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HomeMy WebLinkAbout0053 HYDE PARK ROAD _, o i , o � � o. ' OF SHE r Town of Barnstable *Permit# P� p Expires 6 n _ s 0M Regulatory Services Fee * 3ARNSTABLE�'* MASS. 2639. Richard V.Scali,Director APR 2 0 2016 Building Division Tom errry,CBO,Building Commissioner TOWN OF BARNS r Main Street,Hyannis,MA 02601 www.town.bamn table,ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY ZZO Valid without Red X-Press Imprint Map/parcel Number (� ✓'�� Property Address -/c) 1 rResidential Value of Work$ C) O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressowid ,81'j 1 IPA • 61W Contractor's Name p l Q2 L 0/ 5r- Ira Telephone Number D�=ya-�" Z!7-7 Home Improvement Contractor License#(if applicable) //0 Email: Offi(y_ Q. 2Aa Q y-1' CA_>.7t — Construction Supervisor's License#(if applicable) [IWorkman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner P-Yhave Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# tx Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to yAj?luxclnj Lf4t-i)r-i ZL ❑R -roof(hurricane nailed)(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders.U-Value (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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 w_� yyq�n r r. Y"� •'�u' .11 The Commonwealth of Massachusetts Department of Industrial Accidents Office of hmestia ations 600 ff�ashington Street Boston, MA 02111 wwiv.mass.b Ov/dla Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plurnbers Applicant Information Please Print L,eObly Name (Business/Organization/Individual): ��-yL-- Address: () / /-It City/State/Zip: U_E. MA Phone#: Are you an-employer?Check the appropriate box: Type of project(required): �1.�na employer with/� l� -.17ewt54. 0 I 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 listed on the attached sheet. 7. ❑ Remodeling partner- shipand have no employees These sub-contractors have 8. Demolition P , employees and have workers working forme in;any capacity. 9. ❑ Building addition [No workers' comp. insurance comp.insurance. required] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I.am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself[No workers right of exemption per MGL comp.. 1.2.❑ Roof repairs insurance required]t c. 152, §1(4),and.we have no 13 etherf— employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing.their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for rnjr employees. Below is the policy and job site information. Insurance Company Name: z-f I/V S C-0 Policy#or Self-ins.Lic.#: l/VG.6 3/ J —3t �6��J2-S Expiration Date: �,,/ Ci /State/Zi + l�1 f ' z` Job Site Address: © � C�70 ram' t 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. SiRnatwe Date: Phone#: � /7�cc Official use only. Do not write in.this area, to be completed by city or town offi.ciaL City or Town: Permit/License# Issuin;Authority (circle.one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: i Property QWher Must Complete & Sign This,'Fortn I If Usinga Roofer�l Builder, h a t - J I:rn,►nr� f _ '1� a L ?.°G as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to,act on my behal Jn all matters-relative to work_authorized by:this building permit,application for., : Address'of Job ,Signature of Owner T . Mailing Address of`Owner : . g 7 / c S7 sip e /s,b u/mil- i 08s • Telephone # d , Date ,l < 'Rlease"fetuf this:form to Paul I Cazeault-Roofing along with your'signed<contradt. ' ,f :it is needed for us to obtain the,buiidin ermit°required b our town to com lete our:roofin m ect 1 .. g.P. q Y Y p Y g P 1 - fax#5.08 420 4555. ;office@cazeault.coin . h - i acorrD® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) s/11/2D15 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 DOWLING & O'NEIL INSURANCE AGENCY INC NAME: 973 IYANNOUGH RD PHONE FAx PO BOX 1990 'wc No Ext: A/C No: HYANNIS, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33660 INSURED INSURER B: PAUL J CAZEAULT& SONS INC 1031 MAIN ST INSURER c: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25918664 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 POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑PRO JECT ❑LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ IDXED CESS LIAB CLAIMS-MADE AGGREGATE $ I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-386670-025 8/10/2015 8/10/2016 !