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HomeMy WebLinkAbout0281 SCHOOL STREET �33'i Sc�m c Sr Town of Barnstable Bui1Cl1 ng uatuvsrAsr Post This Card So That it is Visible From the Street-Approved:Plans Must be Retained on Job and this Card Must be Kept . MASS:' - l6;� �$ Posted Until Final.lnspection Has Been Made. Where a Certificate of,Occupancy is Required;such Buildirig,shallNot be Occupied until a Final Inspection has been made Permit _ . _. ���..:��.��_. � ��. .� _ _ .� . . een �. Permit No. B-20-1157 Applicant Name: clay reeder Approvals Date Issued: OS/18/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/18/2020 Foundation: Location: 281 SCHOOL STREET,COTUIT Map/Lot 020-103 Zoning District: RF Sheathing: Owner on Record: TAKACH,ERIC C&CAREY N Contractor Name:'- CLARENCE R REEDER,JR Framing:. 1 p sL S Address: 13 BRIDLE PATH " Contractor License: CS-102351 2 PLAINVILLE, MA 02762 ;• � �- . . Est Project Cost: $82,000.00 Chimney: Description: Build screen in porch attached to house Permit Fee` $468.20 Insulation: i Fee Paid: $468.20 Project Review Req: { j Date: 5/18/2020 Finals Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:'' Service: X 1.Foundation or Footing 2.Sheathing Inspection _ _ .. _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . H E AT LOK W . it 3 Cornpany Name Cape C.od insulation Phone. Number 508 7;75 i21'4 Applicator Namee.:' Installat�on:Date: 7/2511T` Dav,id Sousa Job9ite Address 281 School Street' C A=Sici:e Lot`#+S: P31518340,16 Permit;Number' B-Side' Lot 's; GE017084 Location of • • Approximate Sq. Ft. Walls 32" R=21' 180 Sq Ft Attu R 38 . . 220 Sq. Ft CoatingIntumescent •cation Thickness Coverage Rate a' wwwDem�lecco .MILE E � Bowers, Edwin ' From: Paul Rhude <prhude@cotuitfire.org> Sent: Wednesday,August 23, 2017 4:08 PM To: Bowers, Edwin Subject: .281 School St Cotuit Hi Ed, I inspected 281 School this am. All good there. Thanks, Paul Paul Rhude, Chief Cotuit Fire 64 High St. Po Box 1632 Cotuit, MA 02635 (508)428-2210 Office (508)274-6086 Cell ' 1 H EAT LO K° • - - • Company Name, Cape Cod Insulation .Phone Number. 508 775 1214 Applicator Name 'David Sousa Installation Date 7/25/17 Jobsite Address 281 School Street . Cokw ;' A-Side Lot #'s P3151834016 Permit Number:. � B-Side Lot #'s GE017084 Location of Insulation Thickness Total R-Value Approximate Sq. Ft. Walls 3.211 R-21 180 Sq. Ft. `Attic 5.7" R-38 220 Sq. Ft. Inturnescent Coating Used Location Thickness Coverage Rate .cQG��.Ct.1yr,� www.Demilec.com DEMILEC a to k 14 Commonwealth of Massachusetts Sheet Metal Permit Viap 020 Parcel 103 ® � -7T7 Date: 7/24/17 9� Permit# — Estimated Job Cost:$ Tf p JUL 24 ZQ�7 PemaitFee:S $85 Plans Submitted: YES X NO 21a3s Reviewed: YES ISO Business License Applicant License Business Information: Property Omer/Job Location Infozma`i: Name:1_ 1c� C-M�' eyy_ Name: James Monteforte Street- 1� �_6' Street: 281 School st Cotuit Ma T'elephone:5()?j—%O-e)-ak6qS 'telephone: 508-648-2015 Photo I.L.regnited/'Copy of Photo LD_ attached: YES V/ NO J 1/&�, iqted license I S-2 f ldr-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq.f t./2-stores or less Residentiah 1-2fami-ly X Multi-family Condo/Tovmhouses Other s I Commercial: Office Retail Industrial, Educational Fire Dept.Approval Insdtildoxaal._ Other Sgnarxe Foote: under 10,000 so_.f L X over 10,000 sq.', Number of Stories: Sheet meta-1 work to be completed: New VTork: Renovation: X i H VAC X Metal-Watershed Roof ng Kitchen Exhaust System Metal Cb:ir ey/Vents A k-Balancing i Provide detailed description of work to be done: Furnace and hot water heater 1 INSUR&NCE COO—EPAGE: !have a current rifft insurance policy or its equivalent which meets tile requirements of A&G:L.Ch.11.2 Yes E No Q I If you have checked jgj indicate the type of coverage by checking the appropriate box below: ! A liability insurance p6ficy ��� Baer type of jndenantty Q Mond Q OWNER'S INSURANCE WAIVER:l am awarethat:the licensee does rusk hy-g the insurance coverage wired by Chapger 112 of-the Massachusetts General Laws,and that my signature on this permit application XW�j§this requirement I , i Check One Only owner Q Agent i Signature of Owner or Owder's Agent By checking @his bo",Jeby certify that all of the details and'information I have submitted('or entered)regarding this application are true and accurate to the-best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with-alI pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. l Duc€inspection required prior to insulation installation:YES NO Progress Insgictions �. Date Comments l ]Final lusRection Date Comments I l Type of License: f Emaster Me Q Master-Restricted � �Ity/TDWR - pJoumeyperson Signature of Licensee ElJourneyperson-Restricted License Number. S�2' =ee © _ Check at wwsv.ivtass.govldnl I i i nspector Signature of Permit Approval l i own .of Barnstable Regulatory Services Y 4 9 A MASS r�qy . 1 WI '[S any s F.CeBIler,Mrectar 16 e Buff, ding Didion Tom Feat,Daaftftg commissioa3eh 2001vfaia Street,Hyannis,MA 02601 �s�aa.�as-mS�He.aa3a.aas Ozfioe: 508-8621.4038 Fay 508-790-6230 Properly Owner Must Complete and Sign T s Sermon If Using A Builder James Monteforte ,as Owner of the subject property hezebv authozize to act an ny bebalf in all rmatters relative,to work authojized by this building perrnrt 281 School Street Cotuit (Address of job) **Pool fences and alarms are the responsibility o the applicant. Fools are not to be wed before fence is instaRRed and pools are not to be 11t 1 zeal I a�jnspeetjons are Perf®~Med an' d accepbtd. C', � signat vre of 5i2.natuceof Applicant James Monteforte �t%� `) 1D pzznt Name Print Nacre 7/18/17 Date Q:FORM.S:0VT ERaER2ZSSI0MOOLS 1 I i I I I Estimate #811 From High Efficiency LLC 5088253695 johnny@high-efficiency?Ic.com HEATING I:PLUMBING f AIR CONDITIONING PO Bo::159 l i Forestda!e. MA 02644-0159 Jw-nes Mor;tetarte !! Bill To 281 Schoo!Street 281 School Street _ Cotuit, Massachusetts 02635 Cotuit.Massachusetts 02635 I Sent On 06/29!2017 Job Description Furnace ! 0 0 @ e HVAC Design and installation:, Complete HVAC design and installation-including ;j 1 $9,000.00 $9,000.00 ' material and equipment �; 'I i DUCANE 95%,45,000 BTU,ECM GAS FURNACES: Model#95G1 UH045BEl 2 Work Includes: Hang Furnace in Crawl Space Insulated Supply&Return Plenums Cut-in 7 Supplies&4 Returns 25'of Insulated Supply Trunk-Line 20'of Insulated Return Trunk-Line Tape and Mastic Sea[All Duct Work Joints l! Duct Leakage Test as per Code Honeywell"Lyric"Wi-Fi Thermostat L 2"PVC Flue Termination Kit Extend&Connect Gas as per Code Start and Check Operation Permits and Inspections 1st Yr.Annual Maintenance Included Warranty: Lifetime Heat Exchanger i; 10 Yr.on All Parts&2 Yr.Labor Total Investment$9,000 I! I $300 95%Furnace I, $100 Wi-Fi Thermostat i $400 Total �I Mass Save 84 Month"NO-INTEREST' j Heat Loan$102 per Month ! • I -..........._..