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HomeMy WebLinkAbout0804 PUTNAM AVENUE :s©y� Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 5087398-0399 10-1-13 _ o Town of Barnstable Thomas Perry CBO Building Commissioner 'Q 200 Main St. Hyannis,MA 02601 CO RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 804 Putnam Ave has been inspected by a certified Building Performance Institute (BPI) Inspector. Ceiling: R-38 cellulose(R-19 under deck) Floor: R-19 fiberglass blanket(filled in voids) All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey R•• i �ty • f ! •1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .3 Parcel pphcation # Health Division Date Issued �� . 21 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board p� h3.1i3 Historic - OKH _ Preservation / Hyannis Project Street Address A±8&M RY e- Village Co**.it Owner �r °�nl° e Address S ol.n1G Telephone q '1 Permit Request �� 0.�� �'3 y ce`t%kkase 3 0 e to t6c �I ��r seti ��}� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No .If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) w _ Age of Existing Structure Historic House: ❑Yes ❑ No On Old King Highway 9LJ Y� ❑ No _ -n Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other v cc �v Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing- now w Number of Bedrooms: existing _new NO rn Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use �- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name i amRt.C �vuykei Telephone Number sob M 039 S Address A License # aM1 ov1 a 6 Home Improvement Contractor# 713 8 Worker's Compensation # - W C 33 596 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE �o\� DATE b 'r FOR OFFICIAL USE ONLY 'L APPLICATION# .s DATE ISSUED �f MAP/PARCEL NO. t ADDRESS VILLAGE �z >` OWNER r ' DATE OF INSPECTION: r—FOUNDATION.- FRAME s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL '€ FINAL BUILDING 'k { DATE CLOSED OUT ASSOCIATION PLAN NO. F 'a i it The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street Suite 100 Boston,MA 02114-2017 r. www.mass.gov1dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information ah n ° Please Print Legibly Name (Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ 1 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.= 9. ❑ Building addition comp. [No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs-or additions myself. [No workers' comp. right of exemption per MGL " 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' - 13.[D Other Insulation comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins. Lic. #: TWC3353968 Expiration Date: 04/09/2014 Job Site Address: 8tl Qt�+^fir` flyt° City/State/Zip: ca Attach a copy of the workers' compensation po6ey 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 S 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certi under the pains and penalties ofpedN6 that the in ormation provided above is true and correct Si nature: Date Phone#: 508-398-0398 Official use only. Do not write in this area, to be completed by city or town official. City or Town: - Permit/License# Issuing Authority(circle one): L.Board of Health 2. Building Department 3.City/Town Clerk .4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: t CERTIFICATE OF LIABILITY IN DATE(MMIDDIYYYY) SIJRANC E 4/9/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) 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 endorsements. PRODUCER NAME: Colleen Crowley Risk Strategies Company PHjalONE " (781)986-4400 FAC No:(781)963-4420 15 Pacella Park DriveE-MAIL Suite 240 INSURER(S)AFFORDING COVERAGE NAICf Randolph MA 02368. INsuRERA:Selective Insurance INSURED iNsuRERa:Safety Insurance Company 3618 Cape save, Inc INSURER C.