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HomeMy WebLinkAbout0070 JACKSON AVENUE VVjlv, P .'�r �1 Jv�.p�f r5 jit p F P"tIb ,n tiW f..c:'d•�,`,.._#+„ � oM.�. ,.:.1 pp°�I�h.f1�. �..q{yyy��+.,[C�a.�r.,�r•,��n -. ��,. .:kNrm y.jK�.. �''�_ �.p�A.�..�i,,..�.��:,x�. 'key ❑.r'�r'�.-.,.,.:aV` � c,*���. f-,� .p +.,:, ..�.�.,'rp,.x «:.r. .�..�e i.' 6 ::�_, .�r..y,f.4'.f,�— l� ..�1-tp(`•.`?�' rT+�'•r`kT��AK.' a Clte��Y'�'�,.. �'�,, 11 ,.f�t��'t .'�,d�{{�t, vA@,_'.nS�' y,i_'r nl`gke c , Y �f. 'vI+ O ., N •',:,c , n.��! ;.,..: t, ,,. .y ��, �'eo 'dh� F� 1e�i�. -�, F� "�..�� ��,1 �,� .Fi.,�- Sf..xaP. •�,_'wrf -„-..q. ;e*� r t. ,�_ ,. .... r 1. ,W S�.�. �<•: S :3`� it,1*'�. :$ 7Oali AFA 7 hiIrd" �a �r.. 6j,cLjf� fiC A'� y, ° v ,,4 .o �j z i i e` + A S � f Y � + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . Parcel �'� 9 Application # Health Division Date Issued �1�4 Conservation Division Application Fee Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Villagez,eu 5e /,, Ile Owner3��`S�/ l`Qi2�, � .Address Telephone Y,J-o112 Y e'l,9 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _f®0Z) D Construction Type 7�re�� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 4No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: E.2 o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 0 o Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address ��' �2� � �f2 License# 4101c0 9p8 Home Improvement Contractor# Email ey,jdo 4001 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4/9 J1114 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME I� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Massachusetts Department of Public Safety ^ I�Vf Board of Building Regulations and Standards License: CS-100988 Construction Supervisor i xx HENRY E CASSIDY / 8 SHED ROW WEST YARMOU fH IUh . '•2', "{! vim: ._ :. —'qz^; 12A--- Expiration: Commissioner 11/11/2017 � ��12�G Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116. Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259186 CAPE COD INSULATION, INC HENRY CASSIDY _ - -- 18 REARDON CIRCLE - SO. YARMOUTH, MA 02664 Updatp,Address and return card, Mark reason for change. sCA I Co20M-05/11 (� Address Renewal ❑ Employment Lost Card V/�e oa�u��aoaatuerr�G/o�C%�/l�wa��c/c�aeCZa `�\ •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; egistration: '153567 Type: Office of Consumer Affairs and Business Regulation U xpiration; :.;1;211:5b20,:1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULAVOI$JNC: HENRY CASSIDY 18 REARDON CIRCLE' S0. YARMOUTH, MA 02664 Undersecretary N valid wi ut sign e t? 4! The Commonw ealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia I'Vw-kers' Compensation Insurance Affidavit: Builders/Contra ctors/Electricians/Pl umbers, Alicant Information TO BE FILED WITH THE PERMITTING AUTHORITY, Please Print Le ibl Name (Business/Organization/Individual): 1/11 Address: 2 4 City/State/Zip:. Phone 4: u �.l'/"� / �4' 72a employer?C eck the appropriate box: Type of project(required): employer with . /i employees(full and/or part-time).* sole proprietor or partnership and have no employees working for me in �' ❑ New construction pacity. 1No workers'comp. insurance required.) 8. [] Remodeling 3.[]1 am a homeowner doing all work myself. [No workers'comp. insurance required.)t 9. ❑Demolition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10.❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole Proprietors with no employees. 1 l:Q Electrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.[]Plumbing repairs or additions These subcontractors have employees and have workers'comp, insurance.t 13,[]Roof repairs 6.®We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�Other 152,§1(4),and we have no employees. (No workers'comp, insurance required.) Any aPPIicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submif'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Name: �2 . i Policy#or Self-ins. Lic, #: /,�J�' ��,� .