAN Framing: 1 " Address: 304 POPONESSETT ROAD Contractor License: CS-095581 2 COTUIT, MA 02635 ± 4 Est. Project Cost: $4,299.00 Chimney: ' l Description: Insulation/Air sealing . Permit Fee. $g5.00 Insulation: Project Review Req: a I Fee Paid: $85.00 " Date: 2/27/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months after issuance. All work authorized by this permit shall conform to the approved application and the'approvecl construction documents for which this permit has been granted. Rough Gas: . All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the-same. <} -- -- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection w 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed - 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ` vN� . i 'r JUN. 3. 2011 1 : 22PM SHEPLEY SHOWCASE NO. 625 P. 2 N.:...;:;!::ts:. :'ti "'�`� ,kb' "'i?�:9'r,:i•3:•fi'"r.:�.��'u�v�.iiy!3 Ynf�y',wl;):Y':.. !k'�t.',;''hr�:�':;�: ;.,�+:r,`•% ��, r2`':�nv �..�:�.. >: 2 ?.ji? •;--,?'9F?X.;'SrMi°y:i'>,:>i'.>:h'ij�.fE4�•' „fF':s^ .i.:•�,'a>,�;� a'• 00203682 Hyannis Account#: WHAWIL 0223 Shepley 210 Thornton Drive / Branch: HYA Hyannis, MA 02601- Phone#: I I- USA Phone: 1508)-882.6200 Fax#: BILL TO: SHIP TO: ' William A Whalen =en Whalen Restoration ssett Rd22 American Way South Dennis MA 02660 Page 1 of 1 „ „ .,,;,;,R. oRD1~.[1f::DATO �1fPE:,';. '1N}i;,;;,;;;;;; , ;,;';';; ;; uef PicFc'.U':'.:O.�fd3/1t,,;SgL�g.:. T �rt�`wl 4r„ SHIP�ik., E?(1''fiBl:V'�AFBrcElt7.H�1.t.'.A.Ed.ENTB:. 0''F oh�r.. ... . ��'Ofischtwr�:;;,;..'..�:':AW'GH'�Hl�,,,,,•.,. � . ;. „, i, •�q' �'a��i�nyl.".�Sp•9:f+•<.f'kf•'P..� y,t:•, ;!;n. t;�;f,:;+ai}.rxeli'•f:.a^ ,,�y yy f'.('S •s>S?i"4�F!��exfa�' .,.?.4§CM:,,.,nkekfiy.9? ur �.(.P� `'$K3 c., £• �hX,:H:>.•a�artt':;$,:,�,ik'unxe: ':S.. ��$^(•> R•ri'4,sx:'<?'4>�`�.7^'si.7,>,9t:M.aitr4.b9<::4.'?f'F M:::'�.3..a+!Sr..t:�<+'S,;.":�5r'�a'V�r4fftinnW..•I.......a:.•�: '•�':1'Va aw:fi>,'.C.��:'.?••y�.(�;:!';:6;'a:a9:f'9: r"�.9;'4N•ra ' � Nrf o i Please order Stergls Order #103,221 - cmf.....Tempered Glass required per Bullding Department. 1 EA NS0000111698 Stergis DH Replacement 116r36/EA 116.36 Sash- Upper sash only TTT unit size = 26-1/2fw x 44-1/2"h White /White LowE TEMPERED GBG 4 lite flat profiler 1 EA N800001 1 1 700 Stergis DH Replacemnt 116r36/EA 116.36 Lower Sash only --•..'."�� „LL_, TTT unit alas = 26-1/2"w4x 4 1; !iYi lftiite '+!1 �eRl LowE TEMPERED/GBG 4 obmdua i�npi LL 4:Mnu.:::�:::.:..J °yi�9!0 n SUB-TOTAL:!,,q'1i.ln'nulAP uan:-.:<:.. ;i,: u;;:,_"P,: ,I•i,Qr;��rm�4!^,�..- ,;eim�� 232.72 r' Su4 ,i iihiiiG P� .. MAnrL"'',, ,25% 14.55 ��'Pri mdauelal is E: �:.:� m�anmm _�a:r:�d:fl.`m��i.^:j niamia�n�nin��". _,fir• haw..a._1,.. i ..,.u.f. ,amn i7�� :� � � '44i�' 11u .. i:i M'9'•Njtk .i l!9ili:o.-a{Js ihio uN�:l�uuy _ TERMS: Balance 247.27 5% 1 Oth/ Net 25th Contractor Charge , JUN. 3. 2011 1 : 21 PM SHEPLEY SHOWCASE N0. 625 P. 1 SHEPLEY ANDERSEN SHOWROOM FACSIMILE TRANSMITTAL SHEET 'to: FROM. - Bob McKenzie—Building Department Craig Fischer—Shepley COMPANY; DATE: 6.3 FAX NUMBEIL• TOTAL NO.OV PAGES INCLUDING COVER; 508-790-6230 2 PHONE NUMBER! SENDER'S REFERMNCE NUMBER; 508-862-6228 Ref Whalen Restoration—304 YOUR Poponesset Rd Cotlut. REFERENCE NUMBER Shepley Fax 508-862-6097 URGENT ❑FOR REVIEW Q PLEASE COMMENT PLEASE REPLY 0 PLEASE RECYCLE Bob, Attached is the order which has been placed for Whalen Restoration-304 Pop onessett Rd-- TEMPERED SASH, The leadtime is 4 weeks. Once in Shepley will Swap out sash. John Baylis from Whalen Restoration is my contact—774-487-0437 If you have any questions please call. Thank you, Craig Fischer ��chcx�a shepleygo4c Shepley Showcase LEED AP 508-862-6228, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / < Parcel Application #� (9 q 9 I Health Division Date Issued 4 Conservation Division Application Fee Planning Dept. Permit Fee canq. Z- Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7-7 `7 p0p0/,/�SS o Art Village C � ` Owner_ C-TA C.