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HomeMy WebLinkAbout0290 WAQUOIT ROAD .,.:�9v z. ��� .� . i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . r3 Map f����ee v6 Parcel 070 �k,`,? L� "a:�'a :,,r�l Permit# 4 c5 Health Division AIW63 oo- Date Issued c'S'� 03 Conservation Division S�L Application Fee Tax Collector — h� ©IG 5 ��3 Permit Feb :Z) 7 Treasurer n2 k [� —S5-1 �"" 1 SEPTIC SYSTEM I! UST BE ` INSTALLED IN COMPLIANC., 4 Planning Dept. WITH TITLE$ ENVIRONMENTAL CODE ANt_ Date Definitive Plan Approved by Planning Board TOWN RECUUTIONS Historic-OKH Preservation/Hyannis Project Street Address 2v f D Lot Q Village e6 tl V It Owner j�� ���L Address Telephone Permit Request 30 >< ��� �C�'�YJfA 0 1'1 0l/Ch Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay .Project Valuation 13, �Jbb 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: 0 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 0 No Fireplaces: Existing New Existing wood/coal stove: 0 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 BUILDER INFORMATION rr Name T Telephone Number (T co'CP(a(o{) Address 2 d ' I�� );Or. License# c� 0`tl "�' q� NV�Ke;To jl,:;? Avg I I le7 A Home Improvement Contractor# I Worker's Compensation# tl�EJ"lu ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Aa� s SIGNATURE V • DATE ®� FOR OFFICIAL USE ONLY ` RERMIT NO. DATE ISSUED -� t. MAP/PARCEL NO.. 'r J' ADDRESS VILLAGE i OWNER T + y DATE OF INSPECTION: f FOUNDATION ��'® • FRAME ®kc, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH; = FINAL— GAS: ROUGH `. FINAL _ FINAL BUILDING t DATE CLOSED OUT -- _ - ASSOCIATION PLAN NO. - r The Commonwealth of Massachusetts Department of Industrial Accidents ` = office 011oyestl98t/0/IS _ 600 Washington Street Boston,Mass. 02111 Workers Cam ensation Insurance Affidavit name location. 2q o W D ,t- �d ' ci hone# ❑ I am a homeowner performing all work myself. Q lam a sole r rietor and have no one workiu in ca achy an em to rovidin workers' compensation far my employees working.on this job. •::.,•..,•,:: I am yerp g ...................................:.:.:...::.� ...anv comtl :>...:• }.. �••d ss r"el re ih { •:� }}}:4v4 y A ::: �.�. .::.�..:::..�::::::...:::::::.}..........................:��.:.. ..:..: all #... :iii3siranze�co:«;»:: �'>s.•.• ;;: :-�::«:':<::: :::;.:;<;.::;•,;.::.>;;>:.}::.:<.;:..::..::.:,.::.....::::::::::.:.............. ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have win workers' co ensation polices: :..................................:............... ..........;. e folio mp ....................................::..........::::::::...:::;.:.,.......................................................::.:.......:,..•:4,...•.:M•n:•:.:,..,:.::..: ..........................................::..:...................................... :...................::......................:.:::................:......:..::::. >:s <: r; : :\ ..4}: :;!!•}}iti^};3}}:i:;U.;•:;•i}:';•i4::!r.;}is:;•::?}}}}}}.;.:•:}}i:}:;^'4i}: :•::}:• Y� an :name : :.................:.:.........:...... ........ .. ::... 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S;:;;:?+.'•;:?;+:%':"-'.%::?`2<"':`: '"::: :''' ti' %}'" :'::::;y�`;�:;�: y':>; S:Srf'%`:: •':<::tiY•t%;:£ y';?yes:?:y' <����:':t>�:::: . ddress:: �}. 110 II >•Y: Z:fi::'''::: ;; ? ? ii�iii'i^'?�'`�+"iii`: }i '<i�i �uara�ceX. �. Bajjure to secure coverage as required under Section M of MGL 152 can lead to the imposition of criminal penalties of a Hue to$1,500.00 and/or one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me- I understand that s copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby fy under the pains and penalties of perjury that the information provided above is true•and correct . � 1in Date Signature ,l Print name t e7�/ `' r/Y 1W 1 l� _ Phone# � y rdty,ortown: se only do not write in this area to be completed by city or town ofiidal peradt/license# ❑Building Department ❑Licensing Board if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other orvised 9/95 P1Au Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an 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 section 25 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,.