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HomeMy WebLinkAbout0036 COTTAGE LANE _ . S r , MOM MEN[VP Elm o a . i o r k F a + � t•. ' � � Wu ry� � 9fY• a° t our, '; 3 1� k � {Y ti a•Y n r M_ t! ° a Assessor's office(1st Floor): Assessor's map anp 1 t nun2ber Raa 11 { SEM SYMIA MUST B �1 0 Conservation 01 Board of Health(3rd floor): • AS Sewage Permit number z/ �i7T►DtL Engineering Department(3rd floor): r p TOWN F&OWAMON o6 9 d��� House number ! `J c YAY Definitive Plan Approved by Planning Board 1g, APPLICATIONS PROCESSED 8:30-9:36 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ec-,-d,G- TYPE OF CONSTRUCTION _ r.N(�c E �/'A+d v J S 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location k Proposed Use Zoning District Fire District Name of Owner �ryice�b:!r.'' �r°rc.e 5 Address P• d �� r �z"¢�Yv'�L` Name of Builder s a,z•z Address 5 .ti-R Name of Architect ��C•1,; - e 155 P. Address I sl b /Z t. 7 et (-e r y; l L< t Number of Rooms Foundation Awren/ cu nc rr. 6-e Exterior C dap '� ' t" S� lc s Roofing Floors e'a v�e /v'�`y Interior _� �y ��s Plumbing Heating g Fireplace ���°'� Approximate Cost 6'. 0-dd Area D�ram BftCdiF/&Dimensions Fee r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r gardi the above truction. Name tj 0 1 3 Construction Su erv"i oes License No Permit For Location Owner r Type of Construction Plot Lot i Permit Granted. I 19 z Date of Inspection 19 0 Date Completed 19 r ; 0 r Assessor's office(1st Floor): Assessor's map and lot number Conservation A — yR"°L 9 4 �' O V � Board Health boor): ��� ��/ t Dsas�r►Lt6 Sewagea Permit number ber �o rua Engineering Department(3rd floor): ��lu/�,,A� �� :,i °�t°30'`�0� House number u Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only '��� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO c'a w 3 �- TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1 _ f!6.�. �—�_._--T���,-?.a�"�;tip•_____�r k,.���, �� .� ��) ���)� !,-�} � � ,�' (,�r Location `? ✓ , , Proposed = '�^��° aw, �y ClcJ /1, r• � r Zoning District --,r Fire District Name of Owner Crce.l rY- /ro mr s Address r'• 6 ru Name of Builder s � Address Name of Architect s G' -J ` r Address E S i D Pt, 7 y 1 l 41-f A Number of Rooms Foundation /lvu;•r c�'"r r{ --� Exterior (V/an ti`�' / a' c. S"�r��� s Roofing r Floors C a r/t 4 /-V Interior 5 F r G P Heating 4as Plumbing Fireplace Approximate Cost G T 6b71 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re" e c ardin` th above on' �9� 9� construction. i Name Construction Supervisor's License No Permit For Location Owner Type of Construction Plot Lot Permit Granted 19 Date of Inspection 19 Date Completed 19 T Town of Barnstable } »nx� WPohhis Card SoThatltyisaUisibleFrom:the,Street .,A p•;p' royedPla,,ns'.Must."be Retained on.Job anrd this Card Must be Kept Building 'stTUtnosC: e Permit Permit No. B-18-391 Applicant Name: PAUL J. CAZEAULT&SONS, INC. Approvals Date Issued: 02/09/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/09/2018 Foundation: Location: 36 COTTAGE LANE,CENTERVILLE Map/Lot: 229-118 Zoning District: RD-1 Sheathing: Owner on Record: MELANSON, RITA M TR L Contractor Narne PAUL J. CAZEAULT&SONS, INC. Framing: 1 Address: 41 TCKENHAM.CROSSING: Contractor License 103714 WI 2 WEST BARNSTABLE, MA 02668 v!, Est Project Cost: $3,000.00 Chimney : Description: re-roof stripping old shingles-yarmouth Permit Fee: $35.00 Insulation: Fee Paid:: $35.00 Project Review Req: Final: Date 2/9/2018 Y ro Plumbing/Gas • Rough Plumbing: *; Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: ` All work authorized by this permit shall conform to the approved application and the approved construction documents for which�Phis permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall 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 work until the completion of the same. p � Electrical r Y The Certificate of Occupancy will not be issued until all applicable signatures by the Building a-nd�ire Officials'are provided on this permit. Service: 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" (asset