�? ✓� �- f Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declar tion page(showing the Pol Policy nu ber and Ali Failure to secure coverage.as required under MGL c. 152, §25A is a criminal violation'puni'punishable by.a fine up to$tl 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. , 1 do hereby certify under the pains and penalties of perjury that rite information provided above is true and correct, Signature: 4 y /� Phone Date:#: F only. Do/hot write In this area, to be completed by city or town offlcial n; Permit/License # hority(circle one):Health 2. Building Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector son; Phone#: 0 CAPECOD•27 TQUIF CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 4127I2016 -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, Tills CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVER -S AGE AFFORDED BY THE POLICIE,. BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may 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; Rogers&Gray Insurance Agency, Inc, PHONE A No): (877) 816 2156 A 434 Rte 134 a ANo E IC South Dennis,MA 02660 ADDRESS:mail rogers ra ,com INSURERS AFFORDING COVERAGE NAIC 4 INSURER A:Peerless Insurance Company INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc— INSURER C:Endurance American Specialty Ins, Co. 18 Reardon Circle INSURERD:Atlantic Charter Insurance Group _ South Yarmouth, MA 02664 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 PERIOC 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 LTR TYPE OF INSURANCE POLICIN SO 0 POLICY NUMBER MMIDD� MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,C CLAIMS-MADE a OCCUR CBP8263063 04/0112016 04/01/2017 PREMISES Eaoccurrence) $ 100,C MED EXP(Any one person) $ 5,C T_ PERSONAL&ADV INJURY $ 1,000,C GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,C X POLICY OTHER: ECT a LOG PRODUCTS•COMPlOPAGG $ 2,000,C — $ AUTOMOBILE LIABILITY n - COMBINE SINGLE LIMIT $ 1,000,C B Ea accident ANY OWNED 6232707 COM 01 0410112016 04/01/2017 BODILY INJURY(Per person) $ AUTOS X AUTOS SCHEDULED X HIRED AUTOS X AUTOS JNEO BODILY INJURY(Per accident) $ AUTOS PROPERTY D MAGE $ Per accident X UMBRELLA LIAS X OCCUR $ EACH OCCURRENCE $ 2,000,C C EXCESS LIAB CLAIMS•MADE R/O EX010006635000 04/0112016 04/0112017 OED I X I RETENTION$ 10,000 AGGREGATE _ $ WORKERS COMPENSATION Aggregate $ 2,000,C AND EMPLOYERS'LIABILITY YIN STATUTE 0R D ANY OFFICER/MEMBERIEXCLUDED?ECUTIVE a NIA WCE00431901 0613012015 06/3012016 E.L.EACH ACCIDENT $ 1,000,0 (Mandatory In NH) II Yes,describe under E.L.DISEASE•EA EMPLOYE $ 1,000,0 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIdCtS (ACORD 101,Additional Remarks Schedule,maybe attached If more apace la required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contractor agreement with the Certificate Holde CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BIII Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS, Brewster,MA 02631 AUTHORIZED REPRESENTATIVE — ©1988.2014 ACORD CORPORATION, All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable _ .� �• Regulatory Services WASK Richard V.scali,Director b' 6 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,A4,02601 www.town.ba rnstable.nia.0 s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign Thus, Section Yf Usin . A Bui.Ider as Owner of the subject progeny hereby authorize Ca !11,SU 16411aj��,)Eo act on rnybehalf, in all matters relative to. rk authorized by dhis binding permit application for: o 'er ck5o� Ave, c ra►' vl'll f- A oa 63 (Address of fob)' ""Pool fences and alanms are the responsibilky of the applicant. Pools are not to be fined or utilized before fence is irui;alled and all final inspections are performed and accepted. �I Sign =e hf Owner Signature of Applicant tint Name Print Name Date QFORM OWNF..RPEPUAWS10NPO01S ' t►,E �oWn ®f BarnstableA #v y 30 (Do of T �O Expires 6 months from issue date Regulatory Services Fee * BAI3NSTABLE, 039. � Thomas,F. Geiler,Director �AtfD MAI a 7130��� -Building Division Tom Perry,CBO,'Building Commissioner 200 Main Street, Hyannis,MA 02601 www.tow.n.barnstable.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 Property Address �y residential Value of Work �2�®Q Minimum fee of$35.00 for work under'$6000.00 Owner's Name&Address c Cf-. C 1-f t,•S Contractor's Name Chi-�-�p N ���Q,(; Telephone Number Home `(�Improvement Contractor License# if a licable �0 P PP )_ Construction Supervisor's License#(if applicable) NO/orkman's/12ompensation Insurance CheVk one: a. 4 = I am a sole proprietor ESSPERMIT El I am the Homeowner .PR ❑ I have Worker's Compensation Insurance' JUL 2 9: 2010 . Insurance Company Name WINARNSTA L 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) Re-side' " .#,of doors Replacement Windows/doors/sliders. U-Value" (maximum .35)#.of windows *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 ontractors License & Construction Supervisors.License is required. n SIGNATURE: Q:\WPFILES RMS\building permit forms\EXPRESS.doC Revised 07.2110 6 . T 'l The"Connnorrivealtla of Massachusetts -- — Department o,f Industr al Acciderats ~ Office Investigations 1� of r 600 Washington Street Boston 4, 02111 t fvirov.ruass govldira NSrorkers' Compensatican Insurance Affidavit: Builders/+Conh-:ictoi-s/E ectricirns/Plnmbers Apla \ Brant Information Please Print Le gib Name(Br,sinew/Org=ationludividnai)-_—J!