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Home My WebLink About0097 ROOSEVELT ROAD _ , __ _ 9� � .� � � �. �. -�� ,. �'I �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a� wp,; Map J -1 Parcel Application Health Division Date Issued ' Conservation Division Application Fee C� Planning Dept. Permit Fee S. Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address " N Village Q-0 OwnerQasn(Nek, Sal -Address Al J rM Telephone Permit Request C)Penj :na LJ LG J t n En6,&y tCJ 4_ b _Sco l &A knet- +mac,II Flocs of n!5Le. ray y oF- R -7 Wulose -T,.,s+o I i.te6r Caw 4e s -+-- Q6 QL�r "MO n U)Q11 iA2) � l l 6-1 AJ 4_)1LRd Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation btu Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ 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 Number 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: BUILD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ DEC o 12016 Commercial ❑Yes ❑ No If yes, site plan review # TOWN OF 13ARNS-fA6LE Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -pn)an y-, rl Telephone Number t2),:Jr- Address 4/0 Onnv� sT License # 103961 Home Improvement Contractor# Nh 7 4 7 Email Ajen 1 Worker's Compensation # Y 115, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO LU SIGNATURE �� DATE 0 I FOR OFFICIAL USE ONLY APPLICATION # C DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: E FOUNDATION FRAME INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL 5 GAS: ROUGH FINAL FINAL BUILDING 'S DATE CLOSED OUT ASSOCIATION PLAN NO. izo � p I, _ RASE�agteeriug 3 Dtipgpt Ave;;Stiutb Yar*butb'MA 02"4: ENGtPiE£#2tPfG' mCT s08.3W9m FAX st'}&56$1933. . "Pegs:, PROGRAM: �e cAKtw�r�ffi�arr�c��aa�?x�r�a� • CI:C.=HES two;nna►rra:.asstoe�ar�+voaKaa: cuffirotdea . PNeddE YtAtE .CL&Nr o' iNOR3t ORDEit;: PAMELA$l'WLER 008)420-0544 I0117/2016 22�921: 26002 ....... enuao sra�v: 97 Roosevelt Road;: 97 Roosevelt Road: ssirir+ce cnrv:srgre:za�: ea:uuo cm;;ffiTA7E,ZIP. .. Cotutt,MA 02635`: Catuti,MA 0263- AtR SELiIV AG:t?rovtde:Iabat nals and:mate .to seat areas of your home against wasteful,cscss air Iealage. fh�s �rork willlie perfozmed tit concert with the wt ' f specia3:taa4 and`4iagnostictestA"jbassure that;your home'wrlt W left wtth a:healthful:tevel of air e.,ruhange a►d mdoor:att qusi�ty.Materials us be used to seat:y;our hame;cmt include caulks;:foams,weathers ppmg and other products 'Ih unary awas,Or,seaintg include r leakage:to a#tias;;basements attached garages;and other=unheated areas(windows are: not.generatly.addressed) {4)working hours:.A.reductian rn cubic feet per:m�nute(c&rt)of sii infitinuion•wilt occur,bui.the actual number of cfinrts naC•guaiariuxd: . ATTIC1rfi F:Prov�de,iabor and zriatenals iq ii�statt a 1'0"t ayerof R 35 Glass I Cellulose added to(904}'square feet of opal attic' spare:; theNSA tabor uiid matenais us insulate,the,:bacic of„tire;attic Batch wsih:2"rigid fo�n hard and;;seai thc:e�ge:of 1}P ' $d2 itNE3rWAI,1 FLtX)R't'rav►dc tabor and;matnaLs to usstalf'a 10"layer of lianas packed R 37:Class 1 Celiutosq added to(l;?.U) square feetOfkmeecvall tToor; Kt�i£EWALL t I.40R,Pi onde latigr and tnatenats,to:instaU a b 25".layer'af R 19�dakced fibeto*..Oatts to(i 70)squat a feet of -kneewaH'floor=space:. ATF1G ACCESS t'rovuie tabor and materials#a utsulate the back of the attic char with 2"rtgt!Thermaa btmrd kwseat.the iie>or's edge:;=wuh wea4lierstnpprig W restricE our teattage; . VEiV€III.A FtO1 T Provide:taborand=matenats to ins-WI.(3)&"dismeter;rool vent(s);to increase;ventil lion:n atGC aiw,ias 'The ve�tt can-be supplied in.(rhrcte tutor}black,.brown,gray or ini11:En}sh; SENT fi ATICQN Pravide'`labor and materials`to install(t)insulated exhaust hose to existing batbrooti An(, $50 00 1+El�I fIt ATtt3TJ t'rovidetalior ani nuiterisis to uistall':ventitahon chutes in;(9b)taf2er bays to<tiiauilainair ito x i,.n CtJitilIvtON ,Tt1l l S Provide laliorand mateiais to ir►stall 2"F'SIC faced Seim-ngtd ftrgtasstioard tnsutatt ssture feet o#cgnmorrw;altsree:. e ��•� �,� �� i2ISE Engineering; 5.l3gpobt Ave,Soutk Xnrmauth,.>MA fl2titia st ENGINEERING. ��i1iTW 3�;36$-193b FAJC 51>�5b$=1933 Page 2 l'RocRaM CLC-HEs , a .._._ _.,__w_....,_ ..... _ _._..M,,_...__.__................_....................._.... .._ ...._..... DATE CL 4 :Wti ORM PAIVIELA SPCJi.LER. {508}42f?.Os44 10/17L200 225921: 25001 8 8 a 07 RoosevelfRoad 97 Rooseveh Road:. ,; _ _ _._w..�__..._.__......._._._._._._................__._.___..._...._._� m ...__..... _.__._.._ ,8FAYI CMY STAMZIP _. SRJ_W6 CJTt;STATE MP CotuiL MA 02535, :CdWit,MA 02b35 5G011dMC3N WALI S:NbAde-labor and rnatenals to instal!2.FSK,,fked.iemit ngid fiberpIass:board:ns-wkion:fo.{99 square.fact of common.wail urea,. �29t,28 INCENTIVE:R151;Etgttteering;wi!!apply al!apghi able,e!lgible meetitives to thiscontraa: You wiilbe billed only the,idet amount Cwrently_for;ekgtblemeasures,the Cape tight Compact offers`75°lo incentive,not to exceed S4 000 per calca(k�ycar; and-:an.inroniiye of l:4El%frir the Ali Seatng.measi�ses: . Fo ;the s6f, fd health of ynur.hnine s in(W sir.gi adi we;will be Conducting a blower;d&r diagnostic of the:avaitabie au.iiorv: m your home:bodt before the work is begun,and aftecibe weathenzation,work is complete Vt!e wi71 also conduct';e diagnnstic Asses of the combituton.fumes in the.exliaust flue of your heating system antl,;watcr heater_This has a value of$4©.atFd is s' no:cos toyoui The: amit will`be secwred by t663,m iation contiactbr,at no additional cok if is tilt homeownees;rospnastbility to close out thus pe nit by coritactmg tfieir municspaItty at the cotitpietton 6 this urd1t; �I u j RISE=Eugrrieenng . ee �: �`L 5 DupautAve,'Sttpth Yarmunth.MA(t2Glr4 £NGt�V££AlNG` CONTIC'T s08=558-i92b. FAX' SM8 984933 Page 3 Pk6dkAM .. ... tms COtiTiiACL�EYtiE(tEII:VJi'C BETYiE'E#F REfE ' <'CLC-1ES . Eatra,TaE.wa�a�str-�.v�macra,.;; +. .r.......... W.:..__ _, _.._. . CUSTOMER PHONE cueffs W�iKOROER « AAiVI 1,A'SPUi I ER (508)4204544: 104712046 225921 2:0002� SERV10E sTREE7 BfLtING:STREET� �' 97 Roosevelt Road 9TRoosevelt'Road .._........ _. sEaaircE crnr BTATE LP Bukndc cm sTkrE zm Cotult;MA 02635 Cotm MA-.02635' JOB-DESItN $sv oo` Total $3,915 59; ramtt�c$ntive . Custamer rratai $879 38 WE AGREE'HERM TO:FURMP i BERVMM-COMPLETE IN A=RDANCPVNTN'ASOVE'SPRMCATIONS,FOR:THE SUAA OE - **.*Mght:HUhdred:Sd�ooty-Nine.•-&3011,00 0flars $8Y9 38 UNPO@;pgCANOE: ANO APPROVAL BYRisE ENGfNEERiNO.CUS70MER AGREES TO REM}T-AMOUNT DUE IN FULL.INTEREST OF;i%N9L{.9E CHARGED MONPHl.X ON ANY a UDoN.Fd'dAL INS AETER 3QDAY8.SEE REVERSE PDR 4APORTAINT.BifiMAT10NOM GVARANTEES RIONT8;OF RECi6lON;;sCiA;ING,ANOC6NTRACTOR REGIS'iRATWN.,. .; "- DO NOY SIGN YHf$EONYRAG7! -THERE ARE ANY SLhtdtC SPACE$ IHORIlg09KiNATURE-•AT8E' ..- Gr ;%j_/,,�. '..... ... .. 41 �CUBTQ�R'AOCEPTAKCf. NOTETHtBWNTAItCT6#AY:8EiW1iHl'fRAtVHSYUSff../74T,EXECUTED:WITNIN+ ..TEOFACCEPTANCE.:I.;v � ( ..�,,�.:.- .W._,..._._,..._.�._��._.... ACCEPTANCE;QP,CbNTRAtT THEA6.01IEPRFCMBPEGIFlCATIONS,At�COHDiTtON9,AREi. I '30'. 'DAYS.. - SATMACTORvfiO`USANOAREMEMYB ACCEPM You:iNt AUrfOFJM:to'cclno. ORK :. AS:SPEC*10.PAYMENTVY.L•SE:oAm-AsoUTtUdEallOM a I i The Conintonwealth of Massachusetts Department oflnrlttstrialAceidents Y ;i° .1 Congress Street,Suite 1`00 Boston, MA 02114-201.7 wmv.ntass.govltlia T `orkers'Compensation Insurance Affidavit:Buiiders/C'ontractors/Electricians/Plumbers: TO BE FILED WITH TIIE i'1 llMITTING AUTHORITY. Applicant Information. Please Print_ Legibly Na,tne (13asiness/Or_gaiiization/individual):insulate2Save/Roland Langevin Address:410 Grove Street City/State/Zip:Fall River MA 02720 Phone #:508-567-6706' Are you an employer?Check the appropriate box:' T' of ro ect re utred ; I_7 i am a employer with,20 employees(rull andror part-time).' 7 Ncw 40r1St1'UCt10n 2Tj 1 am a sole proprietor or partnership and have no"employees workinn f`or—me,in, :8. Remodelina. any capacity.[No workers`comp.insurance required] 3.[]I am a homeowner doing all work myself:[No workers'comp.insurance.required;};' 9. Q Dernoli;tio,n 4.❑l am a homeowner a 10 nd will be hiring contractors to conductall work cia mV property. f will O 13uildii g addition ensure.that all contractors either have workers'compensation,insurance or are sole 11.:❑ElectrlGal repairs oY additions proprietors with no,employees. 12,Q Plumbing repairs or additions 5.a I am a general contractor and f have hired the sub-contractors listed on the.attached sheet: , These sub-contractots have employees and have workers'comp.insurance./ �13.�ROof repatCs [DOtherinsulafion 6.�we are a corporation and its oilicers have exercised"their right of exemption tier iviGl::c. 14. 52,§l('#),and we have no employees.[No workers'comp.insurance required] *Any y appli rs who hocks box#I must.also fill out the section below showing their workers eompe.nsation,policy mfonna6on,. t pP submit this affidavit iudicating they are doing all work and then,hire otitside cc enactors must swUrnit a new atfi'daviC indigatmg so h. -Contractors that check this box must attached an additional sheet showing the name of the sub-contractors.,ind:�tate"whct1ier or-not`those entili s.hav® employees. If the.sub=contractors have employees,they rifust.provide their >Niorkers'comp,policy niutiber: am an employer that is providing►vorkers'Cottipensutiot:ittsurartce jcir my employees. Belo is the policy alto/job site in formation. Insurance CompanyName:.Liberty Mutual insurance Policy#or Self ins. Lie.