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1202 SANTUIT-NEWTOWN ROAD
:aoa sfl ut�; NAWAIRd. r j J 4 9F�. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T q P' V Map b Parcel #� Health Division ' Date Issued14 Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board „'tV f',T r=l Historic - OKH _ Preservation / Hyannis Project Street Address 4 ,sa AcFb2l Village C9� p► - (z!.�a�J Owner Address �C Telephone - 0 d` Permit Request U —�C ► s Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type C&-) 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: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes to If yes, site plan review # ` Current Use 6 YY%A— Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name (_"Rmf - nATelephone Number5n Q(_)�_—(J� Address License# MqR C) Home Improvement Contractor# Email Worker's Compensation # l0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � ffid - SIGNATURE /G i------ DATE 0 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r 4 DATE CLOSED OUT ASSOCIATION PLAN NO. w. ® DATE(MM,DW'M) acozn CERTIFICATE OF LIABILITY INSURANCE 12/9/1411 THIS CERTIFICATE IS ISSUED.AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER:THIS j 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 endorsemen4(s). PRODUCER CONTACT . Anthon�r F. Corde_ro Insurance _ --^-" (508) 677-0407 — -rc.N , (508) 67Z-0409 � PHONE FAX i, 171 Pleasant Street ADDRESS: hsouza@eordeiroinsurance.com Fall River, MA 02721 INSURERS AFFORDING FORDING COVERAGE NAIC9 INSURER A:Liberty Mutual Insurance j INSURED INSURERS: Insulate 2 Save, Inc. INSURERC:,.. ,. 410 Grove St. INsut?ERo:__ Fall River, MA 02720 1NSURERE: I-SURER F: COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS Ta CERTIFY THAT THE POLICES 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 "1'0 ALL l"HE (ERMS, - PO ED BY PAID CLAIMS EXCLUSIONS TMPDoCO sgTRw+m�OF SUCH,POLICIES_ILIMITS SHOWN��RVE BEEN R1�D�,uCY-EI=F `POucY i1DOLI$tIBR LR_ .. lDDK I MMIDD/YYW I LINTS GENEirpLLJABILITY Y Y !BKS 56418741 12/10/14, 12/1O/151 EACH OCCURRENCE S 1;000�000 I A i, _— I j-OAMAGETO RENTED {�CCXJBNERCIAL.GENERAL LIABILITY r•pRFrd,($pS(Ea occurrence) S 3L5O O CIAIMS�/IADE j X I OCCUR • MEDEXP,(Aryorep�son) 0 I PERSONAL&ADV INJURY S 1 000,000 J GEN ERAL N_ERAL AGGREGATE_ i S ?,000,000 — _ 1 GEN'L AGGREGATE LcvtITAPPtIESPER j PRODUCTS-OOMPIOP AGG is 2,OOO_000 X 1 POLICY 7 7 PRO- -V LOC 1� iI I I g COMBINED SINGLE L1MR A AUTOMOBILELWBIUTY 12/10/14! 12/10/15j Eaacc,derx) _"_n S _1�000_,000., IBAA 56418741 s_ j BODILY INJURY(Per.person) S ANYAUTO -- PLLOWNED SCHEDULED { BODILY INJURY(Per aaident)I S AUTOS X AUTOS j NON-OWNED !PROPEKfYDAMAGE' NON-OWNED ' PR accident) i S X HIRED AUTOS X AUTOS ! r'- 5 _— II j Ui1�RELLAUAB 12/10/14! 12/10/15!I FpCHOCCURRENCE 1 S 2,OQO,000 J A Xj OCCUR Y Y IUSO 56418741 _ --- - EXCESSLIA8 ! CLAIMS-WD_E_ AGGREGATE _ 5 10.,0�0 DED RETENTION 5 I WC STATU- i, OTH-,.5 -- WDRKERSCOMPENSATION ! iXWS 56418741 12/10/14I 12/10115 A AND EMPLOYERS'LIASIUTY Y I N ! ANY PROPRIE70RIPARTNERIEXECLJTNE CH ACCIDENT„--. S OFFIj:tRMIEMFR EXCLUDED? j N I A; EL DISEASE-EA_EMPLOYES.S__500,OOO ! (Mandatory.in NH) I i 1 if yYes.iiewibe under {. ''i ! E.L.DISEASE-POLICY LIMIT S 500,000-� DESCRIP710N OF OPERATIONS below ' I I i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Rerrarks Schedule,if more space is required) Proof of Insurance. I I . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN j ACCORDANCE WITH THE POLICY PROVISIONS. ! AUTHORIZED REPRESENTAT::,/ ,, lI , ©1988-2010'ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CM Ph(1r1P' Fax: E-Mail The Commonwealth of Massachusetts W Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Insulate 2 Save, Inc. Address:410 Grove Street City/State/Zip:Fall River, MA 02720 Phone 4:(508) 567-6706 Are you an employer?Check the appropriate box: Type Of project(required): 1.❑✓ I am a employer with 20 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[]I am a homeowner doing all work myself[No workers'comp.insurance required.]r 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3.❑ROOf repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.�✓ Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have 'employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site :information. 'Insurance Company Name: Liberty Mutual Insurance :Policy#or Self-ins.Lic.#: XWS 56418741. Expiration Date: 12/10/15 Job Site Address: ' n City/State/Zip: :Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration daL).�)-W'S Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 :and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a ° :day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance :coverage verification. I do hereby certify under the pai pe a perjury that the information provided above is true and correct IK'Signature: Date: 14 ! �P Phone#: (508) 567-6706 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#: 1 van Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement Ctractor Registration t Registration: 180747 Type: Corporation 1�1 ;""or' Expiration: 12/29/2016 Tr# 261507' INSULATE 2 SAVE , INC. ROLAND LANGEVIN , " 410 GROVE ST FALLRIVER, MA 0272010 �� -- --- V Update Address and return card.Mark reason for change. - (i Address F-1 Renewal C� Employment (� Lost Card SCA 1 0 20M-05'11 1" . f�/u3�p'rriir�zvd?tc-�[r��ia tr�'��xddttclLtcdBl� - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ( OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 4'h747 Type: Office of Consumer Affairs and Business Regulation Expiration 12/29/2016 Corporation 10 Park Plaza-Suite 5170 6 1 7i Boston,MA 02116 INSULATE 2 SAVE 1INC7A ROLANQ LANGEVINg' /!G 410 GROVE ST FALLRIVER,MA 0272 � Godersecretary Not valid without signature t� Massachusetts -'Department cst vbllc Safety S : �cfi d egulati«Is ars Board of R cs Standards Construction Supen'isor d icrtse: CS-103861 AAti 'xf�, ROLAND LANGEVIN S36 EASTERN AVE. Fan River MA W23 +k 0812412015 C c,..2rr1€s sioner i Federal ID#06-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth.NIA 02664 CONTRACT 508-568-1926\-0613 FAX i08-568-11933 1 Page 1 S E PROGRAM THIS CONTRACT IS ENTERED INTO BETWEENRISE C LC—RCS ENGINEERING AND THE CUSTOMER FOR WORK AS F.N G f N E E R I N!G DESCRIBED BELOW :.. .,.... _, .. .... .._. .._..._.. ................ .. gaga._..._.. ....__........ CUSTOMCR PHONE DATE CLIENT a WORK ORDER Scott Durante (508)685-4734 03/3012015 187361 00003 SERVICE STREET - BILLING STREET l'>02 Santuit Newtown Road 1202 Santuit Newtown Road SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZJP COWit. MA 02635 Cotuit,MA 02635 JOB DESCRIPTION AIR SFAL LNG:Provide labor and materials to seal areas of vour home against waswilul,excess air leakage. This work will be peifonned in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air':exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other Prcducis. Primary areas for scaling include air Icakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (14)working hours. Arthe completion ofthc weatherWition work,and at no additional cost to the homeowner,a final blower door and/or combustion sal ty analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. A'rflC FLAT:Provide labor and materials to install a 9"laver of f2-31 Class I Cellulose added to(432)square feet of open attic space. 5576.2.1 �STORAGI BARRIER:l lomeowner is responsible for the removal o!the stored items blocking the installation ofweatherization rc()ik in the attic. Removal must occur priorto the scheduled work slart. - S0:00 KNEDVALL SLOPE:Provide labor and materials to install 2"PSk lined semi-rigid fiberglass board insulation to(146)square r"t of knccwall rafter area. 1.3483.26 A'f-11C ACC'E•SS:Provide labor and materials to install(I) easily moved,insulating cover for the attic access foldin- g stair. The cofcr ha<integral weather-stripping to restrict air leakage. $230 19 VENTILATION:Provide labor and materials to install(1)insul.ncd exhaust hose to existing bathroom fan(s). S50.00 E'EN fi1:ATION:Provide labor and materials to install ventilation chutes in(36)other hays to maintain air flow. S 12%(r1 13ASEMENT CEILING:Provide labor and materials to install(124)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the nasernent ceiling at the house sill. 5271.i6 B.ARRIEIZ:Homeowner is responsible for the removal of any ceiling tiles blocking access to the sills. SO.00 RfSE Engineering will apply all appiicabic.eligible incentives to this contract. You will be billed only the Net amount. Currently, for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an incentive of 100%lbr the Air Sealing measures. hot the Safety and hetthlt ofvour homy s indoor air quality.\v::will be conducting a blower dtwr diagnostic of dte available air flow in Your home both before the work is bc!-'un,and after the weatherization work is complete.We will also conduct a full assessment of IN.combustion safo oCvuur heating system and water heater.'fhis hats it value ol'S90 and is at 110 Cost 10 you. Feder al ID#05-0405629 RISE Enhineerin� RI Contractor Registration No 8186 MA Contractor Registration No 120979 �.' \division ut fhiclsch Engincerin CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth.!1A 02064 s® YT® tiCT 508-568-1926 X-6613 03- Sf8-1J33 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE C LC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS E N G I N E E R N G DESCRIBED BELOW CUSTOMCR PHONE DATE CLIENT o WORK ORDER Sett.DUrante (508)685-4734 03i 30/2015 187361 00003 SERVICE STREET BIWNG STREET 1202 Santuit Newtown Road 1202 Santuit Newtown Road _ SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP - Cotuit. MA 02635 Cotuit, MA 02635 JOB DESCRIPTION Total: $2,898.89 Program Incentive: $2,898.89 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE NTH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF I%WILL BE CHARGED MONTHLY ON ANY r - UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. .-. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZ. 'SIGNATURE•R1SEEng—n ,i { - CUS C PTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ----- ----- - """ / ACCEPTANCE OF CONTRACT_THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. - AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE �r/�•f^-fag^r`, Town. of Barnstable Regulatory Services 114 i vmRN Sq'%ULE ;i IL;cit:sr V.Scali;Dinctor Building Division Tom Ferry,Building Corn issiuncr .cts�ti•.tcitc�,ha�-rstablc.ma.us -op, Wn e r M us t Complete and Sign This Scction If L sirtc A Builder r ' ... �.� �"i i.......i\ :. .•_fib. i['? ..::,:1i. L!?t,i7 i.:_`(' ��?i '_i'�'S •�=� .o i:P:flil;!- :'I'�!t .`' 3 �C?!': Gc cJ '(�_; .;ZW �_1.ddriss Cu iot; ._ L .. SUO'lit f i ti i�:1� t� i.c<-^t. i F .ii"c: !?t:'" ,.:) i."i'. s]lii:C� :)!'�l l.1i_1.:CCiI !k_l.t:)l _..`i1Ce 1S 11''3 1Ci�:�Ci LL CI ci�.t Ul::._, :•t':${ t;'.C!.°C!' dI'i' PCJ-;(}_ Z Ci.: 1S:C� 'a,i:�j'iC jar.'-- t I ;. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map : ®2 (P Parcel 620 'm'Application # ��:� d 000� Health Division x Date Issued Conservation Division Application Feey Planning Dept. ='}Permit Fee Date Definitive Plan Approved by Planning Board '' = Historic - OKH _ Preservation/Hyannis Project Street Address +2 62 -S +Zs tA Village ;7 Owner Address S AIM& Telephone Permit Request Q P h.2 DA-rc cA,.ss00 i 6U `Tb ri L-C -m : jze-eL, .& m Q 4r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2 boo Construction Type v-twD i=aAmE 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: A 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: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �'No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name —�>A,-,J Telephone Number 5-09, ZS - 2S - Address 3&4— ��� 6-c5��t Z�, License # C',S ZQt S H t4 [32&%g Home Improvement Contractor# I Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `"'-b �k a-? 0-XQ.-+SETA L,E5 SIGNATURE DATE FOR OFFICIAL USE ONLY x APPLICATION# DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAM 5� 6 a(Ito i; /&sc INSULATIO a4a4o FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED7OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Office of Investigations 17 600 Washington Street =V Boston, MA 02111 i� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndivi dual): Address: `16 4- :tc:,-> City/State/Zip: cex--1L,5; (N . 6210-95— Phone #: �ate_', 425 -6 S � 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 6 El New construction employees (full and/or part-time).* have hired the sub-contractors . 2.[p 1 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. 0 Building addition insurance comp. insurance.f No workers' comp. 10. Electrical repairs or additions We are a corporation and its p required.] 5. ❑ rP 3.❑ I am a homeowner doing all work officers have exercised their 1 I E] 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 13.0 Other - employees. [No workers' comp. insurance required,] *Any applicant that checks box#l.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. _ tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub,contractors have employees,they must provide their workers'comp..policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy# or Self-ins,Lit.