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Home My WebLink About0020 CONNERS ROAD , 00(� C1rs. A .n T IL N ,l" "E } ° r e � 1 ° o o . o a o i ro Town of_Barnstable T _ Building tAe Post This Card So That it is`Visible From the Street-Approded:Plans Must be Retained on Job and this Card Must be KeptHARNim ; MASS ��$ Posted Until Final Inspection Has Been:Made ¢y r T,4' Where a Certificate of Occupancy'is:Required,such Building s •, " hall Not lie'Occupied'until a Finalanspection has'been made. �� l Permit No. B-20-1208 Applicant Name.: richard cazeault y Approvals Date Issued: -OS/12/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date` 11/12/2020 Foundation: Location: 2000NNERS ROAD,CENTERVILLE M'ap/Lot:,_251-066 Zoning District: RD71 Sheathing: Owner on Record: KENNEY,JOHN F&JILL ANN Contractor Name: RICHARD P CAZEAULT JR R Framing: 1 CAZEAULT ROOFING & REPAIRS Address: 20 CONNERS ROAD 2 .CENTERVILLE, MA 02632 Contractor License 168607 + Chimney: Description: RE-Roof Front portion of house only ! Est. Project Cost: $5,200.00 • • i Permit Fee: $35.00 Insulation: Project Review Req: _ Fee Paid- $35.00 Final: Date: 5/12/2020 r Plumbing/Gas Rough Plumbing: Final Plumbing:. Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after4issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final 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. 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 Electrical work until the completion of the same. Service: 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: Rough: 1.Foundation or Footing - -- - " 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 (3!J� CIL- Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT S Town of Barnstable Building snxxsrnsre PostThisYard So That it:is,Vtsible From the Street „Approved Plans Must be Retained ort'Job and this Card Must be Kept ` a A • Posted Until Final Inspection Has Been Made .` _ T' 1 Permit Occupied until a Final Inspection has been made'#Where a Certificate of Occu anc is Re uired-such Buildm shall Not be �- _ - Permit No. B-18-73 Applicant Name: FRAME 2 FINISH CUSTOM BUILDERS, INC. Approvals Date Issued: 01/19/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/19/2018 Foundation: Residential Map/Lot 251-066 Zoning District: RD-1 Sheathing: Location: 20 CONNERS ROAD,CENTERVILLE 3 Contractor Name: _ FRAME 2 FINISH CUSTOM Framing: 1 , . BUILDERS, INC. Owner on Record: KENNEY,JOHN F&JILL ANN r 2 Address: 20 CONNERS RD s Contractor License 169418 � � Chimney: CENTERVILLE, MA 02632 1 `Est Project Cost: $35,000.00 ¢ Insulation: Description: Remodel Kitchen,Take out bearing wall and replace with steel Permit Fee: $228.50 beam.Add footing and Lally column in basement for sd' brts fee Paid: $228.50 Final Project Review Req: A _ r bate 1/19/2018 h Plumbing/Gas Y J Y Rough Plumbing: Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorised by this permit is commenced within six'months"after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application.and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shallbe incompliance with the local zoning by-Jaws 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 A 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. Service: Minimum of Five Call Inspections Required for All Construction Work '- ' x r_ Rough: 1.Foundation or Footing - 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) .6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 CHRIELL-01 DKENNEYFIELD CERTIFICATE OF LIABILITY INSURANCE DATE 09 / /18/2017 017 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 have ADDITIONAL INSURED provisions or 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 - CONTACT AMEm FBinsure,LLC P 1C, ;(508)824-8666 FAX No):(508)880-0142 128 Dean Street t Taunton,MA 02780 Eo AIEss:infoWbinsure.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Ins Co of SIC 19259 INSURED - INSURER B:Associated Employers Ins.Co. .' 11104 Christopher Ellis dba Frame 2 Finish Customer Builders INSURER C: 25 George St p INSURER D Plymouth,MA 02360 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 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 -TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICMMIDDrrfM Y EXP LIMITS LTRrCOM A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE❑X OCCUR' . S2187164 07/16/2017 07/16/2018 DAMAGE TO RENTED 500,000 MISES(Ea occurrence) $ MED EXP(Any one person $ 15,000 i• - - PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:' - GENERAL AGGREGATE $ 3,000,000 X POLICY[X]JE4 FK LOC, PRODUCTS-COMP/OP AGG 3,000,000 OTHER: ' AUTOMOBILE LIABILITY - - ED acc aED;ANGLE LIMIT ANY AUTO - _ BODILY INJURY Per erson $ OWNED SCHEDULED AURTOS ONLY AUTOS yy p BODILY INJURY Per accident $ AUTOS ONLY AUOTNOS ONLY - - PROPERTY DAMAGE - Per accident $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ - EXCESS LIAR H CLAIMS-MADE _ - AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION X I SERTTE- OTH- AND EMPLOYERS'LIABILITY - U WCC5005012305 07I2412017 0712412018 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE,Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBE�Z EXCLUDED' N/A 100,000 (Mandatory m NW) E.L.'DISEASE-EA EMPLOYEEI$ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Christopher Ellis,sole proprietor,excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Wareham THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Memorial Town Hall 54 Marion Road Wareham,MA 02571 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) I j ©1988-2015 ACORD CORPORATION. All rights reserved. Shea, Sally From: Chris Ellis <frame2finishbuilders@comcast.net> Sent: Monday,January 08, 2018 3:54 PM To: Shea, Sally Subject: 20 conners rd Sent from my iPhone Begin forwarded message: From: John Kenney <iohnfkenneyl 17cr gmail.com> Date: January 8, 2018 at 2:12:46 PM EST To: Christopher Ellis <frame2finishbuilders2comcast.net> Subject: Re: F2F-KENNEY.pdf Contract attached. Let me know if you need anything else... Thanks. John On Mon, Jan 8, 2018 at 1:40 PM -John Kenney yohnfkenney117 gmail.com> wrote: Looking into renting a storage trailer for driveway for furniture, etc. but need to know when all needs to be out and for how long?Also, when/if it does come, where would be best placement in driveway to not be in your way... On Thu, Jan 4, 2018 at 3:22 PM, John Kenney<j ohnfkenney I 172gmail.com>wrote: Thanks, Chris. After reviewing, you forgot to omit the paint(which we'll take care of). That should bring the total to: $34,790 (counting the high for allowances subject to change). I can mark those changes up and sign unless you want to send over new draft...When should we expect work to begin and be finished? And re: prep of home beforehand, what furniture do you need removed from house and when? Looking forward to how great you're going to make this place look! .1 o n. On Sun, Dec 31, 2017 at 7:43 AM, Christopher Ellis <frame2finishbuilders a,comcast.net> wrote: john your price has gone down with the floor, plastering and engineering coming down or off of the quote. this is all in there will be some stuff hidden that we cant see that is why there are allowance. so those could go,up or down depending on what we find. the window was ordered so that it.will be here in time. did that like two weeks ago. should be in in the next two weeks. 1 On December 26, 2017 at 12:40 PM John Kenney <johnfkenneyl 17Qgmail.com> wrote: Mr. Elllis, Hope you had a great day yesterday....still waiting on your final estimate—Would love to put this to bed soon for our budgeting purposes... John On Wed,Nov 29, 2017 at 7:25 AM, Chris Ellis <frame2finishbuildersgc, omcast.net> wrote: Sent from my iPhone 2 accordance vvith the arbitration laws of thy:state of ghu ts. 1be arbitrator shall licensed attorney or retired judge who is fionfliar v ith construction law.if the parties Cal mutually agree on are arbitrator within.30 days of written demand for arbitration, then eii the parties shall submit the dispute to binding.arbitration before the American Arbitratitr Association;in accordance with the Construction Industry Rules ofth6 erica Arbitr Asm,xiation then in effect. Judgment upon the award maybe entered in any Court arrin jurisdiction there C if we prevail in any legal prey ling related to this Agreement we entitled to payment of reasonable attcrrney's Fees,costs,and past judgment interest at thl rate. We appreciate thy;opportunity to prestent this proposal and took forward to working wif this in the near future. This Engagement for Services es will remain dt +dive for 14 days t date above atiC1 rae ane Fut y to acf rep .q. . ions or eonop yup may haver a project lest*o . . Frame 2 finish Custoin Builders, Infra I have read and unidertitrro and 1 agree to, all the terms and conditions contained in the Agr nient above, DAITF: Frame,2 Finish Custom Buildlem, Inc. - DAV Ow,net 3 f g FO. S 't14 a .MA, 2' Engagement f6rServi.c.csDATE: December 31,2017 Homeowner; John and Jill Kenny address 20 C;onricrs Rd Centerville, MA. e are, pleased to provide you with this outline and agreement for services as descritwd The Summary Description of Services highlights the major elements of the project and t services we will.provide for each phase: summary ►eseeiptio"ofservk& l��trt` 1 Remodel:the"kitchen* We'Wiil be To re li the ur►tertcs,,ca btrrts and all shhetrwncic : the . We will thean re- a th opetm to the lcitthen by talon out the main suppo w :between kitchen and hall .l will n��l:my engineer to Come cut an, d sire the steel s; are sure that it cat support the'Nvici h oft e second.fluor cif, abd hn +e proper dMumentation for,the building insp tear. We will'have to saws cut in a footing into the t pour concrete and add a lady column. Mien this goes in we will do everything we cant of'the dips and bows in the floor that.are there now, 'During this stage we will also refrat larger window above the sink., and install it. After the re-firamirig is complete a.nd the ho Imck to straight as possihic we will have the electricians in to run the wir. for the tinder lighting, reces—wd lights and pendaint lights. Also at this time; they will run outlets to whr island is going atttd any other place needed by Vie. Nest the plumbers will come in and any of the;pies that Nve find in the wall that we are taming out; and the FIVAC guys in to the rectum that will be iri the..way ofthe.island.. C.rrce the_subs are finished we will get tht in"Od on so thaf wvc e sty cicasitag err itr drat It aip, lltl ning plastt�r rs irti to bar mutt theWalls and ceilings,, an, any other.,holes.we read along the.way to run piles i vents.ea, Next will be tk 'n g ys cote i,n and install bard* flooring to matoh e istin .urt C.plan s we, t i"patch. can also cut in flu h tuoitnt floor grills at th.i, that boy wiril',l to t h the rs ply and not protrude out opt top. Also urirt this t kilthei �hiti will by able to ga in anti� plate for thin countertops. O the lei' installed we will cot a bac and install an,y additib al trim that needs to be done and hay itiaint.-rc in CA Y1atnt tho te'iiAon :UA nlmd Uixe ins wv'ti^vn ''T*to %tit s'r—mt,ac.-alt thi #*4.** 4 fIcKyt guys will come back and s d and finish all the floors on the tIrst t1oor and:two set stairs. Very last think the painters will come hack and do any to that need to be I Demo and disposal $ 2,42 5,00 2, Re-frame,(steel beam installed) $ 4,100;(tt) 3. Basement work. $ '1.335,00 4. Window re4rame new LVL header buried $ 1,210.4 5.. Window st 1 685.Q .6. HVAC:relmatim 650.tDtt 7. E lectri al(Ii trn ;rwire relc tion, outlets) 4j:00.110 allowance ' l'lutr In (pipes ruoved,,fi. ttk'hc �kupi`ect 2, 44.0t 11 t an ): L Iue board an Master patched; � 1,35tI.06(a11owonce)';` l(1 c� °Incar°(mnt�il� install, sated t�nih,gills) 5,�2�.� t 1:Flush mount flo,or.grilles S 700,11+ 12.Trim (ba-w boardl wiftdbw trim iiht x ) t855.00 13. Bac.ksplash material(tile,anastic. grout) 600*0 l(al owanc ) 14. Bac:.kWsplash install (h« ic; install) 980.00 15. Paint(walls, ceilings, trim) 1 ). O+P $ 4,980_tif A Total � Payment Schedule "I`RO when scope is selected *'T`his Agreement will expire 30 days after the date at the top of page one of this rontr� t accepted in writing and.returned within that time. ;standard Xcl.asions. Iuiiless specifically ally incl trt the"l e rrpti n of S r�icc ' act above, this �ernent do ;s Wert rnclti Iabdr or materi'als 6r the fcll�win r�rtr�:Cush milfiM of any:WO.Od for Moving Owner d thesite. ,Laho mates is required t "repair car r pl:t—e Anyll ei i*ie teat rrals tit�u rat"exist) cif plumb or out le ,et`WMIt, art it e tst p structure.Cbtiv,ction-of concealed.slibstm. framing.