#:XWS 56418741 Expiration Datc:12/1:011'6 Job Site Address._ Q©oSvj K�J CitytState/Gip� � Attach a copy.of the workers'compensation policy declaration page(showing the policy number an expiration date). Failure to secure coverage as required under MG;L c. 152 §25A is a criminal violation punishalilb by a#iile up to$1,500:U0 and/or one-year imprisonment,as well as civil penalties in the fot n:cif a STOP l?VORK O-RDER and a fine of u.p to 5250;00'a day against the violator.A copy of this stwement.may be forwarded to the Office of Investigations of the,DIA for insurtt co coverage verification. l do hereblr certify tinder the pains and W nalti s of erjuty that he infnrrtrtafion,proViclYd above is trtreand"c:orrect Signature: Dater Phone#:508-567-6706 Official use only. Do:not write in this area, to be completed by city or town offrciaL. City or Towns- Issuing,Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical.Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1'0"z Of. argsta Red tt ry S; rvic s Tom Pent,Bui ang,(awnistioi3er- i06 Man Street;�yaaais,M&0260I w w.towa jjA$ a ara>us Office 508 s62-4t 38 a7c 5 8 7�tt 23'0 Prapexly Ow -Must ete d Si _n.This Section Pamela,Spuller der of%he stibjec pr. rty. .,, rebgauao�ize 3'Ls - Cts,�o act a mg4f uz:a z $atzve o �l ;authorized by tf us b perirait a plrca d £ar 97 Roospvelt',oao Cotuit MA 02635 �Adc�ss of•'�'ob) , 'Poo (emc s msgomibltyof�C VPlic i �'cxils are nt� to;b�idled Qx u717 befir .fen ��s'uAa f ate: spectizaz,s.art~pgr4oraned acep�e . °E S by Pamela Spu!!er �of.C7wQer _.�.:..,. S�atuzeaf;A�p�icax�t , I Q •��?�x�ssroru�x� -5 C • I AC<:) CERTIFICATE OF LIABILITY INSURANCE D'TE(MMfDD('"w) `—�'' 12/8/15 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: Anthony F. Cordeiro Insurance PHONE M X 171 Pleasant Street EMAIL 508) 677-0407 I A FA/ N : (508) 677-0409 ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURER(SjAFFORDINGCOVERAGE NAIC/f INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St, INSURERD: Fall River, MA 02720 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_. INSR ADDLSUBR(' _._ 1_.POIJCYEFF_ _POU6YEXP �_�_..,...._�.__._r... LTR TYPE OFINSURANCE ( POUCYNUMBER MMf0D/YYW MM/DLVYYYY LIMITS A j GENERAL LIABILITY Y Y BKS 56418741 1 12/10/15 12/10/16 EACHOCCURRENCE I $ 1,000.000 X MMERCIAL GENERAL DAMAGE TO RENTED $ 3OO QOO CO (y)J$E$(Fa occ CLAIMS♦1A0E OCCUR MEDEXP(Arryonapersm) $ 5 000 PERSONAL&ADVINJURY $ 1 000 OQO GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LMITAPPLIES PER !J PRODUCTS-COMPJOPAGG $ -2,000,000 j X I POLICY 7 PRO- LOC 1 g- AUTOMOBILELIABIUTY 12/10/15 12j10/16 COMBINEDSINGLELI IT A Y Y BAA 56418741 Eaacciderfl I $ 1,000 000 ANYAUTO BODILY INJURY(Per.person) $ ALL OS D X AUTOSSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE X HIREDAUTOS X AUTOS Peraccidant $ A X i UMBREUJI LIAR X OCCUR Y t Y USO 56418741 1 12/10/15 12/10/16 EACH OCCURRENCE $ 2,000,000 I EXCESS LIAB CLAIMS-MAOE AGGREGATE _$ 10,000 DED RETENTION$ $� `a' COMPENSATION AND EMPPLLO ERS'ABILIITY XWS 56418741 12/10/15 12/10/16 X WCS� LAI�TT OT Y/N H ANY PROPRIETOR/PARTNER/EXECUTP/E E.L.EACH ACCIDENT $ 500,000 OFFICER9UEMBEREXCLUDED? �.NIA (Mandatory in NH) E.L.bISEASE-EA EMPLOYE S00 OOO Ifyyes,describeunder DESCRIPTIONOF OPERATIONS below E E.L.DISEASE-POLICY LIMIT $ 500,000 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of New Bedford ACCORDANCE WITH THE POLICY PROVISIONS. 133 William Street New Bedford, MA 02740 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ` Office of Consumer Affairs and B iness Regulation us 10 Park Plaza - Suite 5170 Boston, Massachusetts 021.16 Home Improvement Con ractor Registration --..... Registration: 180747 15 t f � i Type: Corporation Expiration: 12/29/2016 Tr# 261507 INSULATE 2 SAVE , INC. l ROLAND LANGEVIN 1 ` - - 410 GROVE ST ,`� "�" FALLRIVER, MA 02720 date Address and return card.Mark reason for change. s%A-I Co 20M-0511! 4 j Address Renewal I Employment Lost Card Office of Consumer Affairs&Business Regulation oo License`or registration stration valid for individul use only =-"'OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration: 4k747 Type: Office of Consumer Affairs and Business Regulation xpiration ==12 9h&% Corporation 10 Park Plaza-Suite 5170 .Boston,MA 02116 INSULATE 2 SAVE �J 1 ROLAND LANGEVIN 410 GROVE ST " FALLRIVER,MA 02720 Undersecretary Not valid without signature Massachusetts Department of Public Safety i = Board of Building Regulations and Standards License: CS-103861 Construction Supervisor ROLAND LANGEVIN 56 HIGHCREST ROAD- 47 FALL RIVER MA 027. CA— Expiration: Commissioner 08124/2017 FAB Town of Barnstable EEI=PTA 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: B-16-3320 Date Recieved: 11/9/2016 Job Location: 663 RACE LANE,MARSTONS MILLS Permit For: Building-Siding/Windows/Roof/Doors 3 Contractor's Name: State Lid. No: Address: Applicant Phone: (339) 832-0632 (Home)Owner's Name: PRESCOTT,MATTHEW Phone: (339).832-0632 (Home)Owner s Address: 663 Race Lane, MARSTONS MILLS,MA 02648 `1 Work Description: Replacing cedar shingle siding Total Value Of Work To Be Performed: $5,000.00 Structure Size: 0.00 0.00 0.00 Width . Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to'violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Matthew Prescott- • 11/9/2016 t (339)832-6632 Applicant Date Telephone,No. Estimated.Construction,Costs/Permit Fees Total Project Cost : $5,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $35.001 11/9/2016 $35.00 X30CJ{ }O{-J JCO{- Credit Card ._..... 5958 ... l ........... Total Permit Fee Paid: $35.00 �.- MA Iell Town of Barnstable +� �' Esp�s6nraltibsfntrm�edate Regulatory Services Fee 3 . �— `. Richard V.Sc*Interim Director +� � � Badimg Division 40 *00 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwwtown.bamstablemaus } Office: 508-862-4038 �Pa 08 790-6230 - EXPRESS LE T aPPiaC>�TTON a RESIDEN'1TAL ®I�TL v Naap parcel Number oZ(7- A(S� Not Valid OmR�X-Pressdnrint Property Address /(o dential Value of Wo& 8�- 1Vtmimum fee of$35.00 for work under 3000.00 Owner's Name 8t Address C, (�V s MA L6, Contractor's Name (� t fiC Telephone Number�df—7� 3yPsy Home Improvement Contractor License#(if applicable)�� Construction S`upervisoes License#(if applicable) t)7 1)n '7 (, worl4aan's Compensation Insurance �� Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compwsati(m Insurance Insurance CompanyName_ /��l(, i i©Sl / l/� - CO - w0dMM's Co 013' COMP.Pohc,:� Copy of Insurance Compliance Certificate must accompany each p Timm Permit Request(check box) U Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers ofmcd) 0 jte-side Replacement windows/doors/sliders,.0 Value - >0 (maximum 35)#of windows / - #of doors: _❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. `QDhe�etequicefi TSSnaucaoftirispeimitd�smitexemptcnmpTiaocewitho8�ertawn ems,is gisraaic,Conservation,�. Note: Property er gn Property Owner Letter of Permission. A copy of. H Improvement Contractors License&Construction Supervisors Liceam is required. SIGNATURE- TAEVIN D\Bm'&g C6aageslIIiP RBSSdoe Revised 061313 I " Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: Janice Campbell : R-1-073-13-00016 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider,named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined'on this form. Customer Information: ming gu 9648118 First Name Last Name Branch Name Lead# 16 thach lane HYANNIS MA F2601 Customer Address City State Zip (518) 957-2045 �— Home Phone# Work Phone# Cell Phone# mingmingstar1954@hotmail.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: X .10/23/2016 Customer's Signature Y Date 1 Distribution: White-Home Depot Yellow-Customer Copy n warsaaci►u: a - 00pati.ax oftl of pubkc Salocy Board of Budding IttrgWatto and $44(VOW06 (•etc+i�u�dp.•t+ itii�r�3w�•o L won" CS-070077 J OSEPH C DUARTE IS FAUST WAREHAJN MA VLi C s'x. r 1 (1(iicr of(otieameP AI?Ai��Rf�t � ;y } HOME IMPROVEMENT t:QN1MAC"�� ; s PV R IscCtrttlon 1 9 x r , ', Expiration tftl17 �'`� . � , Josecn ivarte 15 FaU St +liareham,ma O2571 ' s y xR.'N,` LL � I The Conunonwealth of Massachusetts Depw*nent of Industrial Accidents ~}--- Office of Investigations ' I Congress Street Suite 100 Boston,MA 02114-2017 www mass govli is Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaulicant Information Please Print Legibly Name (Business/Organization/Individual): �/ ��//C.J�o Address: WIL-60 A.) City/State/Zip: ! 60 U M-4 Phone#: 7 71(— 74 Z3 2-f Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 I a a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling m ship and have no employees These sub-contractors have g. Demolition -working for me in an capacity. employees and have workers' [No workers' comp.insurance := comp. insurance 9. [�Building addition # required.] ' 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 I T1 Plumbing repairs or additions myself. [No workers' comp. tight of 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 Homeowners who submit this affidavit indicating they are domg 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:- 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance,coverage verification. I do hereby cerfifyAnder the paips and en 'es ofperjug that the in ormation provided above is true and correct Si ature: Date t. Phone#: —77T— 744 L 9225� ' Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): . 