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HomeMy WebLinkAbout0007 GUILDFORD ROAD &u/IbD eorQ b 1 V 07 now, BMW 4xlv ............... ............ ..................... ..... .... It"A'?I "t'l AQ mma IN mama M; =� ,W. ,'A' m .... ...................... 5 R ON i -VIV 8 '52 ggg Pr"I'Alif At fl-,� .. ...... jgv `W NINE RP1Ai,3Afk0 R, �j, Rn,�, `5 N MR 000.0, MAMA R 'Ar all rV ..vnFM=WP Boom M4 01 0,11 TI �,q k,'i"Vl,�j�k 'j ,`i�,`�'t:.�;l , �- VIA F 17Q RIMNS Hit I�V h ;,k if�x .............. MUSK= SON Town of Barnstable *Permit#2LOT Expires 6 months from issue date •X�� E�S P�I�NI11' Regulatory Services Fee �y Thomas F.Geiler,Director FTLOWN AUG 3 0 2006 Building Division Tom Perry,CBO, Building Commissioner OF BARNSTABLE 200 Main street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - ' RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Cap/parcel Number — o y roperty Address T (�12ze,�,- 4ed Residential Value of Work Q W Minimum fee of$25.00 for work under$6000.00 iwner's Name&Address Y 0 e v ,ontractor's Name Telephone Number come Improvement Contractor License#(if applicable) I C ° FiartS gervisor's� censer {if-appheablej ►—�1 : IlWorkman's Compensation Insurance 4� Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance � G nsurance Company Name o � ti Vorkman's Comp.Policy# C C 15�_00S4 ltz © I a oQ :opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders. U-ValueJ O (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Im rovement Contractors License is required. SIGNATURE: ):Forms:expmtrg tevise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Elects icians/Plum* hers ADiDlicant Inforin2 iOn Please Print L.e 'bl V r Name (Business/Organization/Individual): SS Address: City/State/Zip: Phone#: �. p Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.S . I am a sole proprietor or partner- listed on the attached sheet'$ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#f 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 1 ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: �-- Policy#or Self-ins.Lic. #: 5-00 5-q.4;n 19100)(o ^ Expiration Date: Job Site Address: 7 C�` C--_,4,QY-o i ULf 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 coverage verification. I do here ce fy under the pains a f perjury that the information provided above is true and correct Si afore: Date: `P Phone — Official use only. Do not write in this area,to be completed by city or town official City or Town: 4 Perinit/Licease# Issuing Authority (circle one): 1.Board of health 2.Building DeDastment I City/Town Clerk 4.Electrical inspector 5.Flumbiva Inspector l 6. Other }� I�Contact Persons: I'boue#: _X, ✓�ie loarr�rcanulydC� o���aaaacLiti6el' icense or registration valid for individul use only « Board of Building Regulat+ans and Standards ` before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR' Board of Building Regulations and Standards 4 One Ashburton Place Rm 1301 Registration 132282 Boston,Ma.02108 ? Expiration ;12/21/2006 ti Type: ;DBA _ .:. K.P.REMODELING r; KENNETH PERRY � 19 GUILDFORQ RD �,,,�,�,�„i� • Not valid without si niWre j Centerville,MA 02632 g Administrator ' BOARD OF BUILDING REGLATIONS w1 w License: CONSTRUCTION SUPERVISOR ., NumbenCS 076820 '1 Birthdatec 08/28/1965 ," ¢Expires,. 08/2812007 Tr.no: 1360.0 ilrl i Restricted T00_, KENNETH.O.PERRY j 19 GUILDFORD ROAD `f ta;ir; n. CENTERVILLE, MA`02632 I u Commissioner + r I9 OF LIABILITY INSURANCE 08 DATE(MM/DD/YYYY) A CORD,M CERTIFICATE /30/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St.PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Associated Employers Insurance Compa Kenneth Perry D/B/A INSURER B: K.P.Remodeling&Construction INSURER C: 19 Guildford Road INSURER D: Centerville,MA 02632 ' ' �.INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDT - POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE(MM/DDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED RE a c $ CLAIMS MADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ POLICY PRO LOC - PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY' $ - SCHEDULED AUTOS s. - (Per person) HIRED AUTOS - . BODILY INJURY $ NON-OWNED AUTOS - (Per accident) ' PROPERTY DAMAGE _A $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE - - $ RETENTION $ - $ A WORKERS COMPENSATION AND WCC5005450012006 06/13/06 06/13/07 WORY e LIMITU CER EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT. $1 OO OOO ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 s500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable Bldg Div. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Attn:Tom Perry-Commissioner NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis, MA 02601 REPRESENTATIVES. AUTHORIZED R PRESENTATIVE ' C. ACORD 25(2001/08)1 of 2 #44198 LS1 0 ACORD CORPORATION 1988 CON Cr X.P. REMODELING AND CONSTRUMON 19 QUI L'7FORD ROAD CENTERVILLE, MA 02632 (508)420-2163 CeW(508)360-6339 WE PROPOSE hereby to furnish materials and labor-complete in accordance with above specifications for the estimated sum of: $10,296.95 Payments are to be made as follows:A payment of$3,432.32 is due when conract is signed. A payment of$3,432.32.is due at date of start of job and a final payment of$3,432.31 is due on completion of job. All materials are guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become and extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Owner of home to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance and Business Liabilities. Authorized Signature Kenneth O. Pe ACCEPTANCE OF PROPAUThe above prices,specification and conditions are satifactory and are hereby accepted.You are authorized to do the work specified. Payment will be made as outlined above. Home Owner's Signature Date r of Acce tame: �6 4; NOTE.This proposal may be withdrawn by our company if not accepted within 30 days. _............ -rrr..r�i-!.W"f"'y�""r6*,nw-%r.�7:d/'�'.i.{'+r'4rv+i `+Y.r.-rw.+=�.J✓lWrrr"brr%.'i��'~v'`'" .. „''4✓✓r'T�...v'Y"�`.^'.r^'17.+'.....,�.t.r..yr.rr+c...3:n-y--^• ��.,ry Assessor's office(1st Floor): Assessor's map and.lot number Board of Health (3rd floor): Sewage Permit number Engineering.Department(3rd floor)`. House number °o +by'9 Definitive Plan Approved by Planning Board 19 . M d' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only. TOWN OF BARNSTABLE 1 BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION . 19 j TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to(hefollowing informatio Location Proposed Use ` s'` Zoning District_____ � - `4 `' Fire District vt` " ' i . �;.. lea Name of Owner � SAddress Name of Builders Address 10Qa� X Name of Architect Address Number of Rooms Foundation Exterior \AC, Roofing Floors �`' '� Interior Heating ' Plumbing - Fireplace Approximate Cost jo 00.0 Area f and Building with Dimensions Fee Diagram o Lot g Q K ° AVM Y1p E'�CzvZ r , i N OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS' I hereby agree to conform to all the Rules and Regulations of the,Town of Barnstable..- �ing t e above construction. Nam Construction Supervisora�e�nse t./ w SEVERENS, ROBERT r A=172-084 No 34554 Permit For REMODEL KITCHEN Sin 1 Fami1v Dwelling l C�vof Location 7 ash LeY Centerville Owner. Robert Severns Type of Construction Frame Plot Lot Permit Granted September 10 , 19 91 Date of Inspection 19 Date Completed 19 PERMIT COMPt.M BL L f Iq (\ i LoT i 00, I certify that this property is located in Flood hazard Zone C (out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date_��y 3 1 j CERTI FI ED PLOT PLAN �< LOCATION �fliU✓.�iIlaE � ✓icLE) 'cry SCALE . / �ro.�... DATE Reg. Land Surveyor PLAN REFERENCE . .fit?!�rG Lor'y 93 . . .. .. .. . .. ..ice . . ... . . . . . . . . . . . . . .. . . . . . . . . . .. .. . I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND plan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO T11E SETBACK REOUIREMENTS OF THE TOWN OF supervision. /2!