#: Expiration Date: Job Site Address: V262. ��►� 1! CcCc ue 1 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 insuran coverage verification. I do hereby certify.unde t e and penalties of perjury that the information provided above is true and correct. Si nature: Date: f v Phone# � -g-2 -�2 S . Official use only. Do not write in this area, to be completed by city or town afficiaL 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#: 1 information and Instructions wires all employers to provide workers' compensation for their employees. 152 re al Laws chapter q Massachu setts General ,. of hire statute an employee is defined as "...every person un the service of another under any contract ?ursuant l• Ctrs express or implied, oral or written." "an individual partnership, association, corporatiomor other legal entity, or any two or more ' defined as , P !o er is r the An e�np y of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, o 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 ion or repair work on such duelling house dwelling house of another who employs persons to do maintenance, constntct f or on th grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." e 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 perforrhance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants king the boxes that apply to your situation and, if Please fill out.the workers' compensation affidavit completely, by chec necessary,supply sub-contractors)name(s), addresses) and phone numbers) along with their certificates) of insurance, Limited liability Companies (LLC)or Limited-Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that,this affidavit may be,submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit, The affidavit should be returned to the city or town that the application for the permit or license is.being requested,not the Departrrient 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. in 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.bas to contact you regarding the applicant. Please be sure to fill in the permi0license 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 Y or policy informat ion(if necessary) and under"Job Site Address" the applicant should write"all locations in ficiall stam ed or marked by the city or town may be provided to the town).`A copy of the affidavit that has been of y p it must be filled out each applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit year. Where a home owner or citizen i§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 like to thank you in advanee'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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel 4 617-727-4900 ext 406 or 1-87.7-MASSAFE Fax # 617-727-7749 Revised 4-24-02 „ ace onv/rjia I ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR -ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: prrnl Town: . Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two o tiozis 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Option 1: Basement Q Fenestration exposed Wall Floor. Wall Perunetei AFUE HSPF SEER U-factor floors R-Value R.-Value R-Value R-Value R-Value and Depth National Appliance Energy R=10, Conservation Act'(NAECA)of .35 R-38 R-19 R-19 R710 4 ft 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of RESchec%as listed below:, ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2) REScheck--Web which can be'accessed at htt-p://www.energ3,codes.'kyov/reschecic/ ' ADDrT ONS OR.ALTES�ATZOlVS,TO EXISTING B'UZLDINGS.OVER.5 REARS OLD* *Buildings under 5 years old must use option 91 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equ4ls Formula; (100 x b - a) � -- �S' 100 x 17. _ q44.5�=�� ,S2 % of glazing 6 a (b) Glazing area equals 1,'I SF If glazing is 40%° use the chart below. If glazing is > 40.% proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM and Slab Perimeter ' Fenestration Ceiling Exposed floors Wall Floor Basement Wall, R-Value R-Value R-value R=Value U-factor R-Value and Depth 39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place,of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.. not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dweliing unit where the total ❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120,P) oFIKE Town of Barnstable Regulatory Services �A S& Y,$ Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize 1,oy-qL to act on mybehalf, in all matters relative to work authorized by this building permit application for: /Z®z �.� ...� � f � O2G3S (Address of Job) 'gnature oT er Date Print Name If Pro' petU Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM S:O WNERPERMISSION Town ®f Barnstable o� Regulatory Services swxrrsrnst i Thomas F. Geiler,Director 9q, 1639 ��� Building Division AIFD �n 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. 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 ed structures accessory be, a one or two-family dwelling; attached or detach to such use and/or farm structures. A i constructs more than one hom e in a two-year period shall not be considered a homeowner. Such person who constru t Y „ that he/she shall be Building Official t i homeowner shall submit to the Building Official on a form acceptable to the But g , ection 109.1.1 responsible for all such work performed under the building permit. (S ) p p g 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 Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall.be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC J� _ ,,gi�pp ,ux�p T.�.�,r-- -.+.^ .•r ��. rs V �7 lfze 7�omvi�Yco�i711e1i % bllizbae 1 rc(trce oc retslratcou jalro for•;inc)cvidul use only �- Y7ME`:IMPROVEIVIENT.CONTRCTOR c;ci�c c tt a eannation J(te. If fonn(1 return to: Registration =131833 :: , _* Y fir% rri of iiurldrng=Re"ul rtions and Standards Expiration"9/z6/2�r Ashlturlonre"1301 4 0210$ , ' TYEe inotwdaal•c' t` NP DAVID KERB �?is � _ +• DAVID'''KERR rI u q�sra : » 364 OLD OYSTER 121�> � r/ �z. > COTUIT IVIA 02635 `- �dwlnir Uor w ili(I «cir it sitin.ilur c -, Massachusetts- Department of.Public Safety Board of BuildingRegulations.and Standards i � '• Construction Supervisor License: License: CS 45395 , .�� .•w, Restricted to::, 00 ' ^ DAVID F. KERR 364 OLD OYSTER RD x, _ COTU IT, MA 02635; Expiration: 11/17/2010 d C'onunissiuner Tr#: ,8586 • t c�o�t.►` � ,��Qooc. 'R��a 1+�4Sc.+c A► I'I�►tik l�c9LOS . a ►ZA Res �� 1.1es SS�.�C 1�oe�` "i"e t$ f., SLI ID i• Y( j a�' W La11�DV X 'S �XtS�•�►L P� � {i �Y tzTlYt�i�o t'."�' 9 : S { S Cl.tiS� !.-1 ' YV•'`�'`'i tzX1S'i�.l� W t>tDaN "r2, W AIL.' ClLjVSSE 34 v/ALL.. SOME r Kv'aart 'S'e .1S ry _. N bQ� i 2 i �."- t a"' r cc s.!. A? - - "�' ri K x ;; Tov�t w �t RA » �l. 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I.,„ ,...,^k 7 -:{,„ Vt..o l �'7 ✓,1` .., 3 �. •. �, ?: . ,:; 3.. . x 4.� �.,. ..,v.. ... ,:: F. .. v:t ._,. .. ,.,. ,... .:.,. _. ., .. _ v r r -.. �. _.h _ ,1� vc_ .. ...{ .,. a r r .._ ..._ ti....,� ._ ��. ,� ,:� .. , ... .x.. -:1. - � .... Y- ...