forth in MGL c.142A). Fire Department ? Building plans are to be available on site Final: rr, All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT lcg Town of B aIf°ns LEI b -Txpir•es 6 months from issue date Regulatory Services Fee � BARNSTABLE, - °o 59, mod° Richard V.Scali,Director Building Division�rEp Rfrh`1 a R Tom Perry, CD®,Building Commission®t 200 Main Street,Hyannis,MA 02601 �B 2 www.town.barnstable.ma.us 018 Office: 508-862-4038 TOWN OF BAR�VRUI -6230 EXPRESS P E1[�I�MT APP LICA7CION - RESID EN` IAL QN Not Valid without Red X Press lnaprint Map/parcel Number (5L 8 /• /! Property Address 3 p C o � �`- rr x/ '�J,Residential Value of Work$. J o o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address :R/-fir¢ � �i S Q N �/. /G/Geti `i/1-n, e1Cp,S5/ir,'9 Contractor's Naine .P A U L-,. cA 2�A U i:i'' -{ Sc��S" Telephone Number Home Improvement Contractor License (if applicable) Email: 0' 1 c-e (c� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ave Worker's Compensation Insurance Insurance Company Name L--f- t [_c3 dip Workman's Comp. Policy i S S Copy of Insurance Compliance Certificate must accompany each permit. Permit e est�`heck box) `Re-roof(hurricanen ailed)(stripping old shingles) All construction debris will be taken to yam`JL40 e r u e ed) (not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: Fj Smoke/Carbon Monoxide detectors 4 floor plans marked.with red S and inspections required. Separate Electrical&liire Permits required. :"Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\LocalWicrosoft\Windows\Temporary Internet Files\Content.Outloolc\2PIOlDHR\EXPRESS.doc Revised 040215 Ltd'Co�a�v�eo��vea � of 114'ausachusetts T _ Department of 1ndiustrial Redden s Q -ice 0,Investigations 600 Washington Street wIM>Mass.govIdia Workers' Compensation Insaurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ' Please Print Legibly Name (Business/Organization/Individual): 1�t'�' ld` ( J CA-Z-(.: `•1-u L_F Address: t' '-� !v� ri, a r .E _- City/State/Zip: 05 6f Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I ` employees (fall.and/or part-time).�` have hired the sub-contractors 6. ❑New constriction 2.0 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. employees and.have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. 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 .l 1.❑ 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.❑i Kther 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. lContractors 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 ain an employer that is providing workers'compensation insurance for may employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-iris. Lic. #: ��/ �', f S j 6 6 � 60 Z 7 Expiration Date: Job Site Address: :) lv � s e �� e. City/State/Zip:6-'-,7l e'pvlP 4110 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratio;rate 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 perjufy that the information provided above is true and correct. �� / Sio-nature: l � C,. '�y �t_ Date: ` l i Phone#: IS y 19 —V,2_cat 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#: I (� p mod' ;� {� q/� p p/q/ �p p ��„'��`\'/� l`-�ERTR'CQ lI E OF t'�Iflr BUT 11 �I1VSl�Jfl�lb'�111 CE ATE(MM/DD/YYYY) 08/10/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY Pa°NNe Ext: (508)775-1620 FAX Ne: ADDRRss: Sullivan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: LM INS CORP 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC INSURER C: INSURER D: 1031 MAIN ST INSURER E: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 181752 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD WVD POLICYNUMBER MM/DD/YYYY) (MMIDD[YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OPAGG $ ]OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per a.,dent) cident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER _ AND EMPLOYERS'LIABILITY Y/N X STATUTE E ORH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A WC531S386670027 - 08/10/2017 08/10/2018 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul Cazeault ACCORDANCE WITH THE POLICY PROVISIONS. 