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HomeMy WebLinkAbout0070 CONNERS ROAD k.akl W! �A ,2 "'�,W 1 6LK -Jw ti ,4 a 41"Al Zk� ,&�7 f -m m A R, MEIN 5"V"i�Fi,.'M iT :5,11111 1 111 ��4 gli 0 'x g-m q t p p W km-11 M 17- -R, 9 Vp ,41 "%J-N 0 'Now" 14 �jg —P g R;� ACY 4NM MRUM jA ell gj'g�fq,�,k -73 pz� 16" M-, 0004 44 N;A.14*4. 1-1- V 1 S , Z , g X NO P, 4" j1p PD—A—A Wia X N AM m.4%,t-3� 4""i'mmm X 0 mc �1� A AV i� go k V kA "IM" UR4 "As &W i m� Wg MOO 9r-`WA`A W, - z Ai" fl, M FYI "-ml jgrMAO'-�M,V pl�, IMZ11 W`2-,��,W, MIN ,#?�' mqi!R* I,I �L . Nqgm� ',�-Tr" ;, rl",-- 3M I, K �,Z Ne M �Pll w P-Afl' g�y 07 w -w V4011 �15M Fpp M K7 Wo A FA -1)qwmg 10, avi* IN -1 -4 v ",4 IV, �,Yun WARM,�,k: �,4, . ..... ZmA IA., 'A-5t -;,R "'W i418 'T 41 3 A, �,N, jXr,4 MAW 11L, r _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma I Parcel G� T071,14 OF' IQ"I UIU� P ARNSTABLE Application # Health Division +;r f aE;j j Date Issued ? _ j i. Conservation Division Application Fee Planning Dept. Permit Fee �l0 Date Definitive Plan Approved by Planning Board' F� ' p ' Historic - OKH _ Preservation / Hyannis Project Street Address 7 v (�y n/N C=2t �, �l Z V, I (g PVC A i Village Owner �1n1 42 Address Telephone (0o Z w ( 7 — Permit Request o 4& C2-) (ei f 4 S 1 P _o fP l�c/I(metre /L " dtro t vl () /` 'l 6o�„a,� tic c//�h o-�-) or�nPi w�f6r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation '-) Vb Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name N `l h Telephone Number/ Address �^- y yg� L or— License # e-J 2 ? Home Improvement Contractor# / (00 y 6 I Email U eyA . Ca ry" - Worker's Compensation # 61 f�ZC� f 6 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOCv T— SIGNATURE AA DATE 23 �� C r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION y FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. "4b RISE � S Dupont Avenue I South.Yarmouth,Via;02864 1908-5613�1; yy. IA WW. ENGINEERING' t t €WNER AUTHORIZATION FORM Andrew Ctaiy` .owrw of ft property located at: !o Comers-Road ntervitie MA 02632 (Prppefty Address) (Property Address) hereby suGftrize {subcorltra ) an awhodzed sutconttaaor far.RISE Engineering.toad on my behalf to obtain a building permit and to perms work on:my proteht.This form is only valid with a steed contract. OwneesSignature Date The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.go0 is NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information, f Please Print Legibly Name(Business/Organization/Individual): Address: +�n 8 C)c. 10 S� City/State/Zip: AAA 0311 JPhoneik aM 7 Lt— 16 J-O Are you an employer?Check the appropriate box: Type of project(required): l.�am a employer with %j�) employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]° 10[]Building addition 4.F1 I am a homeowner and will be hiringcontractors to conduct all work on mproperty. I will Y ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ repairs re airs These sub-contractors have employees and have workers'comp.msurance.t �j/ L 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. l4.®Other W�ctYLr.t/'/ 2 c,T7r�'1 152,§1(4),and we have no employees.[No workers'comp.insurance required.] . *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �l Policy#or Self-ins. Lic. #: L�(I UN 6-LRO I Go Expiration Date: Job Site Address: -7 O c-2 City/State/Zip: 9N t-(L/J (C rvL4- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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..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 andpenalties ofperjury that the information provided above is true and correct Si nature: Date: 2 Phone#- spy- 1-7 � �v Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:317787 RETROFITINI ACOR& CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDNYYY) 8/0 512 0 1 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of suca,endorsement(s). PRODUCER CONTACT NAME: HUB International New England At o Ext:978 657-5100 FAX 978-988-0038 222 Milliken Blvd E-MAIL (A/C Fall River, MA 02722 ADDRESS: 508 235-2200 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Star Insurance Company 18023 INSURED INSURER B RetroFit Insulation, Inc. PO BOX 105 INSURER C: Seekonk, MA 02771 INSURER D: 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. LTRR TYPE OF INSURANCE ADD L SUB POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea oNcu ante $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JE Q LOC 8 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS - BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE 8 Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ A WORKERS COMPENSATION WC0 4452/100 8/02/2015 08/02/201 X WC sTATu- orH AND EMPLOYERS'LIABILITYFR OFFIANY CER/MEMBEREXCLUDED?ECUTIVEa N/A E.L.EACH ACCIDENT $1 000 000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1432002/M1432001 RB004 A- Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massach setts 02116 Home improvement Registration Registration: 16MI -; ;; Type: Private Cotpmflon ;.