-Rerouting/removal of Vents� i s� uek, Ametrtra1 rn to �rq,g or t:ondU11 nteslf. rhie may discovered::irt tl e' ;rnrx it 0 walls ttr the Cora', oaf t p rain iri a1 Removal and replacement d exist.m rot or insect infestation. Failure dfsurrounding r rexisting structure, despite good faith ei °nrts.tn minimize,damage; such as plaster or dry cracking and popped mails in adiacent.rooims or blockage of pipes of plumbing fixtures c loosened rust within pipes, Exact matchin ol'existin; f rriah€s r pairttirt ; r tYnisla3.ng u: specified above. Charge for additional work con, sled conditions, deviations from wope of work,., Changes in the work 5 finishes a pc sed to surlli ht a all ty ical 11 t material defect t W rarer strut otr, y 6rtstrictl fr ; EXPRESS WARRANTIES CONTAINED H.FREINAREIN UEU O ALIT OTHER. WARRANTIES, EXPRESS OR.IMPLIED, INCLUDINCo ANY WARRANTIES GT MERCHANTABILITY, HAnn-ARILITY,OR FITNESS F I A PARTIC LAR USE OR PURPOSE.THIS LIMITED t'EC WARRANTY EXCLUDES CONSEQUENTIAL,IINC.II3EIiI`I"A1,,AND SPECIAL,DANI iGES AND LtMrr.a THEDURATION OF IMPLIED WARRANTIES TO THE FULLEST EXTENT PERMISSIBtX UNDER STATE AND FEDERAL LAW, THIS LfM IT D WARRANTY SAY NOT BE VERBALLY MC3DWIFa BY Ali` PERSON. THIS 1,11AUTED WARRANTY IS GOVERNED BY THE LAWS OF THE COMMONWEALTH.OF MASSACHUSE . 'otor nder �Wafow of Contra f6r&fnult We shall h av�thelfight to step all work:on the prof+ t and keep the job idle Jfpayments Mad tc us icily tit aaee with: he I'aylxtcht'Schule trithisrmt,car it"yo rcpeterlly foal ol*reI'u to f'urr�ish us'vt oss is the dab siteand/Or prodact seleticn itlfar n t.ioni n Ce tTy I the v att �rrreut df otar.work. Simultancous vwitlistopping we project, a Will dive you writters rtoti of then e of'the material bf6d cif thi A` and d ill give you 1.l4 r`l zd xri Which i cair 'this Breach of con ract. You will,folk Barrie notice pro% lure with us i f yo al le.. ' rat tare�in in t rial'breach of this A r c I rwork, is stopped due tci any ofthe Above reasons(on foranyether mate al.breach ofet by you)for a period,of Id days; and the you have flailed to take significant steps to cure i default, then we may, without prejudicing ariy other remedies we may have,give written of termination of the Agreement to you and demand payment for all completed work am materials ordered through the date of work stoppage, and any other reasonable loss sust us. "I`frereafter, we are relieved from all other contractual duties, including all punch list Warranty work. Force Majeart Not withstanding the above provisions, neither party shall be..deemed in breach of this,ec for delays eau ed by.Acts of Cod or ether actions and events h yond:their indivii,.d I Severabillty,. If.puny e aurt cterttitrtes that", r provi ton of this nmAd is in lid or arnenlare err rnvalitlity or taper rah Itty dill vq. only that provision and.wt. not trta e any,other: provi inr�ofthis a r rn n. uvalid or unenfo le and etch provisi0 shall be rimodific lrlcn ed Or limited o'nll .tpo:ttthe extent` Bees ryt to reuder'it v4ti�l and rtfo�: ah€ : Dispak Any controversy or claim arising out ofor related to this Agreement involvi an a��au:r than $ , 00(or the rnaximurrt l mitof the Small Claims °curt)must be heard' in the S ai PYf t'ho M14C1"9°n Uitmeir%gl ('1111'a A».ir #4v;* mlo* ue.;'1 eti F'Fue. rro..0 -1t 6 conditions are discovered canoe w ork has commenced or after this Agreement is executei were not visible at the time this Agreement.was bid,we will point out these concealed,es to you, and thewconcealed conditions will be treated as additional work tinder this A We may execrate a>change order for this additional.work: We are released, held harmles< inafer raifio;cl by you fray aF.i p exrstin m U furigus, r�tla ew ,and organiepa.thogen P. and rta at respn rbI fdr etas air d tna s asothtexi with °. ;: ctir co..tainin test re le iatin the same. . iati tt t d p>tl n'crf ins: any atta�ratr r trr uviatican frrarrri'the l i scrtl Services referred to in this A reemlol invo vin extra coasts of materials or labor(includ overage on ALLOWANCE work and.any e.hangcs in the Description of Work required t your design prcrfessionat,agent,,or governmental plan checkers or field buildin inspect+ be treated as additional work under this Agreement resulting in ian additional char eto y forth herein, We may execute a change order for this additional work.. Payment additi m is dare upon cornpletican.oaf e-it er.all or part of the additional work and submittal of invoi WARRA TV Thank you 11br choosing Frame 2.Finish Custom Builders, Inc.. to perf. m this WO for you- Your satisfaction with our work is a high prio ity for us_ flowever, of tall possible complaints are served by our warranty. We.provide a limited warranty against material'. defects can all our suppli6d labor and materials used.in'this project fcar a.period of one y fallowing,substa.bal coMPIetia ra of a.lt wwror . 'F"tris warranty CarvOs rromaaal u s e only: You;must contact us at the adds pn page One ftbrs ent in writing fi6r warrant rtire irnrrtiediatdly upon disaver7n an items in raeed.cafwarranty service, ifthe matter' ureri,.ycru au. t 'Isca Alt ass anal send wrath nciti c�ftfe na�a� far wvrtant 'service: l salute to ht trfy irs oaf& need har,warra ty vi with tr terr buys oafdiscoverry ofa wa n item,may void Ibis ww rrnrrl�r �kddit ral)y, lairirr +�fcthers or direct actions by y.op or y cnar'separ to oarrtractors to repair a warranty.item_... are.n.ot ca.va'red by'this. warranty and will neat bad eimb rs d; No warranty is provided on any materials furnished by you fair instaallatio n. t o warranty is provided on.any existing materials that�trrnv�and/or reinstalled)by us Within—the dwelling or the property(in eluding any warranty that existing/used mat °als will not be darna ed during the removal and reinstallatiawn process).One year alfer substantial CAampletion of the proje." your sole rerrredy (for materials and tabor) Carr all materials tha are covered by a manufacturer's wararrarrty is strictly with the manulktu:rer,not with c.s_ Repair of'the 11611owin iterrrs and dated damages of every kind are specifically exclude ,from our warranty; problems caused by lack of mainten: nce, problems caused by abuse, misuse; vandal ism, modification.or alteration:n: and ordinary gear and tear. Mona es r ulting,from mold, fungus,and other organic ptho er.>s are excluded from this warrantrunless caused hy our sole And active rw t* ce as a direct resultofu. consourction:adef t wrrhia tt eaus d saaddert and sigrttel cant ncaaarts 0fwarater fittrzition into a mrt4the structure. t; viatio that.aria:strdlr as the minor cradkine..ofcorwret . , r l Commonwealth of Massachusetts lugDivision of Professional Licensure Board of Building Regulations and Standards ConstryiEti ir�S�S'FTvisor v\, Tf. CS-094024 �"` I 4�ires: 11/27/2019 CHRISTOPHER W,ELLIS y + 25 GEORGE j PLYMOUTH MAA C�I,SS'f�0 Commissioner ��ie tparnirrcoouue�cC�z a�C�aQatrc�ucaeG�a . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation E before the expiration date. If found return to: ,'Registration Expiration Office of Consumer Affairs and.Business Regulation 0018 06/20/2019 10 Park Plaza-Suite 5170 ME 2 FINISHEC:USTOIVIBl7fLDERS,INC. Boston;MA 02116 CHRISTOPHER 25 GEORGE ST `'',:u"= ( V PLYMOUTH,MA o23so= UndersecretaN Not valid without signature The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations _ 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization(rndMdual): /-; Ah-t. Z Irr..� to Cvs7�h LDS Address: 2 5_ C4a ze, S-r City/State/Zip: eZ o"n 1, AA OUG o Phone#: z r- y� Z Are you an employer?Check the appropriate box: Type of project(required): Iaj am a employer with ZL . 4..❑ I am a general contractor and I employees(full and/or part time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 'Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an t employees and have workers' � Y capacity.P tY• co incirrance# 9. ❑Building addition [No workers comp.insurance comp. required.] 5. ❑ We are a corporation and its 10.❑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 MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state tyhether 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 thepolicy and job site information. AA ` Insurance Company Name: Cl. Policy#or Self-ins.Lic.#:(�)GC.6'yo 5�/'2�o S— Expiration Date: 9/z—vzf Job Site Address: 26 City/State/Zip: w Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against th4ce 'olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' coverage verification. I do hereby certify unr and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#• ,5�k Re-2 EYZ L Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Perhrit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions Massachusetfs General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 emmplayer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shaIlwithhold 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 choddrig the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone mmber(s)along with their certificates)of insurance. Limited Liability Companies U LC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial should d date the affidavit. The affidavit Accidents for confirmation of insurance coverage. Also be sure to sign an Department of be returned to the city or town that the application for the permit or license is being requested,not the 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. s 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 permit(license number which will be used as a reference number. In addition,an applicant that;must submit multiple permit(license applications in any given year,need only submit one.affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town 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 Shed out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: The GOMMonwealth of Massaahusdts Dopartmont of Industrial A=deafis Office of InwStigations 600 Wasbtiugtor.WWt Boston,MA 02111 Tel.#617-727-4900 ext 4Q6 or 1-977-MASSAFE Fax##617-727-7749 Revised 4-24-07 www.mass,gov#dia �VKEr - MABB. ..................Other Fee........................ TotalFa Paid....................................... ......................... TOWN OF BARNSTABLE �..^................on....,Pe�Approoaiby...... ...... . ,�.. BUILDINGPERAj# APPLIC �� MV.................�..�................,�........................................... , . 0 a Secti 17VT� n Information and Project Location on Project Address ZD Village Owners Name Owners Legal Address CgAjzLaf em State - City l�'t.4 - zip Owners Cell# S2e- 6,yf- S-OLrZ E-mail Section 2—Structural Use C�; gle/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit ❑ New Construction ❑ .Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire'slractare) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar (IkRpnovation ❑ Pool ❑ Insulation Other—Specify Section 4—Detail Cost of Proposed Construction le- Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing I 4ZA Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design rust upaatz1-11/72017 /Section 5 -Work Description /lfh,ne4 L Ar 7'GA14✓ — /P/C.4 �l/� ��✓Ce'LL'�� J�I.L /'Zrc�✓C_aC c.� r Sv�oi�on.7- Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage . ❑ Smoke Detectors . ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑.Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site - Historic District ❑ Hyannis Historic District [] Old Kings Highway Debris Disposal Facility: I am using a crane C Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑` No ❑ i Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No Last iinrzoi7 Section 9—Construction Supervisor Name Telephone Number ,5W 9f-9 Address Zt'` rang, YS' City YA,,4h State AA Zip 11 U License Number&-o9'y o Lc.1 License Type L) Expiration Date 1i/ 710' Contractors Ema11 I understand my responsibilities under the rules and regulations for Licensed Constriction Supervisor in accordance with 780 CMR the Massachusetts State ding Code. I understand the construction inspection procedures,specific inspections and docamentation required by 7 and the Town of Barnstaable.Attach a copy of your license. Signature Date Section 10—Rome Improvement Contractor Name C6in.,rr CL,,TI Telephone Number_5?yy 9o� r—j ZG. Address -z 4 - Gc,�,, >4 SP City/foAj, k State,,,� Zip Qz_3l o Regi.st ation Number/G I yllj Expiration Date 4 �ze/g I understand my responsibilities under the rules and regulations far Home Improvement Contractors in accordance with 780 CMR the Massachusetts State ding Code. I understand the construction inspection procedures,specific inspections and documentation required b CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date zlr:: Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date AP LICANT SIGNATURE Signature Date i Print Name Cfy stb�Xi�� F t�. t Telephone Number Ao3 - 9" gl aZ E-mail permit to: /=�2.a � z Last updated;i in2017 • Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) Historic District ❑ Site plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire deparknent for approval Section 13— Owner's Authorization L , as Owner of the subject property hereby authorize to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name Last updated:l l/7r2017 I _ I147 Z'O`VI OF fRI , CAPE COD �L® INSULATION 713A1 30 9. 