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0702 PUTNAM AVENUE
--���-► ,� ,. t �, _ , Zt Im Town of Barnstable *Permit l Expires 6 months from issue date Regulatory ServicesX.0 Fee Z &mwirABL& Mai '71 mass. �' Richard V.Scali,Directoralw& D �6��A�. Building Division SEP 0 7T���N 20'6 Tom Perry,CBO,Building Comm�ss' OF 200 Main Street,Hyannis,MA 02601 BA www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT-APPLICATION - RESIDENTIAL ONLY Map/parcel Number 00 73 Not[valid without Red X-Press Imprint /��- :Property Address 70 Z ` l'u1�i1/i/►'1 A ✓/C- YResidential .Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 702- in Ave Contractor's Name e~ `/J0,J, /&/l 1 //t.5oll Telephone Number (qo I,�R ko 0 Home Improvement Contractor License#(if applicable) 73,2 q 57 Email: Construction Supervisor's License#(if applicable) 6A 7 a 7 [P<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1,46m the Homeowner I have Worker's Compensation Insurance Insurance Company Name `Of7 f`a!A / Ales Let I 1/J S �f&. Workman's Policy Comp. l 313 i Y# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side []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: PropertykOwner must sign Property Owner Letter of Permission. A copy cRthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Oudook\2PI01 DHR\EXPRESS.doc Revised 040215 c •+•- „enewal 1,1 Rtlicem#36079 I,. A,, !+C rl RENEWAL BY ANDERSEN "'"License#I7324 "]N Idea Jel t. p /C CT Wcense#0634I wlssow aaerseNt mAdamncawser 26 Albion Road • Lincoln,RI 02865 /' L read ty„n#t 7 Phone 866.563.2235•Fax 401.633.6602 1O, Federal Tax ID#46-0566.30 Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR t�REMODELING AGREEMENT Date of Atreemene - Buyers)So,"tAddress,City State,and IJp Code/P.O..Box: t' y / M '7 L aTv� T� 62 6-fit' :. E•MallAddreu: 9 dL V,vnf 7—an. 1 /2 / HomeTelephomeNumberV4.Wbto-1)� Work Telephone Number. Buyer(s)herebyjoindy and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal t ." 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 specificationsheet(s)(collectively,this'Agreement"). O Historic ❑ Condo O HOA? Total Job AmounU = � Estimated StartingTDate: ethod of payment: Check O Cash O Financed Deposit Received(33%):�7 it Cards are accepted for deposit only-maximum 1/3 of the Balance at Start of Job(33%): ect cost.(Please see Credit Cord Payment form.)By signing this Estimated Completi1 ment,you acknowledge that the Balance at Start of Job and the Balance on Substantial `0 t-1LS Balance on Substantial Completion of job cannot be made by credit Completion of Job(33%):2- card and must be made by personal check,bank check,or cash. htuyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties, and that l)ere are no verbal understandings changing any of the terms of this Agreement. Buyer(s) acknowledges that Buyer(s) ohas read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated py of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally reformed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. ode Inland Sales Only)Notice to Boyers(1)Do not sign this Agreement if any of the spaces intended for the agreed terms the extent of then available information are left blank,(2)You are eadtied to a copy of this Agreement at the time you sign (s (3)You may at any time pay off the fall unpaid bal ince due under this Agreement,and in so doing you may be entitled to eceive a partial rebate of the finance and insurance charges,(¢)The seller has no right to unlawfully enter your premises r 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, 'Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Buyer's InitioL) Renewal y Andersen of Southern New England Buyer(s) Buyer(s) By: Signature of ProducttfsManager —� S attire Signature Print Name of Product Manager Pri Name �rti Lyhr� �' YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TI Print Name BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION OF THE THIRD FOR AN EXPLANATION OF THIS RIGHT. LLATION FOR MS�c- - — — — — — — — — —ac- - - - - - - -d,— — — — — — N -T— — — — — — . . NOTICE OF CANCELLATION A _ Date of Transaction S� 2-Q-1 A(- You may cancel I Date of Transaction Cthis three business transaction, ays from h without e above date.If y or ou cancel,any I thin this transaction,without any peh� ,You may cancel property traded in,any payments made by you under t I ty business days from the penalty or obligation,within Property traded in,any payments date.If you cancel,an Contract or Sale,and any negotiable instrument executed I Contract or Sale,and an made by you under e by you will be returned within ten business days following I by you will be returned within ten business a the receipt by he Seller of your cancellation notice,and an negotiable instrument executed Y I receipt b the Seller of your c days following security interest arising out of the transaction will be receipt y the E Seller O cancellation notice canceled.If you cancel,you must make available to the Seller I security g out of the 'and any at our residence,in substantially as good condition as when I canceled,If you cancel,you must transaction will be Y oods delivered to you under this Contract or I re your residence,in substantially available to the Seller ' received,any g received, ta^tiall Sale;or you may,if you wish,comply with the instructions of 1 Sale or y goods deliver the Seller regarding the return shipment of the oods at the ou Y•f you delivered to you o good condition tr when Seller's expense and risk.If you do make the goods avast ' the Seller rema,s y Wish, Y u under this Contract or , to the Seller and the Seller does not pick them u �I° l *Sellet+s euPP�en�-.1.1—gse,and a return sh*Comply With the instructions of � ,you may P within to ttie`Seller.and r'sk if You doom ent of the goods at the twenty days of he date of cancellation retain or I t wen d e Seller ake the dispose of the goods without any further obligation.If u Ih'days of the date of does nog-pick egoods available p Yo dispose of the hem u fail to make he goods available to the Seller,or if you agree I fail om goods without a�Ration you ,ii�retainthoi' to return the goods to the Seller and fail to do so,then you I to return tthehge goods available to fiarther obligation If you remain liable for performance of all obligations under the I remain liable fords to the Seller a„de�ellen or if you agree Co cancel this transaction,mail or deliver a signed Contract.To cane rfo traDsactlo ml to do''so,then Y and dated co n,mailall or deliver a signedyou and dated copy of this cancellation notice or an other I py of this g the written notice,or send a telegram to Renewal byAndersen of I written notice,or send a tele cancellation ° n tice or any other Southern New England at 26 Albion Road, incoln,RI 02865, I Southern New En g OR b NOT LATER THAN MIDNIGHT OF I NOT LATER THAN MIDNIGAl Hb on T Op°a yAndersen of (Date) (Date) Lincoln,R1028iS5, I HEREBY CANCECTHISTRANSACTION. I HEREBY CANCELTHIS TRANSACTION. Buyers sig"tun Print Name Dan Buyarq Sltriatun - RbA Copy:White Buyer Co Yellow Print Name pY Buyer Copy:Pink oat t Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts Department of Public Safety - - Board of Building Regulations and Standards icense: CS-095707 I 1..0:-4struction Super-visor BRIAN D DENNISON 7 LAMBS POND CIRC�µ CHARLTON MA 0150 Expiration: Uommiss over 091081201.8 Office of Consumer Affairs�d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home ImprovementContractor Registration RoglWatlon: 173245 Type: Supplemerd Caro SOUTHERN NEW ENGLAND WINDOWS_.LL(' redon• 91192016 DENNISON BRIAN --- 26 ALBION RD = - LINCOLN,RI 02865 - Update Addren and retorn card.Mark ream for el!ange �TmtCtO ------ ��on.nso+w.aa/af yf� of Csaumer AIIahs&Bulaw Regulation License or regi trntion vaW for kadivldul ruc only . E RAPROVEMENT CONTMCTOR before the expiration date If f000d roam to: Office of Consumer Attain and Badmen Regulation latra0on: 1782sS Type. 10 Park Plaa-Soite 5170 Exp1rv"n:911WZD16 SoppiemeN:am BosWa,MA 02116 SOUTHERN NEW ENGLi WINDOWS LLC. c_.s•. RD&VAL BY ANDER_SON'' i DENNISON BRIAN 26 ALBION RD -- LINCOLN,RI 028t5 Undrnarelary 10!vaBd widwut aigoatarc _ I I ! i I The Contntonivealth of Massachusetts 53 r Department of Industt ial Accidents I Congress Street,Sttite 100 Boston,MA 02114-2017 wwly.rnassgov/dia «orkers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER'►4ITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): (,1, W-) Address: �p City/State/Zip: I ad ar,?_M� Phone -2- � b Are,you an employer'Check the appropriate box: Type of project(required): 1.;5 I am a employer with 1201temployees(full andlor.pan-timey.w 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.fNo worker'comp.insurance required.] 9. ❑Demolition 3.Q 1 am a homeowner doing all work myself[No workeTS'comp.insurance required.)' 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property_ I will 10 Building addition ensure that all.contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions. Proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the anached.sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance., 1 6.❑We are a corporation and its officers have exercised their right of exemption pertvlGL c. 14.L7 Ether W i-�UyGJ 152,91(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 must also.ftll out the section bcloly showing their workers'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 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. j I alit an employer that is providing workers'contpeasation insurance for my employees. Below is thepolicy and job site` I nforlll ation. ,p, Insurance Company Name: Policy or Self-ins.Lic.