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�� o I` . . . W � 5 j P.- � / T�r Town of Barnstable *Perini Regulatory Services Fee 6mo s our issrie date seuvsresr.E,�• l��- v Mess. g Richard V..Scab,Director 039. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 .0 www.town.bamstable.ma.us a Office: 508-86498 <O�j Fax: 508-790-6230 EXP SS PEZWPLICATION - RESIDENTIAL ONLY • �n ` Not VaUd without Red X-Press Imprint Map/parcel Number Prop Address Residential Value of Work$ Minimum fee of$35.00 for kork under$ 00.00 Owners N' ame&Address / (/ • � YI'el 6 r Contractor's Name 6� l ephone Number Home Improvement Contractor License#(if applicable) 1 Email: Construction Supervisor's License#(if applicable)_rr) pC ❑Wo ensation Insurance Che ne m a:sole - proprietor ❑ I am the Homeowner ' ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) Re-roof(hurricane nailed)(shipping old shingles) All construction debris will be taken to � r� V/`�JI."►" � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side 1. ❑ Replacement Windows/doors/sliders.U-Value {maximum.32)#of windows #of doors: *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: Q:WPFIL TORMS1building permit forms0TRESS.doc 01/25/17 ' r S The C 'omweahs of M- azw&=effs ' Deparfineut OfflCe brMquadam ' 600 wad6w#ou&reef :BasAuj;MA#21H,s • tPFV1�.T17ffS��DP�l�7f1 • Wurke& ConTensatia*Insux=ce Af ffihrA SuRder-JC�ntra:dar&M in&Tl tubers AyPF=uf Please Print Nm=cityfstat�,—-60� W,- �6V) I W61 Are you an cm pbyer?Checkthe appropriate bay -L❑ I 1 with 4 ❑I am a genital ccufmctar aac1I Type of project(rtxj�ed}= y=P arWith e�* I=Velgredlhe sub-conhMe=S 6. [:]New oomstxudsorx Z. I am a so-le prop%ietat orgartner- Tisfad onfire altarhed sheet~ ?- ❑Bemodelitrg aEp and Dave no emplpyees. • . Demolifion Io aadhave sgorlcers' wo>idag fOF�11E in.any Y- � � $ 9..0 S•nildiag adxiififlst , INO Wadon s' P-iFtstn-ance comp-msararw rieTiiedj 5. ❑ We are a cmPomfi=and its 14.El Elechiml repaim cr adcEioas 3-❑lamahooiemmerdaingaUvmk officers have ee dsed fheir ' lL 0 Bn mbing repz=- or$ddiboms ' o warmers' _ of esemp6ae per M4GL ��ry �} fimuranr���i�8,.j't� • a.z•^�.,§I(ThaadTrrella'vEzta 1.._ Ri?of . employees•[Nowodrere i3-E]offler camp-msosan'ce=quae&l ;Any box RmastalsoSIlo=ttheswff=beiow�esaaZfea•waakeea-2-17 apeycginffi—ma— arnersv3no Sabmit dtis 1ffG19F]L` Ee=they mdk_-0 at 93&87ebIff3P-eaisidecoaamst submit anews$ida�Cmclio=,MrT+ -'f".auau6e.21rl t&box xftcbestMasditi®alS eEtSbOVd:gtbenzneoftbesub-caQa�c�madstuexkeihaurnotihmeeet eshsee m=DRUees.Ifthemlr-ca hme=gAuye-Adaeyaazsrpmriaerhes troikas'cmzp.paficymmbm I am arc sucp7�sr flicr!`ispratririurgwockers'camperrsr�iatt irrsziraacs�nr�y empla}�es $eIaFv is tfcepvticy curd jab sds irz,jorm�finr� Ig5mmceCompaIIyiM me: P�fiey mSelf-ihs Ii l pirationDate Job Om Address: C�yl5taft - At#2ch a-wo of the worku-e compensafiQnpgoUcy declkration gaga(showing the polky number and espaatian dais). Fadnre fn sew coverage as requireduuder Secfia 25A of MO-to f5 can lead to the imposifioa ref criminal penalises of a fine up fo$I,5Oa Oa sndlar ozio-yesrimpfiso as well asriVil peuals in fhe form of a STOP WDM flF=aad a fine Of up.fo a clap against ffie violalar_ Ee advised'fd a cagy offhis.stateme maybe finwmded fn the Om a of Iuvestigatians offhe DIA for mstmce-coverage boa. 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Y.. ■ILII.r r •+fr�■r■_r ••,v: D • �.v:Mat as va MMil il • si_f LABOR PROPOSAUAGREEMENT APPOINTMENT DATES-- ATE 77 TIME INITIAL DIRECTIONS: W CUSTOMER NAME •. N Q O R Z11 I, HOMEPHONE WORKPHONE CELL PHONE K EMMANUEL ADDRESS ` � � R A. CONSTRUCTION Z:) �G o� A p Licenses: CITY4��V /C� STATE z E T R Construction Supervisor#cssl-099382 GG V Home Improvement#145356 Customers will Supply and Pay for CRAFTSMAN Y E Fully Insure:Liability,Workers Comp&Auto. All Materials Separate from Labor D ## CUSTOMER REQUEST(*DESCRIPTION VIA TELEPHONE-) LABOR REQUIREMENTS (*WORK TO BE PERFORMED") INITIAL -\A J TRIP(S)TO STORE: DEBRIS REMOVAL:( )CRAFTSMAN ( )HOMEOWNER ( )NOT APPLICABLE JOB SITE CLEAN UP: PROGRESS PAYMENTSAS FOLLOWS: I HAVE INSPECTED THE ABOVE WORK AND HAVE FOUND IT SATISFACTORY CUSTOMER WILL SUPPLY AND PAY FOR ALL MATERIALS ESTIMATE OF LABOR COST INVOICE SEPARATE FROM LABOR COST ORIGINAL CONTRACT TOTAL(NET): This proposal is for completing the job as