�a L�. �- Address: City/State/Zip: . Phonez. :i=am mployer?Check the.appr©priate box.. Type of project(required)-:. 1. �mtb 4• ❑ I am.s general contractor and I 6- ❑Neu constriction employees(full and/or part-time).* have Hired the sub-contractors 2..❑ I am a sole proprie-tor ar partner-' listed on the attached sheet 7- [ odeling ship and have no employees. These sub-contractors have g- E]Demolition working :for me in any capacity-' employees:and have wotkei's' 9. Building.addition rnsurance,I [No wvorkers' comp-insurance -comp- _ . required.] ❑ 5 We are.a corporation.and its 10.❑Electrical repairs or additions - 3.❑ I am a homeowner-doing all work Y � , officers have exercised their 11. Plumbing repai s or additions self. No vvorkers'co right of exemption per MGL �' � � �- L.�Roof repairs insurance required.] c. 152, §1(4),and use have'no employees.[No workers' 13.❑Other comp:insurance.requued] •Aay apph,caur thsd checks box#1 must also fill ow the section below showing their workers'compensatian palicy infonmtioa t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submu a new affidavit indicating sachL 4-_ntractors that check this boa must attached an additional sheet showing the name of the sub-contmrtors and state whether of not those endries hive employees. Ifthe sub-contractors have employees,they must provide their Workers'comp.policy number. I am air.crnptoyt r tlhat is prot�id rig avorkers'conr/,errs°alimi insurance.for tree e-aarpto}�-s. Betotr''is the polfcy a.t dj b site information Insurance Company Name: q Polity 9 or Self ins-L c. :_4r , Lf 7 Expirdtion Date 1_ D , Job Site Address: d c= CJ .GK.� o Lt ' , ..., cih;statier7ap: Attach a copy of the workers'compensation polity declaration page(sholiving the policy number and expiration date). Failure to secure coverage.as required under section.2.5A of MGL c._ 1.52 can.lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-}year unprisonme'nt;as well as c-i-%ril 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 hembyr F under tkapains and era 'ers of per ua v tltat tiae irrforritatioit prof ided abolw is tare artd carr--ct. Simature: Date_ U Phone#: t1 / Official vise otil Do not write in this area,to be c4inpleted by city crr toat�ra,offFciaL Gy.h or Tonn:= Permit?License Issuing Authority(circle one); 1.Boatel of Health 3:Building Department 3.City/Toxim Clerk: 4=Electrical.Inspector S.Plumbing Inspector 6.Other �. Contact Person: Phone#: 6 MJUL-29-2010 10 :02 AM P. 01 -AC0RD,. CERTIFICATE OF LIABILITY IN*5UKAN1L:r 09/02109 'Roo "a" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA11ON Herlihy Insurance Group Inc. ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE Y HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 51 Pullman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester,MA 01006 Sao 7Se-0159 INSURERS AFFORDING COVERAGE NAIC A INSURED INSURERA: Acadia Insurance Company Caro Free Homes Inc 'INSURER0: Inter guard Insurance Company 239 Huttleston Ave $ INSURER c: Travelers Insurance Company Fairhaven,MA 02719 INSURER of INSURER E: COVERAGEs3 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 POUCIES.:AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, F I I LIMITS TYPE OF INSURANCE POLICY NUMBER A 09NEUL LIABILITY CPA026597411 09/01/09 09/01110 EACH OCCURRE,Tau 6 00 ,000 COMMERCIAL GENER,-A-L-�-L�IABILITY 6 250 CLAIM®MADE L.O1J OCCUR ,. - MID EXP y wm n= 6 FFR80NAL S ADS INJURY 61 00 OENERALAOOREOATE s2.000.000 GENL AGGREGATE LIMIT APPLIE8 PER; PRODUCTS-COMPIOP AGO $2,090,900 POLICY P LOC C AUTOMOBILE LIABILITY BA7011NS4709SEL 07101/09 07/01/10 COMBINED SINGLE LIMIT $1i000,000 (Ea eaald�nt) ANY AUTO ALL OWNED AUTOS BODILY INJURY 8 X SCHEDULED AUTOS (Per ae +) X HIRED AUTOS BODILY INJURY 9 X NON-ONMBD AUTOS (fir 60a6ent) ' PROPERTY DAMAGE 6 (Per eooldonl) OARAoe LaBILIrr AUTO ONLY-EA ACCIDENT 8 ANY AUTO OTHER THAN; EA ACC $ . ..AUTO ONLY: AGG i KXCj9MMsRffUA WA■ILm FAG OCCURRENCE 6 OCCUR CLAIMS MAD!! ( AGGREGATE DEDUCTIBLE RETENTION 6 e WOAKBRS COMPENSATION AND CAWC917429 09101/09 09/01/10 X ETA BIMPLOYEW LIABILITY E:L EACH ACCIDENT 41,000,000 ANY OPPIC!RIME®ER EXCLUDED?eCUTn/E EL.010EA6E-EA EMPLOYEE 61 000 000 n yes,dwarllk under 8 I E.LDIBEABE-POUCYLIMIT 61000000 • OTHER DES(MMON OF OPERATIONS I LOCATIONS I VEMICLSO/EXCLUSIONS ADDED BY SNOORSEMENT 18MCIAL VROVISIONO CERTIFICATE