The URL can be used to link to this page

Home My WebLink About0304 PUTNAM AVENUE 730 y 76 ho-m rye. ti �l2J) �►+�T Town of Barnstable .*Permit;i�W -�9Z �p Expires 6 months from issue slate Regulatory Services Fee , + BAPIMABLE. • _ MAC" Richard V.Scali Director # � Building Division AUG 2 8 2013 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02�6O W N 0� [A B L E www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address_30,4 \jkk ,\K [Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address \ Contractor's Name e � �\� etJ� Telephone Number s�®Y�Z' Home Improvement Contractor License#(if applicable) Email: Co;\ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#&'t Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) n ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to7o-a-r* �,PVAd'A"l ❑ Re-roof(hurricane nailed)(not stripping. Goin over existing layers of roof) Re-side 2 C_P�A•e S Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require , SIGNATURE: = Q:\WPFILES\FORMS\building permit forms\EXPRE doc Revised 040215 fR e The Commornveakh of-Vassachusetts .� Deprarthnerrt ce,f lnd ftialAcciderrts • 1�►,,-Ce o,f Imwlstigations - 600 Washington Street Boston,AM 02111 k4'FV'11LrraEfssgDV�dlll ' Workers' Comlpensatian Insurance Affidavit Bnilder-dCuntractnrslEIecfricians/Plumbers App'licant Infori atian Please Print Le-gib Name use a a��_ ems. S k Address: 3�Li �� • � is V�� - ( t nn CitylStatel _ C eh �y \�F 1 V\ �7 Phone L �Ak Are y ou an employer?Check the appropriate bar: Type of project(required): I.41I am a employer*ith�_ 4 ❑I am a general contractor and I 6. New construction employees(felt aod(orpart-time.* have]sired the suli��osihcactors � . 2.❑ I am a sole proprietor orpartner-' listed on the attached sheet I. ❑Remodeling ship and have no employees These.sub-contractors have - g_ ❑Demolition w g, for me iu capacity- employeess and have wodzers' odYnb �Yc 1 9..❑Building addition INO worloem,comp.insurance omp•rnsuran required-] 5- ❑ We.are a corporation and its 10L❑Elechical repair or additions 3_❑ F am a homeovmer doing all work officers have exercised their I LE]Flumbingrepairs or'additiom myself [No worms'gyp. right of exemption per MGL 12. Roofr��insurance rued]F c.152,§1(4k and we have no �u Io o workers' 13-❑'Other emp .yeess.[1Y camp_insurance mquired.j #?lay appticant thst cbetks box#1 um;1 also fal out the section below shat;iag their workers'campensatianpor=y inf7rIDza0n_ 1 Iiameasuners why submit this affidm9t indicating they are&M_sH Hat and then hire antsi&coatrwrorsamst sub=t a new aff&V'It indica—sucFi ZContractors thst rbedr this bout must attached su additi-al sheet showing the n2me of the sub-co=zc Drs.snd state whether a<nct those entities hzm employees.If the sub-cantmdflesbaue empIopees,dieymusrPrnddetheir workers'comp.pally number_ I ars art euephil,or t£tatis pronadb ivorkers'cotupertsrriian insurance,f or my enrp&U..-ees Below is tJtepo£icy and job site inf orazaliom Insurance CompanyNTame Policy or Self-iszs.Lic_ ''� Q V ' aC S�'l� ETirationDate: Job Site Address_ d �� . ' City/State��.rp:CO�y\� Attach a copy of the workers'compensation policy declaration page.(showing the policy number and respiration date). Failure to secure coverage as requiredunder Section 25A o€MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500 OQ andr'or one-year imprisoumeat,as Well as civil penalties in the form of a STOP WO}RF ORDER and a EM of up to 0_00 a day against the-violator. Be adiised that a copy of this statement may be forwarded to the Office of , Invest gations of the DIA for insurance-coverage:-mdfication_ I do£tens c Under is penaI�s o.f perk wy that 9ie informidi"I.P - a7iw�is Grua rd ctrrrect Sii�tatut'e: 11' Date: Phoae� �� — �' c' (0(0 Official use only. Da not ivrite in this.area,to be camp£eted by city artown of j`iczat City or Town: PermitMicense# Issuing: uthority(drdeonej: 1.Board of Health 3.Building Department 3.Cityffown Clerk .4.Electrical Inspector 5.Plumbing Impector 6.Other Contact Person: Phone#: Information and Instructions Massachusetfs General Laws chapter 152 requires an employers'to provi WDIk='compensation for their employees. amt F Pursto this staid,aa.�layee is defined as."