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial accidents - Office of Investigations I Congress Street, Suite 100 Boston. AM 02114-2017 www mass a ov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiy Name (Business/Organization/Individual): The Home Depot At-Home Services Address:sob Boston i pk City/State/Zip:Shrewsbury,MA 01545 Phone °:508-962-6942 Are you an employer? Check the appropriate box: Type of project(required): 1.FM I am a employer with 2oD+ 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time)_* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑'Building addition [No workers' comp. insurance comp. insurance.= ired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.]3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs required.] y insurance re � c. 152, §1(4),and we have no employees. [No workers' 13.0 Other WV%dQLJ comp. insurance required.] !'e jo(a c Prt e-"fi 'Any applicant that checks box-#1 must also till out the section below showing their workers'compensation policy information. Any 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 n:y employees. Be P is the policy and job site information. Insurance Company Name. NewHampshire Insurance Company _ Policy#or Self-ins. Lic.#: Expiration WC 015519215 Date:3/1/2017 Job Site Address: Aa /hQC h a/!e_ City/State/Zip:l'l,Yo Cs M Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.'152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA r nsurance coverage verification. I do hereby certify u er pains and penalties of perjury that the information provided above is true and correct Simature: 'Date: �— Phone#: 401-714-6 Official use only. Do not mite 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#• � :� irs'and Business Regulation =' T Iv Office of Consumer �1ffa 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement:Eon tractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. ANDREW SWEET - 2455 PACES FERRY ROAD, HSC C-11 ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address Renewal [] Employment [-] Lost Gard /� Y_.r ninr•irr;rrr�/ri r /(r:.i.;r:l lation License or registration valid for individual use only 9fficc of Consumer Affairs K Business Regu i� before the expiration date. If found return to: 'HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 126893 Type: 10 Park Plaza-Suite 5170 Expiration:.g/3/2018. Supplement Card Roston,MA 02116 THD AT HOME SERVICES.INC. THE HOME DEPOT AT HOME SERVICES ANDREW SWEET 2455 PACES FERRY ROAD,HSC - AT)ANTA,GA 30339 Undersecretary Not v with ut signature DATE(MMIDDlYYYY) ACC> CERTIFICATE OF LIABILITY INSURANCE 0211812016 IS Fthm RTIFICATE IS OTUAFFIRMATIVELY FIRMATIVE YEOR NEGATIVELY AMEND, EXTEND OR ALTER R OF INFORMATION ONLY AND CONFERS NO RIGHTS COVERAGE AFFORDED ABY THE POLICTE HOLDER. IES IFICATE DOES NO W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to erms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the ificate holder in lieu of such endorsement(s). NTACT CER NAME: FAX SH USA,INC. PHONE AIC No ALLIANCE CENTER E-MAIL LENOX ROAD,SUITE 2400 ADORESANTA,GA 30326 INsuRE S AFFORDING COVERAGE NAIC 0Steadfast Insurance Company26387 -HomeD-GAW-1E17 INsuRER A: 16535 INSURER B:Zurich American Insurance CoD 23B41 AT-HOME SERVICES,INC. INSURER C:New Hampshire Ins Co THE HOME DEPOT AT-HOME SERVICES Illinois National Insurance Company 23817 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES REQUIREMENT,TERM OR CONDCE LISTED ITION ION OF ANY CON HAVE BEEN TRACT OR OTHER DOCED TO THE INSURED NUMENT WITH RESPECT TOED ABOVE FOR THE LIWHICH CY PERIOD INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED.HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED EFF PAID ICV BPS LIMITS ADDL SUBR pOVCY NUMBER MMIDD MMIDD INSR TYPE OF INSURANCE I LTR 9,000,000 A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03/01/2016 03/0112017 EACH OCCURRENCE $ DAMAGE TO RENTED $ 1,000,000 PREMISE Ea occurrence CLAIMS-MADE FT1 OCCUR EXCLUDED LIMITS OF POLICY XS MED EXP(Any one person) $ OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s 9,000,000 X POLICY❑JECOT 7 LOC $ q. OTHER: 0310112016 0310V2017 COMBINED SINGLE LIMIT $ 1,000,000 B AUTOMOBILE LIABILITY BAP 293886313 Ea amdent BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG PROPERTY DAMAGE AUTOS AUTOS $ NON_OWNED Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR $ AGGREGATE EXCESS LU1B CLAIMS-MADE. $ DED RETENTION$ WC015519215(AOS) 03/01/2016 03/01/2017 X PTATUTE ERH C INDAND EMPS COMPENSATION 03/01/2016 03/01/2017 1,000.000 C AND EMPLOYER5 LIABILITY Y 1 N WC015519217(AK,KY,NH,NJ,VT) E.L.EACH ACCIDENT s ANY PROPRIETOR/PARTNER/EXECUTIVE N I A 03/01/2016 03/01/2017 1.000,000 D OFFICERIMEMBER EXCLUDED? WC01 551 921 6(FL) E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) 1,000,000 If yes,describe under Conitnued on Additional Page E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 101,Additional Remarks Schedule,may be attached if more apace is required) DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD EVIDENCE OF INSURANCE CANCELLATION CERTIFICATE HOLDER THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORD�D REPRESENTATIVE . of Marsh USA Inc. i _MAy;L�t:iL ' Manashi Mukherjee ©1988-2014 ACORD CORPORATION. All rights reserved. re registered marks of ACORD ACORD 25(2014101) The ACORD name and logo a I �T >r Town of Barnstable *rem it# 'b Expires 6 months roar issu ate Regulatory Services � 1AENSTA1t,E, a NABS. Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 0l 0�`;. �� 200 Main Street,Hyannis,MA 02601 !•/°4 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDEN'TIAL ONLY �l ,Z Not Valid without Red X-Press Imprint Map/parcel Number Property'Address 7 pBI �Du'd � ' � tit�S Residential Value of Work$ V7 — Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address uwu ( C �7 S OZ1Pa Contractor's Name �01 Telephone Number (y 01) 7 1 y -6 T 1 Home Improvement Contractor License#(if applicable) /;2(o Email: Construction Supervisor's License#(if applicable) [(Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 71 have Worker's Compensation Insurance Insurance Company Name �in/ tVA5Air'e Workman's Comp. Policy'It Copy of Insurance Compliance Certificate must accompany each permit. Permit R quest(check box) G � Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to row-- / ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U Value (maximum .35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&_Fire Permits required. *Wheii required: Issuance of this permit does not exempt compliance with other town department regulations,i.e-Historic,Conservation,etc.. *"'-,Note: Prope er must sign Property Owner Letter of Permission. A cop of t e Home Improvement Contractors License&Construction Supervisors License is requ' ed. SIGNATURE: QAWPFILESTORMSIbuildingpermi mu XPRESS.doe Revised 061313 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit 1,Shrewsbury,MA 1545 Branch Name: Boston North Date:11/17/2016 Toll Free 8779033768;Fax 8009863610 ME Lic#C 02439 RI Cont.Lie#16427 Branch No: 33 CT Lic#HIC.0565522 MA Home Improvement Contractor Reg.#126893 Federal ID# 75-2698460 Installation Address: 17 Crooked Pond Rd HYANNIS MA 02601 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M david Vandine (203)260-9410 Home Address: 17 crooket pont rd 1 YANNIS MA 02601 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):davevandine(a,maa.com Marketing emails will not be sent from The Home Depot. Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto and any Change Orders(collectively,"Contract"): Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount 9710480 Roofing 9710480 $11,917.26 Minimum 25% Deposit of Contract Amount Total Contract Amount $11,917.26 due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# 9710480 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 06117/14-SA Page 1 of 7 HOME IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of sign.Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Contract is the entire agreement between Customer and The Home Depot with regard to the products and installation services and supersedes all prior discussions and agreements, either oral or written,relating to said products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement.. You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Agreement.By contacting sales office (g77)90 3768 ,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an emailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement�o tr ct �(1/IA , ��`,✓�' M/M david Vandine (Nov 17, 2016, Submitted by: Accepted by: 3:43 PM) Customer Christopher G.Read Sales Consultant p License Name. Signature: (877)903-3768 Customer Telephone No. Signature: Accepted by:CR10(Nov 17,2016, Sales Consultant 3:44 PM) License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION Bl DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT.THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE 06/17114SA Page 7 of 7 2 Massachusetts Depa\mey of /6§fie\\ \ \ ƒ a SQbl Regulations.a d an 7d\ . ° tbec CSSL40IN7 \ \ Construction su w\m s 6a@y ao&ALDO SOLANo ?v 763 WAVERLY STREET � . FRAANGHAMMA ■17o2\ Department of Industrial Accidents Office of Invesfigadons ' 1 Congress Street,Suite 100 Boston,MA 02114--2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Le 'bl Name(Business/Organization/Individual): fj &2 d RooF C=> Address: City/State/Zip: i -6l7aZ Phone#: Are you an employer?Chec the appropriate bog: Type of project(required): L❑ 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 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp,insurance comp.insurance.