4, El®® FIBERGLASS SEAMLESS SPRAYFOAM SUSPENDED ww _ BATTS OVITERS INSULATION CEILINGS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 2-0 COnAZ6 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceii4ings ( ) ( ) ( ) ( ( ) Slopes Floors ( ) ( ( ( ) Walls Sincerely hECasJr, President on, Inc. i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0(0�o Application #�� Do Health Division Date Issued t.- t{ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address KA" Village (yfeA(V1)V" fm 1 A Owner (��✓� 91X•�� Address Telephone 01 Permit Request 01 lAh w '0J akh6^--- �� k�uv F A 4 0 lI'Y(VL(4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay r Project Valuation 2�6f� ' Construction TypeO�9 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 woo coal stove;,❑Yja§ ❑ No o Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: q-elisting �newize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Aut orization ❑ Appeal # Recorded ❑ Commercial ❑Ye Yo If yes, site plan review# � r-- Current Use Proposed Use L" 6 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name��i�1i C�a /,G/�U /�i�� Telephone Number Address,��' %1�� License #T J/ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE �'� 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r - MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i. FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f r Y Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cfitractor Registration Registration: 153567 Type: Private Corporation n 3 Expiration: 12/15/2t14 Tr# 233831 CAPE COD INSULATION, INC _ HENRY CASSIDY 18 REARDON CIRCLE , r SO. YARMOUTH, MA 02664 o i! Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 0 20M-05/11 C�fie�po�rrrimomcuea✓��z a�G/U(,rra�ac�iurte%l„� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only VOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: :y153567 Type: Office of Consumer Affairs and Business Regulation xpiration 12/15/2014 Private Corporation 10 Park Plaza-Suite 5170 c Boston,MA 02116 t= CAPE COD INSULATIONNC HENRY CASSIDY / ' 18 REARDON CIRCLE,,--.,,. "r S0.YARMOUTH, MA 02664 �"� Undersecretary y y of val witho t nat re � rJ ✓ :1 C �L�f�'� a�Y�tl��Q 10 Park Plaza - Suite 5170 ~,. 1 Boston, MassLichusetts 02116 Home [mprovement Contractor Registration _. Registration: 153567 Type: Private Corporation Expiration. 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY , 455 YARMOUTH RD. HYANNIS, MA 02601 _ .. .. Update Address and return card. Mark reason for chauge. Address, Renewal Gmpluymcnt I I Lost Card ;;.;;;i (i mr;i.il:o•i caul��s • .OIlicc't'( nuwcr Arr; . r LDus�ue's Regul•itiou I.iccnse or registration valid for individu! ::::e ^.!, HOME 771�fiIPf2dQ`�(fl(M 1`I�ALTf'JI'1`ulcwe�la before the expiration date. If found return to: Registration: 153567 Type: Officc of Consumer Affairs and Business Regulation 7 ,) Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 ,. l,r Boston,MA 02116 OD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS,MA 02601 Undersecretary /la d ith t Si ture -Department of Public; Sal elt Bu;u 11 nt Btiildintl Re-ulalinri� and Stuutlards ° Qonstruction Supervisor License s Llceri CS 100988 i HENRY- CASSIDY 8.SHED ROW WEST YARMOUTH, MA 02673 Expiration: 1 t/11/2013 t iuni ;..,,•� Tr-#: 7620 The Common 1 r c,rd h of Massachusetts Department r 1.j industrial Acciderits E. Office <.;/ 'l lvestigations -- 600 bl'<r.Nlriagton Street F� Boaz,') ]:!A 02111 W411 . 1;/1S.g'Ovldla Worker's couepertsatiori Insurance Attu!;; ;i: builders/Contractors/Electricians/.Pluli.ibers 1pplicattt lnfortuatimi Please Priitt l..egibly ^ 1 NlaIItC (13ttsitle�s/Orl21n1Zc1t101'1/l[1C11Y1C[U211�: �� `r t — 1l7-- k2L5,-- a _ _ Phone#: .a C , vJ/�' 6 _ / ___ Are you all etployer? Clleck the appropriate box: Type of project(required): I. UN I am a employer witli-- O 4. ❑ l atn a cnc 1 ,I contractor and I have 6. E] New construction culPluyrr-s (full and/or part-tinge).* hired the ulc,ontractors listed on 7. Rernodeliug the attachc,I :heel.$ F] I ate a sulc proprietor or partnership These,u[ 0.,II1VUCtQfS have 8. Demolition and have no employees working for employes s;md have workers' comp. 9. Building addition ate.in any capacity. [No workers' insulanr.:_j 1U. Electrical repairs or additions coin[)insurance required.] 5. We are.1 cj ipuration and its _ r officers li:n� ��ercised their right of L Plurrtbmg repairs or additions C� l ant a hotneowiter doing all work exemp on I ri IVIGL c. 152§(4),and 12. Roof tepait's myself. [No workers' comp. we 1;U111required.]have u, mployees.[No workers' 1 y,� insurauceregUlIeLl.I :[ p. insulim_cl3. Other C�l.tl�'rIZGl tC� Ally apphcant that checks box #l must also fill out the section below showm then workers'compensation policy information. I I t,uncuwuc,s who Submit this affidavit indicating they are doing all wod,,w I ih n hire outside contractors must submit a now affidavit indicating such. i0n1[taaurs that check this box must attach an additional sheet showing tl,,:n:un:of the sub-contractors and state whether or not those entities have engrloyees.It he xib unuacti rs havc employees,they must provide their workers'colup poi,cp number. I ant an employer that is providing workers'Compensation irrsrr7rnrce for my employees.Below is thepoliey and job site iulur'nuUiore• /� .�,� /a Insurance.C ong pan Nance: �_ 1 1!(,��V� Ce s l) Policy it ur Self-ins. l.ic. #: �� a�. 1�S�Z �� C/_' Expiration Date! Job Sitc.Address: .- '"" w ----- City/Sta[elZip:�Jw`' Vt Attach a copy of the workers' compensation policy declaration page(>Iimving the policy number and expiration date). FWILIrc to secure coverage as required under Section 25A of MGL c. 17 c:111 Icad to the imposition of criminal penalties of a fine up to$1,500.00 and/or our-year ilnprisuurrtcnt,as well as civil penalties in the form of a STOP bbt ikK ORDER and a fine of up to$250.00 a day against the violator.Be advised, h:u a copy.uf this statement rrta e forwarded to the Office of Investi au..,„ >t the DIA for insurance coverage verification. 1 do here c if urider the r ins and penalties of prrriia-v that the information pr vided above is tru� nd correct. 0rtzuurr.: _- Date Klu ne#: Uf j'icial use unly. Do riot write in this area,to be completed by ciry or town official City or Town: l'ermit/License# Issuing Authority (circle one): I.Hoard of Health 2. Building Department 3.City/'l'o iii Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: L rl No. 1605 P. I Client#:4597 CCINSUL ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM100NYYY(— THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIIS2 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSrN LITE A CONTRACT BETWEEN THE ISSUING INSURER(S),AU7'HQIZIZED REPRESENTATIVE OR PRODUCER,AND THE CFRTIFICATE HOLDER. IMPORTANT:1— f the car1Iflcate holder is an ADDITIONAL INSURt_D,the 1a011cy(les)must be endor�Ted.if SUI3ROCATION[3 WAIVED,suGljuialo the terms and cunn hens of the policy,certain pnllcles may Wqul,u an andurhanient.A statement on this certificate doer not confer rights to(he Cortlflcale holder in IieU of such endaraemenl(s). PRQUUCEH Rogers&Gray Ins. -So. Dennis NAME:1. Mar aret Youn PHONE 508-760-4602 Ftik 434 Route 134 Ale No Ew: A/c No 677-816.2156— E-MAIL ------�—_ SUuth Dennis, MA 02GUO-1601 508 398J980 _ INbURtR(5)AFFORDING COVERAGE IA NAIL N ------- INsUR6RA:Peerless Insurance INSURED 1B333` ----- Crape Cod Insulation Inc INSURER a:Evanston hlsw'ance Canpany 455 Yarmouth Road INSURERC:Atlantic Charter Insurance Hyannis, MA 02601 y. INsuRERD:.Commerce Insurance Company INSURER F.: ^-- __ __ �N6URtR F: —---'— COVERAGES CERTIFICATE"NUMBER; _ REVISION NUMFIER: TF118 IS TO CERTIFY THAT THE POLICIES OF IN$LJRANCF LISTED d[1-)V%1 HAVE BEEN ISSUED TO IHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIGAT-LD. NO'IWITI-ISTANDING ANY REQUIREMENT, TERM OR CONDITIL%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 15 SUBJECT TO ALL. THE.TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SROWN MAY HAVFz BEEN RCDUCED BY PAID CLAIMS. IN R— T12MMBCKVV[v0K -- LTR — TYPE OF INSURANCE POLICV EFF POLICY Ex aO�lcr NUn,a�R MMIDD/YYYY MMIDD/YYYY LIMI7s A GENERAL LIAalurr BP8263063 4101/2012 041011201 EACH OCCURRENCE $1 000 000 X_COMMERCIAL GENERAL LIABILITY p �q C 7 ENTED P(ZL-MIS nccurrcnce 51 BB Q0Q _ __ CLAIMS-MADE OCCUR MED EXP(AOy one paimil $5 000 PER60NA4&ADV INJURY 11 000 000 — — GENERALA04REGATE" $2,000,000 CErrL aGGRE0A1'E LIMIT APPLI68 PER: PRODUCTS-COMPIOP AGG $2 000 QQD POLICY PRO LOC -- I] AUTOMOeILEuA91uTY 4/01/2012 04101/201- COMBINED SINGLE LIMIT En accidem 1,000,000 _ ANY OWNU ruED BODILY INJURY(P.,Perron) $ ALLUWNED x SCHEDULED AUTOS AUTOS BODILY INJURY(Pat Aaidonl) F ^^ X HIRED AUTOS X AUT03WNED PROPERTY DA_"5' 7_ (Paf dGC1L01111 '� H X UMEIEX".$U LA UAB OCCUR XON 1453512 4/01/2012 04101/201 EACH OCCURRENCE $1 000 000 excktib uAa -_-- LAIMS-MADE AGGREGATE $1,QQO QL OU _ oE0 X RerelvrloN C WDRKERp COMPI:NtlHTION $ AND EMPLOYOPR1ERSS''PLIIABIMLITY£ WCA00525902 6/30/2012 06/30/201 WyPX WGSTATU+ 0TI1, OFFICEFZM[MBOER E �U4r0�QGUTIV( Y N a NIA E.L.EACN ACCIDENT 1 OOO OUO (ybd,d6ory in,md E,L.DISEASE_EA EMPLOYEE $'I 00Q QQQ Ir yae,aew;noa under _ DESCRIPTION OF OPERATIONS Unldw E.L.DISEASE-POLICY LIMIT 111,000,000 r IPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Akiz.h ACORb 101,Addlil.—I R,unarhs ti;hadulp,I(mQfs apace IB reglllred) orkers Corrip Informationded Offlcer6 or Proprietors flcate Holder is included as an additional insured undar Genaral Liability when required by written act or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLFD DEFORL• THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEkED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ®190 -2010 ACORD CORPORATION,All rights reserved. ACOttD 2ti(2010/05) 1 of 1 The ACORD name and logo aru registered marks of ACORD #S838491M83848 MEY p.5 OWNER AUTHORIZATION FORM (Owner's Name) ' owner of the property located at (Property Address) (Propert Address) hereby authorize Ca iC( (Sub ntractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signatur 111-7 Date ,, r7 . Town of Barnstable Regulatory Services OFfHE Thomas F.Geiler,Director Building Division BMWSTABM Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 �'°rFo Meg e Office: 508-862-4038 Fax: 508-790-6230 December 28, 2012 Jill Ann&John F Kenney 20 Conners Rd. Centerville, Ma. 02632 RE: 20 Conners Rd., Centerville, Map: 251 Parcel: 066 Dear Property Owners: This letter shall serve as notice that you are currently in violation of 780 CMR and are hereby ordered to bring the property into compliance. As you may recall, a permit was issued to build an attached garage to the above referenced address and subsequent permit was issued to finish above said garage. In a letter dated March 4, 2010 you were asked to explain the status of the open permits and have been given ample time to take the necessary actions to complete the required work. You must contact this office immediately to arrange the required inspections. Failure to comply by January 28, 2013 will result in additional action taken by this office which may include criminal prosecution to the extent as allowed by 780.CMR. Thank you for your immediate attention in this matter. By Order, J L Lau7zon Local Inspector J effrey.lauzongtown.barnstable.ma.us (508) 862-4034 oFt r Town of Barnstable Regulatory Services . BARNSTABLE. y MASS. Thomas F. Geiler,Director �ArFO MA'S A,0 . Building Division, Tom Perry, Building Commissioner 200.Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 4, 2010 Jill Kenney 20 Connors Rd. Centerville, MA 02632 RE: 20 Connors Rd., Centerville r Dear Ms..Kenney, This letter is to inquire as to the status of your projects at the above referenced address, As you may recall you were issued a permit to create a playroom/office above the garage on March 9th 2007. There haven't been any inspections since the insulation inspection was done on October 1 I t" 2007. This permit was issued November 21",2007. We have not inspected this project since June 18" 2008 for the rough. 'In addition the original permit for the additional two car garage has only a frame inspection. This was done on September 5th 2006. You must contact this office at (508) 862-4034 to explain the lack of progress. Thank you for you attention in this matter. Sincerely, k uzon Buildinspector r Qzoning5 �� u ' A, UWti Ul Ijstl ILO taICJAt. Regulatory Services -..Thomas k';'Ge91er,Director . W-M Iiuildmg Division Tom Feirry,Building CommiagSpeer 2001jaiu Street,Hya;nt$,MA 02601 pace.: 508-fi52-403� • ' Fax. Sl?S-7�C-6230 ' EL'�C'I'FHC�FIa:'Et:VfTT; �R {yermit required in orcer to process imspwtion), Requested Bate of Lus�ieoteon_ -- -- Toc�ay's.Fate - J ere'o-y rejuest at luspectlou under NTassaohusCtts Genera Law aptsr 143,section 3L and.237 Civic 1 ` 7LP installation ww be ready for inspeatiou at - (pre Imo Y'o Type of inspection r©queated: e-' i�ac�on Temporary 5eiv ee � Exeava�on ❑ P,augh F.e-,spEc • SCn3cr�Zaspectfon ( Final Ike-iuspaddor I Final 11ITection for ether jic,ensee's awns,address,and unber 1-f(fil L. ;,icons License nt ibis section fin be oompl �strble&,spsctor we hppcl r ' NotApyrovcd Insp��ote_. � n Electrical 'i1�is work was nct aLyrevad fox riclabon of the idaowing,�uticles and 5t cticns o£tl,e MA Coda: - — - (�;'Pjp�'1 E3:r�rSYl4:elB:k Ei}'agb: Rw;lG2b�A• T abed SLOLTLL80S dzo:ZO LOOZ'61 UV 01/01/19134 00:03 4137393322 MCCARTHV, BOB PAGE 01 COMMOXweafth ®fassachustsLPermitNo. Official Use only Deparbtfleat of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Fee Checkeveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pkffmad to wcordsncc with the Massachusetts Electrical Code(MEC),5,27 GMR 12.00 tPL&"PAWhV X0A 7TPE.lLL 1NF0 RA�4770 . A9 Date: _ CRY or Town ofl To the Irtspeclor oJ•Wires: By this snikadm the Undendsiewels1wil iiis notiee of his a<her iatmtion to perform the electrical work described below.. Locatlioa(Str+eet&iV r) b Owner or Temt -••�+�.i� .�L,f� ��/��.,Zr_ _ _ Telephone No,s'�,� Owner's Address Cy Q Is Oil1wNd4 is toalntW"wft a 6 porugl? Yes VC7 No Q (Check Appropriate Box) parposa alumbB Utulry Authorisation No._ E Bert"9!eL AMP POIA&VOIts Overhead Q Undgrd❑ No.of Mtters a _irolts Overhead❑ Undgrd❑ No.of Meters Ngsgi-er*fjPO"Wj and A gpaelty L,ocattttw dad 141%kre Of Ek%ft al Work., n oftyke 11p i W4 r table ma be%411 vtd,&y the I&Ipmfor of Wir&. No.d!ltaaauwl 30u*6 of Cell.•SuV.(PsaFdle)]raw o•° ota KYA . zN0.o-fLttrroof Hot Tabs KVA Generators!No.if�Lumlaalieve o.a mergency og misAia=]pool � � ualts No•o�kof Oil Burners FIRE Itl�'lS No.of ZAne3No.of 8whaft • of Gu Burners o.o etec4ou anitiatin Devices Na oft AasBasof A irr Coed. No.or Alerting Devices T oas Jun IDcteetiodAdortin Devices No.ofDit here/Area IffiaftS KW IAca1lanicipa �CouatcdonNo.ofDr>ffaing Appliances y SecuritySystems: No.of Devices or L uivaleat No.0 8eattn XW o.S Ballasts Data Wiring: No.of Devices or B ttivalen t No.**swamp Bad lfo..of Motors Total UP Telec7ormironjucanons artsg No.of Devices or>Q �fvelent OTIMR At '' nal detail tf desired.or w required by the Impa!to.cJ Wirer. Work to S tsar Vahm of Elac�igal 64►ork: (When requM by municipal policy,) Work ,,,�Q iarpectis-uoa to ba ra:gsustad in accordance with MEC Rule 10,and upon:carapledon. INSURA NC3 VMt=t EJnlefat►snaivad by the owner,no pam:dt for the perfonnatiee of electrical worrk.may issue unless the licalsoo ptiovidas pi` arcf li�lity ins ndo a iwludiq-omnpioted operation"coveragt or its substantial equivalent. T6c $ , tnaelE<aa"OF is sus force,and bas eatbibited proofof same to the permit issuing offacc. CHECK ONI:: bmuRAN= 0 Dow ❑ On-UR ❑ (Specify:) lento,atnptTerafteptadits owpWaffilff 0000try,that eke ix on nstdia►s on dais application is true and romplete. FMM NAB& �, wS x �{ LiC.NO.: Llceraaeete h)'+K .A .t4 VJ ZC'�t1 L Sigaatnre a e2id O-e c Llty.NO.:/�C' (fldppltdesi eW"CROW in tM E(�Ywst Una) Bus.TeL No. _ Addreaa: Alt.Tel.No.: syst�tt Cmaut to wed for this--wok if applicable,eater the license number here: OWMM'S lI1VBEMANCE WAMR: I taus aware that the Licensee does not have the liability insurance coverage normally required by law. By My 84=%at below,I hereby waive this requirement I am the(check one)EI owner LJ owner's agent. Owner/A ut SiYns<stre 'Telephone No. PERAUT FEE.S 01/01/1994 00:03 4137393322 MCCARTHV, BOB PAGE 02 "tar 2113/3OOT TUMr 4129 PO TOP N wesolYk 0 1.413.513.1352 Paoar 002 _ l v CER1IM"4CATE OF LIABILITY INSURANCE ou�aA:T THIM CE UVWATB 0 M WO AS A MATTER OF MIFORMATIOM JAM d Dowd i ftm COLT AMCCUMM NO ROM UPM WE CERMCATE MUCK CERTMATE DOES AY D,EIfTEND OR U BMW PAN P.O.Boot ALTO THE COVERAGE A"OROED BY THE POLICIES IIELOW. � !f!M MA 910" 9MURM AFFOROWG GOVEILAGA HAIC 4 MIEIAIER� 30 4MM Am OrWMR r1lllllfll¢ MrIMNI E Twa Paim OIL ugmWww M&W TO THE FMISAW HOMP AMO&FOR THE POCEY POPK)D WOCATM,NOTN THSTANDNG ANY OMWJMWW.MW OR CO 40011 OFANYOONIIUCT DR OTHm oomA n WPfH FELT TO W1M H THMGS"CATE MAY BE SWED OR MAY PEWAOL YM/f UMNM APPMM 5Y TMPCUMi ORS 1�1 S$VDi"TO ALL TW2 7WM.E CLUUM AND OMOT)ONS OP SUCW POLICES AAl MATR LMARM SN M1 MAY MWWW I1LyDIJM DY PAD CL NA L or srHwARa Laos A sM1wAAUNMIAN 00110 EIIIToIM1 EACO-OCCUMENCE st NOMMpera a�ar� $30 000 . IN IM mm OOdiR MW EX w P.Pan) $5,000 PERsaw a Aar NAMY s1000 000 aeasw.Aoolllra�Te oZ Q00 000 �IIAMM��TMLAIATAt/L�IIW PRODUCTS-CMPJMAGO OQO000 LADY - COMWkWSINGLEUWT ANY 11 M IEr mew e) ALL GN AUTOM eOCnr wwnr l. �AUTW por prPm) PMTl�AUIOM GbGar NJURr PdL�DARM Mlrm;mwv1 S WOPWTY PANAK "rmwowol V AUTOOMLY-CA.AQWMTAM S OT+ER TkW ' AUTO ONLY: .Add. 3 NA�T eAC►IOOOufwairCe OOaMI DAa l ACA ELATE f � t Of AjIrQMA WCSTATDV OR lY� r EL.EACH ACCOW P � E.l.OWAA[-Sk M"WiljE 1 EL.tl •R;LIL1 u4tt ! N lift a01 114iGI1TIOIM!l IYI A0�MT WIODI�9RT NFEM"PRQIAt1pM I INOW NR OF THE AMM K MAIMMO POLCU ME CAUCkil"8000 TMP EXPRAT10Y Tomato, dATP TNT.THE M1WN91NMAii1 MLL ENYEAVCP TP•Al �� 6AYa MMIITEM ApNc twu PeTry_,BI�o11q Col�fi�dofHu MOTIfA?TO Tlt1�TIPIGTl NoLQJl NArfDTDTlIE LL`�fT,Gu7fNlLYIE T000 ao s>aAu m Who� dWQft 06OTANAnft ORLWMW 6P ANY MW UPiria TIW W&WFR.,1 rl AGENTS OA MIA oIDM1 II�ATNf __... �f/thtA�e' Lei . � - ACM 1 of! I ow G.AcoRD co"O"now"m C "y ` AUG 25j2006 03:18P 5087717075 page 1 'own of Barnstable Thomas F.Geller,Dlrecdor BuRd ng Division �� `�i� � 7: � 1 'Tom ImTy,R�lding Con missianer 200 MVi*Stivet,Rysu is,MA 02601 r Of c: 508462 4038 � FFW'?50 25Q�-6230 MMST FQ E LEC IUC&L IN89ECTI (Permit required in order to process inspectim) TO&a s Datea U-- A�4 RequeAed Date of Iospeceou T, __hereby request azs izxsi+ectian under Musmhusetts Conerat {Etac�iare • Lev ch"r 143,memdon M and 237 CMR 4.02(3). J TUe lurtatation will be ready for inspection at !1547i` (Property Location) Type of inspection requested- [] Tempor+uy SeMm Sorvioe Re-inspection C) E=Mtion RonghRe-inspection SerAce Inspection p nal He-inspection Lj Fits impecter,for_ t ,n fJ�1 isaspetcw IF' l [� Final Inspection for Owner or teaaant Licensee's name,addrem and pbon® Wt*016W, I.iQenae somber lS�D'f�� '.Licensee°a 5ignature,��, CA3) d2r3"-��57 Ivs�mwm to be Inspectm,of bir'i-W SEP 01 2006 m { — primed ONot Approved This workwm not approved for vio ation of the following Astiolas and Sections of the MA Electrical Cede. Cj:VI'FF,'le¢:fvrtrs:orat x�tta�t Rsva91604 2 IVJG 23 ,2006 08:08A 5087717075 page 1 Town of Barnstable osRegulatory ServicesJr , ' Thomas P.Ge6er,Director Balldiug Division � Bonn Tem,lauildbg Cummissioaer ��'� AUG� �� AIM ;�9 200 Mein Sired.Hpanmis,MA 02601 Office; 508-862- 035 - - Ls"{ .rkO 508-790-6230 QUEST FOR ELECTRICAL INS ON ]&LECMUCAI.PEIU�M l UhMZ)R (Permit requlred 9m order to process inspection). . To&y} D l/9GL! Requested Date of inspection L,&!:;d 4 Jer-Ihereby request s n inspection under M assacbusetts General {Etechtsian Laweh"r_143,section 3L and 237 CMR 4.02(3), T&e iastallstion will be ready for inspectiom at .(Property catio TI pe: of inspection requesteech ® Temporary Service 13 ervice er iuspecson Q Excavation Plough Re-inspesed n © Service Inspection Final He-inspection u :90-dgk',suPaCb0a fOr !00,00�-in3P6'°Km Feel {� Final Inspection far L] Qtll�T Owner or tGmw L,-, Licemse's acme,address,and phone I ice= ��) 5��•-�.?AS7 1 icansee's Signature T.6te'mc ov to be com to a Inspector of fFires xnspenen AUG proved ®Not Approved This workwas riot appmved for violation o e following Art3ales and Section$of the MA Electric Code: Q;WPfiie6:fomis:el�tra�ua� Rev:102604 -- -�= Commonwealth of Massachusetts �� 1 ' Department of Fire Services [[Rev. rmit No. M cupancy and Fee Checked tit 5)FBOARD OF FIRE PREVENTION REGULATIONS 9105] leave blank 'APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MEC ( ),527 CMR 12.00 (PLEASE PRINT KINK OR TYPE AL L INFO RMATION) Date: City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) co tiN611LS 20 e�,�Z,2y�LLE �32 Owner or Tenant `.:/ 0 A/ !G L )�C-�,,t/E S/ Telephone Owner's Address >20 6oivsvgU !2!� E�✓TI>tij//(�� yyi/{ �j �3 -Z _ Is this permit in conjunction with a building permit? Yes -No ❑ (Check Appropriate Box) Purpose of Building A t,)C LL 4,�-, Utility Authorization No. Existing Service A ® Amps / Volts Overhead Undgrd❑ No.of Meters N4Servrce Amps / Volts Overhead❑ Undgrd ❑ No.of Meters 14174 u:) Number of Feeders�and Ampacity Location-:and Nature of Proposed Electrical Work: Completion of thefollowitkZ table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans i o.of Total Transformers KVA No.of Luminai a Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ - ❑ 1 o.o Emergency Lighting rnd. rnd. Battery Units No,of16ceptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.ofDetection and- Initiating anT— Initiating Devices No.of Ranges No.of Air Cond. Tons Tot No.of Alerting Devices No.of Waste Disposers eat Pump umber. Tons KW No.of elf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent o.of-Water KW o.of o.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:,4S,1,P Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [] BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 604,1AA liS e LIC.NO.: Licensee: 12-U s-Zep V k Signature ✓*,4 d C.NO,:/l,9 V,G . (Ifapplicable, enter"exempt"in the license number line.) But*.Tel.No.: Address: Alt.Tel.No.: *Secturity System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by.law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent 5108-77)- 76 7s Signature _ :. Telephone No. PERMIT FEE: $ PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 08/15/06 TIME: 09:57 ---- ------------TOTALS.-_------------_--- i ' PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: .00 APPLICATION NUMBER: 91:)994 PAYMENT METH: CASH ,PAYMENT REF: .-:A - -------------------------------- I ne c.,ommonweacrn of lnussucnusecw Department of Industrial Accidents Office of Investigations " d 600 Washington Street Boston,MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piuffibea-s Applicant Information Please Print Legibly Name (Business/orb nizatiowhdividual): Address: '� � P �✓� City/State/Zip: o o�� `�-� Phone# F,S Are you.an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction � loyees (full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. $ 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑I Demolition working for me in any capacity. workers' comp.insurance. g• ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its 10❑ Electrical repairs or additions required.] officers have exercised their eP 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• Roof repairs insurance required.] t . employees. [No workers' ❑ comp.insurance required.] 13 ❑ Other *Any epplicanfthet checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiraition date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year miprisonmen, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to.$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the office; of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that t e information provided above is true and correct. Signature: G Date: Phone#: 'Y1,3 -- Official use only. Do not write in this area,to be completed by city or town official i City or Town.: Permit/License# f Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clerk e.Electrical Inspector 5.Plumbiaa lmsp-�or 6. Other !