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0033 JOHNNY CAKE ROAD
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'� } b !, is •f ).. 4/ .,�t :. m ,. ., a. r„ f_ , aCA— ; z: 1 '2{� A S b { J ! flu, .'�. :::rl r ..,. , n'r t r t;, i y" f , �:v } _., ¢; e> r,,. a 9' .t h I,, lr t n f• a f r-, r1` tn, M 3 k f.` h �t e b i s t a ., .;'n ter:.- } ,�',r.. •1: ., ,. :f." .t ,• i t s Y j 9 ,?`t t. a x a .u� ,,� a — !1 ri .l.' r '� A i A^a• ;{i attizYr.irti ,.,>':A.o, 3xIln i..i .r,; _ i + a, Y11 ,, �. h �iiJ' s r f"S 9 a P.s s� `' t �r ,ti. :Mxi{�'A.. -der'7 r, F 1 a ak p r rt rai�":,gS.�sa-4z.�-,.- :st)7.�� � k 4`?7, s :,! � i i .tK,_!. _a. Jun. 30. 2020 9:05AM ALTERNATIVE WEATHERIZATION, INC No. 5311 P. 1 ALTERNATIVE NOPW WEAfHERIZATION BUILDING D Epr. JUN 3 2020 TOW'V OF.BA81VSTABLE bate:Town of Barnstable 200 Main St. Hyannis,MA.02601 Re:Permit# Villa`g e. The insulation/weatherization work at-CJ✓'� _ l + has been completed in accordance with 780CMR. Regards, Timothy Cabral, President CSL-105454 58 DICKINSON STREET I FALL RIVER,MA 02721 1 (508) 567-4240 1 ALTERNATIVEWEATHERIZATIONOGMAIL.COM � Town of Barnstable n Building s Post This Card So That rt is Visible From the Street A proved Plans.Must be Retained on Joh.and this Card Must be Kept,_ tAE. 'fABIL*, ,.� " Posted Until�Finahlns ection Has'Been_Ma Where a Certificate of Occupancy is Requ�retl,such Building sha11 Not be Occupied."until a-Final'In Permit spection has.been made Permit No. B-20-461 Applicant Name: ALTERNATIVE WEATHERIZATION INC. Approvals Date Issued: 02/18/2020 Current Use: Structure Permit Type: Building-Insulation--Residential Expiration Date: 08/18/2020 Foundation: Location: 33 JOHNNY CAKE ROAD,CENTERVILLE Map Lot: ,210-048 Zoning District: RD-1 Sheathing: Owner on Record: BEATON,JENNIFER ,° Contractor Nae ALTERNATIVE WEATHERIZATION Framing: 1 _ INC. 2 Address: 33 JOHNNY CAKE ROAD' ,, , CENTERVILLE, MA 02632 . ,,Contractor License 175683 Chimney: Description: Insulation/weatherization Est. Project Cost: $0.00 Permit Fee: $85.00 Insulation: Project Review Req: Final: Fee Paid: $85.00 Dater 2/18/2020 r aj Plumbing/Gas " Ga 10 Rough Plumbing: Final Plumbing: "Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicationand the;approved construction.documents for which this permit has been granted. :Final Gas: All construction,alterations and changes.of use of any building and structures shall be in compliance with the local zoning by-laws and codes.. This permit shall be displayed in a location clearly visible from access stre Y`or road and shall be maintained open fogy public inspection for the entire duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures"by the Building and Fire Officia are provided on this permit. ls Minimum of Five Call Inspections Required for All Construction Work - x Rough: 1.Foundation or Footing 2.Sheathing Inspection- Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall notproceed•until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department' Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application number... ..... �. ......................... Date Issued................ ��,�,� ` TOWN OF BARNSTABLE Building Inspectors Initials..... . Map/Parcel............. ..'. .................................. TOWN OF BARNSTABLE - EXPEDITED PERNUT APPLICATION: ROOF/SID1NG/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFFORMATION Address of Project: _ il/! C�%�/G� rP�_7 6 l NUNWR STREET VILLAGE Owner's Name.,Jell � 7� Phone Number /� - a. a Email Address: Cell Phone Number SCANNED FEB 16 2020 Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ,//�1IDIA.4 eV72A_/1'#7L, to make application for a building permit in accordance with 780 MR Owner Signature: dd a,r,� Date: TYPE OF WORK ED Siding ❑ Windows(no header change)# Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's nameAAA&774_�ve_ a e-A 66 Home Improvement Contractors Registration(if applicable)# f�J'� �,� (attach copy) Construction Supervisor's License# /[�J 7J�'� (attach copy) Email of Contractor aJfi r`/ lie zi,7 t, Phone number �gf-5Za7 WYP ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. VAPPLICATION NUMBER ` 1 { *For Tents Only* Date Tent(s)will be erected Removed on ` ' number of tents total Does the tent have sides? Yes No yes please.attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. 