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Home My WebLink About1716 SANTUIT-NEWTOWN ROAD � i� � �?�� ' 4 w ,► r 'Town of Barnstable *Permit#9(9(79,6 - 7 Expires 6 months from issue date saRrisrasr • Regulatory Services Fee XAss. �g Thomas F.Geiler,Director sa3� t. Building Division Tom Perry,CBO, Building Commissioner - PRESS PERMIT g 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us NOV ® 2 2006 I/ Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE , EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint vlap/parcel Number OOZ V n )roperty Address n /to S.44-ryt f 1 1 l0X (_o/o / WV CS g4esidential Value of Work 0 O Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address 'Td n(5 b2gx—s 1?AP 5AA-tuff A,*4,)-tM R, PyTul7 �ontractor'sName �A-- Telephone Number 7 Some Improvement Contractor License#(if applicable) /3(p lonstruction Supervisor's License#(if applicable) 7Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance assurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to `V D U KK V L)L4� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) *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. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts t Department of Industrial Accidents �� Office of Investigations • tu.p ; 600 Washington Street 1 ,,, , .,,.i ; \, Boston, MA 02111 «r,� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �1 -s Address:^ / � or City/State/Zip: L&a lk M od43(v Phone #: ,e5d 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. ❑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. t ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] of 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers'.comp. c. 152, §1(4),and we have no 12.V Roof repairs insurance required.] t 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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 under the pains and penalties of perjury that the information provided above is true and correct. Sip-nature: VALl"aa X �ROaQDate: /l a^d Phone#: !T07 - 5/e7_ 9d/ 9 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#: it • 145 Pinecrest Beach Dr. • East Falmouth MA 02536 • 508-548-9219 ad.,s o October 24, 2006 Janis Rozens 1716 Santuit Newtown Rd Cotuit MA 02635 Job Estimate Scope of work Permit Strip roofing shingles Flash chimney Ice and water all edges and under chimney flashin Install new 4in white drip edge g Install 151b felt Install Iko architectural shingles Removal of all debris Total cost of job labor and materials $ 5,400 Pay schedule To start $ 2,700 when finished $ 2,700 This estimate is for completing the job as described above,it is based on our evaluation and does not include material price increases or additional labor and materials which may be required should unforeseen problems or adverse weather conditions arise after the work has started. Estimated by E and Re Owner Accepted by it� �i�e LRo��r�rnar2urerzlC� a� ✓��G�xJ.Kt,��ec3el�3 III °9�a�; BOARD OF BUILDING;REGULATIONS License GON$TRUGT[ON SUPERVISOR r t. y' Numbers;CS O42239 I : Birthdate. 03/i6f1.959 } : Expires 03/16/2008 Tr. no: 15195:, i Restricted 00 EDWARD T READ 145 RINECREST BEACH DR' G , E FALNIOUTH,, MA 02536' Commissioner �. �fio tpnorUrvafmua:tc�t#t of.,:�`tr,�::ac�uleC� 1 _ r Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR xJ�1 Registration: 136115 " Y'✓ Expiration: 6/10/2008 Type: Individual EDWARD READ EDWARD READ 145 PINCREST BEACH EAST FALMOUTH, MA 02536 Deputy Administrator Erigirieering Dept.-(3rd floor) Map '. Parcel �. `js Permit# �0� House# Date Issue Board of Health(3rd floor)-(8:15 -930/1:00-4:30 N L. Fee (4th'floor)(8:30-9:30/1:00-2:00) � Rst floor/School Admin. Bldg.) t► ved by Planning Board 19 ; RARNSTARLE. MAS& O TOWN OF BARNSTABLE t659. . Building Permit Application ! Project Street Address 1716 �y �, F Village eo,41f Owner Qc�.[ 5` �f)Ze✓1 S Address /}(� A//S 4*Ae �//P Yl.� Telephone 7/ — ` :7 — rvO-7 pv'k— 142!bL3 Permit Request e V Ue_ -e % �Oue✓—I-v�" ��/ (vt c vt u wl `41 cr C i r First Floor square feet Second Floor square feet Construction Type f t 4,OCQ flew ve. m Estimated Project Cost $ OOD� Zoning District Flood Plain. Water Protection .Lot Size Grandfathered ❑Yes ❑No ' Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure .1-50V" Historic House ❑Yes CW-No On Old King's Highway ❑Yes ILlo Basement Type: U jTull ❑Crawl. ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 6,5_6 Number of Baths: Full: Existing New Half. Existing New No. of Bedrooms: Existing 'D- . 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 JdNo Garage: 0 Detached(size) [ �X t Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) "..Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review#INS - Current Use Proposed Use Builder Information Name Jer"M O AV� � Telephone Number _��—X5-716Y5 Address ( License# faj �—Fa l w o,,?(- . D��o Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE TE Q BUILDING PERMIT DENIED FORT OLLOWING REASONS) r a FOR OFFICIAL USE ONLY - PERMIT NO. s DATE ISSUED MAP/PARCEL NO. ADDRESS - ' VILLAGE - OWNER DATE OF INSPECTION: :. �•;. FOUNDATION FRAME - - INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL` i PLUMBING: ROUGH FINAL , r GAS: ROUGH FINAL ' 9 7 - FINAL BUILDING Zf • DATE CLOSED OUT ASSOCIATION PLAN NO. f rRACTo Tie E9PIr' `Qn 104197 _ BRENDAN E p BREPiDAN r 0,HRA nnMiNis � CAN ARA G rRnroR PINE CIf' t rti�MUv'N MA Tht, Ct»moontrealth of.4fassac'husetts _. t;_ De parnyiew of Industrial Accidents t _ _ Office of/nvestig'71'offs 600 N'asltiag;tott Street Boston. Ma.vx 02111 2, Workers' Compensation Insurance Affidavit !�hPlicant information: Plc< use PRINT lei' �� '�• — name: /%/'e�Ila -F, D 14 v'G� location: `LG city 6414 A,1 y►1014N 1`-11. nhonc I am a homeowner performing all work myself. I am a sole proprietor and have no one working* in any capacity -..:. .�o+r,,-..---�o._._.�...,....._ate+-- env,+-z++.xT.�r�-++.r+e+l]A'.r+.:..%fT.%��...r_^'^�++"R'!:nl,^.a.+sw� . ......r.+"••+. ;+��.+r.....n_.-.A•w►•+�-«-•--.....:. I am an emploveerr providing workers' compensation for my employees working on this job. _ W` rmm�am• name: C G ��a77p�Y /r� �Q-✓�� -ta�� address: — `t�1G -� �7� 1 (/z city: O l:tfil .a-t phone#• �17� �S 7/�S insurance co. L4,10 00 Tam a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comnarn• name• address: city: nhonc#• insurance co. policy# cmmnany name: address: city: nhonc#: insurance co. policy# .Attach additional sheet if ne'ccssary -7 ',r. urc to secure crrycr:rcc:rs required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur une years* imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a Copy of this statement mac be fort ardcd to the OMcc of Investigations of the DIA for coverage verification. I do herehr•certi under the nd penalties o pe ' nl that the information provided above is true turd correct. Sirtnature Date 0—g 7 Print name �'C 1 ✓ Phone# official use only do not write in this area to be completed by city or town official ` city or town: permit/license# rIBuilding Departmen; . Licensing Board 0 check if immediate response is required Selectmen's Officer offealth Department contact person: phone#: rj01hcr y n s�� PJA) information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* compensation for their employees. As quoted from the "law an enrpl( vee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An entplover is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the fore�41 , 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 dwellinu 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 :rounds 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 renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirementslof this chapter have been presented to the contracting authority. Applicants Please fill in the workers compensation affidavit completely, by checking the box that applies to your situation 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 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 Nvorkers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that tite affidavit is complete and printed legibly. Tile Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to `ive us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 «'ashington Street Boston,Ma. 02111 fax #: (617) 727-7749, phone #: (617) 727-4900 ext. 406, 409 or 375 - - o The Town of Barnstable - KU&&,$ Department of Health Safety and Environmental Services � Building Division 367 Main Str ed,Hyannis MA 02601 Off oc 509-790-6=7 Ralph Cres= F= 508-775-33" Building Commissione. For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;moderniration,conversion, improveme:tt,.n=cn-4 demolition, or construction of an addition to any pre-edsting away occupied building containing at least one but not more than four dwelling units or to struCtUrm which am 241accut to such residence or building be done by registered contractors,with certain exceptions, along with other requireme ats. Type of Work: Est. Cost Address of Work: Oaner.Name: Ali 5 2e,7 s Date of Permit Application: /'30 ' 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S19000 Building not owner-occupied Owner palling own permmt Notice is hereby gi♦=that: OWNERS PULLING'TFMR OWN PERMIT OR DEALING WrMUNREGISIELUED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date ContractoKqdue Registration No. OR '