#: �cA ,3 13&D 8' Expiration Date: 7. Job Site Address:__ 70 2— A✓t° City/State/Zip: CA 71-0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,}25A is a criminal violation punishable:by 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.A copy of this statement may be forwarded to the Office of Investigations of the.DIA for insurance coverage verification. I do hereby cer ' ruder the p -rs and penalties ofpejjary that the information provided above is.true and correct Signature: Date: 7- 16 Phone Official itse 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#: SOUTNEW-01 UOLLINGER ACORU" CERTIFICATE OF LIABILITY IN.SURAN DATE(MMIDDIYYYY) `,tea 612001.6. THIS-.CERTIFICATE IS ISSUED AS A MATTER OF: INFORMATION ONLY AND CONFERS NO RIGHTS:UPON,THE CERTIFICATE`HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA*ELY AMEND, EXTEND OR:ALTER:THE COVERAGE:AFFORDED BY THE POLICIES ,. BELOW :THIS CERTIFICATE OF INSURANCE DOES NOT CONSTFTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE:OR PRODUCER,AND THE.CERTIFICATE HOLDER: _ IMPORTANTt If the: certcate holder 1s 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 endorsemerlt: .A stateme on this certificate does not confer rights to the cetificate holder in lieu of such:endorsement(s): - CON:ACT PRODUCER NAME:. . COB6 Insu►ance,Inc.-CO GONE (303);988,0446. a:No):(303):98..§, 04 821 t7th Sti &MAIL Denver;CO 80202 ADDRESS.CoBizinsurdn obiznsurance.com INSU AFFORDING COVERAGE NAIC.0 IN SURER A:ContineMal Western Insurance Company 10804 INSURED INSURER B Southern New.England Windows LLC INSURERC: DIWA Renewal'by Ander§en> 26 Albion Road: INSurtER D Lincoln,RI 02865 INSURERE COVERAGES'- CERTIFICATE NUMBER:,:.. . REVISION.NUMBER: THIS IS.TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. _NOTWILHSTANDING ANY REQUIREMENT TERM OR-':CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH:THIS CERTIFICATE MAY BE ISSUED OR:,MAY PERTAIN THE;I. .INSURANCE AF.,FORDED BY THE..POLICIES`DESCRIBED:HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS.AND+CONDITIONS OF SUCH POLICIES ILIMITS'SHOWN MAY-HAVE BEEN REDUCED.BY PAID'CLAIMS.` EFF POLICY INSR. - - ... - - _ LIMITS..- ... LTRt .•.. _ TYPE OF INSURANCE:_ INSD".WVD'. POLICY NUMBER. MMID ,.. . -.MMID A X COMMERCIAL,GENERAL LIABILITY EACH OCCURRENCE $ 11000100 CLAIMS MADE OCCUR CPA3136080. .. 107/01/2016 07/01/2017,:.:PREMISES'Ea ocaurence $ 100OQ MED EXP(Anyone person) $ 10,00 PERSONAL&ADV INJURY.. $ 1 AOoi000 GEN'L AGGREGATE LIMIT APPLIES.PER: I GENERAL AGGREGATE $ 2, 00,0o X POLICY PRO- 0 JECTT 7 LOC PRODUCTS COMP/OP AGG $ 2,000,00 OTHER: EMPLOYEE_BENEFI Is 21060-000 �CO � M Ea8AUTOMOBILE LABILTY � , $ 11000,000 q X A _ _ CPA3136080, -„ 0710112016-,O71011201.7; BODILYINOURY{Per person) .$,__-ALL OWNED, 1 SCHEDULED' v BODILY..INJURY(Per aeddent) $ AUTOS AUTOS NONZWN_ED - PROPERTY DAMAGE $ HIRED AUTOS - AUTOS.-. Per-wddent X UMBRELLA LIAS X OCCUR : EACH:000URRENCE $ 59000,-000 A EXCES LIAB CLAIMS-MADE CPA3136080 07/0112016 .0710112017 AGGREGATE $ DED X RETENTION$ O. ggregate. S 5,000,000 WORKERS.COMPENSATION STATUTE ERA AND EMPLOYErLR'LIABILITY Y l N , A ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA CA3136081. 07101.1201.6 07/0112017 E L EACH ACCIDENT $ .1 r000ro00 OFFICER]MEMBER EXCLUDED? 1j000�600 IMamldory ln'NH) E.L.DISEASE-EA EMPLOYE $ If es,.deaenbe under E.L.DISEASE-POLICY LIMIT $ 1 ro00.o0 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddIHoneIAirnarks'SGredule,nmy.be atfaehedf niore epaee,Wrequlred) CERTIFICATE HOLDER .CANCELLATION SHOULD ANY:OFTHEABOVE DESCRIBED POLICIES BE CANCELLED:BEFORE THE EXPIRATION .DATE.: THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISWNS. AUTHORIZED REPRESENTATIVE -- ©1:988-2014-ACORD CORPORATION. All:rights reserved. ACORD 25(2014101) The ACORD,name and logo are registered-marks of ACORD �►� 1-3 Its OFV r Town of Barnstable *Perm➢t#,Z615� d Expires 6 months frosue date * Regulatory Services Fee Richard V.'Scali Director iOrEp Wlp'l- Building Division t'� HIS Tom Perry,CBO,Building Commissioner TQWN OF ARNSTABLEZ00 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ����!� �� _ Prope Address 7rty `"� /yrew,` �, esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address of• �Zf 4,-� r i ►w yIt , i Contractor's Name c Telephone Number J E .�.Zy� /dff� Home Improvement Contractor License#(if applicable) / 4 / Email: Construction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ` ❑ I am-the Homeowner ave Worker's Compensation Insurance Insurance Company Name �Q,•-,..� / vb�� r LG , y Workman's Comp.Policy# �(f/ ri✓ $�I Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) -�-- " 2�Z1'e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to /��✓'�/ � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side + ❑ 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. r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Ile Commorrivealth o,f_Vassachusetts -_ Deparament o,f Indusdrial Acciderats _ - - 0 e o,f fmwtigations 600 FPashuagion Street ti Bostonx-41A 02111 wiv nniass gavldiri Workers' Campensatian Insurance Affidavit BmldersiContractursJEIectr cians/Phunbers' Applicant Information Please Print Legibly Nsme(Bus-me anizationM i idaal} 2>✓� p a aloes_ & City/StateJ -- ��I I� /°W &63d- Phone 500 a Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with �. 4. ❑I am a general contractor and I 1 6. ❑New construction (fill audl`or part-time)-* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed an the attached sheet. 7- ❑Remodeling ship and have no employees. These sub-contractors have • . g_ ❑Demolition. worlti�vng for me in any capacity. employees and have worlcers' 9. El Building addition [No -orlcers' camp.izasuran,ce comp.insurance. . required-] 5. ❑ We are a corporation and its ltk❑Electrical repairs or additions 3.❑ I am a homeoumer doing all work officers have exercised their 11.❑Plumbingrepairs or'additions myself �o workers �F- I-). of repairs ' Tight of exemption per MGL glo . . insurance required.]T c.152, §1(4h and we have no employees.[No woric�ers' 1-3.El other comp-insurance required.] #Any Wbcaut that checks box#1 mast also fill out the section belowshnwing their workers'compensation policy information- 9mmeoauners who submit ibis afidavit indicating they are doing all wa l and then lice outside contractors mast submit anew affidavit k&ca lug soul- fCanttactors that check this bout mast attached an addilianat sheet showing the name of the sub-couctrmcb m and state whether or not those entities have employees.I€the sub-cones=shave employees;theyrmurpmvide their markers'camp.policy number. I ain an eutplo wr that is prmidrng workers'contpe:isatian insurance for my empk yem Below is fate policy and jots situ informatiortti / Insurance Company Nam: Policy m or self--ins..Lic.#:-2CXJ I (/J - ( Mtpirat on Date: �a f :=�d l(- Job Site A,ddmssz 7�0� K ,.112 �n �V�e City/State/zip - Attach a copy of the workers'compensationpoUt;y 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$1,50a 00 and.f'or one-year imprisonmenk as well as ciO penalties im the form of a STOP WORK ORDERand a tine of up to$250-00 a day against the violator. Be adiised that a copy of this statement maybe f awarded to the Office of Investigations of-the DIA for insurance coverage veri$tation- I d'a Hereby cedify Ander the pvdi s andpenahVes ofpeduiy that Ae informa#ian-prmu&d above is true and correct Simahn e_ ,�/`y-� l ��/ Date_ elby/ C l c�3� Phone SocI �50� /I Ts—� OBIcial use only. Do not write in fhis area,fir be crrrnpleted by city artown affieiat City or Town: PermitUcense# LssuingAuthority(tarcleone): 11 1.Board of Health 2.BuRding Department 3.fity1rown Clerk 4.Electrical Inspector g.Plumbing Inspector 6..ather Contact Person: Phone#: Information and Instructions Massarrh=ctts G&aeral Laws chapter 152 requires;all employerS to provide workers'compensation far their empIoyees. pant-to this stataft-,aa.ewplayee is defined as."_.ev-ery person in the service of another under any cozra.ct of bire, z express or implied,oral or vrittcm" An a7TTvyer 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 tustee 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 tin do maintenance,constraciion 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 Ticensing agency shall withhold the issuance or renewal of a license or permit'to operate a business or to construct buildings in the commonwealth for arrp applic- mt who has not produced acceptable evidence of compliance with the hisurau.ce-coverage required." Additionally,MGL chapter,152, §25CM states"Neither the.commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work unfrl acceptable evidence of compliance with the ihsu:ra„ce.. requ mffrrls of this chapter have been presented{n the contracting aufhozity." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone numbers)along with their certificates)of =m-ance. Liunited LiaboE4 Companies(LLC)or Limited Liabi y-Partnerships(LLP)with no employees ocher than the members or partaers,are not requun-ed to carry workers compensation msrrcance. If an LLC or LLP does have employees,apolicy is regnued. Be advised that this affidayit may be suhhm,fttT to the Department of Industrial Accidents for conformation of inset ance coverage. Also be sure to sign and date the affidavit The affidavit should be retrmmed to the city or town that the application fur the permit or license is being requested,not the Department of . Ln-dristrialAccidents. Should you have any questions reg-ading the law or if you are regrri to obtain a workers' a:omP ens ation Pc3',P eP oli please call the D artruent at the n listed below.lis below Self-insured companies should enter their self-insTMance license number on the appropriate line.. City or Town Officials f at the affidavit is complete,and rimmed le ly. The Department has provided a space at the,bottom Please be sure m mp p � 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 per ilYlicense number which will be used as a reference nurnber. In addition, an applicant that must submit multiple permit/Ecense applications m any given year,need only submit one affidavit mdira± g current p olicy h2f6=ation Cif necessary)and under"Job Site Address"the applicant should write"aH locations in. (city or " -affidavit that has been offic stumped or.marked b the city or town may be provided to the �rvn)_ A cry�f�e-af vrt rally sf� Y applicant as proof that a valid affidavit is on file for future permita or licenses. A new affidavit must be tilled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burro.leaves'dr.)said person is NOT required to complete this affidavit The Office of Investigations would lake to thank you in advance for your cooperation and should you have any questions, please do not hmihate to give us a caI L The Department's address,telephone and fax number: Thg:t Ca�c wealth of Massaahus-_its , Department of lndMtdal Aoeidents CdUce of l vestiotio.AEi 604.washivml t z Bosto-n�MA GPI I I Tf,-L' GZ'-727-4900 cxt 406 Qr I477-MASSAFE Fax#617-727-7749 Revised 4-24-07 :inasF,�gQvldia 508-328-1635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com PO. BOX 1613 sBa = CENTERVILLE, MA 02632 Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc. Proposes to perform the following work: f � Location of proposed work: Mr. & Mrs. Lynch 702 Putnam Avenue Cotuit, MA 02635 Date on which construction should begin: October 2015 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,.and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $4,800.00 30 yr.GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty) Proposal is for left side over garage area only In the event that,while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 fora carpenter and$30.00 for a carpenter's laborer, plus the cost of materials. Thank You For Giving Us The Opportunity To Help You Improve Your Home 1 -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment, and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8 "vented drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -A 10 yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of testimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner ' _ Contractor ��!�- - 1 ?Tie Commorrivealth o, -Mass- adrruetth Deparair etrt o,f rndustriat Accidents - - -- l7,f)ke o,f rnvestigadens 600 Washington Street Boston„4 01111 ivysn!niass govfdidt c Workers' CGmpensaf ffn Insurance Affidavit:$uilders/Cantracturs/Electricians/Plu nbers Applicant Iufarmatidtn l' Please Print Legib Naine( a imfionll &irMY_ —I-&iNM*5 /t1�yj7v4VG 0�^1 �✓�, oa Address: DaX (�i chi city/sfatef �i {w l Phone 4. 5D 0 a ° Are you an employer`I Check the appropriate b= 1.[�I am a employes oath J__ 4 ❑I am a general contractor and I Type of project(required).: employees(full anct(or part-time)-* have hired-the sub-contractors b. EJNew 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 wod:fng fim mein any capacity employees and have workers' 9. ❑Building addition [No w7nkers' comp.irtsutan.ce comp-insurance$ . required-] 5. ❑ We are a corporation and its lux_❑Electrical repairs.+ar additions 3.❑ I am a hzmeoumer doing all urork officers have exercised their 11_❑Plumbingrepairs or-'additions. nrysel€[No workers'comp- right of exemption per MGL o ofepairss insurance required-1 l c.T52,§I(4h andwe have ua 17. employees.[No workers' 13.❑Other comp.insurance required.1 ti OAnyWBczntdst checks box 9lum also fill out the sectionbelowshzwmgibexwoffierecampensationpolieyinfarmsuao_ fiaTMem +arc who submit this affida<<u ind5c •=g tltv_y are dGmg all wank aid diem hue outside contractors amst submit a new affidarst indicate such f Contractors Ybst check this box must attached au additional sheet showing the nzne of the sub-comftscUo-a.sad state whether or not(hose entities hake e=W1WJees.Ifthesub-caataciarshave employees,they=nt provide their umtken'Comp.polity number_ I arm an errepJpy�r tlratirpro�zdirrg a�rrrkets'corrrperrrrdiart iasrirarrce or air}�enrp gees Setodv is thepa cy rend jots rite • informrriion. Insurance Company Nam , / K1�•w• �m� �� C¢�SVa'�� �� �/o 'Policy 41 or Self ins.I ic_ �nL(/J - Q 1 Expiration Bate: '02 f': d?®��; Job Site Address 7�g YC11Y,1hrn �V�e City/StaWzi0: d_ '_)L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Faflure to secure coverage as required.under SeCtiou 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,50D OD and far one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDERMd a time of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Iarvestiga#ioms ofthe DIA for insurance coverage vedficatio ' I dIo hereby cerWfy antler the pabis andpenaWes ofpedury that the inforwrttianprm,-hWabore is trots and correct Si nature: '� l bate: l/y J Phone;k svd'l L9 official use an£y.v Da trot o-vrite in dais inert,to be cainp&ted by exiy rarton�n ofjiciet City or Town: PermidUcense;g Issuing Aatheritp(circle one): 1.Board of Health 2.BuMing Department 3.fit flown Clerk 4,Elechdcal Inspector rr.Plumbing Inspector 6.Other Contact Person: Phone#: l ACO® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/03/2015 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: Debbie Mark Sylvia Insurance Agency,LLC PHONE FAX 404 Main Street AIC No Ext: 508 957-2125 A/c No: 508 957-2781 Centerville,MA 02632 ADDRESS:mark marks Iviainsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Farm Family Casualty Insurance INSURED INSURER B: D&T Construction,Inc. INSURER C: PO Box 168 Centerville,MA 02632-0168 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. 1L7R TYPE OF INSURANCE I SD D POLICY NUMBER- MM DDIIYYYY MMIDD POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 2001XO485 7/21/2015 7/21/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR DAMAGES(RENTED PREMISES Ea occurrence) ccurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT PRO LOG PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acddent ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accdent) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident . $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2001 W7501 7/25/2015 7/25/2016 STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descf be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. Carpentry The workers compensation does not provide coverage for Troy A Thomas and Shawn M Doyle. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. I Centerville,MA 02632 I AUTHORIZED REPRESENTATIVE r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD J CW�egistration- ree ofCousu r4fraonruea�/ ME IMP merAffIV airs&Business���ac�utae� •�OVEM 954CONTR,gCTORg0lationLicense iration 3715/2 °r registration COYLE+Tl i ) .�c 01 p Type: before the expiratio n valid for individ OMAS CONST'INC r'vate Corporatio:, 10 Pare of Consumergffairs If found return to. 99-TROY THOMAS E Boston,MA 02I16aza �te 5170 and Business Regulation NOTTINGHAM pR CENTERVILLE, MA 02632 Undersecretary • - Not v td wi outsignature < � Massachusetts _ .Boassacrd I Massachusetts Department of Public S Building Regulations and Safety Construction Supemisor Standards License: C B Specialty ; L-099913 TROY.-A THOMA ��� �•"� 499 HOTTING CIENTER Commiss Expiration 0411Z016 Town of Barnstable Regulatory Services Tbomm F,Geller,Director Building Division > Tom Perry,Building ComIIris4loner ea '� 200 Mahn Street, Hyannis,MA 02601 d Off ice:.5U-862-4038 Fax; 509-790-6230 Approved: Pee. Permit#- 'C28 C?SCo l � HOME QCCUE `SON REGISTRAU.0 Data, October 8 , 2008 Name Elizabeth '.Lynch PhoneM U8_428_796n ' Address: 712 putnam Avenue Village: �nt.tri t NameofBusiness; Elizabeth A Lynch, Attorney at Law Type of B&,uinos; A t :o rne - Map/Lot 0 3 q/l 1 2� E Tk \M It is the intent of this section to allow the residents.of the Town of Barnstable to o?erate a home occupation with n single family dwdliags,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that ttie`ictivity shall not be discernible from outside the dwelling: there shall be no iucnase in noise or odor;no visual alteration to"tha' prrmscs which would ruggest anything ot}hcr than a residez6al.nse;ho increase in traffic above norma1.r'es dtridal volumes; and no increase in air or groundwater pollution. Aftrs regisuxtion with the Building Inspector,a customary home occupation shall be permittcd as of right=`siibjcct to tRe;; faDowing conditions: • The activity is carried on by the permanent resident of a single family"residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 squwr feet of space: o 'There are no external alterations to the dwelling which are not customary in residential'ouDdings,'and there is no outside evidence of such We. • No na.$"c will be generated in excess of,normal residential volumes, } • -"he use does not involve the production of offensive noise,vibration,smoke,dust or other partiralar matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. " •: Th=is no-storage•oruse of toxic-or•hazardous materials,or flammable or explosive materials,in excess of - normal household quantities. Any aced for puking generated by such use shall be mci.on the same lot containing the Customary Homc Occupation,and not Within the required front yard. • There is no exterior storage or display of mxteziatls or equipment. " o 'Mere is no com=rrl whicles related to the Customary Home Occupation,other than one van or one piclr-up t oot a tccccd dnctrsrr parity,and one trailer not to exceed 80 feet in leaO and not to excfsd d tires,parked on the sane lot 0entaini4 the Customary Home Occz:padon- No.siga shall be cisplxyed indicating the Customary Home Occupatibn. o If the Customary Home Occupation is kisted or advertised as a business,the street addm.'ss shaIl not be t. Mcluded, . • ho p�rron SiraIl"bG cmp)cyedin the customary Home Occupation who is not a pemzanes�t i sident of;he dweM4•:ni.t '4 1,the undersigned,have read and agree with tAe above restrictions for my home occupation I am rtOteriug.' ,< Applicant __ Date; /�. .'