/ STATUTE ER H AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDED? N NIA - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES.(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and.supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION PAUL CAZEAULT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 031 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25918664 1 1-386670 1 15-16 WC I shankar.gadale@libertymutual.com 1 8/11/2015 4:45:09 AM (PDT) I Page 1 of 1 _ - Office of Consumer Affairs Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 : . Type: Supplement Card PALL J. CAZEAULT & SONS, ING:•.,;: :: Expiration: 7/9/2016 RUSSELL CAZEAULT --- -- 1031 MAIN ST ------ OSTERVILLE, MA 02658 Update Address and return card.lllarEc reason for change. scA 1 0 2oM-05n7 ElAddress EJ Renewal 0 Employment Lost Card F?��C,' iOCiIJI%760.TI-L[!(?C!.(��0��l�/;i:Jl("C�dIJL•'�J Ofhee'of Consumer Affairs&Business Regulation License or registration valid for individul use only tip/I before the expiration date. If found return to: I7 , BIOME IMPROVEMENT CONTRACTOR p = Office of Consumer Affairs and Business Regulation Registration;;;1.0371,4 Type, 10 Park Plaza,Sui#e 5170 = Expirati7/9/20.1fi:.:% Supplement:"ard Gaston,MA 02116 PAUL J.CAZEAULTA'SONS'.INC RUSSELL 1031 MAIN ST / T� OSTERVILLE,MA 02658 Undersecretary Not valid witho s nature l Ulassachusetts epartment of Public Sal'ety Board of Building Regulations and Standards Construction supervisor F License: CS-108157 RUSSELL CA ZEAT7LT 2071 MAIN STREET _ Brewster Aa 02631 - =x Milo- commissioner 1 1/2312 0 1 8 • Office�ok m r Affairs �fsiness egulah�o License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,4md 80881 Type: Office of Consumer Affairs and Business Regulation Expiration: 5'41123/2017 Corporation 10 Park Plaza-Suite 5170 viv Boston,MA 02116E IMPROVEMENT.INC 1; r,.. MICHAEL BERNSTESIN ' 53 CONGRESSIONAL`D�2 YARMOUTH DORT, ;. 0267:5, r Undersecretary rT Not valid without signature I A.F..- 615_ ,lid —Pyn_I�I_,_ao Flo Ja6k-) M--e-T�- r-am_emae,0--6- - -t n--c- e�cuc�czn__s��u 1 5of �zzr w—or_C-Avf6-p,-6m- - 53—kh_ Ear Ed_._Cen� i lU eTfl iEl - r V � ` ' .-r � # x fi �. � � vf+ i } Massachusetts -Department of Public Safety - Board of Building Regulations and Standards } Cons-trne:;on Supe,v-,".,u,- License: CS-102185 .t;T 1 R QF EARL T SPAIN 46 Main Street Sandwich MA 025563 Expiration Commissioner 12126/2016 '^ V/ae U1anr.��ra�zraeall��CJ/�/�irzhac�cc�el�s _ \ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:.-."1.77767 Type: Office of Consumer Affairs and Business Regulation Expiration=-'-:hW-- 1$ DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 K.T.SPAIN GONSTRI KARL SPAIN - #° 46 MAIN ST• - SANDWICH,MA 02563\ `- Undersecretary got valid without ignature , J Ile Comm.omveah*a,jfMassac i=etts Depar neat of Ind zirsfyid Acclderds Offwe-of LMVM6gafi0M ' 600 Washington Street , Bastan, 4 0Z111 wrPmmamgapldia Warlmrs' Campemsatiwt Insurance A avid Bmlder-JC-untr ad r&MechicianslPbmabers Applicant lnfcrrma �n t r Please Print Fy 1VaH1e neit.eec cCa,,;rat; f m � II.�JJN ll,(�(�I P Address: J -�� T � , a oac I5 S��S -a�� �t�(t�lo Are you an employer?ChecktheIpproptiatebom Type of project(required): L❑ Iamaemployermith 4. 0 am a general contractor and I employees(fo11 atrdlor partfime). * base hired the sub contmctozs 6. ❑New construction 2.❑ I am a sole proptietur orpartuer- Tisted on the attached sheet 7. ❑Remodeling' .ship and hmm no employees . these nab-contract=have & ❑Denalition, wing for me in any sty_ employees audllave woslren' [NO 'camp-insurance Comp.insuran P 1 9_.❑Butltimg addition required-] 5_'❑ We area-emporatim and its 10❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1L❑Plumbingrepaim oradclidons myself[No workers'camp- right of ememptiou per MGL L_❑Roofrgxim ir,m ante rQqaire&]Y c.152,§1(4).andwae have no employees.