described above.It is based upon our evaluation and does NOT include additional labor and materials which may be required should In �00 CHANGE ORDER(S)TOTAL: CUSTOMER APPROVAL OF WORK PERFORMED unforseen problems or hidden damages arise after the work has started. ESS DISCOUNT CUSTOMER ACCEPTANCE OF PROPOSAL The specifications and conditions are satisfactory and the terms are hereby accepted. FINALCONTRACTTOTAL: DATE I authorize Emmanuel Construction and/or its agent(s)to do the work as specified.I agree to all terms and conditions on reverse of this contract and to cost for labor to perform work NET COST LESS DEPOSIT(10 i MAX): MAKE ALL LABOR CHECKS PAYABLE TO within the NET price range shown unless modified by a signed change order. EMMANUEL CONSTRUCTION Customer will pay half down and then final payment will be made to CHECK NO: APPROVALCODE VISA MC Emmanuel Construction upon completion of the work. PROGRESS PAYMENT(S)TOTAL: p P APPROXIMATE START DATE RECORD OF PROGRESS PAYMENTS APPROXIMATE COMPLETION DATE �_DATEBALANCE DUE: DATE AMOUNT AMOUNT , PROPOSAL ACCEPTED BY(Customer) DATE [s'�'�«ti,��"t.'ac �` i, bz' ^x.i�*ar • * w V` .��x�•°d ,y `,taw � � �gz a, i :� k�a,ey�. - i lien : add, 'Crr'�tCa "� r„,.u', r"�aw`'�he ;..!a�1,s .^.. a N s Massach Department of Public Safety M as rx *�.�� *,t ��2 5�;..' usetts -DeP ri t � , Board of Building Regulations and Standards SUI'leiJiSuT riiiw uCiiOww a. SL-099382 License: CS • t��~;,.r 1'S UFO HECTOR R SANC� r� 286 STRAP `"""°"- CENTER MA . � L1 yyLS Expiration - J,,�,.�•� 09114/2017 Commissioner ��'; �e�arr��rvo�ricuea�o��aaaccc�ccu�o `� ,per w Office of Consumer Affairs&Business Regulation ` _HOME IMPROVkMENT CONTRACTOR Individual Registration Expiration =i a 145356; 01/11/2019 Hector Sanchez j D/B/A Emmanuel Constnicbon W. Hector Sanchez 286 Strawberry Hill Rc Centerville,MA 02632, Undersecretary ` _. R Restricted To- CSSL WS-Windows and siding ,' CSSL-RF-Roofing current edition of the Massachusetts Failure to possess a I State Building Code is cause for revocation of this license. For DPS licensing information visit: www•Mau•Cov/DPS Office of consumer Affairs&Business Regulation I f _ HOME IMPROVkMENT CONTRACTOR Type:,, Individual =Registration Expiration 1145356i 01/11/2019 Hector Sanchea i � D/B/A EmmanuehConstructtor.,; � , I Hector Sanchez 286 Strawberry Hill Rd` U a Centerville, MA 026 i Undersecretary.. I t 3 . Post. N.eR PCrcq 'ck: , 0 22� o o• LP. 04ZlOt ofa Q' a h " u 81 ,S2 �•3 REGISTRY Q'.= �• n;_•�LS . ti® s w RECORDED This Plan does not require ••�s. the appr val of the and Of Survey S�► BGARD OF SURVEY OF BARNSTABLE JUN 29 a`',:, �PLAN OF LA" c� I N - C oru!T; bA.QNsrABLE,MAas: # 5ELONGINQr TO ' Apy A.E.VVE:ST 14ENRY J.t, M - SCALE 1 IN'4O Fr.. JuNE ZJ,1555 NELSON NELeoN BeAnsa�RICNARO LAW, SURVCYORS._ I BEARSE CetVTERVIL.LG. MASS. ` O o �i tiJ S U R I��� ��sessor's ma and lot number .............................' � 3o��'t3� " UST EE °F roe♦ . ._ SE�'i'��`S'� ' EB�'i MUST Permit' number`. Q �• .......................��.:.. 'M .....: f �NIS��aLLE� IN �C��P�l�S�� ..:........ . . WITH TITLE 5 t 339HHSTADLE, House number ..................................... ......`.........:...............'. h i. PQ M a 0 ENVIRONMENTAL a UP TOWN OF BARNI'ABL-E _ { BUILDING 'INSP.ECTOR APPLICATION FOR`PERMIT•TO ....0 ' .. ...iSi.1T.C�t.G� :I SC'Y�' .. ...... 1` . ................... ............ � is ' . .. CSC- ...'�rrl"v ...................... TYPE OF CONSTRUCTION .......... .............. '.' ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies ,for a ermit ccording to the fall wing information: t::, Location ............ �Z....... S�/.! . .' �.. ...... �:................................� .. . '' ................... Proposed Use ......\ ... . ?-1.4 ..�` '1........�u.. . r . ,. .......�.. , ;a.:'j.r....................... Zonis District ..,.. Fire District l..[/.1: ......................... Name of Owner/ !'Qi �P. :.0 ... .0 Fr.YYY6.t��4...........'t'Address0.,•.... ........... :r ... �C� .. Name of Builder ...�� ........:��.1.:!-:.�........................Address ... ....�>. .. .......•.:'.,.................. Name of Architect ...................................Address ............. . .... .....A ..... t ........................................................ Number of Rooms ..........Foundation ... '!!!