- ,.. .0 .. _, s, .... 1 ..p:.+.,f .� :,Ike >u t ,[ .T k \ y �k :-:,m§ - 1. .a: ?. 'f f r �. =O �IQ� ��/�. t<,; .i u 1 15 t S # \ z n t ,ty,1 .. .. 1. .. } ty� t tL�CiYL { A i ��, - - .., . „ .., E 8 ,.. 4 ..x. ' a.C'� ,, tip t �2. I a r - = ,1', 4 l k� Yi 1 ) a : ,.i';i a r .."": ?",.r e ^: ,,,:F« .r.x,ayr e \.,^'�4a J'. r �,•w., ..- �, . l ,. " art 'V S 3 :, ,. ,, a _ �,. Y M : . � � 1 � . _ .. �� -..ram \., .: �hA ,w ,c # r ..4+ -,.�. �.r ,..,. .>; v ,n .,� - L Dogs rescued from burning home in Cotuit CapeCodOnline.com Page 1 of 1 r Y . . Dogs rescued from burning home in Cotuit March 10,2010 2:00 AM COTUIT—Fire damaged a local home last night but no one was injured,according to fire officials and witnesses. Shortly before 9 p.m.,fire crews from the Cotuit,Centerville-Osterville-Marstons Mills, and Mashpee fire departments responded to 1202 Santuit-Newtown Road. The call came in as a suspected bonfire in the area, a Centerville-Osterville-Marstons Mills Fire Department official said. No one was in the house at the time of the blaze but two dogs were rescued,fire officials said. The building sustained damage to one outside wall and one small room,a Cotuit Fire Department spokesman said. The fire appears to have started outside the house but officials are still investigating the cause of the blaze, he said. Fire officials were trying to reach the owner of the home last night. Copyright©Cape Cod Media Group,a division of Ottaway Newspapers,Inc.All Rights Reserved. WA+/XI ow http:HvwN w.capecodonline.com/apps/pbcs.dll/article?AID=/20100310/NEWS/310033l&te... 3/10/2010 4010 1HE TOWN OF BARNSTABLEBuilding � :Application Ref: 200904909 • BARNSTABLE, + Issue Date: 11/02/09 P��ml I II� y MASS. Q3A i639• �� Applicant: SHAW JAMES H rFG MA'1 D Permit Number: B 20092142 Proposed Use: SINGLE FAMILY HOME Expiration Date: 05/02/10 Location 1202 SANTUIT-NEWTOWN ROADning District RF Permit Type: RESI L ADDITION/ALTERATIO Map Parcel 026020 Permit Fee$ 25.00 Contractor P OPE TY 0 ER Village COTUIT App Fee$ 50.00 License Num Est Construction Cost$ 2,500 Remarks ROV AN U BE RETAINED ON JOB AND COVERTING 1ST FLOOR 1/2 BATH INTO FULL BATH ADDING A TU CA UST PT POSTED UNTIL FINAL ECTI EN MADE. WHERE A TIFICA E OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: SHAW,JAMES H DING ALL NOT BE OCCUPIED UNTIL A FINAL Address: PO BOX 480 I CTI HAS BEEN MADE. COTUIT, MA 02635 Application Entered by: RM Buildi P it Issued THIS PERMIT CONVEYS NO,RIGHT TO OCCUPY ANY STREET;'ALL. OR IDEWALK 0 NY PART-THEREOF,EITHER TEMPORARILY OR PERMANENTLY ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PE TED.0 [D ER BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET ORALLY GRADES:AS WELL AS DEPTH AND`L'OGATION`OF PU C SEWERS MAY E OBTAINED FROM THE.DEPARTNIENT OF,,PUBLIG WORKS- THE ISSUANCE OF THIS PERMIT DOES NOTRELEASETHE APPLICAN THE CONDITIONS OF ANY APPLICABLE;SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS RE IRED FOR ALL CONTSTR ON WORK: 1.FOUNDATION OR FOOTINGS. .2.ALL FIREPLACES MUST BE INSPECTED AT E THROAT LEVEL BEFORE FI T FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE C PLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCT AL MEMBER READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE C WHERE APPLICABLE,SEPA TE PERMITS ARE REQ I CAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROC D UNTIL THE INSPECTOR S APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT.WILL BEC E NULL D VOID IF NSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMI S ISSUED S NOTED O PERSONS CONTRACT WITH EGISTERED C TRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). wi I VA BUILDING INSPECTIO A OVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health �Xr.Siln.q . lK'ai�l_df ^+ e+n;'� l V 004"V/A, - 50 �f 00 r �. 3?" Q4lid ��C � } C31C1j ..wAM.'C a �Pi� ,tip a a��ti �,, f7 -- --- � '�aU.gY, `R- . 2 �;�� -Ta,'►.i. o ��a��'L ��er'��ro . Ocdle L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ,V2� P IrvGZ Application # D v L Oc[ l O? Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project-Streeet,Address we.w?�elw- Gil Village�ael-rS+U Ovine hnN*1�a- 6 -Address.JZOZ Szn%L`�✓U+ee� lac# _ Telephone,. f Permit Request near st � '� �h}o aid . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation`t _Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) C7 1 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King` 0, ighwagL1 Nf ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ' �' a Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.1 t) ` Number of Baths: Full: existing new Half: existing 09w 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 U new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes,,site plan review# Current Use Proposed Use APPLICANT INFORMATION '-(BUILDER OR HOMEOWNER) r ' 'Number 85 3y7-Cla�Ka e Address,.:/� Su� _�d/��7� - t"Li�en e Home Improvement Contractor# Worker's Compensation # //rr ALL CONSTRUCTION DES RESULTING FROM THIS PROJECT WILL BE TAKEN TO___ �-�'�� (�SIGNATURf " G �` �' A E %d / r L { FOR OFFICIAL USE ONLY M 'APPLICATION# i DATE ISSUED MAP/PARCEL NO. y ADDRESS VILLAGE OWR!ER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL = =' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT` ' ASSOCIATION PLAN NO. p - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street >r� Boston, MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): � Address: )M7/State/Zi City/State/Zip: Co)ty p: 7Q/, 4Z„,s5 Phone #: 915--39`?-0/70 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 am a sole proprietor or partner- listed on the attached sheet. 7. nBemodehng; 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.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I-am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 certify tin/ e and penalties of perjury that tl:e information provided above ' true and correct. ��- Date 7,?__ �C Phone 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#: c Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, constriction 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 - www.mass.gov/dia Town of Barnstable 0 ok, o Regula tory o y Services , e r � �� - Thomas F. Geiler,Director RNLF— rattss. 1639. ",�� Building Division Tom Perry,Building Commissioner 200 Maiti.Sircet, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 HOl1IEOWNER LICENSE EXEMPTION Please Print D DATE= JOB.LOCATION dI / street village - 'HVEMEowN1ER-OI.