R CANCE46EIRN SHOULD ANY Of THE ABOVE DESCRIBED POLICIEO BB CANCELLED sCFORE THE EXPIRATION Town of 13smatable DATE THEREOF,THE MdUINO INSURER 1MLL ENDEAVOR TO MAIL _3(L DAYS WRITTEN, Building Department, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LOFT,BUT FAILURE TO DO BO SHALL 367 Main Street IMPOS@ NO OBLIGATION OR L"IUTY of ANY KIND UPON THE INSURER.Rs AUNTS OR Barnstable,MA y02001 WR TATIVis. AUTHORIZED REPRESENTATIVE i ACORD 25(2001100)1 of 2 NM38934 gZ a ACORD CORPORATION 1988 rh a 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: Office of Consumer Affairs and Business Regulation Registration- 100503. Type: 10 Park Plaza Suite 5170 Expiration &-j9/2012 Supplement Card Boston,MA 02116 CARE FREE HQIVI 'If�C i DANA PICKUP JR, 239 Huttleston ave;�, Fairhaven, MA 02719' . - Undersecretar Not valid wit ou .y t signa 09991 `411 - aauotssnuuw;y Z10Z/ZZ/£ :uoliencix3 6L4ZO bW .'N3AVHNIVJ ,133231S�i3-1WVH 61" 00 ` ... dam , ° ''oi palolatsaZ{ OZZ96 SO :asuao�� asua31-1 JosinJadnS^uol;:)nalsup`0 Esparpur.;S pur. suoitrin�,aH r uipling}o parog { Ci-Nrtec ►nnna in ivawiar"din -SIV)SM MSSr"W ; Ql`i9CE: (508) 997-1111 OW MA. Builders Lic. #021330 FAX: (508)997-1297 ACWARE F EE Home Improvement TOLL FREE: 1-800-407-1111 �� ��� Contractor's License WEBSITE #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6) • FAIRHAVEN, MA 02719 #15179 R.I. NAME DATE 7hll& ADDRESS j ZIP CODE La EQ ADDRESS OF JOB TEL JOB DESCRIPTION Or of Ail A& //mly «kl 1,0 ' I Scheduled Start ✓1' Scheduled Completions !1eA2e A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two(2)layers of shingles, ea dditional layer to be charged @ ft2. D. Replacement of rotted roof boards/plywood to be charged @ ft2. E. Exisiting chimnet flashings will be reused; replacement , if necessa Is not included. F.Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly._ The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes,fires, and any natural disasters,the ability to obtain materials, or any other conditions beyond the control of the Company. Cost of Project$ l` ,�, PAYMENT TERMS Date zeklwd . 1. You,the Owner may cancel transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners agree to pay any a .�-, penses incurred by Care Free Homes, Inc. in collecting money due under this contract and enforcing the terms of thi nt ct, including but not limited to, reasonable attorney's fees, interest and court costs. SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE FREE HOMES , ACCEPTED: Buyer acknowledges Owner: �— receipt of fully completed copy of this Areement Owner. All contractors and subcontractors shall be registered by the director and any inquiries about a contractor&subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 r °c.IKE� Town of Barnstable *Permit#�C��� 'h Expires 6 months from issue(late Regulatory Services Fee * saiuvsTast E, Thomas F. Geller,Director 9 MASS. g �A 1639• a m wilding Division rF0 MA'S Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X- ess Cntprint Map/parcel Number d`� Property Address Ct C S v n v [O/Residential Value of Work `1.0 ,� Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address at yd-5 C Contractor's Name 6 1 6w e- Free- 46,yyle..5 66, Telephone Number 50 T5 517 ? 0// Home Improvement Contractor License#(if applicable) 166,5,—3 ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor X-PRESSPERMIT ❑ I am he Homeowner 5D,41rave Worker's Compensation Insurance JUL - 8 ZOOS Insurance Company Name j fc,v- T h S yy-e t r,c�e- TOWN OF BARNSTABLE Workman's Comp. Policy# G 0 :2 20.3 5 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this pen-nit 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 is rewired. %�: r;' _w SIGNATURE: / iL! QMVPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 'y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Care- FVee_ Fl oV► e"s (_d, Address: 23 iIyu41e.S44 P, .eve, City/State/Zip: ELI t r X V ein .t"/A, OZ 719 Phone.#: AW=ma mployer? Check the appropriate bog: Type of project(required): 1. mployer with 4. ❑ I am a general contractor and 1 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. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• � 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 1 L E]Plumbing repairs or additions myself o workers co right of exemption per MGL Y � comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then-hire outside contractors must submit a new affidavit indicating such. tContractors 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. r-- Insurance Company Name: !l a rT •4yi surd %C t� . Policy#or Self-ins.Lic.