_.every person de in the service of another under airy cozdrar�of hit e, express or implied,oral or wriff�" An ernplayer is defined as"an indrvidual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged is a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwDIEng house having not more than three apartments and who resides therein,or the occupant ofthe - dw fling house of another who employs persons to do maim ce,constr acticM or repair work on such dwcEng house or on the grounds or building appurtenant shaIlnotbecause Df such emplDymentbe deemedto be an employer" MGL chapter 152,§25C(6)also sues that"every state or local Rcensing agency,shalt withhold the issuance or renewal of a License or permit to operate a business or to construct buildings in the commonwealth for nay applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." AddifionaIIy.MGI.chapter 152,.§25C(7)states.-Neither the cornet®.wealth nor any of ifs poIitical subdivisions shall enter into any contract for the performance ofpubho woik unf77 acceptable evidence of compliance with the insurance._ rcqui emems of this chapter have been presented to the contracting amhority-" A-pplicznIs , Please fill out the workers'compensation affidavit completely,by cherl th-e boxes that apply to your sitnation and,if necessary,supply sob-contractors)name(s), addresses)and phone nrmrber(s) alongwith their certfficafe(s)of n,c�ce. Limited Liability Companies(I.LC)or Limited Liabi-ityPartnerships(LLP)withno employees other than the members or partners,are not rujui ed to carry wormers' compensafion inanrince. If an LLC or LLP does have employees,a policy is required. Be advised that this affidayrt maybe submitted to the Deparrtment of Industrial Accidents for confnmation of insm-ance coverage. Also be sure to sign and date;.he affidavit The affidavit should be retrmled to fie city or town that the application for fie permit or license is being requested,not the Department of L-ndiistialAccidents. Should you have any questions regarding the law or if you are requ i ed to obtain a workers' comen psation policy,please call the Department at the number list d below. Self-ir ed companies should enter their self-h sutra ce license number on the appropriate line. City or Town Officials f - Please be sate that the affidavit is complete and priced legibly. The Department has provided a space of the bottom of the affidavit for you to fill Dirt i a the event the Office of Investigations has to con±$ct you regarding the in applicantt Please be se to fill is the perLh/licrose manber which will be used as a reference number. In addition,an applicant that must submit multiple pemut/Hcense applications in any given year,need only submit one affidavit indicating current a olicy in fb=&tion(if necessary)and under"Job site Address"the applicant should write"all 10cations in (crty or awn)_"A copy of the-affidavit that has been officially stamped or mailced by the city or town maybe provided to the applicant as proof that a valid aflldavit is on fill-,for frmse permits or licenses A new affidavit must be fi11ed out each year.Where a hDme owner or citizen is obtaining a license or permit not related to any business or commercial veufrr<e (if,-- a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would at to thankk you in affiance 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: C�a=ar Wtesjt3E of Massachmdb, DepaitMMt cif I ustdal Aociden:t ` Q�e�ref�,ve�fig�tio� CmVltau Strut �rlstr�IvfA Elul l� Tf,-L 1617727-4900 Cx- 446 car 1-9 -MA-S AFF, Fa 9 617-727-774 Revised 4-24-07 .ma �cgf ilia 1 �pF THE t�,y, t BARNSrABM + ,�� Town-of Barnstable ArEp�M Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us i Office: 508-862-4038 µ Y -Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder `t�s0 C , as Owner of the subject property hereby authorize e to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit formsT)TRESS.doc Revised 040215 -F Town of Barnstable Regulatory Services tHe Teti Richard V.Scali,Director Building Division RAxMWF4 •' Tom Perry;Building Commissioner 9 1659. �� 200 Main Street, Hyannis,MA 02601 �ArFD www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINTMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-y m ear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a for acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109'.