�ci sT l name home phone# work_pbone# CURRENT XTUNGADDRESS: 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 huneowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMMOWNER 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 homeo Amer. Such "homeowner"shall submit to the Building Official on form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) Tlie undersigned"homeowner"assumes responsibility for compliance with the State Building Code.and other applicable codes, bylaws,rules-and regulations. The undersign meowner"certifies that.he/she understands the Town of Barnstable.Building Department on procedures and requirements and that he/she will comply with said procedures and regrrir e . rr atirro of �' cr'�i- _ Approval of Building Officral"`�,W:_' 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 parforrning work for which a building pernrit is required shall be exempt from the provisions of this section.(Section ID9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assurrring 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 homeowncr.hirrs unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it-would with a liccnscd Su pervisar: The homcownrs acting as Supervisor is ultimately responsrbJc. 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 fomr/certification for use in your community. Q:forrns:homccxcmpt r , n t r Town of Barnstable Regulatory Services � h `�$"R''E M Thomas F_Geiler,Director 16.19- "6'. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.m2.us Office: 508-862-4038 Fait: 508-790-6230 Property O mer Must Complete and Sign This Section If Using ABuilder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. San ut'` "/ 140 07V/ Noll'- � a y 4-0 .01 Fji r -N 75 M 1"Int5 t.tr-- / nA CG o p }, al�a6l- R i /2 �,�� (b rN 6"CL . JO C}Gd-I.C' Rye. rq�n"i 1 Glr1C; Oiur^� — J . �j APB IV /-o(�k-� -b CY, r(L, ESAA,i Town of Barnstable pp1HEr Regulatory Services P` o Thomas F.Geiler,Director • Building ]Division BARNSrABLE, v� 63Q `0$ Tom Perry,Building Commissioner AlCD MAC A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8'62-4038 Fax: 508-790-6230 Approved: Fee: Permit#: 2, b HOME OCCUPATION REGISTRATION Date: q f 1 Name: 2A-%,A CS Phone#: SO g 'L-(ZD 1 10 Address: Q 0 2 SAN T`tT- "1 Village: 60T u< i dZ 6 3 Name of Business: t4utA-t,1rr3 Jz.K-S-OuVZcCs •� q L C,q-JZ-4 Type of Business: �� S T t G— Map/Lot: 02,6 0 2 a INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the` activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Hcme Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read ree above restrictions for my home occupation I am registering. Applicant: Date: J (;7 Homeoc.doc Rev.5/30/03 t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS you must do by M.G.L.-it does not give you permission'to operate.) Business Certificates are available at the Town Clerk's's Office, 1NAME in � FL.(which Main Street, Hyannis, MA.02601 (Town Hall) 67 Ts:ry T�"S si4vii ej ' ( l ksN �} � Fill-in please: o��- �s + APPLICANT'S YOUR NAME:_ YOUR HOME ADDRESS: 126 7- sArNzvt r-.Nf-A tuwry✓r6 yzL,. —►I a�- 9 TELEPHONE # Home Telephone Number F t-f Zca `71 o!f NAME OF NEW BU5liVE5'5jj11L&A1N .21-g3ww2Ccg t ,}i�{CR.�� tNiFc.4��vaf1 IS THIS A HOME OCCUPATION?. X YES NO.... TYPE OF BUSINESS catis.jcrt� Have you been given approval from the building"division? YES NO ADDRESS"OF BUSINESS IzO? Sl1n�S� N��.tbwN jeA eo`vi C z 6 S V- MAP/PARCEL NUMBER O?b 0 ZU When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations"of.the Town of Barnstable. This form is intended to assist you in obtaining the information you fnay need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street). to make sure you have the appropriate permits and licenses-required to legally operate your business in this town. 1. BUILDING"COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has informed-of a permit requirements that pertain to,this type CPU LEAND REGULATIONS. FAILURE TO CO MAY RESULT IN FINES. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has b n informe of the ermit requirp ents that pertain to this type of business. Au on ed Signature * ^ COMMENTS:_. AID 0 C 1 /VJ M4-�" 3: CONSUMER AFFAIRS (LICENSING AUTHO ) This individual h en inf ed of the is nsi g e�im�ents that pertain to this type of business: Authorized Signature.* COMMENTS: •Vie-�..�_v�t Town of Barnstable pFTHE r Regulatory Services �P` o Thomas F.Geiler,Director H Building Division ► BARNSfABLE, • b v MASS. �' Tom Perry,Building Commissioner i639. ♦� Alin MA(p I 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: _ HOME OCCUPATION REGISTRATION Date: �i 01 Name: 'FS tl • SNP Phone#: Address: 17-0 2 St►a'ru tT- tJ4'JT13 +r.! %elf) Village: rT o2 63 .- Name of Business: :5Arv'w tT Type of Business: J%oH N Tc N Map/Lot: 0 Z b o L U INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following co ditions:. The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. ✓Such use occupies no more than 400 square feet of space. 4//There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. 1,1 No traffic will be generated in excess of normal residential volumes. ✓ The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors, electrical disturbance,heat, glare,humidity or other objectionable effects. ✓ There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. ✓There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-u, n truce not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to /exceed 4 tires,parked on the same lot containing the Customary Hcme Occupation. �•'/No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be �included. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned, have read and agree with the above restrictions for my home occupation I am registering. Applicant: �� Date: 9 Homeoc.doc Rev.5/30/03 ^h ' i` C YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME you must do by M.G.L.-it does"not give you permission•to operate.) Business Certificates in Main Street, Hyannis, MA 02601 (Town Hall) are available at the Town Clerk's Office, 1�FL.[367h M M Kim VIM' Fill in P)13-9-90.1 Z"RM APPLIGANT'S YOUR NAME: S��-`��S hC_, S H7f- } YOUR HOME ADDRESS: 1 Z0 2- TELEPHONE # Home Telephone Number '11 S 42z) 71 o NAME OF NEW B061'N"E55 S,j*0TQ[T tFA tn�TtN . TYPE OP BUSINESS: G- 1S THIS A HOME OCCUPATION?_ Have you been given approval fro.�n the building'division?* YES NO ADDRESS OF BUSINESS az 2- sA__r_ . ,&-, ic!o coTu- d?3 MAP/PARCEL NUMBER G Z 6 0 7-6 When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information.you rnay,need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street).to make sure you have the appropriate permits and licenses.required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFF' MUST COMPLY WITH HOME OCCUPATION This individual has n informe of ny permit requirements that pertain to,this type of business. RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. Authprized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has e n informed of th permit re ui ements that pertain to this type of business. A%LLhzrized.Sig re** MUST COMPLY WITH ALL COMMENTS: . An HAZARDOUS MATERIALS REGULATIONS r\' 1M z; M/1 - 3. CONSUMER AFFAIRS (LICENSING AUTHORI ) This individual hoorized en inf d of the I' ���ents that pertain to this type of business: Signature.