�� f � CVN..�� ... .� ........................................................ .... ....... ..... .. Exterior ...........4� l®o .` • .1.5 ...L�1/' ...........................Roof ng,....... ..... ........... ..... ..... ................................. l Floors f� 1.t7��0 � �rZv"` ...........Interior .... C�9T .IFO�.IK..�... lJ ' ................... Heating .............y !9......................:...................................Plumbing .... Q. .. y K` ,5/. ...... 00 �� ...-:A Approximate Cost Fireplace .........:............F....................... pp ....................�...�............................... , ................ .. ............ Definitive Plan Approved by Planning Board -------------------_------------19________ . Area .;74/0 ...... .€y. Diagram of Lot and Building with Dimensions Fee ...........e DO ... ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH -75 -yY i j • 4 ' OCCUPANCY PERMITS REQUIRED FOR NEW''DWELLINGS. I hereby agree to conform,to,all the Rules and Regulations,,of the Town of Barnstable regarding the above construction. Name S.4. s .. .._ ' T% •; Construction Supervisor's License D� �D(' �RR SCHMID, FRANCES E. t No ....27922 Permit forADDITION .................................... .......S agle...F:aIXI;-.7..y....Dwellinlg............. Location ....8.2...Scho l...Str.ejet Str.ejet.................. ..................CAltx ............................................. Owner .....FxAI7lGC;S...E,,...S.chmi..d................ . Type of Construction .....Frame............:.......... ................................................................................ _ r Plot ....:....................... Lot ............................. - Permit Granted ......"?a:X. 2 4 r................19 85 Date of.Inspection ....................................19 y" Date Completed ...................�9.J..�.- ...19 F - o�I r 'own 0f Barmsta►le 'Permit . °�y Expires 6 months fzom issue date y� o� Regulatory Services >iee v MSS. Thomas F. Geiler,Director 1639. Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 Nvww.town.barnstable.ma.Lis _ Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. Not Valid without Reef X-Press Imprint Map/parcel Number Property Address � . t� ❑Residential Value of Work A"t15 L Nlinimurn fee of S25.00 for work under$6000.00 Owner's Name&Address f 1' Contractor's Name Gd j i .. .TelephoneNumber Home Improvement Contractor License# (if applicable) Construction Supervisor's License#(if applicable) ,O ❑Workman's Compensation Insurance TOWN OF 6ARNSTAf3 Check one: LE ❑ I am a sole proprietor I am the Homeowner . I have Worker's Compensation.Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box). , t(� Re-roof(stripping old shingles) All construction debris will betaken to � '�'�2 I&a ❑ Re-roof(not stripping. Going over existing layers of.roof) e [� Re-side #of doors ❑ .44 # of windows.Replacement Windows/doors7sliders.U-Value (maximum ) *Where required: Issuance of this permit does not'exempt,compliance evith other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: 4Xulr it The Cornrnonwealth ofNlassachusetts Department of Industrial Accidents d Office of Investigations �1 600 Washington Street- Boston, NIA 02111 rvivz-v.tnass.gov/dia n Workers' Compensation Insurance Affidavit* ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): W : �jj(J��U�y" �li� i� �� iyc /LWr 'P Address: City/State/Zip: 6ej q'` l i Phone #: �� Are you an employer? Check the appropriate box: . Type of project(required): 1.❑ I am a with employer 4. ❑ I.am a general•contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors 2.El I am a sole proprietor or paitner-, a listed'on the attached sheet'. 7. ''❑Remodeling ship and have no employees These sub-contractors have _g; E Demolition working. for me in any capacity. employees and have workers' 9 Q,Building addition [No workers' comp. insurance comp insurance.$ required:] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions 3.W I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or.additions right of exemption per MGL _ . . ._.,.myself,..[No y orklwrs°.comp _ _ ..12. Roof.repairs ._ insurance required.] t c 152, §1(4), and we have no employees. [hl o workers' 13: Other comp. insurance required.] *Any applicant that checks box#I 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 foi;my employees. Below is the policy and job site information. ' Insurance Company Name: t Ex iration Date Policy#or Self-ins. Lic.