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Home My WebLink About0033 JAMES OTIS ROAD �� s9Y ► 76S-7 11 Town of Barnstable *Permit# Expires 6 nths,, is re d Regulatory Services' Fee Q � BARN.YrABi+E, i 9 1 02012 Tliomas F. Geiler,Director - Building-Division , r® v\((O w� �nf of Tom Perry,CBO, Building Commissioner, �� AR�Sr�BL� 200 Main Street,Hyannis,MA 02601 `�, v v www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C_� L iJ- LV1 1L Eesidential Value of Work 4 /['). ke .w Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address v\ J Ce ijA�6� �0 o z -3 Contractor's Name Telephone Number' Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ' ❑Worlanan's Compensation Insurance Check one: ❑ I Yja a sole proprietor the Homeowner ❑ I have Worker's Compensation Insurance. Insurance Company Name Workman's Comp.Policy# Copy orInsurance Compliance Certificate must accompany each permit. Permit Request(check box) k. V 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 r #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 Contractors License&Construction Supervisors License is . SIGNATURE: QAWPFILESTORMSUilding permit fo 1EXPRESS.doc Revised 051811 . e Cammonweah*of Massachusetts Depaph gent oflndusftial Accidents Office of Investigations 606 Washington,street Boston,MA 02111 nvmn mass gavldia Workers' Compensation Insurance Affidavit Bmlders/Cnnh2ctors/Fledric ans/Ph mbers Applicant Information / ( Please Print I*,M Na=Musiu�tnizat.&dividual_ Address: Citylsta&zip: Pion 4 o C7 Y o� Are you an employer?Check the appropriate�box: Type of project(required): 1.El am a employer with. 4. L; am.e general contractor and I employees(full sudfar part-time).* have hired the sub-contractors6- ❑New construction 2.❑ I am a sole proprietor or.pasbxr- lisised on the attached sheet 7- ❑Remodeling strip and have no employees These sub-contractars have 8- ❑Demolition working for me mi any capacity- employees and have workers' 9. Budding addition [No wod=s'Comp.insurance comp..msuranc e t ❑ _ required] 5. We are a corporation and its. 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all:work - officers have egerrised their 11.❑Pl g repairs or additions myself [No worl=s'comp. right of exemption per MGL . l2_E4xof repairs insurance &]T - c.152, §1(41 and we have no employees.[No workers' 13_0 Other comp.insurance required_] 'liaya" litatchecksbox#1mmsRalsofilloutThesectionbelowshowingthe¢waikerecompensationp�yinf� Houneoa�ers who submit this affidavit i>nftatmg they are doing all work and then hire outside contractors most submit a new affidavit indicating sash_ f Conductors dw check this book rmst attached m addlticuM street showing the nee of the s camttscbo¢s and state Whew oroot tthose endues hwe empknm . If the sub-contractors have employees,they now provide their workers'comp.policy number. I am an empi iyw that isprvWd%rug workers'courpensirdan imurance for my omplojwo . Below is the pact'aR d job site informadem t_ Insurance Company Namie: Policy#or Self ins.Iic.4: V—5 o o y Expiration Date: y 2(3 15 Job Site Address: Q Citylstatdzip O 2L 3 2 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 we11 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 fcnwarded to the Office of Investigations ofthe D1A for insurance coverage verifit aticm. I do hereby certify u the pains andpmabUs ofperjuty tliatthe iafotmagm.proWArd above is true and correct Sate: 2_0 Phone#: Official use only. Do not write in this area,to be completed by city or tows afflciat City or Town: PermitUcense p Issuing Authority(circle one) 1.Board of Health 2.Butting Department 3.City/Town Clerk 4..Eiectrical Inspector rr.Plumbing Inspector 6.other: Contact Person: Phone#• 6 • snsrtsreatE, • ' ,� gown of Barnstable _ tFD MA't� Regulatory Services .Thomas F.Geiler,Director Building.Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 Fax:"-508-790-6230 %Ie Owner Must Sign This Section g A Builder I, s O er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buildin ermit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 051811 Cff: 4 �tME Town of Barnstable Regulatory Services Thomas F.Geiler,Director i639' r� r► Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: �'� Tc-Y number \ street village "HOMEOWNER": L Y�.✓\ \ SO O J�i name ome phone# work phone# CURRENT MAILING ADDRESS: MA d 2-C 3 Z city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as 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 wbo constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure an equirements and at he/she will comply with said procedures and requirements. Signatu Ho eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1.1 Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as'supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns.. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) *� 02/14/2012 PRODUCER FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Soutoeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 I INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A. Arbel l a Mutual Ins Co !17000 ALL CAPE EXTERIOR REMODELING LLC ' tNsuRERB: AEIC Insurance 67 SEA STREET APT A4 INSURER C: Hyannis, MA 02601 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER OATS IMMIDDMYYI GATE(MMIDDIYYM LIMITS GENERAL LIABILITY SS00041933 01/14/2012 01/14/2013 EACHOCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea oocunence) S 100,000 ! CLAIMS MADE a OCCUR MED EXP(Anyone person) $ S,QOO A - I PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: r :PRODUCTS-COMP/OP AGG is 2,000,000 POLICY PRO- JECT LOC' i AUTOMOBILE LIABILITY ANY AUTO ( (EaaoudentSINGLELIMIT '$ ALL OWNED AUTOS - BODILY INJURY - S SCHEDULED AUTOS (Per person) HIRED AUTOS }. --- pp BODILY INJURY $ j NON-OWNEDAUTOS '. I(Per accident) PROPERTY DAMAGE. $ (Per accident) GARAGE LIABILITY LOTHERTHAN ONLY-EA ACCIDENT S ANYAUTO EA ACC ONLY: AGG,$ I •;�EXCESS I UMBRELLA UABILtTY 'I EACH OCCURRENCE '$ I OCCUR C CLAIMS MADE I AGGREGATE $ DEDUCTIBLE I _ S _ RETENTION $ $. WORKERS COMPENSATION WCC5007896012009 01/14/2012 01/14/2013 X TORY LIMBS ER _AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECLM Y 1 N { ?E.L.EACH ACCIDENT . Is 1,000,000 B OFFICER/MEMBER EXCLUDED? -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEFl$ 1,000,000 If yes,describe under is PECIAL PROVISIONS below OWNER INCLUDED E.L.DISEASE-POLICY LIMB j$ 1,000,000 OTHER - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT]SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. For Display Purposes Only AUTHORIZED REPRESENTATIVE Joanne Bretton ACORD 25(2009101) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t r TOWN OF BARNSTABLE Permit No. 263II4 t .1AR17T Building inspector cash ------------------------- i i 1639. OCCUPANCY PERMIT Bond ----------------------------.--- Issued to Alan B. Small Address lot #26 33 James Otis Road, Centerville Wiring Inspector � Inspection date 4.Plumbing Inspector '/"'(- Inspection date Gas Inspector Inspection date -9�. '+L/_�N�^� �/�'�•."G`^ Ins pection dateEngineering De artmenth, _ sBoard of Health Inspection date e THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALT. 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. i �1 Building, Inspector L� DAIS-y FL•OW SEPTIC TAQK = 330x15o"/. = •49iG,P, (OV Ov USE I000 GAL. FA9 D15Po5AL P1T u5E Ivoo GAL3 5� GPDBOTTOM AREA= j''o SF -T OT A 1- D E.51 G N -- O q-2 5 GP D. � p TATAL DA I I-Y FLOC,! = 330 G,Po, PE2COLATION RATE : 1"IM 2MIN or-t_E55 /3 t� �.J. HICFIr� DAVIDC. �y Ll f7AX l' Eft en c THULIN m _ I ova Nu.? rJYA 1.• No- 29076 -� `J�i•v I! 4 �sT � st S ONAL EN r" AAlf - W0LF- (Z.�IL-psi r'fj• s!. TOP FNU = 51,0 %W Lokm ,o 1000 INV. f ✓COI(. a P��ST. INS. `G A 6. �3•� B A 'rtG IOoo 4rNV �L TANK /O� LEAGL( Gf1At/@IL.. P 1 T I N V. INV. La WITH r `J�•�L �-j�.d WASNGD '� • - GTor.IE � , CER.TIFIG0 pLnT PLAW 7.PRUFI L� _ L o C A-T I o W C�sT I LLh 13 WO SCALE SCA�� 1' i 1 C E QT 1 F Y T N AT T N 6 C-ov 1�T�tsTl ot� 5y{p µ�N P L-A r,l R E F E 2G N GE Arr R ---0W COMPLN(5 WITH THE• S l �El_IN A►.1D 56T5ACK ZGgL)IR.EMEN�"� OF 'C4-lam b c �a { 711,411, OF-- -68Ar214,;v.r-!:-L.EAND ►S 9cr LOCH ED •WITRIQ TN'E Pt-Ooo PLAII.I R SIC. PG Z� D AT E cl BAxTE cz e ►�1 YE. I N C. ' Tu15 PL&KI i15,NJOrr BA\5r n Ord AN �LEGISTEQ6rD'LAW >•5uiZYEYC>I z 6 )4-$TRUMENT SUQ-vey. 4 -TNE O►=FSETS Suou�,p c�sTE2VILLE - MASS. No-r pE USEDTo pE'TER/�1N4 G L.oT t-INES APPLIG,c�rJT Asses s m p and lot number.. ../�.j:. 7. 7 Sewage .Permit-number .......` ...... ...........:. 1 /.L.;: . .. r,�Q ♦� T E s a pn�y House number ...................................:..#:3..�s.:..............~... L_D N CoWi �, . _Sysr aaM a LE p ;, .. a I _ r' G 1 9� 0 TITLE O'tfp MPV tr\ TOWN OF BARNSA�B= � E �- yM l , BUILDING INSPECTOR APPLICATION FOR PERMIT TO:....... :.....................::......:......... ......... ......... ..:.....................................:.....:.. TYPE OF CONSTRUCTION; r .......... ',_ TO THE INSPECTOR' OF 'BUILDINGS: t The undersigne ereby applies for.;a permit.according to the following information: hs i Location .............................................................. a t. ProposedUse ....... ........ .. ...... .................. ............ ............................. Zoning District ................................... ..........:... ......... ..........Fire District ...... .......... Nameof Owner ... ...........................................Address ................................... ... .......... .. .. Name of Builder .............:.......... :..:....................................A.ddress .......... _.. Nameof Architect ........... ......... ................... ...................Address ........:................................:.. ......... . ........ Number of Rooms .. . .......: ...... ............ .........Fou.ndation ..... :: ....... p , Exterior .' ��i�.t-r--- J..4�........................................... .... .:.Roofing ...... ..... ��. .....Interior ....:..... �41 L�'�/ Floors ..... ........... ............................. �� /•.... .. .... .............................. Heating .— ......1(..:...: .................................................Plumbing ......'�...................................................................... Fireplace .....ylJ. ........ ............. ........................:..:................:..Approximate. Cost ......Q ye....�:d............................ Definitive Plan Approved by Planning Board _____ __ ________-----------19________. Area .. Diagram of Lot and Building with Dimensions Fee ........ ........... _ SUBJECT TO APPROVAL OF BOARD OF HEALTH 0/jo 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 I SMALL,. ALAN E. 26384" One Story Permit for ►zgle family Dwelling ...... ....... M.r Lot 265 33 James Otis Road .. Centerville .................. ..................................................... _ s Alan E. Small _ Y . R Owner .................................................................. Frame < Type;of Construction . ...................... ....... .......... < �F ................................................................................ Plot G'l....... .... Lot ................................. Permit Granted ........May ...........................19 84 I � , tate of, Inspection..•.......�r.........................19 Date Completed .p..� �F Assessor's map and Idt,;number .. ./................ . . . } ypf THE tp bw O� Sewage Permit number .........V..G/.... ......C..� �?...... . Q p i BAUSTAIDLE, i House number ..................................... .. ...:........ :......::... 90. MAO& } p 1639. \e0 0 MAI a. TOWN OF B.ARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... °F:3 r... ............................................................................................. TYPE OF CONSTRUCTION ......... ............................................................................................ ......1.:.. ............................ TO THE INSPECTOR OF BUILDINGS: The undersigned-hereby applies for a`,permit according to the following information: Location .......... .�::�...`..`.:�......f.�. .:... : ..................... ......:: ............................................................ ProposedUse `.....°......... ..........................................................................................................I......................... � 9 ZoningDistrict ..................................Fire District ............................................................................. Nameof Owner . ...............................................................Address ........ .:........................................................................ Nameof Builder .............:......................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... f G t C`f1 Gf Number of Rooms ..................................................................Foundation ....�,>.P?�r?.::.:...:...:..:............................................... Exierior .... ...Roofing :... :.:.................................................... i Floors ..... ' G I ....................................................................Interior .... , .......................................... Heating ...........................Plumbing .................................................................................. Fireplace ........ c t A.C:?u: ...............................................Approximate Cost ....... ;<......................................... ......... 2 � �C' -4) Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... 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 ........, � :.... :, ............................................. 7S Construction Supervisor's License ........................ ........ SMALL, ALAN E. A=171-164 26384 , One Story No ...............!. Permit for .................................... Single„Family Dwelling..................... Location ...L6t..265, 33 James Otis' Road ....... ................................ Centerville ............................................................................... Owner .....AlarIJ.-:-Snall.................... ........... Type of Construction ........Frame........................ .......... ................................................................................ Plot ............................ Lot ................................ Permit Gran+ed ...3.1..........................19 84 Date of Inspection .....................................19 Date Completed ....................19