* COMMENTS: Town of Barnstable Regulatory Services BLARMN Thomas R Geiler,Di'rector MAM Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Q Fax: 508-790-6230 PERNIIT# tP J6 O 7 FEE: $ ; SHED REGISTRATION 120 square feet or less Location of shed(address) Village Abih . Property owners name Telephone number /D �&J1W f, ' )( 0 ode Size of Shed Map/Parcel# • 4{{ C) Si tore —11 Date rm Hyannis Main Street Waterfront Historic District? CD .._ ca Old King's Highway Historic District Commission jurisdiction? r . rn Conservation Commission(signature required) Z PLEASE NOTE: -F YOU ARE VMMIN 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 i t •�M �Nb 3 SILL bf-6 K_ FF..ET 4$.O✓, L;pa4.D f Q � �Q i=ILA OV. WeF&je A/CA 646/N6 607- 2.9 A 5 5110 WIV o1v PCAM/L3oa14 7/Ns-!�NEE a2uEl D�wG s E __ / 7 E$Y C6PrFY"r1W4 T TEE FOOVDATiON 40C.47'/QN!S As s�aovn qOvD_pQ�� CO.v�o� 9Y� Ile 7 UCe?E�ijr4Ei .a. OF Tf,/�E.TOPVAI OF _{ Q .:_ ij N C 7",4 Y44:7 i 4©61/.S7 Y10140 7,.�`���x f4 ft��=r� - R` � N ��'s .�,.t��{rri,��+td y.,��w' �' fi i' cn.•''' � kac 5"¢�^Rs ' 3* "`."�.�� ` �y1y"`jS,�. y G �' � ..i.}�Y.,r"Y+{ �ir' x- ..r'� 'l r { - ./«.`..� ,`tk � Y i•'d 5: � •t: a - 1 � 4 1. /.Y � i s We ell ly A/ 2, F t , /NG,.h OUNDA 7"/0N 40G-L1 7-10N /.5 Q'► ,. ': s' tis95 3',Yo41n/ AA/0 Di^/G SE 7-&3A6 K OF 7-Me TOkVAI OF Z �. � pc� /40 A W..ssor's map and lot number <. ..,r•.�......rr�r�... fTNEt O o♦ P Sewage Permit number ........P. .'......................... e w o w enc kysTEM �e:-:� M INSTALLED IN COM RLE, i Housenumber ........................................................................ WITH TITLE 5 °° i639 0� TOWN OF BARNS?XV UAL COD TIO LaATloNS BUILDING INSPECTOR f `� Dtz,d �a-nr�trtaw � l I APPLICATION FOR PERMIT TO ... } 1' .....L.............................................................f'................` ..... E ... TYPE OF CONSTRUCTION ................: ® (Z . ............................................................... . .................................. .... ......... ............19251 TO THE INSPECTOR OF BUILDINGS:' The undersigned hereby applies for a permit according to the following information: / 2 Location .....� . .T... .q.......,h .l.. YIJ........ ........ ..�T.f......1In,.�i........C �. .. .� Proposed Use .......Fakn.1..4, .l........j:�p?�......... �... ,tf?! ��..1 of...........:................................. ZoningDistrict ....................................... ..............Fire District................... .............................................................................. Name of Owner P.6 V Ab C0kV ).1*z.0. .........Address ..........M W. J(t Name of Builder 6,5.�.�.. ...............................................Address .............L�: -`U 1 �. h�..l�} .......... .......... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...... ..........................................................Foundation ...CP.►L r� ...,.....................:........:........... Exierior ....... .t/j, .....1N. I?PYj.... Ca...........Roofing .......... .......................................... Floors d c) D Interior '.. R �-�.r..................................................... �.................. . ............... ..................... .. .. f Heating ......../-/o-;( ......fftk...........................................Plumbing ............... .........99.......................... ............................ Fireplace ..Wnom.....S.riC tit...........................................Approximate Cost .............d..S® ........:............................. Definitive Plan Approved by Planning Board -------------------_-----------19_______ Area ......�� 4 Diagram of Lot and Building with Dimensions Fee.. . . ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ; i r ' i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. l � Name .. . Condron, David . . dwelling- No j 21732 add to Cotuit Date Completed ..........................�,X,:7.1 9 PERMIT REFUSED da M. . � ^ .^ _ . � ` - ^ - - ' , l � . ^ ~ `— ~ - . ' . ' . . - , . \ ' --' .................... ` . � | � - � ' V ____.___,________. J ' -` .............................................................. ' ' � Assessor's map and lot number +!! —T- —'— -f� � -�, ��OF THE t0� �1 1/. c O Sewage Permit number ........................:......:......................... Z EAWSTAFILE. i House number ......................................................................... 90 Mb a O 39• �0 a MPS Ar• TOWN OF BARNSTABLE R ♦ ti BUILDING INSPECTOR APPLICATION FOR PERMIT TO !:..►.. f�.....!...n.. .. .... .u. .!.. ............................................... /1XII, " `r .................. t% TYPE OF CONSTRUCTION ............................................................................... . i`l w a :E!.�:::....C/Al?i 9` �.:..... GC:TUt'31"tt . 19. .7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies'for a permit according to the following information: Location ...........'''.T.... .r........ ft.c %.i ?c.tl. ........i�t �'. .......`.,.�?'.r.;!....!...r . ........ .`..�:...:?.� Proposed Use ....... ..!`....?.!. �.....+ ......f 'P:�!''�:.......... '.d4 l:.E:: .��� ............ ........................I..........................I.. ¢. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner �1 f;� t I f1. t7t E� / .. Addres ..........lf;;o"A., /Jc. pj /.�. ?................ ................ :J ... ........................... Name of Builder t t')~.�... `...............................................Address .... ..� . ........,............................................. Cr y Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...............Foundation ...!�o..A,C iv-.................... ........................................... ExieriorRoofing ..........AS-. ....... ......:.............................................. Floors t�� .J U.!� .Interior c`. `....... G p ! ...................................................................................... ........... ........ .............................................. .Llr 7` ! /1�'_. ...........................Plumbin Heating ..............................:.......:................ g ..............:.........r.......................................................... Fireplace ...........................................................................Approximate Cost ...........�•:�..................L ................................... Definitive Plan Approved by Planning Board ________________________________19_______. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH F. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ...':....... . :...... .......................................... Coud � con, uavjd � A�26-20 � / . No ....... 2I?32 Permit for .`udd...t»..dwaI�li�g �---. ----------.------- ' Location ..�gA ......................... --------- ...................................... ~ David ',p" of Construction" � . .. --. .. --.. . --. � P| 7 � Permit Granted /Octobe'r...12 .....19 . � 9 Date of Inspection ^ . . � � PEmmmo EFUSED ~ ° . . � - l�..................................... `- ' . � ----- .............. ---��� ----- ............................~' — ---.—.. ' U --------'' ---/ ' ' �' /—.. ----1. --.. - -. � . / � Approved ................................................ lA � ....................................................... -------`----------^----~^^—` 'Asseskor's mpp' and lot numberC .. ...... .. ... . SEPTIC SyT9 � � I J�r. NSTALL r C�^mtIR I A N C E Sewagel-Permit number ....................:..... ........ ..,.,.,. ..... .. I -I C c 14 A;'D TOWN Ai�.'•ITA"y CODS yofTHEto�y ^, Dz TOWN OF BARNSI A� ,gE Z 8JHB9TAIILE, i "6 9 BUILDING INSPECTOR 4au APPLICATION FOR.; PERMIT TO ..............................��/, _.y.�?.... `........................................................... ? TYPE OF CONSTRUCTION .....z.... `-,� L... ........................................................... ;., ........ � ....... ...........19.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .{ `.`.'.�..........Q�1..�1".,...............';:�`�..r�...�"Oc� � ✓il'U- ............... ' �.�� ProposedUse ..... ,/..................................................................................................................:.............:.....: Zoning District // ......Fire District ... ..CCU i ....... :e ........................................... Name of Owner ..... :..���✓ K/°� ..Address D Name of Builder ............... /. �,r..............................Address ....................�... �`— Name of Architect ...............c ...................................Address ...................................................................................... Number of Rooms ....................�.....................................Foundation .....i��.....4�71 ........ Exlerior l... .... Roofing .............................. .f...�4J'e Floors ...........«c.'�....�.......................................................Interior ........� .........................../ Heating ...�'U.�}.............0 .. . .$......................,..Plumbing ..../ ...................� .............................. Fire.place ..... ........................................................................Approximate Cost ............... O / ® v Definitive Plan Approved by Planning Board ________________________________19________. Area �.` �.. ...�:..�r�QQ ..... Diagram of Lot and Building with Dimensions n Fee .......off. -SUBJECT TO APPROVAL OF BOARD OF HEALTH 110 60 2 S__ hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. --------------- _ R Name ... .......... .:...�,/" Cobb, William E. 17977 1 1/2 story, 1 0 ................. Permit for .................................... single family dwelling -W Road ........................................ 6 own Location ................................ ............. .............. ............................................................................ &) C. William E. Cobb Owner .................................................................. or frame Type of Construction .......................................... r E ........................ #29 Plot ............................ Lot ................................ N LY tober 8,/) /19 75 Permit Granted ......... .........................- Date of Inspection Date Completed !P, / zl_—j PERMIT REFUSED ............................................................... 9 ...........................................................:....../............. ,,//� / I' ................................. ......................... . ... .y.. ............................ .................................................. y . Y ............................................................................... J9 C .Approved .............................................. 19 ........................................................................ Assessor's map and lot number �.�..... O Sewage Permit number ................✓.....'..'...................:............. .v THE T TOWN • OF BARNSTABLE r� Z BABHSTOIILE, i "b9 N BVI,LDING INSPECTOR o'EO PY�' APPLICATION FOR PERMIT TO .................................. ................................................................................... TYPE OF CONSTRUCTION /. ............: . "h ..........� ....... ...........19 ..Y' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: y- Location `J` � ••...`O s�' "-.. .. ProposedUse .................................. .............................................................................................. ........................................ Zoning District .Fire District t " Jl�,...........: ` / C/ =/ � j Name of Owner Address ��'�"�^�*`� f X if Name of Builder / �r� ~'- � `�� � C ll1 I—S ................................. ..................................Address ...............................-. ...:....................... r:.................. Nameof Architect ...............`. ........... '.....`.":-:.....................Address'......................................................•.............................. Number of Rooms ....................4-!'............:....`........................Foundation ....` r" / C l s ................................ ............................. Exterior ..... ....�� C �s� �a ��Ar_ , Floors -'�' �' Interior ................ ...... ....................................................................... ..... r . ................................................... HeatingJ"'GlJ fir' '..............................Plumbing ...: / '� .................................................. ............................................................... Fireplace ......! .... . :......................... Approximate Cost lam® CJ 1/0 Lj l...S Definitive Plan pproved by Pla�nnmg Board ________________________________19________. Area ................ Diagram of of and Building with Dimensions Fee\ ..�.................................... SUBJECT O APPROVAL OF BOARD OF EALTH u �. .0 -4k I hereby agree to conform to all the-•Rules and Regulations of the Town of Barnstable regarding the above • construction. � Name ... .:��^.�c"��...............