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Home My WebLink About0053 HADRADA LANE 53 fladracl� La,�ce. Town of Barnstable Buildin r Post This Card.So That it is Visible From the Street-Approved°Plans,Must be Retained on Job aril this Card Must be Kept s�unvsr :+ Posted Until Final Inspection Has Been Made. �� r� _ 1111 1111 Where a Certificate of Occupancy-is Required,such Building shall Not be Occupied until a Final Inspection has been made. 1Y. Permit NO. B-20-2051 Applicant Name: Stephen Kelly Approvals Date Issued: 07/31/2020 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 01/31/2021 Foundation: Location: 53 HADRADA LANE,CENTERVILLE Map/Lot: 148-107 Zoning District: RC Sheathing: 1"� Owner on Record: GUZMA,FRANK E Contractor Name '--,,STEPHEN A KELLY Framing: 1 Address: 53 HADRADA LN Contractor License: CS`040622 2 CENTERVILLE, MA 02632 Est. Project Cost: $31,000.00 Chimney: Description: Installation of an interconnected rooftop PV system: 21(345w) Permit Fee: $208.10 panels 7.245 KW DC Insulation: Fee Paid:` $208.10 Project Review Req: Date: 7/31/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by thi`spermit-is commenced within i��six months afie R& �c�a Final Plumbing: All work authorized by this.permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall.be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road aid shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and Are_O.fficials-are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection ' 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed> „�.,.}. _ Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy . Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Oyu L:^- E � 'VTown of Barnstable *Permit# St5,55 � h ` JUN 03 2015 Regulatory Services 6 W O F BARN ichardV.Scan,Interim Director Bi fflftg Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 rww town.bamstablEmi us Office: 508-862-4038 Fax:508 790-6230 EXPRE S PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wAotdRedX-PrmImpnnt Mai/parcel Number0 Property Address ., Q i �--- residential Value of Work s�3 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Ad_dress Contractor'sName Q Telephone Number Home Improvement Contractor License#(if applicable) /oZ 6 3 Email: Construction Supervisor's License#(if applicable) 1 0 6 0Z4, [ lworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance CompanyName 44,0Sgipf- Co ' Workman's Comp.Policy# W 1 Copy of Insurance Compliance Certificate must accompany each permit. ,cp Permit RiSpest(check box) �vDdf -7L \ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ffRe-roof(hurricane nailed)(not stripping. Going over existing layers of roo f) ❑ Re-side ❑ Replacement Windows/doors/sliders,.U-Value (maximum 35)#of windows #of doors: " ..:.❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. ''Whew rartmed: Lwaaaw of this permit does not exempt comphanmwith other town depa t ment regdations,i.e.Kwonc,Conservation,etc. ***Note: Property er wner Letter of Permission. A copy of H 11h2rpZove=mentontractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN D1Braldm9 Changes S ItESS.doo Revised 061313 , Office o um r Conser Affairs and Business Regulation ffll _ � 10 Park Plaza - u'Site 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - - Registration: 126893 = Type: Supplement Card THD AT HOME SERVICES, INC. _ Expiration: $1312016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE=300:- ATLANTA, CA 30339 Update Address and return card_IN-lark reason for change- -CA i " zora°sni i Address i=1 Renewal Employment rl Lost Card c-�/fze tGoa��n�wecc�d�C%liL�ca�ac�iuQe�, Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Office of Consumer Affairs and Business Regulation Registration-3=26$9 Type: I 10 Park Plaza-Suite 5170 Expirat!ogS��g 3f2846'O Supplement Card Boston,MA 02116 THD AT HOME SERMi IES NO THE HOME DEPOTaAT+10ME_S:ERVICES ANDREW SWEET 2690 CUMBERLAND RARi-M S g a'iM,GA 30339 Undersecretary No I with ut signature The Cotl►tntonweakk of Massachusetts Department of IndushWAccidents ' Oe of invesfiga&RS "0Waskhgtoia Street Bmtonj,MA 02111. mww mass govlditt Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aanficant Information Please Print Legibly Name(Business/Organiration/Individual): Nome, W,91M-e— Address: o 0 5-40 City/State/Zip: $ v 0/S`>'S, Phone#: So Are you an employer?Check the appropriate box: Type of.project(required): I.❑ 1 am a employer with. 449 am a-general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner.- listed on the attached sheet t 7. ❑: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 area corporation and its feq�,] 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. o workers comp. 152,§1(4),and we have no Y [No ' p c I2.�Roof repairs insurance required]r employecs..[No workers' • comp.insurance required.] 13.[]Other 'My applicant that checks box#i must also fill out the section below.shovving their workers'cognpensation policy womution. t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit'a new affidavit indicating such. ;Contractors that cbeek this box must attache an additional sheet showing the name of the subconit rs and their wooers'emV.policy idomnatim. I am an employer that is provld ft workers'.+eonWensadon insurance for my employers. Below is the polliy and fob site lnformadoiL Insurance Company Name: g-`P w Policy#or Self ins.Lic.#:_Vf(21 d y 3 Expiration Date:' 341 o�016 53 Job Site Address: I �C:fa'1 �l� City/State/Zip: WU 1 P 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 ag a violator. Be advised that a;copy of this statement may be forwarded to the Office of Investigations of the DIA cc coverage verification. I do hereby cert}y un paba and ry that the lnfoamadon providW.above eyard COMM i ture: D Phone#: (O 7�- Of`lci d use only. Do not write in thk area,to be completed by city or town offklat City or Torun:' Permit/License# Issuing Authority(circle one): 1.Lard of Health 2.Building Department 3.City/Town Clerk 4.,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit 1,Shrewsbury,MA 1545 Branch Name: Boston South Date:5/11/2015 Toll Free 8779033768;Fax 8009863610ME Lic#C 02439 RI Cont.Lic#16427 CT Lic#HIC.0565522 MA Home Improvement Branch No: 31 Contractor Reg.#126893 Federal ID# 75-2698460 Installation Address: 53 Hadrada Lane CENTERVILLE MA 02632 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M frank guzman (508)420-5731 Home Address: 53 Hadrada Lane CENTERVILLE MA 02632 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):frankguzma(-,comcast.net Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto and any Change Orders(collectively,"Contract"): Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount 8263533 Roofing 8263533 $13,419.00 Minimum 25% Deposit of Contract Amount Total Contract Amount $13,419.00 due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary The Payment Summary# 8263533 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 06/17114SA Page 1 of 7 i HOME.IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of sign.Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Contract is the entire agreement between Customer and The Home Depot with regard to the products and installation services and supersedes all prior discussions and agreements, either oral or written,relating to said products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. y You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Agreement.By contacting sales office (g77)903-376R ,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an emailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement Contract Submitted by: Accepted by: Sales Consultant Christopher G.Read Customer Signature: License Name. — — (877)903-3768 Customer Telephone No. Signature: �'A' I-# �Nk��1=►�1�3►3-fP ay �-1. 2015. 7:51 Sales Consultant License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT.THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE 06117114SA Page 7 of 7 ",:c%--.ptc:cl I.::•;: :;hri _tol;l r Rc--A ;Mal r ' '. N The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): To if n C a r 1 l-- Address: q q �j r t 4 lam St. 4-1-,�t �2 City/State/Zip: ta,-'m ou\ /yJ 023 8'L Phone#: 7 b/2 7 .. Are you an employer? Check the appropriate b ox: Type of project(required): i° ` 4. I am a general contractor and I 1.❑ I axe a employer with ❑ employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.[ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. Q Building addition, [No workers' comp.insurance comp.insurance. required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[ Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.E]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 contractor;must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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$250.00 a day against the violator. Be advised that a-copy of this statement may be forwarded to the"Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u der the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone Official use only. Do not.write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing In 6.Other Contact Person: Phone#: ? assac��asett�` D* rt.'rient bf.Public safety . s �--� Board cif Building Re u at flrts a ld S ar ciar s C olistructioll suns rN isor sjl.ccilfftt License: CSSL-106026 JOHN-CARTER 99 BMGHAM STREET;,EiPT 2� Whitman AU '02382 ./ +V..