( R YJ Address 'y Box IK-A - Telephone Permit Request 1 I4kR`o 2 F'-eW JS+Q vtc41 o J i VSlA(0,41-6-0 o K4c Art/ &ck4eFN,-N7- OPQ laces -/Wo w",�,D0V.6 - l 2 NEid h4eDyo0T> -Nok, sq Fr, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Lvi o Construction Type Lot Size D • 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )d, Two Family ❑ Multi-Family(# units) Age of Existing Structure Ve 5, Historic House: ❑Yes A�No On Old King's Highway: ❑Yes /dNo Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ------ _ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing -� news' CD Number of Bedrooms: 2-- existing _new 6 --9 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: *Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes �lo Fireplaces: Existing(New Existing wood/coal stove: O Yes,&No v '1 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# Crent Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name p Tele hone Number 5-02 76D Address 1 ZZ . f pp o^ro License # 7Y�2- 'I�J fe5T1 k AV N S Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO lowo Awoo,� NG W 1 l/ SIGNATURE ��/ DATE `4 3 FOR.OFFICIAL USE ONLY � I APPLICATION# DATE ISSUED i , t MAP/PARCEL NO. s - ,, ADDRESS . - VILLAGE t h OWNER 3 s DATE OF INSPECTION: 'i FOUNDATION FRAME Wa wl z 2-I1 iZ tn..�-ttii INSULATION t FIREPLACE .'T ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL '3 GAS: ROUGH FINAL z, FINAL BUILDING d , w*/(fxw/r— e..s; J�aa.�ao�• 0 lv� t DATE CLOSED OUT ` ASSOCIATION PLAN NO. I i t l ` f The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations 1=; 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affida0t: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Whalen Restoration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 Phone #: 508 760 1911 Are you an employer? Check the appropriate box: Type of project(required): 1. [3 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. t 2 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their l0.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#11 must also till out the section below showing their works s'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name o;the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for arty employees. Below is the policy and job site information. Insurance Company Name: Arbella Protection Co. Policy#or Self-ins. Lic. #: 9091320408 Expiration Date: 4/1/12 Job Site Address: 3 0 Y P 0P Q AJE1S ET R City/State/Zip: Co ru t T� W!4 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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that theJ inf)orm/a ton�provided above is true and correct. 1 b I Signature: Phone#: sM- 7(o0 l q Official use only. 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#: I Dater 4/1/2011 Time: 10:25 AM To: 9,1508-760-9995 Rogers & Cray Ins. Page: 001 Client#:32193 WHALRES ACORD. CERTIFICATE OF LIABILITY INSURANCE D4T"D'xYYYYI 112011 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 r' 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.N 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 NAMEA T Ann M Pell,CIC,CISR Rogers&Gray Ins.-So.Dennis PHONE 50B 398-7980 Fax 5O8 398-0246 AfC,No Ext: 434 Route 134 E-MAIL alien ro er5 ra com P.O. Box 1601 I PRODUCER @ g g y CUSTOMER ID W South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC R INSURED INSURER A Arbella Protection CO 17000 Whalen Restoration Services Inc 22 American Way INSURER B South Dennis,MA 02660 INSURER c INSURER D' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. NSR TYPE OF INSURANCE I SRPOLICY LVVn UBR POLICY NUMBER MMIDOIYYYY MMIDDIYYYY ( LIMITS A GENERAL LIABILITY I8500040398 04/01/2011 04/01/201 EACH OCCURRENCE 1$1,000,000 X COMMERCIAL GENERAL LIABILITY I I DAMA E T RENTED PREMISES Ea occurrence) $100,000 CLAIMS-MADE E I�OCCUR I M:ED EXP(Any one person) $5,0000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. i I I PROWCTS-COMPlOP AGG $$2,000,000 JFQT I I