�..__...._,�, This quote is valid for the next 30 days,after which values may be subject to Subtotal $9,000.00 change '• ... .�T..,._ _ �... �, , The prices&.incentives of, in this contract are subject to change in Discount jW -$400.001 accordance with Mass Save&MiA CEO 'Any Electrical Code Updates Are Not included in This Bid"" Total $$600°0Q t °*`If Your Quote Is For A Gas Future,Building Codes Require A Carbon -• --- — _? Vionoxide Detector on Each Floo'r Of A Horne.If Your House Doesn't Meet This S High Efficiency LLC Is Required To I, all. N •..ssary Detectors,At Additional i signature: Date: ii __ ._ -7 0o G'Prn zoo CRY% 5 PP y F7r1 6u I i goppty i i i f i I . 5 7)1 I _ . 2040 ids �' :::':;:.:'�:•.::.:..:.:.:.:::::::: • :._..-... �.: _rr::'' '���' ' •a�,.� 1SuUES� '_ ; LU .. � , y . —bf . �. • q sAUnNaim,_ 'zv '.'.A ' •ram=": `.:!"•..:.',r•- �_� COIrFI'ROL# 6�— - IMPORTANT a rr your iicerse is lost,damaged or destroyed;is inaccurate,or needs to be Corrected,visR Our web site at our Renewal for insauctions to ensure the proPer TOO°g of your Renewal Application and any other correspondence ect to Massachusetts General Laws and S This license is subj.anse is a Fries and-cannot be.lent or tv r� toYany p"emn or ertrt�/under Per�altiY ofi law Keep'his licenpj on your person or posted as required by law and/or regulations- r; lUgt �r NMI Elm .. !MM y�yrr s s-f tsl S F�f� i:r 3, t R.�Fr is EZU��-. Sj a 4 ENS s 'a,•CS Owl sc 1 3j°'krixlr ro yi ea� N}i ri ay.Ai,1 {.S �. IeUE 4y(t �C�ig B t;1 R F g. r, NiM ill `fi 4 rrir tff¢ �� Si e ;?i�.1i•� 7 F1:P1 ( um f The Conono twealth of MassachuselTs Department of industrial Accidents Orke oflnvestigations I Congress Stre04 Suite 100 Boston,MA 021I4-2017 www mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/FAectricians/Ptumbers Applicant information Please Print LeObly Name(Business/Organizafion/lndividual): Address: -679 iC.Ouk, I& C4iy ate/Zip: ty" W( Phone#: �S Are you an employer?Check the appropriate bog: Type of project(required): 4. I am a eneral contractor and I 1.❑ I am a employer with g 6. ❑New construction j employees(full and/or part tune).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance-1 id,] 5, ❑ We are a corporation and its 10.0 Electrical repairs or additions, 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MOL 12❑Roof,repairs insurance required.j t e.,152,§1(4),and we have no employees.[No workers' l 3.❑Other comp, insurance required.] *Any applicant that checks box 01 most also fill out the section below showing their workers'compensation policy information. t Hoomwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet stowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-ootmsctors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compmsation insurance for my employem Below is the policy and job site lnforinat n- Insurance Company Name: &LtA Policy#or Self-ins.Lie, �i"'�q �+ f/u 1� EX p Date: a$ Job Site Address. 281 School St City/State/Zip: Cotuit MA 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 flae 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 MA for insurance coverage verification. I do hereby Eat under the and enalties o er' that the ut orrmadon provided above is tru and correct Si afore: Date .— ..� -- _Phone# --- Offklal use only. Do not write in this area,to be completed by city or town of dal City or Town: Permit/License# Issuing Authority(cirdle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector .5,Plumbing Inspector 6.Other Contact Person: Phone#: CO® DATE(MWDWM A C<> CERTIFICATE OF LIABILITY INSURANCE 10/5/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christian Barber, CIC NAME, • The Oceanside Insurance Group PHONE . (508)775-0500 (AAlr o.(508)790-7955 E-MAIL D ESS: 52 West Main Street INSURE S AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURERA:SafetV Insurance Co an INSURED INSURER S:SafetY In lemalty 39454 High Efficiency, LLC INSURER C'Associated Fmplovers Ins CO PO Box 159 INSURER 0: INSURER E: Forestdale MA 02644-0159 INSURERF: COVERAGES CERTIFICATE NUMBERCL168404552 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE POLICY NUMBER MWDD EFF IT" (MID9 EXP LIMITS X COMMERCIAL GENERAL LIABILITY .EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEPREMISES DAMAGE T S 100,000 A E S Es occurrence M9 0023968 7/24/2016 7/24/2017 MED EXP(Any one person) $ 10,000 PERSONAL SADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- 7LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY (Ea accident)COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY,INJURY(Perperson) S ALL OWNED SCHEDULED 6234464 8/5/2016 8/5/2017 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGES X HIRED AUTOS AUTOS Per accident I Underinsured motorist BI split S 100,000 X UMBRELLA LIAS i OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED I X I RETENTION$ 10,000 000005822 7/24/2016 7/24/2017 $ WORKERS COMPENSATION SEATUTE I X TRH AND EMPLOYERS'LIABILITY - ANYPROPRIETOR/PARTNER/E(ECUTIVE YIN N IA E.L EACH ACCIDENT $ 500,000 OFFICEC (Mandatory in H)EXCLUDED? WCC-500-5014925-2016A 7/28/2016 7/28/2017 E.L DISEASE-EA EMPLOYE $ 500,000 (Mandatory in NH) If yes,desMe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD'7M,Additional Remarks Schedule,may be attached if more space is required) _ Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsement of the policy. Nothing contained in the certificate of insurance shall be deemed to have altered, waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Bidding Purposes ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPRESENTATIVE C Barber, CIC%MC p 1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 oniann eck. 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s'I" Map Parcel o� Application # n C,Z a Health Division Date Issued Conservation Division Applicatio e Planning Dept. Permit F Date Definitive Plan Approved by Planning Borrd J . n4, Historic - OKH _ Preservation/HyaTi s?a� Project Street Address Village i i Owner 4K, Address Telephone 0?-&-3C Permit Request D Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District WF Flood Plain Groundwater Overlay Project Valuation 10 000 Construction Type Lot Size 0-4t/ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes fit 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: .2- existing I new Total Room Count (not including baths): existing C 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 Jam,_c 00"1=-c.g VL _ Telephone'Number Address y I �(�.t/I nni � - License # �—. VIA- Home Improvement Contractor# Email lame c mD44r A,(J i . Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTI FROM THIS PROJECT WILL BE TAKEN TO "' SIGNATUR r;r/� DATE I/ FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME dK _r INSULATION Gol 5 /wc FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �h DATE CLOSED OUT ASSOCIATION PLAN NO. y • � t 7'Ite Conintortiveaii7lt o, `?{1&sadiusetfs Depar'tiraart afr'ndus-frial Accide-7ds - - Q}}r[.•e ofiFmystigatiorts 600 Washingtou rS'treet Boston.*M4 DZIII tmiumasmgovIdia Workers' Cumpensat an Insurance Affidavit.BmtderslC+antra.cturslElectriciansiPhimbers ApplicantInform,afrGn n': •f PleasePrinf Ledbly Name�Business�Organizationll9dic dnal���fl�Z_� �/I V yl ! tl7 j/T�G T ' Address Citg/Stater j - 1144. 0 �2 V <ZZ- Phone--if QQ 1/4,9• �7-01 'Are you an employer?Check- ,the appropriate box: ' Type of project(required) 1.❑ I am a �emP 1 with. 4 0 b I ain a general contractor and I New❑Ne consfr >z uctio employees(fish anNor part time * havehired-the sub-coatractors 2.E I am a sole proprietor orpartaer listed ca the attached sheet I. ❑Remodeling f b'These sub-conrac-tars have soup and have no employees. 8..❑Demolition for in any t. employe have es and he workers' y cam. `. 9. ❑Building addition [No TL xkers' comp.insurance comp-insurartmi rewired_] • 5. ❑ We are a corporation and its 10-0 Electucal repairs or additions 3. I am a homeouuer doing alI work officers have exercised their 1 L❑P'lumbiag repairs or additions. �1 n,--A-l£[No-Woks'gip- • right of exemption per MGL 1--❑Roofrepaim inciTranceretlnired [ c.152,§1(4)6aadwe have na employees.[No wormers' 13-❑Other comp-insurance required-) #Any appiitmOntc edesbax#1 must also fMoutthe secticabeIowshu%iuZ the wo&ers'compeasstinapeEcyinformatio L t Hbmeowners who submit dais of adn iK in cating they aze daiag all wa*and thm bfre outside contractors mast sahmit a new af@dsvit indicating sack fCa=Rctors drat checktbds box mast attached as sdditinnal sheet shoring the Hume of dw snb-comdrscdaa and state whether or not Those entities bare en4flayees.Ifthes.uVcontractaeshive®-ployees,theymustpzmddetheir nrorkers'comp.13alicyaumber. .Tani air srsplorYrr flerrt is prrx�zdirrg,workers'cast tsrrtiolt iusuranceforuryearprolvex Holm is the pv-M7 and job situ inf ormaliom Insurance Cotupany.Name: Policy#or Self-ins.-Uc.; l xpirationl?ate: Job Site Address: city/Statelzip: Attach a COPY of the workers'compensationpolicydeclaration page-(showing the policy number and eopiroon date). Failure to secure coverage as regaire3 under Section 25A.of MGL c 152 can lead to the imposition of rrimiyai penalties of a fine up to$L500.00 anWor one-yearimprisoumeut,as well c'-vd penalties•in the fami•of a STOP WORK ORDER and a fine of up to 0-010 a clay against the violator. Be a ed a c . • of this statement maybe forwarded to the Office of Itavestgatians of the a for insurance co y ti Frio hereby ceit' ider the prams r fiiatfTie inrorma€bul?rm rirfd above is true avid correct Date- Phone i�7 ' 0& Offlsial use anty. Do not tvrke in this urea, a completed by city artoiwtI afficiat City or Town: PeriniffAcense# Boning.kuthor€3 (cycle floe): 1.Board of Health 2.Budding Department 3.Ci-tyrfrosrn Clerk 4.Electrical Inspector S.Piumbmg Inspector 6.Other Coact Person: Phone#: — --- -- - -- - . 6 ifaformation and Instructions Massachusetts Geheral Laws chapter 152 re pap all MIPIUMS Yn provide woes'con=pmsafion for their employees. P -W this defined as_"_.every peasonin.the service of another under airy coniraCt ofhae, express or iinplied,'oral or wditeu." An epkyer is defined as"an individual,partnership,association,mrpmafion or other legal entity,or any twO or mare of the foregoing engaged is a joiat enterpII ,and iaclnding the Legal representatives of a deceased employer,or the receiver or trustee of an mdiyicbA partnership,association or other legal entity,employing employees. However the owner of a dwelling house haviag not more thin three apartments-and who resides therein,or the occupant of the- dvweIImg house of anofher who employs persons to do mamfrnan w,consftucti on or repair work on such dweliiag house or on the grounds or bmldmg appurtenarzt thereto shall not because of such employment be deemed to be as employes" MGL chapter 152,§25C(6)also states chat"every state ur local Ticerrsing agency shall withhold$ze issuance or er renewal of a Ticease or permit to opate a bursmess or to construct buuldhigs in the commonwealth for any applicant who has not produced acceptable evidence of cdmpltance with the ffisurann ce coverage regn edf Additionally,M(H chapter 152,§25C 7)states¢bleithert ie comtnaawealthnor any ORES Political subdivisions shall enter into any contract for the perf=ance ofpublic work mitil acceptable evidence of mmpliancewiiii the;nz -a ce.. requfieme:nts of dais Chapter have been pits cut$d to the contrasting aufh.o3ity." AppHcan-ts Please fill out the workers'Compeusation affidayit completely,by checl®.g the boxes$at apply to your situation and,if necessary,supply sob-contractm(s)name(-), addresses)and phone numbers)along with their ca tifacafe(s)of nsulance. LhnitedLiahilhyCompanies(LLC)or LhaitedliabilityParfnerships(LLP)v4lmo employees other than the members or partners,are not rbqui ed to carry woLkers'compensafion fi sol'amce. If an I LC or LLP does have employees, apolicy is regared. Be advisedthatthis a$daytmaybe submiffed to the Department of Industrial Accidents for confirmation of msm-4mce coverage. Also be sure to sign and date it-he affidavit. The affidavit should bez-etomed to ffie city or town brat the application for tha permit or license is being requested,not the Department of n , A ccid=-b. Should you have any questions regarding the Jaw or¢you are rego�ed to obtain a y,�orkers' compensation policy,please call the Departmet¢at the number listed beIow Self-insured companies should enter their s elf-fisar-mce license number on the appropriate Ime. City or Town O$ciak Please be sore that the affidavit is complete and pried IegIlY. The Departmenthas pro-vided a space of the bottom of the affidavit for you to fill out is the event the Office ofIuvestigations has to co33facty0umgardmg the applicant Please be sure to fill in the pem it/li 'mse number which will be used as a reference number. In addition,an applicant that must submti:muYfiple peon VHcense applications is any given year,need only submit one affidavit mdirat m rnrrPnt Or policy mf rc atian.