#: G ® � �D Expiration Date: La/la Job Site Address: 7G J a GFS00 AVC. City/State/Zip: EeA01 SS a1 V%•4 OUR, 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 signafore: di' �' ' Date: !� Phone#: 56 S W 7 Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Insttuctions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hue, 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 al representative's of a deceased employer, or the enterprise, and including the le of the foregoing engaged in a joint rp g g p receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such 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,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, i necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitilicense number which will be used as.a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB. Fax# 617-727-7749 Revised 11-22-06 www.mass..gov/dia a�, •,, �.v -v� , �t-+i r , it�,, I LJ.1JUu I JL'JUL...]L'J f 1' 1 ACORD- CERTIFICATE OF LIABILITY INSURANCE 09119 007 09/1B/2007 PRODUCER (5013) 67'� -6W.18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Frank X. Perron Irie�lurance ,Agency, Inc; ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND DR 1311 Bedford Street; ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 4 15 8 Fall .River MA 02723-0402 INSURERS AFFORDING COVERAGE NAIC 8 INSURED INSURER A: National Grange Mutual CARE FREE EfCbMS _TKC' INSURERS; Star Insurance 239 HVTTLESTON ALVF INSURER INSURER M FAIRHAVEN Mk 02719— INSURER E: COVERAGES THE POLICIES OF INSURANCE UMI=D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDOAION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 51Y'THE POLICIES DESCRIBED HEREIN-15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD'L POUCY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OFINS,UR14CCE _ POUCYNUMBER DATE MWDD DATE MWDDIYY LIMITS A GENERALUA3lLrr MS0779830 09/01/2007 09/01/2008 EACH OCCURRENCE S 1,000'000 x I COMMERCIAL GENE;RMLIABILITY DAMAGE TO RENTED S 50,000 PREMISES Ea occurrence CLAIMS MA-DE 5KI OCCUR / / / / MED EXP An one on $ 5,0001 PERSONAL BADVINJURY s 1,000,000 GENERAL AGGREGATE S 2,000,000 HLAGGREG..LTELNMI'rOj'PLIESPER! PRODUCTS-COMP/OPAGGS2,000,000 POLICY JELQT LOC AUTOMOBILE LIABILrTY / / / COMBINED SINGLE LIMIT ANYAUTO (Ee eccldent) S ALL OW1060 AUrIOS I I I I GODLY INJURY S SCHEDULE DAUTOS (Per person) HIRED AUTOS / / / BODILY INJURY NON-OWdEDAUTOS (Per��) $ PROPERTY DAMAGE (Per sccldent) S GARAGE LIARLIT•Y AUTO ONLY-EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC S. AL.TOONLY; AGG S EXCESBJUMSRELIA L8'ABIrW / / / / EACH OCCURRENCE S OCCUR CUJIUS MADE AGGREGATE f S DEDUCT[II LE RETENTION 5 _ B WORKERS COMPENSATIONA.ND WC0378035 09/01/2007 09/01/2008 TDRYiIAiuirs X ON EMPLOYERS•LIAMILh'Y ANYPROPRIETOR/PARTNERn—=xFc1 vE E.L EACH ACCIDENT S 1,000,000 OFFICE R/MEM DER MLUDECT? E.L.DISEASE•EA EMPLOYEES 1,000,000 IT yes,desc be under SPECIAL PROM SIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 OTHER DESCRIPTION OFOPERATTONarLoaAPI01E'SBIVENICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Officers InCLuded Eor 'Warhas Compensation CERTIFICATE HOLDER CANCELLATION ( — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE So� EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TD MAIL 10 , DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE:LEFT,BUT Town Of B8.rn aEIt tole FAILURE TO OO SO SHALL IMPOSE NO OBUGATKIN OR LIABILITY OF ANY KIND UPON THE Building DapaxbImant INSURER,IT3 AGENTS OR REPRESENTATIVES. 367 Main Str*afit; AUTHORIZED REPRESENTATIVE Barnstable MA 02601- �— [CORD 25(2001108) ©ACORD CORPORATION 1988 �n+INSQxS.(0108),05 ELECTRONIC LASER FORMS,INC..(800)027-0548 Pegs I of Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only "' before the expiration date. If found return to: Registration 100503 Board of Building Regulations and Standards Expiration g .g T E' 6%19/2010 One Ashburton Place Rm 1301 1 Type Supplement Card Boston,Ma.02108 CARE FREE HOMES ROBERT PICKUPS 239 Huttfeston ave Fairhaven, MA 02719��� � Administrator i" _ Not valid without sign ture ,l OFFICE: (508) 997-1111 ®® MA. Builder's Lic. #021330 FAX: (508) 997-1297 CARE FREE Home Improvement TOLL FREE: 1-800-407-1111 Contractor's License WEBSITE: �t�C. #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6)•FAIRHAVEN, MA 02719 #15179 R.I. NAME D K� Yr BC�' Si �q rra S DATE / OF ADDRESS ZIP CODE ADDRESS OF JOB TEL SOB DESCRIPTION o d V e ew e- Ld fe, i 920 Ciro,t,)-t L O-J 5 JJXf '1 r I C afl 4 Scheduled Start Wie