✓s7413_l WHEN CONSTRUCTED.' - DATE � 7.-� C, .�`-CVL7z.i✓s � ✓1 Aviv /•� l/�)L.G .�/-��..•�w ��`rl�vr..,��,� �� ,_ REGISTERED LAND SURVE R I � T • N:r ' F COMMONWEALTH DEPARTMENT ``- S OF OF PUBLIC SAFETY MASSACHUS 1010 COMMONWEALTH AVE. -ETTS BOSTON,MASS.02215 EXPIRATION DATE LICENSE ENCLOSE CHECK OR MONEY ORDER 06/301199. CONSTR— SUPERVISOR RESTRICTIONS 3 � � { FOR REQUIRED FEE, NO NE EFFECTIVE DATE LIC-NO. MADE PAYABLE TO 06/30/1 991 " 014344 "COMMISSIONER OF P G EO R GE W B p PUBLIC SAFETY" SS � ;032-38-5486 130 RED{{ING KELY m, BARNST.AgLE�Np N :BOX 206 too rENo�AslO PHOTO(eusnNc oPR oNLrl FEE: 02630: P ASE . N01\' �F T 100.00° REASE ` HEIGHT: NOT VALID UNTI E E{�T I y STAMPEO GNED UR AND OFFICIALLY1 F E R . DOB: THE MMISSIONER I 1 J j I..))�,. `� 03120 .., - L� LI,I=l _ THIS DOCUMENT MUST BE �` L, CARRIED O I THE PERSON NOT OTHERS BIGHT THUMB PRINT THE HOLDER WHEN ENGAGE, --' ED IN THIS OCCUPATION. 4 + n NATURE OF LICENSEE SIGN D ME IN C H SIG LICENSE. STUB 200M• L A80VE SIGNATURE LINE _. 2.87.g 1429 wi.�..lM.a/G�'�c�.•:• oAC.r, COMMISSIONER Assessor's office(1st Floor): Assessor's map an71t um r � `L/ f THE T Conservation INSTALLED IN e: Board a Health um3rd floor): /3j J" / Sewage Permit number "% � - WITH q� erLnt;e EN Y . �g IRONMENTA, Y• Engineering Department(3rd floor): TOWN ����� House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2.W P.M.only TOWN OF BARNSTABLE BU L - 1 INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION _ \�'�� �� ce j Cl/Z e 4 v-LAO-d Ll TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap lies for permit a cording o the f Ilowing information: Location Proposed Use Zoning District Fire District - rg0Qd�S Name of Owner ky YK. Az Address Name of Builder ' \JJ ( , Z 1 Address 0(3 WW,Lf, IrZ lS 2Yt.�5 �`0 Name of Architect V&A-t Address Number of Rooms `,off '� Foundation Oby coL,Cy6.Q Exterior I 2 Roofing 5 �Zlt G Floors Interior Heating Plumbing ` C Fireplace V 0 L,-k Approximate Cost _ � ,CN 00 Area 30 17 Diagram of Lot and Building with Dimensions Fee C 1� v1 a` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re ar ' the a tr ion. Name Construction Supervisor's License L� SEVERNS, ROBERT & ANN M. HALL .' No 35073 Permit For ADDITION & REMODEL Single Family Dwelling I Location 7 Guilford Road ` Centerville A 4 • ! Owner ' Robert Severns & Ann M. Hall - Type otConstruction Frame Plot " ` Lot Permit Granted May 21 , 19 Date of Inspection 19 Date Completed 19 - - -• x ' 5� 52 r 'ft < .3 a ti, s, s � '• tTt N•Y' '�u, Z� •. �.w�., i � +4-, -'b'1 <�w+Y./ )Y' yy f;Prr" a J�'• : c: �r�'C - ,:.. :. ''._,:: n ..<..' Y h.Y'... .*,.:.� '5;,4'7 t,.b...� �;`�,$'x � x�.;<..'+- .^�T..ly. +� '+ . ya: �-* k. • "' r Psi } •F '�'... ,,,�.`- z�:y,v'''P �'' ` + ., �, t�. - 4.•a `.`! l' cc,.a i,},: a r•*y.Tr,rn3a qt ar �• x a K q _ - DEPARTMENT OF PUBLIC SAFETY •�9Rj_A-7•M�%c'•t 4 r COMMONWEALTH <, + 51010 COMMONWEALTH AVE- OF BOSTON,MASS.02215 MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER L I C=ENL.E FOR REQUIRED FEE, \' 06/30/1991 CONSTR. 3i_IPERVISOR' EXPIRATION DATE MADE PAYABLE TO EFFECTIVE DATE ' LIC-NO. 8'_ ( ; RESTRICTIONS 6 "COMMISSIO BLIC SAFETY" ! 06 NINE ;y E ; i ./:_,0/1989 014344 o � i _ (DO NOT S CASH). _ O,1-p r + CEQR�=E 4J=BLAh-:ELY O 9 IK1 I ' w # • {.. ryas ;ewa }Y "a S' ! " ,I 'laf ` 1(7 0.00 SIGN NAME IN iULL ABOv T-ATUM UN[ .z � •L r 3 r NOT VALID U ILN BY LICENSEE AND OFFICIALLY .P 7 swr r < < SIGN F IIENSE E rNE�NOLDEa GN TWNEHE n"ECAo pNEP r r ate S THUMB PRINT I IN THIS OCCUPATION.r `....fr. e--, ~'•. ° .be F' I �.: i. ;4'* r• a� � -�.t n ,* as "i-,! �►L _ f � .S..-t` —��L..-_.�_..�. :��c.,. 4 '.N"v� f���.. ��•�`-. `h °.`-zdy� 25, s .^.::.:i w.,r.,y :.1, •f � -r t,e� C ���� r �v>''+• �t�'� �w 3' 'F _�,, Y } "t, ,� x; �t r ry 1` 1,1J �Fyrf.�ax: '°` t "� 14 �� '`,n f gift�E � �'+i' <a a I.3 A�br'r•`� Y„+En 3 i� e� .,. ''a4*•y k ��c�. x� �� .r' '�' �� s:= �.". �1p1. �. s � s 5 �,43:r'}` P'o5i`�drP`= `• :FTr"`'�. Y�"` ���, '�' � ` .. .