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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplyingnames, address and phone numbers along with a certificate of insurance as all affidavits may be r,. company an Y ,;R or confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Accidents f -t:- 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 `Uw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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 Permrtliicense number which will be used as a reference number. The affidavits may be retmrned in the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. '�Departrnent's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of insestigatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FZKE, � Town of Barnstable Regulatory Services '* BAMSTABM ' Thomas F.Geller,Director - 9�p 1MA9S A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-962-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.af Woz'k: 19)`x �� ��'�.Y tip 2 Estimated Cost AddressofWork:Zvi U t- rd� Owner's Name Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: - Z�o� ( c� Date, C ntractor Name Registration No. OR Date Owner's Name RESIDENTIAL BUII,DING PERNHT FEES APPLICATION FEE New Buildings_Additions $50.00 68 ®� Alterations/Renovations $25.00 . Building permit Amendment $25.00 FEE VALUE WORKS ET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES (attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming-Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee �oFT► �o<,ti Town of Barnstable yP �„ Regulatory Services * En MAS&LE, � - Thomas F.Geiler,Director 9 AS3. � `bprfp y 9.r a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 t Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A. Builder I, W VY . , as Owner of the subject property hereby authorize � to act on my behalf, in all matters relative to work uthorized by this building permit application for(address of job) d Signature of CvYner Date 00\061 kJC WW Print Name A L 212. 96 A UOITQ N82 27'10 E LOT 107 20 17 ----- ---- -------- 0 0 ✓l. I&I—OftaAeallll 7 aauaclucarlta �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration. 131841 Expirafio.n 9/26/2004 Type private Corporation CENTRAL CAPE CONSTRUCTION 9ftWEN DEVLIN...: 261 BLACKTHORN DR. MARSTONSMILLS,MA 02648------------ BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR � i Number: CS O47993 i I Expires: 02/04/2004 Tr.no: 15943 Restricted: .00 STEPHEN J DEVLIN 261 BLACKTHORN DR ( � MARSTONS MILLS, MA 02648 Administrator tl i PROJECT.TITLE id CA Fu _.i.. -1C..._ . 02s3S i . - r- � i.� __ liNtiTr (rnc:.CrO rs •. ( a + s Ttv ( PREPARED FOR S _._ TM . 1 .._.. .SCat.e�SN i>✓S off. Central Construction Company, In Sreve D.,&n•.Pre ide r.. 261 Blackthorn Drive•Marstam AM,MA 02649 508-420.1340 SCALE _ O , I DATE DWG NO. DESIGN CHECK f DRAWN - .Jas NO SHEET OF PROJECT, TITLE - �. •�i CONh.I.I^hitS. - l�4 n4 F-au, cc k� IZYYY• �[]N GnSTC. I � - -._._ 9C f'GWL YF- -L"rk'rlaN 1 1A4'�= M• se., _ I - PREPARED FOR r , _ tEtti Fu.nt C� -Glwd . -ff �� Central Construction Company, Steve Devan•RztiGGnt CGI�M ti L 261 Bla"orn Drive•Marslosss hulls,MA 02648.50SA20-13 SCALE. . DATE DWG NO. I DESIGN T.-W-WLP. CHECK PROJECT TITLE n..ntu. .aupos t Ack of µay j i .. . _ DSO S 4g�+ .tLh,.. .. .. '. . i COT.,,n., mAz5 Q263S 1 a 411 v: - fiflcasues �r._2<lo wl I OJri� w•.LAdg i 12-tv Co � c *vrtc� j � P vaT i 3 \b �r +jea., pi3L- tj 24z y--^_ VWyL2 tj,`3=v) . 1 0. a cX wl rophar� )Uof 4 I t(011iwtn2S .c _ 3z',•o PREPARED FOR r Gu Ir oU. " G - - SO FFGi VcvY - $tj . 2: rtc �C Gsj �.L GuPPt'1C H�ti br er,sTJ , - Central Construction Company, Steve Devlin•Pr-a dery �1SGe�� S(nrt�'�rScc-Sgre�n(�,- _.-- • i 261 Bladctham Drive•MarstansMflKMA02648.508420.13, T e- Io PT lirvz D - r DATE DWG NO. 1 DESIGN u. 3 CHECK -- -r— --�-----...------- _ i DRAWN s»,v^ '..rate,.. ,� �� •. ,..., � .�,. ... .. �� � .. , .. .«e , ,_ .. ._ _ ._ ___ The town of Barnstable BARNSTAHLE. Department of Health Safety and Environmental Services Y ?LASS. 0 1639. �0 `�plEDMA�p Building Division 367 Main Street, Hyannis,MA 02601. Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: L-e-4'- Map/Parcel: C)-?CD Project Address: U0I Builder: �J i` er\ The following items were noted on reviewing: 5J u+�c ' rrlu YY-ue__ reCG . Gr, rV f e.t - V 00 Yh0-5 f tutu';bon gey,ko r- bc, t4-5 ot" ©tke f C,C(-el- m>m 1"h o C� ( m�rnbPrS 'SznnI,rtc, lobr,, cno cc.b(t enc) ni + GS Gn tx ".C)6 Cob+ Reviewed b n Y Date: ( J ( Q V q:building:forms:review i Town of Barnstable *Permit Expire� months jr issue date Regulatory Services Feet * 1AMSPABIE, i 16 9, Richard V.Scali,Interim Director Building Division ® SS PERM Tom Perry,CBO,Building Commissioner JAN 13 2015 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us OM MP20AIA N SYAB E Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 24 0 G'1 -(Wo 11 ND- rc,)Lt &/Residential Value of Work$_ (7T®�� 0� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address G.L. /�%M &drf (.t/AL,bVGVt/] + 2--Gj d �,® a-GAO U 2 I Q. soul Contractor's Name Telephone Number �y C q( Cp4u� Home Improvement Contractor License#(if applicable) Email: IGoJ Constru n Supervisor's License#(if applicable) ( UI orkman's Compensation Insurance Check one: ❑ I sole proprietor ❑ kdmthe Homeowner ' I have Worker's Compensation Insurance Insurance Company Name 6 L(GMA -1,10LAq UA Workman's Comp.Policy# A) CC, 0 Q `S)Q'L I f l 20 N A 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 ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders..U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 required SIGNATURE: TAKEVIN_Muilding Changes\EXPRESS PERMITIEXPRESS.doc Revised 061313 i sA MAeLE, ' ,� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO 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 I � iW ,_�L cy� T�TC- ill GotTI ,as Owner of the subject property hereby authorize �l�,►� I4 w V J`OV 1'J to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Z Signature of Owner Date . Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_MBuilding Changes\EXPRESS PERMIT\EXPRESS.doe Revised 061313 I , The Coniniounwalth of Alarssachusetts 4� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AAA 02111 w#wv.ntass.gm,1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectiiciinslPlumbers Applicant Information �^ Please Print Leeibl�- Name(Busines. Organization+Tndividual): G10C CCAj C J)�,V uny d, Address: (/l'l a City/State./Zip: I'. ✓V► 3oive##: t)-) 6- 66f�C� Are:yo n emplo3'er^Check the appropriate box: Type of project(required): 1.M I am a employer with I am a general contractor and I 6. ❑New construction . 4. ❑ employees(full and/or part-time).* have hired the sub-contractors '2.❑ I am a sole proprietor or partner- listed on the attached sheet. y- ❑Remodehng. ship and Have no employees These sub-contractors halm . 8. ❑Demolition working for me in any capacity. employees and have workers' (No workers' comp.insurance comp. t 9. ❑Building addition c insurance.- required.] 5. ❑ We.are a corporation and its 10.❑Electrical repairs or additions I❑ I am a.homeoumer doing all work officers have exercised their 11.0 Plumbing repairs or additions self. o workers'co right of exemption per MGL c. 152 1 , I!.[]Roof repairs insurance required.]_ ,§ (4}.and have no employees.[No workers' 13.0 Other comp.insurance required.] OAny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hide outside contractors Must subnait a.new affidavit indicating such. 'Contractors that check this box mast attached an additional sheet showing the name-of the sub-cont[aztors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I Ant an employer that is proWding uvrkers'cottrpensation insurance for n y emptot^ees. Beiotr U the policy and job site inft7rmation. , Insurance Company Name: - t S S 6 e_ �,l(c r cl t-nrLA`7 e".j Policy#or Self-ins.Lic.