$ 9.' ❑Building addition 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 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' ME3 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached adadditional 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. 1 am an employer that is providing 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance verage verification. I do hereb c u e t e pains a alihies o er ury that the in ormation provided above is true and correct Si afore: Date (! Z Phone#: �-4-3 S Official use only. Do not write in this area,to be completed by.c#y 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#: The Commonwealth of Massachusetts Department of Industrial Accidents REW1 Office of Investigations .1 Congress Street, Suite 100 V Boston,MA 02114-2017 wWlv.maSSaOV/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Biness/organizaaottllndMaual): The Home Depot At-Home Services AddTeSS: tate/Z 908 Boston Tpk City/Sip: Shrewsbury,MA OIW Phone 9:508-9.62-6942 Are you an employer?Check the appropriate bog: Type of project(r equired): zoo+ 4. ❑ I am a general contractor and I 6 ❑New constr I.© I am a employer.with have hired the sub-contractors employees(full and/or Part-time). listed on the attached sheet 7. Remodelin 2.❑ I am a sole proprietor or partner- These-sub-contractors have 8. Demolition ship and have no employees employees and.have workers' 9 .❑Building a working for me in any capacity. comp.insurance.- [No workers' comp.insurance, I0.❑Electrical r required.] 5. ❑ We area corporation and its .❑ I atn a homeowner'doing all work officers have exercised their 1L❑Plumbing repairs or additions right of exemption per MGL 12 ARoof repairs myself. [No workers' comp. c: 152, §1(4),and w-e have no insurance required.]' 13.❑Other employees. [No workers' comp.insurance required.] •Any applicant that checks box-N1 must also fill out the section below showing their workers'.compensation policy infoma new.affidavit indicating such t Ho-MCON vers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new ' an additional sheet showing the name of the sub-contractors and state whether or not those entities have Cofactors that check this box must attached employees If the sub-contractors have employees,they must provide their workers'comp.policy number. workers co ensation insurance for my employees. Below is the policy and job site I am an employer thid is providng mP information. Insurance Company Name: New Hampshire insurance Company Policy#or Self-ins.Lic.#:WC 015519215 Expiration 3/12017. City/State/Zip: \S Job Site Address: iration date .. Attach a copy of the workers' compensation policy declaration page(showing the policy nu her and ex ) imposition of . n Failure to secure coverage as required under Section 25A of �I• an leade to orm of a STOP WORK ORDER and crimi al penalties oa fine fine up to$1,500-00 and/or one-year imprisonment, as well penalties 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 D�k r nsurance coverage verification. I do hereby certify u pains and penalties of perjury that the information provided ab is true and correct Date: Z Si afore: Phone ik 4O 1-714-6 . r6. al use only. Do not write in this area,to be completed by city or town official. r Town• Permit/License# g Authority(circle one): ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector herPhone#• act Person- ew 441i �lf 9 1 Off c'e- . f Consumer Affairs and Business Regulation ' 10'Park Plaza . Suite:517U Boston, Massachusetts-.02.116 Home Irnprovement Contractor Registr-ation s RejistraUon;: 126893 Type: .Supplement Card + Expiration: .8/3/201.8 'THD AT HOME SERVICES, INC ANDREW SWEET. ' n 245.5 PACES FERRY ROAD, .ATLANTA, GA 30339 ` Update Address and MOM card .lVIark`reason for ehatige. Address :.n'Renewal (� Employmenf [] Last Card $CA 1 +a 2QM U5119: . ( 1�r�G+r Ullllfk/lfRGlf��/L:f/^fJllI2J1Ul,/!/I irs�ll, _ . Y ffiCe Of Consumer Affairs&Business Regulation License or.registration valid for tndividuilI use only before the expiration date. if found return to fH0ME:IMPROVEMENT CONTRACTOR:' Office of Consumer Affairs and Business,Regulation Gx T.ReglsUatlon:. f126893 Type 10 Park Plaza,_Suite 5170 Explratton g/3/20]S Supplement.Card Boston,i4.Not.vrjpts1gn THD AT HOME SERVICES INC THE HOME DEPOT ATjHOME SERVICES ANDREW SWEET 2455'PACES FERRY ROAD HSC __ --------. MA' NTA,GA 3.0339 Undersecretary: iature A, ® �/� �E DATE(MM/DDrmY) N , 16 � INSURANCE 21 8120 R 1NSU o Aco LIABILITY CERTIFICATE OF LI AB 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). " CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER AIC No IE-MAIL 3560 LENOX ROAD,SUITE 2400 ADDRESS: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW`-16-17 INSURER A:Steadfast Insurance Company IM387 INSURED INSURER B:Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. INSURER C:New Hampshire Ins Co 23941 DBA THE HOME DEPOT AT-HOME SERVICES 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 123817 ATLANTA,GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:8 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 INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY C" POLICY EXP LIMITS LTR TYPE OF INSURANCE I POLICY NUMBER MMfDDNYYY1 1MM1IDD1YYYY1 - A X COMMERCIAL GENERAL LIABILITY GLO4887714-06 03/01/2016 03/01/20,17 _ EACH OCCURRENCE - $' 9;000,000 - DAMAGE TO RENTED 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occunance $ LIMITS OF POLICY XS MED EXP(Any one person) $. EXCLUDED OF SIR:$1M PER OCC PERSONAL s ADV INJURY $ 9,000,000' GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 POLICY❑PRO ❑LOG PRODUCTS-COMP/OP AGG $ 9,000,000 X JECT OTHER: $ BAP 293886313 0310112016 0310112017 COMBINED SINGLE LIMIT $ 1,000,000 B AUTOMOBILE LIABILITY Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED - Peraccident) $ HIRED AUTOS AUTOS $. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE' $ $ DED F RETENTION$ C WORKERS COMPENSATION WC015519215(AOS) 03/01/2016 ' 03/01/2017 X STATUTE ERH AND EMPLOYERS'LIABILITY Y WC015519217 AK,KY,NH,NJ,VT 03/01/2016 03/01/2017, 1,000,000. C ANY PROPRIETOR/PARTNER/EXECUTIVE /N❑ NIA A ( ) E.L.EACH ACCIDENT $ D OFFICER/MEMBER EXCLUDED? WC015519216(FL) 03/01/2016 03/01/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In NH) 1;000,000 ,,,as, des-be under Conitnued-on Additional Page - - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF 0 ERATIONS below - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION ,DATE :THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee -Mau4o� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and.logo are registered marks of ACORD Assessor's office(1st Floor): — Assessor's map and lot number 1-1// pF TWE to Board of Health(3rd floor): / / // SEP,T 4 x � �C. l l ��6°�:�Fes. � �B�t: 29i47 tt3r AMC b w Sewage Permit number ll ((( • AYH T flf � , DAa9T&BLL Engineering Department ment(3rd floor): � rasa House number i� I r e � i' tf= ; ° �63q. Definitive Plan Approved by Planning Boar 19�� ? o \, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only A P P R 0 v EFOWN - OF BARNSTABLE \�„$.tap'1. Servatfcn Commile s^ aU I L.D I N G INSPECTOR SiI6��CATION FOR PERMS s r- r�,e ( I S 1 h 4 _�1 C K TYPE OF CONSTRUCTION ,Y OS .S G V e e to cot u,4 R B s� 19 — t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location / V /� O 7 U 1 Proposed Use .SCVe—P V\ X1S�'/ �G e, 'A y-nteG'L— 4Dw, b (�,5S Zoning District Fire District / Name of Ownerj�� C� V' l� Address 9 �O Name of Builder .l)cj tt i 61 u'r" h 4 L Address Q- o� Name of Architect Address Number of Rooms D e V'O 0 P%n S Foundation C O t^ C y e ZL .SG c� ti y�e,S Exterior ]C re—e- f Qvnd Sgi�Lf Roofing C4J Floors .�w O o c� Interior U Heating Plumbing Fireplace Approximate Cost Area © IL14 C14 G Diagram of Lot and Building with Dimensions FeeQ 00 .0 C10•q c/ e C Lot U, _ C Sergi C `ec`« Pi t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name )( ' 4 — Construction Supervisor's License EARP, JEAN _ y r + No 34382 Permit Foy Screen Deck Single Family Dwelling Location 97 Roosevelt`!! Road �} Cotuit Owner Jean Earp:r. s � Type of Construction Plot ' / Lot -,Permit Granted June 7, 19 91 � s Date of Inspection 19 • - 1 -" '- - Date Completed 19". r r - r� zw,5 h� it 0 G, re e- Sc Ile I a C.R y e 4�4 oo r o iS-¢- s� b Ls � � I t L J cad ° S A Tl I I ui . C. e e h Rome Sc. V- e� - i � x 6 1-01 oalr' OiS S b . 0 '" a e� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY s OF 1010 COMMONWEALTH AVE. MASSACHUSETTS BOSTON,MASS.02215 LICENSE:- EXPIRATION DATE _ r f .CONSTR. :SUPERVISOR: 03/31/1992 RESTRICTIONS o EFFECTIVE DATE LIC-NO. 7G 4= '04701I1989 050096 :1 -9 .2 FAMILY 1HOME. ?