[No workers' 13_❑Other camp-morance regtured] 'A]3Y spyBcsatffat cbecUbcs#1 toast also Mcratthe sec6onbeT,awshmoag theirwndcas'compeasatinupoTcyiafermaQ� I Homem m n who sabot dm afadavit=&=ng they an=_thing all wads sad&m bim outside cantscbm—st submit a nem afadavrt indite sacb- fCaatmctosthat checlr tb¢s boa mast a2tacbe�as addiliaasl sheet shmriag the names of the sub ca�suoa and state whew or im tbose entities have employees.Tf the at-c�love emplayeas,tiiey=nrp=2de thek tvurkers'comp.policy number-, I a�n an erne er tTiatis pra�ddirtg tvarkers'cotrperesafirrle inszirartrre�cr }J eatp ¢ Below is file psrTicy and job site irrforrtxafion . x. Ittsnmance,Company Niame: Policy li'or Self-i s.lic-lkE�pir�iaa Date: Job Re A ddre CstylStateez.p: ' C)L�L-)3 D� AC#at h a copy of the worlrer coanpensationpoUcy declaration page(showing the policy,number and erpimtion date). Fare to semne coverage as required.under Section 25A o€MM c-157 can lead to the imposition of criminal penalties of a fine up to$l,5aa t70 and!'or one-year imprisonment,as well as cive penakies,im the farm of a STOP WORK ORDEIRand a fine of up to$250-00 a clay against the violator. Be advised that a copy of this statement may be favarded to the Office of Investigations of tale DIA for iusura —coverag5 veElfication- I da Trersby csr;fy aatder s pains and psrsaffcazs a Fe>jzcr that f7�e i f orRsafzar�proved abm is bus and arrrect SL-mot"'a: Date- L ( I((M Phone iF _ Ojft ial um only. Do-not ovrke in this area,robe crrmpTetesd by tdty ar tenrn o,-cial: City or Town: PermxWUcense;9 Issuing Anth&rity(drde one): L Board of Health I BwIffing Deppartment 3.CitylFown Clerk 4.Electrical Inspector" S.Plumbing Inspector 6.Other Contact Person: Phone it: Information and Tn.structions �. MM ss�se fs Geheaal Laws chaps 152 rej=M aIl employer,`to provide warkeas'=npensat=E'r•their employees. pu=zottn this statrft,an.wpiyee is defined as."-evmypersonmffie serviee of mukhm order any cant-act ofhirey express or jmplied,oral or vet." An m pk yer is defied as"an.individual,partnerabip,association,axporation or other legal mt�.y,or nay two or mole of the foregoing engaged in aJai:at Vie,andincbidmg the legal representatives of a deceased employer,ar the receiver or tMStee of an inaVidual,part[JMMhip,association or other legal entity,employing employees- However the owner of a dw i-,Mag house bav ngnot more than three apartments and who resides therein,or the occ4md of the dwelling house of ano$er who employs pens=tD do mahtman cc,coon or repair walk on such dweIlmg house or on the grounds or bmldmg appurteQant1h retD shaIlnotbecanse of such emplaymeztbe deeffiedto be an employer" MGL chapter 152,§25C(S)also states that"every state or local�'—b agency shall wifibhold ffie issuance or renewal of a license or permit to operate z business or to constrdet bufldhV fa the commonwealth for nap applicant who has notprodnced acceptsble-evideuce of coiupH=ce vvitlz th,-,-insurance covet age req¢ired" AdditionaIly,MCM chapter 152, §25C(7)states Neither the mz coo oawealtU.nor'a'uy of its political snbdivisians sbaIl ' ear info any contract for the perf=a act ofpubho veork u atiL acceptable evidence of com plimce v,�ifh ffie insm-ance• rCT3i ens of this chapter bane been presented to fho cnntr�,v antiiodty_" ' Appac wits Please fiII out the wozb=,compensation affidavit completely,by chect the boxes that apply to your sitlaaiion and,if necessary,supply name(s), addzess(es)andphonemmmber(s)alongwiththeir certificate(s) of insurance. Limited Liabfity Companies(LLC)or Limited Liability-Partneahfgs(LIP)withno employee$other than the members or partaers,are not regoaed to cry wolicers`compeasaiion iisu== If m LLC or LLP does have employees,apolicyisrmpired. Be advisedtisattiusaffidayitmaybesnbmittedto the Depazfinentoflndvsftial Accidents for confirmation of fimnmce coverage. Also be sure to sigic and date ithe afhda-Vif The aff davit should be retcmme•d to the city or town that the application for the permit or license is being requested,not the Department of ExIastial A cci� Shonldyou have any questions regarding the law or ifyou am reqcdred to obtain a WO'krzs' compensation policy,please call timDeparfmenfattbennmbeali edbekw 5e3f-msured companies should=:ft-rtheir self-fi sm-a ce license nm bw an.the appzapaaie Ire. City or Town Officials . t - Please be soi a 13at tine affidavit is complete and printed legibly. The DepartinentIm provided a space at the bow of the affidavit for you to fJl out in the event the Office oflnvesfi moons has to co�actyouregarding the applicant Pleas a be sure to ffil i a the pen:�itllicrose number which vM be used as a reference number. Iu addition, an applicant fbat mast sabmit multiple pezmWHcense applitmiions i a any given year,need only submit One affidavit it cating cant policy in=ation(if necessary)and under"Uob S`b--Address"the applicant should write"aII locations in ( Y or town).