` / `'�. Cobb, William E. A=26-20 Pr , 17977 1 1/2 story, No ................. Permit for ..... single" family'dwelling � �1ewtown Road Location ..................................................:............. S Ul t ............................................................................... Owner William'E. Cobb ..........................:..................................... Type of Construction f...ame .................................................. ............................. f . Plot gp29 tot ................................ October 8 75 Permit ...Granted .............:"...... ..........:.....19 \ Date of Inspection ....................................19 t Date Completed .......... ................19 PER/ITREFUSED .... .l.................................... 19 ..................................................... .a :.......3................. .. r Approved ..........................................................._................... I! b`✓1�C.�G/t1»0,W2/byt 197;rO5 t�po .L/07,x c".L } 7.7 oa0 iKv eD /vmoj gH-L :210 41 a M` 1S/Y7 ?H-Z 1tyh'.L.Ay i �• 39 t� 'ssa� J ,009 No -407 J/N/.:'8' : /v-7zra--y72a /vd7d t T-7 l 1,ArS?VO- -!�a be7-, :NO/1 VD O 7 /V V.7& --.Z O 7& n � i 0\ 1 I i .F s( avid • i 1 � � S pl 1p7 �, �•I' _y •�•.b.� 'may r 'I F Tne t� The Town of Barnstable s • ''` ST& Department of Health Safety and Environmental Services 9`b 1639. °i g Buildin Division 367 Main Street,Hyannis MA 02601 - Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner TOWN OF BARNSTABLE Permit: YS3? SOLID FUEL STOVE PERMIT Date: Fee: Owner: ��� q V1 0 f ` y✓l u 17 Phone: 54^W-•1 da y' Address:_ a ME)04) �j d, Village: cd't f f- Map/Parcel: Dater Stove 4��Used B. Type: Radi Circ C. Manufacturer: e Qu j Lab. No. D. Model No.: Chimney A. New/Existing If existing,please note date of last cleaning) k B. Flue Size C. Are other appliances attached to Flue? OC) D. Pre-fab Type and M acturer E. Masonry: In nlined Hearth A. Materials: 6/'"c B. Sub Floor Construction: • 4 Installer Name: Address: (0/-g Phone: Y dl— 1 a-3 I Location of Installation: r,re-1O/ace APPROVED BY: - Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc Assessor's Office(1st floor) Map U0 Parcel d ermit# �® 9�� Conservation Office(4th floor)(8:30-'9:30/1:00-2:00) Date Issued /6 /2 — 9e Board of'Health(3rd floor)(8:15 -9:30/1:00-4:45) o 0 Engineering Dept. (3rd floor) House#t STAI I`E *IN Planning Dept.(1st floor/School Admin. Bldg.) RAND Definitive Plan pro ed by Planning Board 19 - ��WN TOWN OF BARNSTABLE � Building Permit Application, Project'Stre t Address 2- Village Owner Address a Telephone Z 8— 72 Permit Request ov , a e A;Ir�b A-1 C8r/N7c�727�L'S t . First Floor square feet i ! - Second Floor square feet oc• Estimated Project Cost $ d"(7 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential y Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Ale Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and-Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name /3 Telephone Number Y2,Y-Jur"/,F Address 411f Ln,t/ W^l A d;?!/a% License# e5i K Home Improvement Contractor# /OD 7.06 Worker's Compensation# Gg—u1w$aJ-- 7 9 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4�J SIGNATURE DATE BUILDING PERMIT DE D FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - PERMIT NO. r DATE ISSUED 1 MAP/PARCEL NO. , y ADDRESS - VILLAGE ' • 1 OWNER ` DATE OF INSPECTION FOUNDATION i 1 FRAME, INSULATION - FIREPLACE 1 ' ELECTRICAL: ROUGH FINAL PLUMBING: I t t)ROUGH f t FINAL GAS: C"9 '1 ©iJH FINAL FINAL BUILDING I I,( t , DATE CLOSED'( ASSOCIATION PLAN NO:' a . ✓/Z6 �O�l7t�lZ04ZU/f'LGfiI,rG ��a.���[.(.11loQ�lZCIQ(�fifa I _ _ I ; HOME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards - One Ashburt on Place Room .1301 I Boston , Massachusetts :02108 I I . . I HOME IMPROVEMENT CONTRACTOR I _________________.------------ Registration 100740 Expiration 06/23/96 r Type — PRIVATE CORPORATION i �°lammllwlam I � ' NNE IMPROVEMENT CONTRACTOR. ... I >Jleqiatratiom 100140 - I Capizzi Home •Improvement , Inc. I Type -...PRIVATE CORPORATION- II Thomas -Capizzi , Sr .. I E>�pir4tion 06/23/96 1 1645 Newton Rd . Cotu i t MA 02635'. i Capizzl Hose IUproveseat, Inc I I Thomas Capizzi, Sr. G� ►�o �d646 Newton id. Amw&"MR -Cotalt HA 02635 7 , Restricted To: 10 DEPARTMENT OF PUBLIC SAFETT lug CONSTRUCTION SUPERVISOR LICENSE I 10 - goal ' - Nre6er: : Expires: iirtldete: 1A - Nisoery oily CS 146189 10/21/11% 10/21/1148 16 - 1 a 2 Fleily Kokes Restricted To: 00 X.,rL..4 :_ DAVID N IEBB COWISSMM '100 PLUM NOILON RD I E [At MOUTH, 0 IZS36 —=--__ The Commonwealth of Massachusetts Department of Industrial Accidents � —_ �_— OlflCB01/�'S�IgSdOOS 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit nameo mum locations G G�� si Zg�3SJ phone# I am a homeowner performing all work myself. ri I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. _. comnanv name: address: city: phone#. insurance co: 21f-am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: pity phone#: . insurance co. 777 olicy#::! aX�Fgl�cl comRany name address: city: phone#: insurance co. �'ltac �s Itiona: eh f.�neeessa . .�.. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/orf one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under t s an penalties rjury that the information provided above is true and correct Signature Date Print name O ;' Phone# o: official use only do not write in this area to be completed by city or town official r. 1: [.k city or town: permit/license fit nBuilding Department Licensing Board i 1]check if immediate response is required Selectmen's Office i. i OHealth Department contact person: phone#; r-10ther (revised 3105 P1A1 e Town of Barnstable Department of Health Safety and Environmental Services Buiildi--Division 367 Main Sttoek AYE MA OM' Ralph Cmsseu Officer So&790.6227 Budding Commtssicr F= 508-775 3344 For oT=use onip . Permit no• Date AFFIDAVIT _ HOME IIVPROVEMENTENPERI IIT0 CATIONW SUPPLEMENT tiM conversion, Y MGL a 142A that the tamtstrn�i�•a �O�OII'� ownerOecatpied �p�IIent,.remo«l, demalitioa or co�aron of an � wlnch ate ad#c=1 building containing at least one but not more than four dwelling to sts along aontraer=with certain==pdwa. with other to such residetue or braiding be done by ttgista+ed / Est,Cost "ram Type of Woric '`� Cy�rrf�7 J Address of Work: /Z o 2 /Vl�Z� W nl /P� O nerNamer Date of Permit Application: I hereb% certify that: Registration is not required for the following reason(s): Work caduded by law -Job under S1,000 EuiIding not ovi iedg°wn Owner permit Notice is hereby gh =TMMD �en that: CONZIt�AC'IORS OWNERS PULLING THEIR OWN PERMIT'OR DEALING��EEAVE ACCESS TO THE FOR APPLICABLE HOME IIu1PROV�p DER MQ.c 142A ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the cr^=!r- 6.47221 Na Date ��.c0dua= A-Cav�• . OR ' • /�nwM!fHJfTY . J 5 3 4 eo J �x16 -r7ev fwk ♦ a � A Y. -r y � r t