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HomeMy WebLinkAbout0031 CHILDS STREET r / d n .. ,. i a v i,.. — e �, e - n ., a ,. �� ,.; - u �. Assessor's offioe (1st floor): C OVOTEM MUST B Assessor's map and lot number r�.�.�....�.G I ALLED IN COMM .................... THE T ° Board of Health (3rd floor): WITH TITLE 5 d �" Sewage Permit number ..... Engineering Department (3rd•floor): WAROHMENTAL Co® �o 9Ta L0� House number ...,. '�.l..K/.... ��639........................... ........ p YAK APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF B INSTABLE BUILDING INSPECTOR J. APPLICATION FOR PERMIT TO ...- ...................... TYPE OF CONSTRUCTION :.. !°����.....f ..................................................................................... ------..... ................. ......9.Z(5. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................................C-V.........................V............, ....................:........................... �J�/ , itf Proposed Use ...: .... ........................................................................................................................................ Zoning District ...... _ Fire District ..... Q .................. (�. Name of Owner ..�� Ys� � �7(�1....C�.:......Address .. ...�• �X...95 C!�! � 'i v� .. ...... .. . .................. ............ ..... . ... Name of Builder ...............�!./.. ....................................Address .................................................................................... Name of Architect ... ....R /�S .........................Address .....407.0.E 7.......................................................... Number of Rooms ...... ........................................................Foundation ...../o.(,j ....... o/� ............. Exierior ��/ I-50 /�A.....I......5!l./!V.64F. ..........Roofing ...... N T................................................... Floors. .C4I1.f. 1J4K.... ...0!�L.L...............Interior .,. 1! �...... .....am ....................:........ Heating CJ ..... �P� ......../.[.t✓.�.....�iU 7 1�....PIumbing ... {1 .:..T....!:;tOmFz<.. ......... W 02. . .... .T/y5..� FireplaceNc TO.... .>; ... ...05)�.ul /L..........Approximate Cost ...... f!f .................... .................. . Definitive Plan Approved b Planning Board --�PPT --19 6/-- pP Y 9 - Area 5'So't fl Diagram of Lot and Building with Dimensions Fee <........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 'V s� o (01 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r _ Name ....✓.: .......................................... Construction Supervisor's License ...14. .6.y5'....... BAYSIDE BULL' DING CO. 30899 N .. .............. Permit for ....9ne... Y......... Single Family Dwelling........... .......................................................... Lo Location ..........t.......�.f......�3l Chi- ds Stree-t .............A,................... Centerv.ille ...................................... ........................................ B a y.s.i d e Build 4 ng Owner ............... .........................:i%.. ... Type of Construction ....... ...................... ................................. X PI 6t ................:.................Lot ...................�1........... june 23, 87 Permit Granted ........................................19 Date of Inspection .......I.......�Z2 . .........",,19. Date ompleted ,fit:IA�7--14 n ..........14�, t12 6A M �P a L/9 Assessor's offioe Ost floor): — piTNETo Assessor's map and lot number . �G� L_ P �♦ Board of Health Ord floor): o Sewage Permit number .......O,C .....r.......... .... .......ew Z 33AHII9TADLE. S Engineering Department (3rd floor):. °oo 11 IL s, 3 House number `e........................................................................ CFO YPY a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO Cv..e(/5,7/ lJC,7.,,...../f ,,,;S/!v�o ✓�L� � h'I/C y.... F1d#r� ................. T it TYPE OF CONSTRUCTION ...�,4009A.....6"' ......... . ........................................................................ ............................. ....., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby-applies''for a permit according to the tfol,lowing. nformation Location .� � „• ,I �L: S....... . .......... .:. :.....:f. ........... . . _l c c:G_. ProposedUse ................................... ................................................!. !r �,•° ,t✓ ZoningDistrict ........................................................................Fire Distract ...... .r.....................................::...:.dr..................... Name of Owner �� 7 S�� e4:X6` j CQ:......Address .. :..�: QX 57 S CF—iV74�Z V./3/141�: Name of Builder . .. :'fJ2 Address -g - /.�......,.p..... '../....................... ................. ..................... v ................0............ Name of Architect ! I��NS.. /,....r.:.f................Address .....4070.07......................................................... Number of Rooms ............Foundation .....�Q ..•,.,.C. �/L/G/ZF�7 ............................................ Exterior . 14-f i ! ................................ .......... Floors , ,'� .V� 7L .Interior .. /l/ ............ SU� -t� �J . ........... J%.. �` C�'.Y. ................... `.............. Heating t�, S ... � ..... ,N .7 r4z�s' J'..Plumbing ... v�....y.... 0���� .......... ............. :. Fireplace ��N�i�FT ... ..e...` ....4.9A :I ..........Approximate Cost ...... C�G!�.�'�I..................................... Definitive Plan Approved by Planning Board _- PPT g 6 t,� ------------------I 9---�-- . Area .......................................... Diagram of Lot and Building with Dimensions / Ya /f Fee SUBJECT,TO 'APPROVAL OF BOARD OF HEALTH L 14 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of B�ble regarding the above construction. Name .... 7.4/N re ...... Construction Supervisor's License ... 4 G / 51 ........................ . a _t ^ BAYSIDE BUILDING CO. � A=249-1 � � No — Permit for .... }la.Q.—�G±ozy. ........ ___S ' Ie_�.��\����_��Wye.jlino__.. Location .....I,gt...#.! ......3.]...[biIdz...Street � -- .............CQ.13.tarI[iIle.............................. C)vvne, .......84-YAi.d.e..]3ulldj'zzgc'Co......... ' Frame � Type of Construction -------------- � --------------------------' ~ Plot ............................ Lot ----------' Permit ^ ,onxe6 ......... iun.e...23.............lP 87 Dote of Inspection ------------lg Done Completed ------------'lV ` ` ° � � - _ ., .-.- . _ .�' -.s. ;a:';R-�^tr�^47'L-'.a..:;,r,,,is,{,mot' -r,.:r•"xb ra.fW`+r"h :s..R.�:d, .A,.,}^<.lr.C--•Yi •.tai.,>tiYwbww.fM, yO!THE}0+ TOWN OF BARNSTABLE, Permit No. ,30.M...... BUILDING DEPARTMENT Cash .............. . {D°';a. I TOWN OFFICE BUILDING // �HYANNIS,MASS:02601 Bond ..... CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Buildinq Co. Address Lot, #l, 31 Childs Street Centurville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED -BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. October 2; .,, 19 g 7 Building Inspector t y ��..� °•°ew TOWN OF BARNSTABLE BUILDING DEPARTMENT = rssaSTAsr TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 �OII�Y 1' MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has beet issued for the building authorized by BuildingPermit #.... o...�....... ,/...................................................... ........... ............................. . ......�- _............ issued to"a 9!s vim. �E3 y C,,,o............ 1 4; I . 1 r,I A �c-v y� �:. . Please release the performance bond. r - Jill J- 4 4V t3F NS' §U, Ar4AS �;�3iJS i�� Jill .-...DATE .._... a'w_ ., r a: .h._ .19 APPLICANT tSaY'r�ldt l�iCl�;• Cu. ADDRESS �. C�. 