('if nmessary)and under"Job She A ddmss"$e applicant should write-all locations n ( Y town):' that has be a officially stamped or marked by the city or town may be provided to the A copy of the-affidavit applicant as proof that a valid affidavit is on file for fut= 'permits or licenses_ A new affidavit must be fMed out each. year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i D. a dog license or pemit to burn leaves etc.)said person is NOT regmied to complete this af$dayit The Office of Inns would like to thank you is advance for your cooperation and should you have any,qu estions:, please do not hesitate to give ms a calL The Department's address,telephone and fax nurmber. n�an tIl of I chns�ttts Deparfxment of Ind dal Awleats f04tRn S .BczztanzMA 111 T 14, 617- -4 Qxt 4-06 or 1-977 IL4 GAF Fax#617 727 7M Kevised 424-07 w -mar, II • Town of Barnstable Regulatory Services oFTKE Richard V.Scali, Director Building Division RARNST"M Paul Roma,Building Commissioner w►ss. 1639n. � 200 Main Street, Hyannis,MA 02601 AjED � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE• P, ' JOB LOCATION: SU✓1 D 0) <t . - number 4 - street - village "HONIEOwNER":-JQ:fm L� �jy I✓1�(TD✓T. _ V_ " tZV► ' 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 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"home er" rtifi t he/she understands the Town of Barnstable Building Department minimum inspection ced quirements and that he/she will comply with said procedures and req ' ents. , Signature'ofHomeo er Approval of Buff `Vepl-ita llote: mily 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 to amend and adopt such a form/certification for use in your community. DIME Town of Barnstable Regulatory Services BARNM��LB. Richard V.Scah,Director Eo;9; Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 roperty.Owner Must Compl e and Sign This Section If sino,A Builder ` as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building ermit application for: (Address of Job) **Pool fences and alarms are the responsibility of the ap licant. Pools are not to be filled or utilized before fence is installed d all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OVNMERMISSIONPOOLS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �'��1 Ac ` Map 02� Parcel / 0­3 Application # J6 — ` Health Division T Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board of BAFM!s7A,3LE Historic - OKH _ Preservation/ Hyannis Project Street Address )ZI SAoo 1 3-+ Village Owner Address Z&/ S z 3-6- Telephone 56f5- Y -2016- Permit Request .Air Sgal,'/w l to pftssvre- "" &-a"Isamcc t ce ss AIty-f • �r,a=� � cz.A a,, Wi^a_ e �p 6 s J13�s31n)6 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation q 6 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: 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 Q6��� ( ate v,i, Telephone Number 06,T 7- (9?0.(0 Address &fad St License # ► C7 3 I rlA O Home Improvement Contractor# 40 Email a1% (Pik s-i6kXS_ .; Worker's Compensation # xr,�S 6 Q1&-?y/_ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )pm A r P-+ ld FLU I MA 61-?)-D SIGNATURE /G o��.---_ DATE Th 7 r^ 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 h GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 5 ASSOCIATION PLAN NO. r ��y Town of Barnstable �� Regulatory Services tUrt'15T.1BU, t fv i Ridard.Y.Scali,Director Building Division Torn Perry,Building.Cormnig!�io.aer 40 Mttiu Stitt',, a uus,_\^xA 62601 v%i" town.barnstabl`e.ma.us Offw(: : 50S-R62-,40_M Fax: >08- 90-6230 Camp€etc and Sign: `: bis Section If Us in o- A Builder L,James Monteforte w4Ov,,ne o �he�ablixr.j,.)TO y-v-y Z all LLlnITL'rs r 0 1:0 ;x,ork iu&,oiizcVbv Li,!,-11)L lIdi p Mut i'ppI1c.:_o.7'fc?Y: 281 school street cotu'it MA P r,:ni TienceS an, d aIu ms are the.rtspo iskbzl y of t}it apphcani. :l.,o(As a:r not to be Red o ut �f' ti hefore I',unce is msLA.ed arzd aU i"Jil-. w :test 4 t+a� s a e nxiorsrz6l I-Ad aCC-_P ed. y � ignature-cad z Si �c�,r( Of,�i�p l c it Paint Name Pn'DL NaM-' ,.a6 Q:FOT�'•14,C7 rl R° ??r4?55�{17 Y{t)d.S OF M 9 DEBRIS FORM' In accordance with the provisions of MOL c,44,s,54;a condition of Building P&n t:Nijen r Is that the debris resulting from this work,shall be disposed ofin a prop erly`licensed ; solid waste disposal facility as defined by MGL e, 1110 s: 150A, This Debris will be disposed of in: Re ublic Services Dum ster: 1080 Airport Rd Fall River, MA 02720 (LOCATION OF FACILITY) Signature of Permit Applicant /l'r all ��res ft A COzA-0 bate IF ®UMI STER IS USED lilt EXCESS Or SIX C? .CUBIC Y iRDS A,PtAMIT r$`OIVI THE I+IRE DEPARTMENT IS REQUIREU fOR COMMERCIAL;iNDUSTRIAL, 1NS71TVT1:O-NAL A ®ltl U T[-MMILY Rtsibt ti AL CtUI b C3NITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING CIRC6E O NE ** E:Y0U:SUSMITTED THE A 06 NOTIFICAT ON TO T14E MAS5AC US SS EP YES Na A`'Z® CERTIFICATE OF LIABILITY INSURANCE . DATE(MM12 8 )16 ii THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER - CONTACT NAME: Anthony F. Cordeiro Insurance PHONE FAX 171 Pleasant Street E-MAIN.L 508 677-0407 / No: (508) 677-0409 Fall River, MA 02721 ADDRESS: hsouza@cordeiroinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, MA/02720 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE WVD POLICY NUMBER MM/DDIY MM/DD/YYYY LIMITS A GENERAL LIABILITY y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ToR PREMISES RENTED $ 300 000 CLAIMS MADE lil OCCUR ME EXP(Anyone person) $ 5,000 PERSONAL&ADVINJURY $ 1 000 000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY P C LOC A AUTOMOBILE LIABILITY y y $AA 56418741 12/10/16 12/10/17 EOT entSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ — ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED P eOa citlentDAMAGE X HIRED AUTOS X AUTOS $ A X I UMBRELLA LIAB X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 Ifyes,describe under DYSCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) "For Insurance Purposes Only" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Office of Consumer Affairs and Business Regulation 10 Park Plaza.- Suite 5170 Boston; Ma qh,usetts 02116 Home"_Irnprovem tractor Registration r Type: ~ Corparation . INSULATE 2 SAVE , INC. Registrat,on 180747 Expiration: 1 V28/201$ 410 Grave St Fallriver, MA 02720CC =� s•a sca i 0 zone osri Update Address and return card; Mark reason for change. �� [ ,,� __., ......:....m.._ _i...�.......�. Aen. v..a1 O Errt,,,ployment.D Lost Gard {iCL3697147tt2'7i{{fCC{t{lf�tx�(�'��t'tG1CY�l.{tff,�ii - '. _ »""m. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid fordndividuat use only TYPE:Corporation before the' on date. If found return-to: ; Exairatjgn Office of Consumer Affairs and 8 isiness Regulation 807�i7p 1'2/28/2018 .10 Park Plaza•Suite 8170 Boston,MA 02116 INSUL74TE 2 S�A�VE,iN ,�� Roland Langevin 4 410 drove St Fail0"v ,,MA 02724 Undersecretary Not valid"wi#hciut slgratur8 'Massachusetts Departniew ot,Public Safety, €36ard of Building Re ul itions and 5 a g t ndards I . License: CS7103861 Constructibn Su rvisor ROkAND LANGEVi�t_ 561iI0HCRE_S"r R'O FALLAIVEAA a2T R t 8' f Coniniissioner �812dt2ttlT The Commonwealth of Massachusetts ~. z Department of lndustrialAccidents V 1 Congress'Street,Suite 100 Boston, MA 02114-2017 www Mass.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WiTli T.If.E PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Insulate2Saye Inc. Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone#:508-567-6706 Are you an employer?Check the appropriate box: Type of project(required): LE]I am a employer with. 20 employees(full and/or part-time).* 7, Q New.construction In I am a sole proprietor or partnership and have no employees working.for me in $, 0 Remodeling any capacity.[No workers'comp.insurance required.) 9. ❑Demolition 3.E]t am a homeowner doing all work myself:(No workers'cornp.insurance required.)t [], addition 4.o I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a'1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.QRoof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑X Other Insulation 152,§1(4),and we have no employees.(No workers'comp.insurance required;] *Any applicant that checks box 41 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and thenhire outside contractors most submit 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.Lie. #: XWS 5641.8741 Expiration Date: 12/10/2017 ` Job Site Address: �-&) Sck.( Sf— City/State/Zip:" (/, +V4 MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violationpunishableby a fine up to$1,500.00 and/or one-year imprisonment,as well as civil,penalties in the forth 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: /do hereby certify undo ry that the.inkrin0ion provided above is true and correctt. Signature: � Date: 691131)7 Phone#: 508-567-6706 - Official use only. Do not write in this area,to be completed by city or town offtcial. City or Town: Permit/License-9 . 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#: t FedemllDL,#'05 M5626. R r RISE Ei#.g veer g RI Contractor Registration Nd 8186:, MA Corr6ractor 12eMrateatfOn Na,"t28S79 t:orrtractor Reglstr*6611,Nb 620120. , a„t)npant AvmiSouth Yarmauth titA 02bb;4 /+ ENNEERiNG ©N.TRACT 508=$68-t926 FAX�08-5.68 1.933': pRUGItAM: Tk15 CONTRACT:IS ENTEREOINIO 8Er4VEEp R[9E :.. NGC;C-liES Ei GINEERINO AND TkE'COSTDMER FORwoRK AS! DESCftMED•aE€OW .. PATE,' ... WENT C: WORK O"ER_. .. James ivionteforte (s48)G48 015 45/19/26.1.1 233138 26Ek44: sEavttie'STai:ET ,. .. : En.!{lN0'•STREET .. ...... .....:. 28i School Street 281 Scholl!Sheet SF.RVtCE Crf:Y.`tiTATE,LPG - ... �otult,i1i1A 42635 , Eotuit;�r1A 42635' JOWDESC.RIMON PHASE ONE,, proposal.for this calendar::year: AIR SEALING Provide laborend materials to seal areas of your home agatnst,�vastefvl eaeess air leakage This'work will"lie perform[d 580 00; in concert ivnh the use ofspt teal tools and dtagntxs is tes[s to�i ssure that?your horpe wdl be,tet3 with a hi althful.icve!of air,_eachange. and in,odd a[r quality Matcriais to be used to seal:your home can Inciitde caulks'foams'wea fterstnppiitie and other products= Pr[mary areas for sealtog inolu a air"leakage-2o attics basements attached garages and other;tuihcatc l'areac(ir�ndm»areinot generally addressed';} (6)Working hoar"s::A;ruitscton:ln:eub'icfeet pt'r minute(cfiii}ofatr..intiltratlonw7ll occur'but.the'actual riuintef of cftn'is: not tnwraateed; AIR SEATING Provide IabOt'and materia#s to install(}-fun weaiherstrippml,20 'a:dcmrswaxi Ei t0(I)':ddor{,)to restrict aifA S80.00 F3ARRIER:Your ceilings aze cgnsuvcteai of a l lghtrvetght carctboazd a ornpostte ntafertal These celltngs`cannot support the addltioital` jvetghroflilown-tn.insulauon.or arr sealing measures the ulrg.could be dislodged due to mpvement ofwprk�rs to the attic aril cause: ;damage tottie telling Hies Until you renovate these.cethngs we,xnll only tnsulate`:wtth rolled out fibergtass ball trisulauon> This tsbeing brought to yauratienUon io denufy it as a pre-existrng_condtuon io:the,Aeatherimi Wurk,planned for yaur'liome Your. §rgnattuc,is,your acknowiedgeineai of thesc,condgionsand agreement,to,pp*!e:' STORAGE 8AI2RR HomcowTter Is responstblefor the removal ofthestored atoms blocking the.,tnstailaeion.of.: {iditiRls} `` weatheri aeon Work,in the crawfspace kern Vaa rsrusi occur poor Eo the scheduled_wosk.stgrt.. CRAW[SPACE HEIGHT RESTRICTION Youriiome s crtt�vlspace height Is lmver.than our standard for work to:proceeti 'Th:snE coptractor.assigned•to install„these We*rq.ization•,measums cesenes tt[z:risE[t of mfusal.upan.,rrsual:nspection of.}our.crawispace; CRAW25t?ACE Provide labor andmaterials to install($58}:square feet of 6 ml poEyethylt nt:o�cr open:ground m;destgnated. '' �6t 0 66 CmWispaee/cazthen basement areas. ..-._:.. •CRA, PACE Pr' a labor and materials to Frame and construe[{I}pressure=treated,crawlspac�access door_Access to be insulated: $3S0 DO` with 2 rigid Thertnax board and st�lt.d atthe edgewnh weaderstrtppitg::. CRAWLSPACE Piovtde label"r;and materials to to"stall uaze feet of rigid kiaard at 2;rigid board with, i de:requrred file raang to (336jsq 5l 36�80 the CM%V,space perimeter Watt:up to the sill and.aga nst.the banii.,pist 8s t - Federal lb'#GSkt405528 RISE.:Engineering ►cartractor Regtstraaon Nc ei8s MA.Contrai t r'R tia'"$o�Yt O' V 'F Catrtractor RaglstraElon Mo.620f�0` a Unpottt Ave,South 1>:rmouth,.Al 02ti64 ENGINEERING' CON'TR�CT 568=a68 I92G' E AX A&5b&1933 Page, .2 p>zocRaM THISG COLWNONTRACT IS ENTERFA INTO BETWFF.N RISE'- �TGGC-Fi S 11 :ANQTNECUSTOMERFORVJMAS Ept DMIMEDBELOw Ct18T0AiER - PHONE, :DATE CEJEM A: WORKORDER James;lviante#orfe;: 008 Wr'20:15 0 /19120:I;T 2331a8 26004 .SERVICE-.STREET _.. .. A LUNG;STREET 281'School9treet. 2$1 School Street 8F3tUILE"`CnY;STAT£,31R .. 6ILLINti CtT:Y'STATE::LP GoNtt,:A A.0203. CbtU4;MA 02G3'-5. JOB -ION tNCFN I iVl 91SE tingtneering will apply all lapplicablei eligible Inc ttves to this contract„You wdl be billed:oaly the Net amount, $165.00 Cunentty: for eligible tneasums Nauorial Grld.otlers 75%incentivl'not to c�.cecd.