-A copy of the-affidavit that has beta offickUy s 3nped or maiced by the City or town may be provided to the applicant as proof that a valid affidavit is on file for f 3 t a e permits or licenses A new a$idavitmust be fmc-d out each year.Where a home owner or cif is obtaining a license or pe�itnot relai�:d to any business or commm-cial veut im (ie_ a dog license orpennft to bum leaves etc-)saidpm=is NOT regahed to complete this affidavit The Office of Inym gaii=would him to thank you m a&mce for your coopmzdan and should you have any questions, Please do not hesitate to give us a call- The,Department's address,telephone and fax nnmbez COMMMWMIth Of Massachu&eM - D:epa dmmt cif lad ial A ideuts i aFY z Offlce of ktvegt�gatio= 6QQ� .g�an �Qstonsl�fA f�11F Fag#617-727-7M Kevisea4-24-07 ��St1E tpyy - . t t • =ABNS-4BLE,MASS • ! ,� Town of Barnstable , 'OTEn +` Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner ' c 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us. Office: 508-862-4038 Fax: 508-790-6230 Property-Owner Must Complete and Sign This Section: If„Using A Builder as Owner of the subject ro '. l P PAY hereby authorize �57� to act on my behalf in all matters relative to work authorized by this building permit application for: . , 5 avA— ,i , C ll (Addre s of Job) Signature of Owner Date Print Name , t If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. ,. QAW MISTORMSIbuildmg permit forms\UTRF.SS.doc Revised 040215 Town of Barnstable Regulatory Services , pG tCyy Richard V.Scali,Director ti Building Division * mum * Tom Perry',Building Commissioner s63q. �e� 200 Main Street, Hyannis,MA 02601 F www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION I I Please Print DATE: �-� JOB LOCATION: number�(Qstreet OM village "HEOWNER": CA 6a 6ifflan — •X 3 9 (D 19 35 name home phone# work phone# . CURRENT MAII)NG ADDRESS: 53 4\,i A P a c-L - . st;itr rfty/tDwn zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year ear 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval ofBuilding 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 t amend and adopt such a form/certification for use in your community. Q:\WPFHXS\FORMS\bmlding permit forms\EXPRESS.doc Revised 040215 P Town of Barnstable .y Permit# Regulatory Services Expires 6monthsfrom issue date • 3ABN6rA 4fto r[/ $ Richard V.Scali,Director Building Division APR 0120 Tom Perry,CBO,Building Commissionerr®w �s 200 Main Street,Hyannis,MA 02601 ®�19A R�/ STA www.town.barnstable.ma us D LE Office: 508-862-403.8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY O/'�T Valid without Red X-Press Imprint Map/parcel Number f / (�"I . Property Address53 L PO C K- G,4��A:?A�I-k e- Ma ()Q(03a 'Residential Value of Work$ (�� .(� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 5-1 4u6e , (-A 61�px�le_' Mao-ato- 7D a Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) S )S L Email: Construction Supervisor's License.#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor . ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going-over existing layers of roof) V l e-side ("Replacement Windows/doors/sliders.U-Value c,?j(� (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,Le.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter_of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPMESTORNIMbuilding permit forms\E32RESS.doc Revised 040215 Assessor's office(1st floor): —� rJ SUBJECT TO A?P;D7]%_ 0,l' FTNEr Assessor's map and lot number•1 . 2T-...Qf'....... �73...� BARPSSTASLE CONSE:3VAi;:�Q�° Board of Health Ord floor): oK { '�� COMMISSION Sewage Permit number .....:..:. 6... �. NAG& Engineering Department (3rd floor): �' S. SEPTIC SYSTEM IH�ST B 90o 1639• \e� r� Housenumber '.........................:................... ...............:......... INSTALLED IN COMPLIANCE O YaY�' APPLICATA( ,V , Pl ��Wlb 8.30 9.30 A.M. and 1.00 2.00 P.M. only" WMT=5 - " DE AND Barnst•a')le Conservati0-,,--m'ss'on'' N- OF B A RNWA% � DE NS Date ILDING' !INSPECTOR APPLICATION FOR PERMIT TO .[1.4J h ..... TYPE OF CONSTRUCTION ......!��1.�Y`....: � 10'':�-.w................................................................................... -----------------19-��� TQ_!THE &1SPECTOR OF BUILDINGS: .The undLTrsigned, hereby applies for a permit according to the following information: Location ........kn�t...... ..........Rb, C&.....PCc?z!'