POLICY PRO- 171 LOC A AUTOMOBILE LIABILITY j BINDER446766 4/01/2071 Q4101/201Z COMBINED SINGLE LIMIT OOO OOO 1 $1 (Ea accidenQ ANY AUTO I BODILY INJURY(Per person) is ' ALL OWNED AUTOS BODILY INJURY(Pe,accident) $ X SCHEDULED AUTOS j 'PROPERTY DAMAGE X HIRED AUTOS (Per aeculen:) $ X NON-OWNED AUTOS ( is $ A UMBRELLA LIAB X OCCUR 14600021586 04/O1/2011 04/01/2012 EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE' I I AGGREGATE $1,000,000 DEDUCTIBLE X RETENTION 10000 - g A WORKERS COMPENSATION (9091320410 �Q4/O111011 (14/0112012�X1WC STATU- R OTH- AND EMPLOYERS'LIABILITY ANY PROPRIE70R1PARTNERIEXECUTIVE Y 1 N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) i E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under I DESCRIPTION OF OPERATIONS ceww f E.L.DISEASE-POI,ICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACDRD 101,Additional Remarks Schedule,if more space is required) Project Address-304 Poponessett Road,Cotuit,MA 02635 CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Gall&Ted Rennie ACCORDANCE WITH THE POLICY PROVISIONS. 564 Main Street Cotuit,MA 02635 AUTHORIZED REPRESENTATIVE - 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S65313/M65285 AMP r Te >°ovvnao7uuealC/i a�✓�aaaac�ivaPt7a - j Office of Consumer Affairs&Business Regulafian License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i Registration: 129244 ' 10 Park Plaza-Suite 5170 Expiration: 7/30/2011 Tr# 287004 Boston,MA 02116 Type: ' Private Corporation Whalen Restoration,_Services Inc;. - William Whalen t " I 22 American Way �s South Dennis,MA 02660 Undersecretary Not valid without signature -• Nlassachusetts - Department of Public tiafeo Board of Buildin- Retulation:s and Standart)s Construction Supervisor License License: CS 74928 WILLIAM WHALEN 122 POND STREET BREWSTER, MA 0201 . Expiration: 8/10/2012 b (',nunisiuncr Tr#: 70 Restoration Services Inc. Fire, Smoke, Soot,Water Damage&Mold Remediation Services *4aCleaning • Deodorization • Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at 304 Pononessett Road, Cotuit, MA 02635 to repair damage caused by fire on 1/11/11 As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Dorchester Mutual Policy No. 4405679 to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: L OWNER DATED SI NED ` OWNER rHALEN STORATION REP. SIGNED i` 22 American Way, South Dennis,MA 02660 Phone: (508) 760-1911 Fax: (508) 760-9995 • 1-800-244-2598 •E-Mail: restore@whalenrestorations.com. Web Page: http://www.whalenrestorations.com OFFICE COPY The Commonwealth of Atassachusetty .il' '• '''--_-_��.�- Department of Industrial Accidents 6/I0 11'ashinrron Street ' \;� "� ►: Bustun,A1as's. 02111, �- Workers' Compensation Insurance Atftdavit Please PR(NT-le- �� name A ltcant mtrmation .1121X�,.::—a - C location Z 4y /� cj � g ' �o��r Eq I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ m an employer providing workers' compensation for my employees working on this Job. cnmlilnx nnm4 II s • city- phone#- incur•Jnce co policy# ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compiny name: -� r Sit? phone#• �urnnce co nolicv# -{f ..:• .ee-a•e�-r—,.rZ-.vCt�sGersl.-'z7---nt. •7�Ir+L3 '�c? !RiT4..uw'.r^' .'!?':�"'.-.� companv name- address: city: phone#• insurance co policy# ,� Attach addi_tional'sheei it'netessa +'_� "`''•`' 1" Pollute to secure coverage as required under Section:SA of 111GL 152 can lead to the imposition of criminal penalties of a fine up to S1,5OO.