`S?000 per calendar.]ear and_an IDcenpve of 100%q for th0,r-Sealing measures: Fnr the<safety and;heatth of your homes"indoor air quality,we m r";door d agnosttc.of ihciavailable atrilow,n your home both before the work Is bcguri arld.aftcr.the wCsthenzauonyrork Is complete Inbt:to be cDiitlucted if asbestos Is:present�-We will also conducra.dtagn is ,-rise hilt Qfthe eombustw.n;fumes,ta,the exhaust flue,ofyour hCaibng'system and water heater,This has: a untie of S90 and-;i"s ai.rio cast royoii:. - "i'he Peitiiilt�wll lie seclsted li;the msulaiiDnconiractor"tills has a'=value of 57�'"and is.at'ilo cost to•yi3u.It Is.the:tiomeowner:s.: responsittlity to close out tltisi.permtt bycontactitg thelYsnutiic€patity.at t#tetcorri{sletloriof this'cvorir.:.. ' Total:: $2;996 46 f Program.;incentive:: $Z613 7fi , Customer Totali: WE;AGREEHEREBI TO EURNiSH SERVICES tAAAPIETE IN 7kCCDRDANCE;t!1iTH A[ioVE SPEgFttittTlONS FOR 7HE SUb1:DF. Four Hundred Et4*Jwo&70f.1.00�Do1[ars UPON FAiA ALVC A . .. 2:OF,Y'K VALL 8E;CNARGEn H1oNTNLY.Ofl ANY . Tf0(J.A#D APPROVAL$YfiFBE ETi�NEEi,�INO�CUS?OMER�AOREES TO'REMrF AMOUNf�DU£W FUi:G ,ttNPAfO BAtJINCE AFTER Ea DAYS SEES.REVFJtS£fORtItPQRTAN,fiiMFilRpIATiON ON GUARRNT"E£S.R1G OF` - . . .. __. .. ........... . ... ...• _. _ ,AN RACrOR R 1 RATIO.��:..' furtL .;AUTHORIZED WGNATURE...RtBE,Fsg ..- - CUSTOMER ACCEPTANCE* . .NOTE TMi8':CONfRACYrMAY8EN4TFIDRAWNBYt7S7FN0'fEXEC:.... UTEO VATHIN :DATEOF ACCEPTANCE '"� ACCEPTANCE OF CONTRACT THE ASOVE PWCEs*SPECIR;Apbks AND CDIJDmCNS-AR.E 30. 04 ;SATL4iAGTORY TO US AND ARE'NEREBY ACCEPTED:YOUAfM AUTHORIZE TO'QD THE"wC1RK AS"SPEWF/ED AAYMENTawILL�eE MADE AS OUr,LIDlED ABOVE. . la V"E Town of Barnstable *Permit#2--1 Regulatory Services Efe;6 months Pm issue date snatvsznst,e, MAW Richard V.Scali,Director 1639. ♦� Building Division y Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 JA�-17 2011 www.town.barnstable.ma.us Office: 508-862-4038 Eax 5'0 81790 6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y r Not Valid without Red X-Press Imprint Map/parcel Number � (hJ ' Property Address 0( _5CM00L_ S j coi?V® 7- cZt:� S # Residential Value of Work$ &OW,,00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � �/fJj �p/Z,r' /6 Contractor's Name aJ177J',EfQ / Telephone Number ( O�� �O!S Home Improvement Contractor`License#(if applicable) Email: ZAA No M/�g Fd 1Z j t "g yAmi, .cQ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ` 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) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 051EAULt�. 7i 0 FF Si/ o�V ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) '7 Re-side Aoi F-n4 c-AA-2 Replacement Windows/doors/sliders.U-Value 47ADgft�(maximum.32)#of windows_ 7 #of doors: 7. ❑ Smoke/Carbon-Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner sign Property ner Letter of Permission. A opy of th a Improveme ontractors License&Construction Supervisors License is uired. SIGNATURE: , Q:\WPFILES\FO uilding permit 12ESS.doc 06/20/16 The Commorrtveakh qfMamdiuseds Departneet afI'udusbid Accidents J OJ-j e-qfTr ga#ions -- Boston,MA 02111 wFinu irrass. /dia Workers' Cumpensaf anIusuraance AfRday t B•ugderslCuntracWrsJEIectriciansThmbers AppReant Infarmatinn Please F ikt Eye IY Address: 16 / 1 S .Phone Are YOU an employer?Check the appropriate boss .®7-653 Type of project(retledred): L❑ I am a employes with 4 ❑I am a general contmctos and I 6- ❑New won employees(full andfor part-ime)* have hired the sue-contractors 2.❑ I am a sale proprietor orpartuer- listed on the attached shet I- Rernndeliug. •slip and have no employees These se&crzatractors hate g_ ❑Demolition, wodting forte in any rapacity enFloyees and have wodows' 9..❑Building addition. [No Wodmw comp-insi ante comp-insmmrt—l required-] 5- ❑ We are a corporafionand its ME]Electrical repairs or additions 3-P(I am a homeowner doing all work officers have exercised their IL❑Fhnnbingrepairs or additiems myself [No o warlaers' F- bt of esemp6on per M(M ry❑Roofr repairs ;�, c required-]T c.152, §1(4h andwe haven 1� employees.[No Mockers' a❑other comp-insurance required-) $Any sppffc=Bhat cbeds•bos#1=tst also fiIloutthe sw6cabdowshav&g&&wmkme c®p—saianpoHcyin5=twuaa # �o submit r3ris af�damfi�rag 6ney sredaia�alf�cedc saddum}gxe a�der,.,,hsrt�,.z�y�saTamitanewaf�dsYit'mdicming sack. . ICo -M chedrM bmcmastsitachedaaaddiii®sl shed sImusagtlmnameofthe .sad stafewhetheror not 8mseenfitinh.nm emp99yees.If tbe.snb-taahac hM employees,they=msstpnnide dye's to udeets'—p.galiY number- I am art Re&ov is tfte pv cy nerd job si O inforrnatiort Insurance Company Name: P ficp or Self-izes Lim FxpirationDate: Job Site Address: ciiplStgelzip- Aftach a-copy of the workers'compensation policy ation page(showing the policy number and expiration date). Fail=to secure coverage as req=-ed under Secti A o€1MJM a 152 can lead to the imposition of criminal penalties of a ftue up to$L,54a OU indf'or one-�;10 ea-r- as well as rM penalties in tiie form of a STOP WORK ORDER and a ffme of up is$250-00 a dap agaias . B;41sdsed. a . y of this statement waybe forwarded fan the Office of Inves igationsof far , I do Irer- c under the all r:alms ' ry that the irtforma6m pm--W abmw is Gus and correct Si Date: f -17 24 f Phone 027ciaf use rarity: Do not write in tho area€rt be arrripMted by rite artown ojoic&I City or Taws: PPermif &ease;9 Issuing AuBror4(cane one): L Board o€$ealth '!.Building Department 3.C ityf rawn Clerk 4.Electrical Inspector S.Plumbing Inspector b.Other conftet Person Phone#- - — 6 ormatzou and lastructions LE&3=cl mcetts Coal Laws chapter 1.52 regm=all=pIopeas'fn pravide Workeas'compen%±M for ihelr employees- r pMMuantto this stafndn,an employee is dsfm ed as"_-eMy person in$ie service of another u der any cantcart ofhfi-q, cxPMss;or implied,Oral or wniften" An er TkyEr is defined as`°an individual,p ,assor�hon,corporation or other legal entity,or any two or more of the foregoing engaged is a joint eoitTprise,andmclndmg the legal representatives of a deceased employer,or$ie recejM or trustee of an filffV deal,per,associafion or o#herIegal entity,employing e<¢Ployees. However the Owner of a.dweUi g house having not more than thrw apartments end who resides 8ierein,or the occ Pint of the - dw.eIIi ng house of ano5xer who employs pessrms to do maim,raustacfii on or repair work.on such dwelling house 7d ng app ffieretD shall notbecause of sack employmead be dyed to be an employer." or on the grounds or bm MGL chapter I�2,§25C(6)also states$iat-everysfate or local li p�ageaxcyshalIwitiii�Old.$ie rssaance or renewal of a ticeaxse or permit to operate a business or to constrict buildings in the commonwealth for=7 applicant Who has not produced acceptable evidence of compliance tun the himu-ance.covexage required." Additionally,MGL chapter M.