k-- Scheduled Completion A. Replacement of missing or rotted lumber is not included unless specified. B.Ali start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two(2) layers of shingles, each additional layer to be charged @ ft2. D. Replacement of rotted roof boards/plywood to be charged @ ft2. E. Existing chimney flashings will be reused; replacement,.if necessary, is not included. F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other conditions beyond the control of the Company. ©® Cost of Project$ 47 ' PAYMENT TERMS Date 1. You,the Owner,may cancel this.transaction at anytime prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes, Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ARE F E M INC. Al — ACCEPTED: ,�i/j By: Buyer acknowledges Owner i receipt of fully completed CAFE FEE HOMES,IN copy of this Agreement All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617) 727-8598 Engineering Dept.(3rd floor) Map Parcel ermit# .2 � T House# 2�� Date Issue Board of Health(3rd floor)(8:15 -9:30/F1:00-4:30) iji� J_SsS'� � Fee. / , &71 Conservation Office(4th floor)(8:30- 9:30/'1:00-2:00) s=-� 1 i �, ®//V C� Ie ��1�4 Planning Dept.(1st floor/School Admin. Bldg.) � � t/AiV Definitive Plan Approved by Planning Board 19 - - � T - BARNSTABLE. ' 4/V A,1 . RFD MPS (� TOWN OF�BARNSTABLE. N - i639 �'{ r Building Permit Application t Project Street Address O A 61-t Village _ r Owner u)F-,s v [ /9 6Z2 4 S Address l Telephone Z/7 •Permit Request e�c�S ' ,r.Q,+ �t�l �`•� to a'd -First Floor square feet Second Floor square feet Construction Type mated Project Cost $ J -O-0 a TV l Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half- Existing New No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) e ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Boar!LJ:JYes eals Authorization ❑ Appeal# Recorded❑ Commercial ❑ o es, site plan review# - Current Use Proposed Use Builder Information Name /f Telephone Number 1 foe il,�'2 Address 0 License# 10 /`ZZ !1?6 / 7/1 Home Improvement Contractor# %% G 3 L1 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �~ DATE. �— Z 0C BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ` - - FOR OFFICIAL USE ONLY PERMIT NO. if DATE ISSUED MAP/PARCEL NO: VILLAGE E ADDRESS { OWNER DATE OF INSPECTION: - FOUNDATION FRAME - INSULATION { FIREPLACE' ELECTRICAL: ' ROUGH FINAL PLUMBING: ROUGH r FINAL - GAS: ROUGH FINAL . FINAL'BADINGP J `2 U f _6/8 DATE CLO`SD OUT,- 'A { ASSOCIATION PLAN NO. , z • �T11!T� ' The Town of Barnstable MAM• enevsz.,mr.� • 9 �0� Department of Health Safety and Environmental Services Eo 59. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione For office use only 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: _ Est.Cost i' 1 07) Address of Work: 7 0 Owner's Name Date of Permit Application: / 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 appi for a permit as the agent of the Date Contractor Name Registration No. OR • The Cunlmonitrealtlt of:lfassacllusctlr ":► -•-. 1:_- Department of Iudustrial.4cculelits Office 0/111VeSUy,7IIOAS 600 If ashinhtotr Strcet Bttstun. A1uxx. (1 111 Workers' Compensation Insurance Affidavit / y phone t t am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity M I am an emplover providing—workers* compensation for my emplovees working on this job. cntt mov name: atltlrccc• city- rhnne#• insurance co. rnlicv# [j I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices: comn:tny natnc: addre5c: tin , ohnne#• incur-ince rn. nnlicv# cmmnnnv natnc: addresc: tin ohnne#- insurance co. it Attach additional sheet if necessary• :s' 7 --T yS, ___ •��• r�"�•� +�+ a Failure to secure coverage as required under Section t�ion:SA of NIGL 1.52 can lead to the imposition of criminal penalties of a line up t S1.500.UU ndiur une%cars' imprisonment as well:is civil attics in the form of a STOP WORK ORDER and a fate of S100.00 a day against me. 1 understand that a copy of this statement mac be furss•ar d to the omce of investigations of the DIA for coverage verification. 