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0074 COTTONWOOD LANE
�y 00)o7To �0 ,,CAPE �° INSULATIONf'w" R4ir, p / 4el f MIA GLASS SIAMLISS SPRATSOAM"SUSPINCSp "' q e - IAiTf GVITIYf INSULATION CFIlING3 1-800-696-6611 Town of Barnstable ry Regulatory,Services Building Division 200 Main St -Hyannis, MA 02601 Date: Dear Building Inspector Please accept th 's 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 74171 Insulation Installed: :Fiberglass Cellulose_ R-Value Restricted Unrestricted Ceilings O (u) ( aI ) ( ) (X) Slopes Floors ( ) ( ) ) ( ) ( ) Walls ( ) ( ( ) ( ) Div e r�y 6VOr ll l��gror lied 4"t Sincerely , VCHr ssi r, President Ins ation, Inc. - - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION n, {� L p �� Parcel $ ��.N Application Ma �� ,,:.�T��,BE Iw K)o Health Division :_ �, a:, Date Issued Conservation Division Application Fee t� Planning Dept. Permit Fee �. l �� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 70- Village er.2 a Owner Lf2�N � ,LT� Address Telephone //&2 44 f® Permit Request Ze, sl' �� �� l d r/`a n�) y d� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new'. Zoning District Flood Plain Groundwater Overlay Project Valuation -,7J©67, 0 Construction Type_�y 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 �dNo 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) NameCf /Z��v,�ia�6,� Telephone Number Address / � �'��� License _Z;i Home Improvement Contractor# Email Worker's Compensation # ol ���® ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. s. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE — ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. y � > Town of Barnstable Ptegutatory. Services s�nxsrem Richud V.'ScA Director "�ouxe`0� Building Division ; Tom Perry,Building Commissioner . 200 Mam Street,Hyamis,-MA 02601 www towabarnstabie_ma us Officer 5.08-'862-4038 Fax: 508-790-6230 Property Owner Must Complete-ands gn This Section If Using:A.Builder I; Tw sw.I l?' as 0%mer of.the subject,property herebya#orize 1 to amon mybeb*, ,cl� n�j lal in au tnatters to wor authorized by,d is budding pern it application-for.te (Address dJob) -Pool fences and alarms are the r`espon$J )rof the applicant. Pooh are not'.to be.:Sled or utili ed 6 bre fence is installed'and.all,fiii-J; ipspections are performed.and'aeceptecL q 5 of Owner :Signature of Applicant Print.Name PrintNarne Date Q:F0RMS:0NVNFMEWJ5S10NP0UrS �I,�.,,p.,a., � Masr;,tchrustt`f;=, •• f� ' .. par4ment of Rublic.Safety• . •.:130ard'c,>f Building f0gulation- aiid Standards' Cunstruc'lion Scipervishr•. L.icens*e::CS-100g88 HiNRY SIZED ROW SSII?�' WEST YARMOU'rii7,;3 i I - ✓. . � ,I•lu !` Expiration Commissioner 11/11/2 ion Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, Massachusetts 02116 . Home'Improvement Cbr�traetor Registration Registration: 153567 Type; Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION; ]NC , ; HENRY CASSIDY 18 REARDON CIRCLE ` SO, YARMOUTH, MA-02664 Update Address and return card) Mark reason for change. KA 1 0 20M•05nt F-71 Address E] Renewal (J Employment Lost Card ... ...... Office of Consumer Affai sU&(Business Regulation'e� License or registration . .... vapid for Indlvtdutuse only it OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to; egistration '163567 Type; ' Office of Consumer Affairs and Business Regulation j xplratlon 12115I20:16 Private Corporation 1-0 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION,`fNC HENRY CASSIDY 18 REARDON CIRCLE" SO, YARMOUTH, MA 025$4 Undersecretary ; g IN- valid wi utsign e The Commonwealth of Massachusetts Department of Industrial Accidents j Office of Investigations 600 Washington Street Boston; MA 02111 :< www.mass.gov/dia r rr. ,�,� •' Workers' Compensatibn Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationnndiv!dual); - Address: l �r✓ la�� � � ✓ '_ City/State/Zip:. Phone #; � `� Are you an employer? Check th appropriate box; , ' 4 r Type of project (required): l, .l am a employer with 4. [� I am!a general contractor and l ' � have hired the sub-contractors 6• „New construction employees(full and/or part-time)," 2.❑ 1 am a sole proprietor.or partner- listed on the attached'sheet, 7. [] Remodeling ship and have no employees These.sub-contractors have em to ees d have workers' g' Demolition y' working forme in any capacity, p y 9, [] Building addition [No workers' comp, insurance comp, insu and have required.) 5, We are a corporation and its 10. Electrical repairs or additions 3.[] I am a homeowner doing all work officers haveexercised their 11,7 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—WU ' comp. insurance required.] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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: Policy # or Self--ins, Lie,'#: - Nic'ef Expiration Date: I Job Site Address: La!zz d /"'y � 2 L City/State/Zip: Attacb 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 a 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 insura covera e verification. 