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,` bylaws,rules and regulations. , _` , The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval ofBuilding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15)_This.lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed'Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILESTORMS\building permit forms=RESS.doc Revised 040215 ; x.. / I ar,dac aac�seCt, ; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR (_ Type: Individual Registration Expiration _132149 12/07/2018 Dean F.Stanley, Dean Stanley 359 Capt. Lijah Rd'. Centerville, MA 02.632== Undersecretary 1 Commonwealth of Massachusetts ' Division of Professional Licensure Board of Building Regulations and Standards F Construetibri`Stipe.rvisor CS-035037 - --' Expires: 01/1912020 DEAN F STANLEY 359 CAPTAIN-tIJAH CENTERVILLE MA 02637 ?> Commissioner 1 Registration valid for individual use only on date. If found return tO before the expirati Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 } Bo 02116 i I • Not valid without ature I I I Construction Supervisor s of any use group which contain Unrestricted 3500 c cubic feet 991 cubic meters)of enclosed less than 35, space. f the Massachusetts possess a current for revocatnt edition 0 ion of this license. Failure to p Code is cause State Building ovldpl For information about this lass g Call(617)727-3200 or visit www• I MIS(I=K 11I I(:A I t OF INSUKANGt UUtS NU I.GUNS I I I U I t A GUN i KAU I tit 1 V1IttN 1 Mt ISSUINLi INSUKtK(S),AU I MUKILtU KtYKtStN I A I IV t OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CONTACT NAME NORTHWOOD ESHBAUGH INS PHONE FAX 540 MAIN ST (AIC,No.Ext) A/C,No): E-MAIL ADDRESS: HYANNIS MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# 27JDD INsuRERa:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 236115 INSURED INSURER B: DEAN F STANLEY BUILDING INSURERC: CONTRACTOR INC INSURERD: 359 CAPT LIJAHS ROAD CENTERVILLE MA 02632 INSURERS: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY) (MMIDDIYYYYI UNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE ❑OCCUR PREMISES occurrence S MED EXP An one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POU, PROJECT LOC PRODUCTS—COMP/OP AGG S S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY(Per rson) S ANY AUTO OWNED AUTOS SCHEDULED BODILY INJURY Per accident S ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED eracciden S ONLY AUTOS ONLY S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LU1B CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION PER OTH- A AND EMPLOYERS LIABILITY (7PJU6-2E49857-5-17) 10-08-17 10-08718 x STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? YIN EL EACH ACCIDENT S 100,000 (Mandatory in NH) y NIA N r ELDISEASE—EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE—POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SG & D INSURANCE AGCY LL AUTHORIZED REPRESENTATIVE 540 MAIN ST STE 9 HYANNIS MA 02601 ^-�� 91988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 4/17/18 Town of Barnstable Brian Florence CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit — c� 03 TO: Building Inspector(s), r- -- m This affidavit is to certify that all work completed for'304 Putnam Avenue,-Cotuit has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey (2 -� Town of BarnstableREcEiPaT 200 Main Street, Hyannis MA 02601 508-862-4038 16"3� , Application for Building Permit Application No: TB-18-6 Date Recieved: 1/2/2018 Job Location: 304 PUTNAM AVENUE,COTUIT Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 applicant Phone: (508) 398-0398 (Home)Owner's Name: Delores Montiero-Gibbons Phone: (508)428-5123 (Home)Owner's Address: 304 PUTNAM AVE, COTUIT,MA 02635 Work Description: Add R-11 fiberglass,R-19 cellulose,and R-49 cellulose to the attic. Add R-19 fiberglass and 2" rigid insulation to the basement. Air seal the attic plane and basement with expanding foam, General weatherization. o O O Total Value Of Work To Be Performed: $5,000.00 w Structure Size: 0.00 0.00 0.043 , Width Depth Total @yea I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with_the Workers' Compensation Act(Chapter 568). l.understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued, it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. - Signed: William McCluskey 1/2/2018 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,000,00 Date Paid I Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 1ie/2018 $35.00 jX}d(C-)CM-X70CC-; Credit Card 0299 Total Permit Fee Paid: $85.00 1/2/2018 $50.00 =xXXx-xxXX-mot-! Credit Card 0299 �`� r THIS ISM Y UT A PERMIT � �,�� 'nM.M%+M,iw.,...e..mw,-W.�v✓ �.ose-wa.,a e'rc%e awka✓"-,iP ,wn. <. F': cweuivr.'8te 3c,..o ik �€wr»�Aso...-rn.....�-*a&�r.,,<'v�».,e