= iz"`.. Expiration: 7I2MO18 Trd �9184 RETROFIT INSULATION, INC. JOSEPH REIL!Y P.O. BOX 105 SEEKONK, MA 02771 "' gM ;` Update Address and frelnra esrd.Mark ream for cbiop- -_ Addrtes Renewal ❑ ympb jmeat Lost Card 60A1 v 20M4W11 Y C�//dfl T/10l/t1fGG9KG8�[NL O�C3'LGfldd�QCG6&�d . Offiiet of Consumer Affairs&XR MM Re>taistion License or registration valid for individual use only HOAR IA1PR CONTRACTOR before the upiratiolt date. Xf found return to: , Regietratlon';� pq�e1 Type; Office of Consumer Affairs and 110new Regulation Ewl 8 Private Carporetlen 10 Park Plaza-$utte 5170 ,,��;;,�� ••:; Rortoo,MA 02116 RETROFIT INSl1lAffAlhaN� 'y JOSEPH REILLY 544 RODMAN ST FALLRIVr:P,MA 02T2� '` Undersecretary Not valid without signature Massaehusetta-D*P tmOM of Public Safety ` i Board of Building Requlatiorta and Standards s (onstructien Supers i. ...r S ccirth License:CSSL j0?T71 ;V , FV BOX 105 i Seekonk MA 02"1 y � ExPi/abon i '^��'• 08/DV1017 -- .�, NOTICE OF ASSIGNMENT ' ` . :EMPUQYER: M .,KEMPTON NICKER.SON D/B/A BUREAU FILE NUMBER STATUS OF EMPLOYER NICKERSON BUILDING, & REMODELING 240-725R iNOIVIDUAL 13 THIS WAY ADDITIONAL INSTRUCTIONS OSTERVILLE MA 02655 POLICY ISSUED SUBJECT TO PENDING .PREMIUM CHANGE ENDORSEMENT (WC20040I) . ;__: COVERAGE UNDER THIS ASSIGNMEti THE WAIVER OF OUR RIGHT TO RECOVER FROM APPLIES TO MA. OPERATIONS OTHERS ENDORSEMENT IS AVAILABLE ON POOL ONLY. FOR COVERAGE OUTSIDE POLICIES. CONTACT AGENT FOR DETAILS. .:OF MA., APPLY TO APPROPRIATE POOL OR ,PLAN. AGENT ROGER.S E GRAY INS AGCY "INC INSURANCE COMPANY: OR 640 IYANOUGH ROAD PRODUCER: HYANNIS MA 02601 AETNA CASUALTY & SURETY CO - _ MS COLLEEN BISHOP P 0 BOX 943 R- - BOSTON MA '02.1,03 TAX IDENTIFICATION'NUMBER: 04-225-4905 (617) 984-1000. CLASSIFICATION OF OPERATION CLASS ESTIMATED CODE TOTAL ANNUAL RATE ESTIMATED REMUNERATION PREMIUM CARPENTRY-DETACHED.'"PRIVATE RESIDENCES 5645 51000 15.46 $ 773 EMPLOYERS LIABILITY 100/100/500: 984.5 STO ?REM SUBJECT TO MASS DIA ASSESSMENT 773 EXPENSE CONSTANT - 0900 160 MASS DEPT OF INDUSTRIAL ACCIDENTS ASSESSMENT 3.2:;; OF STANDARD PREMIUM 25 I -L----TOTAL PREMIUM $ 958 AUDIT BASIS - ANNUAL REQUIRED DEPOSIT PREMIUM $ 9.58 COMMENTS COVERAGE EFFECTIVE 12.01 AM ON 03/02/95 WITH ABOVE INSURANCE COMPANY. DATE OF NOTICE 03/08 J45 PREPARED BY ,HOLLING:SWORTH JACOB e VOLUNTARY. "DIRECT. ASSIGNMENT �; x THE WORKERS'COMPENSATION INSURANCE PLAN OF M4SSACHUSETTS a , EMPLOYER COPY � > 11,'02'94 17:02 V6177277122 DEPT IND ACCID 001 - i canunLojvtlea&L O/ )Wa.6JaC1j.usetb aUapartntent o�J'•,idu�triaC�cccden,U 600 Wu4iyton Sht t James J.Campbell Dolton, Nwachwstfa Off f Commissioner Workers' Compensation Insurance Afflidavit (aoett�ec/pemiuee) with a principal place of business at: (Gcy/sraw4p) do hereby certify under the pains and penalties of perjury, that: ( am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number () i am a sole proprietor and have no one working for me in any capacity. J () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. I underscard th;:t a copy of dais s=tesnent will be forv:arded to the Office of investis-arions of the DIA for coverage verification and that failure to secure cove.age as rec:ired under Secdon 25A of MGL 152 can lead to the Imposition of criminal penalties eonsisdne of a fine of up to S 1,500.00 and/or cc= years' imprisc-,nent as well as civil penalties in the form cf a STOP WORK ORDER and a One of S 100.00 a day against me. Signed this fir{ day of �c 19 9) Licen eel ermittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # .3 7s 0 0 The e o_\VTI (If rz sf n hIc wi 1;�»Jac i��:un�,N.A 02v01 Off oe: 5N-790.6227 F= 5084 5 3344 h Foroficcusronly B� �mmissiona Permit no_ Date AFFIDAVIT HOME IWROVF?,fENTCOONTRACMRL&W SUPPIEMER 'rp PERY&TAPMCATFOX M,GL,c..142A zequin=iliac thc—rcOOvsUUc6Otj,akcm6eas, ip o,eemcat. Tcm()%-ZL denolitim or ct-m em addition to m building oomaining at Icm one but not more than fourdaclii MY io such ttsideaoe or buildingbe done units or to=Uc=m which am* by c�ontrlctors,Qith artam exCcptiov_l,along Viih odic= Tvpc of work. y Est.C �JG�O 020 Eye s _ 4 Datc ofPcsrriit Application_ I hcr$n-oatifythat: l!Rcgisuation is not rquircd for the follo�inf r7c2 on(s): Work<scludcd b%-12W 305 under 51400 Ecilding notvO­n<r—z pic& O�•rscr pulling o..n pernvt No:icc is hC7CbV Si«n thzt: OtZ'NEPS PULLTING i OP DSI.!T:;G i:Trjl L:�'REGISTERED CONTRACTORS FOR tPPLTChDLE FON�Z �i �:p:i, D4 F 1:07 I-�,t'L ACCESS i0 7r� �iiTr��T10�'Ff.(3G �� O�Ci1r F c�.�'T� _D t:'DSO:►.;Ci-<. 142A :SIGNED UNDER PLl;�LT1ES OF PS)tiTil�1 - OR D�tc Gt::cr•s n2rc DEPARTMENT OF PUBLIC SAFETY . � raaiur�toposrseasaca�rem! COMMONWEALTH NaasacAusetis 5tateBuildUr9 .5 OF___. __.ONE ASH_SOBTON..PLACE_ � I _ p;,Da alBE fl MASSACHUSETTS BOSTON,MA 02108 7y this licease. .�r� � L I C CAUTION ENSE:- CONSTR. SUPERVISOR. EXPIF{AIT1O,N DATE • . FOR PROTECTION AGAINST �1/0 /1 996 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB RESTRICTIONS 3 9 9 S014358PRINT IN APPROPRIATE �I+3 N E BOX ON LICENSE. E MELBOURNE NICKERSON Z 1 3 THIS ,A A Y ° BLASTING OPERATORS SS P 028-34-7660 OSTERVILLE MA. 02655 ° MUST INCLUDE PHOTO. PHOT, G OPR ONLY) FEv ry 1_ a}. 0.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER , .;wm 1 j{ rrll '}. DOB: iUL V / ���3 01 /17/1946 THIS DOCUMENT MUST BE SIGN NAME IN FULL ABOVE SIGNATURE LINE ' CARRIED ON THE PERSON OF AT EOF LICENSEE ""44 THE HOLDER WHEN EN- SIO R �D)CSCS OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. V �1 T; � r Z • -a c x v v m , ac 3 G ti• ro N ., c> A a ro �• o z o .� w x c m R z., x .c+ a U. n �+ r ®70 ro ro F� P,. I i J., LAI CIt' - � A ti fl�2 N I c�.ss — IT a = a� 77t% ggb` i � f le ►.