-Technology Insurance Company 7 D Huntington Ave - INSURER D: INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVV 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. LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MPOMf�EXP ulmTs GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 0 RENTMr- PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE ❑X OCCUR 91919448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 - PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PIECT RO El LOC $ AUTOMOBILE LIABILITY Ea e I ED SINGLE LIM 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWqED AUTOS AUTOS BODILY 208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ NON-OVMIED _ PROPERTY DAMAGE X HIRED AUTOS X AUTOS PeraccideM $ X Underinsured motorist BI split $ 100,000 A X UMBRELLA LIAB X OCCUR 199448001 0/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB Li CLAIMS-MADE AGGREGATE $ 1,000,000 DIED RETENTION$ $ C WORKERS COMPENSATION Officers Excluded from. X VrCSTATU OTH- AND EMPLOYERS'LIABILITY YIN TORY T ANY PROPRIETORIPARTNERIEIECUTIVE overage E.L.EACH ACCIDENT $ 500,000 OFRCERIMEMBER EXCLUDED? NIA (Mandatory in NH) rM3353968 /9/2013 /9/2014 E.L.DISEASE-FJAEMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as additional insureds as respects General Liability as ,required by written contract. CERTIFICATE HOLDER CANCELLATION (50 8)7 90-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, NA 02601-3698 AUTHORIZED REPRESENTATIVE chael Christian/CLC,- ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. I/dCrt9g i Mnnc�n4 TL.. 8I"A�I'1--- --J --- -------- —_-'-- - ww► tom! Massachusetts -Department of Pudic Sa;ety Board of Building Regulations and Standards Construction SuPervieor SPecialt% _ License: CSSL-102776 WILLIAM J MC C_-LUSKEY- , 37 NAUSET ROAD n West Yarmouth MA 02673 J.•�s..J1 �� +'` _xpiration Commissioner 06/28/2015 e0mmiev Office of Consumer Affairs and usiness Regulation ..� 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 - Home Improvement C-ontractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. - 7 Address 17 Renewal Employment D Lost Card DPS-CA1 sa 50M-04104-13101216 License or registration valid for individul use only ' Office of Consumer Affairs&B siness Regulation p _-, HOME IMPROVEMENT CONTRACTOR . - before the expiration date. If found return to: Registration 171380 Type: Office of Consumer Affairs and Business Reputation - Expiration- .3/1412014 Corporation 10 Park Plaza-Suite 5170 s. _• ___-_ _-_____ Boston,MA 02116 CAP1=SAVE INC.-,:- WILLIAM McCLUSKEY r E 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA_0266. r Undersecretary Not valid wit to - signa 1 - f Housing Lill Assistance Corporation. Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM 1F YOU ARE THE APPLICANT HOME OWNER. I J-14�� herebyconsent to and agree that weatherization g work may be done by the Weatherization Program.of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform- weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this a reement as listed and freely give my consent. Home Owner. (Signature)" t 7K11"z Date: Agent: (signature) Date: HAC approved Weatherization Company -v All Cape Energy Cape Cod insufati n Cape Save Efficient Buiidings,LLC Frortier:Energy Sol,utions, . Lohr:: .. .ons,....: Resolu#io.n Energy - • t grJlnlrJCdiutilil7GkiirJCidil�ixutT+idq&birrrinT"FiFiwintirem'Z%'iaFi/rrU'ivaN; a' ',tl/il,Y yfllbrTND/'.y' ,7NY�TInd"J.aTt�aUYPhJN4SYGb7tarnW;'l/tf 'aC"A,'t."LJ nrv- 4v 7" y � 6y� � 555ggg qq - - n 1 ry Ade ��� sue' .. - S`l".a.Y Cry .:✓�.� - - `� 44 _.�.se.::.�..._.-::_'-.-R._:m.a.G.lw.L..��Z:�1;:"s'+c''l,Yi` +.u".7G",;:�.�...bbu'"G�n r � •,,,r } .. t. `107). U 'oun():L��x.0I1 is, 7 Ui '•E,E=v0rl ft_?E G .c:bovo nai1 (',VE'. w T J t:i:.•> j(' i}�=1' ! bpi• �nEiR'iT��'��.Dy3- � �� 6(} E Ld3U4C8() � (iC)'�ta �r,m ctt::1� y SSA :4 t. FE PLAN Y�� 64EV�°C&. Land y tl.1A e .J�) -^•.E.� 1 • I CERTIFY THAT THE7. . EA t 1 3 .1 rrrf N ON 'THIS PLAN 1S LOCATED 0,,6 THE 0f-l0S.JN D 'M R e,`a y i`-WS i THE Yt7Y�Y�YI ( La/'p.Vk OF THE ;OWN OF s �1J7.r1. L l c�� y Sr@ )ace U7 w t o V�d�iEN l l:�r/V (.r- 'r;U Y`1,F.�,�1 � sJi a��:'(� 4AT. �/ /rrf err• f� '��.'r s f g, i" i6'14�6`A 6'G I ,r'x`,)..T;..l`1i,sjk'lansr�.c J.i.uJo't 's - -s id n� . ,,,,,............ „opw.a�a.,�,�� a ,w,,,,„M „���,.,�Mm„��,,.. w w..,,�.w,u,,�.,,�m _m.