1 do hereby certi7/ ( . the pal an penalties of perjury that the information provided above is true and correct. S( nature: ` Date C/j7�l Phone#: , Official use only. Do not write in this area, to be-completed by city or town offr.ciah 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 (nntart PPr.cnn Uhnno 44, ACORO" CAPECOO.27 BDELAWRENCE '�- CERTIFICATE OF LIABILITY"INSURANCE DATE(MM/DDIYYYY) 613 012 01 5 _ THIS CERTIFICATE IV 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 pollcy(les)must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may requlre'anendorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s)- PRODUCER CONTACT Rogers&Gray Insurance Agency,Inc, PHOI e 434 RIB 134 FAx South Dennis,MA 02660` EMAIL ac No; (877) 816=2156 •4e ;.ADDRESS; INSURERS AFFORDING COVERAGE `g INSURER A;Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSuaERB;ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulatlon;Inc. INSURER c; —— 18 Reardon Circle INSURER Or --- South Yarmouth,,MA 02664 _ INSURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TMAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T018 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DO/YEYYy MM/D /YY p A X COMMERCIAL GENERAL LIABILITY LIMITS CIAIMS•MADE a OCCUR{' CBP826306 - EACH OCCURRENCE $ 1,000,00C 0410112015 0410112016 PREMISE Ee occurrence) $ 100,OOC MED EXP(Any one person) $ 5,00C PERSONAL&AOVINJURY $ 1,000,OOC M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POL JECT LOC + PRODUCTS•COMPIOPAGO $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO • , . '. • E0 8eI Ide�lS E M $ _� l I ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR $ -- EXCESS LIAR CLAIMS•MAOE EACH OCCURRENCE $ , AGGREGATE • DEO RETENTION$ ' $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER ---- B ANY PROPRIETOR/PARTNER/EXECUTIVE.,Y/N WC E00431.901' * STATUTE EERH OFFICERIMEMBER EXCLUDED? NIA 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1 OOO,OOO (Mandatory In NH) It yes,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS,belo%y E.L.DISEASE•POLICY LIMIT $ 1,000,000 44 DESCRIPTION OF OPERATIONS'I LOCATIONS I VEHICLEI'(A CORD 101,AddItIonal Remarks Schedule,May attached It more apace la . Workers Compensation Includes Officers or Proprletom required) Additional Insured status Is.pmIded under the Genoral Llablllty and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, -South Yarmouth,MA 0.2664 AUTHORIZED REPRESENTATIVE ACORD 25(2014101 ©1988.2014 ACORD CORPORATION, All rights reserved, ) The'.ACORD name and logo are registered marks of ACORD �pFtHE tp,,� Town of Barnstable *Permit# V 0 i Expires 6 months from issue date * ~ B�`xaTwsc.�, : Regulatory Services Fee �cb ,HAM:.. Thomas F.Geiler,Director M AIFOa�A X-PP. PERMIT Building Division Tom Perry, Building Commissioner S E P 2 3 200 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 TOWN OF.BARNSTABLE Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 .. Property Address t? / //� p (, !%ki- Residential Value of Work Owner's Name&Address l�1 t i G tM S r Contractor's Name B i t—RAY Grp Telephone Number 5 0 8—4 2 2—9 6 9 3 Home Improvement Contractor License#(if applicable) 12 0 4 5 6 Construction Supervisor's License#(if applicable) , ❑Workmen's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name American a''j Workmen's Comp.Policy# We 55151 Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to- ❑Re-roof(not stripping. Going over existing layers of roof) d Re-side Replacement Windows.-U-Value_ _(ma imum.44) Other(specify) *Where required: Issu ce of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. . �l . . __ _� Signature 0orms:expmtr9 _ — RMsed121901 is - k F i , a +_�:.: .. �?-a:k r•- t.. i- ''d} i . V)LG 1�6'IIY�2�ITwP�F�✓vGQdG�F� �_ Y .. ', . Board of Building Regulations and standards ` License or registration valid for individul use only HOME I%P,ROVEMENT CONTRACTOR before the expirat►on.date. If found return to: Board;of Building Regulations and Standards Reglstraal wit: 1.20456 One Ashburton.Place Rm 1301 P2006 4 ;_ Boston,Ma.02108 y lement Card BIL-RAY ALUM.11:SS1 I Paul McDonald , l - ,4D ELMONT RD EL ONT NY 110{13 7ldiiunastt atoir7vt 5.�1[d�7tlio9t signature I • '"�dw,� ,a `r' 4 � 2` _ .. i.'c 4' F— •.� •s - o -.. _ � �..t_' - ,-r- _ - --_... .., ��.� `�.:- -.- .► -.,. - - 'l`.:;r phi�:.;:�,,��;'�i`;" .. / w%�,Cvu�` b1iGH PF_RFQRMANC_F VANDOW&DopR SYSTEM .._. 11«Ap nmh Amery m • , _ .,� � '. �i� !Ual sight LjTl Viny-1 Dr uWe_ Hung . - _ INTMOUAIMA ❑,,y� _M q r s-. § t w�l tl� Ind n nor A*ft�lIM*M': li�es�y#e iII .F�er�ys�4.95 P � 0=40d I _ . -is'we6 Fnr morE nfiormatrp , ll'� .712-047:nrns[t . [ • t , 5olar•tieatGai� >� Ysilife:Gg�rt . U'Facmr Goeffi�iertt 'rtansmittaq�e=�,� �. Y >r� �llanufac�uersfipula)Ps:�hakrihese r,�9s�o�atmn applicable�iFAC�rncedurEs�ur�leteRt►u�mg:. _L3 JOS whole pmduct energy perfnitA e.NMG►aiinpm determined gra d sett�f�nuwnmer�fial' nrmdti#MdsDBffm.prnduds¢es. . . . .. --� -��'���' "fir..^�X`..�` +..:,..;., •._r,,.:,.. Alto .a9 ai- t.zs �ri �} i +> r r� r , qy ' afF; .y y 6 t�SlrrM1d,r 4.'c� ` SOLD, FURNISHED 8� INSTALLED°6Y f3�aton 800 SEARS 31 8 krs e.::- - A . .t -. i , S EA Bit=Ray�Allufmllnum Sitliny 6orp. Hartford Area 80Q-SEARS-99 of Queens, Inc., Providence Area:8887SEARS-51 N01 tE'.u�Bfl/ICBS ; NeW.Hampshire:800-829-2375--. A SEARS AUTHORIZED CONTRACTOR' JOB# 2� ,. 113 CedarStreet, Unit S3 •`'Milford;'`MA'01757::. F.I.D.-No 11-2320449 MAINEiIC.NO.DD1893 NH LIC NO "" MASSACHUSETTSLIC N0.120456 VERMONT LIC.NO '•RHODE ISLAND LIC N0,,13707 NEWYORK CITY DEPARTMENT.OF CONSUMER AFFAIRS LIC.N0:0730686•NASSAU i'IC.NO.H27041.50000•SUEFOLK LIC.NO 21194Hi •YONKERS 1397 -:PUTNAM PC934" :,WESTCHESTER:WC0613--H87:• LONG'BEACK GC2001 • NEW JERSEY LIC:NO.9949269 � CON NECTICUT'DEPARTMENT�OF CONSUMER AFFAIRS LIC. NO..00532774 L10W 'CONTRACT SOLD, ADDRES . 