�1. .,. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION'...-, Map Parcel';'F `. :Application# 0 Health Division ""Date Issueei Conservation Division lY Application Fee Planning:Dept. i.r Permit Fees �' • Date Definitive`Plan Approved by Planning Board Historic = OKH Preservation / Hyannis Project Street Address L)e a Village Owner GERA an } t6 CUz gci�-T�� VmCN Address ;5AMC Telephone Permit Request 16X 20' F�C-E5TAV bJ-+J6 P/q P Ro2.T )zEE� c�i oRTS �oo `Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater.Overlay r (Project Valuation ?_100, Construction Type Lot Size Grandfathered: 0 Yes ❑ No If'yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑ P�Yes UP On Old King's Highway: ❑Yes 2<o Basement Type: O'Full ❑ Crawl ❑Walkout ❑Other a Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft a Number of Baths: Full: existing 2. new Half: existing n�av -: Number of Bedrooms: existing _new co Total Room Count (not including baths): existing `7 new First Floor Rock Count Heat Type and Fuel: @--Gas ❑Oil ❑ Electric ❑ Other Central Air:, des ❑ No Fireplaces: Existing New Existing wood/co I stove"❑Yes' U4�o Detached garage: ❑existing U new size_Pool: ❑ existing ❑ new size _ Barn: ❑ exis ing ❑ new size_ Attached garage: &Kexisting ❑ new size _Shed: existing ❑ new size _ Other: ey-Poz /1.,k2V 1 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# - _ Current Use = Proposed Use ti APPLICANT INFORMATION (BUILDER O HOMEOWNER Name 6a=8F_-D LN,.t11 Telephone Number SOS= �2$� gDaZ Address �D Z�1 uTuill!& A,JG License# 9-ru i r, MA eus!r Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ONE SIGNATURE DATE /��D FOR OFFICIAL USE ONLY ri4PPLICATION# DATE ISSUED MAP/PARCEL N0. ' ADDRESS VILLAGE J OWNER DATE OF INSPECTION: 'FOUNDATION FRAME INSULATION I' FIREPLACE s ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGH FINAL s , FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Ma-ssachusoffs ,Department of Industrial fLceidents Office ofrnvestigations 609 Washington Street Boston, AM 02111 www.mmass.gov/dia Workers' Compensation Insurance Affdavzt: Builders/ContractorsTlectriCla115/PXumbcrs A Licantlnformatiou Please Print LEdW Namr, pusiDr- s ?rgm:T oa/LndiAdual)- Crgpx-t Address: City/State/Zip: ,07 Are you an employer? Check the appropriate box. Type of pirojcct(required): 1.❑ I am a employer with 4• ❑ 1 am a general contractor and I 6. ❑Ncw construction employees(full and/or part-time).* have hired the s7ib contaactors listed on the attached sheet 7. ❑ R smodeling 2 ❑ I am a sole proprietor or partsacr- These sub contractors have ship and have no employees 9. ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition [No workers' comp.-insurancC comp-insurance.t 5. ❑ We arc a corporation and its 10-❑Electrical.repairs or additions 3:5eTub) officers have exercised their 11.0 Plmnbing repairs or additions I am a homcownrr dcimg all work mysclL[No workers' warp. right 6f exemption per MGL 12 ❑RDDf repairs in�rtranec rcquurd] t c. 152, §1(4), and we hayb no 13.❑ Other employees. [No workers'. comp.insurance rcquimd.] �fwy applicant that ehcci5 box#1 must also fill out the section below showing their worka�'eompc asahon policy infurnali - t Homoowncn who submit this of davit indicating they arz doing all work;md tbcn biro outside contractors must mbmmt a new affidavit mdieatin g such. tCantractors that ebrck this box must atbAcd an additional eboet sbowing the name of the staim wbetbc:r o'r not thosd entities havo employees. If the sub eonkactors have anploycrs,they moat prwidb their workers'comp.policy ntunber. Jam an employer that is providing workers' cornpensa-ion insurance for my employees. BeLu-yv is the policy and jab Site ' inforrriallnn. . . Insluance Company Name: Policy#or Srlf-ins. Lic. #: Expiration Datc: Job Sitc Address: City/Sb&zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to scare coverage as required under Section 25A of MGL c. 152_can lead to the imposition of criminal penalties of a 5nc uT to $1,500.00 and/or one-year i Dpri_sonmLnt, as well as eillil penaltit s in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator. Bc advised drat a copy-of this statement may be forwarded to the Office of Invcsti atians of the DIA for n'jnu-ancc coverage verification. Ida Izereby eertf under the ins d penalties of perjury that the information provided above is true and sacred. Si attae:. hone c; — Q Offzcw use only. Do not write in this area, tb be completed by city or lawn offrclaL City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2.Building Department 3. City/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: • Phone#: Massachusetts General Laws chapter 152 requires all cmploycrs to provide workcrs' compensation for their crupjoyecs: Pursuant to this statute, an employee is dc5ncd as "...every person in the service of another under any contract of hire, `f 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 e fore din en aged in a joint enterprise, and including the legal representatives of a deceased employer, or the o f th g g. g rccivr or trusted of anindividuaL partnership, association or other legal entity, cmploym e ee g mploys. Howevar the c e owner of a dwelling house having not more than tbrcc apartments and who residcs therein., or the occupant of the Jwclling house of another who employs persons to do maintenance, construction or repair work an such dwelling house Dr on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." vIGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or -enewal of a license or permit to operate a business or to construc.t buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." �dditionaIly,MGL ohaptLr 152, §25C(7) states `Neither the commonwealth nor any of its POI.J cal subdivisions shall. :rater into any contract for the performance of public work until acceptable cvidenee of comspliznec m,#h the mama =_ cquircmcnts of this chapter have bccn presented to the contracting authority.. ,pplicznts Iease fill out the workers' compensation affidavit completely;by checking the boxes that apply to.your situation ant% it rx_�saly,, supply rdb-eontractor(s)name(s), address(es) and phone numbers) along with their ccrtifieate(s)of mxance. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no-cmployccs other than the umbers or partacrs, arc not required to carry workcrs' compensation manner. If an LLC or LLP dots have npl.oyecs, a policy is required. $c advised that this affidavit may be submitted to the Department of Industrial ccidcuts for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should returned to the city or tnwn that the application for the pc=it or license is being requested, not the Department of ulustial Accidents. Should you have any questions regarding the law or if you arc required to obtain a workers' ,ropcnsation policy,please call the Dcpartmcnt at the nurnbcr listed below. Sclf-insured companies should enter their lf-innuanro liccma number on the appropriate line. ity or Tow-R Officials ease be sure that the affidavit is complete and printed Icgibly, The Deparment has provided a space at the bottom 'the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant case be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant it must submit nuiltiplc permitlliccnsc applications in any given year, nccd only submit oap affidavit indicating current licy information(if necessary) and under"Job Site.Address" the applicant should write"all locations in (city or 7m)."A copy of the afidavit that has bccn officially stamped or marked by the city or town may be provided to the plicant as proof that a valid affidavit is on file for fuhrrc permits or liccmcs. A new affidavit,must be filled out each ar.Wherc a home owner or citizen is obtaining a license or permit not related to any business or commercial venture a dog License or permit to bum IDaVcs etc.) said perso, is NOT required to complete this affidavit davit Office of lnvestigations would hkc to thank you in advance for your cooperation and should you have any questions, ase do not hesitate to give us a call Department's address, telcphoac•and fax number. Tha C6mmaiaw(-,lth of MassA6husotts De)az fmt of IaduEtrial ACCid(_IIlts Offlce of Iuvestipt ons 6Q0 Washing Street Boston, MA 02111 Ter. # 617-727-490.0 cxt 4-06 ar 1-M-MASSAFB Fax # 617-727--7749- 11-22-06 " www.ma.ss.gov/dia COLLIER-PORTS TM OF NEW ENGLAND carports and garages 13 Clinton Street CCCCCCCCCCCCCCCC © Hopkinton, MA 01748 ® CCCCCCCCCCCCCCCC 800-345-7678 Regal White- Pure White- Ivory-Tan Fax 508-435-1534 Green - Ivy Green - Bro -Stone Red - Black - Royal Blue - Gallery Blue www.necarports.com Moss- Buckskin- Brown Gray- harcoal COLLIER-PORTS and Garages PRICE LIST Enjoy your Collier-Port for many years.The framing is constructed of round carbon mechanical steel that is 11 gauge thick. The roof is a 29 gauge steel with baked on enamel that carries its manufacturers 25 year limited warranty. We are able to provide the following LOW PRICES due to standardization in model construction. However, other sizes are available.by order at low comparable prices. Call us today. 