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HomeMy WebLinkAbout0005 PUTNAM AVENUE f Barnstable _ Town o Building n Post This Card So That it is Visible From the Street-Ap'proved Plans'Must Retained on Job and this Card Must be Kept sMARK ,� $Posted Until Final Inspection Has Been Made. ppy�m�+1 l�l ill 1. ram° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Insp ection has been made " Permit No. - B-20-875 Applicant Name: Dean Fraser Approvals Date Issued: 03/30/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/30/2020 Foundation: Location: 5 PUTNAM AVENUE,COTUIT Map/Lot: 036-034 Zoning District: RF Sheathing: Owner on Record: JOHNSON, DAVID G&ELIZABETH T Contractor Name: ",,Fraser Construction Company Inc. Framing: 1 Address: PO BOX 254 Contractor License: 194747 2 COTUIT, MA 02635 ' '°F Est ProjectCost: $2,921.00 Chimney: Description: replacing skylight Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid $35.00 i Date ' 3/30/2020 Final: P_ lumbing/Gas i Rough Plumbing: j vR,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"approved 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"p rmit. Minimum of Five Call Inspections Required for All Construction Work:l Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection =. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f Town of Barnstable *Permit# Regulatory Services � �?kmdgo AM Richard V.Scali,Interim Director Building Division N� Tom Perry,Clip,Building Co obsioner JUL 10 26W ' 200 Main Street,Hyannis,MA 02601 `N.. www town.barnstable.ma.us Office: 508-862-4038 TOWN®F&+ 230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �E Navoid>��Atx- Map/Farcel Number gym►Address Residential Value of work$ �® MM=m fee of W&00 fokwerk qn s�oo.00 Owners Nam&Address � ���Q P(Ar dw� , a C uiu(�d 3 Contractor's Name ) 'J��.u�(A WQ �l d U)s Telephone Number gQI.7 Ze f(- Home lupwemeut Ca*actor License#(if applicable) l 7!3 24J Email: Construction Supervisor's License#(if applicable) 0 7 J /�-7 WM man's Compensation insurance Check one: ❑ I am a sole FgXidor I am the Homeowner I have Worker's Compensation insurance Insurance Company Name„ �c,kN�j I/(49 c_,b' workman's Comp.Policy# 2 Copy of Insurance Com ce Certificate nut aeeompany each permit. Permit Request(cam box) ❑ Re-roof(hurricane sailed)(stripping old shingles) All consbncctian debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of root) Re-side Re*..A W &ordAdem U-Value • 3 (maximum.35)#of #of ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspecOons required. Separste inechikai&Fire Permits required. 'Where juiced: Immm of this permit does sot ommpt comphmm with odw town depe bnW regubhms,i.e.HiANW,CMWMUM SW ***Note: Property Owner must sign Property Owner Letter of Permission. A of the Haae Improvement Contractors License&Conainacdm Supervisors License is r SIGNATURE: T.-IMM Muddm8 Chwses1BJ4MM PERA9T187C W8&doc Revised 061313 Renewal - • r •. Rl License#36079 byAndersen. RENEWAL BY ANDERSEP -_ MA Lin#173245 ���� CT License#0634555 WINDOW REPLACEMENT en Andean Company 26 Albion Road • Lincoln,RI 02865 Lead Firm#1237 Phone 866.563.2235•Fax 401.633.6602 Federal Tax ID#46-0566630 Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England �/�,yC�UpS.T1OM WINDOW �,AND DOOR REMODELING AGREEMENT 11/y� (/ Buyer(s)Name: FLI CFI 17Ci1 r7 \m T)NJIJ� i)Ave) Date of Agreement w • _1 Buyer(s)Street Address,City State,and Zip Code t P.O..Box: if AVe, Q'� l 1p [�. -'Cb,AA rr MA mQDa/d�srry ` Q. E-Mail Address: &1003JS0W0 E JWNSW }LOA Home Telephone Number: �.10(R1eTelephone Number�k"I�yI _a��/ r _ l O ut, Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms.and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this`Agreement"). ❑ Historic ❑ Condo❑ HOA? Total Job Amount: 1 931 Estimated Suiting M Date: Method of Payment: 0 Check a'Cash Q Financed y Deposit Received : 1340 Credit Cards are accepted for deposit only-maximum 1/3 of the Balance at Start of Job O: y J►b_�IJ: project cost(Please see Credit Card Payment Form.)By signing this Estimated Co letion-Date: Agreement,you acknowledge that the Balance at Start of Job and the Balance on Substantial Balance on Substantial Completion of Job cannot be made by credit Completion of Job o): 968�/ y/ card and must be made by personal check,bank check,or cash. I Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement. Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,"and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under,this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.,(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyers)received the consumer education materials provided by the Rhode Island'Contractors Registration Board7—""-(1h¢Fer's Initials) Renewal by sen of 7rn New England Buyer(s) Buyer(s) By: L�- Signature o Product Manager gnature Signature Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT;ANY,TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - = - = = = - - - - - - - -'- - - - - - - - �- - - - - - - - - - - - - - - � NOTICE OF CANCELLATION X NOTICE OF CANCELLATION I Date of Transaction >Ci/9" y You may cancel 1 'Date`of Transaction You may cancel this transaction,without any penalty or obligation;within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any I receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.If you cancel,you must make available to the Seller I canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when 1 at your residence,in substantially as good-condition as when received,any goods delivered'to you under this Contract or- I received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return.shipment of the goods at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.if you do.make the goods available x Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them.up within i to the Seller and.the Seller does not pick them up within twenty days of the date of cancellation,you may, retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation:if you. 'I dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,'or if you,agree j: fail to make the goods available to the Seller,or if you agree to return the goods to the-Seller and fail to do so,then you I. to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the remain,liable for.performance of all obligations under the Contract:To cancel this transaction,mail or deliver a signed I Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other I and dated copy of this cancellation notice or any other Written notice,or send a telegram to Renewal byAndersen of'I written notice,or send a telegram to Renewal byAndersen of Southern New,England at 26 Albion Road,Li col 1102865, 1 Southern New England at 26 Albion Road,Lincoln,RI 02865, NOT LATER THAN MIDNIGHT OF �/ I NOT LATER THAN MIDNIGHT OF, t I HEREBY CANCEL THIS TRANSACTION. �. I HE Date) CANCEL THIS TRANSACTION. - K Buyer's Signature Print Name Date Buyer's Signature'.` Print Name Date RbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink • c.a tiJ Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers isor License: CS-N5707 BRIAN D DENNISON 7 LAMBS POND CIRCI� "`; ^: Chariton MA 01507 Expiration Commissioner 09/08/2014 _. � C?/>Cie �a.�iLyiza��rvec�ll� off /��C�,1:5cc rri�eflf Office of Consumer Affairs �Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: M245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119=14 DENNISON BRIAN - — ------ 1137 PARK EAST DRIVE --.._ .._.. WOONSOCKET,RI 02895 Update Address and return card.Mark resume for change. su r o xawv;i _:Address r Renewal Employment L]Loa Card T1/...Y.`,µ,., /i/•j /i,,,r„/,,,w is - :-OOke of Coesmmrr Affairs A Bmdnen".buaa License or regisfndon slid for Mdividal we only E IMPROVEMENT CONTRACTOR before the expiration date.If found return to: n OlTin of Consumer Artatn and Business Regulations 3,�43'Y;,RoglaVatbn: 173245 Type; IBParh Pt--Snue 5170 EnPiraUon: 9119=14 Supplement:xrd Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERStNI DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,R102695 Umdrrrervory Not valid without signature _.._ The Commonwealth of Massachusetts Department of IatdmIrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leeibl Name(Business/organization/Individual): �/� s air Address: gOCtG� City/State/Zip: L Ja/CD 11V , -/�6 , W165 Phone#: YD/ Are you an employer?Check the appropriate box: Type of project(required): 1.1I am a employer with A D 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner-, listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp,insurance 9 Building addition required.] 5. 0 We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions mysel f. o work 'comp- right of exemption per MGL y � workers' p. 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 must also fill out the section below showing their workers'compensation policy inform 'on t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. /1 Insurance Company Name: Aq0,Vz&4- SIJ1—QiJI! l� af!/ Policy#or Self-ins.Lic.