4^-C.l L/IQfrY JI� rZ �/"� STATE PHONE 7 �woRK`G � 2__ 1 EMAIL � t4 L JOB;SITFADDRESS (I,F DIFFERENT) . , APPLIED VI WINDOW SYSTEMS General Description Of Work at Above Address; li' Type of House. FRAME 0 MASONRY -:_ - r Date;whlch;work is scheduled to:begm ,Date which work is scheduled to be ubstantially completed e 1 i Sears approved V. materials will be furnished and!installed 1164hese specifications PLEASE READ CAREFULLY ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER. YE 0 YES-N 1 ` _ REMOVE WINDOWS from opemn"where they nowedst on 22 ❑`! }SPECIAL ORDER Wiridows(in Addition to Above) s 2_;= FIRSTLEVEL #Openings ;#New WindowUnits ' 3 p SECOND LEVEL �#Openings #New Window Units 4 p THIRD LEVEL #Openngs #New Window Unds` , 5 p BASEMENT #Openings #New Window Unds 23�,❑ CLEAN UP 'Alf job related debns will be removed fiom` roe } P p rtY 6 ❑❑ OTHER #Opernngs #'New Window nits Wcomplehon of work REMOVE AND DISPOSE of existing windows 7. ❑•REMOVAL OF METAL•or other-uniGsrequiringmodifiedinstallation' 24. ❑ :INSURANCE.All wodmian s compensation and liability is maintained, #Opemngs�_ #ofUnds �' WARRANTY-Maledtocustomeruponcompl&dnandfillpaymentlsreceived' 8 ❑ Install new PRINTABLE MOULDINGS 26 ❑ PAYMENTS °=On nori`=financed orders)is payable to installer on Inside Stops ,#of Openings dayof installation Clamshell arCasing #of Openings fs 27 p n ings Aqu!npnal Inform ation s 9 p�Install new MASTER FRAME�� �.#of Ope ' 10, A ❑ New wnndowi'unds to hAVd FUS10N WELDED SASH # 11 .❑ NewwindowundstohaveFUSIONWELDED�FRAME # = V f2`,'' ❑ New win doW'unds include Insulated Glass 7/8 totaiahickness79 t Withthefollowing INSULATED GLASS OPTIONS I 0 12a) Tnple GlazeDouble LowE'Kryptonflled R 10'ratmg 2B ❑�WoAdtto Be Done - y (mcludestn/ectedtaaminsu/at�sashes&fiamesJ #of Unfts s ❑ 126) Tnple blaze Single Low E ArgorVKryptonfilled_R 6 rating s (mGudes►n7ectedfoamtnsularedsashes&frames) #ofUnds , \ pi 2c) Double Glaze Single Low E ArgoNKrypton filled f ( (mGudesln/ected(Qemuisulatsashes&flames} #`ofUnrts t E (� p � Double Glaze°Singl e Low E.Argon f2d) filled #of Units v\ ) or} #of Units ' or ME V70F 13 s ❑ NewwindowundstohaveCAMLOCKs orLATCH[OCKs 'fOfa� Sale Pt'1C8 $ . ❑ 12e Sun Clean Glass(on eaten 14/di L New window undsto have NIGHT1VENT LATCHES 15 New window ands to have OBSGUREG GLASS DepositWlth'Drder # ❑full 4rfr , Paymenton 16 ;�® New window ands to have HALF(1!2)SCREEN _ r k (�UBSCreell0lfC8SBmPll�tj�86t�l1doW) �; ti r Mea5Ur8 Or Start; 30 $ a 17 {❑ Windowsto:haveGRIDS�Coloni4-� ` Diamond a� Balance DUeOn f, } ul°o %2Aaurbonalinfo` k`" 1 SubstantlalC9mpletlon 34°�h $ a �; 18.,(�❑ install PVGQ NUMtowindowframes TOtal'AmOutlt'of i Color- , T 3 rc #.of'Openings�,a Balance to be Financed $ F 19A❑ CAULK AND SEAL-Windows with3pointsy%gT If finarced,'balance :payable ,r° nt ly installments of . . 20:ed❑ COLOR OF�WINDOWS`to be dew gTimbertone O Sandtone approximately$ �� r nth" ay le_ °Owner to=contractor 21 0 Total#Double Hangs Total#Two Lde Sliders but If financed 6y Owher3hen Owner well p said amount to the lending plus such r. Total#Casements:. . :. Total#ThreeLite Sliders ' . . interest, and credit service charge o "`said lendin i tltutlon payable.' ' Total#Ho Total#Dead,Lite/Richites directly to the lending institution loaning such monies - i lllsceueis Have PPS caner and will execute a Retail Installment seenAppued Standard or E ual lendin Total'#.BasemerdSliders to 0 9s '` obligation and'anyi.documents 'ri:gwred bg such � iiererred P` eet q g instduUon m(connection.with said loan _ _.merest wlicrue, A1TR/CCT>~lilt.I��N©' RRESPO�[;SIB E)LI�STII�IG� E RIT�S(SiYSYEMS P �5� +1��ALI<'�H � �C1lLS ` BLINDS tyUR7A1NS,DRAPES ElEi WINDOVV,M NTIEDrAIA COND1710NERS t?RIOR TO i1jIE INSTA1:L11PION , YOUR N Vi01tlIDOf�VS�INSTACLERS AEIE"NQ►T RESPONSIBLE FOR Ti�E'RER/OYAB.OA INS�PALLATION OF THESE$YPES O�iTEMSx �; �. , Notice:If financed,any holder of this Consumer,Credit:.Contract is subject to all CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY PROBLEM. —claims and defenses which the debtor could assert againstthe seller of goods-or = - - - _ -- = services obtained pursuant hereto or with,the proceeds hereof. Recovery bythe SALESMAN.HAS NO..AUTHORITY TO.CHANGE-ANY ITEMS_OR:MAKE ANY debtor shall not exceed amounts paid by debtor hereunder. REPRESENTATIONS OTHER'THAR:CONTAINED IN THIS AGREEMENT AND OWNER REPRESENTS TO HAVE HEAD"AND RECEIVED A DUPLICATE'ORIGINAL'OF.: "OWNER";REPRESENTS THAT`NONE HAVE BEEN MADE TO OR RELIED UPO THISAGREEMENTANDTO BE THE AUTHORIZED AGENT 0 FALL"OWNERS" OFTHIS' BY"OWNER".YOU'ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE PROPERTY UPON WHICH THE-WORK OR THE MATERIALS ARE TO.BE SUPPLIED. ORIGINAL OF THIS;AGREEMENT, NOTICETOTHEHOMEOWNER(S),GUARANTOR(S);LESSEE(S),CO-SIGNER(S)." "YOU,THE.BUYER' .MAY CANCEL,.THIS TRANSACTION AT ANY TIME PRIOR TO Contractor;ti the expense ot-owner,"shall procure'all'penTi is required by laws MIDNIGHT OF THE THIR1 BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. 1.Do not sign this agreement beforeyou read It or if it contains any blank spaces SEEATTACHED NOTICE OF CANCELLATION FORM FORAN EXPLANATION OF THIS or.if It does not contain everything:agreed upon: .2.Any person who shall have-co=signed guaranteed or slligned anycredit application RIGHT ON ALL ORDERS:CANCELED AFTENISTRA IVt ANON PERIOD;CUSTOMERS or note relaUngto this agreement hereby accepts tobe bound hy this agreemeiit. WILL BE RESPONSIBLE`FOR' ADMINISTRATIVE ANDRESTDCKINGFEE 3.,Owner(s)top resents that the comentfonthebackof this agreement Isatrue SEE REVERSE;SIDE FOR ADDITIONALTERMS�ANDCONDITIONS BY SIGNATURE part hereof"and has been read and acce tad b Owner. BELOW,CUSTOMERAGREES TO'THE TERMS OU LINED ON THE REVERSE OF THIS 4.ALL INSTALLATION LABOR GUARANTE D 1(NE).YEAR. CONTRACT DATE �y Contractor Aceep} Pin`: u ,� - Salesman's:AIame Sidnatu e {Custom Ign.Here Saleman s License No Signature „ € z I (Gusrome'r'Sign Here} . . ; OM Brayer*urWrra a4. o 10 Town of Barnstable ermit: Regulatory Services ate: �0 THE 71, Thomas F. Geiler, Director Building Division * BARNSPABLE, " Tom Perry; Building Commissioner . MASS. g 1639• .� 200 Main Street, Hyannis, MA 02601 MAy a - www.town.barnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: J]J&Zz, P46 hon - Install at: U6/Z)w--;� p Village: Map/Parcel: Stov�e A.v w/ Used B. Type: /Radiant/ Circulating C. Manufacturer: Lab. No. D. Model No.: Chimney A. �w/Existing (If existing, please note date of last cleaning B. Flue Size C. Are other appliances attached to Flue? A!o D. Pre-fab Type and Manufacturer E. Masonry: eYLllled/Unlined Hearth A. Materials: �Z.