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Sr '� ;lt#,�, ''c 'S � :;�: W f Y/'. ,A" Yt.{{a•� ' S w.. ;S.,i Y''t.,.� ( 1 •t?':r a FL 7 Y ,5�; .� k �, .:�£fr¢jrd ,�,; •d"h° +'•1} ,%a'.?�. a.�Jj}�� 1,}� ,#:} �fi ,�!- � �fY., ,oy z. 7 Town of Barnstable *Permit# Expires 6 months rom issue date �7 Regulatory Services Fee BA msrist$ Richard V. Scali,IDirector 0pppo llEfta tom ► Building Division Tom Perry,CBO,Building Commissioner NOV 13 2015 200 Main Street,Hyannis,MA 02601 TOWN,OF BARNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1-13 ® t 0(5 Property Address a'YiJ>t 0 Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � ( � Contractor's Name % Telephone Number. Home Improvement Contractor License#(if applicable) , `ts�s/ Email:. '7 Construction Supervisor's License#(if applicable) t g 3 n/workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 1 t M+ Workman's Comp.Policy# Dp t �j ?5'6 1 °. Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ e-side [I Replacement Windows/doors/sliders.U-Value �:�7 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property, wne ust sign Property Owner Letter of Permission. A cop of t H me Improvement Contractors License&Construction Supervisors License is r d. , SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc ' Revised 040215 y , i fL 7Tze Comiltollivealth of Vassadiuse tts Depaartar a ntoflivdwftialAccidents - O, -ce o,f Irrixestigadons b4U Washington Street y.. Boston,MA 02111 imsntv.mas&govrdia Workers' Compensation Insurance Affidavit: Bu ldersICantradurs/EIectr ians/Plumbers Applicant InfGrmatkn Lei/ Please Print W Name(Bus®em1Drganizatioallndiviz}tins} 1)TE_ rl�,or•i.¢S City/States ip: lb�ttiit�Cr.� oW3 2 Ph 328 i �3 AFam u"an employer?Check the appropriate box: Type of project(required): 1. a employer with 3 4 ❑I am a general contractor and I ta_ ❑New construction employees(full andlor part-time),* _ have]sired the sub-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling s and have noemployees. These sub-contractors have � 8_ ❑Demolition working for me in any capacity. employees and have wodmrs' [Nosvoriners'camp.,"*�s, „re comp. nsurart 1 9. ❑Building addition.required] 5- ❑ We are a corporation and its i 0'❑Eh�ctricai repairs or additions officers have exercised their 3.❑ I am a hameoumer doing all work I1_[]Plumbing repairs or additions self [No workers'czmp. right:of exemption per MGL 17.❑ afrepairs insurance required-]i C.152, §1(4),and we have no employees-[Noworkem' 13: Cther [,Lf �tvru,5 comp.insurance required.) •AMy VPHCatl2&at checks box 4F1 mnst also fill out the sectionbelow shavring they workers'compensarinapolicg in:fnrnffition. #I3ameovunerS Wbo Submit ibis afiidaeft uuffcxtmg they are 3aiag 81l W90�and then 3ni m autade CantrBCtnr5 nIIISt submit anew off davit inriicati�sacb f 00n actors that check ibis boa must attached au additional sheet show#g the-of the sub-comtrzct rs_and state whether or not ftse entities hzve e=ptoyees.lithe sub-tantactorshave employees,theyzorstgmt.-ide their workers'comp.paltry number I am atz ernpIap¢r fferrtfs pra�ading rvark¢ts'catrrperesrrl�art irtsairartce far a9r}*¢nrplgf es Be1oov is tliepv cy ruzd job rrte i►fvrnzadon Insurance Company N": M r c Policy,4*-or Self-ins_Lic.* de>o 1 W15,01 Expiration Date: Job Site A,ddress:_ 6/4 e-E P^-f 40,a Citylstawzip: OZG'3 Z— Attach a copy of the workers'compensationpolicy 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 S1,50a 00 an1for one-year imprisonmeuk aas well as ci%ml penalties.in the form of a STUP WORK ORDER and a fine of up to 0-00 a day against the violator. Be adtdsed that a copy of this statement may.be fo warded to the Office of ' Investigations of the DIE4 insurance coverage verification_ I rIa hereby Cerfzjy u er th rs and penahties afpnj'Wy that the mforenadorr pt-m &4 aboi and correct Si2rraature: Date: Phone;k 3z-s / G 3:c Ojjaeiai uc a drily. Da not avrfte in is area,to be cornpW d by city artown offidaL City or Toum: Permitff icense# Issuing Authority(circle one.): 1.Board of HeaItb 2.BurTtfiug Department 3.Cityffown Clerk d.Electrical Inspector S.Plumbmg Inspector 6.Other Contact Person: Phone#: ' Information and Instructions Massachusetts General Laws chapinr 152 requ res all employers to provide workers'compensation for their employees. pmM=tto this statute,an.ewplayee is defined as."