�'�, � ��HYh I-�Ib,e'(� ems! 4 i"�wig 70 GON►- {'h IZp G�u��/IU,� MA. + TER LU FF ARCHITECT 032 M;in Street•Suite q Ostervillc,W 02655 (500)420-9119 I � . Assessor's Office 1st floor MaD. Permit# 2,_ C2 f2 Conservation Office Oth floor) Date Issued S` 9..51' Board of Health Ord floor) ' .k cA'-vO/ Engineering Dept. Ord floor House# ®rE Planning-Dept. (1stfloor/SchoolAdmin.Bldg.): $EP'�IQNSTALST BE Definitive Plan Approved by Planning Board 19 I�4mOE (Applications processed 8:30-9:30 a.m.& 1:00-2:OOp.m.) � ���® �� IRON' TAL CODE AND TOWN REGULAT9ON3 TOWN OF BARMTABLE Building Permit Application Project Street Address CO N,v Village `"r -1°op;�la��11���' Fire District LP, .Owner .y h7�27fi✓ Address OZ,S~ aKiq F>s.1A'yq /(o /V&wTo"t/ Telcahonc Permit Rcauest ��^/"jA-1-q-W (,971416 a'4pD, ► /Ud � 19jj/ Zoning District Flood Plain /v�/ Water Protection Lot Size Adt Grandfathered Zoning Board of Appeals Authorization Recorded Current Use n Pro sed Use Construction Type 6 J Existing Information Dwelling Type: Sin le Famil Two family Multi-family Age of structure ?0 Basement tune 'FE)4 Historic House !�/'D Finished Y� Old King's Highway- 4A64 Unfinished Number of Baths ' �/,_ No. of Bedrooms -3 Total Room Count(not including baths) S First Floor Heat Type and Fuel )Ggcs? IbT Aig - Central Air A-10 Fireplaces YES Garage: Detached Other Detached Structures: Pool Attached Barn / None Sheds Other Builder Information Name AJfC 1(0UB,j) Telephone number A Address j 3 ��lY,� License# DSCc=A V eL.L 1 _h?4-z Home Improvement Contractor# / 0 Worker's Compei►satior► # <1` 12.� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Oc- Proiect.Cost DoO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T l -r 70J FOR OFFICE USE ONLY 7 7 Jr d 3/15/95 3-75'0'O- '4. 251.023 ADDRESS 70 Conners Road COh4. :sj r � It, SAGE Centerville Tony Martin , OWNER DATE OF INSPECTION: FOUNDATION t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: F ROUGH FINAL f ) FINAL BUILDING: DATE CLOSEDa r ( ASSOCIATE PLAN NO. -y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION \t.mhp �; I A '_Parcel 023 Permit# Health Division 1 If i qq—Z � Date Issued Conservation Division ­37�k / Application Fee_ Tax Collector L ` _ Permit Fee Treasurer Q a� SEPTIC SYSTEM MUST BE, INSTALL1'®IN COMPLIAN ,_, Planning Dept. di � WITH TITLE 5ENVIRONMENTAL CC � R Date Definitive Plan Approved by Planning Board — 0L Historic-OKH N1� , Preservation/Hyannis ON Project Street Address C'Oi✓✓�C S Q2Go Village C'C�u7C A 0 A L Owner A&ron) IV1 r Al Address C H,4 Telephone C t -7 �� f 7 g Permit Request C e Square feet: 1 st floor: existing proposed 2nd floor:existing proposed — Total new Zoning District _ Flood Plain Groundwater Overlay Project Valuation it Z '��» Construction Type W O0 10 Lot Size 2.3 000 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 23 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: N 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 C new First Floor Room Count Heat Type and'Fuel: 3[Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 1 No Fireplaces: Existing — New Existing wood/coal stove: ❑Yes q No Detached garage:❑existing ❑new size — Pool:❑existing ❑new size — Barn:❑existing Cl new size Attached garage:❑existing Cl new size Shed:❑existing ❑new size — Other: " Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name_ I c VA CAL I C Telephone Number 714 39 Address-1 gs'I S's, , vt c�` '��c License# — "� G►�+n t _ -- S <'' Home Improvement Contractor# Worker's Compensation# '?f -3T ALL CONSTRUCTION DE RESULTING FROM THIS PROJECT WILL BE TAKEN TO 171 SIGNATURE DATE °— % a r_ FOR OFFICIAL USE ONLY PERMIT NO. j r bA'W#`'aSSUED MAP/PARCEL NO. ADDRESS ' r" VILLAGEer oe OWNER. DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL+ ' PLUMBING: ROUGH FINAL ^ GAS: ROUGH FINAL' FINAL BUILDING 1h DATE CLOSED OUT'' ' ASSOCIATION_ PLAMNO. J / / .... { �• The Commonwealth of Massachusetts Department of Industrial Accidents == - Ohice o/%stigations . 600 Washington Street , - Boston,Mass. 02111 Workers' Com ensation Insurance davit name: !-► �`l`'�� �� ^�_ location City - nn ►N_ — � l�.�V� f11��- phone ❑ 'I am a homeowner performing all work myself. I am a sole pr rietor and have no one working m' ca achy I am an employer-providing workers' compensation for my employees_working,on this job.:r:?{: >` ......... .....:..x..:.... .- ...:{.:;..�:::::..:::::.:.<;.::.;;:.?i:.iii:.:;.i:.:;.?:.ii;;:.i::?i;:;i:.:i:.;?:.i:.ii:.?:.;i: :.::::.::.::{.i.::{:::..: {.: :::. _ __ .i;..::::::.:;:.:..:..:.:.......:.:.::.........:..:.: ..: .., .i:;.i:.i:..ii::::i:;..i..;.::.:�.i:::;':::::.....:-':.:::......::.: ......:::.. fir.... %%%:%:%%%:%::%i%:{r:;�%%:;{ti{i:%:v:?:%:ti�i%%%::�{;:.ii?:L??:•:{?•ii:•i?::::;y}....::::•:.�:::::w:::•.:........::::•.�:-.:.:�v:...... %%%ii:'v:4i%%i:;%:;:ji{•i:;%:{•:%':'?�:v'i'%%:is :::.�•:::;•i:c�iii:•i•i:�i:{<•:�:::;;'s:•?:�i;; .: .. .•: Xx ::: 02 .....:... ....:::::.:...{.}:::.>:.:is ...i: .:>:.. ..:::.:::.:::::......... ................................. ❑ I.am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have M1 slice the following workers compensation s:.............................:...:::.:::::.::::::.�::::::::::.::.�::::.�.�:;.ii:.:;:.i:.i:.:.:.::;.i:'i:;.:.:.;:;:. ;;.:{.i:.i:.;i:;;{.i:.i;i:.;;:{:?•;:.;:::i:.i:;:.i:.;:.i:.?