�� C -4'V�Z� )c C'9%LD f�ti, �'c11> iAL %il� B. Sub Floor Construction: W 6o.o Installer Name: Address: Phone: Location of Installation: H.I.0 Registration# Construction Su rvisor# OR check Homeowner Installing, no h ense require APPLICANTS SIGNATURE lr�c z� APPROVED BY: Please make checks payable to the Town o Barnstable .*This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stoVe r r i Town of Barnstable ermit: 1010 Regulatory Services Dater P�oFSHETWyy Thomas F. Geiler, Director Building Division BARNSTABLE, ' Tom Perry,., Building Commissioner`.P MASS. - 1639• 200 Main Street,;Hyannis, MA 02601 A�FD MPy a www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 TOWN OF-BARNSTABLE SOLID FUEL STOVE PERMIT Owner: GS T.�.z l Phon "YG/ n�e d D/ Install at:7// /e. )w-�.,0 Village: @iU Tee U Map/Parcel: . c�2-50 /eS Date: �/�,// Stove A.v ew/ Used� B. Type: radiant/ Circulating C. Manufacturer: R/.� Lab. No. D. Model No.;- chimney A. ql'ew/ Existing (If existr'ng, please note date of last cleaning) B. Flue Size (o // e t C. Are other appliances attached-to Flue? !J o' D. Pre-fab Type and Manufacturer E. Masonry: i,ned/Unlined „ Hearth 12�i . C =� A. Materials: •'� `�'� 6,411C�id4� .�SOrf2o N ;C°c/1> /IL 77/1 g caa B. Sub Floor Construction. (,UGC D , Installer rT3 Name: Address: Phone: Location of Installation: H.I.0 Registration# Construction Su ervisor# OR check Homeowner Installing, no 1' ense require APPLICANTS SIGNATURE r� APPROVED BY: Please make checks a cable to the Town o Barnstable *This constitutes an of stove.permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 The Commonwealth of Massachusetts Department of IndustrialAccidents., Of lee of Investigations ' a 600 Washington Street Boston,MA 02111, ,�•�' www.mass.gov/ditt Workers} Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMc(Business/Organization/Individual): . Address: City/State/Zip: Phone.#: Are you an employer? Check the appropriate bog: I am a general con .Type of project(required):, 1.❑ I am a employer w 4.-with ❑ g . .tractor 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 These sub-contractors have ' ship and have no employees 8: ❑Demolition '. . orking for me in any capacity, w employe,sand have workers'a 9. ❑Building addition [No workers' comp.insurance comp, insurance,$ e aired. 5• ❑ We are a corporation and its 10.❑•Electrical repairs or additions q ] officers have exercised their 3. I am a homeowner doing all•work .- 11.❑Plumbing repairs or additions myself. [No workers'comp. ; right of exemption per MGL 12.❑Roof repairs insurance required.]f c. 152, §1(4), and we have no , ,employees. (No workers' 13.❑ Other ' corup, 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 anew affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the$ub-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.thepolicy and job site, information: Insurance Company Name; Policy#or Self-ins.Lic.#: Expiration Dater lob 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 G. 152 can lead to the imposition of.criminal penalties of a fine tip 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 ins an c vera e verification: I do.hereby c under the p Ities o perjury that the information provided above is true and correct. Si afar c Date: �S/ z/1. Phone#: G � Official use only. Do not write in this area, to be completed by.city or town official City or To-On: Permit/License# Issuing Authority(circle one): A,Board of Health 2.Building Department 3. City/Tofvn.Clerk 4,Electrical Inspector 5,Plumbing Inspector 6, Other. Contact Person:_ . Phone#: Q Who is responsible for making application for the permit?;' Application for a permit is required to be made by the owner or lessee or their agent of the building (e.g.; the HIC registrant ). If application is made other than by the owner, written authorization of the owner must accompany the application. Such written authorization shall be signed by, the owner and shall include a statement of ownership and shall identify the owner's authorized agent, or shall grant.permission to the lessee to apply for the permit. The full names and addresses of the owner, lessee, applicant and the responsible officers, if the owner or lessee is a corporate body, shall be stated in the application. Please note: It is the responsibility of the registered HIC to obtain all permits necessary for work covered by the Home Improvement Contractor Registration Law, M.G.L. c 142A. An owner who secures his or her own permits for such shall be excluded from the guaranty fund provisions as defined in M.G.L. c. 142A. Back to Top c�. My contractor told me I need to obtain the permits for ^m_y construction. May_I obtain the relevant permits from. my local building. department, or is the contractor re uired to do that?' While you may certainly obtain your own permits, be aware that if you do, you will fall into a.homeowner exemption that will disqualify you from being eligible to receive.:recourse through M.G.L c. 142A, the HIC Law, or the statutorily authorized Guaranty Fund, should a problem arise. It is the responsibility of the-registered HIC to obtain all permits necessary for work covered by the Nome Improvement Contractor Registration Law M.G.L. c. 142A. If the HIC you are contracting with refuses, you may wish to reconsider using that contractor's services. ��,�-ct t Town of Barnstable Regufatory Services y T Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Maui-Street, Hyannis,MA 02601 vt ww.town.b arnstab 1 e.ma.us Office: 50 8-962-403 8 Fax: 509-790-6230 