#: W GC 59 U SOCA l q4' 7 0 1 4 A Expiration Date: Job Site Address: 2,q Vlf Wdy o I i U• City/State/Zip: (27V i 1; 01A iS O631— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine up to S1,500.00 and/or one-year imprisonnwnt,as well as cixil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the,,iolator. Be advised that a copy of this statement may be,forwarded to the Office of Investigations of the DLA for insurance coverage.verification. I do hereby certify ntider the pai d penalties of pednty that the irrforrrratioit prot.7de-d a bon a is true and correct. Si titre: Date: / Phone#: O O tciat use only. Do not swite in this area,to be.completed by cit�t or tatvn offciaZ City or Town; PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inslector 6.Other Contact Person: Phone#: Office of Consumer Affain a dBusiness Regulation 10 -Park.Flaza_Suite 517G Boston,Massadhus ,,0 116 Home Improvement QgiM4Mr'Regtstravon Re cgistrat o' 13 r6'41 V$ t T ateCorpmtion irafrom 13Y 1'(l16 Tr# �6305 -• �r:v. ��� t CENTRAL CAPE CONSTRUCTIONCW, STEPHEN DEVUN �..: 820 MAIN ST_ COTUIT, MA 0263 ` Update Address acid retwm earn mark-a zas�rn far change :kddress #t Renewal Jl E-mployment n Lost Card # F:J��e�tf�rrvrcrrccerr�f��f��`�irR�ae7arr�e%�., =` _pflFer ofCanr�m s_4£fairs&.l�gssv Reg:tac oa I.fieense or Tegistraflun vmfid for indhidul use onh; Y.g�'F;[9i}f33`lil.l�.E:IIVy1�F�itt31lOYIE U CONTRACTOR T before t�h^e(+eafr ration date. if fdTmd.retuT}n}�to: q .�,1Ql�.gfJRt4UMY ;;941 y4m: Office jai Ca:nsumer L`m.'Y3:ah-s. ���fER'gniaLio ^-�Expira m 6 Private Corporafion f't:Parh-�'l=-Sni11e,S Y 70 r= Boston.MA 02116 CENTRAL CAPE CONSTPAXT OTMCO.INC. STEPHEV D-EVUN 820 MAIN ST COTUIT,MA 02635 Underseua;; Tv Bali$mvithan#suture Uassachusett-Deptrnent of Public Sates � Board of Building Regulations and Standards } License. a snWEMN g ?gV7{, ♦ d .d CotWt lilA 41263 Client#:384M 2CENTRALCA DATE(MWDDNYYY) ACOR& CERTIFICATE OF LIABILITY INSURANCE 12/01/2014 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(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NASA Dowling&O`Neil No .508 775-1620 No•NOTT81218 Insurance Agency E4WL ADDRESS: 9731yannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIL e Hyannis,MA 02601 INSURER A..National Grange Mutual Insuranc INSURED INSURER 6:Associated Employers Insurance Central Cape Construction Company,Inc. Iti.StiRER c 820 Main Street INSURER D: Ciotult,MA 02635 INSURER E 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 CONTRACTOR 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 POL IC EFF Y EXP L.MARS A GENERAL LIABILITY MP197640 1/14/2014 11/1412015 EACH OECCCURRREENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY M ES Ea a° $500,000_ CLAIMS-MADE IX OCCUR MED ExP person) $10 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRC4,r El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMrr ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED %ODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraoddent 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE- $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC50050091992014A 5/1412014 05/141201 X WC STATU- OTH- AND EMPLOYERS'LIABRJTY EEL- ANY PROPRIETOWPARTNER/EXECUTIVE Y t N E.L.EACH ACCIDENT $500 0 0 OFFICERIMEMSER EXCLUDED? N I A (M ya en adatary in NH) EL.DISEASE-EA EMPLOYEE $500 000 If ,describe DESCRIPTION O r OF below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attadr ACORD 101,Addltbnal Remarks Schedule,If more space Is-quired) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained In the cerdfioate of insurance shall be deemed to have altered,waived,or extended the coverage provided.by the policy provisions. CERTIFICATE HOLDER CANCELLATION ANY OF THEJames and Meryl Kaye THE SHOULD EXPIRATION DATED VE THOEREOF,E NPOTICE WILL BEAN CE C EELLED LIVEREDOIBE N 125 Mayflower Terrace ACCORDANCE WITH THE POLICY PROVISON& South Yarmouth,MA 02664 AUTHORRED REPRESENTATIVE B 1988-2010 ACORD CORPORATION.All rights reserved, ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1421491M142148 LS1 �w .Y� ale S(f�r J n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �.��� ��n( �ParcelJ Permit# � Health Division ��� �® Date Issued Conservation Division 3 L 00 Application Fee Tax Collector J Permit Fee c ®O I—j Lq SEr 7� CYvT��� E,71UST OE Treasurer R I1123F11LEO IN COMPLIANCE Planning Dept. WITH TITLE S Date Definitive Plan Approved by Planning Board ENVIRONMENTAL COCE AN[TOM REGULAMNS Historic-OKH Preservation/Hyannis Project Street Address C\cc , )Qyv-, 2(1 Village " -+ S h S Owner mm 5 L I Address !S6 A__- Telephone Permit Request rQ E Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. r oject Valuation b Construction Type l-rn Lot Size Grandfathered: ❑Yes r ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes M No On Old King's Highway: D Yes VNo 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: CiGas ❑Oil ❑Electric ❑Other Central Air: D Yes "V No Fireplaces: Existing New Existing wood/coal stove: ❑Yes D No Detached garage: LJ existing ❑new size Pool: ❑existing ng ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing D new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 41 No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name se Telephone Number Address /69 old1'(���: License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE IZZ24 DATE , f 'ED f) FOR OFFICIAL USE ONLY PERMIT NO. r DATE ISSUED < MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL F - PLUMBING: ROUGH FINAL GAS: ROUGH' "' * ' _ FINAL FINAL BUILDING t ' DATE-CLOSED OUT ' ' F ASSOCIATION PLAN No' ' O I' ; The Commonwealth of Massachusetts - --il WERE.- --= Department of Industrial Accidents -= elffer ofINIV85� 899Hs 600 Washington Street =-. Boston,Mass. 02111 I Workers' Com ensation Insurance davit iff name: \n ki 11-c("'Ay 13 location: �b a C)1 a1�7a `Mn,(IM Q A . (3 D-(0' hone# am a homeowner performing all work myself. . I am a sole n,etor and have no one workm in ca acity %%%%/%%//G% %%%/��%%%%%%%%%%/%��%%%%///%/ //O/%%%///%%%/%%%%%/%%/%%/%%%%%%%%%%%�%%%%%%%�%%�%%%%/////%/G%%%%% ❑ I am an employer providing workers' compensation for my employees.working on this job. :::.:.:::::::::: :??::}}::.::.:::.::.::?::?::::::}:::::::::.. `:;}Sn2C . ;>:.%'i"i'{: ::.:>'i*-X-..-:.:` :::i%%:i;i 2`iiY: i :: ! ji`:i2 %:: [ ^i`;i i2; ?i':ii: is<?:>>:>?i k::'it:is?:?:::ii isi?i;i:: ..:: ;> t.i 2 :::.:<:t i+:'?<:^? ?.....:.....::::'t2 j>:.:i i.i 3?< comnanv n }}:: 'C1tYr;:s?<i`: `> %?:`riiy.: i:;:%%:2F?<ifi p hn ................ ::.. ����������������� n ,or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices; : - : :: .... =M ::::::i::i;::::'t:::::::'}::;:i:}:i:::::}};:.:.}:.;::;.:;%.;}}:}}:?.}:.;:•?ii:i::}:•i:::-.ii}::::.}}}:.}::.: }:.::.::..:}}:}}::.}:.}:.::;:.}::a::.;;:{•;:•}..;:..;i .:}::.;:} }.::;::<.}:;.::.;:.}:.}}:;: . :camaanyname.::::.: ::}:;:::::i::<:......;;.} «::::.:}::}:};::;':<>:}:.;............}::: ::;:}<}::.,;:;:.;:.<.;. :::::: :;:::;.: 1.:::::<:i:::::ii<:::>: ........ :.:.:.:: X. ::?.: . :.:: . ...........:.::.::..:::::::.:... ::.:::::.::::.: .:::;.;:.::}:.:.::::.::: << . . : .......::.. adress ::?:::;.:;.;;.;:._.::::;::;.:: pt ::.}:.:?.::. ::.}:.;<:»:<:>::}: 1. :.::.... ..:.:. ... t:n.:. i:::•:::•ri:i:::;::::i:;:•}};}:isiii:>.::?::::: :ii:.::.;;:;::::::;:::i:i:::;;:;.::::}:i;:::;ist;:::::::;:::;'::::;:::i;::} ::::}> :......:;:<:::fi:::i:.:::i:;::i::::?:i<::i:.}::}::.;:;?:::R:;?;.:.:;:: {.:::. :::•..::•:.:::.::::•:}}}:^::•.?^}:^}::}::}i}i:v.�}i:•; }}}ii:::ii:•:iv}ii:::ii+i:?4:•iii:1<-.—..i:!?:iiiiii::i;:ii{::}:::{:'iii'::::`i:::iiiiiii.--,-,:::::::*,::.,.-,-. ::}}ii.}: .... .......................v .........K:::::::::::::::::. • fj :::}:.�::n:::•:::::::v::.:.......:...... :. :::::. }. :': •:. t n; ?:;y....ti::!.y:;:i::?{:l?t:::i::::i:ii:i:::; ...--...ii::-->ii}':::':::v:::iiii}i i:hi:? .'#:':*.:+4}:^:?: .}•:.:gin};.}::::.}::::.::ivi}•.....::......::v.....::v:.;...::.... ..... .. .:n•::.:.......................... ;::.;.•:n..•;::..::::.::....{:.}v...nv:.:.:.::iG;:....•;:::••;i}:•}:•:?:.....is;...n.:::•;:.;:::::.�:::::..:;:n:v.}v yn;::.;::.}i:' .::.nw:::.:v.�::::n•:::.:.:::i}}}}i:'::::n..::::::..::n:.......::v:.....:::.::::..::.:::.:::::•.:::::.::.::.::.:•...:::.�::::::.�:::::n�::::::::::.�: t????•i}}:{{U??.}}:?•i}}}}:•}:i•}}:..::::::ii:::::...v:.::.:::::::::::::.::::::::•::::n�:.::::::::::t'i..i:•:4:i:�:•:??i}}}:4}:•}}}}:•:i•:::.}/:}}}:::{.};.;:::.i: {::x:.}:tiwn•::: ?•ii}:{•}}:ry}}}i.....:?•}i}}:{:+}:•}}.:.