>:{:::?:.}:i::�:.;;.._�-°.:::;:.>;:. ...............:::.:..................................... 777. ::.::.�..;•iii;:<•i::.::}:.;;:.;:;;:<:::%»::>:{;%:<::?:%;:>::%::%% ... ........ : :2SS}�:%;'::�::;:�::':::s::�: :`�'%:�?:c:::::t:�:�:`�<:�:;::;%;::: •r':%:°i::::::::�::r�;:::��r::�3£::�;:%is:;;�::::: i::;:;:;::::: :::�::'•::C;#`::: i:%%%:;:%:::%%:;�:%%%::`;:?2�t?3:i:%%:?:�r:�'��%::�::>{.:{;::t;;:::::;;;:;�::�:;:%;;::;i::%;::%::%:;:� :R::<�....:..:....::.......i.:%;.: •city' .........:..�.�:::::.�::.�.�:::r:?:i:;•;::::.:::::::.:;:i::.ii'::..i:::..:i..::i;:.?...:.:•,:'.:;.i:.::.i;.:i:i::�:;;.?.•i;:;:.is•?:.:;:.�:.;.::::.:::::.?':.�:. ..................::::::v:;.�:.,...............;r:^:ti�:w:i??i iii:^:•i}is:�:.:v:'::::::::::::::.'::::.�::::n�:::--:�:,. ........ .............. ........ ..,.. ...,. .r. ........... ..........r.......... : ..........................;.-•:::::::v:.r v::.:........v:?-4%:;-'•?:Y'4ii:C•...........:..::..::::::.J':::: ...�{ .................:•::...,•,r•:�{•:rc::::::..,..;.......3 •. `Ls. ...:...... n.{.:ri.:v........................... ...F...... ....}:.::......... � ....... :-':..?y.?v:.�:.�::..:....................... �•.+.�;n,n}r...:f�YF.{1:.?ti?;•i:: +:.:.....................:w:.�::::1.�::w:r...x........ .::::::v:.�.�.�::.:........v::.:�:::.................:::::::::::•.�::•:::•?::::::::::::::. '�.•ilf.�':iii:?tiP:?:•:::;.:i:•i?:4i:ia:•?}:}>?:}:::::::.;:�::::.::v:�%?i:;•i:4::::•.�::�:. •ri:................................ :::.�::. ......:.....;•:�?iii.�::oiii:•::•i::::.:::;::;%%::ii:<.:::%k•i:•:{•?iii%:•i:•iii�:>::%:;�:%:�%::%:::;%-::::;::::%�:�%:�:ri�=<�%`% %� :?:2;i :: < ::.'•::<:%';. ....................................:........................... ... ::..:..::..........:........,::::.:::::::::::�::::::::::.::.�i:.:::::::::::::::::::::;.iii?i:.?iii:.;:.i;ii:;.:ii:.;:;�:;�i:;.;i:.%i;:;.i::i;;i:.:{.;:;;.i?:.:i:•:;ii:::;:%:?i:%::;;..?:.;::.µ::........::.....:.; :::•�•j�:ti:{J%i:iii:-:' <.%%is:;;::% ;%%: vy: :;:;%::y ';%: •i�:?}:: ':':;i:;:;{:;.';:;{:1:N:•%%%;:';{:y:;:{;:: i�:::i:+!}% ii:is+>.:%:::;:;:iiv;:r:�,:;i:ii::):isi2 ?i:4%:;:;:i::)iii:?%::{i<:ii:; :;, :i:3%%%::?::i:: ::J:t::':i%i%j%ii::ii::ii%:�Yv}�::j%:;ii:•:, .ii•.;;•i.:ii:•:�iii•:.;:•:::.:.�::.;:.:?:::;;•?:•:;i:.i:•;:•ii:•r:::::•:•:.�:.�•::....:.:::.::•:::..........i'.:.....:::::::.........:...�:....: ..:v::;•i:•i:;•....::::::%:%%ii:%'%%::::x•::•-;::::::`:'`':'::'i::::::::�;::::::::::: :�:?:: :#r:'S::::i:::: ::: :::;:;:�:::i:::`:;;::;:::�r"�;:;:>:::`�;:;%:3i::%;:"j'l�ln MM •:;Ji:VL - %'{::?.%':i;:+;:?:%{ii?ii::i}':, :i'�i:�:{{{v•:Y�'.:vi::'i:�:ii:•%:•i:. .i :::r:::•r:::::::::::::v:.,,�::..••i?:{vi??'::::.�::::.�:::::::i::::.i????i'S�??i'::.i ii':.�;•i?:{{Ji:;:':::.:...v.......... .n..l:i i::":::.;;....:;.:............::::::::.................. rvx•::::...;.....�.......;.y{..;:.:{v:;•Y:v:'•......::•v::i•::'::•i:{•.?•i•:}i:•i'v::�:{•i::v;;::;{{•:i:.,•.?:..:i:•: .......................v::•::::.•:•}:}::!:C4?::•::::1;'.{•:?�::{•ish:{L:G::S•:{•i:•}:Ciiii:;S�}%is•ii::Jr::•::iit:•%%:Q:v:•?}i:}%%::iii�.isi{•i:{%J:•i%%%i:;G:•i:'Y::•%:;::}:•:i::::•ih%lti::%:•:i:?:•?:::::!{iv:L?:•%?}ii :{4 ............. ................. ..........:.......... .......................;...:....... ....... .........:•::::�.�_'•'ai:i::....,...........................:.,.........--.w:._:.,�::::::::::{::v'�^%}:•ii??:{i,:':'v v.n{i}i:?•x..}.}.. +,•lrir?':.i::.• v::::w::::........•:-'.v::::::.:..:....:.....:x:v:::.�::.::,.::::..:........{•::::w:::::w:.........�:w::W:x:.�::.�.:...:::::.:.....:::::::::.�.y•, iw:t• :.::w:::::::: ,>'•:>?:`:-ifiii: �nJllrAlYge•<CO2:�ri;::.>.::2�:%;ci:::::::;::;.;:':{::;:;::%%;;:;:.:;.i:•:•.i:.iii:.:;.;i:;.ii:?:,:{•i::•:.::.:.�:..:::::::::::::................................... Fafiure to secure coverage as required under Section 25A bf MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonme wen as dvrl penalties in the form of a STOP WORK ORDER and a One of$100.00 a day against me. I understand that a- copy of this statemea y be forwarded to the Office of Investigations of the DIA for coverage verification -- I do hereby; 1b��T- n es ._of perjury that-the-information-pr-oviderl_above-s_true-aniLcorrect L _ — �- Signatur —Date tac3��JQ,`' 60e 2 - Plione# officwi use only do not write in this area to be completed by city or town official city or town: permi6Ucense# OBuilding Department OLicensing Board ❑check if immediate response is required ❑Selectmen's OMce _❑HealthDepartment contact person: phone#; ❑Other (devised 9/95 PJ2a r r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract o of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association,.corporationfor other legal any two;or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual-,partnership, association or other legal entity, employing employees.. However the owner.of a ...