-.every person in the service of another render any contract of hire, J express or implied,oral or wntm.." . An mTkyer is defined as"an mdividnal,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint a and including the legal representatives of a deceased employer,or the J receiver or trustee of an individual,partnership,associafion or other Iegal 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 - dwejjing house of ano$rer who employs persons to do maintenance,contraction or repair work on such dwelling house or on the grormds or building appurtenant thereto shall not because of such employment be 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,MCM chapter 152, §25C(7)states"Neither the commonwealth nor my ofits political subdivisions shall mtez MtD any contract for the perfaimance ofpublic work until acceptab15 evidence of compliance-with the incn,EMce.. requiremcnts of this chapter have been presented to the contracting arrthozityf ApPHcants Please fill out the workers'compensation affidavit completely,by checking me boxes that apply to your situation and,if necessary,supply sub-coniractor(s)name(s), addresses)and phone number(s) along with their cerfificate(s)of sins nmance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cairy workers' compensation insurance. If an L LC or LLP does have employees, a policy is required. Be advised that this aflidayit may be submitted to the Department of Industrial Accidents for confamalion of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Departmeat.of hjdL1 ft-1?J AccidMtS. Should you have any questions regarding the law or if you are regoaed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-m m*7ance license number an the appropriate Ime. City or Town Officials t - Ple-ase be sort that the affidavit is complete and priated legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event tare Office of Investigations has to contact you regarding the applicant ffi Please be sure to fill in the permit/licrose mnnber which will be used as a reference number. In.addition,an.applicant that must submit multiple penitllicesns5 applications m any given year,need only sabmit one affidavit indicating current olicy inforn ation.(if necessary)and wader"Job Site_Address"the applicant should write"all locations in (city or town)-"A copy of tilt-affidavit that has been.officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fuiire 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 any business or commercial Pent n-e (Le. a dog license or permit to bum leaves etc.)said person is NOT regrred to complete this affidavit. The Office of Investigations would at to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Depa tnenfs'address,telephone and fax number. 'mac Capon tar of Masmchusf_-tts . Depa2imenfi c}f 1rid�ial A�ont.� Office of Twesi?gaiio= Bwtou�MA 02111 T6L 4 617 727-4900 cot 4-06 ar 1-977-MASS4FF Fax 9 617--727-774 Revised 4-24-07 _m gQgjdia 9LOZ/£L/Vo Jauolsslwwoo uoilejldx3 \ VW TI'HAHUN*J-:* W MOa 11 LON 660 OMZ V AOXI §* ` '£L666o-1S 3 :asuawl "4IU1:)adS joswadnS uogan jsuoj spJepue1S Pue suol;eln6aH 6uiplinfjo pie08 Ala;eS oll9nd 10 Wawpedaa- sj49sn4oLsseytj - �e�par�vrnoaacuealCli a�C%liGaQdac�2c�e%Cis � �, ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ? e istration: 9 145954 Type: Office of Consumer Affairs and Business Regulation. > xpiration ---- A 201.7 Private Corporatio.� 10 Park Plaza-Suite 5170 1= Boston,MA 02116 DOYLE+THOMAS CONST INCH TROY THOMAS 499 NOTTINGHAM DR I I .�.c CENTERVILLE,MA 02632 ..