� m DAVI D G "HUFNAGEL . FMIASHPEESMIA--02649 PHOTO(BLASTING OPR ONLY( FEE: 0.00 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ' STAMPED -OR -SIGNATURE OF THE COMMISSIONER I 2201959u '�3'1L � I THIS DOCUMENT MUST BE. t CARRIED ON THE PERSON OF! SIGNATURE ICE THE HOLDER WHEN ENGAG OTHERS -RIGHT THUMB PRINT ED IN THIS OCCUPATION, w I /_LONER I ely 20OM-2-87-81429 �� %/17 oFtME r� Town of Barnstable -Permit# j Expires 6 months from issue date Regulatory Services Fee • snaxseABtE 9� '""SS Thomas F.Geiler,Director i639. ♦� Building Division �7�30113 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number p-3q (S� Property Address -I? Residential Value of Work$ Cb-0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address R � �t9S�iJC-i� l� Contractor's Name �c"ib `f Telephone Number Home Improvement Contractor License#(if applicable) Q 1 5�1� Email: Construction Supervisor's License#(if applicable) S-4 ❑Workman's Compensation Insurance % C�hee X one: PRESSPm a sole proprietor ��"" ��'� ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance JUL 2 9 2013 Insurance Company Name Workman's Comp.Policy# TOWN OF BARN TABLS 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 He-roof(hurricane nailed)(not stripping. Going over existing layers of roof) tRe-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require . SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E SS.doc Revised 060513 the Commonwealth of Massachusetts Deparftnent of IndustrialAccidents Office of Inmligafions 600 Washington Street Boston,AM 02111 wmik inass.gov1dia Workers' Campensatiou Insurance Affidavit: B.rilders/ContractorslDectricians(Plumbers applicant Information Please Print Legibly Name oksmeWorganizationll&-vidual): _�w^x& CP Ob Y e Address: City/StatefZlp: VA JM,�(5 Phone Af Are you an employer? Check the appropriate bG= T of o'ect r 4. I am� contractor and I }'� pr I (required): 1_❑Alta a employer with ❑ t� 6. ❑New construction oyees(full and(orpart-ime).* have hired the sub-contcactois. 2. sole proprietor or partner listed on the attached sheet �+- ❑Remodeh>zg ship and have no employees These sub-contractors have g. ❑Demolition working for in any capacitT employees and have workers' 9. [:]Building addition [No workcers' comp.insurance comp.insurance-1 required-] 5. ❑ We area corporation and its 10-F]Electrical repairs or additions 3.❑ I am a homeawnes doing all work officers have exercised their 1 LE]Plumbing repairs or additions nTyself [No workers'camp. right of exemption per MGL 11❑Roof repairs insurance required.]b c. 152,§1(4),and we have no employees_[No workers' 13.❑Other comp-insurance required_]. *Amy applimat tbat checks boa#1 must also tall out the section below showing their wozkers'compensation policy infarmatimL T Homeowners who submit this afadavit indicating duFry are doing all work and then hire outside contractors nntst submit anew affidavit indicating such. tractors that check this boa Est attached an additional sheet showing the name or the sub-coutracrors and state whether or not those entities have employees. If the sub-couttadars have employees,they must provide their workers'comp.policy number. I am an employer that is prm�iding nrorkers compensation insurance for my enq?loyees. Below is Ste policy audio site information. Insurance Company Name: Policy 4 or Self-ins.Lie #: Expiration Date: Job Site Address: City/Statel7_ip: 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 rfiminal penalties of a fine up to$1,506.00 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- I do Hereby c;e ender tk 'ns and penalties ofpeditry that the inforrrration prinided ab4n a is tnw and correct Date: Phone#: Qfilcial use only. Do not write in this area,to be completed by city or town ofuciaL City or Town: PermitUcense# Issuing Authority(circle one) 1.Board of Health 2.Building Departmeat 3.CityfFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 �R Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any 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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(I LC) or Limited Liability Partnerships(LLP)with no employees other 1[han the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ile to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents off m of investigations 600 Washington Street Boston,ISM,.02111 Tel,#617-727-4900 W 406 or 1-977-MASWE Revised 4-24-07 Fax# 617-727-7749 w .mass_gov/dia f - Town of Barnstable r Regulatory Services &UMSTABLE' Thomas F.Geiler,Director 1639. iDTFo,,,o�A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.ba rnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �nV� to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 7z7,o;�0 Signature of Ow r Signature of App ' nt ors0 Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 i f t ' ti Town of Barnstable Regulatory Services BAMSTABLE, : Thomas F.Geiler,Director 9 MASS. $ apt i639• A�0 Building Division FO MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 1 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`i(Section'109.f,.l) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official �l 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 fon-n/certification for use in your community. Q:forms:homeexempt I Office .License or registration valid for individul use only 1 f I � •id EY fl HOME,IMPROUEMENT.CONTRACTOr't before the expiration date. If found return to: Registration 114561 ` :'...Type:. Office of Consumer Affairs and Business Regulation ! YP Expiratian: 1W013 . :DBA , .: 10 Park Plaza-Suite 5170 i Boston,MA 02116 VGADY CARPCNTFY r David Gady ; ` r= �Aw� 1 ! ;,1. 217A.TtmberLn ,,` � ; � • Marstons Mills MA 02,648 !' Undersecretx:y { Not valid ithout Sig ure Massachusetts Department of Public Safety Board of Buildin Re g egulations and Standards Construction Supcn isur l &2 Family License: CSFA-057540 46 DAVID J GAD.h 217 A TEVMj t y� MARSTON a MA o a h 7 y �� ..C.... �: a° 74�n C01nmissioner Expiration 12/28/2013 "P �IK r 13 2012 ry Town of Barnstable *Permit#au Qv Expires 6 months from issue dote Regulatory Services Fee „ sAuvsr�sra, , OF MR� ST�B. ;Thomas F.Geiler,Director.` Building Division Tom Perry,CBO, Building Commissioner 206 MainStreet,Hyannis,,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 Fax: 508-79.0-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Propeity.Address 12-(.25e-Ve-4 A7 esidential Value of Work 3QVD Minimum fee of$35.00 for work under$6000.00ev A Owner's Name&Address S `� ' R7 se >A Contractor's Named G Y Telephone Number Home Improvement Contractor License#(if applicableL � Construction Supervisor's License#(if applicable) CS r ❑Workman's Compensation Insurance Che one: I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp..Policy# Copy of Insurance Compliance Certificate,must accompany each permit. _ Permit Request(check box) �A4 ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to. ❑Re-ro f(hurricane nailed)(not stripping., Going over existing layers ofroof) Re-side #ofdoors Replacement Wiudows/doors/sliders.U-Value' (maximum..35)#of Windows,— Smoke/Carbon Monoxide detectors.4 floor plans marked with red S and..inspections-irequired: 'cal&Fire Pe rmits its required. t Electrical Separate E Se P _ om fiance with other town de ariment regulations,i.e:Histonc,Conservation,etc. +. . Issuance of this permit does not exempt c p P Where required. 4 ***Note:. -Property Owner must sign Property Owner Letter.of Permission A copy of the me Improvement Contractors License&Construction Supervisors License is required: SIGNATURE. . ;:, Massachusetts=Department of.Public Safety Board of Building Regulations and Standards er�"isor 1&2 FamilN • Construction $up� License: CSFA-057540 ,. a DAVID J GADY� 217 A;TIN Mkk L T . MARSTON&IVMI�S,W 0 648 v-12, _X tin Expiration . Coinmissioner ; 12/28/2013 License orreg►stratiOn valid for indrvidul use only. t' Office o `� before the expiration date: If found return to: HOME IrY ROVEMENT CONTRACTOR ;11 Office of Consumer'Affairs and Business Regulation Registrations 414561 TYpe - 10 Park Plaza-Suite 5170 Expiration: 1Q14f2013. . . DBA �a Boston,"MA 02116 GADY CARPENTRY t. DaVid.:Gady 11 217A.Timber�Ln — "— Marstons Mills, MA 0- Undersecretar} i Not valid ►thout sig ure ?Ise Commonwea th o►,f'Massachusettts Deparhnent oflndustrial Accidertls +Qrke or,f Investigations: bM Muhirxgton Street Boston,H4 #2111 rfncnv.zr a gov1di Workers' Compensation Insurance Affidavit:Bidders/Con"ctorsMectricianslPbtmbers. Applicant Information Pease Print Leybiv . Name{BusinewM tiontu&vidnal). Address: l✓ityfStafip . > .�s Phone -zga Pia. Are you an employer?Check the appropriate box: Type of a]ec (required):d)= 1.❑ I am a employer with I. ama contractor and I❑ 6_ ❑New motion ogees{full and/or par#-time).* have hired the sub�n�cbais 2. am a sole proprietor or listed on the attached sheet_ 7_ ❑Remodeling Fropri pa These sub-contractors have ship.and have no employees 8_ ❑Demolition M for me itt a ct employees and have wx�ess' o�tng uY cape. ty. , . � 9. ❑Building addition Fo wod=s' comp.insurance 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 ommption per IAGL 12.❑Roof repairs insurance required.]T c.152, 1(4)-and we have no employees-[No wwkers' 13.