}:?:•}:?:}::.�:.�::•:r:.� ..a.•:::::•i::::::.:?•i:::.,..lb• .............:::::::..:...............v......n.......:::::.................................................•,v.......n................................. �{ r....... . ......................r. ....... .............................................:........-................................. ..............:.:::.:�:... v'S v.•nW:v>.}.Ain:........ ... .........h....r............ .............................................................::::::::::::::: .. ::•.:.............................:::.�.:.:.::.................................................:•:: :v::................ ::M:'.....•:;i:;ii ...... ;^:;:ii;:;.i;:.::%`:��::<:.i�:{.:::::isv`:t't:L:::`:::::•}}.:?»::;:•:?::::;:;i:f ii}:}i:.... 11 h3nrartceca>:..:.::.::.:::;.::,:.:;:::::.}•.r,::;:::...:....:.....::......... .:..::.:.....:.... ..,..,.::: :... 81rca .:......... .: : I%:- ::..... , : .,::::.. .'.....'.. .�.. ....... . im=: :c an nam };:::;::.::;: addiess. _ I. bn ::.::::::::::.::::::::.:::.::::::.:.::.::::::::::.::::::::.:::::::::::::.::::}•:.:............................ ............. .. ::::.:::::::::.::::::::::::::. :::::::::.::.:::::::.::::::.:::.. ....:.......... ...::::.:...:.:::.. :.;..:....:..............................................................:.................::.................... ::::;::::;:::;. ::;;;; :.. M a+'': ?:z r'....::.... >:,o ,.. :»:.: »s ? > " > ;t;:;cO ..:: <"? `?i > y '>'; iis:i ?a< ;; >;t i;; <2<ii.is;<> < :';>r'?::i<:> :i;; ?=?<i;'<i niraace i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is taro and correct Signature !� Date - 9-6� Print name2L_ J4Li Phone#�--� 21- �� . official use only do not write in this area to be completed by city or town official • city or town: peradt/license# ' ❑Bonding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectinea's Office ❑Health Department contact person: phone#; -- ❑Other____ (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an 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 section 25 also states that eve state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants z. Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation.policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. '�Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Otflce of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 f °FtHE lti Town of Barnstable �P Regulatory Services snaxsresr.E, ' Thomas F.Geiler,Director - XAM sbj9. Building Division AIFD Ma't°' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-962-4038 Fax: 508-790-6230 Permit no. Date3�'),� AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: Estimated Cost Address of Work:% Owner's Name: Date of Application: - _G I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ! Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING TEEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IlYUROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date• Contractor Name Registration No. OR -�-03 Te Date Owner's Name 4 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOVMRLICENSE EXEMPTION Please Print JOB LOCATION: ' number street village "HOMEOWNER!/,_, Ao'et<!2d Dp' 6�- `t S S 6 name //�� �'home—phone-# •work phone# CURRENT MAILING ADDRESS: bC Yn 5� r 1� city/town state zip core The current exemption for"homeowners"was extended to include owner-occoied 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 work12erformed 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 B am table Building Department minimum inspection procedures and requirements and that he/she will comply with said proc ores and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a fnrm currently used by several towns. You may care t amend and adopt such a forr/certification for use in your community. E �b= COLG"/?