12 ft. wide 13 ft. wide 20 ft. wide Garages wide long high Arches Price wide long high Arches Price wide long high Arches /Price wide long high Arches Price 12' x 21'x 8'5" 5'apart $1800.00 13'x 21'x 12' 6" 5'apart $2400.00 20'x 21' x 9'5" 5'apart $2400.00 12' x 20'x 8'8" 5'apart $5800.00 12'x 26' x 8'5" 5'apart $2200.00 13'x 25'x 12' 6" 4'apart $3000.00 20' x 25' x 9'5" 4'apart $3000.00 12' x 25'x 8'8" 5'apart $6300.00 12'x 31' x 8'5" 5'apart $2600.00 13'x 29' x 12' 6" 4'apart $3500.00 20' x 29' x 9'5" 4'apart $3500.00 20' x 20'x 9'5" 5'apart $8100.00 12'x 36' x 8'5" 5'apart $3200.00 13'x 33' x 12' 6" 4'apart $4000.00 20' x 33'x 9'5" 4'apart $4000.00 20' x 24' x 9'5" 4'apart $8700.00 Complete garage.includes: Options Overhead door with operator and glass 2 ENCLOSED SIDES ENCLOSED END EACH GABLE END lights. Stanley back door with glass 21' long-4 Sheets ................$550.00 12'Single ..............................$650.00 12'Single ..............................$250.00 lights, vents & trim. 26' long-4 Sheets ................$650.00 20'Double .............................$850.00 20'Double .............................$350.00 31' long-4 Sheets ................$750.00 ADDITIONAL SHEETS ADDITIONAL ARCHES 12'Single ..............................$260.00 3'X 21' ................ $120.00 per sheet 20'Double $340.00 ............................. 3'X 26. ................ $140.00 per sheet X X 31' ................ $160.00 per sheet Prices include installation. Prices subject to change without notice. Prices do not include concrete slab, footers, building permits, or site preparation. If you need assistance in these areas, call Collier Ports. STANDARD FEATURES• . 29 guage STEEL roof Figure Your Costs • •All colors trim for neat finished appearance Baked on Enamel • 25 Year limited warranty Size X " on Roofing • All screws are enamelized for low or no maintenance Extra Height --' Additional Sheets ' J channel trim • no Enclosed End sharp edges exposed Gable End •21/2" 11 guage steel framing system Additional Arches Enclosed Sides Many colors available no extra cost. �. 8 anchors for ground Heavy duty Additional Bracing Installation bottom rails Engineered to withstand 3.51b.per square ft.snow Ioad,100 M.P.H.wind factor 2'-6" 2' 61-p 1. 8. to.8" to 10'ot/8" 10 e" Delivery Sales Tax 21' 21 28' IrT ® TOTAL ---12' -- --20.--- This Pamplet is copyrighted and may . ---16'--,� knot be reproduced in part or In whole SINGLE CAR DOUBLE WIDE SINGLE - EXTRA without the . written concent of UNIT UNIT HIGH Collier Ports Inc. © Collier Ports, Inc. 1994 The,Collier Port is manufactured under and is protected by U.S. Patent No.5295335 y Loy t.FA(14 fiJuiad € LP �Y W. �h, / La ' 2p0Qe� J [y144 • ` yl AA Yjr'�''� (�� 1 CUM H ED' PLO PLO LOuAu 6() SCALE i �' ` r• �r i,+ '"•`�` PLAN RK': � 6::(+C .ti t I' .l" ' 4 •• LLf.Y CO.LAIND r 4(il.:Oi7t. :�f tND F.7RiVt; atASS• -' i CERTIFY T.11AT THE �~_ N. THIS PLAN. IS l_OGA-r l OP3 l`wL'€ AS SHOWN HEiZ�r3ia �P:C?Ttl�ji ITi O� t1,;'��:: 'its i THE ZONING LA`e�`S pt CIIE: T>VVi G;1 WHE DATE.1V.�y�t Town of Barnstable ��OF SHE Regulatory Services N Thomas F.Geller,Director • BARNSTABLE, • . F MAS& Building Division PlFD `�� Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnSi2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ���0/OS JOB LOCAT70N: r]D Z !-td number street p Q village "HOMEOWNER": C2� F u SOO ' ZCJ g�OZ- name Q home phone# work phone# CURRENT MAILING ADDRESS: tJ R"4g city/town state zip code The current.exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other applicable,codes, bylaws,rules and regulations. 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 requi ents. Signature of Homeo er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section lo9.1,1-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 aic 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 fom>/certification for use in your community. i oF"THEt, Town of Barnstable Regulatory Services swxN MAS& Thomas F. Geiler, Director rFOMn�a 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 lA//* , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to wor authorized by this building permit application for: (A ess of rob) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on 'e reverse side. COL-LIER=PORTS® of New England Carports & Garages fy" 2.0x21 Carport,$2400 r x ..21.Carp ort$1800. k 1 12x21_Garage Fully Enclosed $5.800 13 Clinton Street Hopkinton;:-MA 01748 508-435=1534 Fax 800-345-7678 All Prices Include Delivery:&Installation Whatever you need.:. µ r . : . _ 7 ::20x2I .Garage Fully Enclosed$8 100 r R.V. :& Camper-Ports Custom Sizes Available i 20x21 Carport 3 Sides&:Gable End$4,350 ...We've Got You Covered=! _, - _ Y ... , yr. F � .'y• z' �r, , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I �` .Application Health Division Date Issued.' Conservation Division YDIL/ Application Fee ^�d Tax Collector Permit Fee �� Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address?Dz�Lc7'N F?W1 E Village 2arGt t T_ Owner L 72412D f &�1 z r}1 0J-4- L 4"v Cl-1 Address AL)6- aTi4 iz— Telephone $D02— Permit Request �661 ca 4�_ 7� Square feet: 'st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d� Construction Type Lot Size Grandfathered: ❑Yes ❑No `If yes, attach supporting documentation. Dwelling Type: Single Family Ok""' Two Family ❑ Multi-Family(#units) of Existing Structure 3D g6A,2S Historic House: ❑Yes ay o On Old King's Highway: ❑Yes W- o Basement Type: 1111 ull ❑Crawl �/alkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new .r, Number of Bedrooms: existing new Total Room Count(not including baths):existing _:`;' new 44— First Floor Room Count Heat Type and Fuel: UGas ❑Oil ❑Electric ❑Other Central Air: Cues LJ No Fireplaces: Existing / New -0- Existing wood/coal stove: ❑Yes 2 0 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new,size Attached garage:Veisting ❑new size Shed:❑existing 2-n`ew size&kU6 Other: 3 ;P;I Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ El Commercial ❑Yes B'IVo If yes, site plan review# _ Current Use 0oue2a7aF;- A� w Proposed Use 6-Ale4asC D TD 0T4 64114 BUILDER INFORMATION Name C6:_Jeke-1> l uwe_14 Telephone Number ,!!9— V23-1,002— Address 102 — License#3 D I T' AS" Home Improvement Contractor# �iJNE2 Worker's Compensation## ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREGA41W DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t � ADDRESS VILLAGE OWNER '4 s DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL �F Y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. JW The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston.,MA 02111' wlOmmass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): ,G1�A 2D l", Lc1titQ�1 Address: '70' urti[Rty� City/State/Zip: PhoneA: Are you an employer?Check the appropriate bog: :Type of project(required):. 1.❑ 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 sub contractors listed on the-attached sheet. 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition employees and have workers' �.,� working for me in any capacity. $. 9. L��ding addition . [No workers' comp,insurance comp,insurance. 10. •Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3. I am a homeowner doing all work . officers have exercised their 1 LEI Plumbing repairs or additions ' myself.[No workers'comp. right bf exemption per MGL 12,❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no ] employees.[No' workers' 13.❑Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownera.wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that isproviding workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: - Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine lip 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 insur a covers a verification. I do hereby certi under the ins d penalties of perjury that the information provided above is true and correct Si ature: Dater - Phone#: Official use only. Do not write in this area, to be completed by,city or town off ciaL 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#: �pFTHE T � Town of Barnstable Regulatory Services EARNSTABLE, Thomas F.Geiler,Director MAss. 1639• a.�� Building Division Fv � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnsta ble.ma.us Office: 509-862-4038 Fax:` 508-790-6230 --------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: /D JOB LOCATION: /7D1-' 4 -fil.A HIJ�' DTu IT n/(mber // street village "HOMEOWNER": 6A_aA*-Z) `/ L-Qt4L_14 ,5^0g- �z�f'�810Q2. me home phone# work phone# CURRENT MAILING ADDRESS: ,�F}rt•IE city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned."homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. 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 requ ements. 4gnaturc of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions - of this section(Section.109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, 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. VEJ � Town of Barnstable Regulatory Services �BA"STA LF4 Thomas F.Geiler,Director MASM Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: IdUlzD SgED toX/D '/O m68M( _Estimated Cost + 1pm. Address of Work: 702�ur>u AM AOF,-lI TM IT' Owner's Name: 6 r�-P%/2b �54-12_jn- , uAldN Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑W rk excluded bylaw ob Under.$1,000 OBuilding not owner-occupied Qwner 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 agent of the owner: Date Contractor Name Registration No. Date bwnefkf Name Q:foims-.homeaffidav �Q1+LS�T2—ld[°T'�OJ�1 ►►'t14TCIQ>>14L 5 AecrBr, ��pA/,fae--rL, us> r/ 7�n 1 2Xla /t2AKAtu 2xG NcA 14,"O c Ofi [1r E'PAR. µAV-G:5 stDC!t—RLAIZ t >� boo g- oN Feo t.c i t 1, F , I� li j Real,, j �cy7..'oA ...