❑other comp.insurance required:] *Any applicant thatcheck box 91 must also dill am the section below showing theirwaskers'cmnpensaannpalicp infom3tiaa. Ha meosvn!ers who submit this afff&wd indicating they are daing all wal and rhea hire outside contractors umst submit a new affidavirt indicating such. ICoutracmrs that check this ban most attached an additions(sheet showing the mane of the sub-c tml sad state whether or not those enutees been empinyees. If the sub-contractars have employees,theymnst psnvide their ainrke s'comp.policy number. I am an emplayar that is providing workm,co.mpnwalion irrsatrarice for MY employes Beloto is the poUcy and job sits j information. Insurance Company?Name:- Policy or.Sell'ins_Lic. ' ExpirationDate: Job Site.Address`_ citylstateMp: Attach a cupy of thr workers'compensation policy declaration page(shoeing the policy number and expiration date). . Failure to secure coverage as required under Sect m 25A of NIGL c_ 152 can lead to the imposition of criminal penalties iof a Rule up to S1,500.OD and/or one-year imprisomrw t,as well as civil penalties in.the form of a STOP WORKORDER and a tine of up to$2250_90 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of imestsgations of the,DIA for insurance coverage verification- ` I do hereby ce ,rrr or ins and awles a.J�3 u►3'that the information provided above is true and Correct r - Date: c Phone Official use Drily. Do not write in this arm,to be ctrtnpUtetd by City or tourer of ciat CSity or T6Nm: FermitUceme# Issuing Authority(circle fine}. 1..Board.of Ileahh' 3.Bu ng Departmient 3 Cit f row Cleric`4.lrlectrical faspecter. S.Phimbing Inspector, -------- -__ f ---..�__. .--- ---......__._,_ - " THE Tq�ti Town of Barnstable Regulatory Services y mass. �, Thomas F.Geiler,Director �p s639. len a Building.Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.to wn.b a rn s to b l e.m a.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize u ib to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed arid all final inspections are performed and accepted. _ Signa of Owner 7 Signature of Applicant Pant Name Print Name Date QTORM&OWNERPERMISSIONPOOLS 6/2012 �+ Town of Barnstable C° " CF tHE �P� tio Regulatory Services Thomas F. Geiler,Director 9 MASS. s6 Building Division J 39• ♦e 'O�Fn►dw'�° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-623( PERMIT#c 066 3S7(p FEE: $ 075�� 00 SHED REGISTRATION UV 120 square feet or less ( f 1"_0 C-01-TU i 7— Location of shed(address) Village ( c J Oct QD U OJ 021 0� Property owner's name Telephone number 03q . 1.; Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? �i U Conservation Commission(signature is required) Z Sign off hours for Conservation 8:00-9:30&3:30-4:30 `� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 f P MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER USE). 'AO to A.M. 039 PAR. 154 ��` ��P�PAi .7 R 0,j D GA• 6�ti� '„ 354 42„w s #9 7 w �t- \ co 9 LOT 53 O9 ' A.M. 039 A.M. 039 PAR. 155 . . ' PAR. 156 \ N77 p6,49 � »w ,pp pp Z A.M. 038 SS `SO PAR. 002 - - ---- - —--- - --- -- - -PRE - ----- -_ ACCORDANCE W1R-FT-TMORTGAG W -- ----- -- .-- -- -- ---- --------- ----- - . -- --- THE PRACTICE OF LAND SURVEYING.THE BUILDING SHOWN IS. NOT AFFECTED BY A SPECIAL FLOOD HAZARD AREA AND DOES _CONFORM TO THE LOCAL ZONING BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQUIREMENTS OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASSAC_HU_SETTS_ GENERAL LAWS EHAPTER 40A SECTION_1. REFERENCED GEED SUBJECT TO_AND__WITH THE 8ENEFIf OF ALL RIGHTS. RIGNIS OF WAY. EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT. �RZSF � � dQ - A - ` UAlh TOWN: BARNSTABLE (COTUIT) DATE: 08/23/06 BUYER: MICHAEL J. & NANCY A. BURDULIS -CERTIFY TO: JOHN W. KENNEY SCALE: 1"-40' A. � 1 � F€©F"4s� TI AE REF: C sO171025 MacDougall Surveying PLAN REF: 36 8 C SH.4 & Associates FLOOD ZONE: "C" 9TEPHEN� c A COMMUNITY PANEL: P.O. BOX 242$ ry DOr�E y ® 250001-0018-D Mashpee, Ma, 02649 - ; 7- DATED: 07/02/92 ph.' (508)419-1086 CURRENT ZONING: "RF" 4 �" JSio�T fax. (508)419-1087 o� email: macdougallsurvey m��sURv��a J.OB# 10.056 ftomcast.net . Fl- v { M .� l 71 fill. to • P- Co cwe J I ( r _ �� ,�y��Cam. � �' ,�---^--- ��~�� .rl�" �'R �f� ,"��I�!•� f � � � � t r ' s , Ix Lle 1,. Ede C s � IN y � Assessor's o1fioe (1st floor): Assessor's map.and lot number o.. ... . THE ° ............... hsbdG Sr Q�o� T�f Board of Health (3rd floor): �� IN COMPLMNCV�� Sewage Permit number .... .7.°.. .1.... dl......... . ..•••... � WITH TITLE 5 Z BAHa9T11DLE. i ABIL Engineering Department (3rd floor): Wl (1 L f.[,IVJRONMENTAL CODE A�� °° �b 9* House number ..:..................................... �.7...... ......., iO�oMaYd. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only ®�� L�T�®�� TOWN OF -,-BARNSTABLE BUILDING- INSPECTOR APPLICATION FOR PERMIT TO .......Q10e ...7�i8 .. . .....P',z--iJ 4- 01W. .�.. .... . ...... .................... TYPE OF CONSTRUCTION •---.....y......;�......................19.$ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....kol7.....52............. L�.�.. '.r�E'..jyC ........ �.CX.t.I�...... .1..44.� ......................................... ProposedUse ..........016—&X lvf!4. 44t/................................................................................................................................ Zoning District .................(l.. ..............................................Fire District .... .X�x.. ...................................................... �iN�£/-�U 247' Name of Owner .......1,�.�'.�:k✓ic.�....�?'V..�:��..................Address .....��....��.✓1+�...u.C.��.a�..11� .........��C:��.? Name of Builder .j .. 11, 111 . ............Address 1 .... Nameof Architect ..................................................................Address .......".......................................................................... Number of Rooms ............. Y' -.......... ..:...................................Foundation ..�... ...Q.v ..... Exterior ....�, 4-.11.....a. :vti� L ...Roofing m f(V!If........ Floors ......................................................................................Interior ....... jee* ................................................ Heating ......&tf.......117.4,L4.� .................................................Plumbing ......... ...., 7T .......................................... Fireplace .....\/!,�.........`...... ... ...............................Approximate Cost ......1?10 ....................... (.,.�.,.........11.. .... Definitive Plan Approved by Planning Board _______________________________19-------- . Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTHQ o � / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .................................. Construction Supervisor's License :y GU L Ji 1ES 3093� Permit for ........1 Story Nso .......... „ Sinq-le F«mii.y. Dwelling ...... .. .......... .. ..... f Location ..,Lot #53r 97 Roosevelt Rd. .................. C.ot.ult , ................................................................................. Owner .....James.. ..Guild................................ �•.} }1... e A N Type of-Construction ..........F........ram........................ ¢. t:•:;>..... . . ............................................................... Plot ............................ Lot ................................ + Permit Granted ....,...une 30 , $7 i- Date of Inspection .....................19 -Date Completed ;:? ....19 v1 } 1i . .j ,FTM�r, TOWN OF BARNSTABLE � Permit No. .....30.93.2.... ` BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................ � wa ��rer.r HYANNIS,MASS.02601 Bond .......X....... CERTIFICATE OF USE AND OCCUPANCY Issued to JAMES GUILD Address lot #53 97 Roosevelt Road, Cotuit USE GROUP FIRE GRADING OCCUPANCY.LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. FebruarY.11....... 19..$8.......... ... A-� ............... ...., Building Inspector ' Y T '�•� TOWN OF BARNSTABLE Ow BUILDING DEPARTMENT f DAHslT : TOWN OFFICE BUILDING O°�,►�Ei639'�� HYANNIS, MASS. 02601 o r�r h s �4 MEMO TO: Town Clerk FROM Building Department,9/ � 'I l An Occupancy Permit has been issued for the building authorized by ri Building Permit #'...`. ........ . � . issued to ......... ..\tea ........: ......... ......... - Please release the performance bond. r 1"F +k Tcs Rf+'c!'�I'gi lRT7T +fi." ! �.ar� .7•T'�1x°•-, x .',1.i .;faf: .. a ,r .:+w Z - TOW�1 OF �ARNSTABLE, M,�SSACHUSETTSMR Am.039 155 r`DAfE JLICld 3Q`'au I! APPLICANT Owner y, ADDRESS 030439 ! .. (NO.) PERMIT To " Build dwe113n �:, (sFREET) �7y .7 (CONTR S LICENSE) I' - ITVPE OF IMPROVEMENT) `i. (--�) STORY Single RO mi yP' NO. dwellin ` NUMBER OF IP USE) .. LL DWELLING UNITS 1 AT,(LocnnoN) lot653 97°Roosevelt Road 'Gotui.t �(S TREET) DISTRICT BETWEEN ZONING (CROSS STREET) AND — - SUBDIVISION" L;: � os[ I- -.'(CR 5''STREET) LO �., T BLO , - 'SIZE LOT CK; S K.- I — = 'SI Z E - - BUILDING IS TO 8E '� - � _ '• 7 t FT, WIDE BY T FT. LONG BY FT. IN HEIGHT AND SHALL CONFORIv{'.IN CONSTRUCTION is TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION. REMARKS. (TYPE) 4 .. AREA OR VOLUME 1564 a '. ft. BAND: .. (CUBIC/SQUARE FEET). ESTIMATED COST $ PERMIT- 90,000 ------ FEE $ ' ''10$'.50, OWNER ADDRESS �H_ p�n�(�rll8't FOfld FA�mnnth� A (17SZG BUILDING DE BY j�- FROM THE DEPARTMENT OFPUBLIC WORKS. THE ISSU,ANCE f$"7=''E - OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. - i S -- MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR S BEEN PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS ALL CONSTRUCTION WORK: _ ._ELECTRICAL, PLUMP.!ItG ANEW I".-FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY_ I_S_RE- MECHANICAL INSTALLATIONS, 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL IN IRE INSPECT TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE - OCCUPANCY. - If POST THIS CARD S© IT IS v 15IBLE FROM STREET UILj/DING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 04 1 2 2 a --- — — 1 3 HEATING INSPECTION APPROVALS ENGIN RING DEPARTMENT 1 _- ?K �_ _ -- _ OTHER BOARD F EALFN— WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HA90APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SI,' MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. 