��/✓a.MY: t{ •EXpiY:wit ion / Commissioner 0.1108/201$. i 117 CAPE COD INSULATION IIt3q MTTS S[AMi[53 3PAATfOM1 SY$p[NO[q 4y..,.3 53 OYTifgS INSYIANON CSIUNOf Oni'� p � . 1-800-696-6611 i' a -f'own of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: / �— Dear Building Inspector Please accept this Affidavit as.documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village C 6 ?-A4 G(�12&� GA 6e-0! 11.E Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( Z� ) ( ) (. x) Slopes Floors Walls ( ( ) ( /g ) ( X) ( ) l O Sincerely He y E C sidy J , President . Cape Cod nsulation, Inc. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V� Application #C;)610 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address �3 Gall G- �l��► -e�-�� 01 A 0Z6 Zi Village m'; Owner fL Z b�Gt/ Address Telephone 50L �ZU 573 Permit Request K-: a/1 .a WL46V Z��C ` JQ h V5 AU je�d 464- v Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ' Oti Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su rting dc'.imE%tion. Dwelling Type: Single Family -91 Two Family ❑ Multi-Family (# units) o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's1-fi hway: 0-Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) rn Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name afw �f �/��i�s Telephone Number , ��/Z z44- Address License #�/Gx� Home Improvement Contractor# /��✓� �� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �• �Q Z 1 Z_ i FOR OFFICIAL USE ONLY r ' APPLICATION# DATE ISSUED 4 MAP/PARCEL NO. t ADDRESS VILLAGE OWNER ;4r �f ;i ` DATE OF INSPECTION: FOUNDATION z FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL TM PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r ? FINAL BUILDING f DATE CLOSED OUT �� ASSOCIATION PLAN NO. � � �• . ... sa f { 71C� -ctx C�(� �11fatYl?1C1 1�11 �� al� I'�• 10 Park Playa - Suite 5170 - Boston, Massachusetts 02116 y Home Improvement Contf'actor Registration Kr , Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC _ --- ............ ._ .. _ ._. HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 Update Address and return card. Mark reason for change. Address Renewal l_I Employment Lost Card PS-CAI b0M-04/04-G101216 ltfficc. of burner AIT B ue Re*ul11•ition License or registration valid for individu! :a. .•!, }% uheuJeCl6 before the expiration date. It'found re.tur►► to: HomE� pit�S� 10(f�`et A i Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 OD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. �� HYANNIS,MA 02601 Undersecretary t alid ith t si ture l3-At liuK[[S-dlepai'tntent of Public SafetN Boai d of Building Rc�,,ulations anti Stuntl:u tls Construction Supervisor License License: CS 100688 HENRY CASSIDY 8 SHED ROW WEST�-ARMOUTH, MA 02673 Expiration: 11/11/2013 ('uuuui,.i ncr Tr#; 7620 �. �vIL No. 1605 P. 1 Client#:4597 CCINSUL ACORD,,. CERTIFICATE OF UAEILITY INSURANCE r07/02/2012 E(MM100NYYYi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UP ON THE CERTIFICATE HOLDER.CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMFND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES S BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS'rn U"rE A CONTRACT BETWEEN THE issWNG INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPQRTANT:If the cerUflcate holder is an AbD1 I ONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION 13 WAIVED,subject to the terms and condltlons of the policy,certaln PollCles may reyuku an endor6emant.A statement on this certificate does not confer rights to(he Csrtlflcate holder in Iieo of such endorsemengs). PRODUCER Rogers&Gray Ins. -So. Dennis NAME: Mar aret Young PHONE 50t1-760-�4602 434 Route 134 A1C No Exl: A!C No: 6/7-816.2'I56 EMAIL South Dennis, MA 02660-1601 _ 508 398-7980 _IN8URERI0)AFFORDING COVERAGE NAIC 0 INSURERA 1 Peerless Insurance wsuREo J -- 18333 Cape Cod Insulation Inc INSURERB:Evanston Insurance Company ..,_ 455 Yarmouth Road INSURERC:Atlantic Charter Insurance �- Hyannis,MA 02601 INJURER D:Commerce Insurance Company 34754 INJURER E: INWRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BCLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFOrDE1) BY THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. IExXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS sHowN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TIA TYPE OF INSURANC1: ADDL SUER POLICY EFF POLICY ERR POLICY NQ616ER MMIDDNYYY MMIODNYYY LIMIYs A GENERAL LIABILITY C13PO263063 0410112012 04/011201 EACH OCCURRENCE %1 000000 X COMMERCIAL GENERAL LIABILITY pA�A DES ENTER.occurrence PfQEMI� ) g100 00D CLAIMS-MADE OCCUR .MEOEXP(Any onaoemon) $5000 PER80NAL&AOV INJURY 51,000,000 GENERALAGORGAT& sZ000r000 GEN'L AGGREGATE LIMIT APPLIC8 KR: - PRODUCTS.GOMPIOP AGG s2,000.000 POLICY n PRO- LOC 4 p AUTOMOBILE LIABILITY 12MMBCKVMK 4/01/2012 04101/201 EOM,°BINEDSINGLELIMIT 1 OOOOOO AIJY AUTO BODILY INJURY(Per-Per-_on) ALL OWNED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Pat ecoidebL) 5 X HIRED AUTOS X NON-OWNED PROPERTY DpM�Ap AUTOS $ B X UMdRI=LLA LIAR OCCUR XONJ453512 H41011201204/01/201 EACH OCCURRENCE $1 00O 000 EXCE$,LIAB CLAIMS-MADE AGGREGATE $1r000 OOO OEO X RETENTION 10000 WORKER,COMPENSATION $ AND EMPLOYERS'LIABILITY C WCA00525902 6130/2012 06/30/201 X WCSTATU. OTI1. E ANY PROPRIMrEPR4 rqR NE /''ECOTIyPa E,L,EACH ACCIDkN1' .1 00O 000 OFFICER/MEMBER E?(C�UO�� N NIA etltletory i0 NH)It E.L.DISEASE_EA E PLOYEE It Yee, - M $1000000 DESCRIPTION OF OPCRATIONS bnldw E.L.DISEASE,POLICY LIMIT $1 000-1-0-0 0- SESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Allaeh ACORD 101,Addhla—I R.mwItc tirhpaula,II More sPgCeJe regU1160) "Workers Comp Information " Included Qfflcers or Proprietors C.ertlfloate Holder is included as an additional insured undor General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,Inc SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROV1310N3. AUTHORIZED REPRESENTATIVE - ®190 -2010 ACORD CORPORATION.All rights rejerved. ACORD 25(2910/05) 1 of 1 The ACORD name and logo ar0 roglslarad marks of ACORD #58384Q/M83848 MFY I l he Comm 0111i;. :i'ih of Ma sachuse its, _ Department , industrial Accidents . -- — W Ofice i ltliiestigations _ w --/w 600 I gs/iington Street INII'l1 .(r :7..S.goVfdla Worker's c:t►ntl)c:tisatiorl 111Sttrmice Anti:;.,:A: kiuilders/Contra_(torsiElectricituis/.t'ltitiib t-S 1pi�liiunt Luft►r'trrat�c►n 1'lertse Prilit Legibly 1 N:uli: (Lil.tsiucsti/Ocatli� ttiprt/I.nCliviClutll): >c I Q , --- If6 pdd Wilk �C3c�._ f� ,.� � A,c yuU un culpluyerY Check the appropriate box: —_--- ,, `l'ype of project (re(tuircd): I.un a c tupli,yrr with 4, ❑ I am l ,, 11,1. 1 1cultractor and I have 6.. [] New ConsltucUoa _ -�� - tulliltiyres (full alld/or parr-time).* hired dic �lihr,omractors listed On T Fj Remodeling I the aua ` -� I:uu ;t 5olc latoprietur or partnership These sal, ,.-utt:tctors have 8. ❑ Demolition ud Itavc:. nt.r clnlrloyc es wurkin 1'or employe:., :r;.l.have workers' comp. 9. ❑ Bililcling addition hic in any capacity. (No workers' insuiaut c.j 10, L__.1 Electrical repairs or adiluiuos "mih 111,SMUItCe le.(luirecl.] S. We ale t, .,il u,Ition and its f I ofhcefs il.it,. Xc�rcised their right of 'I- ElPlumbing t�)airs or additions L_a I ;all a htoticowrier doing all work •-exem tort I' i MGL c. l52§ (4),and 12. Roof repairs ntyscll lNo wurkrts' comp. we hart w ,.nq loyees. (No workers' / 13., Ocher1`1�,>��1.�7f'I'I?LT�(Cl ni urulcc t't<luuCd.l w comp ui ur:ur.; reC)llll'eCl.] w.y,ph aut that checks laox ill roust also fill out the section below showu,,-the it workers'compensation policy information. i 1,m:a wuc,s wiu;,ulnnit this affidavit indicating they arc doing all wo,l..-„1 if.,n hire outside conu'tictot'$must Subi-nit a now aftidavit'indicatiug such. it 011t;w4a,that check this box must attiich an additional sheet showing ih. w:;,,of the sub-contractors and state whether or not those entities have etnplo.w.e; 11 cunliuctois have employees, they roust provide their workers'couy, ,d, cumber, I run an employer that is t„'ovidiiig,ivorkers'compensation m w"inee for my employees.Below is 1l1eyolicy aril job site' inlurrrutliwn. , lu;ur<uuz Company Name: �^ /�/n Policv it fir Sell-irts. 1..ic. it: ��t lJ l-� 7��? Expiration hate: 5� U �l lob>IlC r"\dtllCs>' J �� n_f<� l/`T.