#: 042! f 3 S02 J( Expiration Date: o� Job Site Address: i 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is e a d correct c t Signature: Dater phone#: !iv a 91D' n Official use only. Do not write in this area,to be completed by city or tows: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#: f Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODIYYM 8/06/2013 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 pollcy(lea)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 NAME; Anita Little Willis of New Jersey,Inc. PHD Ne ,856 914.4660FA 1015 Briggs Road,PO Box 5005 E-MAIL Ne:856A14-1881 PO Box 5005 ADDRESS: anita.little@willis.com INSURERS AFFORDING COVERAGE NAIC A Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED Southern New En INSURER B:Argonaut Insurance Co. Ian 9 19801 England Windows LLC D/B/A Renewal by Andersen INSURERC:Beacon Mutual Ins.Co. 24017 26 Albion Road INSURER D: Lincoln,RI 02865 INSURERE: 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. INSR ADDL SUBS ' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MIDDIYYM (MWDONYM LIMITS A GENERAL LIABILITY S202945900 8/10/2013 08/10/201 DEAACCH��OECTCURRENCE $1 00Q QQ0 X COMMERCIAL GENERAL LIABILITY PRE %1 J Ea�,r°�n�a $100 000 CLAIMS-MADE ER OCCUR MED EXP(Arty one person) $10 000 PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE $3,000,000. GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY jE LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/10/201 COMB�I��SINGLE LIMB 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS ED PROPERTY DAMAGE AUTOS Per aoddent $ $ A X1 UMBRELLA LIAR OCCUR S202945900 8/10/2013 08110/2011 EACH OCCURRENCE s5,000,000 EXCESS LIAR HCLAIMS-MADE AGGREGATE $5 00O 000 DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 0000068028-RI 8/21/2013 08/2112014 X WC STATu oTA- B ANYPROPRIETOR/PARTN CUTIVE FFICER/MEMBER EXCLUDED? N NIA A AIC927818352394 8/21/Z013 OS/21/201 E.L.EACH ACCIDENT S1 000000 O (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS befow E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space la required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXI I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. q.D . Map 3 Parcel 0 Application# o Health Division Date Issued t g5 Conservation Division Application Fee C/. Tax Collector Permit Fee Treasurer Planning Dept. 11r Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village C'.C�(A cp► Owner ��fy , ::r __yj Address 36C>9 38-'o S PEW Telephone U2- Wa6h In n DA C;?(T Permit Request -c ( firy Square feet: 1st floor:existing 1Wb proposed 0 2nd floor:existing proposed _Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6,,D1)z Construction Type Lot Size 0. 9 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Gd Two Family ❑ Multi-Family(#units) Age of Existing Structure l s. Historic House: QYes ❑No On Old King's Highway: ❑Yes OIgo Basement Type: 3/Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 6 V Number of Baths: Full:existing new Half:existing / new Number of Bedrooms: existing new 6 Total Room Count(not including baths):existing 7 new First Floor Room Count Heat Type and Fuel: /Gas ❑Oil ❑Electric 0 Other Central Air: ❑Yes 5d/No Fireplaces: Existing _ New ® Existing wood/coal stove: ❑Yes �o Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:@(existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name _Se v) T Rnyc f O-Et Telephone Number :174 -63-:36 2 Address lo,5 @bah SI'> J+h P_©CCQ(_ License# `9"3;;0-0 C n-4ff L, k-1. 02G 3 Home Improvement Contractor# c;�a-5' Worker's Compensation# V< q!4`7 23 " ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL B`E TAKEN TO VIcS SIGNATURE DATE L O r Y FOR.OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 1 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT- ASSOCIATION PLAN NO. t r` r • ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' www.mass.goY1dia ' Workers'Compensation InsurAnce Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiowhdividual): 6KLGf=L Address: �n �_wL 1 C CAd- City/State/Zip: nICT V115�' 14 4-9� 2- Phone.#: -7-7�--8'3 6a z"k 4 Arer u an employer?Check the appropriate box: :Type of project(required):, 1.I�J I am a employer with 4. [] I am a general contractor and I _ 6. []New construction . employees(full and/or part-time).*• have hired the gub-contractors • 2.