-. . dwelling house having not more than three apartments and who:resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall-Withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe' commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation'incr supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tlie-affidavit should be returned to the city or town that the application for the permit or license is Accidents. Should you have an questions regardingthe'law".of wif.gou being requested, not the.Department of Industrial A Y. Y� .. - are required,to obtain a workers compensation policy,please call the Department atthe number listed below:. City or.Towns Please be sure that the affidavit is complete and printed legibly. The Depari ment has provided a space at the bottom?cMe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. :Ple'a'se, �- be sure to fill in the.pern" cense number which wM a used as a reference nuuitier. The afTdavits may die'ietumedtq the Deparhnent tiy�maiT of FAX unless othei arrangements have been made: a. a x� •�. .i•f%1•' The Office of Investigations would like to thank you in advance for you cooperation and should you have any_questions, . please do not hesitate to give us a call �d y•, / - ✓ �./ -e kill � S .^,•--1. The Department's address;telephone and fax number: ' The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investlgWons 600 Washington Street ,t Boston,Ma. 02111 fax#: (617) 727.7749 phone#: (617) 727-4900 ext. 406, 409 or 375 F ^- _ -."-� •..._- V�/ee�ianvmeo�e��t/,l�c o��/�aaaac�ivaeLla HOME IMPROVEMENT CONTRACTOR Registration: 131501 . Expiration* 08/03/2002 I Type: Individual JOAO L. JUNOUEIRA JOAO JUNOUEIRA W OLD CRAGVILLE RD ADMINISTRATOR NE51 HXANNI MA 02672 z t 67,l e�omvmanuiea//z o�✓ "�euaetta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR NUi 'SQ5\ 068855 rnb B,irthde"1�4191 Tr.no: 24976 04t-29 04 e � R '��, MICHAEL C ROL�A �y, I PO BOX 864 { , HYANNIS, MA 02601 Adrninis4ra4or 1 Q s Town of Barnstable Regulatory Services BARNSTABIL4 Thomas F.Geiler,Director 9 MASS. �pr 039. A 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. ; Type of Work: G C Estimated Cost 7-100 0 v Address of Work: 70 Co A/c-P7 l� C'y (C✓1 V 1 C C fT I Owner's Name: ��ti I � y nJ`J �° ` '► �� Date of Application: 01 r( O I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000. []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: > TOT Date Contractor Name Registration No. OR D Date Owner's Name Q:foms:homeaffidav r i ✓fie V�omvmoouaeaf� a�✓�.Gavdacf ' ! BOARD OF BUILDING REGULATI S a License: CONSTRUCTION SUPERVISOR Number: CS 084605 ' Birthdate: 07/18/1975 " Expires:D7/18/2006 Tr.no: 84605 Restricted: 00 TOBY W LEARY 46 LAFRANCE AVER - HYANNIS, MA 02601 Administrator - t ✓fze�omr�novxcueall�a�✓�°acfu�aella Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: _143942 Ezptratwn 8/17/2006 -- Type Private Corporation . TOBY LEARY FINE WOODWORKI T60 LEARY 46 LAFRANCE AVE HYANNIS,MA 02601 Administrator � I f 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 WORKSB EET .NEW LIVING SPACE r� square feet x$961sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE - - ----------- `r o square feet x$64/sq.foot- x,0041= r 15`7 plus from below(if applicable). QARAGES`(attached&detached) square feet x$32/sq.fL= 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 x$96/sq.foot= x.0041= STAND ALONE PERMITS ' Open Porch x$30.00 (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) r Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 - (plus above if applicable) / Permit Fee TOWN, OF BARN:TABLE BUILDING PER11411T i tiRCrE1s .Lj 251 023 GEOBASE ID 161.05 * s ADDRESS 70 CONNU0AD ZIP CJJE9TL] L E.3 LOT S!TZIE DEVELOPMENT D1STRT.CT C0 DBA PERMIT '78840 DESCRIPTION BATHRM tR,EW,' "1F r� PERMIT TYPE BREMOD TITLE; RESIDENr!,AL A141" CONY CONTRACTORS, ROGERS AND MARNEY Department of A:RGHITFCT:, regulatory Services i,y BOND .OCR Ox� CONSTRUCT I.Iv, COSTS $2,560.00 ,� �► �t3 RESID ADD/AIN (~�"� V_ � PRIVATE BARNSTABLE, MASS. FD MIS BUIfDDIYG SION I' Bye.... , DI''€1 ISSUED r /�;'ii/20; ra EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AWHERE APPLICABLE, SEPARATE FOR ALL CONSTRUCTION WORK: THIS CARD KEPT POSTED UNTIL FINAL INSPECTI 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE] gNICAL INSTALLATIONS. . 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MA 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTIOq APPROVALS 2 2(1,)4L f7 /! /e�o� / 3 1 HE G INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL persons contractin8 with uwe&taed contractors do not have access to the gqaraotY fund c.142A WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- NOTED MONTHS OF ATE THE PERMIT IS ISSUED AS T TELEPHONE PHONE OR WRITTENNOTIFICA- TION. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_�,S t T Parcel 023 I 'Permit# o Health Division rI Date Issued Conservation Division 6J0,4 `t 6 Application Fee Tax Collector _i� - ��' Permit Feet Treasurer F4]j _-P f rC SYGTEM MUST BE Planning Dept. :CTA°.LED IN OOMPLIANC F, Date Definitive Plan Approved by Planning Board VATK TITLE 5 9 gq y gyp 0 .,...,...tier.-��.... Historic-OKH Preservation/Hyannis TOVYN REOJLI TICFN113 Project Street Address 1,70 Co W F ec C2 Village - C E NTE T_v I LL V - Owner Atstmtiow x $ %,.EeAoP_.e m A gr(N Address 3 c_NANNj k4 e_, oz C_AM13Q1bL_ 01A oz)38 Telephone t?