� Contact Person: Phone r: 7bWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0&6P Application# C9 M Health Division Conservation Division Permit# Tax Collector Date Issued J Treasurer Application Fee " Planning Dept. Permit Fe Date Definitive Plan Approved by Planning Board j(( Historic-OKH Preservation/Hyannis U_ Project Street Address C �� Village �� ✓ Owner _ AddrescZCb S2.' Telephone (7�S Permit Request Square feet: 1st floor:existing proposed 2nd floor:existing(Jn 0 proposed Total new Zoning District Flood Plain Groundwater Overlay 5 { Project Valuation �O�C� Construction Type i. Lot Size Grandfathered: UYes ❑ No If yes, attach supporting documentation. ' `F Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structured qO �eQ(S Historic House: ❑Yes [Ntr� On Old King's Highway: ❑Yes:;- ❑No Basement Type: ❑-gill ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Lo .0 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 F7es* l ❑Gas it ❑Electric ❑Other Central Air: I ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑Ae Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: xisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Na TelephoneaNumber di ��✓�'�� '�C�� Address License# ,. �.J� �T�.� y��`'P �� Home-Improvement C-ontractor# Wo>�rker s Compensation#-"`- ALL CONSTRUCTION'DEBRfS'RESOLTING`FROM-THIS PROJECT'WIL'L BE TAKENFTO _:�)Upc QL�an � SIGNATURE ( DATE C) 0 1 F r r FOR OFFICIAL USE ONLY 4 i PERMIT NO. {.„.DATE ISSUED , MAP/PARCEL NO. ; ADDRESS i VILLAGE, OWNER s DATE OF INSPECTION: ; FOUNDATION i - FRAME i INSULATION1�1�e1 Dtl� � 3 FIREPLACE illy ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL 1 .GAS: ROUGH FINAL Y 1 i FINAL BUILDING DATE CLOSED OUT 1 ' ASSOCIATION PLAN NO. i i The Commonwealth ofA assachusetts Department'oflisdi strialAccidents O ce o Irc e ,�.� f vestigations• • ' 600 Washington Street ;- Bdston,IK4 021I1' wwtv.massgov/dia ' Workers' Coin',pensation Insur�mee Affidavit:Pnildera/Contractors/Eledtricians/Plu ers' Applicant Information Pleas e Print Le 1 Name usiness/Organiiation/lu ' 'du •(B dzvi at, A . Ad&ess: - City/State/Zip � �one Are you an employer?-Checkthe appropriate a$: 1;❑ I Mn a employer with 4, (] I am a general contrattor'and I :Type of pioject(required); . employees(full=d/orpart-time).*. have hireclthe slab-contractors 6• ❑New construction 2.D I am a'sole. iroprietor or* artaer= listed on e P p th attached sheet; e, 7. mode ' . ship,andhave no employees These subcontractors have 8, Demoli' �vorkin for me in azA ca ac' to e' ❑ ti0n g i es Y P. tY. �P Y . and have workers • [No wo comp,insixiance comp,insurance$' 9. Building add ttion . re ' ed.] 5: [� We are.e corporation and its 10•[],•Electrical repairs ox additions 3. a=�homeowner-doinga7l.work = officers-have exercisedtheir 11:❑Plumbiag myself.[No workers'comb, right df exemption per IvIGL repairs or additions - insurance,requued]t c, 152, §1(4), and we have no'. 12,[]Roof repairs . employees,[Nb workers' 1 :❑Other ' eorrtp,insurance required,] *Any applicant that checks box#1 must also.fill out the section below showing their t Iiomecwners, workers'compensation poflcy informafion, who submit this affidavit indicating they are doing all woik and tlien him outside contractors must submit anew affidavit indicating such, #Contractors that check this box must attached sn additional sheet showing the name of the pub-contractors and state whether ornot tho • employees, Ifthe sub-contractors bane employees,Theymustprovidb th*workers'comp,po se entities have licy number I am an emp foyer.Mat is providing workers'compensation my employees. Below is.the policy and jab site' information. insurance for " Insurance Company Nate: Policy#or Self-ins.Lic,P. ExpirationDate: w ,ob Site Address' Attach a copy of the workers' co City/State/Zip; mpensation policy declaration page•(showing the policy numb er and expiration date); Failure,to secure coverage as requiredpnder Section 25A•ofMGL c. 152 can lead to the imposition of fine ii tb$1,500.00 and/or One-year' P criminal'penalties of a P y mzprisonment,as well as civil penaldes in the form of a STOP WORKDRD of up to$250.00 a day against the violator, Be advised that a•copy of this statement maybe forwarded to the pfBc o and a fine Investi ations of the WA for insurance covers a verification. I do hereby certify under the p ins and penalties of perjury that the informatiox pro,•vided above,is true and correct Signature: � Date: Phone#; 77 Official Us -only. Do.not write to this:area,.tb be campleferiby,city or down officiaC City or Town: . Yermit/License# . Issuing Authority(circle one) .'1.Board of Health 2,Building Department 3., City/Town Clerk 4,Electrical Inspector 5,Plumbing Inspector .6,Other Conta.Ct Nrsoll: ' Phone#' .lI��i.(�.CII.�.�.L1�Pd1 �.l.d:�'1�..��Li �,1�9.1�➢11A� ' • • • Massachusetts General'Laws chapter 152 requires all employers to provide workers' compensation for their emnplo`Yees. Pursuant to this statute, an employee is defined as"...every person in the service of anothez under any contract of hiie, express or implied, oral or written." An emTloyer 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." IvIGL chapter 152, §25C(6)also states that"every state or locallicensing 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•aeceptable evidence of compliance with the insurance coverage required.". Additionally,MGL ohapter.152, §25C(7)states"Neither 6o commonwealth nor any of its political subdivisions shall enter into any contract for,thb performance of public7.work until acmptable evidemree of co3npli sue t�ith theinsilianD e' 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-contiactor(s)name(s),address(es)and phone numbers)along with their certificates) of • insurance. Limited•Liability'Companies'(LLC)or Limited Liability Partnerships(LLP)with no'employees other than the members'or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Bp advised that this affidavit may be submitted to the Departm ont 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 requirecl to obtain a workers' comp ensation'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 ToWA Officials Please be sure that the affidavit is'completa'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 permitAicanse number which will be used as a reference number: In addition,as applicant that must submit multiple permit/license applications in any given year,need only submit ono affidavit indicating current policy information,(if necessary)and under"Job Site Address"the applicant should write"all-locations in (City°r town)."A copy of the affidavit that.has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each. year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le, a dog license or permit to bum leaves veto.)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. TheDepa;tment's address,telephone-and fax number... . . Thy�aa. a.�� rr� �� ' • ' .. TO.0 617-727-40.0 ext 406 a I-M-MA�SABB Ft �617`- 7-77-49 Revised I1-22.Q5. }� '1 V TTu V1 J.J N4i AAP 1-64 JAV of o f"o� 'Regulatory Services „ w • tYE, Thomas T,Geiler,Director ss. 9, �� Building Division �pl�D Tom.Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.town.,barnstable,ma.us Face; 508-862-4038 Fax; 508-790-6230 permit no. AFFMAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142Arequues that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied - b,'lding containing at least one but not more than four dwelling units.or to atcuctures which'are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other 1 requirements. Type of Work, Estimated Cost Address orf Work'. Owner's Name: Date OfApplication1�/' I hereby certify that: RegistratiQu is aot required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 QB_ ' g not owner-occupied caner 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 Signature. RegistrationNo. Date Owner's Sign e Q;�,,p�u,{crms:homeafr�d2Y Rev: 060606 '. d RESIDENTIAL BUILDING PERN T FEES • APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 ' Alterations/Renovations $ 50.00 Building P exmit Amendment $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq°foot= x.6041= plus from below(if applicable) . ALTERATIONS/RENOVATIONS,OF EXISTING SPACE square feet x$641.sq.foot= 1 x.0041 I p us from below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft.= x°0041 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 perarit square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x S30,00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00=' (number) Inground Swimming?ool $60,00 Above Ground Swimming Pool $25,00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev;063004 .'THE 1p� Town of Barnstable Regulatory Services • BARNSTABLE * Thomas F.Geiler,Director MASS. i639• •� Building Division lfD MA1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: Clo y� J Cc number ('street village "HOMEOWNER": \ "� xry name (r1l home phone# work phone# CURRENT MAILING ADDRESS: l�V 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. he anderstands the Town of Banistable Bufldirig Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. �� (9__� Signature of H m owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt gEsMENTIAL BUILDING PERMIT FEES ►PPLICATION FEE New Buildings $100.0.0 Residential Addition $50.00 AltmutionLeenovations $50.00 , Change of Contractor/Builder $25.0.0 • r FEE VALUE WORKSHEET NEW LIyING SPACE ' square feet x$96/sq.foot= x.0041- plus f$ombclow(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SPACE p 3ro msquaie-fbet.x_$.64tsq foci; 35 x_,0.0.41= plus ftombelow(if applicable). 9ARAGES'(attached&detached) square feet $321sq.ft,= x,0041= ACCESSORY STRUCTURE>120 sq.ft.. >120 sf-500 sf $35.00 >Soo sf-750 sf 50.00 . >750 sf-1000 sf 75,00 >1000 sf-1500 sf 100,00 >1500 sf.Same as new building penait: , square feetx$96lsq,foot= x,0041— ! STAND ALONE PERMITS Open Porch x$30,00 (number) Deck x$30.00= (number) Fireplaee/Chimney x$25,00- (tmiber) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 RelocationlMoving $150.00 (plus above if applicable) ._ Permit Fee • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �,[ � Parcel 06(a. Application# Health Division J_QA 61 -0 Conservation Division c3 D !� Permit# d Tax Collector l Date Issued Treasurer EXISTING SEPTIC SYSTE 00 UMnW%on e / Planning Dept. Permit Fee 1 7 5V a4rcuDate Definitive Plan Approved by Planning Board "" �' �`!- _"e liv`'.r S��owCe �j�jav��oV'� ��C1✓v �4Jcrue �t . Historic-OKH Preservation/Hyannis 044 v��Qgfeurla,��Pc� .s'7�os� Eq� Project Street Address f4) CbNc) CS QA Village_ C?Q�\R c Owner ��. -� \\ \�QY1�Q�p _ Address amnef�� \A Telephone Permit Request l CA Square feet:1st floor:existing_ proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2`j D Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family a.-"Two Family_ ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O NlO ' On Old King's Highway: ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas fail ❑Electric ❑Other Central Air: Ules ❑No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes ❑No Detached garage: xisting ❑new size �C Y�(Z Pool:❑existing ❑new size Barn:❑existing- ❑new size 71 Attached garage:❑existing ❑new size Shed:fisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ <; I rnmmcrnial n Vne 11 nln if vnn m4n nlnn rn.rin...JF � r ter' d'�$ CARBON MONOXIDE ALARMS � MUST BE INSTALLED PER MASSACHUSETTS BUILDING CODE ��rr� aFk I 8 C� `SMOKE DETEDTOU REVIEWat' ' Aft ' AS _B/FIL9'M;GEPT. DATE r r ++ NRE DEPARTMENT DATE t . i�--- - 80$H Slfs`Pf01TtJRE4, ARE 4-SO{+daFn =00 0ERMITTIN`..'T`_.....__..._�.......�,.__._._..r..__�._........_._.._.__................e,.._..._._ .._..�_....«_� —- P IMPORTANT ANY CONSTRUCTION THAT INCREASES LIVING SPACE I BEYOND 1200 SQ. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE �ooAf i INSTALLATION OF SMOKE DETECTORS—THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. U\'&C-) 6N::�'fp, sr ow\ce i a ' -� ;", �►, Fes_^ .: �, _._..�._.... .........._....-__...__.__...�_._.�..._.._,..-_�—.�.. _tom. ....e._.�..__.......—...-.e__ i 1 _ � �f��''`� Ye a /, _; ' � G� � . �' � � �� E^�. i � � , � _ s � ., 3 � � � � � {i]f�j l 5 � _ 1 f � .