❑ I am a'sole proprietor or partner- . listed on the'attached sheet 7. ❑Remodeling . e no e to ees, These sub-contractors have 8. ❑Demolition shi and hay y . .. P employees, , capacity. employee$and have workers din addition �vorkin for me in any9. Butl g g ❑ comp. msurance#' mP [NO Workers Comp.insurance . 5. ❑ We are a corporation and its 10.❑•Blectrcal repairs or additions required.] 3.❑ I am a homeowner doing ill-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 4 ] 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 Homeowoers.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such. 1Cantractors that check this box must attached m 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 worker;'comp.policy number.' jam an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site information. Insurance Company Name: ` yYl Policy#or Self-ins.Lic.# WG - - �f Expiration Dater C� .Job Site Addressi5p d202M Avcy), City/State/Zip:Cnftj E) K4.)9— Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Faiqure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of _Iuvestizations of the CIA for insurance coverace verification. I do hereby certi under a ains•an nalties of perjury that the information provided above is true and correct Signature: Date: _ Phone#: Offccial 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).- J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other . . Contact Person: Phone#:- 11/07/2007 17:13 2025378449 SIDWELL DEVELOPMENT PAGE 02/02 00, i j [FIE Town of Barnstable Regulatory Se rvices �t nu�ss.HAPKASS R = Thomas F.Geiler,Director I ' %6N',P,�►`� i Building Division Tom Perry, Building commissioner 7,00 Main Street, Hyannis,MA 02601 www.tow n.ba rnstabie.ma.us Office: 508-862-4.038 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section If Using,A Builder 37 / J %3 Owner of thesubjegtVopett(;�. hereby authorize_SE'CXirj - �U VC''�-t to act on my behalf, in all matteu relative to work authorized by this building permit app)acation for: _ :?uj r G�r)n NYC!)Lj "i, Cam - (Address of Job) 7 Signaturc of owger hate 179 1 riur Name i tf Property Qw,u.:r is applying for permit please complete the Homeowners License Exemption Fort- on the reverse s,idc: Q:FORMS:OwNr;RPI3R..M ISS10V i z'd ' �bGT-orb-BOS %JojoRos uesS ese=60 40 so AOW ' :���e. '�rinnaurus[rnra�lf n���lauaclaJelld Board of Buildiug Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 141225 Expiration: 1/22/2008 Type: Private Corporation ROYCROFT&KUEHNE BUILDERS,INC. Sean Roycroft 65 Eben Smith Ro-.. � Centerville,MA 02632 Administrator s,,�<,v ✓�c inoii[ireuiurwra`l� n�:�fla<:�ac�u.:rsl� Board of Building Regulations and Standards Construction Supervisor License License: CS 83280 Expiration: 11/29/2010 Tr# 5313 Restriction: 00 SEANJ ROYCROFT 65 EBEN SMITH RD CENTERVILLE,MA 02632 Commissioner GRANITE STATE INSURANCE COMPANY 71337-0000 WC 447-03-14 13102 ----- ----------- o� -- 3-66-0807-00 -•.-. PENNSYLVAN I A ROYCROFT & KUEHNE BUILDERS INC. �� Member Companies of CE NTERVILLE, MA 02632-0000 E SMITH ROAD American International Group RV M EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 • a SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI#: "•� ••' SOUTHEASTERN INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS 641 MAIN ST LIABILITY POLICY INFORMATION PAGE HYANN I S, MA 026o 1-5403 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 004392269 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go6io ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 08/06/07 TO o8/06/08 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Remuneration Premium Classifications Code Number ❑ ❑ lunera on X Annual 3 Year m t 0 Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $124 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $2,550 If indicated below,interim adjustments of premium shall be made: Semi-Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 08/30/07 ASSIGNED RISK , 66 Issue Date Issuing Office Authorized Represent ive wC 0o 00 61 39967. ---- ' Y �• Millis x - mot. � r Town of Barnstable Permit# Regulatory empire n:onthsfromissuedate g y Services Yam1. Thomas F.Geiler,Director Fee EG'RAAr Building Division Tom Perry,CBp, Building Commissioner 200 Main Street,Hyannis,MA 02601 �m www.town.barnstable.ma.us �� �J PERMITf ce: 508-862-4038 APPLICATION EXPRESS PERMTI' Fax:508-790-623MO V 1 3 2006 ON _ RESIDENTIAL ONT,y `SOWN OF BARNSTABLE --Press Imprint rcel Number Not Valid without Red X 3 I, I Address vn� /I '96 3ential Value of Work " y �Y Op Minimum fee of S.25.00 for work under S6000.00 Name&Address /J�t (� )r's Name 1j (Z Telephone Number provement