§25C( )states-Neither the amnaawealih nor my of its political subdivisions shall ear into any confront for the perflmnaace ofpublic Wads until acceptable evidence of campliancovAlh the msmance. regan-enie±s of this chapter have lieen Presented to the cnnfr�a athozdy:. ' Applicaa� , Please fill oht the wodmas'compensation a$davit completeln by cheakmg the boxes ffiat apply to your situation and,if necessary,supply sob-contzactm(s)name(s), addresses)and phonennmbez(s) along with then'cmtda e(s) of fimzance. Lmmmited Lia. dMty Companies(TLC)or LimitedLiabf7ity Partneaships(I.I.P)widino employees other than the members or partne as,are not rbgrmed to cagy worke&campensafion ihsmrfmce_ If an LLC or LLP does have employees,apolicy isrupired. Be advisedfaatthis affdavitmaybe snbmrtfedto the Department of Industrial Accidents for con—Ermation of insurance coverage. Also be sure to sign.and date the affidavit The affidavit should be retumed to ihe city or town that the application for the permit or license is being requested,not the Department of haastrial A=de-ts. Should you have any questions regardmg the law or ifyou M regairedto obtain a workers' compensation policy,please call fhe Department at fhe number listed.below. Self-insured can-pan cs should ear their self-insarance license number an.the apprapriadn line. City or Town Officials f - Please be sane that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to U but in the event the Office oflnvestigaflons has to coz>hmtyou regarding the applicant: Please be sine to.fill is the pen t/ cemse namher which.will be used as a reference number- In-addition,an.applicant that must submit mvlfiple pemulOicewo applitaiions in any given year',need only submit one affidavit indicating c rot policy information(if necessary)and un(ira`Job Site Addis"the applicant should write'all locations in (city or- town)-'I A copy of the.affidavit that has been officially stamped or ma3ed by the city or town may be provided to the ' applicant as proo-fthat a valid affidavit is on file for fufm a p=#R or licenses Anew affidavitmust be fIled ot±each year.Whew a home owner or citizen is obtaining a license or pexmit not=aired tD any bites or commercial v� (i.e_a dog license or pe mit to bum leaves eta.)said person is RIOT requircd to complete this affidavit The OfficeofJu figatiom wouldifimtotfiankyauiaadvan=for your cooperation and should you have any gaestions, please do not hesitate to give us a call. The Depsitmenfs address,telephone and fax number. thofMassachu ' Dawt eif Accidents �4 Akan Sizee� ,. T61.4 617727-4,00=t 4-06 or 1-&M MA SM� Fax#617'27'749 Revised 424-07 w -gQg Town of Barnstable Regulatory Services Richard V.S=14 Director 6�bs¢ Nua► Building Division: Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA M601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 .E,Property Owner Must z t. Complete and Sign This Section If Using;A Builder as Owner of the subject property r hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) , **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections,are performed and accepted. Signature-of Owner • .7 Signature of Applicant Print Name Print Name Date QYORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ,gin t Richard V.Scali,Director Building Division `* 1L4JV re1= Paul Rama,Building Commissioner K i639• �� 200 Main Street, Hyannis,MA 02601 Fps www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION -7 DATE: Please Print / Z0.� JOB LOCATION: Z g 1 5C tf-&V L- $ Co m r number street village "HOMEOWNER": CrAof65 tIONmlcoa c 6;0 -zo r S - name home phone# work phone# CURRENT MAILING ADDRESS: /6 Jff/5 Al/fY ; 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 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 re s risibility for compliance with the State Building Code and other applicable codes, bylaws,rules anZregulations. Th rsigneerti7fi that he/she understands the Town of Barnstable Building Department minimum inspection roce es and a he/she ll comply with said procedures and requirements. ature of Homeown 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 ��+ G ` � . , � �� �'�� ST-,ec��- �T. S�ra � -F- �-+�,� �° 4��?��_-�-(v 4�G� Parcel Detail Page 1 of 3 v� "'� .� .. p. e, {� . Wa i.,:)Cj gCii Ii'i A5: Parcel ®����g Tuesday, Se()telYlb IL�JJ Parcel Lookup 71 Parcellnfo Parcel ID 020-103 Developer Lot PT OF 33 & 39 Location 281 SCHOOL STREET Pri Frontage .100 Sec Road GROVE STREET Sec 200 v Frontage village COTUIT Fire District COTUIT Sewer Acct Road Index 1433 ~ �, Lnteractive Map Owner Info owner CHANDONAIT, MC &WILFRED & H TRS Co-Owner Streeti 22 JEROME AVE Street2 City W NEWTON I state MA zip 02165 Country - Land Info Acres 0.46 use Single Fam MDL-01 I zoning RF Nghbd 0108 Topography ,Level Road ,Paved utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year Roof' Ext 1955 Gable/Hip Wood on Sheath Built -- -- I Struct Wall Effect Roof AC Area 824 .._.._... Cover Asph/F GIs/Cmp Type None style Cottage Int Plastered Bed 2 Bedrooms Wall Rooms Model Residential Int Bath '1 Full _ Floor __ . Rooms Grade Average Minus Heat Hot Water Total 4 Rooms Type Rooms _ htip://issg12/intranet/propdata/ParceIDetail.aspx?ID=931 9/16/2008 Parcel Detail Page 2 of 3 ;a r qgf � t Heat _ - Found- Stories 1 Story Fuel Gas ation -Typical Kv 8 � �yy Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 3/30/2005 12:00:00 AM Paul Talbot Drive by inspection only 9/5/2002 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 11/19/1999 12:00:00 AM Paul Talbot 3rd Visit-2nd Notice Left 10/21/1999 12:00:00 AM Martin Flynn Permit Entered 6/1/1999 12:00:00 AM Frederick Stepanis Meas/Est Sales History Line Sale Date Owner Book/Page Sale P 1 6/7/1999 CHANDONAIT, MC &WILFRED & H TRS 12322/132 2 10/15/1993 CHANDONAIT, MARY 8820/250 3 CHANDONAIT, HENRY J & MARY 701/176 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2008 $75,000 $2,300 $0 $251,000 ; 3 2007 $75,000 $2,300 $0 $251,000 4 2006 $66,700 $2,300 $0 $235,800 5 2005 $63,800 $2,200 $0 $157,100 6 2004 $56,700 $2,400 $300 $157,100 7 2003 $41,100 $2,400 $300 $87,300 ; 8 2002 $41,100 $2,400 $300 $87,300 9 2001 $41,100 $2,400 $300 $87,300 10 2000 $33,900 $2,000 $100 $52,300 11 1999 $33,900 $2,000 $100 $52,300 12 1998 $33,900 $2,000 $100 $52,300 13 1997 $32,400 $0 $0 $52,300 http://issdl2/intranet/propdata/ParcelDetail.aspx?ID=931 9/16/2008 Parcel Detail Page 3 of 3 14 1996 $32,400 $0 $0 $52,300 15 1995 $32,400 $0 $0 $52,300 16 1994 $34,400 $0 $0 $58,900 17 1993 $34,400 $0 $0 $58,900 18 1992 $39,200 $0 $0 $65,400 19 1991 $45,300 $0 $0 $69,800 20 1990 $45,300 $0 $0 $69,800 21 1989 $45,300 $0 $0 $69,800 22 1988 $38,600 $0 $0 $32,200 23 1987 $38,600 $0 $0 $32,200 24 1986 $38,600 $0 $0 $32,200 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=931 9/16/2008 Building Detail Page 1 of 1 e � . 