IIORIEOWNER LICENSE EXEWTION Please Print DATE: . JOB LOCATION: /(J l�®lJd� 7740' number strmt village "HOMF0WNER': It /I-'�IN OS/�2 �j��j e69-63t name Q /home phone,# work phone# CURRENT MAJUNO ADDRESS: r� 2�TI>rtl ` AM r-2 /Sb 7 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 superyisor- 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 fans structures. A person who constrticts 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,riles and regulations. The undersigned"homeowner"certifies that lidshe understands the Town of Barnstable Building Department minim inspection p e and requirements and that he/she will comply with said procedures and r ents. Si a 're o HOrnenwn 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 HOMOWNER'S Exvr2 TON .The Code states that Any homeowner perfomiing work for which a building pernvt is required shall be exempt from the provisions of this section.(Sccticn 109.1.1 -Licensing of construction Supervisors);provided that if the homcov3mrr engages a person(s)for hire to do such work,thats-u[[ch Homeowner shall act as supervisor." Many homeowners who use this rxemption are unaware that they arc assuming the responsibilities'of'a supervisor(ace Appcndiz Q, Ru1cs&Regulations for Licensing Construction Supavison,Section 2.15) This lack of awareness often ms lilts in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed peraon'as it would with a)ic'cnscd Supervisor. The homeowner acting as Supervisor is ultimately responsrb)c. To ensure that the homeowner is M)y aware of his/her responnbilitics,many communities require,as part of the permit application, that the homcowncr certify that he/she understands the responsibilitics of a Supervisor. On the last page of this issue is a farm cut-rcrit)y used,by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fomts:homccxcmpt r, . y IHEr Town of Barnstable Regulatory Services f ♦♦ep hues. g Thomas F. Geiler,.Director 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 A Property Owner Must Complete and Sign This Section If Using A Builder 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 If Property Owner is applying for permit please complete"the Homeowners LiGense Exemption Form on the reverse side. Q:F0 RMS:0 WNERPERMISSJ0N 6 )(CYIA__ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map,z;�5,>2 Parcel S a ;,Application # � Health Division _ Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ®{� 613A J)W— Historic - OKH _Preservation/Hyannis Project Street Address 2Y Llo&lo 2 Wov 6 d.% Village e ry Te2,LJ = /b Owner, i �oS722 Address 7 /�oyGUvyO � 4 Telephone Permit Request f�- ,,41 Roe Moue. C,4_12g:5e Qoc4- ADZ) y'>eL! ,LUiAj6ow he2ONI � b e2 S l4 e S 1 Aeon A)a 9gee'T i2oe is �2m�r-r t2 e1-,a gp o a Square feet: 1 st floor: existing &Proposed 2nd floor: existing proposed Total new r Zoning District Flood Plain Al o Groundwater Overlay ^ Project Valuation /,-2t?A Construction Type `- Lot Size D a Lo /1 e 2es Grandfathered: ❑Yes ❑ No If yes, attach-s*upportinFdocumentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) =`' ram; Age of Existing Structure Historic House: ❑Yes &lo On Old King' 4s Highway ❑Yes &No Basement Type: Zull ❑ 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: 2 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: MIG" as ❑ Oil ❑ Electric ❑ Other Central Air: &4 es ❑ No Fireplaces: Existing New Existing wood/coal stove: ,ees ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:21J existing ❑ new size _Shed: Er'e'xisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 2lo If yes, site plan review# Current Use Proposed Use t,/ POO I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � � i m 5STP/L15 Telephone Number C�oo� Ga-O 30 IAddress �'7 . �o�oNCe 4 1 License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SI NG ATURE l ��-DATE l /%� r } 5 FOR OFFICIAL USE ONLY f 1 APPLICATION# DATE ISSUED � x MAP/PARCEL NO. ADDRESS VILLAGE 3 of OWNER y 5 DATE OF INSPECTION: s FOUNDATION FRAME INSULATION 2 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING (,IA I DATE CLOSED OUT ASSOCIATION PLAN NO. r f s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street " Boston,MA 02111 e www.mass go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le `bl t Name (Business/Organization/Individual): oSTP//L Address: d// r!1 oop iC fJ ��.0 7?2dlIle- City/State/Zip: InA d 1�63a Phone #1 Are you an employer?Check the appropriate box: Type L❑ I am a employer with 4. ❑ e of project(required): . I am a general contractor and I 6.T ❑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 t F• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity., workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL l I.[] 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. $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 and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 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 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 co ge verification. I do hereby ce der the pains penalties of perjury that the information provided above is true and correct Si afore: / Date: Phone#: L only, Do not write in this area,to be completed by city or town offtcial n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone#: i Information and-Instrudions 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." m An employer is defined as"an individual, partnership,association, corporation or other legal entity,or any two or more of the foregoing en a ed in a 'oint ente rise and including g g g g ) the legal representatives of a deceased employer, rP g g 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 employmentbe'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 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. 