Contractor License#(if applicable) ion Supervisor's License#(if applicable) can's Compensation Insurance h ck one: I am a sole proprietor ] I am the Homeowner ] I have Worker's Compensation Insurance -ompany Name s Comp.Policy# surance Compliance Certificate must be on file. uest(check box) r Re-roof(stripping old shingles) All construction debris will be taken to i Re-roof(not stripping. Going1 over existing layers of roof) Re-side Replacement Windows. U-Value ------- (maximum .44) ere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Yote: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. h r f . . Town of Barnstable RAPIWASM q X"S& Regulatory Services � � Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 - www.town.barnstable.ma.us IHfice: 508-862-4038 Fax:, 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 1��� ��d✓��ia.1 ,as Owner of the subject property hereby authorize Ta G/e �� �9 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature f Owner bate P ► Wei / 7--exrano-d. Print Name L Q:Fomis:expmtrg Revise071405 The Commonwealth pfMassachusetts Department of Industria[Accidents l• �' Office of Investigations 600 Washington Street j Boston, MA 02111 www.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiowhdividual). • Q r S i f Address: City/State/Zip: , ,,, � Phone k -535?- 77/- 786 y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I T6. ❑New construction employees(full and/or part-time).* have hired the•sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. workers' comp:insurance. g, ❑Building addition [No workers' comp. insurance 5. ❑, We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11.[_J 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#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. t am an employer that is providing workers'compensation insurance for my.employees. Below is the policy and jab site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: fob 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 .me 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 )f 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. r do here"bWY3Sunde the pains an penalties of perjury that the information provided abov is true and correct 3i afar Date. ?hone#: FrOther se only. Do not write in this area, to be completed by city or town officigL own: Permit/License# uthority(circle one): of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 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 pf 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-eontractor(s)name(s),address(es)and phone nuniber(s)along with their cert.Mcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year, Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Of 11ce of J.nvestlgations 600 Washington Street Boston,M.A 02111 Te1, # 617-727-4900 ext 406 or 1-8.77-MASWE Fax 617-727-7749 Revised 5-26-OS wwwmass.gov/dia 1 s -- -- ri` ✓die iJamznzooz+aeczl� a��i'layrac�ucsetta Board.f Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: .139481 Expiration: 7/17/2007 Type: Individual P,TRICK CASSIDY F PATRICK CASSIDY`. 15 IRVING STD CENTERVILLE MA 02632. Administrator TOWN OF BARNSTABLE SIGN PERMIT PARCEL-ID 036 034 GEOBASE ID 2175 ADDRESS 5 PUTNAM AVENUE PHONE COTUIT ZIP - j LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 31547 DESCRIPTION COMPLETE WELLNESS (12 SQ.FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS. and Environmental Services TOTAL FEES: $26.00 BOND �- $.00 Ox tNE CONSTRUC-tION COSTS $.00 753 MISC. NOT CODED ELSEWHERE H�►RNSTASLE. *' r` 39. BU LDIN DI ION DATE ISSUED 06/12/1998 EXPIRATION DATE`• r°'``��, The Town of Barnstable • Department of Health, Safety and Environmental Services • MAM Building Division 1659. A� 4 I 4 1 Ep Mpl 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Application for Sign PermitIM it P P"`A Applicant: �� Assessors No. U 3 Doing Business As: [f' ��)L l �5 Telephone No. Sign Location Street/Road: Zoning District: Old Kings Highway? Yes, 0) Property Owner Name: 14/� COCATelephone: Address: Village: Sign Contractor Name: Telephone: $7'75-"2S 0 t Address: 73 e SF, Village: �f S Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? YesO (Note:Ifyes, a whingpermitls required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: 61ft&e Size: Permit Fee:_ Sign Permit was approved: Disapproved: Signature of Building Offi 'al: _ Date: 4 J i a i i i . Co. Name: e,,mhCI* wevyiew's °� (508)775-2501 S i.MIw1�l`� FAX #:(508)775-2502 Address: Price: CoTv r MA Phone: CS�s� H2B- 196g b-►- i5�� Fax: Date: / ►o / 99 3 COMPLETE WELLNESS 4� a place for healing mindbodyspirit C.Patricia Fater,M.D. 4281969 O Copyright & Property of Sign It! Signs Size Colors Surface # Signs SAP 1+ . -awt ClZeA .., Qom ides: 1 Please Sign & Return With Approval Payment Method: Cash Check (#/Name): j Credit Card # Exp. Date .. •: .