- &61 - o 7-SS'- Permit Request 2EvAboF_L CXiSTiN6 13ATN12t)e)m — M0 STMOcrukz,FVN_ CMAAI CoE.S, Square feet: 1 st floor: existing 1 t 8 6 proposed C _ 2nd floor: existing gn:;) proposed 0 Total new � Zoning District �- ( Flood Plain Groundwater Overlay- G t Project Valuation ZSGO Construction Type �, /oop F' wte- Lot Size .S Ac- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 2-6 Historic House: ❑Yes A No On Old King's Highway: ❑Yes r�No Basement Type: 3 Full V Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) S9 Y _ Number of Baths: Full: existing new O Half: existing l new Number of Bedrooms: existing 3 new O Total Room Count(not including baths): existing S' new O First Floor Room Count S- Heat Type and Fuel: ;@ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing I New _ Existing wood/coal stove: ❑Yes 19 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 ANo If yes,site plan review# Current Use 1 i�t ! L.�. . >F k w rk--.Y _ _ -Proposed-Use__ -.5 A:M-E:-s:—. — BUILDER INFORMATION Name FoG Er2S 8 IM6P-14 L`7 T'wC_ Telephone Number S'e 8 YZ 8 6 ID6 Address «o X 3lo License# G S o t(, 7 y n MV 1 LLE 62&a' Home Improvement Contractor# t oo t3 Worker's Compensation# w C. ?ZS330p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN SIGNATURE DATE Y-6 -6 f FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ; MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . GAS: ROUGH ' . FINAL ti. FINAL BUILDING t c4b r -ys _ t DATE CLOSED OUT t ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents OI111re ol/oyest/gativos 600 Washington Street Boston,Mass. 02111 • Workers' Compensation Insurance Affidavit name: location i ciry phone ii I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. 1 company name: ROGERS &: MARNEY;: INC. :..: ; address: P.O. BOX 310 i OSTERVILLE, :MA .02655. phone#: (508) 428-6106 insurance co. AMERICAN INTERNATIONAL police # WC 7253309 f $g I am a sole proprietor, creneral contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: • t company name: SEE ATTACHED SHEETS • �ddresc• O • phone#. insurance co policy.'# �_..-._.-r...... _.�,. _ compinv name: address city phone insurance co policy# •'Attich addidonaVsheet if -T__ Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of crimina l penalties of a fine up to 51500.00 and/or one pears'imprisonment as'Aell as civil penalties in the form of a STOP WORD:ORDER and a fine of S100.00 a dac•against me. I understand that a cope of this statement may be for-%2rded to the Orrice of investigations of the DLk for coVerave Verification. 1 do hereby certify under the pains and ena/ties of perjury that the information provided above is true and correct. Sienature ROGERS & MARNE ate Print name Phone= (508) 428-6106 orTicial use only do not M rite in this area to be completed by sin or town orricial eir< or town: permit/license* EOOHcalth g Department ng Board (] check if immediate response is required en's Office ' Departmentcontact person: phone a: ' i frn nnl inc P1A1 I• 01/13/2004 05: 23 5087781785 PAGE 02 I CORDL CERTIFICATE OF LIABILITY INSURANCq CSA DATB(MWDDW) P R!�ffi 1 01/13/04 THIS CERTIFICATE I8 ISSUED A MATTER OF INFORMATION Northwood Eshbau h its. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE B HOLDER,THIS CERTIFICATE DOES NOT AMEND.EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. -� Hyannis MA 02601 Phone:508-771-1632 Fax:508-778-1-7 INSURERS AFFORDING COVERAGE INSURED INSURER A; NPICARP INSURER B; Jon E. Gemae Tile 82 Seth Parker R INsuRERc: a or Centerville MA 03 2-2164 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR I TYPE OF MSU PAN CE POLICY NUMBER OPOLICYe MI Fec Y DATE AWNTR GENERAL LIABILITY LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE CLAIMS MADE C j OCCUR (Any°Ao ft S i NED EXP(Am"person) $ PERSONAL d INJURY S GENE GGREGATE i GEN'L AGGREGATE LIMIT APPLIES PER: - POLICY PECOT LOC PRO CTS•COMP/OP AGG S AUT0140ENLE LIAINLITY ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY S HIRED AUTOS NON-OWNEO AUTOS BODILY INJURY (Par eCCitlerR) I t - PROPERTY DAMAGE (S GARAGE LIABILITY (Per aWde") ANYAUTO AUTO ONLY.EAACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: AGG = EXCESS LIABIUTY EACH OCCURRENCE 3 OCCUR LJ CLAIMS MADE AGGREGATE OEDUCTIke 5 - RETENTION S _ WORKER3 COMPENSATION AND d _ EMPLOYEiB LWBIU / l oRMIis ERL62ZUB81610 TSYEAI A03 11/17/O3 11/17/04 E.I EACH A NT $100000 E.L.DISEASE A EMPOYEE 3100000 OTHER E.L.0ISeME.POLICYLIMIT S500000 A Work Comp A832- ed -6 ZUB816X100Ap3 11/17/03i 11/17/04 DESCRIPTION OF OPERATION3/LOCATIONSAIEN LESWCLUSMS AaM @Y ENDOR9EMENTI3PECIAL PROM! MS CERTIFICATE HOLDER N ADDITIONAL INSURED;INSUMM LETTER: CANCELLATION RIDGE." SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ML11NG INSURER WILL ENDEAVOR TO UAL -2 Q_DAYS INRITTEN Rogers Harney, Inc. NOTICE TO THE CERTIFICATE INJLM NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL & P. 0-. SOX 310 IMPOSE NO OOLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS A"NT3 OR Osterville HA 02653 REPRESENTATIVES. AUTHORIZED R EN ACORD 25.5(7197) ®ACORD CORPORATION 1988 J ACORD. CERTIFICATE OF LIABILITY INSURANCE 1DATE 112 M/DD/YY) 11/25/2003 'RODUCER (508)994-9688 FAX (508)991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RUTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 414 COUNTY STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WE WBEDFORD, MA 02740 INSURERS AFFORDING COVERAGE a,;) Randall C Agnew Electrical Contractors Inc INSURER A. Providence Washington Ins 381 Old Falmouth Rd INSURERB: American Home Assurance Co Unit 13 rl � INSURER C: Marstons Mills, MA 02648 INsuRERo: INSURER E: :OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION _TR DATE MMIDD/YY DATE MM/DD/YY LIMI GENERAL LIABILITY PENDING . 