�� 44 ��- 1 � _ }}� � � �� _ � � � , � t ! �. , �. f 9 3 i tpCf c�-�— �11(jd7 TOWN ARNSTABLE �t�E> Building Application Ref: 200700807 sARNSTASLE, Issue Date: 03/09/07 Permit 9 MASS. �A i639. Applicant: KENNEY JOHN F&JILL ANN CFO�.l s Permit Number: B 20070412 Proposed Use: SINGLE FAMILY HOME Expiration Date: 09/06/07 Location 20 CONNERS ROAD Zoning District RD-1 Permit Type; RESIDENTIAL ADDITION/ALTERATIO Map Parcel 251066 Permit Fee$ 96.56 Contractor PROPERTY OWNER Village CENTERVILLE App Fee$ 50.00 License Num OWNER Est Construction Cost$ 2,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND FINISH THE ROOM ABOVE THE GARAGE THIS CARD MUST BE KEPT POSTED UNTIL FINAL PLAYROOM INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: KENNEY,JOHN F 8L JILL ANN BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 20 CONNERS RD INSPECTION HAS BEEN MADE. CENTERVILLE, MA 02632 Application Entered by: JL Building Permit Issued By, THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR'A PART T ,EfTHER TEMPORARILY"OR PERMANENTLY ENCROACHEMENTS:ON PUBLIC PROPERTY,NOT SPECIFICALLY.PERMITTED:UNDER THE BUILDING CODE,MUST BE APPROVED BY,THE JURISDICTION'. STREET OR ALLY 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 ITHE CONDITIONS'OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL a.142A). C4p11 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health j TOWN OF BARNS TABLE BUILDING PERMIT APPLICATION Map Parcel Application# Health Division p G/ Conservation Division o c3 ® !? Permit _q Tax Collector Date Issued fi 0 Treasurer s EXIST1NG SEPTIC SYSTE / V LIMI oIWO Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �'' ��/��r,, y (f�S,P�,e (y / Historic OKH Preservation/Hyannis / r/ v.�J v�� i'1►,s�Pc�s7�o� e any Project Street Address r�o c �< �, �)6 Village Owner %Qnne 14 Address ` 11 C`� Telephone Permit Request ( p an f CAsg Bca A Z CG Gt �'G 8 r it, 4D ®4> Square feet: 1st floor:existing I 100 proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _Z�,600 Construction Type a . Lot Size I Cj Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family m.,- Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O446""_ On Old King's Highway: ❑Yes ❑No � Basement Type: ull ❑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 adt ❑ Electric ❑Other Central Air: 3- es ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Q14xisting ❑new size `Qk Pool:❑existing ❑new size Barn:❑existing; ❑new.size Attached garage:❑existing ❑new size Shed:fisting ❑new size Other: ? Zoning Board of Appeals Authorization. ❑ Appeal# Recorded❑ l � Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use r- BUILDER INFORMATION ,IM Name -��Iu �f ��,�v p Telephone Number 77/" 767,5 Address /?��/ �<L D License# 1'PLJ � LZtzl�� Home Improvement Contractor# Worker's Compensation# -�— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO tS .J l lt;Tt SIGNATURE DATE �� FOR OFFICIAL USE ONLY PERMIT NO. DATtI SUED } MAP/PARCEL No, ADDRESS VILLAGE OWNER DATE OF INSPECTION: `-" FOUNDATION 1 ® toPiz I FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH i-- FINAL FINAL BUILDING r Ilt •rr DATE CLOSED OUT rj ASSOCIATION L-NO!! ` ti r� The Commonwealth of'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbeli-s Applicant Information I Please Print Legibly Name (Business/organization/Individual): C_�7�(1n \(ev) . Address• 0 City/State/Zip: Phone Are you an employer? Check the-appropriate box: 'Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 employees(full and/or part-time).* have hired the sub-contractors El New construction 2.El am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling I/ ship and have no employees These sub-contractors have S. ['Demolition working for ale in any capacity. workers' comp.insurance. 9. D4uilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3. 1 am a homeowner doing all work 1 right of exemption per MGL I I-E Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑•Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy®f the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct- Signature: --.:A Date: 0 / i Phone#: J Official use only. Do not write in this area,to be completed by city or town official. 1 City or Town: Permit/License# Issuing Authority (circle'one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." 9 An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or 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-contractors)name(s),address(es)and phone number(s)along with their certificates) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town 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.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. _ 617-727-4900 ext 406 or 1-877-MASSAFE Fax #;617-727-7749 Revised 5-26-05 w-w-v.mass.2ov/a1a °FzSKE r� 'Town of Barnstable Regulat®ry Services B"NSTABLE, ` Thomas F.Geiler,Director Mass. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 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. \ 1 Type of Work: �� \�� \'�\C`�\ `��'� Estimated Cost �� Address of Work: �L J C ( e ' l� A\ Owner's Name:s_�n� Date of Application: C2 I hereby certify that: Registration is not required for the following reason(s): ❑ ork excluded by law ❑ b Under$1,000 ❑ uilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply.for a permit as the agent of the owner: Date Contractor Name Registration No. i Date Owrb�'s Name Q:forms1omeaffidav `5 1 Town of Barnstable °i Regulatory Services BAMy MASS.I E'$ Thomas F.Geiler,Director 639. ,e Building Division. Tom Perry, Building Commissioner 200 Main Street,. Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Mier Must Complete and Sign This Section If Using A Builder nl e ,as Owner of the subject property hereby authorize ��} ( to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) igna a of Owner Date 'Jill �nn Print Name r Q:FORM&O W NERPERMIS SION i T y ZHE Town of Barnstable • OF 1p� Regulatory Services zvszns , : Thomas F.Geiler,Director 9 MASS. g � 1639• ,� Building Division prED A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ,� Please Print DATE: ^ //0Z-9 l 00,0��JOB LOCATION: D 'c'7/✓�LC' number' streetG village •'HOMEOWNER": -j0A& �E� n-e.G� �1J0 ?�1`' �D 7 name home phone# work phone# CURRENT MAILING ADDRESS: Ile- 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"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 require ents. ^/ Signature jbf�loiieown V Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. Q:forms:homeexempt f 76 a rV Q(Aj CK ( c� � ._ i 1 4 �. ,. ,., _� �, j 4-0 - 1� rope,,-- ) -P V\ Le J c —_ � �.. v ,j o � E .. .. .psi � ., � - � a. .. � , a � _ � .� .. � � j Y .. e _ � � 6 � _ ,. � � 03/10/2006 08:55 5084200583 AMESELECTRIC PACE 01 0 ly X 0 Amm 2 r,-65Gol.lte8 Gc? t�dt, M ..A 02635 2_ 1 (508) 42.8-60:32 i y E-4Ti�111 �n,e>F+�ec'la!rr3�:.,e!:rCl.l"lEt § it IE 4 ; e l ' Jell Kenney 20 Connors Rd Centerville,MA 02632 E f # March. -10,2006 s m t ay Concern: � : Il This letter is to L:01-Ffir.€11 61W a11.lx�ints cif�s��e.I t.: the garage l()cated.al 20 h : Connors l: d., C",entelville, have been ter--nmated and disconnected, � 1 { Rodney W. Ames Atnes Electric-Co-1 tic, i 1I � t j I 51 ; 4 (�...i+�.n....w�•..t�.n.--_n+.e.......�xm.u�vr=.�,. c.�...:.�..:�.ze-. .-_......��w....,�.x.. ...�_�.a.�. -,s�.........ka....-..+....e.............wax.•...va.n.w...w.,R.uv......o.�.wvw�u.o+om....-m+me•.i-...mms..•�..�.....e - MAR 10,2006 09:57A AMES,ELECT 5084200583 page 1 l t - BOiSE- Triple 1-3/4" x 18" VERSA-LAM® 2.0 3100 SP Floor Beam\F13O1 BC CALC(&9.2 Design Report- US 1 span 1 No cantilevers 1 0/12 slope Wednesday, March 08, 2006 13:35 Build 141 File Name: J Kenney_20 Connors.BCC Job Name: John &Jill Kenney Description: BEAM OVER GARAGE Address: 20 Connors Road Specifier: City, State,Zip: Centerville, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ESR-1040 Misc: 1 a i 18-09-00 BO,3-1/2" B1,3-1/2" LL 3625 Ibs LL 5105 Ibs DL 1242 Ibs DL 1657 Ibs Total Horizontal Product Length=18-09-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area Left 00-00-00 18-09-00 40 psf 10 psf 01-00-00 2 Unf.Area Left 00-00-00 03-09-00 40 psf 10 psf 01-00-00 3 Unf.Area Left 03-09-00 18-09-00 40 psf 10 psf 06-00-00 4 Unf. Lin. Left 03-09-00 18-09-00 282 plf 85 plf n/a Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 29216 ft-Ibs 41.7% 100% 1 1 -Internal Completeness and accuracy of input must End Shear -5430 Ibs 30.2% 100% 1 1 -Right be verified by anyone who would rely on Total Load Defl. U644 (0.341") 37.2% 1 1 output as evidence of suitability for Live Load Defl. U855(0.257") 42.1% 1 1 particular application.Output here based Max Defl. 0.341" 34.1% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 12.2 n/a 1 Installation of BOISE engineered wood products must be in accordance with y %Allow %Allow current Installation Guide and applicable Bearing Suoports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 4866 Ibs 54.8% 53.0% Spruce-Pine-Fir ( ask questions, please call 800)232-0788 before installation. B1 Post 3-1/2"x 3-1/2" 6762 Ibs 76.1% 73.6% Spruce-Pine-Fir BC CALCO, BC FRAMER®,AJSTM, Cautions ALLJOISTO, BC RIM BOARD TM BCIO, BOISE GLULAMT"^ SIMPLE FRAMING Member is not fully supported at post BO. A connector is required at this bearing. SYSTEM®,VERSA-LAM(D,VERSA-RIM Column at Bearing BO analyzed for bearing only, column analysis has not been performed. PLUS®,VERSA-RIM@, Member is not fully supported at post B1. A connector is required at this bearing. VERSA-STRANDTM,VERSA-STUD®are Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. trademarks of Boise wood Products, L.L.C. Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. Connection Diagram ►Ibs -d- a c e o a a minimum=2" c=7" b minimum=3" d= 12" e minimum=3" Member has no side loads. Connectors are: 16d Sinker Nails Page 1 of 1 Town of Barnstable �oFSHE ra,� Regulatory Services �.� Thomas F.Geiler,Director r BAMSTABM * Building Division 1639. �� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PROCEDURES FOR A DEMOLITION PERMIT 1. The following departments, located at 200 Main Street,must sign off on the permit application: ❑ Conservation Commission: available from 8:30-9:30 AM or 3:30-4:30 PM ❑ Health Department: available from 8:30-9:30 AM or 3:30-4:30 PM ❑ Tax Collector ❑ Treasurer ❑ Historic Preservation Commission 2. Historic District Commission,200 Main Street, approval required prior to construction/demolition for any properties located in a Historic District: . ❑Old Kings Highway Historic District(north of the Mid Cape Highway) ❑Hyannis Main Street Waterfront Historic District (See map for boundaries) 3. ❑Specify on permit where demolition debris is to be disposed of. 4. Certification that all utilities are shut off is required. ❑Gas ❑Water ❑Electric ❑Barnstable Engineering if on Town Sewer(no certification needed if on-site septic system) 5. ❑Workers Compensation Insurance Affidavit form must be submitted if more than one person will be involved in the work. 6. ❑ Property Owner must sign Property Owner Letter of Permission 7. ❑Fee to be paid. Note: Dumpsters with a capacity of 6 yards or greater require a permit from the Fire Department having jurisdiction pursuant to 527 CMR 34 q:formsAemoperm rev.010505 e :Apm Frt N & WYNN 508-TT5-1244 T-480 P.001/001 F-551 ,y o r. Ins else, f7or C2Qf rasp V T C/ shed � Q 10 � T Ot) 11 30 OV 19 / a , re,�: 13�589 food �,2�000�000�� flood Wn¢:Vhemgg ✓ n'' � nn ,� coon wc -,�}r�� r io PAU� °yN y �Gl tcz'en�s � T. 1�rrcg shown. h�reon.coesn �l<l t . C'or OROYE y the dwel li j with atl.ef�'ectwe-daze o f 8>9-85ar d 7h I=h {, "I�OM con f n r toCtiZ�IQtL s twv +aF•construct�on, Widi �tm V�laws t�,¢ G tut dtrner-trio Q a'cfi,ortd under 1Nctss, Genet�al, s°r»: vzola tort,ext ot'eetmrLt7' tee: >t R = «h '40A-..SFCtIOYL?: Fie 1Yo. PLEASE NOTE: The struc[ures as shown on this plot plan are appr�>ximate only. q determination of the building location and'ehcroachments. if an used. for recording Y cXOR, etcher way acrossctual propertyCj,nC� ec ssplanfor a must rcciot bc S purposes of for use in preparing deed descriptions and must not be used for var' purposex This play must not he used ti<> locate property lines. Verifition of building locations, or Inc configuration can only be accomplishedd b lance or building IS. shown hereon, Y an accurate instrument _survey which may refteccprop property line different dimensions,9crtc; Please be that this is "NOT A BOUND SURVEY" and is "FOR MORTGAGE PURPOSESrONLY",thy what COLONIAL LAND SURVEYING E'i'�NG CfJMPA�1l'Y, INC. Hanover, Mass- 02339 Phone:781-826-7186 Faye: 78i-82&a23 DEC 08,2005 04:42P WYNN,&WYNN 508 775 1244 page 1 i NOTES: 1.) THIS PLAN IS VALID ONLY IF IT IS STAMPED AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY.FOR INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNATURES IN RED. \ Lor.2o2 �Q I LOT 198 EXIST. SPIED �00 FENCE 11,oft •cc, LOT 201 TO BE REffoVED 6S A� 33.4ft �6 11.9ft �tK/ ADDITION ADDITION ? IN PROCRESS `� 13.Oft LOT 200 A� >>, 182t SQ. FT. / �� L 0 T 199 0.26.1- ACRES v '� K? �O 34.5ft �s " 24 S' - BUILT " PLOT PL,4N LOCATON.