0 3�E/�/' A3% . Iil;S ! Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICOT9S SIGNATURE 17 J( Date o7 f� v Signature _ All permit applications are subject to a building official's approval prior to issuance. I SHE Tp�y y� Y Town of Barnstable a Building Department Services BAREN BLE, MASS. �]639. Brian Florence CBO 9�pA Brian TFu M A°' Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 _Property Owner Must Complete and Sign This Section If Usin4 A Builder I, Jennifer Beaton , as Owner of the subject property hereby authorizeAk''11.6,,71l Z , j��;�h to act on my behalf, in all matters relative to work authorized by this building permit application for: 33 Johnny Cake Road Centerville (Address of Job) Sign of Owner Signature d Applicant Print Name Print Name Date The Commonwealth of Massachusetts = Department of Industrial Accidents - 1 Congress Street,Suite 100 Boston,MA 02114-2017 b`ee www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET - City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.P I am a employer with 16 employees(full and/or part-time).* 7. F1 New construction 2.M I am a sole proprietor or partnership and have no employees working for me in $• O Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition • 4.r�I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole ' l l.E:]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance 3 13.[:]Roof repairs 6.F-1 We are a corporation and its officers have exercised their right of exemption per MGL a' 14.❑✓ Other INSULATION 152,§1(4),and we have no 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. 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. Insurance Company Name:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#:XW058867158 Expiration Date:06/07/2020 Job Site Address: 33 , A/7/7 City/State/Zip: Attach a copy of the workers compensatio olicy declaration page(showing the policy number and expiration da e). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify under e s and alti s of e ury that the information provided ab ve is ue and correct Signature: Date: Phone#:508-567-4240 " Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector,5.Plumbing Inspector 6.Other Contact Person: Phone#: i D/YYY1� q Ram CERTIFICATE OF LIABILITY INSURANCE DATE(MMID(MMID19 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 have ADDITIONAL INSURED provisions or 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 NAME: Anthony F.Cordeiro Insurance Agency a/c"No Ell: 508-677-0407 A/c No: 508-677-0409 171 Pleasant Street E-MAIL Fall River,MA 02721 ADDRESS: HSouza@Cordeirolnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL 5UBK POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR - - PREMISES GE T'JEa occurrence $ 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE . $ 2,000,000 POLICY"PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 HOTHER: - $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED x SCHEDULED Y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED - PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident x UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $. 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION - .PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ '500,000 C OFFICER/MEMBER EXCLUDED? Fn� NIA XWO58867158 06/07/19 06/07/20 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS.. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT x r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i / Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const` ltup rvisor CS-105454 - s�ires:05108/2021 TIMOTHY CARAL 68 DICKINS01 STREET+ FALL RWEIR��,�,�, 027 1 Z r Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvem ntractor Registration Type: Corporation ALTERNATIVE WEATHERIZATION, INC. z 1 W1 Registration: 175683 2 LARK ST Expiration: 05/28/2021 FALL RIVER,MA 02721 s.: Update Address and Return Card. SCA 1 A 2OM-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYP�E:aComoration before the expiration date. If found return to: on Registrati Expiration Office of Consumer Affairs and Business Regulation R, 5G83 '�05/28/2021 1000 Washington Stre -Suite 710 ALTERNATIVE,j rRI A1ilON,INC. ton,MA 02118 TIMOTHY CABRAL. 2 LARK ST ����%� ��•� ' FALL RIVER,MA 02721 Undersecretary Ot V WIthOU signature t l Town of Barnstable �ermtt(#'� OCI pir My,` P O Expires 6 ntonUrs.jr�Iuedare Regulatory-Services Fee � gpRYSrpBLE, i Thomas F. Geiler,Director Building Division Tom Perry, CBO, Building Commissioner =F ` 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Off-ice: 508-8624038 3 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - A RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Nunber cb Property Address � � (.e i j+e f Nr esidential Value of.Work (� Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address de n e"G Contractor's Name \\ i tI n� \�� ,� I.l Telephone Number Home Improvement Contractor License#(if applicable)' A Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance C eck one: �PRESS PERMIT dill I am a sole proprietor AUG 4 2��0 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSWLE 'Insurance Company Name s 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 to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) _.. #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. e A copy of the Home Improvement Contractors License & Construction Supervisors License is required.' , SIGNATUR - - Q:\WPFILESTORMS\ din rmit forms\EXPRESS.doC - Revised 072110 /, The Conintorriveal'thr.of Ma ssachjusetts - Department o,f 1ridustrial Accideratr � x OF ce of Investigations. _ 600 Washington Street �. Boston, M4, 02111 �- ww w.wass govIdirr 'Workers' Compensation Insurance Affida-vit: Builders/Contractor-Alectrici ins/Plumbers Applicant Information `I Please Print Legibly Name(Businew'OrganizationfMviduai): Addrt.ss: IXA IQ Cityfstate./Zlp: 0-gjq Phone Am you an employer?Checck the a propriate box. Type of project(required): 1_❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. New constnution eBrployees(full and/or part-time). . 2 I am a sole proprietor or partner- listed an the attached sheet. 7- 0 Remodeling ship.and have no employees These sub-contractors have g- ❑ Demolition , vvrorking :for the in any capacity- employees and have woricers' . [No workers' comp.insurance . , comp,11.1 ? . 9. ❑Building addition required] 5. ❑ we are a corporation and its 10.0 Electrical repairs or additions 3.❑ :I am a.homeowner doing.all work officers have exercised their 11..0 Plumbing repairs or additions myself [No workers'camp, right of exemption per MGL 12.0 Roof repairs insurance required.]? c. 152; §1(4),and we have no employees.