+ ._~\.t •. -. _ - •Ali/ t �• r I r XOME . IMPROVEMENT CONTRACTORS REGISTRATION t �. Boardlof Building Regulations and Standards t One Ashburton *Place - Room 1301 t t .Boston, -Massachusetts 02106 t . t HOME= IMPROVEMENT CONTRACTOR -�"-"-"""-"---"----"-'--""- "-" - P.ec_stration 100740 Expiration 06/23/98 Type — PRIVATE CORPORATION �s WE I19101EMEdi C7NTRACTOR E Registration 100740 CAPIZZI HOME IMPROVEMENT., INC. Type - PRIVATE COR?ORATION Thomas Capizzi , Sr . Upiratian 06/_3/98 1645 Newton Rd . I CotUit MA 02635 t CAPIZZI HOME IMPROVEMENT, INC Tiaras Capin, Sr. � �i`_ ?ies+tca ACWN5TRA'yR Catuit MA 022- t r a: '19'=}ti ONE AG140ui� I QOSTUN, •kUCTj1ON-.SUPERVISOR LICENSC ti`': =" � `"' ExPires: . il� ScCURIT:Y. � 030-5a- 49d { r tR APIZ�I.-tJR: �; ?ExCIVALb fir..:.: — _- RR ABLE;,;'' A` a26bII �' y in Q\ The Connnonwealth ofMassac•husetts Department of Industrial Accidents ;Office 01117Yestig2tioas 0. 600 ll itchin ton Street Bocton, Ma.u. 02111 Workers' Compensation Insurance Affidavit tear lnf rm tion: PI ase nam loc tion: city - 3S phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working 1n any capacity ts.?w� ri:-o,mr r�+>:x_:,-,.ta��? +y��nr'.3»�"a4,' �ssa• m..+K.�.e xetrr,....l::in.a'a.cya �::.-:.ana:..:. i,ar....i.:afs:•.r3rw�s ,�l.�w,sa:.is�asa-�'.` .ticXc.£..sry.��.L�*'�'Ti���C'•,,.:..: �:e..:v. ..::'o���..,� '�t''L'f.%�...�t,,:�_..=:.�r.''..�.•. .,:�.: ❑ I am an employer.providing workers' compensation for my employees working on this•lob. company name: address: city: phone# r� � insurance co. f / i�7L -a Policy# �e 'z. t••z'K:^Y"" l wall" "{51�+1Y"^^'r•enr*•i"i t ..•st r.r. +W'i�.+T" ypt!�I.':v'u.4+..ewyrr'^'ta n+ d �w,.. - 4...i...:i..:.:,.ia_ss_.:._._s,..-:.�7 .._..:......:.rG,.:...._.::.....,...rat..'�wi._:.t_.s...,,x... .ia:zski....7.,.-s^��'-'.'..t.},..•:'�. `:' -. ""�.s,..+rt.'.Y�'`:�.....�:.i...+.'en.�:.ems!-..:s.sia'\i..w_.�...::i,ia -. .: 1 am a sole proprietor,general contractor,or homeowner(circle one) and hav, hired the contractors listed below who have the following workers' compensation polices: company name: address city: phone#: insurance co. -- Policy# ... • r.�dsa;i..t.:..n::r•.:,:,l..:ii+:T�iie...a�.. ��:. t ' �..'.� � ..tii.-..: company name: address city: __ � _-.phone#• s? insurance co. polio'# Attach additional sheet tf ncecssa rc" `fa' lam„; -' ...=a.s: cr.:;..c �S_'. r 4:..._._n x,.y 'i'_""#.�r ra •f ," Failure to secure coverage as required under Section 25A of NtGL 152 can lead to the imposition o`criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fite of 5100.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage%'HrICation. 1 tlo herehl•certify turd �1 ,yainsand nalties of perjwy that the information provided a5ove is true and correct Si2naturc , - _ ]sue �������� Print name �i9�/ /L �P�1/ Phone# r` oiftr,- cit%.cial use only. do not write in this area to he completed by city or town officialor tarn: permit/license# uilding Department ' Licensing Board 0 check if immediate response is required 0Sclectmcn's Office 0Ileallh Department contact person. - phone#• nOthcr �:�.,;_«:.:.,....r...,,>rt::....,,.,::::.s.: .."':^. .. ., :,.max. ..�n_`s=?fir^. "'-M'=s�^.t<^n�m'-?c -��,_'=-�r--r-+- ,�.•.r ,��:'�.y.•..e-•-rF,�-��ra,-.rp.; IrecscC�"ii I'Jr\1 - - ol inform tion ai it lnstr ctionti . Massachusetts General Laws chapter 152 section 25 requires all employersto provide workers' compensation for their employees. As quoted tom the"law",an emj)1(?Vee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An entp/orer is def ir:ed as an individual, partnership,association, corporation or other legal cntify, or any two or more of the foregoing enga�_ed 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 dwellings 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 seztion 25 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, 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. ► .� -•' ---'- -•--�•-�'�` x---'-• -a--•._,.-..r .n.•.,.�,,.� raas +w�,-w; .tcc.-may...-,_.,.,_...,.