__- `r Isf5 &' .. �r 1 I ..:? . '"" ,- ' ,s'``* � �`� "" ' c > fin �aK _ .3r ' • �t��, ,tyz k; t rc,. s fiy �?; i C f`VJp) 4 y 2 ....1 r\ 7`N{� r�•'P Ft ,Jh}zgiyC ° .. .,a -' - _. .,, ,--`"--.s.-•^ -,•G-.�.s....,. .w......,--.r•'•.».••^•..'Y"L*�sMtm. ,.� -+•�-^�-."",' _ ,ram...,..... ..�...`s'�.;.a»._._....�...H-..y....-. --� -- 1'ilz�•^�A d - . f 4 Assessor's office(1st Floor): /J ) Assessor's map and lot number /A' r ���.r.'C A P P R 0 V D D pi 7wE to Board of Health(3rd floor): �,EM'M �'`t" INSTALLS a. �1.'m ion Sewage Permit number — (� CO PLI� i 2 Engineering Department(3rd floor): ■„G House number °o+039- x � w EPIVIRON E DE �5r,. r�r Definitive Plan Approved by Planning Board 1� ����� 1.�® NS APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING NSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION �l 19 TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies f r a permit according to following informati Location01 Proposed Use `�. `���� I���4 Zoning District � "1 Fire District ��V�� ; �e�1G'+f S Name of Owner �Q� Address - VL, Name of Builder 49D `�'``� Address \WOK BG17-�Z�r4S12?`� Name of Architect Address Number of Rooms <; Foundation ZK—k Exterior W C �' ,u � Roofing Floors V00 Interior Heating "a\' Plumbing I Fireplace V\U"— Approximate Cost 6,90 F 00 Area 61)kO I ©� Diagram of Lot and Building with Dimensions Fee Ave wo e 6'z+,)0 , OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns4,ngnstruction. Nam Constru J , l SEVERENS, ROEERT P* No 34554 Permit For REMODEL KITCHEN Single Fa ilv Dwelling - Location 7- Ashley Drive ^ Centerville *"Owner9, Robert Severens Type of Construction Frame =Plot Lot Permit Granted September 10-, 1g 91 * rg . Date of Inspection 19 ^ Date T*npl*ad, 19 ;4 H MM _ v th „ cis .� ° m _ t F r } 1 } r _ Assessor's Office.(1st floor Map Lot , Ta i. i /Q q�� oor ` te Issued /6 and of Health(3rd floor)(8:30-9:30 3c Q Fee.*: 605d• = �neering Dept.(3rd,fl�House _. IA N$TABLE oar 19b� TOWN OF BARNSTABLE Building Permit Application " Proje Stre ddress_/ �TC� i 161 -�o YA poac( Village �E �� l L L�' M ' _•�y� _ _Owner R©ben-t— � Anh SeVrews Address `� �yi(t,(- YIA R4, cpJYI44 _ t1le ,Telephonea�, �� ,. Permit Request 70 T UJ;J� l b So 4-4 - � 6f60 how .Total 1 Story Area(include 1 story garages&decks) ahM OX SO square feet f Total 2 Story Area(total of 1stt&2nd stories) square feet Estimated Project Cost $ tESS AdY101 coo -�A- Zoning District Flood Plain Water Protection Lot Size 0-b d"dX -3 4- CeUW Grandfathered ? l Zoning Board of Appeals Authorization Recorded Current Use QO Si AeTl Ce- Of— Ot2»'l4e-fS Proposed Use 4lyy1-0— Construction Type , — S Y�„ r2/Yl C-k Commercial esidential Dwelling TypZ. �mgle Family Two Family Multi-Family Age of Existing Structure Basement Type: Finishedl Historic House Unfinished Old King's Highway Wit/ Number of Baths 3 / No.of Bedrooms Total Room Count(not including baths) First Floor 6 Heat Type and Fuel h at. 4a5 hefa t r centralAir, ked-sug Fireplaces t Garage: Detached Other Detached tructures: Pool Attache 2— A&&-.- Barn None heds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE DATE _ J 2 q BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP[PARCEL NO. ADDRESS <- VILLAGE OWNER DATE OF INSPECTION: - • - �, -� , '� r< ! " _� 3 rA • -? FOUNDATION- {= ?' •,� _._. : � -- f �- , r' FRAME INSULATION - FIREPLACE - ' ELECTRICAL: ROUGH =_FINAL A + 'f PLUMBING: ROUGH FINAL G AS: -ROUGH -°'FINAL FINAL BUILDING o`;� 7 DATE CLOSED OUT ASSOCIATION PLAN NO. p� I TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ; Please print. DATE Q JOB LOCATION 'N er Street address Section of town "HOMEOWNER" 10 V�SYI L� Q S"-3 __ '. .... Name Home phone Work phone PRESENT MAILING ADDRESS Q,n ity .toWn State Zip code The current exemption for "homeowners" was extended to include owner-occupi, dwellings of six units or less and to allow such homeowners to engage an in: dividual for hire Who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to r .side, on which there is, or is intended to be, a one to six family dwelling attached or detached structures accessory to such use and/or farm structure A person who constructs more than one home in a two-year period shall not b considered a homeowner. Such "homeowner" shall submit to the Building Offi on a form acceptable to the Building Official, that he/she shall be respons for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with the Building. Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he./she understands the Town of Barnstable Building Department minimum inspection procedures and requiremen- and that he/she will comply wi said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requirec to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for whiS :�-a:. uild: permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided tha,, Home Owner engages a person(s) for hire to do such work, that such Home shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assume the responsibilities of a supervisor (see Appendix Q. Rules and Regulatz for .licensing Construction' Supervisors, Section 2.15) . This lack of awz often results in serious problems, particularly when the Home Owner hire unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Rome Iodiner, as supervisor is ultimately tesponsible. To ensure that the Home Owner is fully aware of his/her responsibilities communities require, as part of the permit application, that the Home 'Ow certify that he/she understands the responsibilities of a supervisor. 0; last page of .this issue is a form currently used by several towns. You i care to amend and adopt such a form/certification for use in your commun:: 'The Town of Barnstable �S Department of Health Safety and Environmental Services Building Division 367 Main Strut,Hyannis MA 02601 Office: 508 790-6227 Ralph C'msscn Fax 508 775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME MOROVEMENT CONTRACTOR LAW , SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,.removal, demolition, or construction of an addition to any pm-eadsting owner Pied building containing at least one but not more than four dwelling units or to mCtuctures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements •l1'ype of Work: Est Cost 07 �— �� r /Address of work: /0%ner.Name: D` /Date of Permit Application: /d I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 ding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WIITI I�NEtEGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT .HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor name Registration No. OR ' Da Nvner s name The Commonwealth of Alassachusetty WT is Department of Industrial Accidents tTW_ f i�' office of/Most/gat/ons 600 Washington Street Boston.A1ass. 0 111 Workers' Compensation Insurance Affidavit rmat M eocy . 3 am a homeowner performing all work myself. rJI am a sole proprietor and have no one working in any�. capacity.t`�w..ryr�•'n'-.eYw'_.t f.":.,�._-• ,�'E�J�. -,.La. r� yyq'.T�^^,.1•'Y�r _ a... n.* +w.�y�e�':!•!At+.x++`^...+.e��.er • ...em::_. .a.....zL ..Y. _.,.nt.awea.r.a . ._.y..__ ��. �:.r_....._ ._ ., _ - ,*_... 1 am an employer providing workers' compensation for my employees working on this job. company name: ad dress: city: Phone#• . insurance co. polio # ,. ... ...:...,. .... ...,:,...-;:. ,rs+-r.. 1 ..-.ter ^'.«.� v�1•.� _ .�....�...�.,y.... I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comijany name: address: city: phone#• insurance co policy# ._......i.. ..R,.-_.�. 7.�r. Mtfl•.7tf Ti: :7l .,'7--"= TS•!9ltt 1'Tn'• pr�'�►,' company name: address: city: phone#: incur�nce rn 120Iicy# ;Attachadditioriai`sheeiiftieceia�r%,:.,_<,,�::.:.:..yrrF-,�: Failure to secure coverage as required under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years•imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Mee of Investigations of the DIA for coverage verification. J do lterey con, tnder the =stdalties of perjurt•that the information pro►'ded ab is true and correct. !