- Undersecretary Not v id wi out signature "' . M f DATE(MM/DDIYYYY) AC40RD0 CERTIFICATE OF,LIABILITY INSURANCE `� 08/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Debbie Mark Sylvia Insurance Agency,LLC PHONE FAX 404 Main Street Arc No Ext: 508 957-2125 A/c No): 508 957-2781 Centerville,MA 02632 ADDRESS:mark@marksylviainsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Farm Family Casualty Insurance INSURED INSURER B: D&T Construction,Inc. PO Box 168 INSURERC: Centerville,MA 02632-0168 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLIC POLICY EXP LTR IN SD POLICY NUMBER MM/DDY EFF (MMIDDrrrM LIMITS A X COMMERCIAL GENERAL LIABILITY 2001XO485 7/21/2015 7/21/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO PREMISES(Ea occu RENTED ) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ElLOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $. A WORKERS COMPENSATION 2001 WT501 7/25/2015 7/25/2016 SPER TATUTE OR Y❑ H AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required). Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. Carpentry The workers compensation does not provide coverage for Troy A Thomas and Shawn M Doyle. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -8 Marvin Ultimate Glider windows to be installed (As specked with Vin Marino from Marvin) -1 Marvin Sliding Patio Door to be installed (As specked with Vin Marino from Marvin) -Azek PVC trim to be installed on exterior& primed pine trim ready for paint on interior as discussed -5 Yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$10,000.00 of estimate is due. Further payments under this contract are as follows: $10,000.00 @ start and remainder at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner �� �c� Contractor TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MO Parcel G ` L©f G ' Permit# K',, s p e Health Division e fis - �,�► �� �� Date Issued L 2 4 L 3 Conservation Divisiori s -51 ic�e?"R?tlll r A Smo ('C�+9AI Application Fee by VeR ur ea Tax Collector Permit Fee rod Treasurer s SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board EWRONMENTAL COOE'AM Historic-OKH Preservation/Hyannis TOWN REGULA7.IONS Project Street Address .., le ��L � ► �e/✓i /1e yy�u, p� G. Village Owner L Address�u Telephone O - UD Permit Request 6e uz n cue c!G - rLaG�� ���- rn oT,d ri'nT _ Square feet: 1 st floor: existing SG proposed_� 2nd floor: existing Gd proposed�� Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation /�. D`0_0) Construction Type Lk,,,M-cG ��+' i1 - CY��L- 0C, Lot Siz _r e` Dc�'e- Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure i !ZkaIS Historic House: O Yes �(No On Old King's Highway: O Yes l No Basement Type: EfFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing off- new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new First Floor Room Count a -yo u- Gdv nT L� ✓/aLs�i ily ro o� Gip r-Go171-5 av t- Heat Type and Fuel: 0 Gas C&il O Electric ❑Other Central Air: ❑Yes 1 o Fireplaces: Existing Z New Existing wood/coal stove: AYes 0 No Detached garageXexisting ❑new size Pool: ❑existing 0 new size Barn:O existing ❑new size Attached garage:❑existing Cl new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes XNO If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address k d • �o K / 33-3 License# �• -1-/ `n— ✓�� D g Home Improvement Contractor# /Jroc�vC,)C-, 0 -5- • r t Workers Compensation# ALL CONSTRUCTION DEBRI RESULTING FROM THIS PROJECT WILL BETAKEN TOli SIGNATURFr, DATE • G f FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED " t MAP/PARCEL NO: ADDRESS_ VILLAGE OWNER rJ DATE OF INSPECTION: s FOUNDATION , 'r ` - 0 3 j t 1 FRAME INSULATION ! FIREPLACE.. r ELECTRICAL "ROUGH FINAL + PLUMBING: ROUGH FINAL 1 ` GAS: ROUGYH t x • `: FINAL t FINAL BUILDING I 6 Az DATE CLOSED OUT ASSOCIATION PLAN NO.. . • ; - O Jun 24 03 02: 27p p. 1 Coastal Construction &Remodeling ~ Tom Kane #080462 . PO Box 1333 West Chatham,Ma. 02669 Jack Fitzgerald 508-862-4035 Fax: 508- 790-6230 June 24,2003 Dear Jack, Please find the drawing of the deck to be installed at 6 Hyde Park,Centerville. The property owner is,Karen Mercer. The deck will be 9.5 x 18.5 Ledger board will be PT 2x10 which will be lag bolted to the building " The joists will be PT 2 x 8 16"OC supported by'Simpson joist hangers The