• R. 0 'Hearn, P.L. S , R. �S' L 077 200, #20 CONNL'RS Rq, 35 Route 134, Swan River Plaza, Unit 2 C�'NTERUILL�; 111A. South Dennis, Md. 02660 ASSESSORS AUP .ZS> PARCEL 66 I CERTIFY TO JOHN F. & JILL A. KENNEY vex ✓08 NO.: 106OR AND TO THE TOWN OF BARNSTABLE BUILDING INSPECTOR HOFMgs THAT TO THE BEST OF MY INFORMATION, KNOWLEDGE �Z AND BELIEF, THE STRUCTURE SHOWN ON THIS PLAN .��'P `r'�C+ DATE. MAR. 16, 2006 ti HAS BEEN LOCATED ON THE GROUND AS INDICATED RICHARD �+ cuENr.• AND THAT I T IS L OCA TED IN FLOOD ZONE C PER J '�',► KENNE Y FLOOD INSURANCE RATE MAP DATED 7102192 O'HEARN NO.27871 c � SCALE: 1 IN = 30 FT 22 / �'°c�s9FG1STtiPQJ` DR. 8Y.. S� R. 0'H. LAW DATE EG. PROFESS I NAL L O SURVEYOR SHEET OF 1 Dec-08-2005 04:54pm Fr & WYNN 508-775-1244 T-480 . P-001/001 F-551 ATJ N enney x' an .Pro�= en ter�� _C Q f 10 OIL �pto�gg ' f - ref. 9 � food pmu ,2500010 •o ;C food, zone.� taE or PAUL ,yn'�'&�nn - '� Cti01L Wififi5^�1i pared-For � T. M �� • G'or�. � GROVE ti , shown, heat wmof-oeswvt,*U jM a s�ec'ii ., a�Na 3 0 ha�ar>rL G[>1�C>C w�th,GTCL e# 'ectxve date of$�9�85and '7}1¢IOCtiL>?Ian, 8TE ?fie dwei tin u, dwey con n, ' O locca849 Ana U t�ac oFconstructian, witk res4ec t'to hor z&L&t. �r, cWMOM under Mass. yr is aws rM Vto�.aft �n e�l� OMCn�e�� Scale: 1 GCttECGtL 1QWS CI •►� ..SeCir10YL'7. Dater PLEASE NOTE, The structures as shown on thir plot Ian are a File Np dctermittation tsf the building location and encroachments. if any cx,at, either w P pproximate only: An actual survey :s necessary for a precise uused for recording purpnxcs or for use in preparing deed descriptions and must across hperau say for nCvar slier.oran must building��plan r tcp C-Onf{gura ion can only theeaccomplished d W thypanpaccura ccin.uymentt�survcybuil iingma ation.s t is shnwn,'heieon. Please mote that this is "'NOT A property line dimensions, fences BOUNDARY SURVEY" and'is 'FOR may PURPOSES different rONLY".mation than what COLONIAL LAND SURVEY 269,HaQover street ING CJMP�INY, INC. • Hanover, Mass:02339 Phone: 781-826-7186 ]Faye: 78I-826-4823 DEC 08,2005 04:'42P WYNN,'&WYNN 508 775 12441e, page 1` I — -- o � _,� �� %� � �,� a� � � �� 3 � � ti G �----- J �� o (Cl , Table J31-1b(coutianed) Prescriptive Packages for One and Two-Family Residential Bufldlagi"Heated with Fossil Fuels MAXIMUM MINIMUM tllazing aaang Ceiling Wall Floor Basement Slab H64ng/Cooling Area'('/o) U•v due= it-value' R-value' R-value' Wall Perimeter Epipaunt Efficiency' Package R-value' R-valuer 5701 to 6500 Heating Degree Days' Q 12% 1 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 l9 !0 6 Normal S 12% 0.50 38 13 l9 16 6 15-AT T 15% 0.36 38 13 25 NIA N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A NIA 85 AFUE W 15% 0.52 30 19 19 10 6 .85 AFUE X 19% 1 0.32 .38 j 13 23 N/A NIA Normal Y 18% 0.42 38 19 23 N/A NIA Normal t 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 I0 6 90 AFUE 1, ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: Z`- O • 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q-AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERNMgING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL YES: NO: q4orms4980303 a 4. 780 CMR Appendix J Footnotes to Table A2.1b:• '- Glazing area is the ratio of-the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding.opaque doors)to the gross wall area,expressed as a percentage.Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft�of decorative glass may be excluded from a building design with 300 fl of glazing area. 1 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRQ test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. The coiling,R-values do not assume a raised or oversized truss construction: If the insulation-achie�res he full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted. for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity . insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity.insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. I The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding. glass doors of conditioned basements must be included with-the other glazing. Basement doors must meet the door U-value requirement described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes electric resistance heating use compliance approach 3;4, or 5. if you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see-Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels.Insulation R-values are minimum acceptable levels. 'R value requirements are for insulation only and do not include structural components. b Opaque q ue doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested dance with the NFRC test procedure or taken from the door,U-value. and documented by the manufacturer m actor in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. a be excluded from this requirement(i.e.,may have a U-value greater than 0.35). One door may � c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O�(y Permit =` Health Division q!� it � 3 Date Issued (� Conservation Division !—� a Z5/0-5— SEPTIC SYSTEM MUST B€ INSTALLED IN COMPLIANCE Tax Collector WITH TITLE 5 lication Fee 1 06 11 ENVIRONMENTAL CODE A& Treasurer TOWN REGULATIONS Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 0ox_)e_'(?5 Village Lof k�. 1 Owner �__/�A:VD D V Address al�?i tk'15' Telephone J� 7Zj ,2A?-5- Permit Request .` Square feet: 1 floor: existing proposed 2nd floor: existing proposed / Total new Valuation ZoningDistrict Flood Plain Groundwater Overlay Y �✓� Construction Type Lot Size �l� �e— Grandfathered: ❑Yes ❑No If yes, attach supporting docq'mentation. F Dwelling Type: Single Family UY"" Two Family ❑ Multi-Family(#units) Age of Existing Structure�� Jam— Historic House: ❑Yes ff�o On Old King's HigffMiay: ❑f91 Oo Basement Type: eFull 0 Crawl 0 Walkout - ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) La Number of Baths: Full: existing new V Half:existing n8w t��5 Pn /Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas 06II ❑ Electric 0 Other Central Air: RrYes ❑No Fireplaces: Existing New l2 Existing wood/coal stove: ❑Yes Oslo Detached garage: ®existing 0 new size Pool:Cl existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:�xisting ❑ new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial Q Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name J -I— 5n1_,0U k Telephone Number .oft Address j o rna,,>U o-V { Z b License# n. d� (!!! _�_ (,,3 Home Improvement Contractor# a Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECTWILL BE TAKEN TO rr SIGNATURE DATE %//a3�( �� t, FOR OFFICIAL USE ONLY q � F r PERMIT NO. DATE ISSUED C " MAP/PARCEL NO. ADDRESS VILLAGE ; OWNER DATE OF INSPECTION: F ' FOUNDATION S O'n L9 O /2`D FRAME �(�/` :iF l7e �ao ,nb� �w�De INSULATION FIREPLACE t-- CD t 3 � ELECTRICALS UGH FINAL . � n PLUMBING: c s ROUGH FINAL rr, GAS: ROUGH FINAL FINAL BUILDING ► DATE CLOSED OUT ) ASSOCIATION PLAN NO. A ; ► 1 L RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE _ New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET -NEW LIVING SPACE square feet x$96/sq.foot= 2 R O x.0041= 1 2 plus from below(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= kplus frombelow(if applicable) . GARAGES'(attached&detached) square feet x$32/sq,$._ x.0041= 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 $96/sq,foot= x.0041= t 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) I ff�� Permit Fee ./`�'-E), Prajcost w.___I.f4l.I1A WP`QP THE TQ The Towne of Barnstable O 1 N BA-N 'Department of Health Safety and Environmental Services ABLE'' 7i MASS. g a t639' �0 pTE�MP Building Division _ 367 Main Street,Hyannis,MA 02601 o ' I Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW .+ Owner: Q Vk VA<z CA Map/Parcel:t._t7 l - Project Address: 0 C,oh t 6 S 2 Builder: 0U-)ne.1r I The following items were noted on reviewing: ` . -- IDSoh o4 uLa-e \ , 7 'V-U G, i, L y 1sne,f e Q-V Q y L ) V)-) J i S ,� 1 S v t � 3 ��S-t �f l c1 Cn 2 1• u ,+�y Y1 C��t o y� C y VY-C)o " a o �lrr;� ec_l iY1 �VI cA?'(Y IA lC' C)riG-vI GVP4� 'f L V 1 CU'1 J '1 u - Y Q1/►'1 A Y1 t Reviewed by: Date: /Z`Z Z" q:building:forms:re3iew Town of Barnstable y��pfTNEfp�O� Regulatory Services L _ Thomas F.Geller,Director Building Division "�fo 't ae Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wvmtown barnstable.ma.us Fax: 508-790-6230 Tice: 508-862-4038 HOMEOWNER LICENSEE m7nON Please Print j DATE 2 !• ' -JOB LOCATION: street village number ; °HOMEOWNER: a �name .home phone# work pbone# CUMU NT MAII3NG ADDRESS: Cl-_7 Z city/tows 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 su�soT• 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 dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs-more ihaa 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 Tpmo 'b for all such work verformgd under the building vermit. (Section 109.1.1) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons 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 requirements. tAof wwn ding 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. HOMMOWNER'S EXEMPTION The Code states that: "Any homeowner perfowbz work for wbich 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,th-Jsucli Homeowner shah act as supervisor." lvlariy homeowners who use this exemptibn are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Aegolations for Licensing Construction Supervisors,Section 2.15) This lack of awaren a mien results would with a licensedy when the homeowner hires unlicensed persons. In this case,our Board-cannot proceed against person Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many comnnlast p require,as part s the permit application, that the homeowner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns• you may care t amend and adopt such a formlcertifieation for use in your community. f1•fi..rne•hmmeexm]TJL \ 1ILG LV/ILI/IV/i►IG KLNL VJ lI1KJJKL.Ii LLJGLfJ Department oflndustrial Accidents Office.of Investigations' ' . 600 W.ashingtfon Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu>onbers Applicant Information Please Print Legibly Name (Business/org =ation/Individual): i jI 4 i�Y;�Z/ ZA., lAS��1 Address: 2_6 ®e✓�t1p 12 S City/State/Zip: C'P�� y:�'lo lid �,5;Z Phone#• r&. Are you an employer? Check the-appropriate box:. Type of project(required):- 1.El !am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, 6�Building addition [No workers' comp. insurance -5. ❑ We are a corporation and its • required.] officers have exercised their 10.❑ Electrical repairs or.additions 3.1 V1 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.❑ Roof repairs insurance required.]t employees. [No workersl 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. - Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500,.00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOPVORK ORDER and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certio under the pains and penalties of perjury that the information provided above is true and correct: Si afore: Date:' Phone#: Official use only. Do not write in this area,to be completed.by city.or town official. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.,Electrical Inspector S.Plumbing Inspector 6.Other Contact'Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employeeo: 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 ao"P4 MdM�lual,:Partp.er l4,-.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.,*e- 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 woikvn such dwelling house � shall not because of such employment be deemed to be an employer."ands or building appu rtenant thereto . or on the MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or a business or to construct buildings in the commonwealth for any renewal of a license or permit to operate dence of compliance with the insurance coverage required." applicant who has not produced acceptable evi Additionally,MGL chapter 152, §25'C(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-contractors)name(s), addresses)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided 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 appl ict Please be sure'to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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-hcenses..Anew affidavit mast be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for.your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts r - Department of Industrial.Accidents a, ..Office of.Investigations r. 600 WaslungEon Street . Boston,MA 02111. ' Tel.