11/16/2003 11/16/2004 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any o (fire) $ 300,000 CLAIMS MADE a OCCUR - MED EXP(Any on arson) $ 5,000 A PERSONAL 8 V INJURY $ 1,000,000 GENERAL GGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PROD TS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY PENDING 11/16/2003 11/16/2004 OMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ w (Per accident) O L, RAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY PENDING 11/16/2 03 11/16/2004 EACH OCCURRENCE $ 4,000,000 OCCUR CLAIMS MADE AGGREGATE $ A $ 4,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WC 587-47-77 /23/2003. 06/23/2004 ER W EMPLOYERS'LIABILITY LIABILITY TORY LIMITS B E.L.EACH ACCIDENT $ 500,000 E.L.DISEASE-EA EMPLOYEE $ S00,000 E.L.DISEASE-POLICY LIMIT $ S00,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSI NS ADDED ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Roger & Marney Inc 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, General Building Contractors BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO Box 310 OF ANY KIND UPON T -�MPANY,ITS GE T$__ EPRESENTATIVES. Osterville, MA 02655 AUTHORIZEDREPRESENt ACORD 25-S(7/97) ©ACORD CORPORATION 1988 ACORD , CERTIFICATE OF LIABILITY INSURANCE 1DATE 2/0 M/200 .M 12/04/2003 PRODUCER (508)�i1-6061 FAX (508)991-3283 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeast Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 662 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ?.0. Box 79398i Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE INSURED David G Holcomb Plumbing & Heating Inc. INSURER A: Central Insurance Companies i PO Box 170 INSURERB: Arbella Protection Insurance '-• ) Osterville, MA 02655-107 y// INSURERC: O //7 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD'INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/W DATE MMIDD4 LIMITS GENERAL LIABILITY CLP7973954 12/18/2,003 12/18/2004' EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE a OCCUR J/' MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 re GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ` PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY 90035400001 12/18/2003 42/18/2004 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS f BODILY INJURY X SCHEDULED AUTOS '!/` (Per person) B $ 100,000 HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ 300,000 ` PROPERTY DAMAGE r' (Per accident) $ 250,000 l GARAGE LIABILITY t` AUTO ONLY-EA ACCIDENT $ ANY AUTO J OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY j EACH OCCURRENCE $ OCCUR D CLAIMS MADE i; AGGREGATE $ i $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC797 955 J O1/O3/2005 wc Y TORLII ITS ER EMPLOYERS'LIABILITY `, / E.L.EACH ACCIDENT $ 100,000 A j/ E.L.DISEASE-EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS OR ANY AND ALL OPERATIONS PERFORMED DURING THE POLICY PERIOD CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE' EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Rogers & Manney Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P 0 Box 310 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Osterville, MA 02655 AUTHORIZED REPRE ENTAT E f Karen Bernie —hwfw"n ACORD 25-S(7197) ACORD CORPORATION 1988 t I 1 .. 4 j, I i I q. { t i Z W Z J Q �14 6 ("ftt�TlN �E.S1bENCE. CxISTIN� � P�OPosi=D P4A1�1 R i RESIDENTIAL BUILDING PERMIT FEES • APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 2S. Building Permit Amendment $25.00 FEE VALUE WORKSHEET { NEW LIVING SPACE square feet x$96/sq. foot= x .0031= plus from below(if applicable) ALTER,4TIONS/RENOVATIONS OF EXISTING SPACE Z✓O square feet x$64/sq.foot= ZS6 O x.0031= ?. y plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.l • >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x .0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x S30.00= (number) Fireplace/Chimney x 525.00= (number) Incrround S«immin;Pool 560.00 Above Ground Swimming Pool S25.00 Relocation/11oving $150.00 • (plus above if applicable) Permit Fee projcosl ' 1 1 S E Town of Barnstable TOkti Regulatory Services BARNSTABU. ' Thomas F.Geller,Director v MASS. $ �ATfD 39. a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 l Office: 508-862-4038 Fax: 508-790-6230 i 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 j requirements. 3 Type of Work: Estimated Cost 2 S O • Address of Work: '70 Go N biro fLS R D Owner's Name: M;Rou�? M QTi�4 Date of Application: O q I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: O Y 0 2 ►M a 214 E Y __VMC; ►oo t3Y Date Contractor Name Registration No. • OR Date Owner's Name Q:forms:homeaffidav r Board of Building Regula ions and Standards One Ashburton Place - Room 1301 .Boston. Massachusetts 02108 { Home Improvement Contractor Registration Registration: 100134 Type: Private Corporation Expiration: 6/9/2004 ROGERS & MARNEY, INC. Charles Rogers P.O. BOX 310 Osterville, MA 02655 Update Address and return card.Nlark reason for change. Address fE] Renewal ❑ Employment ❑ Lost Card ✓�ie �omzma�uuealC�i a�'..%C`aasac�ivael�s Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: -100134 One Ashburton Place Rm 1301 Expiration. 