#: P. Job Site Address: City/State/Zip: Attach a copy of the workers'.compensation policy declaration page (showing the I olicy-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 certi under the pains and penalties ofperjurythat the information provided above is true and correct; Stonahtre 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 s r` 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, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or t construct buildings in the commonwealth for any renewal of a license or permit to operate a business or o g . applicant who has not produced acceptable evidence d compliance liance with the insurance coverage required." uired." 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 ' completely,b checkin the boxes that apply to your situation and, if Please fill out the workers' compensation affidavit y g 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 pai: eii are not regirired It o carry workers'compensation insurance If an`LLC or'LT P 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 permiUlicense number which will be used as a reference number. In addition, an applicant that must submit multiple perrnit/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)." , town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit, The Office of Investigations would 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 Fax# 617-727-7749 Revised 4-24-07 www.mass:gov%dia Y °pIKETp� Town of Barnstable Regulatory Services EARNSrasLE, -Thomas F. Geiler,Director. - S, Mass $ 639p�A Building-Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601', www.town.b arnstable.ma.us Office: 508-862-4038 " Fax: 508-790-6230 Pro e Own k Must p rtY Complete and Sign This Section If Using A Builder, a 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 f or: (Address of Jobe ,� • Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable P�Op (HE Tp � o Regulatory Services * Thomas F. Geiler,Director BARNSTABLE, crass. 9� 1639. ��� Building Division pIEO �a 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 � � �Le� �GGrl�YL1 4 �Z`�p ��i�I� �/"HOMEOWNER": name home phone#1 work phone{I CURRENT MAILING ADDRESS:' ke- CO?gA-,r city/town state ztp code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside;on which.there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he s "e understands the Town of Barnstable Building Department ents and that he/she will comply with said procedures and minimum inspection procedures and requirem 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 AWPFILES\FORM S\homeex empt.DOC r Assessor's map and lot number ...... go- ''." .�.......:.... ° �� THE Sewage Permit number ........................ M................... Z BABHSTIBLE, i House number ........................................................................." 90� ,"6& 0� 3 �0 �D YPY of, TOWN OF BARNSTABLE BUILDING INSPECTOR . r APPLICATION FOR PERMIT TO .....C12A .iA.Lrb`.....h!E v.)1.� ,!OP!! ............ .................. TYPEOF CONSTRUCTION .......... ............................................................................... _............................................................................ ................................................19........ TO THE INSPECTOR OF BUILDINGS:''31 w - i The undersigned hereby applies fora permit according to the following information: . Location ...... c9................. / .:....................................................................... Proposed Use^.....�� � Yl.... ....:. CxCz;..�� 1....... TS' .. ............................................. .. Zoning District ......................� ..............................................Fire District ........................ .... �..���. ........................ Name of Owner . .inr �..(.,..,,...-?r . 4vd1.. .............. LJ `.. Address .t..�-........... ...d.a .................................... �- Name of Builder ...r•, �':. !.. ... Dj�.. .........................Address ...��.....�....� cv��. �� ..::.. ................................... �4 Nameof Architect .............._�..................................................Address .................... ............................................................. Number of Rooms / <',_vrI Pnv- DCiC,,.