4 a eat. 2gai, Logged in As: Building t 'i l d!n g Detail Tuesday, Septemb Parcel Lookup Parcel Detail Error: ILtoadOBGrida EXECUTE permission denied on object 'getOB , databasi `TOBI—Production_P'roperty', owner 'dbo'4 Building 1 of 1 #& + : 717 �' # # �^ ' , Iy Code Description Gross Area Effective Area Living Are BAS First Floor 780 780 FOP Open Porch 221 44 Extra Features Code Description Units Unit Price Year Built Value Commen FPL1 Fireplace 1.00 3,000.00 1984 $2,300 Out Buildings http://issgl2/intranet/propdata/BuildingDetail.aspx?PID=931&BID=965&N=1&NN=1 9/16/2008 f ) �oF z r� Town of Barnstable �ermit# � 0 'es 6 mort from issue date Regulatory Services HARNSTABLE, F n Thomas F. Geller, Director b Building Division Pro Mai �. TOWN op Tom Perry, CBO, Building Commissioner BARNSTABLE' 200 Main Street, Hyannis, MA 02601 www.town.barmtable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number l)!A 16�-1-1 Property Address 'j( �6(A St' �(S�Vi� MAr-Irs 2/Residential Value of WorJ 1 hn a� Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address otu L �• Q1 c _ Ft ��� �>�T Vn(A SS o( �1 yea _ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ 1 have Worker's Compensation Insurance Insurance Company Name Workman's Comp, Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ' . t"jL T Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e:Historic,Conservation,etc. **tNote: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE:. ��`` ave � . OAWPFILESTORMSIbuilding permit forms\EXPRESS.doc The CommonwedIth of Afa-ssachusetts Departme7ni of Industrial Accidents Office of Investigatzons 600 Washington Street Boston, MA 02111 Tj www.mass.gav/dia • Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumberg Applicant Information NaEaf, /' Please Print Le 'bI (Business/Orgauizehanllndividua>): �U ` City/ tate/Zig: �t-/C Ff�'U� MK 61-�rk Phone.#: 7 00- Are you an employer? Check the appropriate box Type of project(required): L❑ I am a employer with 4- ❑ 1 am a general contractor and I 6. ❑New constriction employees (full and/or part-timL).* have hired the sub-contractors 2[�I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship andhavcnn employees 'These sub-conira.ctors havo g" El Demolition working for me in my capacity. etr�ployees and have workers' 9. ❑Building addition [NO workers' cOn1p.?n�rrranr_C Corp-insurance$ 5. [] We a c n arc orporatio and its 10-[]�Elcctrical repairs err additi- rtgtrrrt l] officers have exercised tbrir l L[]Plumbing repairs or additi 3.❑ I am a homeowner doing all work aryself [No workers' comp_ right df exemption per MGL 12-[ Roof repairs , in srttanCe r t c_ 152, §1(4), and we have no � � employees. [No workers, 13.❑ Other comp.i-nnn-ancc required_] 'Any applicant tlut checks box#1 unsst also fil out the roc orn below sbowing their waic='coropaua-tion policy infmTmtion. t Hort=wnM%who rubmit this a$davit indratinK fiiey arc doing d wnrkand then hire outside contaLinrs must rubnrit anew afdavit indicating wrl, i—_=tractors that cbmk this box umrt avamed an additional sheet showing the name of the sub-cmjrarurs and daft whether or not host cntitics have cmployaer. If the sub-contsactnrs have atPloyccs,they must provide thCil warkaz'comp.policy numbcr. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site ixfarmafion. Ins i ancr.Company Name: Policy#or Self-i_ns.Lie:#:' Expiration Date: Job Sits Address: City/sta_tc zip: Attach a copy of the workers" compensation policy declaration page(showing the policy number and erpiratiou da Failurc to secure cavetago as req lil- d under Section 2 5A of MGL c. 152 can leaA to the imposition of crjmi A pan itics c 5nn rip to S 1,500.00 and/or one-year impriwonmcn�as WcU as civil penalties in the farm of a STOP WORK ORDER and of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Offico of iuvcstigsEons of the!)IA for insvramr.coverer c vcri-ficatigm I da hereby c J Urx the pains-and penalties of perjury that the information provided above is Prue and correct Dates: Phoact6 q73^Y�PO` G!R/G - Offidd use only. Do not write in this area, to he cornp�tted by city or fawn offaciaL City or Town: Permit/License# Is:gTdng Authority(circle one): 1.B•oard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspecto-r 6. Other Town of Barnstable pp SHE r� Regulatory Services satuaszes>e Thomas F. Geiler, Director � MAss. $ Building Division prEO �a Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: 5087790-6230 HOMEOWNER LICENSE EXEMPTION //�� Please Print DATE: n CA-, w —a0G " i JOB LOCATION: O �00� IS+ �T ci Po number stre-et vvillage � ..HOMEOWNER":Po i f ' (u ndom to `p-)f_—3Va—I qc�_o `� `L /6 e—4G� name home phone# work phone# CURRENT MAILING ADDRESS: a na 0 rLCtd + h)oUQa mass olya=o city/town J 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 PCrSDn(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/she understands the Town of Barnstable Building Department . minimum inspection procedures and requirements and that he/she will comply with said procedures and r irements. 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 shill be exempt from the provisions of this section(Section 1o9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homcowncrshall 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 scrious.problems,particularly whcn the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would Hith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the bomwwner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the r=ponnbilitics cf a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a forrr✓certification for use in your community. a °FtK�r y Town of Barnstable RegulatoryServices EARNSM Thomas F. Geiler, Director _ Mass. YQ p 163; 9. L7JFb ,(b Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r , as Owner of the subject property heteby 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 Ovmer is applying forpermit please complete the Homeowners License Exemption Form on t1fe reverse side. a ' � � � -� f t E 3 .� i � � � i;' � ' � a • � :�: a � ' �. ti S � � ; i � v �.. ;. � � r � y t t 4 Y C 5 It i e r 6 4 cI a G L�. f t 1 � Y t. • r—Ir' S �,� � . s ,�... �...npy:.n�. . I `f�--� � I T i F i i F I l G L 7 { t ..... z —`��2� i 3 { t t { a rl + k b Y yy �� 3 t S d : fy Yq • i a o. p • 9: - a k o F - Y q t� y,���}�,1 f S a S F ti P Y 1 ,' � �.:� e. . 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