- -------- 4FoR2 SNIuc7.c Z277!�) i r �xTti GA�U� - -- `2A M P _771- 1. i-r-ACY AZ �c/.•t7rzou00 o` qr, f L� r Ji! T ;t 5Z � 1 (v 1 !f , • JI ( '. ,:, . . � " . Yip;✓'' t Xis nr� I f1 (/� y^ .E l I_VuAT 10ri;. \.moo - �..i.9•� �.• �-Jf'••n f:r.l �w� 'CHC1T11h:SJ: IiI.F-.F-.}s'1' CO. � r- 1y ., r i' t:;, •i;. t' u41i LONG. 1"OND ,ORIVE 5Ci1,!i kl YAFti"RC1:13«, m rNsS: 0266 i it I Y y'q���� _ : _ . . . : . . . -, , r • 1 i CERTIFY THAT-THE ON THIS PLAN 'IS 1`0'Cailr0 N T i1j. 11. 1,/ C . i-?.; c :/`tiL':�"`� AS SHOWN HEREON ANDTHA7 ITr�Ji�� ' 510THE ZONING LAWS 'OF THE: TC�k N 0 'A { '�" 1 I.w'W {• ��,..;/:\S7�J''C r� �'i �.�-�»�M-1 1 . NP H GI,f t.1 1 T`N.17 �: . � �Y.��+• DATE,lV.p�r,��F.� Map Page 1 of 1 Town d Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out f{fl 0 J 1 j J U 9In FO ( o- ]PG Map: 039 174 Location: 702 PU1 039114 q 118 Owner: LYNCH, U#039113 16 Location Informat Map&Parcel Location Acreage 039115 p 134 Current Owner { Mailing Address r 039112 #702 1� _ Appraised Value (I Extra Features 000001 Out Buildings ` Land Buildings Total Appraised Ht�O�Y�VENtr Assessed Value (F a Extra Features 039111 Out Buildings 0 039116 67-Feet„, a678 Land _� S _ 1 Buildings Total Assessed Set Scale 1" =,67 ' , Aerial Photos Copyright 2005-2007 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v0.2.91 [Production] 1+44+a•//��r�snir4n�sm 1an+-nc.�nl�10 mn iic•/nrnimc+/nr�+•�rsnnnr�r�/mnva nc•r�v�s+«nv�nrfi�TTl=n2t111'�R�mnr�r�n«lann 1nr�z/�nn� r F Assessor's office(1st Floor): rNt Assessor's map and lot um >o` Conservation �= ?, is sy-z f nm MUST BE Board of Health(3rd floor): IN g LLE.®IN CO PLIANCEAU ` e• Sewage.Permit number _ WI,N E 5 � ""ULE Engineering Department(3rd floor): d T House number _NVIFIONM. E L C®®E AND �o esr r Definitive Plan Approved by Planning Board TOWBREGULATIONS 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 Add full shed dormer and cover existing deck TYPE OF CONSTRUCTION _ Wood frame September 16, 19 92 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location___ 702 Putnam Avenue_, Cotuit Proposed Use Single Family Dwelling Zoning District RF Fire District Cotuit Nameofowner Gerard F. & Elizabeth Lynch Address 702 Putnam Avenue, Cotuit Name of Builder Gerard F. Lynch Address Name of Architect Gerard F. Lynch Address Number of Rooms 2 Foundation N/A Exterior N/A Roofing Fiberglas Asphalt Floors N/A Interior Sheet rock Heating N/A Plumbing One Fireplace N/A Approximate Cost $5, 000. Area Diagram of Lot and Building with Dimensions Fee v© J See attached OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r arding thepbo construction. Name 1 Construction Supervisor's License ,1 LYNCi, GERARD F. & ELIZABETH No 6 Permit For Renovate & Addition Single Family Dwelling Location 7 0 2 .Putnam Avenue Cotuit Owner t Gerard-. F., & Elizabeth Lynch Type of Construction Frame ' f Plot Lot ,-'Permit Granted September 12, 19 92 `Date of Inspection x 19 ! -^ Date Competed t' < 19 1 at 1 d t t I Y 1 1 i • i l s TOWN OF- BARNSTABLE I, BUILDING DEPARTMENT _'Q,ROXEqh1NER LICENSE y EREMP4TION ' a.4 Please .pr ' int DATE September 16 1 9;g2 JOB LOCATION t S.d702 Ptriamo w Avenue s ' a r t+ Nuatb@r£rmje3'� u �tYll" ,r Street Address H e:f�ci t a = _f. nTeo 5w.,nO16OWNEN" abethLync "E N tz r Phone Work Phone PRESENT'MAILING , } r - <3 ,"s"d 4rn$� , ADDtE53 � j �putiram-� 2 } yy Avenue, <Cotuit;= n E. :a f,:t,. ♦ 1I'ti t,A d .Tb 43 Jt.i{.➢ 13M{.�.... ` 1 . City .Town Stat ), _ e z. fi . . �', � _ r �;F� •: �..:. : j i��,.,:�.r.��r,�., .:,,.: ,_ .. ' :' . , Z1p�Code Thecurrent'exemption for "homeowners" was extended to include ' occupied dwellings of six units or less and totallow such homeowners engage -an individual for hire who does not possess a license to the'': owner acts as su ervisor. , provided that DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or 'reside, on which there is, or is intended to be, a one to six family, dwelling, intends to z„ q, attached or detached structures accessory to such use andor farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. . Such "homeowner" .s to the Building Official on a form acceptable to the Buildin Ohall submit that he she shall be res onsible for all such work erformed and buil°din Building fficial, ermit. (Section 109.1.1) er the Thelundersigned "homeowner" assumes responsibil t State Building Code and other applicable codes ' by for compliance with the regulations. , } y-laws, rules and .. The ,undersigned "homeowner" certifies that ur he/she understands the Town of Bar `)'stable Building Department minimum inspection Procedures es and E HOMEbWNER'S SIGNATURE ' <, Jerry Lynch, a G rar y APPROVAL OF BUILDIN FICIAL Note'"'"N '• Three family dwellings 35,000 c , requ �ed to comply cubic eet, or larger, will b 1 P Y with State Building Code Section e { Cont �ol. 127.0, Construction I MISCS _ i no' i`r t 11TOME Of OWNER'S EXEMAT30N The code states that: f °'` Any Home tOwner Permit :is required shall be exam t Performing work for which a .building (section 109.1. P from the, 1 Licensing�of Construction-Provisions Supervisorof this section , . Home Owner. en a 9. g personhire` to do such work, that�sucha that if Owner shall act as .superdisor. Home Many Home Owners who us©, this exemption are the responsibilities of ;� supervisor (see 'A unaware e unaware_ that they._are'•.assuminq . fob Licensing Construct, en Supervisors, Sectp .x awareness often results in serious Q• Rules and Re ion 2. 15 j This.,_lack:'of �" Owrier�hires" unlcensed ogrsons � Problems, 'particula=l ' ahen the R g ?inst the unl,�censed prop gs it wouldcwAWa " Board annoy, prpceede Y6, fH 7 1 SM1 �'T1 Aonie Owner acting � rw8�"�" , !; �s Pet�.s,o is ultimatel ,� � , � uper� sor. } desnsibl°` To ,ensure tthat the` x} ,k tRJirXa Ha nee Oamer is full many communities re hire ,� f �_P R Y are of hislhe re's onsibilities, Owner certif that as�:Pa _t=of;'the permit, application,- that the Home Y /she ufiderstands the responsibilities of-a- 'supervisor. On the last page ofhss issue .is-.a 'form currentl ' 4us You .may,, care to amend and' adopt such aform/certif > . community. Y ed by severah°"towns. cation. for use in- your �j i j j ',i Assessor's map and lot number ....:V ... THE Sewage Permit number ........................................................ 0 DAR33TABLE, MABL House number ........................................................................ r0 t639- O TOWN OF BARNSTABLE BUILDING , INSPECTOR APPLICATION FOR PERMIT TO .......q�a..... .....rn?K..... ............. TYPE OF CONSTRUCTION .........j.t0..q.Q.d.....................................................................I....................................... .................. .19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... 6. ............................ ...... ...... .... Proposed Use ............ .1114J.. ....... ......(!R.nd. a 4��.............................................................................. ...... ... ... ...........Zoning District ..... ............................Fire District ...(2.0.6.p.i t...................................................... Name of Owner &�rqnJ..F.x?xj...61i-24 L.c Address .................................................................................... Nameof Builder .......�!O.p..................................................Address .................................................................................... Nameof Architect ......�.!'.J ................................................Address ..........:................................................ .......................... Number of Rooms .....I... P0AFou nclat ion ... ............................................. Exlerior ........ .................. ......(Z. ...Ro.fing .1e.n�.14..75.:�........ J Floorsp.j1..kj.P,,..................................................Interior .....S.k9.-e:t...e..,2 a.............................................. HeatingYi.la n. .................................................................Plumbing ......yk.pn.�............... .............................................. Fireplace ......Yk e. ..............................................................Approximate Cost .....i0A... ......................... Definitive Plan Approved by Planning Board -----A)-Ijq----------------19--------- Area ...zX.;:Z 13.......................... Diagram of Lot and Building with Dimensions Fee ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To n of Barn oj—ble regarding the above construction. Name.. . . ........ ec...................... Construction Supervisor's License .... ........... LYNCH, GERARD & ELIZABETH A=39-112 " No ...28202:.. Permit for ,Add Family Room & Garage ` .......Single Family Dwelling Location Lot 59, 702 Putnam Avenue .......................................... Cotuit ............................................................................... Owner ...Gerard & Elizabeth Lynch .. .................................................... Type of Construction ......Frame 4 ................................................................................ Plot ............................ Lot ................................ Permit Granted ......... July 12, 19 85 Date of Inspection ....................................19 Date Completed ......................................19 '.f� ". � J S k rh IX 1 j `1. t it 1 'rf .' ,•1 t - aa• E { ri f',K J �# f� .X ! 4 i i} �r r a �- J fit I!•� .Ir ,3 ,'y ` Y # :y 4 ,t f:� , iY `..,:' s ' � r,c'vs w a :. e .