[No workers' 11El Other. comp.insurance required.j. *Any applicant that checks boat#1 mast also fill out the section below showing their workers'compensation policy informstion- I IlGnO when who submit this affidavit indkating they are doing all woA and then hire outside camtaactnrs must submit a new affidavit indicating such. (Contractors that chec this boa must attached an additional sheet showing the name of the sub-amtractors and state whether or not those entities have employees. If the sub-cantcactors have employees,they.mast provide their workers'comp.policy number. I am an employer that is providing twarkers'corrr nsafian insurance for arty employ-ees. Below is the policy rind job site information insurance Company Name: Policy A or Self-ins.Lic.A: Expiration Date: Job Site Address: CityfStateaip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and emph-ation date). Failure to secure coverage as required under Section 2.5A of NfGL 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 hem ky certify ar the r s an penultias of peVitty that the inforrnatian provident a.boue is true and correct Si tore: ..- Date:-. Phone#: official use.only. Do not write in this area,to be completed by�city'or town officiaL City or Town: PermitlLicense# 4 " LBoard ority(circle one): ealth 3.Building Department 3.C ty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on: Phone#: P of r►+F rq� BARNMBLE. ' 639. Town of Barnstable prF�MAC A i. . . Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 \ www.town.barnstable.ma.us Office: 508-862-4038 { _ Fax: 508-790-6230 Property Owner Must Complete°arid Sign This Section',, If Us in' A Builder I, ►rl1 U as Owner of the subject property J hereby authorize h t ,k f) CC ��" to act on my behalf, in all matters relative to work authorized by this building,permit application for: (Address ofYob) t Si atur Owner Date Print Name Y �. IT Property Owner is applying for-permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 HETo Town of Barnstable Regulatory Services jaAJAS& Thomas F. Geiler, Director 16 9..�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5D8-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 0 number street vi]age P ` HOMEOWNE �� R' �� �J Or s ` UC� me ''\\``-- home phone# work phone# CURRENT MAILNG ADD S; 3 �vlN 1n h -& ) Ue_ /town state zip code The current exemption for"homeowners" extended to in ude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire w oes not ossess a license, provided that the owner acts as supervisor. I TION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she re s or intends to reside,on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures acces ry to h use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a omeowner. h"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she sh be res onsible for uch work erformed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes resp risibility for compliance with the State ding Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies at he/she understands the Town of Barnstable Building D rtment minimum inspection procedures and requirements tad-+hat will comply with said procedures and requirements. o e Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building e 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 072110 /�aavczcLutta !a expiration date. if found return to: of Building Regulations and Sfandurds I License the expistration valid for individndardsonly Board b Regulations and Sta Board of Building Reg HOME IMPROVEMENT.CONTRACTOR One Ashburton Place Rm 1301 Registration 162081 Tr# 279746 iraUon -1/14/2011 Boston,iv1a.02108 Exp_ it c: . I i Type Individual x 7 1 QAVIQ WILCIAM RICHARDS III 'trp ? DAVI.D RICHARDS ft j not valid without signature. .636 COTUIT RD Admi listh-ator { MASHPEE,MA 02649 ` _. Massachusetts- Department of Public Safety 4 Board of Buildin!� Rculatwns ltnd Standards Construction Supervisor License License: CS 101506 --=--- P Restricted to 00 ...' DAVID RICHARDS' :. 436 COTUIT RD MASHPEE,"`MA 02ti49 Expiration: 1 1/291201 2 Tr#: 101506 ' • r Rood Oeh a Lk1+,eoo Oc _ gent PH cum U6 r 3 AXI Q P Neu kei d i d l _ / a I � 1 + ` i _ -- 10, 7 - - fJr� i c MORTGAGE INSPECTION PLOT PLAN r ZOO 0 � • 9 APRACA k wr fB `b . 