supporting beam will be 2 PT 2 x 8's The supporting beam will be 7.5 ft from the ledger board The beam will be supported by 4 x 4 PT posts with Simpson post ends on cement footings which will be poured into 10"sonotubes. Decking will be 5/4 x 6 PT The railings will be constructed of 4 x 4 posts;2 x 4 bottom rail-, 5/4 top rail;with 2 x 2 ballisters 5"OC. There will be a staircase with 5 stairs. Stringer;will be constructed from 2 x 12 PT material. Stair tread and risers will be made of 5/4 x 6 PT Handrails will be at 34" 1 hope this is enough information to satisfy,your needs. Best regards, Tom Kane ej,k, °o IL Ck -_ -� clu N � ' Sf U X i��' V\-,\L.�.. f The Commonwealth of Massachusetts Department of Industrial Accidents -— - - Office 01/11ruffooffoas •600 Washington Street Boston,Mass. 02111 Workers Com ensation Insurance Affidavit Damp.* '�6crt-0' ,, location -L,U /��d G � �-i1. �o a 0/ 11 - city �evJ e- G 3 vhone ❑ I am a homeowner performing all work myself. ❑ I am a sole DroDnetor and have no one workan in ca acity ravidin an em to er ........... oil .# insttrunCe co... i ❑ I am a sole proprietor,general contractor, 7ec/circle one)and have hired the contractors listed below who have - ' o ensation olices: e followm workers mP P :::::::.::.;.>:.;:.:;.::.;:.;::.:;;.;:.:«<>::;: . ::::::::::...::::::::::::::.::::.:.:::::.. �e co my anv ram ......: ..... ............:.::.:..::... . .. ..:.i::s 4v..i:.iv.i.::i.:•.:v.:.:..:.:s..}.'..i..•i..i...:i..:.:v...:.:.: .•:.::.:•.::.:•i.....i:.::.::•i::.s::J..v..:..:i..iw..•i....:•.i...s.v.:.:.:.....:::•......:.w.. :•..i........ ...................::.:.:..i....i...........::..::.;.:...:.::i:::..;.{..:...:..:.C..:..i....::.:..:..:.}.:..}::.•:.i.:..::.•.i:..::.:.:.v.:.ti.:•.:.:.::.<...j:.:.ji} i i i� ...;.:..;.ip..i..:: b.'..:.<.y.•.::.: ne ............. i•0. ...... � ' . v : : : Y ...: : ::::.::..:::.::.:::::::.:::y::+::;:,;;::::i.::y;::•;•:r'::+ .. .......:...... .............................::.:..:::::::: :::::::::. :,. ::. t::: ;;:.;;;:.: ::> ::;::;::i::i:::::>;:a:.;::.:.;:;;;:;::;:::;:.;;;:<.::. ram :.......:......::....:.....:..............•.................. address wx ea ....:.:::.::::..:.::...::... ............................... .:................. .....::.:..::..::.:::::::.:..:::.:'..;::.;;:.:. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sue np 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$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify wider the pains and penalties of perjury that the information provided above is tt ru-o and correct Si tore Date Print name Phone# � offidal use only do not write in this area to be completed by city or town official permit/license# ❑Bunding Department city or town: ❑Licensing Board ❑Selectmen's Office ❑dreckif immediate response is required (3Health Department contact person: phone#; _ ❑Other UeYiW 9195 PJA) r- Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer 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 repreidiitatives of a deceased.employer, or the receiver or trustee of an individual,partnership, association or other.legal entity, employing employees: However the,owaer of a dwelling house having not more than three apartments and who resides therein,or the occupant of the-dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 incnrance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation 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 insurance 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 call 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 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Oiflce of investigations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 I °FINE r° Town of Barnstable ti Regulatory Services * saaxsrns . ' Thomas F.Geiler,Director 9`�AIE �a` Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date q 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: �� lJ�/i�L c✓ c i'L Estimated Cost Address of Work: ��/��Cu r%L C'2�,/�r✓��//e ,'j'i� l/d—� 3 �— Owner's Name: f2 Z_ Date of Application: I�Zl P_ G 3 e I hereby certify that: Registration is not required for the following reason(s):' 3 ❑Work excluded by law ❑Job Under$1,000 []B pilding not owner-occupied P wner 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: Date Contractor Name Registration No. R Date Owner's Name O:forms:homeaffidav The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division C . Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1.� 3 JOB LOCATION: 1 number street village "HOMEOWNER': name home phone# work phone# CURRENTMA=GADDRESS: city/town state zip code r The current exemption for"homeowners"was extended to include owner-occUied 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 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 B arnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements._ ' Sign 7 e o omeawner 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-Sup ervisor. The homeowner acting as Supervisor is ultimately responsible. Tn a itrP tHO tha hnmenwner is fully aware of his/her responsibilities,many communities require,as part of the permit . cton property: OaI4 149,gs 00� t 2 srory porch # 6 dwe1/1 acck o � C,71r&-a 2 7,'545 t=ST Ot"J N ,Ea�ay_5 _4 /� N ref. l 1281/132 Mood,ratt¢�: 250 001 001.5C Mood zon % C �,tM of e� +o �o s hereby W r6 tmt tw mortgage inspects"on was-Mpared for PAUL T. T Wi�nv��11�yV1vr,�C. avidirstCitiz��ts�ederal GROVER H No 1311 'J 1 le 4XIl tYLg 5hmm M em do o5 m o t-r f ad. im a sp", ca ` E v& �n/ T E �a �O h � =tT with am effective daze o f 8-j9-85 and The localt'on; o� l Su14 the dwelling does confmu rCo fh e local Boning 6y-laws im of f eet . wt the tune oFconstmct%on wit�t, mpec t to hor«ontccl dime"((la _ �- 5¢ bG6C12 1'pq_tLIi'C111entS or 1$ eVen 3r4-ro 1, vAatt6ti aj�o_rce Y1�Cl�"' Scale: 1" 50 - 6ZCtLom .Linder MASS. Geturat -Laws Date: 1__i I_0 O----- 4o -Secttort� 7. File No. O 0 -0002J PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary .for a precise if any exist. either wa}' across property fines. This plan must not he determination of the building location and encroachments, used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not he used to locate property lines. Verification of building locations. property line dimensions. fences Lor lot configuration can only he accomplished by an accurate instrument survey which may reflect different information than what _is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY"' and is "FOR MORTGAGE PURPOSES ONLY". COLONIAL LAND SURVEYING COMPANY INC. 269 Hanover Street • Hanover, NWS. 02339 Phone: 781-826-7186 - Fax: 781-826-4823 y ,,Building Sketch Borrower Client Mercer Karen L. Propeq Address 6 Hyde Park City Centerville County Barnstable State MA Zip Code 02632 Lender First Citizens Federal Credit Union y v a """YYYY 2a.0 ` I•vl Bedroom Bathroom L C� Stairs Bathroom ti Living Room Dining Room, Wood Deck Bedroom r � Bedroom Closet Den Foyer Kdchen 9.9 Bedroom Close 33.0' First floor living area _ � � Second floor living area Sketch by Apex N Windows"' - • 4 Comments: n � , 4 �, t M i 1L � �3II ����Q��y,4Jfi 3/lvT k -.�� � 1� rTl�l�1 �I �I�kny� �•�3�3�331�3�11 'Y ': GLA1 First Floor 1338.00 1338.00 First Floor E GLA2 Second Floor 766.00 766.00 26.0 x 33.0 858.00 P/P Deck 162.00 162.00 20.0 x 24.0 480.00 �. I Second Floor 6.0 x 23.0 138.00 14.0 . x 35.0 490.00 6.0 x 23.0 138.00 r June 18, 2003 Building Inspector IIf Hyannis, MA 02601 Y Dear Sir, I have decided to have Tom Kane as my contractor for this job. The job is due to begin June 27th so I am hopeful you will be able to issue the permit by that date. Mr. Kane only has that period in which to re-build my current deck. I have enclosed an old picture of the deck that I believe was most likely built in the 70s. When the picture of the deck was taken the stairs coming off the right had already met there demise but you can see the cement footing that was there originally. (see the white flower pot). The deck will be the exact same footprint, replacing both sets of stairs and installing railings and balusters to satisfy the current codes. Thank you for your time. If you need any further information, please do not hesitate to contact me either at work.