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement mac be forwarded to the OMce of investigations of the DIA for coverage verification. I do herebt•certify under the pains and penalties of peduiy that the information provided above is true and comer: Signatu G Date LY a�- 2 iP Print name C Ole ` A V^`n Phone# r 4. oftcial use only do not write in this area to be completed by city or town official cih or town: permit/license# nBuilding Department �Lieeusing Board 0 check if immediate response is required �Selectmea's Office []Health Department contact person: phone#• n0thcr___ ~Imised 195 PJAI The Town of Barnstable � MOM ,S Department of Health Safety and Environmental Services Building Division 367 Main Strut,Hyannis MA 02601 Ralph Cmssea Off= 508-790-6227 Building Commissioner Fwc 508-775-3344 ce urse oni r offi 0 F Y Permit no. t Date AFFIDAVIT 130ME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the-reconstruction.alterations,renovation,repair,modernization,cOuverston, improvement,,removal, demolition. or construction of an addition to any pre- buuilding containing at least one but not mom than four dwelling units or to Mctnres which store with other to such residence or building be done registered contractors,with certain exceptions, g Type of Work. J Est.Cost Address of Work: .�v Owner.Name:� Date of Permit Application: I hereby certify that: Registration is not required for the follcming reason(s): Work excluded bylaw Job under S1,000 ; —Buidding not owner-occupied Owner pulling own permit Notice is hereby green that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM L9NliEGIS FOR APPLICABLE HOME IMPROVEMENT W��GLOT 42A ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the Towner. Contracxor name Registration No. " Date . OR Date Ovma s r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ` Please print. DATE JOB LOCATION - Number Street address Section of town "HOMEOWNER" C 0.e` Name Home phone Work phone---- - PRESENT MAILING ADDRESS go k ' City town State Zip code The current exemption for "homeowners" was extended to include owner-occupie_I dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor". DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she ,resides or intends to re= l' side, on which there is, or is intended to be, a one to six 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 Offic: on a form acceptable to the Building Official, that he/she shall be responsil for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the St Building Code -and other applicable_ codes, , by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirement: and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATIIRE✓s . APPROVAL OF BUILDING OFFICI Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. • HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which=,"a bu±1ding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that. if Home Owner engages a person (s) for hire to do such work, that such Home Owr shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 01 Rules and Regulations for . licensing Construction' Supervisors, Section 2. 15) . This lack of awaren often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this vase our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner act as supervisor is ultimately responsible. To ensure that the Home Owner. is fully aware of his/her responsibilities, . m. communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On t, 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. Building Department Complaint/Inquiry Report 7 �� Rec'd by: Assessor's No.: G/ _G's Date• � Complaint Name: Location Address: WP— Originator Name: 7- Street: Vdhge: State+ Ztp: Telephone:D/E Complaint Description: Inquiry Description: For OlEice Use Only Inspector's �7 Inspector. Action/Comments Da te• ]Follow-up Action Additional Info. Attached Copy Distribution: Mjiw-Depa=ent File I'effow Inspector Fink-Inspector(Return to Olfce Manager) 7 Ass U/ !c Parcel `0, f- 1 Permit#` 7 ;L .. T Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued Board of Health,(3rd floor)(8:15 -9:30/1:00-4:45) �Jjl � Fee �5Y, Sb En ineerin Dept. 3rd floor House# S&TIC S't UST BE INSTALLE P ) w' L6Ai' O De 19 EFL VOIO6�9M M T®U m TOWN OF BARNSTABLE Building Permit Application Project Addressit y- Village,Cf py'�1��' -• s Owner C e- v-i c Address 5( y �yJ..Q.