1.aT 51 tot' $� v° � *33 � A 44,e° _ i � �,a-� SOH>'�PIY C�►10E,.¢aCA® "'_—'►�" f e �� ,��.��_• c �� cam_...._,._?�- ,� SCALE VA w'8® . REGISfiERED LAND SURVEYOR, DO HEREBY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION PLOT PLAN WAS PREPARED FOR IN CONNECTION WITH A NEW MORTGAGE AND IS NOT INTENDED OR REPRESENTED TO BE A LAND OR PROPERTY LINE SURVEY. NO CORNERS WERE SET. IT CANNOT 6E USED FOR ESTABLISHING FENCE, 'HEDGE OR BUILDING LINES. NO j RESPONSIBILITY IS EXTENDED HEREIN TO THE LAND OWNER OR OCCUPANT. IT IS NOT INTENDED TO BE RECORDED. ' P.J.CONNORS. & ASSOC. oaar,�� CIVIL ENGINEERS--LAND SURVEYORS o LEWIS LEGAL A DESCRIPTION: >B 7 ®i4 33 HOWARD AVENUE �OLZINAN ` �! .� RANDOLPH, IIA. ,02365 �No.7817® & TELEPHONE (617) 963-0334 ���, FG �� � ADDRESS: ° r-ACSIMILE (617) 986- 0047 PURCt1ASER: ® y L THE LOCATION OF THE DWELLING AS SHO" HEREON IS IN COMPLIANCE WITH SUBJECT PROPERTY j M.- = Th'' KCAL APPLJCA ' ZONING BY-- LOCATED IN A FEDERAL INSURANCE IN EFFECT WI- CONSTRUCTED, ADMINISTRATION DESIGNATED ---. 3ESPFCT Tr .ONTAL 1)"Irl°.,,ANAL FLOOD HAZARD AREA, 01/27/1995 02:58 1-508-790-6230 BARNSTABLE BLDG DIV PAGE 04 ` Tije Cammanusealth afAf wachu ens t*.i. ter Departine�/r Of I ndaurial Acridt nn� 42 ; _ 1 i .Md1 mom XMION.Main 02111 Workers'Compert>wtion fouruee AMdavit �nnllcrtnttormation _ . n► Thnymas leeminn• 13 Johnny A1LCeltv lQcl C �Ek vi,l S?9--1Y33 I am a homeowner performing all work myself. p 1 am a sole proprietor and have no one working in any capacity L= ' ,,,'"'a . I am an employer providing workers' compensation for my employees working on this job. MMUM Ram etn'• hone a ' r M1. O 1 am a sole proprietor,general contractor,or homeowner(ehrle one)and have hired the contractors listed below who have on the following workers'eompensation polies: 3C name! addrem �hi• nitiewa� _ ______ — insurance to- MddMqJf 1,��-s:�: .«er:,Y..�.. �.. -. wv�eu'.a..•J�+�'+"r.�'t �'�"'��. -- --- -- -- ----- ------- �7_!�tiL711{�7 �u - --- - Cif nhane tt: — ina�mlif� ee1 N • . '' w� :Attach addidii6al'sheet if tieeasa »•: �' >" dr::t:.� Failure to secure ca.•crnoc as required under Section 2SA of MGL 152 can teed co the imposition of ainda d pnnaltin ors lice op to 31d00A0 and/or one rears'ltoprisonmear as wcil as civil penalties in the tbrm of a STOr WORK ORDER and a fine of 3100A0 a day apissrt me. r understood that a min,of this statement ropy be forwarded to the Otlice of to.cstiltadoos of the n1A tar eenrW•et'tt adel. I do hrreAr care under the pains and penalitai ojperjtrry that the in jammiar ceded a mw/s trot sad corrm r 5'9S"3 Print name �, e ti n i 1"l? fi3 P _, l�S Rloae if,5 �i-/�13 3 y-9� _77f J-__:dIY use only do not.trite in this area to be completed by titp or Cora official wra• perodtAkan N r'�Sulldttt0 Department (jUccadn0 tlaard if immedlate response is required 13$OKtan's OQlcc tcrsour PbMN4 Uthcr used 3.195 P)A1 - 01/27/1995 02:58 1-508-790-6230 BARNSTABLE BLDG DIV PAGE 05 The Town of Barnstable . NAM Department of Health Safety and Environinental Sernces Building Division 367 Main Stioet,Ills MA 0=1 Ralph Cream:# Offi= 303-790-M7 Bw1dwg Commis Fare 308-775-3344 for office we Only Permit no.- Date AFFIDAVIT SOME WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL'a 142A requires that the"R=nstrocdO .altaadwM raauvsdOW rq=.modaaixadox Wuyersi irrtprvvem .removal. demtolitigm or aoostrncdon of as additive to any pm-a ilemg ac�j zood rd building communing at least ome but act morn than four dwelling emits or to Sae C=15 wfdch me cent to such residence or building be done by re$staad coamotors.with ccmin cw*doas.along vh&Other oU Type of Wark Iqe - fZoo� GIOl t � Y Est. Coat (000 Address of Wark: Owna.Natrrr. rl i t d3e.