�<✓r: N:•,,.m .a* *..': �:' s:>;'. .•^++.- � r Y k ti 'a, - s tt .�t. " LFAry Pit iL 20 ,_ Y 3. 4,� 1 i3O+It L '44. wVdw✓/ 5 4 4 , LOT 1. 4 k J t ,.t � / t Y •.� ly,. , JY. i t a� d t 4 � •� „ � (t a r = F N ^d ♦ A e1 f r` `r f \ �I _ M1 s � �v r•b' `f r x r � k• \'• r� Y/ •`h` D' } I(. .r.k•, T.��,\- yl� •15 ' �W+,+.a..ir•�.J yL�' :..'�C, +�, y f .17 CE�zTI a D �3a OT PLA E4* L :. 4. r �...�.��. .�...,........., ,a.":: ,..... •......,� PLAN u'� I[it(k(kf. t+tr'L. _,. : f `'p c14OKIA,s 'F L A NL D SURVF? 10kL5' I.ONC VPOND DRIVEL St�i11ll YAR14f,1UTM A5:,, 02664 ` a 1 CERTIFY THAT ,THE -"�fP1:1{ ' , y ON THIS PLAN IS t OCA;E0 ON T� l POIJl"3D \ l., R. S. AS SHOWN HEREON 1lNID THX; Ii t"OE4 u t)".gA`i TO � '• '� . 6 O Prtr.P ' �`�".Y i<G �,, THE OJIING LAWS.1 �•6a OF THE g�C�i� t Wpl E ' �p,.¢iyy,,`� tom.-. �•r''�,, :.' f �"{�r 'Y DATA &J.0 1 I't.! 4 -PETITIONER - / G . RE I.60 570 WEST MAIN STREET HYANNIS, MASS. 02601 TES 775-3932 - y. f . BE Assessors map ,and lot number ......:. .. T �jv v ...AdT F /�. INSTALLED IN CQ-MPLIANCI= ,. - w : � > ti WITH.ARTICLE II ;STATE • �� _ G'/! 74 SANITARY CODS AN® T9WN 96Wage Permit number•.......................................................... 9 - . Gut;AT10NS, � 'kt. � .. _ } o-^+.tom R _ .- _� -- = � • ti QyOFTNEtp�y TOWN OF' -BARNSTABLE 4i O C d l T t "AS` r' BUILDING INSPECTOR nlc APPLICATIONFOR PERMIT TO .... . !..........:..................i.............................. ...- .............. ............................... TYPE OF CONSTRUCTION ................. ................. .. ........... .................. F.../ ...... ..........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit accordingto the following information: location .............................................. ............ . ...... .,/' '...... . . .......... ProposedUse ..:.S� l...lam`' ........ �'l/ �✓//`,c��..............................................................f...................... Zoning District Fire District .....t .... ......��.............................................. �....... Name of Owner ..........Address ` L Name of Builder "ice. l:.G..?.. � �L ....� .............:...Address ....... Name .of Architect ................. ............................Address ...................................................:.:....`.............r. ... f Number of Rooms .................�................. ..............Foundation .©��G �l �/fivC.l , ........... ..... ........................:...................... ` .OIL Cr/ �fJt��l.......................Roofing .../d��G� T .. Exterior .. .................:�........:� Floors ...... ......1....f..!�!I y�...................................Interior ...f/lC"r°T/ISG ........................:....................... !!1�.zo.......— �00.-� ...Plumbing o ' Heating ....... .. ........................................ ....�••••"•••.................................................................. do c� Fireplace ........../.....................................................:.............Approximate Cost ..............S ...�........................... Definitive Plan Approved by Planning Board ________________________________19---------. Area l' Gar....! ......:...7Diagram of Lot and Building with Dimensions Fee ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OFA V r� / --.— hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ........... ........................ ................. ....... xf W. E. D. Realty Trust Nox 18814 ._ on sto . ' - a ..... .... Permit-.for ............ ....... .............. Angle family dwellin f...... .......................................... Location�OPutnam AvenueIV `' f Cotuat........................................................... ................... i ♦. f� W. E. D. Realty Trust t- � Owner f frame , Type'of Construction f lPlot.. ... ......... 1................... Lot ........�k59B............... 'r •�� , , r f� -.. _ - � � ' f � i Permit Granted November 16 76 ..............:.:........19 kbate of Inspection � .........�......:.......:...19 J. r d a yl .. I L�Date Completed ,1,�:. .�t .19 4, �• f —3 r + / c j PERMIT REFUSED !r 1 i 5- - ..R. .................................................... Approved ................................................ 19 ............'.................................................................. ............................................................................... ,' '�� � �,:; �. _� } � r �4 ,k•t �7F i "~ "� �► • R �_ .�r �. i�? s 3 ��/ i.. —pop .46 r ', Assessor's map and lot number ......... ......... p .— 2fJ O F'rNET ®/�: �� - 7 r��r SEPTIC SYSTEM Jwage Per number .................................................:..... w INSTALLED IN COM `fliouse+number WITH TITLE , MAM :......... t6 \00 ENVIRONMENTAL CO T GULATION f , TOWN OF BAR.NSTA�' BUILDING INSPECTOR APPLICATION FOR PERMIT TO........aja/......L'_ftlily.;... P.J ....4's.kL.cf,... a�!1° ....,l.�.................. TYPEOF CONSTRUCTION ...........4?.o o.j........................................................................................................... ..................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according ggJto the following information: Location ........7.b.9....04:6ta..'Y�'►......AIi�YI.U.�r..,...4.....Q. .4?!. .............e�.0.. ........ ProposedUse ........ .i..' ....... ...... ..... . rQ.Q.°4.z.............................................................................. Zoning District ........C.011.i.t.........../..........................Fire District ...0 ot.P . ZG..................................................... Name of Owner .G!i!w.rd... :..Rx.d...6214c, !.L/-W- la.Acldress .................................................................................... Name" of Builder .......5I.kp..................................................Address .................................................................................... Nameof Architect ....... ................................................Address .................................................................................... Number of Rooms .... ............ ............................ Exterior ....OX ...... ........Roofing t rD. .✓ '.(�c.SiS........ . Floors ll� (/ .....�.a...n.f:...................................................Interior .....S.Y4..i°..�.�..►!!.©Cr;!�.............................................. Heating Y1.0.?!.C'.,................................................................Plumbing .......k1.a:11.e................. .... .. .. ......................................... Fireplace �..... YLO. .1.e..............................................................Approximate. Cost .....hq f � ... Definitive Plan Approved by Planning Board ___-_ - 7�g'� --------------�9--------. Area ...l.J.................................... Diagram of Lot and Building with Dimensions Fee 7 .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To of Barns le regarding the above construction. Nme ......... G � J................... j• nstruction Supervisor's License ..................................... LYNCH, GERARD & ELIZABETH ,fo ... Permit for ...Add Family Rqqjp & Garage Single Family„ Dwelling........................ .. Location ...7.02...P.utn.a)F..Avt]Rqe.....Lot...5.9.......... .... ...... Cotuit ............................................................................... Owner ..G.e.rar.d...&...Elizabeth...Lynch........... . ...... . .. . . ........ . .... . ...... Type of Construction .......Frame........................ ................................................................................ Plot ............................ Lot ................................ Permit Granted .. idly........... 12, .................... ......19 Date of Inspection ...... ...............19 Date'Completed .......... 9.. ............19 > 0 M m m 0 in M •ate 3j A Assessor's map and lot number ........,.................................. Sewage Permit number .......................................................... TOWN OF BARNSTABLE Z BASHSTADLE, i "bt MPY RUKUNG INSPECTOR •k O,p�Oa�O SEE _ r r ' - APPLICATION FOR PERMIT TO ....... -!!r.... v...J...................... P L TYPE OF. CONSTRUCTION .........................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....�...... N �;....... nr N� f......0 i / ..... ..................... aProposed Use ....: iN // .. /�?� ''!....... ���CYt �/� Zoning District sei �..................................................Fire District � � .................. ......................................................................:....... Name of Owner / .i �f ...........Address ......................................... .��ti..•� Name of Builder `'�� / `,.. / �.... � � G 'l��y /f��'�/Yn�Jf z. ......... ................. .............:... .....................Address .......... .:.................... .,.................... Nameof Architect ...................................................................Address ......................:...........................................................:. � r Number of Rooms ..................................................................Foundation ....ia;..f�/ Exterior �l'�r/1:..... .. .......................Roofing ..../'�r✓�!T/its/ ................................................... A r A / .Interior S�ii /�JC Floors ...��..................................... .................................................................................... C Heating .......!'z.. _ u .........� i0.ss-.................................Plumbing ....� ...:.............................................................. Fireplace ...................................................................Approximate Cost ..................5.. 