1 do lrercht cenift rrnrler.t rims and penalties njperjun•that the information prorided above is true and correct. Si=nature Date y Print name Phone#• ' official use unh• do not.write in this area to be completed by tiny or town official city or town: permit/license# r1luilding Department Licensing Board G tt 0 check if immediate response is required C3Seicetmen's OfGcc t k.. 011calth Department phone#• rIOthcr . contact person: r. I information and Instructions Mass. General Laws chapter 15'_ section 25 requires all employers to provide workers%con {tettsation for employees. As quoted from the "1a��' an enrpl( ree is defined as every person in the service of :in4licr wider am contract of hire, express or implied. oral or written. An emplorcr is defined as an individual_ partnership, association. corporation or other legal entit}'. or atty m,o or me the foregoing engaged in a joint enterprise. and including the le- tile representatives of a deceased employer, or the receiver or tntstee of an individual . partnership_ association or other legal entity, employing employees. Ho\\•ever : owner of a dwelling_ house having not more than three apartments and who resides therein, or the occupant of the dwelling_ house of another who employs persons to do maintenance , construction or repair work on such dwcllin�_ or an the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an empiov MGL chapter 152 section 25 also states that even• state or local licensing agency shall withhold the issuance,or reneival 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 cotnmomvealth nor any of its political subdivisions shall enter into any contract for the performance of public work 'un(il acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting' authority. Applicants Please fill in the workers' compensation affidavit completeiv, by checking the box that applies to your situation arc supplying company names. address and phone numb ers 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. Tile 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 reauir: to obtain a ,vorkers* compensation policy. please call the Department at the number listed below. City or '(,lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P' be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returner the Department by mail or FAX unless other arrangements have been made. uld\like to thank you in advance for you cooperation and should you have The Office of lnvestigations'wo any questi. please do not hesitate to _ive us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax R: (617) 727=749 �'�� j �� � ■ 1 . 1.����� mow` i . :y. . ,•. � `,► p j ��� ,, ,� •ter: A LZ b a r AOL J� os z zT 1 '4. •"' , TOWN OF BARNSTAB _ LE permit No. ___ 24893_____________________ 1. Building Inspector •..,� � cash --------------------- �'" OCCUPANCY PERMIT Bond Issued to Seaside Associates Address lost ;#C 70 Jackson Avenue, West Hyannisport Wiring Inspector Inspection date Plumbing Inspector` � Inspection date � „ r Gas Inspector ' 1n 4 — 'r�. Inspection date it s vEngineering Department. Inspection date A Board of Health <c'.G' Inspection date 1/.-26 A, 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 OODE. "7 ? ................................_�� :fa............... 19.....: ....f....yr �?- Building Inspector a r Z3, IT IZ Z4' Z3•S o co N, G 1C, I hereby eertify -that the lot and MORTGAGE SURVEY' structure shown on this plan are not located in the special flood , hazard area as -delineated by the SCALE � " = r} O.. DATE -Fsr!�• Z-8 083 Housing and Urban Develcpment Division of the .F.H.A. I certify that .the buildings and lot lines shown on this plan are approximately located on the ground as shown hereon -and that they have IA OF M conformed to the Zoning and Euilding. A9 Laws of the Towµ c>r- C'�'*Rwg��.r L.� z �y �o tAWRENCE when constructed. � EDWARD TA LAWRENCE E. HUGHES v HUGHES y i EGISTERED LAND SURVEYOk .��No,2aosa�40 KINGSTON,MA. 747 0232 cisTER�o� Y`' .NU SURF' Assessor's map and lot number a e � � oFT ETo a ,+ 1 "yak "iw N �y OJ 5 Sewage- Permit number ........................................................ g ��� � "' �' d� t 1is, g LE i<. i d s Z BJBBSTIIDLE, i r4 n House number _ ....# :..... " ................................. � � `_ :.., ` f n C i639 '• AL AIR' 'STABLE , 4 . LL BU1 61N-G ; I SPEC TO APPLICATION FOR PERMIT TO : ''.. � . .`...�.�. ... TYPE OF CONSTRUCTION .....(�Q.O"l ..... ff! ......Z117 .... ....................... .........19........ TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby appl' for a ermit ac ding to the followi info tion: Location*�� .....1� ... ..................... . ... .... ..... ..................... ProposedUse .... ..:.....:. ... G ,�1•�•�L.... .................................................... ......................... ..................................... Zoning District ...............: �.. .....................................Fire District ............. ...... Name of Owner. 1. .�j.. P. . 5',r�ll. ........ .Address 4P14.a.. Name of Builder ..................... ........... ................Address ... ... ' . ' .......................:...................................... • Name of Architect _54.�17 .` ...............: ...Address ........................................................ .......................... ................ .............. /f .....Foundation ........ Number of Rooms .................tr ."...._. �6.......4t?: ......LG/ �! , �, f Exterior ............. .7T°�...... o.et S. :;......Roofing ...Lf.. 5.... .. ►r?.!!�.'Pi ....C: •• Floors. .:...............4re.•a, 1..............................................Interior ....� s �.,s:......... ........................... Heating ........ P. P........ Plumbing ........ ... .t Fireplace ........�7fry�. I^gr., .A.f.:' 7..........Approximate. Cost .�.��..G?�'1,�:?.r....... Definitive Plan Approved by Planning Board ________________________________19________. Area 0A�........ Diagram of Lot and Building,with Dimensions Fee•:....�� � Y SUBJECT TO APP.ROVAL.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 Supe'rvisor's License .—�:. . .. i r SEASIDE ASSOCIATES 248-93 ,ova....... ......... 'hermit for 1 Story„ , Sin le Famil Dwellin ......... . ..........................y........._...........s........... { Lot 6r......7.0...JaLocation .Avenue ................. ............ ............ nor k .... Seaside.............. AssOClateS Owner . .......... ` Frame........................ Type of Construction t ..........................................._......................................._ •t Plot Lot ................................ ,L, V Mrch 2 9 83 �. . <. Permit Granted ...........................................'r 19 Date of Inspection ......................................19 I 1 Date Complete ..(.....4..........:.......f..Ak 19 P t.t 'a�4� 4; Assessor's map and lot numbert .,, ,,,.,,, .,�7 . ......... Pyp*THE Tp� Sewage Permit number .. ��Q.................................... Z 339H33TADLE, i House number �7..D............................................................... Aoraea t 1639. r _ a �L'p Mpy pr TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �i .. �N..:...!�-:r. Y ,�:..� Z. ........�.....f�...:.. TYPE OF CONSTRUCTION .......... �,Q.....f�p'rf ............ . .. .................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accofding to the following inftof m/ottiion: Location � ... .-': t`�a -�� ..... fP,? � i.....t. ✓%cam. .... .................. ProposedUse .. /.,f//.G ►.�' `J.e!t. ...................................................rl..............................................0................. Zoning District ................ �4.0—a.....................................Fire District ....0........0_yto............................................................. Name of Owner ......��;® ��. 6.c ?.. .���Sr`��GS.........Address '.t.f�r... c��. .. ./.c'lt!?.d,.�y,n46 k1l..OQ Nameof Builder ..................��Grr/1...� ...............................Address ..................................................................................... Name of Architect ................: /!l..!C"t.. Q,.........................:.....Address ..................................................................................... / 1f �. Number of Rooms C Foundation ........�lF.......C �!1..................,.....,.......................... y?............. /] 1 �. Exterior ..............�, c� s- 1......r f�'}1Tct.�.. .. .............................Roofing ...�.... ..<�......l; s „Gv,�.!.......Floors - ' .!')m- ................0............................Interior ....71.'..14..6/1: S7............i........................................... _> g ...I^ Y Plumbing `.......m�. ! .:.-Heatin t.............. ...'................ ....... Fireplace ........ V-)..4?........ e?...'.......Approximate Cost .......'?, ..!?<'?c ...................................... Definitive Plan Approved by Planning Board________________________________19________. Area . .................................... Diagram of Lot and Building with Dimensions Fee ......G4.../.Ot �J ii ..................... 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 SEASIDE ASSOCIATES A=226-179 No ...4....3 .., ermit for ..2 to .y A, Single Family Dwel ' ng Location ,,,Lot 6,......7.0...Jackson. . . . ...Avenue... .. .. .. .. . .. ....... ..... ..... . .................................................. ......... .. `i� .�• Owner Seaside Associates Type o Construction .......Frame..:................................ ..... Plot ........................... Lot ................................ March 29 , 83 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19