13oit 95 r C-t..rltJrv1 1_lt� �iltlri� a (NO.) (STREET) (CONTI LICENSE) PERMIT TO BulJ:d -Dw'J�._1111C.( 1 "'•'- ^" !'::!•1..L`: S.Jt"fL:.1. :•1.-NUMBER OF (_I STORY _DWELLINJ UNITS II - (TYPE OF IMPROVEMENT) NO. . (PROPOSED USE) •�� ift.Ii.. 1�1 �iI C.1•l _L.�.t:: !'e .I`.. ZONING •i;•, AT (LOCATION) r --• - -9 -"c .i:�y1.LA. DISTRICT -�) (NO.) (STREET) ii BETWEEN AND 'NI (CROSS STREET) - (CROSS STREET) Jill SUBDIVISION LOT LOT _BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR ..C1 L.:! • V i% VOLUME ESTIMATED COST $ r ULIt3• FEEMIT 1 (CUBIC/SQUARE FEET) OWNERBU ADDRESS S �.-'. .J.�.:•. .Jr t_ �. BUILDING DEPT. ✓'w !it• i �) ij'P� t� 1 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS �j OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. -1 MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE _1 INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND .I I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. j - -,y3. FINAL INSPECTION BEFORE � - OCCUPANCY. . . POST THIS CARD SO IT IS VISIBLE FROM STREET - BUILDING INSPECTION APPROVALS ' PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I.. I .•1 2 2 ^r J2 Z, -_ 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT ILLI' OTHER BOARD OF HEALTH 5;1ol to zA0 WORK SHALL NOT PROCEED UNTIL THE INSPEC- P•E RM I T '+J!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES 01 WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR.BY TELEPHIONE OR WRITTEN' CONSTRUCTION, I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. k J Lf r rc$y k oL f M F oz G1v,99 S. , i Y �.w 1 t ra t the fA; . 3 0 ,o q{ A� 0 ^ i r rjeat 4 J LOT i 3 3 iy} I CERTIFY THAT THE a Y r ti SHOWN ON THIS PLAID IS LOCATED ON THE GROUND or ? R ' AS INDICATED eIN J � W m == 117IILC®/� fV 134 ATE REGISTERED ND SURVf~YDFt ; LEVY a ELDREDGE ASSOCIATES,INC. CLIENT Ys,o€ CERTIFIED LOT ,. ENGINEERS - LANDSCAPE ARCHITECTS JOB NO 1 120,,.,. �flS STR�E r .xt _A PLANNERS— LAND SURVEYORS ®R. BY _ � IN 431 889 WEST MAIN STREET CHKD. BY,, _. CE(VTER /ILLE, MA. 02832 S HE ET1C?F.1.... SCALE= go OA►TE= �vN�z2+�W H. s ZO N '� 1, 3 Lo T � r1: 20 PpotjTA(:�I_ 7 '+ s I25 viIt T"4 qy"X8585-p4tito 45s ;fyF Ass vM r- LoT L° F " S t co .. .•I� r", � '�� a yak; i DRaUr< ESTHF_-� L , PROP. LANK M:4nl ; , ' L o �;• . � r�EP.�1E Box t,eAc.N � + tarT 3 U" :Lo7 / 3 s F tom. t :. CERTIKY THAT THE 'PROPOSED BUILDING. °wrt SHOWN OWTHIS PLAN" CONFORMS :To THE ZONING LAW OF 8 s L , MA. ' LEGEND DATE, Z 3 � EXISTING SPOT ELEVATION 0 ' PROPOSED SPOT ELEVATION I �!�cP OF^'4, EXfSTING CONTOUR -- —— .PROPOSED CONTOUR 0--- q� DAViq P.' �5' a PAUL A LE . Nam + VY �MARIANO,. ; ,,, ,- NOTE: THE LOCATION OF ANY UNDERGROUND a No. Icsi7 ILn SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON civlL THIS PLAN IS APPROXIMATE ONLY AS DETERMINED 00 No.31115� CIO A FROM RECORDS AND/OR VERBAL INFORMATION. �a � � � {•� r= �/�. ;rR THE CONTRACTOR IS RESPONSIBLE FOR THE VERIFICATION OF THE EXISTING LOCATIONS IN THE FIELD. N I N y p '�'°r� {,•,r ;yet _ 1 F4 rJ "Fig LEVY a ELDREDGE ASSOCIATES INC. F �. t .' CLIENTPLAN. A ENGINEERS— LANDSCAPE .ARCHITECTS . 8 NO. f PLANNERS — LAND SURVEYORSiL DR. BY, ��"J �`�"�"""•""," 3 „� �` 889 WEST MAIN SYREET r CHKD.BY, % � MWERV I I.I.E MA. 02f 32 ET.,. � SCALE, �,«�;�'�' ��� r `• .,�.. DAT s '{ x `?;`, .r.J.i ra _ .. Y'�< •`'g ';4. �T�,�.���?�`.�+cir�i'�,w!r r^ « .d;�'��� H L.t- _ 7 ?V.&R 7-NjC.5—AF'P.r1d 7AoVo< IV074 /.,w el 7 20 P7. - A dtZr tVORE 77NAIV lz"SzLow . ZrACH1,oVa P17 o=7- -A- 40 aAAA6:.;A ?4",P1AAlE7ZR COVCR- =- COP. sc e 40 SWALL &AFeR0&4S.Y7- 7-0 P.v c. P/P-- WIN. AITCH xi,=-AVY Co4S7' 1le0W Coplle�I m SAIA I-L- a..-- 41se%0 JEL. /00, /.IV z;YTIVIEWAY CZ --AoV .5AAIP 2�00 C 0 K2FA, 46A cle)=l LIqUID LEVEL zvLAYER OF 11B, 1: MJN.pjlr4cw- D s-7n. # WASH-F-0 SMNe -SePrIC 7ANK AD O)e e WASAEP STOA40'.e S77,57 QrPZ> -5/x---? , x. PA-ECAS 7 ZRAa4 0 0 lvv&A-r ffA,-=-VA7'1,0,V5 -Prr cAl>Acq Ar -51 3 INMEXT AT ffillLDI)va p r C(,sro 7ABvLA-ri oA,�) -VK 16-,4er F7: PPIAM. hVI-E JzvrlC r,4. 