00v ................................................. Definitive Plan Approved by Planning Board ________________________________19________. Area :. r.:........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH - � C N. �/ i-A �f I hereby agree to conform to all the Rules and`Regulations of the Town of Barnstable regarding the above construction. . �% �?! Name .... .. ................... W. E. D. Realty Trust A=39-112 . 18814 one story, No ................. Permit for .................................... single family dwelling ............................................................................... Putnam Avenue Location Cotuit ........................................ Owner ......�. W. B. D. Realty Trust ........................................................... " Type of Construction ........frame .....!............................ ..................................................I ...... . ............... ....... .. #59B Plot ............................ Lot ........................... .... November 16 76 Permit Granted .....................................19 Date of Inspection ....................................19 Date Completed .. .............................19 PERMIT REFUSED ............................... ........ ..... 19 ................ .. ..... ................. .............. ...... ............ . . ........ ..... . ....... ....... ......... ...........%............. . ...................................... .. . .. .. ... .... ....... .. ....... ......... ......................... Approved ............................................... 19 ........... ......................... ......................................... ............................................................................... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mapa D 39 Parcel //Z Permit# 17 Health Division RtP — a - A,41 A"; �� 77 Date Issued 5 � .4 a 7 Conservation Division S vZ 0 Application Fee , Tax Collector Permit Fee3 ` Treasurer ` C� Y) Planning Dept. EXISTING SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board LIMITED T® S Historic-OKH Preservation/Hyannis �ncrl � Project Street Address 702?crV/4W , Village i907U, ,— j "' c2 Owner ('EI�2,R2Df Address Telephone 5o8'- 51� Permit Request 7 s/�0. e q .. y cn r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain i— Groundwater Overlay Project Valuation c:2 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O-' Two Family ❑ Multi-Family(#units) Age of Existing Structure 8,0Ws Historic House: ❑Yes O-W On Old King's Highway: ❑Yes aflo Basement Type: ❑ Full ❑Crawl U*alkout Cl Other Basement Finished Area(sq.ft.) 1yoA&_ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half:existing / new Number of Bedrooms: existing new Total Room Count(not including baths): existing. S new First Floor Room Count s Heat Type and Fuel: W 6as ❑Oil ❑ Electric ❑Other Central Air: Ur es ❑ No Fireplaces: Existing / New Existing wood/coal stove: O'hes ❑No Detached garage:❑existing ❑new size Pool:❑existing. ❑new size Barn:❑existing ❑new size Attached garage:Ullexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes O'No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name , ce gp Ly,,,c,v Telephone Number Sob- 21-Soo2- Address 7a2'-?0rvAm 41.- License# -OTu�T�A• DZG � Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ouw26 wo SIGNATURE DATE T FOR OFFICIAL USE ONLY y PERMIT NO. DATE ISSUED MAP/PARCEL-NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH +� FINAL PLUMBING: ROUGH r j FINAL GAS: ROUGH b� FINAL ti FINAL BUILDING t,1 1 ri „ DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents ` Office of Investigations `A 600 Washington Street, ;`h Floor Boston,Mass. 02111 ` L Workers'Com ensation Insurance Affidavit:Buildin lumbin [Electrical Contractors A>ip 1 n on. P name � �D X'.�y�/CN address city &-e 7—al T state: zip:D 2fo1 J phone#.�Dg' 22—92V Z. work site location frill address): I am a homeowner performing a]l work myself. Project Type: ❑New Construction emodel ❑ I am a sole proprietor and have ngoy�one working in an�capacity. ❑Building Addition W-Wk;u —.a7.t'r7�'i+7bu 'Fri".Y'i2tr' w'�h'.•.ha,..... .... :..-e�1.:.'i'.✓. '�:b•�d:e :,;i!t.,.Fr. i,'.':�F'.:'�: ......'I.�+[i'>:7. .,r'�: 7•. ❑ I am an employer providing workers'compensation for my employees working on this job. k H company name, address: city: phone#• -- insurance co. DOW# ❑ 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: com an .name•. address: city: phone#: insurance co. olic # , ;J��..���s?'/�: 'r+. '�?:'�x,�•'�Y'ra�'.'"r�rt+"_e1e����.''.k�. ."�"",�G:;�a+, ';�'r�"e;,'" i�`i �' company name: address: city: phone#: insurance co. Rolia I Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of investigations of the D1A for coverage verification. I do hereby cert' under the pain d n Ities of perjury that the information provided above is true and correct Signature Date 0 Print name Phone# S!O�— z8 ea07- official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board y ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (7ev,sed Sept.2003) r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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 section 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. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits 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. 7 � a, $ IIF II II IAlIA1f"flf City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. FAR.RM The Department's`address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7'h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 Town of Barnstable rY o Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 5'/AI/ JOB LOCATION:_7D L �i.�Td_J] L=1� Tel!T number street village ame home phone# work phone# CURRENT MAILING ADDRESS: �.9wlt city/town state -zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual•for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER - Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm,structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be reonsible for all such work performed under the buildine roermit. (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 ands ht e he Town of comply with saidprocedures Building Department minimum inspection procedures and requirements and that re eats. v Signature of Ho eown Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction ControL HOMEOWNER'S EXEMPTION The Code states that: "Any homeown&performing work for which a building per 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" at they are assuming the responsibilities of a supervisor(see Appendix Q, Many homeowners who use this exemption are unaware th Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This ladle of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a licensed Supervisor. Thehomeowner acting as Supervisor is ultimatelyrespom le. 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..forms:homeexempt , f Barnstable �t�t° Town o - °� Regulatory Services BAWSMIX, Thomas F.Geller,Director NAM 'b 039 ,�� Building Division Tom Perry,Building Commissioner ` 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date ` AFFIDAVIT HOME WROVEMENT 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 limits or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. t Type of Work Estimated Cost :;P Address of Work: tit �f cc TV nl 1 77 Owner's Name: E ,� Date of Application: I hereby certify that: Registration is not required for the following reason(s): (]Work excluded by law M ' ❑Job Under$1,000 []Building not owner-occupied 20imer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING W T WORK DO NOT HAVE CONTRACTORS FOR UNREGISTER APPLICABLE HOME IMP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERTURY I hereby apply for a permit as the agent of the owner: Contractor Name Registration No. Date 8 -OS S ei's Name D e Qla m -.homeaf£idav Town of Barnstable CF SHE tp� Regulatory Services • -•� Thomas F.Geiler,Director BnartsTAat.e, i639, Building Division ��� 'arFD MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ; Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 48�D5 JOB 1ACATiON: 70Z /'Gl��y(,q/sf/Y�G C- T�(/T number street village . name home phone# work phone# CURRENT MAII TNG ADDRESS: �iA�11E 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 individuaffor hire who does not possess a license,provided that the owner acts as_ Omer isor. DEFR TTION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under'the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. 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 requir nts. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowact 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 ultimatelyresponsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the pern t application, ilities of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that he/she understands the responsib several towns. You may care t amend and adopt such a form/certification for use in your community. n•fnrms:hameexemot y 7 � I ' xAcN Pi l' 1 C 4 1 , oLo di CERTIFIED PLOT PLAN! ATIO SCALE "A e , 4'- 1 t�t t t , Cf t?fit �;°t.. 6C.C:Lx }��`' COPLAN RE�ES��i��� -tr J w 7 3p i7`hiML'}'.Y KS �; �.:, t•' 1 (2664 a I CERTIFY TtiAT;-'6'ti E . '-.�?;') ! ON. THIS PLAN. IS LOCATED ON T�iE 4 a'l` rl';1) � —7 .�t t•: I.l�r L ':`(' : r .1 3�` AS SHOWN HEREON AND,Ti Idea: !T GON I�,1'�,IM.; T o } ... l �✓j t'S ttti� THE ZONING LAWS OF THE "fi)WP fit'" � WHEM ct,..V`:,,E't nw.xr�x.:r�-„ �a�:y.�� ,.��.; w.s�.ax. yn.•s+ ��. 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