� 77�s .. �a� lcArCg��iNy 16" Zx I 20" �GLL �SE�1?LeAI f' - EX e i ,r TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION Map d 6' Parcel iJ 70 . Permit# D � Health Division 6,4 ����. f�Date Issued l J, Conservation Division Fee- Tax Collector 1 �hc�UPn':'cI " Treasurer i �� 1�l �i�LLE® PlanningDept. i 1�✓IT►� _ 'TiTLE 5 p � .. E6V901R®1YARE111T AL C®® AGED Date Definitive Plan Approved by Planning Board 6 T6l�ON ND ; Historic-OKH 3 Preservation/Hyannis i Project Street'Address - �w Village fc4l � Owner ddress Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Z D b Zoning District Flood Plain Groundwater Overlay 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 O 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:❑exi ' g't3 new siz Attached garage:❑existing ❑new size Shed:❑existing ❑new size Ot Zoning Board of Appeals Authorization. ❑ Appeal# Recorde ❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION / Name4,61,_44 �4 C:- Telephone Number i Address License# yU r ' � o, Home Improvement Contractor# Worker's Compensation# Gr/G 'Z 916 6�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE 5 ' FOR OFFICIAL USE ONLY _ ..;PERMIT NO. DATE ISSUED. - _ _ t i � ' • •' � s ' ` MAP/PARCEL NO. ADDRESS rJ VILLAGE OWNER _ J I e•} DATE OF INSPECTION FOUNDATION V , ; FRAME t INSULATION F FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ; ''; FINAL GAS: -ROUGH ► FINAL FINAL BUILDING DATE CLOSED OUT 4 ASSOCIATION PLAN NO. ks The Commonwealth of Massachusetts T — Department of Industrial Accidents Offrce ollolyestf atloas ' = 600 Washington Street ; . Boston,Mass. 02111 , Workers' Comyensadon Insuranccee Affidavit ri OO FirTil�� rirfritO Y/� name: locations a ZZ) /- 7 city 6 i� hone# / �' O . ❑ I am a homeowner performing all work myself. ❑ lam a sole ro rietor and have no one workingin any capacity ��%///////////////%//////////Y% //%/%/%%////////%/%///%/%/%//%%////%//%%%////%%///%/%%%//%//////%///////%%/////%/G//%%///%%%//////%////%%%/%////////////%%%//%%%%////%%//%%%/%%�/ I am an employer providing workers' compensation for my employees working on this job. g con anv name: Z addre_ s� city: //�/`//Q¢ /�� �( ►)6L? � phone #: CJ� '"�7�.' s J insurance cn. � policy# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractor listed below who have the folloNOng workers' compensation polices: companv name• address. city phone#- insurance co. >'.: . . olicv# iiiiiiooiiiiiiaiiiaiaiiaiaiiaaiaiiiaiiii�///iii companv name- ::... address: city phone M # ltu olicvorancrco. .. .... >. ... :... ..... ...% Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a ane of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and pen 'es erjury that the information provided above is true and correct Signature J > Date Print name G1!/1&Z-/r4`tom/ Cr!-; "L 7/2 - Phone# oincial use only do not write in this area to be completed by city or town ofltcial city or town: pertnit/Ilcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone# ❑Other . ..., (evusa W95 PJA) oFTMF The Town of Barnstable • IARNSTABU& • Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name: ��SL �I G't.�.GY l? t P )� I Lon C_f Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:fbnns:Affidav '• °--.�,�` mat �;r"3� r ME 1INPROVEMENT;tON ACTOR,�4 Otrat on12049 . YPe=�`��tIDiVPDUAI �` ��,z fxPirataiion�2NAM /i9/99 , rn * £ LIRM�SCHULIE �ItIILYAM�L ;SCHULIE ' �ce�.°o'�i"��€6mpOX 288/ 65 CROCKER ST �"- k"D"�" " �EHTERVIIl� MA 0263� -- ,� fie �am��na�uueall�i a�-Z ,�uJel1: DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION;SUPERVISOR LICENSE Nu�ber Expires: Restricted`To 00 YIILIAM;a� SCNUl1E PO V r *CENTERVILLE, MA 02632 RESIDENTIAL ADDITIONS OR ALTERATIONS If located: ❑ North of Route 6 - any work visible from outside- needs approval from OKH ❑ In Hyannis -If work visible from outside- Check to see if it's included in the ❑ Hyannis Historic Waterfront District-if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: Map/parcel number Sign-offs fro Health VConservation(if exterior work) []� Tax Collector Treasurer Street address Owner's name & address Permit request- full description of proposed project ❑ Square footage -proposed project Estimated project cost ❑ Complete Dwelling information for Assessor's Office Builder's information Signature ❑ --Plot plan ❑ 2 sets of reduced (8.5"x 11: or 8.5"x 14")plans with cross section&aming schedul [� Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name &Worker's Comp policy number ❑ Energy Compliance Form Copy of Construction Supervisor's License &Home Improvement Specialist's License OR Homeowner's ❑ License Exemption Form. Fee NOTES: CHIMNEYS ❑ Need Home Improvement License ❑ No plot plan required PIERS & DOCKS ❑Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS 1 Rev 12/14/98 01 ` P�OF7HET��� f TOWN OF BARNSTABLE i BAUSTMi, i + 9� DaYp��� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...