— City/State/Zip: ` ---- :\each a copy of the Workers' compensation policy deelaration pagk-kl,nwing the policy number and expiration(late). fAmc Io weal(covcrttoc its re(luirccf undo Section 25A of MGL c. I S'-n lead to[Ile iulpositiun of climi«nl penalties'of a fiur up to$1,500.00 and/vi 01u ;tar lulpllsunrnr,nt, as well as civil penalties in the form of it STUI'1i t rKh ORDER and a fine of up to$250.00 it day against life violator, lit itdvise(l h.a.;'upy ul'dus stutcrncltt tna e forwarded to the-office of Llvesu,,.u:,, :;ul the D1A for itlsuratice covr;lube vetifiGation. _ t du here c t if tcncter the �ius and penalties ofperyt v that the information p vided above is true cla-7d correct. � �iC �26i ZQ� Da[e: lfpiciril use wily. Do not write in this area, to be completed l)r rirr or lowtt official City of-Toms: Ptrmit/License f# ISSUIIIb Atlttiol-ity. (l:rl'('le Ulte): + 1.hoartd of Health 2. Builtling Department 3.Cih'/l ooif Clerk 4.Electrical luspeaor S.Pltimbilig l )speaor • , - 1. . _ , t Contact l'rrsun: Phone#: ' L Y ' I 3 d OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) C2h erYI'/)� 141 z632 (PropertyAddress)' C:hereby authorize _ a (Subcontract r) ry an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on prope y. \ Ow ees Signatures Date `' a sand lot n er .. ./....?.�.•••r. .. ' .. l� \' �c l��0 r 73 SEPTIC SYSTBA: Mtk:3T BE INSTALLED IN CGS-U`LIAN Sewage Permit number /....... ........ .... 4 . WITH ANTI vLE I i STATE CE s.:. .... ..... ..... - SANITARY COID� Al.11D TOWN y10F THE r0�y TOWN , OF, B A R N 5 .I E - .,, � INSPECTOR R:U (�L""DING - i APPLICATION:FOR PERMIT TO � 1 '✓ ... -. 4A �p .... TYPE OF CONSTRUCTION ...........t. . ........ ................. ....................... ....... . P_, TO THE INSPECTOR OF BUILDINGS: The undersigned .her by applies for a permit cording to the ollowing info�tion: 01 I Z7 Location ............................ ....................... ............................. . Proposed Use ....... . 1:-'... .. .... ................. ZoningDistrict .............................................Fire District ...... ...... . . .:.... ., .......................... . Name of Owner ��:E !••••••••.Address .. /� . . T (. Nameof Builder ..............�./...........................�.�.................Address .................................... ...................t........J................. Name of Architect Address / ' �� ............. .. Number of Rooms . .......................Foundation Exterior .......... . ...........z..............:........................Roofing ..... ... ... ..:........................................ ' ....Interior .......... .............. ....��'��............................. Floors .............��,,��. . .. .................... ....................... Heating .... .lk...... . . ................... .....Plumbing :.Z........................ Fireplace ................../...........................................................Approximate Cost ................................:.........................I.......... Definitive Plan Approved by Planning Board - 19 / Area ....../L?.. -4e,.[..'-.... Diagram of Lot and Building with Dimensions Fee .....�7.�.:�................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ab e construction. Name . .. .. . ..... Capewide Development �LL 18CI97 one story, ................. Permit for .................................... single family dwelling ....................................................................... Lane La Location .....................HaArada ...................... Centerville i ..................................................................:........... ........................................ Capewide Development...............Owner ........... Type of Construction ............f.r.ame .......................... t .............. ................................................................ low, Plot ............................ Lot �V....................... Pe6ember :LO 75 Permit Granted .........................................0 Date of Inspection ..... . Date Completed' ...'.�19 PERMIT REFUSED AA �11 9 ooA ........................................................ ................. oell ................................................................... .......................... .................................................... ..................................................... ......................... Approved ................................................ .19 ........................................................... ....... ............ ................. ........ ...................... 14 ^/ �t � , i �,. r a:t• t`'xf �`F, r{c s��+*a ^*''��.,'+ w+.t 41 Ih "rt t 'Z, s API 2 � r r _ �./w *., ; •y; `�f� a r� 4 ��*td�f,;}� ��Y�� .'