�.F........... ��.l..1. .......................:............................................... • V Proposed Use 9, ................ ZoningDistrict ........... ..0 ..............................................Fire District ........� ........ ................................. Nameof Owner .......... la . 5e....... ��G�......�6............Address ..........'......... `?. ................................................. Nameof Builder ............... -t....................................Address ..................0 .................................................. Nameof Architect ........ ..........................Address .................... .`? ..................................................... Number of Rooms ............4P...................................................Foundation ........T&U a¢.A.... ......................... Exterior �'CG� �/S ?UC... .............Roofing ............... �.�. .. . .... ............................................. �.. ....... .. /lam-� t U Floors '...........Interior ,.................................. -- - Heating ... ...!! ......0 ................................Plumbing ............... ........!— ? c..................... Z Fireplace ...........! .!t. ..... ...... ............................Approximate Cost .......... ..........................�/- Definitive Plan Approved by Planning Board ----4�4.____��L----------19 ` 5 Area ��� 0 Diagram of Lot and Building with Dimensions Fee ........./.. ...."" "............ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . ........ ... ................ Construction Supervisor's License o '..l. ............. AYSIDE BUILDING CO. ' 3020`5 N � �•- 1'. Stor •t No ................. Permit for ......�z�?...........Y............ Single Tamil Dwellin ....I.... .... .. . Y.... �. .......... ......:.... Location ...Lot #3• 53 'H- de 'Park " .............. .i.............,............................. Cente:r-v-°lle � Owner .....Bays.ide`r Bui1ding:..Co ...... .*' Type of Construction FXame .:...................'....... ............................... Plot ................. ........ Lot ................................ 60 November 19 , 86 Permit Granted .......... Date of Inspection .......... ............19 � ' Date Co plet (]� ..... . ...�A'w... 19d / ' M Cc V i' • E f, " Sii 4C 5 i w ; +� C2 Mom `++ S �! iY y M ay. Assessor's roffice (1st floor): /-73 , F?NE T Assessor's map and lot numberRRT ..��......... �� Quo o�y Board of Health (3rd floor): 411 Seage Permit number .......... ._ w, ��..................................... Z 33ASH9TODLE, i Engineering Department (3rd floor): #. �53 r�TS. 'oo rb 9. \0� Housenumber ..................................`...................................... o MOR APPLICATIONS PROCESSED 8:30-9:30 A.M. and. 1:00-2:00 P.M. only TOWN--rO'F BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....&.`.`.1......40t.':�'�..................................................................................... ' TYPE OF CONSTRUCTION .............1...... l �---.--............19 Y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: kLocation ........ . .......3........ . . .. ...... _�..................................... ................. ..................................................... ProposedUse ...........�-.�'..`?.................................................................`.................................................:....................................... Zoning District ........... ......c................................................Fire District ......................:.............................. ........ ................ Name of Owner J.S. ( e.......�� c�J...... 0 ............Address .......... ... Nameof Builder ................7..? U✓l.-Qu.....................................Address .................. . ........._......................................... I�< Nameof Architect .........-�:�.:.�4> -�—p'..........................Address .............................•....................................................... ot— Number of Rooms ............ Foundation ......:T� CC,G�1 ................. ............................... ................................. Exlerior ............