� ....:..J ................................................. • .TYPE OF CONSTRUCTION ...:....<<S/.P..oj... ,/.�f�N-t.�.....:.41 ., .........". ..../.t/....................19. 2 TO THE INSPECTOR OF BUILDINGS: `;6 The undersigned hereby applies for a permit according to the following information: Location ..............�.Q. .r.zo q ...... .o . .�d!.T..... .;iTA .. i .l r/..l!9,tt9 `............":.!'.. .U.�.�.l ProposedUse ............ . .......... ................................ oo Zoning District .............. . .... '"..........................Fire District ..... .1760.. v.J ................................ Name of Owner .... /V.....Address .LLQ? .47/U. ^..... Name of Builder ... ........Address ... �....:.J.. ! �*�.lG..(rY/..j�':�! � Nameof Architect ....................../...........................................Address .................................................................................... Number of Rooms 6 .......................................Foundation ...... Q. G f�2....Cd.o/Uc�l� ~T..; .. A _ Exterior .........Gc�..4. �. �........1..1`l�/. G L..E:. ...........Roofing ..............�qA.S ' ?` ................................ Floors .............!'�`�/.P° .......................................................Interior .AP. ' :/T . /. Heating ....... ./��^.- !� d. ' ' r ..�,'' G ............................... ....C:. ..1� T..:....r�..!1�..............Plumbing ........../..� .f.�................... I Fireplace 1 ......Approximate Cost Definitive Plan Approved by Planning Board -----------____---------------19--------. Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH - J, ts1 W rs , ,r, w U) �67 0 C z i M 2 ) LL LL0 mO o-a Z �, w >� 0o ci �1ir� I Z�r.m act LU ZDW w y � � • e r tLI Fes•- 0 �-'_ I hereby agree to conform a all the Rules and Regulations of the Town of Barnstable regarding the above construction. .................. a€ Haley, Miss Marion 4 one story No ............575...... .Permit for .................................... single family,dwelling ....... ��6 ...................... ... Udefquoit Road i,` • Location ............................................................. .. s Cotuit ............ ... ......................................................:��.� ' t� Owner" Miss Marion Haley-- p Type of'Construction „frame F ... .... ...................... . ................ { Plot ............................ Lot ........#107.............. 'r\ Dece be I Permit Granted .............. A .. ...x...$...:.....19 72. r 1 Date of Inspection ... .... 7.3..AFI�A^b I Date Completed19 `—� PERMIT REFUSED ................................................................ 19 .......................................................`...................... ............................................................................... , ............................................................................ r 1 r Approved ................................................. 19k ............................................................................... Y f WAQUOIT ROAD N 82°27110"E 212.96 N O� SONO"D�TION F0� EX,STING G w D 4 °o 0 14.0' N � o o tTl HDUSE Np.290 LOT 107 33,400 SF 114.78' N 82°2T10"E "I certify that the foundation shown on PLOT PLAN OF LAND this plan is as it actually exists on the LOCATED IN ground and that it conforms to COTUIT,MASS. Barnstable zoning regulations f Mrs PREPARED F O R yard setbacks." �� DAVID c'� CENTRAL CONSTRUCTION CHARLES 1:51 _ _ ' ��.�. y' L.IANI CKI ATE:JUNE 10,2003 SCALE: 1"=30' date.June10,2003 28085$ ��r �� �o� APE & ISLANDS ENGINEERING floodzone c[non-hazard] ss�o�c/STE MASHPEE,MASS. L LAW waquoit rd 290