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 dite the affidavit The affidavit should be returned to the city or town that the application for the permit or'Iicense is being requested,not the Departmen t 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 permidlicease 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 anybusiness or commercial venture (i.e. a dog Iicense 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE, Revised 5-26-OS Fax# 617-727-7749 ' www.mass..gov/dia Town of Barns-tale Regulatory Services Thomas F. Geiler, Director aAFwsrASLE, - �� Building Division - �� Tom Perry,Building Commissioner r 200 Main Street, Hyannis,h2A 02601i www.tbwn.ba rnstab le.m a.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION i Please''Print DATE: I . JOB LOCATION: aA 1U0010 !l,4, number street village HOMEOWNER": name home phone## l work phone# CURRENT MAiUNG ADDRESS: ryl o / 6 7 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 coristructs more than one home in.a two-year period shall not lie considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to,the Building Official,that he/she shall Se responsible for all such work Krformed.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 Biulding Department minimum inspection p rr, requirements and that he/she will comply witlr'said procedures and re ents.- YX s - 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 hbtireowoer performing work for which a building permit.is required shall_be exempt from the provisions of this section(Section 109.1.1-Licentsing•of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Home*wner shall act as supervisor." Many homeowners who useethis czcmption'art unaware that they are assuming dreFresponsibilides ofa supervisor(see Appendix Q, Rules&Regulations for Licensing Cons ction Supervisors,Section 2.)5) This lack ofawarcncss 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 ofhis/hcr responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilitieg ofa Supervisor. On the last page of this issue is a form currently used by . scvcal towns. You may care t amend and adopt such a form/certification for use in your community, Viorms:homeexempt of'THE I-, P� y iARN6T♦xrr � - . ��prEMASS. Town .of Barn' stable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma'.us Office: 508-862-4039 Fax: 508-790-6230. Property caner Must Complete a Sign This Section If sing A Builder I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work uthorize y this building permit application for: (Address of Job) Signature of Owne Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:kUscrsldccollikVppDatolLoc&AMicrosoMWindowslTcmporwy lmcmct FilcslContcnt.0utiooklDDV87AA-7Z EXPRESS.doc Revised 072110 --4#ssessor's map and lot number ... STHE Sewage Permit number .... ....................... SEPTIC'SYSTtM 33ARN SMULE, House number .................................. MUST BE MAG& INSTALLED WCOMPLIANC 039- a WITH T1 L�� BXRM�tF RgUDE ANO Vr BUILDING INSPECTOR - . APPLICATIONFOR PERMIT TO .................. ............................................................... ................................... TYPEOF CONSTRUCTION ......... ....................................................................................... ..... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 4 ......Z� Location ..........7.�z..... *:/(1.�.;Z.................................... Proposed Use ..... �.......................................... ............ ................................................. Zoning District ...........d /.......................... .......Fire District, ex.ra v'�Ie— nc✓ 2/ .............. Name of Owner ...... ..._.Address .......�;�ZY.Vvaz.7 7 111ye; e V14 Z, 4.................. .............. ...............Name of Builder ...IF,./ r..Wi he ....Address ........ Nameof Architect ........vo.kp—...... ...................................................................................... Number of Rooms ........t-e.ezl.................................................Foundation .....M. e"" le......................................... Exterior ......... 4--// ........................................R o' ofing .......... Floors ......... ........... Z.........................Interior ...... ........... .... Heating .....L/72-1.5.....—../ ...174. ...........................Plumbing ..... ......K,l.?7.5.... ......... ................................ Fireplace ...........1,Ve.A,14............................................I.........Approximate Cost ..........sp/v-ano....................................... Definitive Plan Approved by Planning Board ------------------------------ Area .... .................. 6a, Diagram of Lot and Building with Dimensions Fee .........._—P..�- .. ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH 976i 3 I hereby agree to conform to all the Rules and Regulations of the Town, f Barnpable regarding the above construction. Name +, . .. .. .................... la ~ ' SBAMBC), EI,IDABETB M. , - ' ` _24��O.. Permit for ..{)Rq... .......... ~ ' *4 � ' __..Sioole.. . ling�____ �ot �l66 74 ^ Location ----,,`==---.. .�szze , Centerville ` —.—.---..—~-----------------.. ' � �lioabeth D8. S]z�mU�o ` Owner —�--------------------. ' . ' . I7zanne - . Type-of Construction _------------.. . ` . } . -------------------------- Plot —.-------- �t ----------' . ~ - � � Permit Granted —.J1� '3l'-----lg 83 ` / ' ~ Dote of Inspection -------..----lP ' � � � Date Co " ` ~ . ' . . PERMIT REFUSED � '' lA .. ......... ' —����"------ . � -' - . --.. ---.--. � ------- ......................................................... Y'' -----� '' —'� ` �� ^ ` ---.—. .. ---.—..----.--.~^-.'��' , � ----.--..--------..----.