40U-T4,67-SZP7'IC 7ANX '96 E Fr 40157R1'a&71'0JV BOX-p5'76 -,&7 . GROVAID WA7EX 7A S.E-C-7/O/v 0,0a S KS 7W/W 1,V4,e7- ILEACRINCr 40=".17' Fr EA CHI/V 4 5- JO/7' 4orr $CAL-E FT. DArSl6dV CR/-r,=.jq 1A DIMENSION 0 F7. CA R&A-GE P15PO-5-4 I- ZIA�7- So/z- L�0&- 7&,S7 7-0 7-A I etrl,%,j 7- L A-reZ> Frjo*V 0,41./ AV Soll 7 0/ 7US A E5 0 5 4ErZAFV- I/ I 7E 0. r vumaEA, c6x -Acviva P17:s--L— 921 '�-L IV .0A -- SO//- 7ES SIZ>--Z,--A CHIM6 X'.-.St A71 7- 15 5kq� --r ::;-i- .4RE5ULrS AV1rAl-=S5Z=Z> 40y 76-Al el-3 70v-sa,,4. 40 0 7-rom LA94 CA(INC- 19>0 R 7.- 'IA AAEWC0,4A770" RAT&A�l ^lj'v1-fjYCH' 011A '64 -,,ecoi -1aA(RA-rE Ika '44 I-eACHINC- ARE" So. 'F r. 77 )cL -A7 TO 7, -Z .. . k5o/L 7,42577 va 0 DAVID P. 5,�w .7-- 'JOARIANO Ln C3 civi N 31 0. LEVY & ELDREDGE ASSOCIATES. INC. k- '70NNA ......... 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632 NO Cr)?OUN4P� ;,V,47 eff -ffNCOU GAZO IJVo I-V.4-r--,Ir A 7- ,�Z-EV //70 J06 I'vo. --o-P -9=-- - Town of Barnstable Regulatory Services �tHE Tp� - P� Thomas F.Geiler,Director. 4; r fin,' , (ABLE Building Division sn[uvs•eesn - ?1178tl� 2 ' v M� g Tom Perry,Building COII1tIlMon Am, 11: i639• �� i°TEp MO;I 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: 5- Permit#: HOME OCCUPATION REGISTRATION Date:T�.��g Name:70_+rl Lt 6' L►mod o U_e-L.— Phone#: Address: 3( C,�. S" S k-YC 14 Village: Name of Business: f-+1 I P 4-e_r�_Hn 0f C_ e_ l/0 J Uv--V 0eZ57' k.0Gl k j f k yS c1 2 1 Type of Business: N -� vo w—S Map/Lot: t INTENT: It is the intent of this section to allow the residents of the ToMl of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 44.4 of the Zoning ordinance, provided that the activrity shall not be discennible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase im traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration wifli the Building Innspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling ulut;located«rithin that dwelling unit. + . Such use occupies no more than 400 square feet of space; There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. •' No traffic will be generated in excess of normal residential volumes. Tlme use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • `I'Inere is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of nornial household quantities. •. Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • 'There is no exterior storage or display of materials or equipment. • 1'lnere are no commercial vehicles related to the Customary Home Occupation,other than one vim or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked,on the same lot containing the Customary Home Occupation: • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address slmall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree writh the above restrictions for my home occupation I an registering. Applicant: \\1 G Date.: '7 lgq Homeoc.doc Rev.01/3/08 YOU WISH TO OPEN A BUSINESS? V For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which t1 you must do by M.G.L. it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, '1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) jCc DATE�1 1 Fill in please: APPLICANT'S YOUR NAME/S: AffilMU ire � k BUSINESS YOUR HOME ADDRESS: S 5RZZ �Vl -��YV t i YN TELEPHONE # Home Telephone Number NAME OF:CORPORATION: r NAME OF NEW BUSINESS d 6A a C TYPE OF BUSINESS 0� [rS- IS THIS A HOME OCCUPATION? L/ .YES ADDRESS OF BUS I NESSLLAI C.4 1 S C�rrE�r�.�t a A O P3 Ji MAP%PARCEL NUMBER 4cI ©� I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need._ You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S O E This.individual has beenjpVmed of y,permit requirements that pertain to this type of business. uthori i?nature* PLY WITH HOME OCCUPATION COMMENTS: RULES AND REGULATIONS. FAILURE TO COMPLY 2. BOARD OF HEALTH . This individual ha ee in r `eftothf ermi requi ement t pertain to this type of business. �. Authorized Signature** COMMENTS: . 