�'� o - { It fi4x, :a. f• f QA y..' r N Sod .0, VF� x �.w � +\ 14 ,dry q `�w.• � �F i 41�4' �i,_ � Q .. (N��O�,F C.�.l �.EZ�.�'Oe.>iV/ �. �,: , .. V � QQ..1 � 1M6' •e�'p��r n� �sk�"s }� tq ��. _ .. p N o iN ��. ��E�L/.vim t�; 4 ' '• ,_ ,�`.�`� -� � � � '� � a P ` ' t � •r ',t � '.fir§ � � 'i� w� Y � 't'.L e• '1 Lwrr► y44 l4 All t t a 14 +' z��. .®Gs�3.0 .CF®®siL Z8/9 /o✓7" W/ttoi/ 0��d �iVl�✓E��' J/�9 /� 3 F eA � 7Z. f ,✓BC�Y ee��T/FY �fd�T T�✓� �v/�.D/r�/�' ~�'j � . �,� Tr+-✓/. G�L's�M /S LOGr�iT�Z� OA/ YN& r a. ;d ! .4/a ^9.S rM®WA/ "ea@OsV A.4/a 7AVo97' /7 NWI(+(� � # cO.v,G-oACA. f 7 o rN.� .Z'O.4///L/Gr ��1� OF �9a `' d VWS 0,0 TA✓E 70WiL/ OF c /9.�'�1T�QBL.6 b r� t(f 'T'f; I { ' s OJALA ;�' ♦�'S��iF � G'>�//L . E.t/G/6E0�'S - -. .. ' 'K +` t-�+� � � =Ar� Ea ��,.®,�.,ky t�= . ry FA 'x t Ht 4.0 of lio Roo .G " .• �� r� dp r s � �.•#�4 t 1� Nj•,3 0 �` ®�D. ,� - N O i"c�+J�'/9�� .�1�[�GL/,v�y ., `Qa� •Y.,:t� s k'� �� '"{xti y�Q ic YO i i.• � s� •; f �a k � �k�u r ` r Y,�.;. �� —+�+e-•--�-.�-�... _ ^""a s�. a _ j AFT tS 3 t �t �— e x.0��'/4�/C�o�/. :.G'ER.17E�✓/L L� , /✓!.�SS. � a > e .a�r's, fa . 4-�cP 77 2 7 2 e/' Fes/T b1//T/d /' O� 3h/t� c T®Af �o' Ril ��/�N/.4/ OA✓ i•'J eAS All-IQ AV /S 4 OC�7'E D OA✓ TJ4/E fi .i/P A ."d? WHO Wa/ h✓P,0490a/ J*A,O 7-A'oQr /T �"'' COetJFO�Ai1 TO T4.1,E- .—C7A/<A./Cr y� �afa Iiv GOa/�TBC T�M. /,� JC his, �' 9 _ � �` � �L�.i��1.3 �p' ' ,,r. •a +'� �. y��pd , • ` ��A✓a sei�V6 Boas ,.. /�/,//ZS/.7Jr` u '� ' e� 5,� ` � �� 4 �'®6 TE Co14^'YX3C�'MOG/TL-/, /d�JASS. i DJ19TE AL�" at y �t Ca P � 2,4ssessol,s map, and lot -number ...../W '2 ............ ......... ............. Sewage Permit number .................. ..................................... *TNE TOWN OF. BARNSTABLE A STAILE, BUILDING INSPECTOR 0 M APPLICATION FOR PERMIT TO .... .............................................................................. ............................... ......... TYPE OF CONSTRUCTION ............................................... ......................................................... ... ....................... ................................................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:111-41. Location ............. ..................... ........................................................ ProposedUse .............. ....... ........ ........................................................................................................ Zoning District .....................Fire District ................................................. ................................................................... ....................... ....... Name of Owner ... .....�!�Aciclress ........................ Nameof Builder ................Address .................................................................................... W ?/ Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ... ................................................ Exierior ...........0.,,-rSA-�....... ................................Roofing ........................... ........................................................ ....................................... Floors .............. ..................Interior ..........A........... .............................. Heating ...... ..................;ow...................;....................................Plumbing .................................................................................. 'z_<9 0-0-0— Fireplace ..................../...........................................................Approximate Cost ....................../............................................ 7— 0 Definitive Plan Approved by Planning Board --------------—--—-----3_1 9 Z� Area ............................... Diagram of Lot and Building with. Dimensions Fee ...... ..........Z —................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding construction. Name .......... ........................................................... Capewlda Development A=148-107 � 18097 ' one story, ' .. fbr '-*44�igle family dwelling - . --..�—.------~--.--.---------. . ' ' / � J�Badrada Lane v/ ^~^~^`^' ==`------------------''' Centerville ' —.-------,-----.------------ . . ^ Capew1da Development ' ' ` Owner --------_______..______. ' . ~ � Type of Construction f^ . . . . ' . ` ' ` . .~ ^.. . \ . ` p�,mn Granted ^ y ' . ' . ~~'~ of Inspection^ � � ` "°= C" "p`"=~ ' K �^ � \ .' PERMIT . ' � ' ` . . � ' .................... . . . ' ..................................... ........................................ . i ' "�� . � ..---- . --. . ` ' ................. ' ) � lg ' � Approved ------_______.__.. � �~, ^. -----------------..»�----~-- . . . . -------'— ' ---------^^'~—' ' ^r ' [ �- TOWN,OF BARNSTABLE BUILDING PERMIT APPLICATIONf Map / V� Parcel Permit# a Health Division Date Issued Conservation Division t Fee Tax Collector Treasurer , Planning Dept. Date Definitive Plan Approved by Planning Board - Historic OKH Preservation/Hyannis Project Street Address Village Cex�ICEW L�` Owner !3� bti Address Telephone (��'C�� s Permit Requesk C \ �GC;�Rv1 fir_ OCl�e^ &F1\1g a=a`cLQ Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Q Zoning District Flood Plain Groundwater Overlay 'Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family .Two Family ❑ Multi-Family(#units) Age of Existing Structure `X!3—\nS Historic House: ❑Yes O'No On Old King's Highway: ❑Yes O'No Basement Type: C1'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 C21S Central Air: ❑Yes , Ci No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ®'No Detached garage:❑existing ❑new size Pool:O existing 0 new size Barn:❑existing ❑new size Attached garage:Ofexisting ❑new size Shed:❑existingr ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes ❑No If yes,site plan review# Current Use r_A_UtAP_LAA r Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ->LL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 04,71 SIGNATUR _ ��S, DAT 4 ' - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t� MAP/PARCEL NO. ` ADDRESS - VILLAGE f } OWNER DATE OF INSPECTION: FOUNDATION FRAME 4 _ INSULATION _ ,K • ;• . �. -, `! ' ` �� -` _.. _' FIREPLACE r ELECTRICAL: ROUGH FINAL r ' PLUMBING: ROUGH FINAL - + ' GAS: r ROUGH FINAL FINAL BUILDING t r r DATE CLOSED OUT Iti ASSOCIATIOINPLAN;NO. , 'ME t The Town of Barnstable Department of Health Safety and Environmental Services 9r:msrA zs,� Building Division ATEc 59. 367 Main Street, Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Check One: Shed Deck e-roofing* E]Sidewalling* Pool FOR L APPLICATIONS: [gompleted Building Permit Application Approval/sign-off from: H' ric Co io - Old King's Highway Historic District(North of Route 6) Hyannis Main St. Waterfront Historic District(see map for boundaries) Historic Preservation(if applicable) e a II pt r oofmng/re-roo�flng_(4thfl. (3rd wn Hall-8:30-9:30& 1:00-2:00 pm) o ery om ept sidewa Town Hall 8:30-9:30& 1:00-2:00pm) Tax Collector(1st floor-Town Hall) FIT r Surer(3rd floor-School Administration Building) omeowner License Exemption Form (if homeowner is acting as general contractorlbuilder for project). Worker's Compensation Insurance Affidavit must be submitted. - []Home Improvement Contractor Affidavit must be submitted(residential only). op a Contr se n i Permit fee. SHEDS/DECKS : Plot Plan or mortgage survey required to verify zoning compliance. Placement of proposed structure must be sketched in and the distance from property lines indicated. The location of the septic system should also be shown. Two (2) sets of plans (8 1/2" x 11" or 8 1/2" x 14) showing cross section and framing schedule. Prefab sheds require factory brochures & specifications. Prefab sheds require a copy of the Home Improvement Specialist's License unless the homeowner is applying for the permit in their own name. ROOFS: �# of squares of shingles or sq. footage of roof. Specify if going over old roof or stripping. If going over, how many roof layers exist? What size are the rafters? What is the span? LS(over 250 sq. ft. require a building permit) Plot Plan or mortgage survey showing the proposed location of pool and the distance from property lines. Plans must also show location of backwash pits if applicable. Basic construction drawings indicating materials to be used or factory brochures and specifications are required. Notes: Residential pools require a minimum 4' high, noel-climbable fence with a self-closing/self-latching gate. Home Improvement Contractor Affidavit must be submitted for an in-ground pool. No license if needed for an above-ground pool. q:forms:permapp2 Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 ` Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building.be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: > Estimated Co U ou Address of Work: Owner's Name: V--- Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Contractor Name Registration No. OR Ali ate Owner's Name • s g1ornu:Affidav I , : _Z Department of Intharrial Accidents 600 Washington Street Boston,Mass. 02111 " Workers' Compensation Insurance //��/idavit /////L%///a/i///!