�r_„�,...,r } Applicants Please fill in the NN'Crkers' compensation affidavit completely, by checking the box that applies to your situation and supplying company:Tames, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accident>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. r - �,. '�'x.'saa r^"" H ...,n'•'p',�,�y�",$••^ta ` r � r ki S 2 - ^e .ur J,'} b:n�+�c9i,�'�. �:`t"'44ra+.r�'•"�,.� ' ► . a -r, ;.rt ._-:. : +:. �+.�., i r^ r... �+}i': 'fi.#�'':t:� �:'.es '�'�aY`Xi!.-i`�''?+� Xn. > .,k?`.+";?�"r.. Y'-v-••`•r_'+>v� - Cilh or Towns Please be sure that the affidavit is complete and �rintl'd legibly.,-The).•_The Department has provided a space at the bottom of P P ) P P P. 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 perhiit/license number which"will be`used as a"reference number. The affidavits may be returned to . the Department by mail or FAX unlessother'arrangements?have'beenrmade. ± The Office of Investi_ations would like to thank you in advance for you cooperation and should you have any questions, please do not hesita,e to give us a call. .a _ !"'l'0`^i r^• ,,,1.�,.�"'a�.�'',;4 .ti s `t q'Sv� r 45-. �. +ri+o rs-. - '1+ , :.� :•.) .y }.� . �:; ;. ,fi -.J "�{ "^.�t 1« 'a Y r.?•'�"�.� , r " r f••,,�K X 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409, or 375 I� The Town of Barnstable 9q, ' Department of Health Safety and Environmental Services �FGN+i`�a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date— AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost 1741 Address of Work: c_,V_ /�o_AM- j Owner's NameV�/dZ Date of Permit Application: 12—7-4'6" I hereby certify that: Registration is not required for the following reaso.n(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the age t of the owner: Ale - '✓1_"' Date for Ndi a Registration No. OR Date Owner's Name 1 Assessor's office Ust floor): _ ,/ yofrNETo� Assessor's map and lot number o,/..,.�11........ P Board of Health (3rd floor): SEPTIC SYSTEM MUST B err- -t . ...► Sewage Permit number ............................... INSTALLEDI LJAN B�9T�BI Engineering Department- (3rd -floor): F ,,6 9• House number .................... .... ° oYpYa�e�' .... .... ...................................... ��` ENVIRONMENTAL CODE AND APPLICATIONS PROCESSED 8:30-9:30 A.M. and' 1:00-2:00 P.M.,only TOWN REGULATIONS TOWN OF : BARNSTABLE BUILDING .1-NSPECTOR APPLICATION FOR PERMIT TO .......... TYPE OF CONSTRUCTION .............................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...J...�U. lf��t ...J�Vs /... O.T�✓� ��.:/7K Av`Y.V..................................................................... r t............ Proposed Use ....5/rllfGG-Lt.... lQ.t //..y...../ ./h' i .Cff.......................................................................................... ca Zoning District ....../.pp .......... Fire District .......... ........................................................... .1./`. Name of Owner .........Address Name of Builder ..Atf7,W.A...c�..���I�F�y..........................Address Name of Architect '-tiG .y...h4.�ilttlt.l�1....................:........Address f. kae. ............................................................: -31��J-S Res .7 8igrss Number of Rooms PKO/li.3.M..9.X&5....... .. ..............Foundation ..................................... Exterior .G&� G�C. ..:-..1..2G `'.. 1Lf�1�j�t ......Roofing !.....C�'c�lGtrS....................... J J Floors ... )Ocd.......4, .............................................Interior �► '. . .... 4..y...pia--1.. ........................... Heating ......................................`....................Plumbing -.... 1" C��"........................................................ Fireplace ..............:..................................................................Approximate Cost . ��.��j� Fi - Definitive Plan Approved by Planning Board ------------------------- 9 Area � ' — 6 i .................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 73' h % V)� 1 RCy' Z�-I 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. ,h Name ... ...... ...... .................... Construction Supervisor's License ....`... �....... . PERRY, ARTHUR & PATRICIA No...'..28887. Build Addition & Permit for F T _ l � & Renovate/Single Family Dwelling Location .... 5"Putnam Avenue - Owner Arthur. .&,-Patricia -Perry . ...... — ............................ "Frame ` Type of,Construction .......................................... ... ....... ....... r ............... v Plot :................. L'ot Permit Granted .......j.� uax'.y..2.T.........19 86 Date of Inspection ,! .� ��. ...........19 'Date Completed ............. 