3 tAl- RooSEV _ yef2p.0p $ 75q 47 2'E 3 EXISTING 0 m tiry \v N FOUNDATION !� 46.61 ti mi � N L_OT53F 27, 235 50.01 !00 00 N 52 00 90. 59 h N 55.O g3' N 77•06 PLOT PLAN OF LAND "TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION L OCA TED IN SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND BA PNS TA BL E THAT IT CONFORMS TO THE TOWN OF BARNS TABLE ZONING PREPARED FORREGULA TIONS, REGARDING YARD SETBACKS" ,�:�=" "� - I,F DA TE' ✓UNE 29, 198•7 LJA MES GGUIL D Gli7 `' - DA TE.• ✓UNE 29 19B7 SCALE. 1 "m 50'FT. R - - - - - - - - - - - - . .L.S. E. _. FL OOD ZONE C (NON-HAZARD) M� CAPE 6 ISLANDS SURVEYING =� TEA TICKET - MASS. +lc ' i • 617-775-1 120 ftxt TOWN OF BARNSTABLE „$-�- _ ZONING BOARD OF APPEALS MML °o 2639• 367 MAIN STREET HYANNIS, MASSACHUSETTS 02601 April 23, 1987 Mr. John L. Banner, Jr. Real Estate Broker 48 Hudson Street Falmouth, MA 02540 Dear Mr. Banner: After consideration and investigation of your request for an extension of your Variance, the Board of Appeals has voted to grant .you asix-month additional period of time in which to exercise s your - rights of the Variance; this will cover you through November of 1987. I trust that this will meet your needs; if you have any further questions, please do not hesitate to call me. Sincerely, Richard L. Boy, Chairman Zoning Board of Appeals CC: Building Inspector Appeal No. 1986-32 IN REGISTRY OF DEEDS CQ1fPLIAN6E WITH SEC 11.0'FT0WN OF BARNS. ,�,y�� . 0vit>I f; f Ri( f BOA, M G i . �r�eLE CHAPTER E. .,IQss. Zoning.Board -of Appeals Geor e Hamilton &\Sam V MAY. —8 HF1 2 14 Rich_............« D duly my recorded in the _ Property Owner County Registry of Deeds in Book ...:...«._John L.,•,Banner� Jr. .�� Petitioner Pageftegistr� h District of the Land:Court Certificate No Book ary Appeal No «« ACTS and DECISION,..: Petitioner �« « filed pn'on _«._ . «...._........_.«_. etitio _..... 19 ^� requesting a .variance permit for premises welt Road at ...... Lots 154, 15 «._..._ 5 Roo se treetl( «••••••, in the village �1 of «_..«._ Cotuit G n adjoining premises of (see attached list) nder consideration. Bari stable �sscssor's '►I Locus u ..... )o > 154, 155 ap no 39 \ � t Petition for Special Permit licat PP ion f g or Variance ''® made uiiaer Sec. ...... J . f B %� of Zonini, the Town o . by-lags' and` Sec: . a ii. •........... (h.iptc r 40A `Dlass. Gen fur the `p P of to alloy•ur'purpose _ two Undersized lots to ...... .............._...._...._......_............ «...«....... .......... .................................................................... .........:............ .. Locus is presently zoned" in ....:...........:.... RF ................. ...._......................................_..........................................................._................ notice of this hearing was given hY mail, postage prepaid, to all persons de.--niea affected and by publishing in Barnstable" Patriot newspaper published in Town of Barnstable a copy r,f which is attached to .the record,of.` these proceedings filed with To' ru Clerk! Ax public hearing by the Board of Appeals of the Town of Barnstable wits held at the Town Office Buildin g, Hyannis. Hass, al 7;45 _ = P.:II. April 17 1, 86 upon said petition under zoning• by -laws. r Present at the licaring were the f01101ring uienihem: . «Gai `N. sk� .ara.sa . ._....... Chairman . ....... «... ..._........ r a r I.+G } At the conclusion of the hearing,: the Board tools said petition tinder advi>:ement.:.A;vien of .the locus was made b the`Board ` { Appeal No _ Yagc �. _.. of. On — _..May...1.,.—__ _.� � .... ....__ 1!t gfi... The.,Bo�irdf of Appcals,found Mr. Banner,presented the j' Petition for Variance relief for' area and frontage requirements at Lots. 154 and 155 Roosevelt Road Cotuit in an'..RF, zonin g. . district. -. The petitioner a ppeaced on behalf of the owners who.purchased the 2 lots about fourteen years 'ago, and residing out of town. were unaware of zoning changes,__n addition, they have, received two,separate tax bills for he property. Lot 155 contains '27,000 square feet while` Lot 154 contains 431000 square feet t It is..not feasible to subdivide the lots in any other K manner. Luke Lail y made a motion .to grant Variance.relief for frontage ' and area requirements 'under Section J ofthe zonang by laws to allow two` 'buildable Pots HelenFWirtanen seconded' the motion. , a. e F at The Board voted unanimously to, grant the Variance based on the,;fact tr,trt would not be detrimental„ to the neighborhood nor in derogation of the spirit. and intent of the zoning by-laws, Town of Barnstable. I I� 4_lf1".on�....... __..........��j,,,�.5..... C'Iril• o: thy• '1'4111•11 o1' 13arn5tiilk. 1;arnStaL1v Count,,Dlassacliusetts,.hereby i•ertif} ;that twenty 120� da}•s ilavt, rJal,s d,tiinrr t Iw l;o u d of .11,1,�•ril. rendered its decision in tht, above entitled pt,tition anil that n,' appeal of ,aid dvvision has beelt filed in the office of the 'Porn Clcr'}. Siff rncd and Sealed this ........... day of ....... LL.................. S.` l.t �7......:....... under tli• P1in5 and Penalties of perjtuy. . �� Distribution Property Owner Town Clerk _.__... . , APPhcant , t;•1zr1 of .1��ry 11. P r fo%rn of I3aritstal,lr e sons interested Building Inspector v Public Information �_ - Board of`Appeals Chair nrin I I BARNSTABLE COUNTY REGISTRY OF DEEDS 100 V S1 ?50 67 STEPHEN; WEEKES . i.. REGISTER ` Engineering Dept. (3rd floor) Map U. /� Parcel /.5-1) Permit# C1 ?D& House# o Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) , 's� y l%0 IT BE �5��ALLED IN CE Definitive Plan Approved by Planning Board 19 WITH , ate. ENVIRONMEN ND TOWN OF BARNSTABLIPWN REG S r i Building Permit Application G Project Street Address / $ e_y e .,ji7®R-0r Village Owner' -Te- ci.! C G L Address C!-7 Dos C V e G Telephone s O' s 4� / 9 06� ' Permit Request /01 X f/ S o h o t'rl �,u c l� r h S �g it e d a vt v -e. First Floor 1,300 i square feet Second Floor D O square feet Construction Type WOO C Estimated Project Cost $ g. 0 D a C) Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family W"' Two Family ❑ Multi-Family(#units) Age of Existing Structure / 6 Historic House ❑Yes Ua<o On Old King's Highway ❑Yes p�10 Basement Type: 4411 ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 'V O Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing�_ New p Half: Existing 0 New (j No.of Bedrooms: Existing 3 Newer Total Room Count(not including baths): Existing New ,S u k(gym•. First Floor Room Count Heat Type and Fuel: ❑Gas U�Oil ❑Electric ❑Other Central Air ❑Yes �o Fireplaces: Existing New 4z_ Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Alo ❑Attached(size) a (7 ❑Barn(size) k1 0 ❑None ❑Shed.(size) %✓f9 ❑Other(size) A10 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U`No If yes, site plan review# - Current Use Proposed Use Soh `Roo vv, l.�in*' s Builder Information Name 4 Telephone Number Address g _ of S n `ram e �L License# (� �b 0 LP f� GI_( � e A 1, q , Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS „i PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO M qu p SIGNATURE Gam. DATE BUILDING PERMIT DENIED WR THE 0011LOWING REASON(S) s FOR OFFICIAL USE ONLY PERMIT NO. - < DATE ISSUED MAP/PARCEL NO. _ ADDRESS VILLAGE % OWNER DATE OF INSPECTION: _ FOUNDATION FRAME INSULATION - FIREPLACE ° ELECTRICAL ROUGE FINAL` PLUMBING: ROUGH ; . FINAL,' .• GAS: , , ROU' FINAL FINAL BUILDING I- i DATE CLOSED OUT4 In ASSOCIATION PLAN NOS . To Deter Time WHILE YOU WERE OUT M of Phone Area Code Nu Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILLCALLAGAIN WANTS TO SEE YOU URGENT RETURNED YOUR Meeseg� t Operator AMPAD 23-021•200 SETS EFFICIENCY* 23-421•400SETS CARBONLESS �.� he Town :of Barnstable 9� ,� Department of Health Safety and Environmental Services Building Division 367 Main Streef,Hyannis MA M601 Ralph Crosser- Office: 508-7,90-6ZZ7 Building Corr--i Fax: 503 90-6Z30 For office use only Permit no. Date AFFIDAVIT `HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMEINT TO PERMIT APPLICATION ' MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition,one but construction of than fourn to dwelIing nnt pre-existing to owner occupied building containing at structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements rk: Type of WO y' I S (l In Q 00 Est.Cost Address of Work: Owner's Name Date of Permit,application: I hereby certify that: Registration is not required for the following resson(s): ,. g Work excluded by law Job under S1,000. Building not owner-accnpied Owner pulling own permit Notice is.hereby given that: 1�t'FR OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREG ED CONTRACTORS FOR APPLICABLE ROME EMMOvEbUNT WORK DO OR GUARANTY�'uND UNDER MGLO I4Za � ACCESS TO THE ARBITRATION PROGRAM SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner.- ICy C/ ' H 4 e4 Contractor Nam Registration No. Dare gp g O v0 .w �O �a 6 ?`tJ �w 60 A (0 �'OUSE�9? N 21± 6' 10 LOT-54 µ R- 120 ROAD - FLOOD ZONE:C OO RESIONE: R F NOTEPECOMMEND INSTRUMENT SURVEY THIS M0FRTGAGE I NSF->ECT ION PLAN IS FOR •USE TOWN:__ COTUIT REGISTRY OWNER: DAMES C: GUILD BANK ONLY DEED REF: cTF.00654 - BUYER:— JEAN G. EARp DATE: ' 9/24/88 c PLAN REF: 36608 SHEET 40F 4 SCALE. 