/ Signature Date Print name /- N tJ 14 AL_L S ENS Phone#'�0 1 a 1&i2l use oniv do not.write in this area to be completed by city or town official ►, city or town: permit/license# riBuilding Department Licensing Board check if immediate response is required C3Selectmen's Office Health Department ' contact person: phone#• nOther 4 (revised 3195 P1A) a Information and Instructions f, Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an enrplr{vee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An empl(!rer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoing engaged in a_joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However tiie owner of a dweiIina house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that ever,state or local licensing agency shall withhold the issuance or rencival 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, neither the commonwealth nor any of its political subdivisions shall enter into anv 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. !�N Z. .. ` r Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits maybe submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'lie affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. y * a 1 y •... �• i.'.. <� a +N n City or Towns Please be sure that tite 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. 7 he affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tlie Office of investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to Live us a call. t r„rr a...,=.. �.,..„.,. .•.,.,.......�..,-....yr..-.,,:,... .;y-a.�,-..,. .r•-+� � -,�.td....„�....+..,.�.,..- 71he Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department artment of Industrial Accidents �� Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 'f SACHUSETT- , UNIFORM APPLICATION FOR PERMIT TO,DQ GASFITTING (Mint a Type) s , Mass. Date 19 Perms V i L1>t=a R-J e l BulWing . Owner's Name e01:A/-F-e7— ��r.�,T�./7cJ�L�/' i�I�_ Type of Occupancy New Q Renovation Replacement' Plans Submitted: Yesp No -- N rt Y W rA • N 4A V Z e: V; y 0: V1 Z O j 0 = H W W 9030.cc V a1 ►' = 7r Z 0. W i Cr }" W O > .t N cc N {7 V W N W < a Z O :. !" O {~A I < p< < < O O W e' O YI F SUB—;BSMT. BASEMENT 1ST FLOOR ZHO FLOOR JRO FLOOR 4TH FLOOR STH FLOOR i aTH FLOOR 7TH FLOOR aTH FLOOR Installing Compelty Name rA172� Check one: Certificate -7 Gz4�Cf; -I /'/Jf Corporation �S;✓e�717 1V 61_4f� ❑ Partnership Businm Telephone �3^— / -7 p Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: 1 hsve a current 111bjIfty insurance polity or its substantial equivalent which meets the requiremgnts of MGL Ch. 142. Yes ' No If you have checked W,,plgas4;Indicate the type Coverage.by checking the appropriate box. ' A IW)Iityy Insurwwo policy Y. Other type of Indemnity 0 Sond 0 ' OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Ct>a W 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: OwnerD Agent Q Spatial-it of s Agent I hereby certify that&Wof the details and Information I have submitted(or'entered)In above application are true and accurate to the best of my knowledge and that all�plumbing work and installations performed under the permit Issued for th(s application will bs in ;&M with alto, W*wd provisioru 01.11110 Massachusetts SUIs 0"Code and Clurpter 142 of the t3enersJ wa of Congo: mbar Signature of U censodumber or i astitter Master License Number G flown Journeyman F. .�` { ' .t Za p •1.':t'i!irilh.i'�,- 'ram •.`c: ; S:eAt$1GuiFcsrlG w. ........_....,..L,L......,,;eu,,4Nt Na.;bat a7i#�in lJb.b3 ires.el oas s -.�R.ue�!w. .t.,a..tW:;J..s la;uee.:.d:i..:.... = BELOW Folk OFFICE USE ONLY, FINAL INSPECTION , - SKEW TC _ PROGRESS INSPECTION F ' FEE Nos APPLICATION FOR PERMIT TO DO OASFITTIkQ e - 4. NAME i TYPE OF BUILDING LOCATI N OF BUILDING PLUMBER OR GASFITTERJ?'I� - - - -.. PERMIT O TE RAN O -- . . r.•.o+y� r a' ±... m ..,. . DATE S�Z it c�,^ clan INSPIiCTOW �� s t ,• -:-.�. i