///�////gym/iiilO///i//i// / / �� j�ji%Y.fE ////// :'r• •••• tlt$//////////��//.%/ ��i !i �� nic�ns�rrrlat�raut�tr. ////��/ name: location: city V,�� phone# — I am a homeowner performing all work myself. ❑ I am a sole =actor and have no one workin in aav ca achy �ii/�i//iraia/.��.�/�/i�/�///�///iioiiii/�iia�i/iiaia/�/ii/�/�,a/�/� ❑ I am an employer providing workers' compensation for tor►employees working on this job. comnnnv name: address: :.:..:.....:.,.:.:. city phone#: insurance co. oiicv# r ❑ I am a sole proprietor, generai contractor, or homeowner(circle one)and have hired the contractors Iisted below who have , the following workers' compensation polices: comoanv name, address: ; .xiar. . . » city: .. ... . .. ."' .......... •�.::ti:••�•.:w•..w, ;;�.: :. ohone#. :.. ......:.... .:::..;.; . .. :"i• •.Y jy:v+�Y�•.f•';:i:4C0bJ:•,ir•S:S..:i insurnnce cn. camnanv name: :...,:.: address• cit%- phone#� : . ....:... ......... irtsaran ce co. :..:.: .. :.:::....:. .:::::..:.<�. oliev# :.,. <.,...:.:.....::;....;.:M>:k•:<<:;,.:.,.,M o....... :.. .:: ..... ......... Failure to secure coverage as required under Section ZSA of MGL i52 can lead to dw imposition of criminal pmWdm of a Anne up to st.soo.00 and/or one vears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aft*of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do errhy ce under the pains and penalties of pei jm y that the information provided above is true and correct y =e t name oiIIdal use only do not mite in this area to be completed by city or town otIIdal city or-town: Teradimcense# riBuilding Department ❑Licensing Board ❑check if hMediate response is required ❑Selectmen's Otnce ❑Health Department contact person: phone#: ❑Other�_� Uemm 9,95 P1Al Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the. employees. As quoted from the "law", an employee is defined as every person in the service of another under any'conzs.�- of hire, express or implied, oral or written. An employer is defined as an individuaL partnership, association, corporation or other legal entity, or anv two or more o: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.—..Ye trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house or another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds c. building appurtenant thereto shall not because of such employment be deemed to be an employer. .- MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewL 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 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 con rac= authority. , 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 along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insaraance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you .are required to obtain a workers' compensation policy,please caU the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the botUam 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 is the peimiuEcense mumber which will be used as a refamace n t aber. The affidavits may be rc=fied io the Department by main or FAX unless other anangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any qucs ions. 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 Once of ImrestloatlORB 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Building juivision A ' 367 Main Street,Hyannis MA 02601 teas �639• Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: � Q �`e number street village "HOMEOWNER": C. %3E -cZ � L\71F6'C(._)_(A_ name home phoneC# work phone# CURRENT MAILING ADDRESS: ( e,�c�� CnQ 1ti,e ,u&11S1., a 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 su e�rvisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such ' "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mi ' um inspection procedures and requirements and that he/she will comply with said procedures and uir ents. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMSIX MPT a 9, k 1 r January 25, 1983 Mrs..-Kathleen,Jenkins - r"'S3 H drada Lane t v Ile" Dear Mrs, Jenkins: I respectfully request that you contact my office and snake arrangements to discuss some concerns regarding your residence, Peace, Joseph D DaLuz Building Corrtnissioner JDD/gr . - - 531��n I , I � I ; I ! � i i {I � ! ! � I I I � � � � �. 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