6�.........19 I , Assessor's office (1st floor): Assessor's map and lot number ,.. � ' �... Board of Health Ord floor): coo-- l Sewage Permit number .� T✓�iNARESTkU ..................... . . Engineering Department (3rd floor): S. �e� rb 9. House number tf. ` r 0 YpY d' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00- P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR. APPLICATION FOR PERMIT TO .......�..��.��.�....�i1.L„l.�/��s-. `� RLI%!�1�1�'c.�....c..../.Q:�`,Q��fI KC-A............... ............................. �rZLs>rIJG3 /�rJ��Gr� ���rp�A TYPEOF CONSTRUCTION ..................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies for a permit according to the following information: 'i A��/ ,c E//� l'J��i'G /�IASS�a Location ...�.�..;�„✓.�.+:(�.............�........;:........�.s........�..,:........................................................................................................... i Proposed Use .... ........ f�;;'/. .y..... ' ; �/A�kr�.�'Ls (� K ....... ZoningDistrict .........!......1.....................................................Fire District ..........!;. ......................................................... Name of Owner A f �.. 7.� / ............Address Name of Builder ..f� T, r'/ ..1 ..........................Address1{ Name of Architect �� t:...�;1C--7.),�.An.............................Address .�"e'.?�e..f t 1�°:.-. ......................................................... Number of RoomsPY12r'i734 )L9!.A4 .Z`.....:3 endr--V: ..............Foundation IV.... e�Lrr......................................... Exterior .%.('1,.?�( hi;!^G -- Cltf ..:•:' 11.!.`"? � ......Roofingr�! E' `? ...................f............ . Floors !:..........1! l.�!�.............................................Interior �� t��?F- C?C�C ..-:"... l,G(,: T C4 . .. .... ................ Fieating�.. -.:..... .. ......................-..::...::....................Plumbing t /:��............................................................ Fireplace ..................................................................................Approximate Cost .'�.... ...................................... _............................::.. /&A Definitive Plan Approved by Planning Board -------------------------------- Cf ! 9 Area ;.`................. ... ............. Diagram of Lot and Building with Dimensions C� /7 Fee .........� ��. ............... ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 7� zv r ; f'Ji2C,</ +1 1 LTJ /'(/T 14.41 AIlr 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. If I Name .C%�N y-ati , Construction Supervisor's License ` ✓ f'........................... PERRY, ARTHUR & PATRICIA A=36-34 28887. Build Addition & No ............... . Permit for .................................... ...........Renovats.�...Sngle„Family Dwelling Location 5 Putnam Avenue Cotuit ....................................... Arthur, & Patricia Perry. Owner .... - q "'Frame Type of. Construction ..:.............................:......... Plot ............................ 'Lot ..... I. Permit Granted ........Janu�rX::2.�z........19 86 Date of Inspection Date Completed ...............:..:....::.............19 G Engineering Dept.(3rd floor) Map Parcel FJS_Permit# House# FIJ Date Iss e / -6 -9 G Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) / �� Fee Conservation Office(4th floor)(8:30-9:30/ 1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) Defi lan Approved by Planning Board 19 BARNSTABLE. 16 TOWN OF BARNSTABLE Building Permit Application Project StieetAddress__, Village Owner /d Address S- Telephone®-w6 4,6-- ' PermitRequestfL �E �� First Floor l,,CC /y square feet Second Floor square feet Construction Type Estimated Project Cost $ 1,7" Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family I" Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes al�o_ On Old King's Highway ❑Yes AffNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing - _ New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information l Name Telephone Number Addres r 2�tWW1 ' 4�flT- License# 3Z, Home Improvement Contractor# /e'lD 74/0 AA Worker's Compensation# f��!/✓��y✓ - $d � 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 11�_ DATE 2-- BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY P PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION } FRAME ' s INSULATION FIREPLACE . i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL °1�- . FINAL BUILDING �+ . 00 , s DATE CLOSED OUT ASSOCIATION PLAN NO. P $