�.:;., Of' . , - Telephone. a - ®5& Permit Request C �� _�cnn�� s ��`�'S `� L s�` c Q,`a s r c s First Floor square feet r AD Second Floor square feet Estimated Project Cost $ bb 0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family ✓ Two Family Multi-Family Age of Existing Structure Basement Type: Finished / Historic House /l1y Unfinished ✓ Old King's Highway /Jo Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel 9 Central Air Fireplaces j Garage: Detached Other Detached Structures: Pool Attached Barn None „ / Sheds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE .�' .l oe1��„h c�DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r r FOR OFFICIAL USE ONLY PE' IT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE ? 9 f , 04NER DATE OF INSPECTION: FOUNDATION a , FRAME` INSULATION ' FIREPLACE _ ELECTRICAL: ROUGH FINAL 1 , PLUMBING: ROUGH FINAL + GAS: ROUGH FINAL FINAL BUILDING i T"''}""' DATE CLOSED OUT . ASSOCIATION PLAN NO. , ! ! i 1 f APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name WAALC—tv SOU«-E�S- Telephone Number :�-0�- -2(o6 Llt (k Address License # 7 q 7 ef� o 7/30) 1 ujkk� tjkvAA Home Improvement Contractor# 7 Vqn)S-- I as PoNa ,Zr c� ►A�14 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO OvuN ®k' -/baWlaJ"VA ®V%-- SIGNATURE ul �''" ` -(ot0 i DATE off" �`p1 a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ID 19 Parcel ®Sg Application # obii 11 n el Health Division Date Issued c ll 5 l lI, Conservation Division Application Fee J�6 Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board !n Historic - OKH _ Preservation / Hyannis Qw� Project Street Address 3aq PbPO/UcS5E7F R(-)4&l Village Como`a Owner e-dVAUN (-Feb� REKnf Address PID �30yk :7LV CoTyi mA Telephone Permit Request f-oyL t iJ FVL-tcyt- of r,(LE Itia wAl�n- OA►AP41E Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay f Project Valuation 1 '-d00'o000 Construction Type Lot Size 0.3 AcipoS Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) Age of Existing Structure (P R-S Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I 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: 0 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 . APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ► I4Va. Ap,LFo Telephone Number Address o10� �Li � �+'�y S. tiN�S License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED ` -,MAP/PARCEL NO. ADDRESS VILLAGE OWNER t ti r ' f DATE OF INSPECTION: << FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL i b` FINAL BUILDING a B �. -7 , 4 DATE CLOSED OUT C ' 1. ASSOCIATION PLAN NO. ' The Commonwealthvf Massachusetts. Department of Industrial Accidents ' jOf ce o Investigations N a '600'Was"hington Street r s M Boston, MA 02111 ` W)4W.mas&gov/dia 1�1 - 1 Workers' Compensation'Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information x - Please Print Legibly Name (Business/organintion/Individual): -4halen•Restoration Services - Address: 22 American Way City/State/Zip: South Dennis, MA 02660 Phone#: 508 760 1911 Are you an employer?Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 1.[�I am a employer with g 6. ❑,1`1ew construction employees(full and/or part-time).* have hired the sub-contractors• 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached,sheet. 1 1. ship and have no employees ; These sub-contractors have t 8: ❑ Demolition working for me in any capacity. a workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance '5• ❑'We are a corporation'and its' 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑-Roof repairs insurance required.]t I employees.