1031 Main Street AUTHORIZED REPRESENTATIVE Osterville MA 02655 t /f �" Daniel M.Crobv ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD •' .j ' :air:; ,,: ° �';-� /'i`` �' r.•_.- ��`�---,--j=�•�- r' �-'�'t''/-fit.'?:: ' r`. ✓` �:., i� vi,is4,--_,vie,<%''e:,��;:( �i;:c1' I (7 l tj Office oz consu'i . Affairs ed - Business Regulation 10 Parr l 70 Plaza Suite 5 Boston, Massachusetts 02116 Home Improve ment Contractor Registration f Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2018 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Marls reason for change, Address Rencival E sca i c;: 2ot�,i-osii i � mployment Lost Card � ,,ffice of Consumer Affairs Business Regulation iceilse or registration valid for individual use only r =� � kTOME IMPROVEMENT CONTRACTOR befdre the expiration date, If found return to: Re istration: '"q Office of Consumer Affairs and Business Regulation 9 10371. TYpe: 10 Park Plaza-Suite 5170 "= Expiration: ;7jgj20jg, Supplement Card Boston;MA 02116 PAUL J.CAZEAULT&SONS,INC. RUSSELL CAZEAULT j f 1031 MAIN ST OSTERVILLE, MA 02658 " " UridersecretarY Not valid ivithoutcsi nature 1 PJlassachusetts -Depariment of PL;hllc Safety 8oard'of Suilding Regulations and Standards I Cunstructir>uSupert'i.eur ---`�_=�=.=�= License: CS-108157 \\� RIfSSELL C.A.ZEAVLT..,,;._ 2071 MAIN STREW) s'^ OZ.,i= Brewster Na 02631 Cr�rnmrssiur;rr 11/23/2018 .' i . • f i Property Owner Must Complete & Sign This Form i If Using a Roofer ! Builder. 4 t i I (print) as�wnerAgent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job �° © - 1 ` A 14 C- Ce I g Signature of 4wne Mailing Address of Owner / �'�-v< c&"-r ia- ,t-- C— Ross o S Telephone # 5�� J �— —7 -- Date i Please return this form to Paul J. Cazeault Roofing along with your signed contract.. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com of r Town of Barnstable Ov •y - - 'Permit # Regulatory Services m Is ue d Expires 6 monthsFee �artsrasr.e, 9 Asa 1679. Thomas F. Geller,Director `�� iOrFa�,�► Building Division t Tom Perry, CBO, Building Commissioner 200 Main Street,.Hyannis,MA.02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C® 7A 2 61 C e v�"e/l llj�l, esidential Value of Work a� C�c� a 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` yl Contractor's Name Ley E; (, jA P% Telephone Number Home Improvement Contractor License#(if applicable) .' q 673 Construction Supervisor's License#(if applicable) C S ` [ be/ 9 � X-P ES,S P RMIT . ❑Workman's Compensation Insurance Check one: O C T 9 2011 ❑ I am a sole proprietor TOWN ❑ I am the Homeowner �N Op ` ARNSTAB E ® I have Worker's Compensation Insurance Insurance Company Name f3Z A C f ` S 7-6?1 'P— Workman's Comp. Policy# l.(/CC Too 7fj0 -70 :�O+ //, Copy of Insurance Compliance Certificate must accompany each permit. _ Permit Request(check box) ® Re-roof(stripping old shingles) All construction debris will be taken to�A/t n� C�� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Lam/ Q:IWPFILESIFORMSIbuilding permit formskEXPRESS.doC [devised 070110 I 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 Lembly Name (Business/Organization/Individual): reoq ede e r'�� „e ¢• 6 �c Address: 6 Ci /State/Zi l7Yt► ' C t5' P t'l/? L Phon S"D Are an employer? Check the appropriate box: Type of project(required): 1. a employer with 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'. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp,insurance.$ 9. ❑Building addition required.] 5. We are a corporation and its 10.Fl 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. t 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 whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. r I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: &AC.,k I-Tbh Policy#or Self-ins.Lic. #: &1 Cc Dd 7 60 70 6 t Expiration Date:.