(Ji tJ, ......................................................Foundation ...., ... �'�. ... _/ J i Exterior ..........�aU(+.. \ !h /- ............................Roofin A is%11,b(.,�<'-1. .' ,.� ......... g .......... .... ©© � ���i�l` Floors ?� WT}c�. ..........�! r°Q� ............Interior ..... )r?('� ll. /� ................... Heating _.1.. ......:..............:...................................Plumbing .... Cl �a Yl h� ............ r t 7....................................... Fireplace ............ / ............................................................Approximate Cost .....................f....d..........G ........................ Definitive Plan Approved by Planning Board ________________________________19-------- Area � ............... . . Diagram of Lot and Building with Dimensions Fee ... OD SUBJECT TO APPROVAL OF BOARD OF. HEALTH t +x OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .......'--��l...?....� Construction Supervisor's License �'✓�'v SCHMID, FRANCES E. A=35-21 No ... Permit for ...Addition Single. Family Dwell nc�......_.. Location .....$2..School..........Street................. ........... ......................Cot. t......................................... Owner .........Frances„E. Schmid ................................. Type of Construction ....F1;AMe......................... Plot ............................ Lot ................................ Permit Granted ........May..24.!..............19 85 Date of Inspection ....................................19 Date Completed ......................................19 R TOWN OF BARNSTABLE.PUILDING PERMIT APPLICATION 0' Map- Parcel' -,,�Applicatioht # �` 7t Health:Division '�Date Issued 0 Conservation Division ,;Application"Planning Dept. Permit Fee Date Definitivd Plan Approved by Planning Board Historic - OKH Preservation Hyanni's Project Street Address Village .oOwner Address 0,01 VAhrS Telephone ,, 6 77J7 J L00 7Y- 0-7 R/ V 5- -) Permit Request A V Square feet: 1 st floor: existing—proposed .2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiof3_ 2 060 Construction Type Lot Size Grandfathered: Ll Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family Ll Multi-Family (# units) Age of Existing Structure Historic House: LJ Yes LJ No On Old King's Highway: LJ Yes Ll No Basement Type: Q Full D Crawl 0 Walkout LJ 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: LJ Gas Ll Oil L3 Electric LJ Other Central Air: 0 Yes D No Fireplaces: Existing New Existing wood/coal stove: Ll Yes L1 No Detached garage: LJ existing U new size—Pool: L3 existing L3 new size Barn: LJ existing Ll new size Attached garage: U existing j new size —Shed: LJ existing Ll new size Other: Zoning Board of Appeals Authorization Ll Appeal # Recorded 0 Commercial ❑U Yes ❑U No If yes, site plan review Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) rn Name Telephone NumberG G 9 2 5- Address License # Home Improvement Contractor# /o d 3 a.2 /I w c7 0 6P " 301 cLl� Worker's Compensation # ALL CON TRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO zt� /) SIGNATURE O �� DATE i 4 FOR OFFICIAL USE ONLY * APPLICATION# DATE ISSUED 1 z x MAP/PARCEL NO. k r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH f .FINAL PLUMBING: ROUGH FINAL j GAS: ROUGH ` FINAL FINAL BUILDING I DATE CLOSED OUT ASSOCIATION PLAN NO. ,f ram,, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLTibly Name(Business/Organization/Individual): O1 r4/iyr}/d,/ d c"_0 4� Address: s-t Wiz' Wh y City/State/Zip: /z S n,r��,,i��,1,� a�`1,;5� Phone.#: '�5'O 3' a a IZ1 Are ou 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-tim.e). * have hired the sub-contractors 6. ❑New construction .2.❑ I ant'a sole proprietor or partner- listed on the attached sheet. T. [-]Remodeling ship and have no employees These sub-contractors have 8. -0 Demolition workingfor me in an capacity. employees and have workers' Y P h'• # 9. ❑Building addition [No workers'-comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work - officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Ep400f repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant_that checks box#1 must also fill out the section below showing their workers'compensation policy infomration. 