(508)'77$-4899 or at home 428=5247 after 4:00. Sincerely, Karen L. Mercer Subject Photo Page Borrower/Client Mercer Karen L. Property Address 6 Hyde Park City Centerville County Barnstable State MA Zip Code 0263.2 Lender First Citizens Federal Credit Union Subject Front 6 Hyde Park ` Sales Price n/a Gross Living Area 2,104 Total Rooms 8 r : Total Bedrooms 4 Total Bathrooms 2 4 Location Suburban/good 1 View Pond view Site 27,545 SF �� � 3 . n Qnatity Average Age 28 years 1 Subject Rear Y rr t �H _ �i Subject Street r t a �rx � ; r Y10US Li) N FLU} ; tR c y, 4A- er? z:S+ "` fi Y�10 �eC�Vi ep • '�� LJ ( `'jh s 'utCk�ts�+"r`•! �VI E'. �� Z� S. r+•i3 �'u � tk1'�`S77fi+i{ Lu c�S # �r°} � ��� ky+iM+t� ' St5 i .,tr�'> t,.rw ' F ➢r ` f +�;`�t"`4t,�'�,y f fi."F�v�k1o}µki"�`" � '��� +a ���r t'i � \•.-- �� Sytlti,�l J. r„1,• ^y, i( 1 rf1� �n-��' a SN a�'�•P6��'yt. •G _ \.-�<. .N'.! yr 3. _ _ _MR qP P. 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ADDRESSADDRESS ......................................................................................................................... STOVE TYPE I`-1J ............................................................ CHIMNEY: NEW ........................ EXISTING Manufacturer .................. .......................................... CHIMNEY: Masonry ..................................................... ....................... Mass. Approva'I CHIMNEY Metal . .This is to certify that the above installer has permission to install a solid fuel burning -appliance at the listed address in accordance with an application on file with the .................................................................................................. Fire Department, and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. IssuedBy: ................................................................................................................................Title .................................................................................... Date .......................................... Permit to install expires 60 days After.issue date Stove ..................... ...................................................................................................................................................................................................................... StoveClearance ............. .......... ..........I q........................................... . Floor ............ .......... d. 4A . .....6>...........fQ1.15P.. ......... ......................................................................................................................................... Smoke ....Pipe .................. .. ........................................................................ ............................... ................................. ............................................ SmokePipe Clearance .......... /X............................................................................................................................................................................................................................ Chimney .................................... ..............................................................................................................................................................I .................................................. SmokeDetector ......................................Y............... .......................:......................................................... The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au- thority of permit dated ....................................................... has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto'...;..................................................................... Installer • INSTALLATION APPROVED By: .................... Title ......... date WHITE: FIRE DEPARTMENT CANARY: BUILDING INSPECTOR PINK: APPLICANT