#617-727-4900 ext 406 or,1-,S77-MASSAFE Fax#617-727m7749 Revised 5-26-05 www.mass.gov/dia r Town of Barnstable Regulatory Services Thomas F.Geller,Director ,� .�'�,• 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 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- I d 'type.of Work: -a lA� ►� �� s — `� ` y C��l_Estimated Cost �5, Address of Work: D La 1,J0"e 1?'K 1-1 Owner's Name: .- Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): DWork excluded by law ❑Job Under$1,000 ❑Bu dmg not owner-occupied 25wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WIT 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:forms1omeaffidav ccii E 2 s q 3z+ I I � 1 ' ' �''' d � � � �; � .. � � 1 1 � , � { l VM 1+\ BUILDER INFORMATION Name i�y/I l.�ni !i� S?off r�i io Telephone Number ._5 ell11 - r1 G Address i_(� ��,�� /L L u2 License# I, � r./ ;, 14 q Home Improvement Contractor# Worker's Compensation# eA 7LIc1C7`° *"I�f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE L 1i�� DATE J 0.3 --- c��-- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map` 1 Parcel Permit# ?D Health Division O� _4 - Date I ed � Conservation Divisi n J' L-1010l( L3) Fee , o�3 Tax Collector - at`? �- -ee ) 5-0 (20 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ® � C) � Village Owner tD6Address Telephone Permit Request e IrOO , o Square feet: 1st floor: existing oposed 2nd floor: existing proposed ® Total new Valuation_ �6Zoning District Flood Plain Groundwater Overlay Construction Type Lot S;Le Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwe',bng 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.) 1000 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: bI Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 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 BUILDER INFORM TION 'nVI Name der 0,0 Telep ne Number r I Add r ss C t` Lic e#C 0 cto # l or er's Co pensation# ALL CONSTRUCTION DEBRIS RESULTIN THIS P JECT WILL BE AKEN TO (,,,SIGNATURE DATE C D a FOR OFFICIAL USE ONLY , PERMIT NO. ( ., t DATE ISSUED 3 MAP/PARCEL NO: f s s ADDRESS _' VILLAGE i OWNER , f ` DATE OF INSPECTION: r FOUNDATION FRAME .,aC'/ UZ INSULATION FIREPLACE s' 3 • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH- FINAL GAS: ROUGH- FINAL 1 FINAL BUILDING - 24 — DATE,CLOSED OUT ; ASSOCIATION PLAN NO.Y s i �``�l'? '• ✓/�e�x '4��nrnbiuvea�l/�a��xuae�.� ' aura IJ1, tea t a yw n , BOARDVOF BUIL'DING3REGULATIONS » PY 5,y kqa,.+&t z• 'd 3vy A .�" M •��¢ .. �¢ ,za ��iCe se, CONSTRUCTIONFSUP,ERVISOR;��)��, ". s ,l �.�`"?y 't�i' Nu nbB'CSti s�074928 { )" ti �Birthdate 08/10/1961 �'' f, * xpires Og8/10004^� - ''" It Restri ed�001 'f dda�'C aV' WILLIi4M WHO-EN1 +"04 im-�r - w� BREWSTER; MA' 02631t ,d„ .r�� Adr»irnstrator>�^ - X?,�• '+X^'^ 4T �,asrr`'�'3�'cz��t� +"5'�.,..rt-:m�'�..e. �- c..-_..'cr...:r ,..a'r�p3 .. aC/ .at H � r.4�R,rC� t k .nb� /�..a+�.�� ar"P�"��"531 •t`. _'• 'a oard$of Building Begulations anulatandards4 s r�'FFx. ,r. `? � ;{ .- i ,z„i� Sn'y"`'�'*dim'' ✓ir # irt. §''SisaS`°^t TMrr''� NFIOMEkIMPROVEMENTCONTRACTOR ` s o- w a H a3•` .r a «>;Fy,�'zt�4Y5 YapY• zEr s � ��. t�� #'•'r' rry.f w u'��-a. f '��T�`iX*of � �s t i��.g�3�' r° _ �sReglstrationfi�129244 . ,a � fs•£'p�s.�5"'s'�2zo-z'!^' �U i1ratlo��Q�J�3 ra' a 7iWl - 4° a *rp1 r v tie . �vrfe 4 Pr`�vate,Corpo�ratl0n a,as aja+ a pats �S ,. • ff .WhaienRestoradO e�t�vi,ces nc� h 4 Wz4�„d1_�{d,l x e �gkr �htgq b w • � � _ 110 Breeds HIII�Rd�Umt�� ;r � �,�.�,.��' ,� �r �� Hyannis,MA U2601. t 3 ,MA�dmi'n`'istr�tot�r ti - `� fi�+tlar ^'r, i�Jx 5 •t?+.R gs� �r^ m K '� � r...,..•..::«yw s«..s''++tt�."":"'p+'+z„: :Nr <sic,.:-��-.,�ts§.ai.,m.aa.w�.�..r. �. OCT-01-2002 16:35 ROGERS & GRAY,,COMM LINES 15083980246 P.01f01 fA MALSIM ACCIM CERTIFICATE OF LItABIL.IW IhlSUMNC:E IUMI102°"" PROOUCCR IRIS cFMiiP-mAIE 13 ISSUREI A9 A MATTER OF INFORMATION Ropers 8 Gray IIIIs.Apency,Inc, ONLY AND CONFI RIS NO ROMPS UPON THE CERTIPICAT'i EMD OR 0401yanaugh Read RALLY TH LE ICOvEmeE AFROWED BY THE PO 4109 BNELOW. Route 132 Hyannis,MA 02601-1999 tNSURHRI!AFFORO0181 COVERAGE INi1�E0 iw&A AA: Ar6sihl ProlooMm 0e Wbaien Reelorallon Services Ina INauaeRe:ArbW*Mutual Insumnee Compan 110 8reede HUI Rd,UnH 4 0; Hyeanie,MA 02001 Ir INURE COVERAGES THE POLICI93OPINSURANCE USYE:D BELOW HAVE SEEN ISSUED TO T'WE INSURED NAM ABOVE PCRTHE POLICY PERi00INDICATED. NOTWI"TANDING ANY RRAUIREMENT, TERM OR QONOITION OF ANY CONTRACT OR OTHER OCCUMENT WITH RESPECT TO WHICH TNIe CERTIFICATE MAY K ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDaD AY THE P^OLIM OE90RI ED HEREIN IS 3UWECT TO ALL THE TIS MS,EXCLUSKM AND COND710"OF&UCH POLICES. A93REOATE LIMITS SHOWN MAY HAVE BUN REDUM BY PAW CLAIMS. LTN NOR TYP99FINSURANCII PdICYlNNHI9I MOM Warta A aEReRAt UAaIUTY Il000021061 04 01102 04►01103 EPCH OP,CURRENCE a 0o.oa0 -- 40MMERGIAL08NGRALWAtifLRY PIRft:DAMAaE an•Nn 00000 CLAM MADE �GCCIIR R ki®E7si•f oae Noel S$ !10 - ," PEROONALOADVINJURY 000 • GSIIERALAflOREGATE sz 000 QEN'LAQORSQAMLIMMAPPLIiePI PR0mcm•OmpwAm i2 000 P4LICY !4 LCC A AYTOMCe1LALJ IUFY 74017400001 0212BM2 0w2�103 � SINGLE UMrr s1,000,000 ANY AUTO AliQYIrAICALITOD 0we nodal DILY*U RY X 9CHEDULEO AUTOS ' A x NIREC AUTOO SLID LY D IURY $ X NON.OWNWAUT06 ` (Pat*= p TOIANROC L$ RAmcen dla>•WAORRY AUTO ONLY-P.AACCIDFIIT S ANYAUTQ WHO THAN FA AGO i! AUTO MY. AM S WAISIWPY 41MOD21M 04101102 04/01103 Ga< AT 00b 000 OCCUR ❑mmmeMACE AQGR80ATE � s CF�UCTIBLE S x RereNn0N $10060 8 rYORa ncomp1 urIoNAIm 8 1320402 "Cli0R 0Ub1003 YA F. • 1W CM 0UYffl 6"WAftITY . E.LEACHACCDENT id00,bOb }. Pi,m -6AeMIM.OY �OQ�0 LL McASS.PWCY LIAT 2900 000 OTm DRdCRIPTION�OPeR11TKNrtA 4�►TgNmbC111CLEdE700LY01pN3ADC®!Y PRQVggwt , FAX 1-5014MI793 C.=1061F HOl09R AOaIT1omm • "MLEM& OE «. _ - aNaaoAN+raPTNSAsoveoeeaaseoroLx�esaseANo�os •rrIePIIv+RAnoN JohIn&JIII Kenney « : , oAre TNICie®P,TIw IOw 4INumm vm waluvoR TO u L 10_oATBwwrrar 20 Connors Road In ICIST011110 RnPl� n TReISPr, UrrAILVm TOD990#NALL C•eitletvllle,MA 0M1 , IMPUBN00111 T� 3 ETYMA" IT•AieNT111011 AUn RlllMaOmrrA1�1 'l • ACCIRD '0"(710T)7 02 0=64 000RATION 1988 ; t TOTAL P.01 The Commonwealth of Massachusetts - - Department of Industrial Accidents --_ Office ofl7yes119811affs. 600 Washington Street Boston, Mass. 02111 j3 Workers' Compensation L2=,ance Aifidavit / location: �q aC] .I am a homeowner performing all work myself I am a sole zo rietoz and have no one workin in ca aci i % % 1e %z / t%ob�y%//%%////%/G/ 1- com ensation for p �� e9' Omker$ P :.v:rr.•••4r 4.4:;{ ;•:f•?,ivT1:32::t aS:S¢N,C;£.>~}r.s:3j:£i v: 2',' i`> ! r: ^2Y •..:'now: :<;�f• er_ rovidin w }}CS:, n:;{:2�:;fff.;.:hs..f...:. 4,^:5 �:.::,xY..: .. ...,nih•:x,.},{:n: ^::3: ?•,:.`,i`:¢,::xr '•:4:,.F,., vc Y 2 ..•<>: vc e 1 g {:. 4 r•.vY:t t {.....i. :. :$. .ifi an � •:rox•}:t;'? i::»•... : ^xt4: i+•#:n :'•r',ct• .}.J:;^.,'fit;}; •.t•..�C.+i`. •.;.k^.jt2'x,:,} I am mP >f< 2 :.:.:: :y;{+: {} ;` •}: .:,; :}a .i...y.. 4rnh.• r:x}}: •r .. ..... .:n•.v::4}:{.:':.}•.{?:i}2},:•::::i:•,r,:}.w: ri.:..r..;:;:;;. : :"?nos.:. ...a,. , ..... f.. x,rn• :.....{. ..vv....:. .F ... .r:.;+?•. 4•:, .:;'i:ix: 4p, •f? ?.:.vr.h.. { '•:•?J'v.}.: •}}$j;:v.nfi.2`2, Gyx•\::. !:3?f:2fS2::L{iT'.4: '.Y, ,:}fv;::'+,•}: •.}Y77.4. ..b. ...to >}>• r♦.r. ••.r. ..} :r.3... ::}r �Arr.: .•:•r .. r•:.,:;.x+•r ...:{ :•x••:::.. .;•:•:}Y•:•:}4::••::..:::.:+... n:•:v:{,,:•. }xe!t•.. •x„•.........35• ',r`0.•%�' C 5.,7. n�:•....e.....r..n•:>..� ..:.. .ta,. ..:r... .-:,..:•.:}y}f.•+:+ ..r.... .: ... },. 2..: 26;�.{,:.xt.^• }•.yr•:.y �,},..?;: .'rY.sv:: •i. n••:'rY..:::......;;t.r.:•.w::•.....an:::♦ .v♦..,2...,Y{.... :q.:•:r:...r.v.:y ,;;., .... :,n: ,.! :i: ..f;f}`} ..v,:...,nx.,.,f.:••:Y...:::•:..•}.,x. v. .. f .:n }r-:L?• .. v. v v,•. :: •^;;yT:?4}:+ {x•{.y. ... .. ..... 1 +... .. ... ...h. •...: .. :.v.:..,.:.to.:., .. ..........:v {+ +:SS:�• .:•x+.f .hi...4:.Y'•r =trot.. •2t>• :r}a:. :•T:f:42�}• fiY,•�r.t .?R:. �S24]Y.�: ::7••. ;•�S nt S:•. �+{Sf?}' •.rl... ..}:r:•{•}:{•}'.:rir:;.}'n`::f 3.•\. .... ...... ....:•.,•::::..:t{'}•.}•nx:•}::rr......}:::}}:r^.:i..}:. {va••rr<•.:-:'''.:v.:}:;f:r:;}•.r...n;;:':. r,:r•. •:;.,nr. 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'Phone# .- ' '•Print name vV afacial us a only d thi o not write in s area to be completed or town official by dtp _ peanitliicense# OBuilding Department dtp or town: ❑Licensing Board ❑Selectmen's Offlo_ . ------------ contadperson: r L .Information and Instructions rs' compensation for their Massachusetts General Laws chapter�152 section 25 requires all employers to provide ee is defined as every pe son m the serviceeof another under any ontract ployees._.As quoted from the `law , an atop y ..nfhire,'express ormaplied, oral or e er is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of em la player, or the receiver or An p Y the foregoing engaged in a joint enterprise,"and including the Legal representatives of a decease amp ye , . 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 onthe grounds or appurtenant thereto'shall not because of such employment be deemed to be an employer. c building MGL chapter 152 section 25 also states that every state or local licensing agency shall Withhold the sspuP ce br renewal erate a business or c , of a license or p ermit.to op to buildings in the commonwealth for an a licaat who has not produced acceptable evidence'of dompliance with the insurance coverage required. Additionally, neither the'.,... r into any contract r the e of public workuntil .commonwealth nor any of its political subdivisions shall enteements of this cha ter have been p�ancented to the contracting table acc evidence of compliance with the insurance requirements P authority. Applicants cng the box that aplies your situatiiaii�� Please fill in the vvbrkers' compensation affidavit numbers along with a ffidavit completely,byecertificate of insurance as all affidavits may supplying company names, address and _:. submitted to the Department.of Industial Accidents for confirmation of insurance coverage. Also be sure to sign and e is date the affidavit• The'affidavrt should'be returned to the city or town that the aanpph ation for questions regardingePe mit the�`la�',o _ifyQu not the Dap&tment of Industrial Accidents. Should you have y qu being requested, i the D artaia atthe number-Iisted below:.: equired••C6 obtain a workers' compeasa.an polioy,please c ep 'are r .. i• ,�: City or.Towns ; be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of�%e Please gations has to contact you regarding the applicant. Pleasq affidavit for you to fill out in the event the Office of Investi bei wluchwlll.be used as a reference numh'er. TTie affidavits may ie'r '` _to.: be sure to fill inthe.pemnit�lcense nun -� '• ant b"mail'or FAX unless other arraugenients Have been made. -ti the Dep .. ^.�si,.. artm ,r, Y,�:". ,.: .�. .� estions, The Office of Investigations would like to thank you in advance for you cooperation and should you have any�u please do not hesitate to give us a'calf. y i The Department's address,telephone and fax number. ' . ,.... ThCCommonwealth Of Massachusetts ..Department of Industrial Accidents ' � Oft1ce of initestlgatlans r . 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 (617) 727-4900 ext. 406, 409 or 375 The Town d Barnstable . . . MAS&erg. Regulatory.Services t639. �0 4'prfc►uy• Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyas MA 02601 nni ' _ Fax: 508-790-6230 508.862-4038 Permit no. nn Date 'r� 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: IOp CI � 'J• Estimated cost d �Oo ffnn ] . Address of Work: a bG1 TI'S 9 N Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law OJob 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. SIGnp UNDER PENALTIES OF PERJURY I hereby apply for a permit as t of the own Date r . Registration No. trN e. / OR Date Owner's Name p,OF THE►, The Town of Barnstable BA N E.MASS. Department of Health Safety and Environmental Services 9 ASS. 0P ,6}q. �0 �P�fOMP Building Division. 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspections Location ?() C m r\a r•� Permit Number 5 9 3 4-9 Owner Builder�al�C,t One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ZJ -24 = -3 r Please call: 508-862-4 38 for re-inspectio . G Inspected'byn r Date AD _f-G Z