~--.. �. - / - / .............................................. lA .^ ---------------~~---.------ .. ` . .~` . -----------------~--~---~7. ` � ` Assessor's map and lot number - THE ���\�����e���-. � | Devvoge. Permit number ....................... l.�� ~ npuxe number 13ARNST LE, -'���v:._------------------`' � ������ ��� � � � �� � � �� � � �� �� |� � �_� BARNS TABLE ' BUKRING N �� ���� �� ��N �������°�� � N� ��` / APPLICATION FOR PERMIT TO ........7�/*1...................................................................................................... . . � TYPEOF CONSTRUCTION --- .. s............................................................................................ � --....—. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o ponnh according to the following information: Location -'�� �~4�_. --'—� -__--'—_'_ =-_-..�/.--.--_._--,_---- ---....,~.-----....----..-.. Proposed Use --~ g~~...-..--------.--....-------.------------ ��/l ` ^/ - // ^ Zoning District ---../�s/^�'L-.------------..Rve District -��/�<��c�/�/�...�.��������/��...----.. . . Name of Dvvnar -''�.^/��+n/t=^.m-,��.� zxg�-.A6Jres --.�u���7- .. ��._ ----, -_-.—��-.�'-'.~.. .-----. � -�A66reo ..................��� ��- /�--- ' --''---- -------7---- -----'-------'' Nome of 8ui|6o, ' Nome of Architect �~^ �s ` -'-^=='=� -''>= s�`"" ---______________.__~_______.. Number of Rooms ......... ---------------Foun6otion -'^IK' �,-. /. .................................... Ex/erior ........ ------'RnoGng --- --- ................................................ �^�� ' Floors --------.��r�r --~^xzy�`.��e�.'(.. -__-____, ' Heating -'4- .--------'P1um6ing ..... -- _______________ Fireplace ............ .....................................................Approximate Cost ........... ....................................... Definitive Plan Approved by Planning Board - lQ--__. Area -� ���� Diagram of Lot and Building with Dimensions F� _,.. __. - . ' SUBJECT TO APPROVAL OF BOARD OF HEALTH - _ ) � , ' ' ' . / | . \ ' 1 � � | hereby agree to conform to all the Rules and Regulations .h*^onsof Town LJp/ Barnstable regarding the above � construction. Nome .. --,_,,,, � / ' | / � SHAMBO, ELIZABETH M. A=,:52-152 -�24230 One Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location Lot #166 74 Cottonwood Lane ................................................................ Centerville ............................................................................... Owner .. E.liaeth M. Shambo ... .......z.....b................................................ Type of Construction ......Frame .................................... ............................... Plot ............................ Lot ................................ Permit Granted ........................................July 21, 82 19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED .................................... 19 ro-0 */,� ............................................... ....................... ................................ .............................................. ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... V�7lc�ty _ yNl �-a �j11JGt.I✓ FAMtIr.�( - 3 BEORooM �� � FJO GARBAGE (�WhIDEIL �03-ZZ- ��. DAILY FLOW z 110 X 3 = 3306.PR $EPT1G -rAsuK = 330xl3c>% =-4956.P. "� 94G QRE4 �f usy-- %000 GAL.. 0l5Po5AL PIT y'SE� IOoO GAL• 5%DEWJALL A?-Sh, = 15c S,F �- 15c 5.F x �.•5 = 3?5 �.Po y.b BOTTOM AREA- Jr' 0 5•F, � + �, PZOP 49•q S0 S.F x 1•o - 5 o G.P o FNa• nook . "TOTAL- �E51GN = .q-25 G.Po r _:4 'faTAl DA11-�{ F�-Ot/�! = 306.PQ IP PERCOLATION RATES 1 110 VAIN oc�.LE55 ..... . ... _._ _......... .._..,..i,.,. ..._ . &OC)i o°\� - OF bmi y P#CHAHO : N A ` o ALAN BAXTER Na 2VJ48Q o }ONE y 01 TGft A� SiJB'�4' D. 10 AtEiG IT65T q T��gp . = 99 TOP F,•NO=1oo.0 !ao•w1 lao� 1Nv. -ST. GAS SJPSSOtI. BaX IN SCPt►G � Z. . taco INJ 9��L -rra�tK INV. INY.. __:....._.__._�... _. ._.._._._..__1... _ ..._ WA SWSD vro C.ER.TIFiGC pl-oT PLAN EL- L o C 4'T t o f�l C. EQTMVI LLTS - IZ • ' NO SCALE SCALEVL DATE 1 ►4182 1 GERTl1+Y 'T%AAT 'TNTc 1`-aV1�C(�TIOIJ 5Nv1r1�N: PL-AtJ REFrc2ENGE NER1`orl GOMPUL 6 WlT0'TH6 p.ND -6 E--'T 5AC.Y, R-GP019-etASNTs of IWG- -rawN o Bt 5r, Lg. ANC 1s aot 1_ocp.T 0 wITN1L .E G ov F�Lv.•IN . . .. : ..... ._...._ _ -_-. .. . . DATE-1 ,1/) 1 .. . BA)ceszi myc- INC. REG I -Tr D S u iZY E`�oes -Ttlltj PL&M 16 t,lorT 5456v old Ahl d3TEPTYILL - /V1A55. (1J�jTlZ•u M>✓NT S u ev G-Y 4-T NE oFF5ET5 suoul� ' No'T e'E VS�t>"tb OsTES2_MII G L.o'T l;.1NE.5 APPLICANT' It.-lrl �•'"` 'TOWN OF BARNSTABLE '42-3C I Permit No. ___--- Building` Inspector ...� Cash - -- °°"� OCCUPANCY PERMIT Bond _ _ No building nor structure shall be erected, and no'land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Fli zabeth M. Shbo Address lot #166 74 Cottorn-vo d Lane, Centexyi.11e Wiring Inspector l r!�! .�. � Inspection date Plumbing.Easpector' Inspection date Gas Inspector - Inspection date X Engineering Department Inspection date ` THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. r Building Inspector J .4 Town of Barnstable ][regulatory Services oF�goy, Thomas F.Geiler,Director Building Division SAMWABLE. �. HASS. Tom Perry,Building Commissioner o .t 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Pee: :�O Permit#: 6�D HOME OCCUPATION REGISTRATION Date: Name:. 