�. ,a�.M m�. �., ,.. ..,....,,,.,,,,,,....... cv 17 4 4 ,Ii1G1E�'iNir;'.'rig]urtiAilkt-'uk�iilib7�?uJl!k7a�di�i!ii<�;�4:;Dilia'n".ta",Y71,.:Jldkb�'iY'iS7FT��s+7, ^1Tii%l,�KiJ7i,TFi�:2'l,1/':i` �97"r,.�r,�R•�;Yr�d�,'ft7;c;:7mx'!5T'L�7 7+ r•'� i r-r< ��- Jrn..r ,.,' , ';u;:G..:a;w:.x::xrrv�.:�>;;csrc;�;rwomrL•:u;srrr¢�:rvnmrurw.ru,� , i _ J..'Q7i O :" FG1.A'T'1=. ui✓1.UT.i. is t:a. above- r C E R T%i F UE'.a'b ...o.—,..,./^F LO rya' —..._^ :z L_A.S.�.._....�,._.._,.y..�_...�� { e °• •` �! `{��Ir^��J�� �LO eAT Z O N �.��)nl✓�ll.�.°i�A�M ` m;:`.�P'::.:..�......................._........_._........:"t SCALE �)ATE t . . . . . . . . . . !).. .. I CERTIFY17'IF41 ii�l.� T,J.Dil ',`;)' ♦, r.�l(,�irE I• t J! I . - ' ON 'THIS I�'I..Ca1�; I".'; 7.C�f;Fa,e:.CY t,;'v PC-0.3 u"J aria t 'S"1"E ZOO jr L..,, /9?� fl"r ' {7� I I r• �rET . ( ,� �: . a Y✓.'! 47 . LOa,,�.r i4• t6f ,.. .� 4 Asessor's map and lot- n uner �Y/:.. . '.....: . � F SEPTIC SYSTEM MUST BE t-' INSTALLED INCQ�v PI IANCE Sewage Permit number .......................................................... WITH ARZTICI E 11 STATE SANITARY CODE AND TOWN T"ETo�., TOWN OF BARNSTA' E I; 89HB9TdI1LE, i - •F101 YPY a' 039. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ...... ........................................ /•• � .0. .......................... TYPE OF CONSTRUCTION ..ili,./.�S�.J�.......� ........ ...........................:....................... ....... ..r sue..... . ......19. S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ....... .....7RaTN.Aj.t\...../�q. Ca �.�... ... ..1. A.�. Location .�a..T.... ProposedUse .S1/..1. -16...... ................. ..................................................................... ...................... ZoningDistrict ........................................................................Fire District ....C0.77.1....r................................................. Name of Owner .....14�e�31..1 Y.................................Address ��. ..�rL?:... ......fl.........� /i/f1f✓�.�.... .r � r Nameof Builder ....................................................................Address ........................:........................................................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms Foundation ./.�.�. oGs� ................................................................ ......... .....................�................. / � 'o�E121 ...Roofinr ��T Exierior �1 ��..........�. ... ............................................ g ........... ............................................................ ��`C �" Floors ...............Interior ...... -... ....."............................................................. Heating4?..A. .........P. dq..............................................Plumbing ..... ..... ..................................................... Fireplace J.. ............................................................................Approximate Cost ....a o. p.......... Definitive Plan Approved b Planning Board -------------------—-----------19--------. Area . pp Y gj.....,,ll . d ......... Diagram of Lot and Building with Dimensions Fee ........ f�....... ..,�4........ SUBJECT TO APPROVAL .OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �+ Name ...G1 C/ . W. E. D. Realty 18180 one to Y, No ............. Permit for ............. ISingle family dwelling Putnam Avenue Locatio�Mj......................................................... Cotuit ............................................................ ..................... Owner ..............W. E ...D.........Realty .. . .. ...;.......................... frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot .......................... Permit Granted .......F.qbrtj.4L.r.y...I.$........19 76 Date of Inspection Date Completed ......................................19 T.PAO PERMIT REFUSED 19 . ............................................................................... ............................................................................... ............................................................................... ................................................................................ Approved ................................................ 19 ............................................................................... ............................................................................... •cXA sesso s map and lot number ...... .7..r??.. ......... 0� Sewage Permit number ..............!....l.....................................` yofINEro�♦ TOWN OF BARNSTABLE S � i B9$B9TAI{LE, i "6 9 BUILDING INSPECTOR �0 N a' r APPLICATION FOR PERMIT TO ..60.Ad? .OKT..... j� '� � �V ........... ............................................................ TYPE OF CONSTRUCTIONS .t. �a...a ........ w.n �. ! a............................................................................. ✓✓ 0,,1 ...........�C............. ......19..J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location f :�� •�f. l . �....... Proposed ..41 . 1 ct{ Zoning DistriI ..�...•.v.......,'..Fire �/DtistrUic t 1..1..�..�®../.. �-1I'/�....,�`,�. . 7..f.i....�.(.•.h..,',�//,.....=..................'.....�..'..V......(........ S S Name of Owner W !' .....�4. ! .r. �� .............Address / �• � o;d. .�.................... , ............/.`........................................ .� .................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......................................Foundation w �Gk �,mu meC/� . .............................................................. Exterior . a N.,.i-.........c r��� Roofing . 1 ,9 `/ /T— ...................................................... 1�..........................................................................Interior ( yCc' /Z 0 ../( Floors .1....... Heating t /�_� G{/ ` _ ... .}' ..._...............................................................................Plumbing .................................................................................. Fireplace .... ............................................................................Approximate Cost ...... oo trI Definitive Plan Approved by Planning Board -------------------_-----------19________. Area Ap1.R�,9,t". ......./g.)S ......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above d construction: 0 Name W. E. D. Realty A=39-ft- 747 No .....18180...... Permit for ..... .......... .ftle family dwelling Location Putnam .................................Avenu..e............................. ......................C ox.m.i t................. .......................... Owner ............W........ ....R. ..I. .t.y j -I- Type of Construction .........trams..................... ...................................... .................................. Plot ............................ 0 ....... ,(- L -t Aj 3G,3 19 A Permit Gfanted ......February...18..........19 76 ......... . . .. . . . Date of Inspection ......................... ..........19 Date Completed ......................................19 PERMIT REFUSED ............................... .................. .... 19 .......... ..... .................. . .......... ... ...... ....1...... .......... .......... ...... . . .. . ................ ......... ............. .......... ........... ............ ............... . ............... ...... ......................................... Approved ................................................ 19 ............................................................................... ...................I........ -13 Engineering Dept.(3rd floor) Map Parcel �� Permit# House# Date Issued 4-14. 