`e ,( Ze� Job Site Address: '25t9 C 47-7,9 e— 6-1 , City/State/Zip C e_'1 Y'e/Z y k C, 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 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 penaltiesof perjury that the information provided above is true and correct Signature: Date: ®t/� r•EC Phone#: Of use only. Don,ot 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#: 1 THE Town of Barnstable Regulato Services y • ry • �aN6T��+. y 1 d• s Thomas F. Geiler,Director i639. 1 Building Division . Tom Perry;Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I' ) a s Owner of the subject property hereby authorize to act on my behalf,, in all matters relative to work authorized by this building permit (Addy of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. 9 Signature of Owner Signature of Applicant C. . . F ORed3� Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS �THEI Town of Barnstable Regulatory Services * snatMRrnsca, « Thomas F.Geiler,Director y MASS. �p 1639• Building Division �o ,tor 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: ' JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellhigs 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 *4 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 requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . I 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 o may caret amend and adopt such aform/certification for use in your community. Q:forms:homeexempt 4® CERTIFICATE OF LIABILITY INSURANCE AC DATE(MMIDD)YYYY) `..�' 09/20/2011 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackstone Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 37 Harvard Street.Suite 213 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01609 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. A.E.I.0 Eldredge Frame&Remodeling INSURER B: 268 Pine Street INSURER C: West Barnstable,MA 02668 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, LTR INSRO TYPE OF INSURANCE POLICY NUMBER DA LIMITS GENERAL LIAajuTY . EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurence S CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADVINJURY S GENERAL AGGREGATE. $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO Me accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED ALTOS BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE $ (Per accident) GARAGE LL401UTY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY. AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR 17 CLAIMS MADE AGGREGATE $ DEDUCTIBLE g RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ✓ TORY LIMITS11 ER A ANY PROPRIETORIPARTNERIEXECUTIVE WCC5007607012011 10/01/2011 10/01/2012 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED9 11es,describe under E.L DISEASE-FAENFiOY� S 100,000 00,000 y SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $ OTHER Charles Eldredge is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Building Department DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE T000 SO SHALL Hyannis, MA. 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE tNSURER,ITS AGENTS OR REPRESENTATIVES. ' AUTHORIZED RI3RESENTA71VE .�' ACORD 26(2001/08) ©ACORD CORPORATION 1988 ribIN& r.0 u.. n a ...... - .. G" I 9mird of Building- Re-ulution� and Sand 11 ds ��e ooir�raoozcuea/G1 o�C�/��roaac/uueCLt Y i Office of Consumer Affairs&Business Regulation Construction Supervisor License I OME IMPROVEMENT CONTRACTOR License: CS 104802 egistration: 169693 Type xpiration 7/27/2013 DBA ELDREDGE FRAMEt&REMODEL CHARLES ELDREDGE ! s .:=-, M .. L. WEST BARNSTABLE, MA 02668 I CHARLES ELDREDGE 268 PINE ST N,it,T W.BARNSTABLE,MA 02668 Undersecretary Expiration: 5/16/2014 Commissioner Tr#:. 104802 � 3. i r, License or registration valid for individul use only the expiration date. If found return to before Regulation Office the C onsumer Affairs and Business 10 Park Plaza-Suite 5170 Boston,MA 02116 No out signature t valid . I 01 bless&ssor s,O,f Parcel . ��:.