6/9/2004 Boston,Ma.02108 Type: Private Corporation ROGERS&MARNEY,INC. • ,hades Rogers 445 WEST BARNSTABLE ROAD � ,� O Osterville,MA 02655 Administrator Not valid without si ature v BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016174 B i rth d a te: 05/07/1939 Expires: 05/071.2004 Tr.no: 24057 Restricted: 00 CHARLES D ROGERS 1. PO BOX310 OSTERVILLE, hIA 02555 �. Administrator TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel v� Permit# 4 Map . . 7 Health Division v�CS `' Date Issued Conservation Division 3/ A&'7!/6�® Fee 1 (® l) Tax Collector 6Y 0J-Abf' �L) a/ Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Ne Project Street Address )`70 C Q .Village Owner A-N 41JV J WJ0 a AA 4L l N1 Address Telephone n ���� ,INMPhle @W Permit Request rZ 0 Cd N l U-5 AJJ 56M 's ""MI eoe amff 1 ee A�CWr 6-1/0 CAILIV C 4 0/ Square feet: 1 st f oor: existing proposed 0 2nd floor: existing V proposed d Total new Valuation 0, 00 Zoning District Flood Plain Groundwater Overlay Construction Type RYA"u'od, 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 Po On Old King's Highway: ❑Yeses ^o Basement Type: ,-Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ( q. ) -�Basement Unfinished Area s ft cn cot Number of Baths: Full: existing new Half:existing ` ` new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Ro County.:.; Heat Type and Fuel: �9 Gas ❑Oil ❑ Electric ❑Other Central Air: O Yes �@ No Fireplaces: Existing New�_ Existing wood/coal stove: ❑Yes �A No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:0 existing ❑new size Attached garage:O existing ❑new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes N No If yes site plan review# Current Us Orb LC'B - -= -Proposed-Use — A& — - --- BUILDER INFORMATION . Name Telephone Number Address Ab License# 605 Home Improvement Contractor# f q Worker's Compensation# 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /`� SIGNATURE eIU9f DATE 0) 6 . FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED'' r MAP/PARCEL NO. ADDRESS 'VILLAGE OWNER M DATE OF INSPECTION: _? FOUNDATION _ FRAME O�A<' J Z- INSULATION FIREPLACE ELECTRICAL: -ROUGH FINAL'-, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING D Y DATE CLOSED OUT I ASSOCIATION PLAN NO. F. '`own of.Rarnsit iWe._ o ' Regulatory S gVices - nA.aias"m T►o�as V. Getler,n sector =659• `0DO Tom Perry, $u ldwg.Gomm ss ouer: 100 Main$tre6t; Sya s,MA 02501 roswc�aaaivn.barnstable:maus O=*i ce 508-.862403.8 1za 508-7.90=52310. Propetty:Owner Must Complete and Sign "fh s Secti6n. If six g A B-dilder , I, A4 140 {.. ,as,: e of tlie-SAJ1ect_propekt hereby-authorize. ;`#' .. t Lvl � l- �� to.aCt: xi zriv:behalz in au=sfess i elative.to:wo= .;autlicir ze :bg bulcitiag. ez eit gplic ton figs. (Address afJob) 3.- Sigaarare of OV6' ex: Date :FOR?✓S:OWNBt�'�RtviT�Sitii� ` , V_ �FTI'lE.I Town of Barnstable Regulatory Services Thomas F.Geiler,Director �fo.��a 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 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 ownef-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. ��b P-5�k9 t p®�5'J .w Type of Work; tkm(ri& (IJ Estimated Cost �_`0®d, Address of Work: -7 D Cb a pi&A 9,D c& C— Owner's Name:_/ +htJLI V4 k(2-+1 a'J Date of Application: S . I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED E PENALTIES OF PERJURY I here y pply for a permit as the a f e o er: 10 0 5 2 Da-4 I ontractor NP Registration No. OR Date Owner's Name Q:forms1omeaffday �•r Nov 15 05 10:59a toby 508 862 0310 p.2 Toby Leary Fine '"01"oodworkl'n Name: lack Fitzgerald Organization: Barnstable Building Dept. Fax: 508.790,6230 Phone: 508.862.4035 From: Toby Leary Date:11/15/05 Subject: 70 Connors Rd. Pages: 2 aUrgent El Reply ASAP ❑ Please Comment FX I For Your Records Dear Jack, Sorry I didn't have the pe;rnit on site today. I am sending over the drawing for the beam design per the Architect, and engineer. We did put on hurricane straps, and the plan called fur 6"of rafter on the outside, and we have 7". Thank you for your consideration in this matter. If you still would like a hanger, I would have to cut the bottom off of a hanger because the rafters are 2'/z'wide. Thank you, Toby Leary 774-836-5571 From the desk of... Tdby` w Leary Fine Woodworking Inc. Oil Lafrance Ave. Hyannis MA 02601 508 862 0310 Nov 15 05 10:59a toby 508 862 0310 p. 3 i f { 1 T i .. �� ! ' s •.Jam. I 1 C✓ '1 !:. }, ?tin Nov 15 05 10: 59a toby 508 862 0310 p. 1 r—_r I l0:ti � • 0 'i' x� y�f 1-` .a •-%�DTI LEv~:.�., �'� i 1 ,v's f 04/08/2004 09:12 FAX 6172899201 DUANE MORRIS BOSTON Q 002 04/06/21304 08:13 5084203550 RbGERS AND MARNEY IN PAGE 02 Town of Barnstable Regulatory Services NAft T6otnas F.Getter,Director Building Division Toth Perry, Building Commissioner 200`12in Street, Hyannis,MA 02601 Office: 508-8624039 Fax: 508-790-6330 Property Owner Must Complete and Sign This Section If Using A Builder �r� irL�h1�112G G 17/�-r iVr�ti7 c7�v�f ryyyas OwneI of the subject property hereby authorize ROGERS & MAMEY, INC. to act on mybenalf, in all matters relative to'Uma au orized—by this bddinb permit application for(address of job) Si,� �tte!�tre of G•cc�er � Date Z_C`'jV u")z NG Name Q,FOI��IS;O�t'�6RPER.WISStO� i n -' ''i' ywi '��J, ^! �rix*-_i'If y a''a F•B,4 aF. . - �,a�r�" ,`�`"�'}yE�,'s�.,f'a„3��s•���,�y��,i�� a : rn '�e"xf�`G`3.�.�+�,����� z � `j✓1��1 • ����� �'4 j1A h 6 N � 1 .,r -- F' ✓i.' } •'� fly +;`�.. }��r !ate -�, r _ d . 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