0a Board of Health(3rd floor)-(8:15 -9:30/.1:00-4:30) Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) �1HE Definitive Plan Approved by Plannin Board 19 pp/,�7^ • BARNSTARLE, • //pJ `�`//�/,J/J Y � o� _ t619- MA&S. lf0 MA'S 0 T OF BARNSTABLE Building Permit Application Project Street Address Q U `:&77 ,Prrn Village /7--� Owner V, \,54AJne7CS d d�J ddress Telephone 7 za Permit Request o� First Floor_ O square feet Second Floor square feet Construction Type ea,,,L� Estimated Project Cost $ 1-5�00U Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family J Two Family ❑ Multi-Family(#units) Age of Existing Structure / , Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use ji Builder Information Name Telephone Number Address 6 lJa-&t _1S- L 0L1516 C94 jo/z 4l License# l cil &I Home Improvement.Contractor# 0 0a`�5L--FS Worker's Compensation#I•TGO NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO t. SIGNATURE44( DATE lD b BUILDING MIT DENIED F E OLLOWING REASON(S) - 1f FOR OFFICIAL USE ONLY ' a - PERMIT NO. - DATE ISSUED 1 MAP/PARCEL NO. _ F ADDRESS VILLAGE r r OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts „a =� Department of Industrial Accidents =-- Olfice oflosestigo ions ,� - - _ 600 Washington Street - Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit / � I / name: location city �,© l phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and hvxmw ave no one working in any achy ravidin workers' co ensation for my employees worlszng on this job.:::: :;>:;:;:::::; ::;< ;:;::::;;::<:>:<::>::<» I am an employer P g ....................... . :.. ::::....:..:: ....... ......:...:.....:::.:....:::::: ....::...:.:..::::::::::.:;:: jT. company name addre ii.; SS <::'......phone#k C1tV i : .. •..ii:}i is ii:> is i:'.;:... ... .^:�:•: :::. insurance co. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who. have workers' compensation polices: ork ... :....:....;..;:....;:. ...:.......;:.:.::;;;:::;:;.;;;.;;:.;;>:; the following w mP...... .. ..P ::::......:::.:. .:::,:::.;:,::::::::::::::.:: ::..:,.: .:.::.:..:::._:.... :::._._::.:::::.::::::...:::.:.::,.:.;:.:.;:.;:;.:.;: mpanv name: ::>:.;;;.;:.:;.:; ;;.;..::,::...::.:::.::.. ::. . XX W— .........•i:":ii` ...... :•:::: iii ii•::•::;:::i:•.};: ;::`:;%:'Yr:{ ?::;::::::<::::':.: .....:...... :> ........... ........................................:.:::•.� :.................... �y one: .......................... :............. ...... ................................................................................................... ..............................::. ......:.-�:::::•:::::::::•:::•:::::::::.......... .:._... ........... ......o......:............................ .............................................................. insurance cm :........................:....................... ........ /%%%/%%/ catrnpanv name: . address: :.: :. . one :.. ::.::.::;. ::::..::•:: w..... insurance en ZZ I Failure to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine tip to S1,ntmd and/or one veers'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I undenatand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do hereby certify the pains and p allies ojperjwy that the information provided above is&n�and correct GY�rol.�n � - Signature (� Print name yI / Phone# d ,?S 9 ofncial use only do not write in this area to be completed by City or town ofllcial permit/license# ❑Building Department city or town: QLicensing Board ❑selectinenb Office ❑check if immediate response is required ❑Health Department phone#contact person: ; �er (rcnsaa 9i95 P1A) • - • :1•:1 • • :.1 M• •It w• 1 1 w. I i111• • :/ • • • • • •1111•�•1 .1• •1/ • • �1•/ • • • • i• / •111 It 1 / / / •�4./1�• 1 N • •N •11 11 •1 a • 1• �l 11•�1 • •1• • / / / I • •1•nod eiq•• .II •11 • • II m-1 �••Y• :1•Itl • •II ••• •) /(• - I • • • 11 ' :i• • • • 1 • II :••1 - • ,11 • h • 1 • 11 •I: - • �11•'.1• • •1 •i ws i• :Inl• • a •I /• • • \ 1 • •1 • •/�/ 1 1• •« ,1• •It • • 1 �•Y. 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I 1 / . off 1 I I I 1 1 •' I I 11 1 1 1 1 1 1 1 � 1 1 \ 1 t :• 1 1 1 I 1 . 1 e Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner 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. �f Type of Work: Estimated Cost rao 0'&U Address of Work: Aa an Owner's Name: l✓�rl�� t &114,4 4t✓` Date of Application: V Oao I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 12 -T c �9�v r� cJ r.v�UJG Date Contractor Name Registration No. �— OR O'�t l Date Owner's Name g1orms:Affidav_ I onE�N • IbPQ VFbENT FONT `ter a � 91sfrat oA ,.Y tt RAfTOR � r BONNIE :I 8 ROOFING -AntiuNMANNIArIOR" fNTERVI[lE a