1 "= 30' I. hei7eby certi y t at the building shown on this plan is located on y ' OF VANKEE SUF2VEV the ground .as shown .and it `lN Mq�4� C0NE,01- FITS position does conform to the PAUL yes 70- RASPBERRY .LANE zoning law setback requirement of s A. MARSTONS MILLS BARNSTABLE 3 URRITNENI32M H and does not lie within. the special NO' o� MASS 02648 flood hazard area as shr•:n on gfg�g L a . ,u. d. ' flood map _dated ��NAI l His _ ITis plan not made fron TninstruaentPaul A. Merithew. RPLS survey, not tobe used fcncr.s1ctc 4686 q _ -- i T11L' ClII11J11U1rf1'CUZZ Uf Ifas achusci DepartllrL•trt of ludiurrial.4cridclrts . Y Oflicsollsyesllyalloffs 6110 1!a-vN11,11tun Street Workccrs' Compensation Insurance Affidavit �tiPlic nrinftirntatinn - PIE— l'RINTZMiiiv`�— '� lj nartc 10 U �y -r Inc^•inn "/ �it,• � � �� h � � � i�. � s nftnnt' l am a homeowner performing all work: mvself. �am a sole proprietor and have no one wori:kn_' in any capacity I am an empiover providing workers compensation for m% empiovees working on this job. t rnnrrumv nnmr- atitl rr�e• . city' flf10flC#' in�nr^nrr ^n Holier•t! [ am sole Yroorie:oJ et`neral contractor, or homeoti�ner(circic oue) and have hired the contractors listed beiow ••+ c the 'bilowtng wo a compensation polier_: cmm��m� n•trnr- :1(I rl rr«• nitnne 8• ...�_ � '--- 'Y•. - _. —_�—vr-- -tT•-+�.�.r. �• .rife _ .i._._.. �(icirrac• , rttt.. 6 flSti10nC e!• in,nrnnrc rn nnitc�• Altzch addit(onli sneer if necez ry _-_ t —_'i►.i:.� �:i�' �- - _ _ •Ny^�~ - __ N—_ ,•, .,.., .. .... ...r. _. .. .+..... ...r..r-.`:air• .. '�•;w.rn. �ectton_cA of 111GL 112 can Iead to the imposition of criminal penaities of a line up to Sl °OU.UU anurc: F:u,urc it)secure cu,crat c as required nu tier unc cars' imprt.,tnment :is %icil:ts ci,ii pCnaitics in the form of a STOP WORK ORDER and a tire ufS100.00 a day against me. I understand the.t cop? 4 ttri.% ,taterrtcut ma, uc furnarded to the Orrice of lm•cstit:attons of the MA for coveritre verification. l«o iterchVi ceniii•turner fire Pains.and enaities nrjuty that the information prodded above is trur uttd correct. n, Q Date �� /�. `7 U -T Pr:n: mite � G 1, i 11 of Phone* ,�• atTiciai use vnt,• du not„•rite in dtis area to be eompieteti b}•cin•or totrn ofriciai ` t cit,• ar tn,cn: permitilicense 0 r7tluildin_Department (-jUccnsinr;Huard selectmen's orricr t _ cnccx irimrncuialc rrspunsc is rcUuircd [Ittcaith Ucpartmcnt ; coma:: ;-cr.nn. phone xt• rUthcr Information and Instructions Mass'ICIIUNCtts General Laws chapter 152 section 25 requires all emplovees to provide workers' compensation for tile; employees. ,As quoted from the "la%% an entph ree is defined as every person in the service of :inothen-under anv contract of hire, express or implied. oral or written. An eniplurer is defined as an individual• partnership, association. corporation or other•legal entity, or any two or more the foregoing, m�eaucd in a joint enterprise, and including the le-al representatives of a deceased'°ctri'p'1o'yer, or the receiver or trustee of an individual • partnership, association or other legal entity, employing employees. However rile 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, hog 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 even- state or local licensing agency shall withhold the issuance or rencival 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 h. been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names- address and phone numbers 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 cite 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 police, please call the Department at the number listed below. City or Towns Please be stare 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. Plea be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t, the Department by mail or FAX unless other arrangements have been made. The Office of lnvestiaations ld like to thank you in advance for you cooperation and should you have any question. please do not hesitate to �_ive us a call. - The Department's address. telephone and fax number: The Commonwealth Of Massachusetts 4 Department of Industrial Accidents 4. «, Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 �q �JtC Vt a417//ttO�I2RUP�GUl O��'l'G�A'JaCJtttle I �\ DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Restricted To: 1G DAVID G HUFNAGEL 38 JONES RD a~' w*"41 MASHPEE, MA 62649- 1.. g a HOME.IMPROVEMENT CONTRACTOR Registration 110880 Type I:PRIVATE CORPORATION ( kExpiration 11/09/98 CUSTOM REMODELING INC D A V I D G. HUFNAGEL OX 267/ 38 JONES RD .,f 1. a ADMINISjRATpp MASHPEE MA 02649 x, �, .. ,:, -..r ,_,. _ ', ': n�.. Y} ; ` • -.�- -•r..yY"""..+,•i;..r ^r'.r'r d�tn.,;�..{�r,...sa•Ys• ..„r Assessor's office(1st Floor): Assessor's map and lot number (/ � �� r poi THE>o� Board of Health(3rd floor): number Sewage PermitO r� Engineering Department(3rd floor): ✓/ B�rss ca House number / ,�'r�" °° i639- Definitive Plan Approved by Planning Board 19 ��rr►Y d. APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE , T BUILDING INSPECTOR APPLICATION FOR PERMIT TO ��+r. rce, k e C K TYPE OF CONSTRUCTION c.y e- a Ln r-ol w r, {{` a 1r h1 � cif R 0 0-P :.1 ) IN to f! 19 • TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following ]j information:Location �� C� � _ l�c!1 C 4— Proposed Use s ` f C• V C^' P h In � I`. � ,_ i r^o G7 e iC" /''' � '� V"t-� "�E'_C_"�' -4-•��i u,.-, h -`Zoning District Fire District Name of Owner , ) lam'�a a.,a �' In Address Name of Builder ^\r c, P z Address To e, C Pram"'!' `M c,, f 1J tD e Name of Architect Address Number of Rooms C I v 0 Foundation C b VN C V e 6, a 4, S Exterior r V 0P In Roofing1.. ,D Floors z) Interior Heating Plumbing ' Fireplace Approximate Cost /1 Fire P Area �f f� 1� t.._9 C Diagram of Lot and Building with Dimensions Fee 100 , `ice W � ' `� C �,c�✓ p i t �\ � t 0 o's e, V -- T C/ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS �~'�`"��-`� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License TARP, JEAN . A=039 15 7- /.� R No 34382 permit For Screen Deck Single Family Dwelling Location 97 Roosevelt Road Cotuit Owner Jean Earp Type of Construction Frame Plot Lot Permit Granted June 7 , 19 91 Date of Inspection 19 Date Completed 19 Assessor's.,offioe (1st floor): ^� �� 5 y Assessor's map and lot number ................ ...,. P.,°FTNETO�♦ Board of Health.(3rd floor): ^ Sewage Permit number ...:�.2-. U./....�.e.!!. � : aIa9TAI , !.................. B LE Engineering Department (3rd floor)> L *°o MAM House number ' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only . f• TOWN OF BARNSTABLE ,. "BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......Q.l'�.`.p..,Tccy.;r.`...... .....!4.�e.�;r. �Pti-.!#`.�.........!.......l•1.......................... TYPE OF CONSTRUCTION .......��P.. ..................................................................................... ..........7.. �/.....................19.�� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .( . ..... .. ............. D.. ..5. .1?P...l ........ U.C ..Q................................................................................. n ProposedUse .......... ?P.S. cvP! .....Q. ................................................................................................................................ Zoning , District .................ll..✓.................................................Fire District .... .XU�. _ Name of Owner .......'To.. v\!e.r�....(�P.f..Cvo�..................Address ...../.�...��.!'?+P..�1.U.I..c.. .. S/........r-cC wu, ............. Name of Builder t..�� P� .(...(1Y1....�,...4�Y�.. Address ...................P.l(.4................1`6.....f'. .k/,1;w�.` 1... Name of Architect ..................................................................Address ................... Number of Rooms ........' ........... .....................................Foundation .. ... /7�.✓. ..�-.. ?rl.� v ...... WE leilibr .'.�.�`v .....s. f....................... Roofing ...... 1?. ./ .. .......................................................... Floors .......................................................................................Interior .......-c.��a�T /L.l��.`..1............... Heating ....... .. F.4.fry.............:.................................�lumbing .........� .....�Y.J!! !!:. ........................................ Fireplace ......y. ` :�.a.............. A roximate Cost 0,000................................................. P J•`•PS V?Pc. r c� Definitive Plan Approved by Planning Board _______________________________19________ . Area• .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH >t � w OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...\T VK.e.5...... V.!u.................................. Construction Supervisor's License ....D.a.o....d. .../.. GUILD, JAMES A=039-155 No 3 0 9 3 2 Permit for ..1?...S.tory............. Single Family Dwelling.......... Location .Lot...#53., ....97, Roosevelt Road ....................... Cotuit ............................................................................... Owner ...James Guild ................................................. Type of Construction .....Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .....,, June 30 , 19 8 7 Date of Inspection ....................................19 Date Completed ......................................19 A/0 . i ice/