3. CONSUMER AFFAIRS (.LICENSING AUTHORITY This individual ha blr n '��n'fo,rm'e `of.the lice e i ents that pertain to this e of business. _�/� g �r p tYp , Authorized Signature** COMMENTS: PERMIT PAYMENT. RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 07/29/08 TIME: 11 :41 ----- ---- -- ._ _TOTALS------------ -- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 ` CHANGE: .00 APPLICATION NUMBER: 200804066 PAYMENT METH: CHECK PAYMENT REF: 1836 f 1112/aq - Town of Barnstable *Permit# Do qomo& Expires 6 moist is from issue date Regulatory Services Fee r7, g Thomas F.Geller,Director Building Division ' 7.VY.s.c. .:;xi.;µ'—'ut:4a^+`F'�+'EMY.Y}` �SY3:!.'J.e^'::'a-x'3••ptrt..4... . �'A T Tom Perry,CBO, Building Commissioner - ER�''r'- 200 Main Street,Hyannis,MA.02601 www.town.bamstable.ma.us JAN 8 - 2007L Office: 508-862-4038 TOWN OF ���I�5-HgLE30 EXPRESS PERMIT APPLICATION` - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint r 's• Map/parcel Number°l.Lk q 001 t , �s � Property Address 01, tL'10 S n t,i t c3 d [Residential Value of Work 'p`l�7® Minimum fee of$25.00 for work under$6000.00 y... ,� t .j.. Owner's Name&Address Sk.7 t-:,N Ge-,Q- Contractor's Name —T Telephone Number Sorb I Home Improvement Contractor License#(if applicable) k2,601 Erj�, kw Construction Supervisor's License#(if applicable) _r *�'e Wcxtl �r ❑Workman's Compensation Insurance I - Check one: r..` ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 0 C—Z_".Le,`�� �0 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) 12�Re-roof(stripping old shingles) All construction debris will be taken to A dk_Taarrl� ❑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. ***Note: Property Owner must sign Property Owner Letter of Permission. t A copy of the Home Improvement Contractors License is required. i` SIGNATURE: Q:Forms:expmtrg... '' a;s Revise061306 F The Commonwealth of Massachusetts Department of Industrial Accidents• j Office of Investigations , 600 Washington Street Boston,MA 021I1 www.Mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address _ L ,C ,r� City/State/Zip: ' o `1A-oavt a.�,t_ Phone#•_. Go% `n S 4 y,q do A2 (required):am. ou an employer? Check the appropriate box. Type of proj ect 1. I a employer with 1— 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).*- - have haedthe'sub-contractors 2,❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees • These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp:insurance, 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its requiied] officers have exercised their 10.0 E18ctricalrepairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11,❑Plumbing repairs or additions myself. [No workers' Comp. c. 152, §1(4),and we have no 12.Moof repairs insurance required.] t employees. [No workers' 13,❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. am an employer that is providing workers'compensation in foamy employees. Below is the policy and job site . 'nformation. . nsurance Company Name:_Lta imm!i �L'r\)AA, 'olicy#or Self-ins.Lie.#:W >2 � � Q �-� Expiration Date: 'ob Site Address:at,Cp5` �K . Qgn ,"ki 11"A City/State/Zip ' 02taB'L attach a copy of the workers' compensation policy declaration page (showing the-policy number and expiration date). . railure to,secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a . ine 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office-of avestigations of the DIA for insurance coverage verification: 'do hereby certify under thepains andpenaldes ofperjury that the information provided above is true and correct li atureL Date: 'hone#: Official.use only, Do not write in this area,,to be completed by city or town officiuL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6, Other Contact Person: Phone#: -Information and Instructions - r�- e. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, 'L Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual;partnership,association or other legal entity,employing employees.,However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." .MGL chapter. 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate.a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)•of insurance. Limited Liability Companies(LLC)or Limited Liability Partaerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you-are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is.complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that-must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations.in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.There a home owner or citizen is obtaining.a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc,)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Co=onwealth of Massachusetts DepatmeAt of Industrial Accidents Office of Irwesdgatlons 600'Washington Stred Boston,MA 02111 Tt~1,# �1 - 7-4900 ex 406 or 1-$.77-MAS.SAFE Faxl 617-727-7749 Revised 5-26-05 WWWME -M&OVIdia 508 775 4498 FROM :0 KELLY FAX NO. :508 775 4498 Dec. 07 2006. 11:33AM P1 4 4 /64 OLWER KELLY 9 PEREGRINE LANE . SOUTH YARMOUTH PH/FAX 508 775 4498 M.A.. REG4128957 MA 02664 INSURED December 7, 2006 Proposal submitted to the owners of 31 Childs, Centerville Ma. We propose to supply all materials and labor necessary to remove and replace the existing roof at the address:_. All debris to be removed'jo town transfer. Aluminum drip edge to be installed on all eaves. Ice and water damage protection membrane to be installed-bn first ttre�feet of eaves and in all valley areas. Remainder of deck to be covered with#30 felt paper. 25 year limited warranty 3 Tab style shingle.to be installed. (Similar to existing) Bathroom vent pipe boots to�be replaced with new.. Cobra ridge vent to be installed on entire length of all ridges with hand nailed caps. Repair chimney flashing as necessary. Protect all walls, windows; decks, plants and shrubs etc. during roof strip Obtaining of town permit. At a total cost of$6750 For use of 30 year architect style shingle add$630 Payment Schedule, 400/9 with signed contract,balance upon completion. Respectfully submitted, Oliver Kelly "Proposal accepted y, Date t24 __7 /2006 If acceptable, please sign and return one copy and keep one for your records. This proposal is valid for 45 days from date above Boar MB tu fing"Re ionsAantan ards One..Ashburton Place - Room 1301 Boston, Massachusetts 02.108 Home Improvement Untractor Registration Regletradon: 128957 Type: Individual EVIratlon: 6/14/2007 Oliver Kellyy Oliver Kelly g Peregrine,lane S. Yarmouth, MA 02e64 ` Update Address and return card.Mark reason for change. [] Address Renewal [] Employinent [] Lost Card. DP8.OA1 0 6OM44/044101218 �"•�.� p.9QL0 VW'4lnOWDA 41noS euol aupoemcl g Y ly 14ION JOA11O t• ' t A1101 JOANO tanPiMpul scl ?f , . 98gZ1 :uoi�olBeN . aQl�ftjl LNIBVwd adINI7WOHSPJNPUW . • ���S° �pel°�°PgaB Jo paeog � . . Y andpiper Insurance Agency January 8, 2007 Town of Barnstable 230 Main St Hyannis, MA 02601 ATTN: Sally RE: WC2-31 S-338804-026 Oliver Kelly This letter is written in regard to the worker's compensation insurance for Mr. Oliver Kelly: Please know that his policy is effective from 12/28/2006 to 12/28/2007 with Liberty Mutual Insurance.Company: A formal certificate of insurance has been requested and will be forwarded to the Town of Barnstable via Liberty Mutual: Please contact me.if you have any questions: Thank You, Kurt M. Kross 12 Enterprise Road Hyannis, MA 02601 (508) 790'1919 Fax (508) 790-3560