�`� Permit# Conservation Office(4th floor)(8:30-9:30/1:00-`2:00) L Date Issued Board of Health(3rd floor)(8:15 -9:30/-1:00-4:45) <<s Engineering Dept. (3rd floor) House# 1 % J� - t� �, SEPTIC S ST' EE M' Planni t. (1st floor/School Admin. Bldg:) INSTALLS I V1� " De f' itiv Approved by Planning Boa d i{t L 19 1 wl ,� &S OWN OF pBARNSTABLE' Tor ",, t '/hIUIG! Building Permit Application� �� , P oject reet Address 0 Vil e 1�.O6 aug ,Owner Z e7&4 /— Address 2. L(�/J,�-s�--1�� Al� a-qb*4 Telephone F /� Permit Request /�''�' CZiff �OJ�/(ZtS `fQ POT_17L4 D First Floor square feet r - Second Floor square feet Estimated Project Cost $ 4WINA. Q Zoning District R D ( Flood Plain h ° Water Protection k c Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use �7/^ LP� t� Qe S' (C,91 GLc_Q_ Proposed Use Construction Type Commercial Residential ' Dwelling Type: Single Family o/ Two Family' Multi-Family Age of Existing Structure 30 c 4a,5 Basement Type: Finished Historic House 00 Unfinished Old King's Highway Number of Baths Q.� No. of Bedrooms n`� Total Room Count(not including baths) J First Floor .� Heat Type and Fuel��S F44- Central Air &6 Fireplaces o�,v Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name J/ G Telephone Number Address /V �� O License# Home Improvement Contractor# Z6�3 Worker's Compensation# �lC( 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 'ta W7 f Z�iv�,v.4 SIGNATURE DATE BUILDING PERMIT DETJED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. `VVV DATE ISSUED w _ MAP!PARCEL NO. A ADDRESS w VILLAGE OWNER DATE PF INSPECTION: FOUNDATION 1 FRAME INSULATION ' FIREPLACE ELECTRICAL ROUGH } ' FINAL PLUMBING: cROUGH, t FINAL " GAS: tROUGH4 FINAL { FINAL BUILDINGP, 71 d DATE CLOSED OUT ASSOCIATION PLAN NO. ? ' y ► j F W Tile C(InInionsvealth of Afassachimells Department of Industrial Accidents 6110 11 tultingfm Street Af "02111 Workers' Compensation InsuranceAlTidavit 7. Wint in-Mr—mat fon. n lociti city nhone# 0)An a homeowner performing all work self. I am a sole proprietor and have no one working in any capacity WMPITWIT 1 am an emplover providing workers' compensation for my employees working on this job. cowunnny nnm address: phone#: MEMO=C21 I am a sole propne—to., general contracto or homeowner(circle one)and have hired the contractors listed below who have the following wo le po ices: 7 COM111111V name: Sddress! Sim phone M? 7-7/ 9�3 nsurn CC cn. ctimnany"am. 14 Y addre S: phone#*— 39 city: Insurni".. :Xtiach if 00.00 and/or 7 can lead to the imposition of criminal penalties of a fine up to 51-5 Gnii�—re to coverage as required under Section SA of hIGL 15'. one nears'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S1110.00 a day against me. I understand that a of investigations of the DIA for coveragevedOcstiOn. copy of This statement mad be forwarded to the OMCC t W the infonnation proWded above is tare COMM I do hereby cerrUy un er th ins and peilldesopfp h Signature_ o Print name one#: n —and 0 c T—, . o Icial use only do not write in this area to be completed by city or to,%,o oMcizi c permitilleense Building Department citV or town: Cpcensing Board.:, [3 check if immediate response is required Cscicctmcu's OM"c (311callb Department c phone N; f7lOther contact person: f. ✓lie 1Oo7a7�o7uue� a�✓v'.C',�' �����G�• a �` ���A t � ' dry Rp�A 7�^• y. '?' ,3^`O ° �Y Y. f ill r caF OF BARNSTABLE Town of Barnstable 2005 APR 20 AM 8: 52 i THE T Regulatory Services Thomas F.Geller,Director • sanxsrnBIA • DIVISION 9� , � 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# 3 1515 FEE: $ SHED REGISTRATION 120 square feet or less Location of she (addres Village Il L �_ /_,�o S� Property owner's name Telephone number f� 9 Ilk 6- Size of Shed Map/Parcel# i tur / Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District-Commission jurisdiction? Conservation Commission(signature is required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMNIISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . Q —� BP;10226-fl2b$/Q6-05;30 12.49 �}0306D1 1 ROUT£ 2E STATE 4{1CNl4AY s, l e N er3V7r E—t]a.z7 —MAW ----------; e• .�- - post' •ce t: �••s ,totals ,� rta LOT d \gk ) AW•Jaa1.µ 014 Ao , • '`� .bw. U.wS ro.n 1 M alreJ'�7 L -�, o,n a... 1 (IU+1C5 A. a h 7 :C :i+S FO i100 1 i%o l•?.T C ' 1 q 21 p lt7lc: FMO �a Not Co, Scale // •eY . �;G ? �. May 29t 1996 �� s tTlaoi• L VO BAR aSi BLE IREGiST;3Y Gf lac S •