� , U `� .......C....u. . .....f ................,.n.., ....................................... Floors .................fi). .............................Interior ............ ..............::f...................................., ! 2Q� Heating ............�.�... C ......Plumbing :..................... Fireplace ........._.. -........................Approximate Cost .......... ... DZ7........�.�.......................... ..C. . ` 5 , tY Definitive Plan Approved by Planning Board ----Au�)-----�___�t__________19�_S__ . Area .......................,.N.......`..� ` Diagram of Lot and Building with Dimensions Fee /_�......' •w " ............ ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH. /. ;.v i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... /r!u ........ ............... U Construction Supervisor's License �S�-............................. i 1} BAYSIDE BUILDING CO. A=173— lei No ..i.0.20.r-. Permit for ..1.?...Sfor Single Family„Dwelling:,,,,,,,, Location ... !Qt...#3 • ..................... Centerville ............................................................................... Owner Bayside Building Co. .................................. Type of Construction .......Frame.... ............................. ............................................................................... Plot ............................ Lot .................................. i November 19 , 86 I Permit Granted ........................................19 Date of Inspection ....................................19 I Date Completed ......................................19 No ) 07 �1 -THE, TOWN OF-BARNSTABLE 30205 � ♦ Permit No. ................, BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 ,Bond ..... .. CERTIFICATE OF USE AND OCCUPANCY Issued to BAYSIDE BUILDING C014PANY Address lot #3 53 Hyde Park, Ceuterville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. July 27, 1987 19............ ............ . ................ ....... Building Inspector e TOWN OF BARNSTABLE BUILDING DEPARTMENT U 2�°TuaM ' TOWN OFFICE BUILDING r i6J9' � HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #...... .......................................................................................................................................................... issued to .... ....�� ..... �--?f?s/ .... .! { .. .`. Please release the performance bond. TOWN OF BARNSTABLE, MASSACHUSETTS.", y ~ ,.. �I�.� ;� PERMIT'. DATE 19 PERMIT NO�. APPLICANT (''^ " ( ADDRESS (N0.) (STREET) (CONTR'S LICENSE) 6 PERMIT TO i5li-`-[-c2 "i^'G'' - (�) STORY - DWENUMLLING UNITS ER OF (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) / ZONING C7 (NO.) (STREET) DISTR BETWEEN AND (CROSS STREET) (CROSS STREET) LOT �11 SUBDIVISION LOT BLOCK SIZE 1, BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION ii TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: i AREA OR VOLUME ESTIMATED COST O! FEEMIT " (CUBIC/SO UARE FEET) OWNER "•' i fi �_ ADDRESS BUILDING DEPT.. 1; BY 7+ THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE'SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND' I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. I. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MI NAL INS RE INSPECTION TO LATH I. E FINAL INSPECTION HAS BEEN MADE. . 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT .I5 VISIBLE FROM. STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 AAW Co.n(-e*,f y i CU 2 z � Z 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 OTHEF Z r T BOARD OF HEALTH 9. '10RK S ALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIB MONTHS OF DATE THE ARRANGINSPECTEONS D FORIBYTED ON THIS CARD CAN TEELEEPHONE OR WRITTEN -ION. I, PERMIT IS ISSUED-,,A N TED ABOVE. NOTIFICATION. *t v HYDF- ,� = LOTZ — PAR K 0 P'' a yr LO Is,L19T -A n1v `0 n' r ,OJ��t ^I r 15T a8 = LoT y X /6 6i 6, / JOB # 84-198 CERTIFIED PLOT PLAN PREPARED FOR: LOCATION. LOT 3 HYDE PARK BARNSTABLE SCALE: 1 "=40 ' DATE. 11/15/86 REFERENCE: PB 406 PG 8 BAYSIDE BUILDING. I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON THE j GROUND AS SHOWN HEREON. BUILDINGS CONFORM TO SETBACK REQUIREMENTS NN OF OF THE TOWN WHEN CONSTRUCTED. o/ARNE H. down cape engineering °JALA 9 #26348 4 CIVIL ENGINEERS - a '#ECi S � LAND SURVEYORS /�/y�e'Q L D - --R O U-T-E--•6-A------- Y A R M O U T H - MA-- ---- DATE-_ . ._---- -•-- __-AEG_. L ND_ SURVEYOR