1 ! %YI iOS7_,�en_ Phone#: .5 0 0 7(W Z7S' . e Address: 7 C6z/ 419 Name of Business: JAVVi•e o2,UTPkDf21Sc_9 (_Q_ _ _, Type of Business: ,�-P1LA_z2"7 51+l ec Map/Lot 2 Sa2 1 S c;Z INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a hoine occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the- premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to,the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space: • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No,traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects, o There is no-storage'or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be mei.on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • .There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick=up4raek•not to7,exceed-one ton.:capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and agree with e above restrictions for my home occupation I am registering. Date: Applicant ��� YOU WISH TO OPEN A BUSINESS? . For Your Information: Business certificates [cost$30.00 for 4 years). A busi ss certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L.-it.does not give you permission tq operate.). You must first obtain the necessary signatures on this form at 200.Maiq St., Hyannis. Take the conpletediform fo the Town CTerk's Office, 1 st FL,.367 Main St., Hyannis, MA 02601 (Town Hall).and get the'B'usiness Certificate that is required by law. DATE: / Fill)"lease: --� k; g, APPLICANT'S YOUR NAME/S: ivy C P o s:Qom. BUSINESS YOUR HOME ADDRESS: 7 / a w J a y' TELEPHONE # Home Telephone Number 5Va 7qO 2 NAME OF CORPORATIQN: J Asunjie . T-ej z. ?/SPS L L. NAME OF NEW BUSINESS ,I A-N,V .Q.Iu 1-11Z .2/s101 TYPE OF BUSINESS- IS THIS A HOME.00CUPATIONS YES NO ADDRESS OF BUSINESS 7� �a�n�Z c>cio�J � � MAP/PARCEL NUMBER � ��" [Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may.need. You MUST .GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits,and licenses required to legally operate your business in this town. 1. BUILDING CO. MISSIO ER'S FI This indivi cjal_h et+-inf r e a p rniit re u reme that pertain to this type of business. * MUST COMPLY WITH HOME'OCCUP�TION A th z d Sig at e - f�Ul.� ARVD F3EGULATIC)t�l FAILURE TO OMMENT 6 v ILT IN FINES. 2. BOARD OF HEALTH This individual h n inf ecL of fie permit requirements that pertain to this type of business. Authorized ignature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORIT�) This individual h en info. d'of the li si age, irements that pertain to this type of business. Authorized Signature** COMMENTS: i Commonwealth of Massachusetts Barnstable, SS December 18, 2008 On this 18`h day of December, 2008, before me, the undersigned notary public,-personally appeared Janice M. Foster, proved to me through satisfactory evidence .of identification, which was a valid Massachusetts License, to be the person whose name is signed on the preceding or attached document-'in m n p g Y presence. ' &anne M. Duchemin,Notary Public ' My Commission Expires: April 4, 2014 r °FtKKE r° Town of Barnstable Regulatory Services *9 mmsrABLZ 9! Thomas F.Ge11er,Director 039.tp�e0 . Building Division Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# � FEE: $ SHED REGISTRATIONO� � 120 square feet or less Location of shed(address) Village Property owner's name Telephone number �n i2- -AL-2\ Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old.King's Highway Historic District Commission jurisdiction? � Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,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-forms-shedreg REV:083001 {{ S►aGtt= FAMILY _ � t3EORooM 103.22 I t,JD GA�?•BAGE �j21NDE2 - u exR �ovV .: tto x 3 = 33o G•Pt? -*' qqG Arr�a SEPTIG TANk = 330x15o'/• =.c}95�,•P. 9 4 v$t= l000 GAL..• _ — ! u5E taoD E�AL• Pjr '�10 t�t5Po5AL- P►T H S pEvJAIL A►z-E1� = 15b S.F ri- Fo 37 9 G.?.c, prop 44.9 50TToM A2EA= s� s.Fx too _ 5oC�.Po FNa.. , -foTA1- p�•S1GN = ,4.25 GP.D to PE2Got�Tlot1 GzATE j 1''tN 2M►N oQ.��55 `LoL Of al.rN .\`, '0oD r RtCtiAHO � - o� ►-•�W a A.BAXTER Ld No.2aU48 �� � 1014E H qt QtSTE CIO .G�� •! __�._. ._ __ .-i _ _ su F'i U� = 9/ TO FND=too•0 j 'TEST gIzS�Bo ply NvL�c FL a y r Pa RIW.P �.�; .. . 7Ja�i�l �F' � Iooe tNv• . l.A4A tSr Gay. 9L• Srn�o�t. t3ox �N $��►� IOoo ANY �.•�i •rA►aK ? t •i Z GAS.. qp,Q - l_EAGtd ' PIT -_ INV. INV. 4 - r ^I G E SZ.T t F►t�D P L�T P L..A PROFILE L044-rtoN CF-QTt WfLL6 o SGAL E= SoA►-E �� 4.tj.. IZ N � � I UATM +.. . _._ . , `Y 1 cPaP--r K 'THAT 'TN�c ��� D(�T1o1� SKa�YN ,4 µE26ott GoMP1-`�5 WtTN-tNE : : 1-0 :1�G ANp SETt •GK 2.6QUIR.>:M'E.NrS oF-TNE II : /' TowN of 8AR1.15ri�t_g ANC ►S � � . -t�•--- :_...: . ov f�l.A•1N t_ocpct [� W tTNt N T UCL , � BAKTEtZe IJ�{E INC. R.EG t S'r f�2 FsD�1.A�05 E,(cl -T"%:I , PL&KI 1!j NOrT gA56D pId A,N OSTEi�VILt.� (�15TtZt�MENT SutizV6�( -rNE oFF5�T5 $4101JI,� APPLIC-AtJT It�l INNS NoT C'rc VS�OTb pETEt2..!`AI1•tE L:•oT �.INE.�S IL' � -- ti I' y 4 , } I SeaportsVillage REALTY --. Juan L. Marich,�l er Sales Associate 128 Main Street,Hyannis,MA 02601 Office:'508-771-1994'111 Cell:508-934-6745 j uan @seaportvillagerealty.com www.seaportvillagerealty.com. w oc Ll VL 0 0 (-1 -�M 4e- . r i r,: -".tom. 't� •�i��. r� A'& 'r`. 4,�,"'vk rg'7�i afi'}}a ��.r �r��i'�§� ,{+�'f'1�}� 4! r}; ,•;, ` • ; , ykk 4�: 4 • { �' 4 - + [ ' ry, ,S;' �, ♦y,.*..j fir! 1 «� �t7r .. 7r � xl: R k.}� ��• �,�t j 1' � t_v >, r�+� - t �� �1 'y�•*y'4 t �� #��' `� �„ Aft 'i•1. , e • C ��. - .- y e .+* 'S_ �• �y,. t S 4' ! 3 �}t t..: spa- ��E + 6 '! V a i ...�� r R { �3 t ! 'C` 1^ �� �� �q�s ♦ �4,,^�,� `a.�,�i�-.+�'� *i�', ,dr}, �; � �� i-i. '•fir .� ... - - :. �' `F�.} '� r +(i w} � �1.�« 6r :r wt ,s-•�,,,�. �r�` �'� r..�t` R �fy 1• ;wR � (fol ' . e�yrS i r.}* u4.�'"�.!�� yv all 0410 'at4 r yF' IWO r a p It. r2 r i r ae c. • � 'may;•*, �3 '�r.71�:F_ � ��• ,t�'[#��,.�. rr�-1� 4 f'�` k' ��r*�Y��t�,}t F 1`y*�y': d. I Ste_ �y' yo ly i1o'n�. j2pe' c, 'K 221 VK- / 32 ' 9716 s� s i -T 8'' SMOKE DETECTORS REVIEWED �b1 i/ IIVIPORTAPITA fA "BUILDING DEPT. DATE ANY CONSTRUCTION THAT INCREASES LIVING SPACE BEYOND 1200 SQ. FT. PER LEVEL MAY.REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. FIRE DEPARTMENT DATE NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT 29MN-201 SATISFY THIS REQUIREMENT. G a �y 2,of�nl-,j6vd Ln