`[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill'out the section below showing their workers'compensation policy information' t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional street showing the name of the subcontractors and their wo&iw camp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. -Below is the policy arid;job site information. Insurance Company Name: Arbella Prote,ction Co. < I Policy#or Self-ins.Lie.M 9091320408 Expiration Date: 4/1/"11 Job Site Address: 309 PoPo6 FsSC_1r_ ROA-c�— City/State zip: CQ7UE'T__ 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 S1,500.00 and/or one-year imprisonment,-as well as civil penalties-in the.form ofa 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 anMd penahies of perjury that the information provided'above is true and correct. — Si tore: Date:-'% Phone# FO)TIcialonly. Do not write in this area,to be completed by cityor town officialn: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,ate: 2/10/2011 Time: 9:47 AM To: Gail 6 Ted Rennie C 9,1508-760-9945 Rogers rr Gray Ins. Page: DO1 Client#: 32193 WHALRES ACORD,. CERTIFICATE OF LIABILITY INSURANCE °211012o 1 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 CONTACT NAME: Ann Pell Rogers&Gray Ins.-So. Dennis PHONE508 398.7980 AIC,No. AIC.No Ezl 434 Route 134 EVIL ellan ro ers ra ADDRESS: p 9 g y•com P.O. Box 1601 CUSTOMER ID0: South Dennis, MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC0 INSURED INSURER A:Arbella Protection Co 17000 Whalen Restoration Services Inc INSURER B 22 American Way INSURER C: - South Dennis,MA 02660 INSURER D; INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 CERTIFICATEMAY 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY POLICY EX LIMITS A I GENERAL LIABILITY I 8500040398 0410112010 04101120111 EACH OCCURRENCE $1,000,000 X COt dMERC1AL GENERAL LIABILITY PRFMISFS e:'occurenee• $100,000 CL.altdsMADE �OCCUR i I MED EX (Any One Per Son) $5,000 I PERSONAL&ADV INJURY $1,000,000 E GENERAL AGGREGATE $2,000,000 GEN'L AGGPEGATE LIMIT APPLIES PER I PRODUCTS COMPIOP AGG $2,000,000 POLICY I PRO 1 I LOC 1 $ A AUTOMOBILE LIABILrrY 27491174000011 9/251201010912512011 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AU1 O BODILY INJURY(Per person) $ ALL OWNED AUTOS I I BODILY INJURY(Per accident) S� X SCHEDULED AUTOS I .. PROPERTY DAMAGE XI HIRED AUTOS (Per a,-.,:Iden:) ILI NON-OWNED AUTOS I A UMBRELLA LIAR X OCCUR 14600021586 D410112010 04101120111 EACH OCCURRENCE HEXCESS LIAB LAItdS-tdADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTIONS 10000 1 $ 41 WORKERS COMPENSATION WCSTATU- O�iH- A 19091320410 l0112010 04/0112011 X T RY s ( -R AND EMPLOYERS'LIABILITY Y 1 N ANY PP.OPRiETORIPARTNFR/EXECUlly- i E.L.EACH ACCIDENT 1500,000 OPFICERIM,EM3ER EXCLUDEp9 NIA I (Mandatory in NH) I I E L DISEASE-EA EMPLOYEE $500,000 aydescribeunder DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT 95500,000 - i I DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Ir more space is required) Workers Comp Information Included Officers or Proprietors Project location:304 Poponesset Road,Cotuit, MA CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Gail&Ted Rennie ACCORDANCE WITH THE POLICY PROVISIONS. 564 Main Street Cotuit, MA 02635 AUTHORIZED REPRESENTATIVE 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009I0% 1 Oft The ACORD name and logo are registered marks of ACORD #SS34431M 614390 M EE � ��e {c��rrxnantuea�l,l aJ�.i�tfii::su�✓zuaelld Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR r - Registration: 129244 Expiration: 7/30/2011 Tr# 287004 Type: Private Corporation Whalen Restoration Services Inc. William Whalen 22 American Way South Dennis, MA 02660 Undersecretary 1)vp.,rinirIII ,11 I'll hllk. �:itrlti Beard ��i f3uil+li+r:; Kr•_ul.ui� n, :ur�l �I;uul:rr�1• Construction Supervisor License License CS 74928 WILLIAM WHALEN 122 POND STREETS. BREWSTER, MA 02631 Expiration: 8/10/2012 ..num..i..u.'r Tr=- 70 'TKEr Town of Barnstable ` Regulatory Services • BARNStASLE. Ruas. Thomas F. Geiler,Director o � 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 uakk A 1��.►' to act on my behalf, in all matters relative to work authorized by this building permit application for. Ill�1,A-�vC;-S<; 30 (f AWOL- (Address of Jo'b) C «_<< Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 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