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 subcontractors and state whether or not those entities have employees. If the subcontractors 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: i M /) UAJfa L l" S R e. Policy#or Self-ins.Lic.#: AV07 60 P l 3 O f.2 00,? Expiration Date: / //a'< Job Site Address: ;?,-g- S� 'S't City/State/Zip: N"V 1., 5' 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 tip 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 0:. 1111-Ale4w. nder the pains andpenalties of perjury that the information provided above is true and correct. Si afore: Date: ! `' Phone#: "C 3 (, Q a 7 Official use only. Do not write in this area,16 be completed by city or town offu:faL 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#: 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 cf the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )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 completeand printed legibly. The Department has provided a space at the bottom :)f 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. hi 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 maybe 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 io 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 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 Investigatkus. 600 Washington Street Boston,MA 02111 W. #617--727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 ' www.mass-gov/dia f Town of Barnstable Regulatory Services . tSAMM13M Thomas F.Geiler,Director i639. � 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 Y , 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: Sa- (Address of Job) q -Signature of Owner Date Pre S,` en/FIZ; c Print Name If Propedy Owner is applying for en-nit lease complete.the P P P Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISSION J)"* �. r Town of Barnstable �tHME ' Regulatory Services ;I RARNs,B Thomas F.Geiler,Director WUM Building Division PlFD � Tom Perry,Building Commissioner 200 Mairi.Streett Hyannis,MA_02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: :OB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code t 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 doe`s not possess a license;provided that the owner acts as supervisor. L DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,-on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and t , 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 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 assurning 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 can t amend and adopt such a forrnkertification for use in your community. Q:forms:homeexempt ACORD CERTIFICATE OF LIABILITY INSURANCE DAT06 52008' TM. PRODUCER Phone: (508)987-0333 Fax: 508-987.0063 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO RMATIO OXFORD INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 370 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN OXFORD.MA 01540 ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE ® NAIC# INSURED INSURER A: A I M Mutual Insurance Company LIBERO MOLINARI INSURER B: DBA MOLINARI HOME IMPROVEMENT INSURER C: 11 SHEEP PASTURE WAY EAST SANDWICH MA 02537 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR'ADO' �—PULICY ErFeC1iVE POLICY HwPIRATIGN LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMroom LIMITS GENERAL LIABILITY NONE EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea occurence) CLAIMS MADE OCCUR MED.EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ PRO- POLICY JECT LOC AUTOMOBILE LIABILITY NONE COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ i HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY NONE EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ WORKERS COMPENSATION AND AWC7008113012008 05/21/08 05/21/09 X ORSY uM TS OTHER TU EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The workers'compensation policy does not provide coverage for Libero Molinari CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20O MAIN STREET EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE HYANNIS,MA 02601 TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. FAX#508-790-6230 AUTHORIZED REPRESENTATIVE `=- � � - Attention: BARNSTABLE BUILDING DEPT. Joseph E.AnastaSl ACORD 25(2001/08) Certificate# 42128 ©ACORD CORPORATION 1988