� F n 76 mc4s Date of Pandt Applications: I hereby astifv that: . Registration is not required for the foiloaing reason(s): Worst excluded by ltiw Jab walff SL000 Building mat oMneroo�iod puftg am Pali# Notice is hereby even that: OWNERS FULLING?HEIR OWN PERMIT OR DEALING WrM VI�ItEGIST�CONTRACTORS . FOR APPLICABLE HOME IMPROVMAENr WORK DO NOT ARHII'RATION PROGRAM OR GUARANTY FUND UNDIIt MGL c I4?�A RAVE ACCESS 'I�0 ME SIGNED UNDER PENALTIES OF PERnMY I hereby apply for a permit as the agent of the ownw. Date Cone cm" me RcZm=tiun No. OR n,.. owner's n=e • TOWN OF BARNSTABLE BUILDING DEPAiTMENT HOMEOWNER LICENSE EXEMPTION Please print. Job LOCATION 3 Number eet address Section of town "HOMEOWNER" • . .---- - �•- -S4s.3 5-3 9-%/ NavA Home phone Work phone PRESENT MAILING ADDRESS •:� City town State Zip cc The current exemption for "homeowners" was extended to include owner-occi dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owne: acts as supervisor. DEFINITION OF HOMEOWNER: Person(sl who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwell-4 attached or detached structures accessory to such use and/or farm structt A person who .constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"- shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resuo for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and'requiremE: and that he/she will comp with said procedures and requirements. HOMEOWNER'S SIGNATURE ) APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State Building. Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for ahch�. bu: permit is required shall be exempt from the provisions of this sectic (Section 109.1.1 - Licensing of Construction Supervisors) ; provided i Home Owner engages a person (s) for hire to do such work, that such He shall act as supervisor. " "*,�, , Many Home Owners who use this exemption are unaware that they are as: the responsibilities of a supervisor (see Appendix Q, Rules and Regu for licensing Construction Supervisors, Section 2.15) . This Pack of often results in serious problems, particularly when the Home Owner Y unlicensed persons. In this case our Board cannot proceed against tl inlicensed person as it would with licensed Supervisor. The Home Owr. as supervisor is ultimately responsible. t. .•. To ensure that the Home Owner is fully aware of his/her responsibilit communities require, as part of the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. r care to amend and adopt such a form/certification for use in your cos gmeering Dept.(3rd floor) Map ( 0 Parcel fir Permit# House# j 3 ��� Date Issued LZ Board of Health(3rd floor)(8:15 =9:30/1:00-4:30) ,4 - -1 Fee E-,dt Conservation Office(4th floor)(8:30- 9:30/1:00--2:00) SEPTIC S Rq.;)5 J Planning Dept.(1st floor/School Admin. Bldg.) INSTALL PL6A4 SCE 7y" pproved by Planning Board 19 TOWN OF BARNSTABLE j Building Permit Application Project St'reee�t Address Lp was Village lid y1��� ✓ Owner Jen n►.fie;— 66CL-b h 7 1* 3 Address 33 l hywl cl,. ( A 96( Telephone "?�0-69�'3-/fitvt V.Iso S3 /Y43 F) Permit Request ,Do'y Kn t Y. Re- it ob P First Floor square feet Second Floor square feet Construction Type � Estimated Project Cost $ , , cro(). Csy Zoning District Flood Plain Water Protection Lot Size H-C✓e S Grandfathered .❑Yes ❑No Dwelling Type: Single Family Q-' Two Family ❑ Multi-Family(#units) Age of Existing Structure qb V Y"5 , Historic House ❑Yes J4 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: XGas ❑Oil ❑Electric ❑Other Central Air ❑Yes 5(No Fireplaces:Existing I New Existing wood/coal stove ❑Yes L*JNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ,None Shed(size) $ ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# 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 % BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. t�I ; DATE ISSUED MAP/PARCEL NO. r r � ADDRESS` F : VILLAGE r _ OWNER DATE OF INSPECTION: i FOUNDATION 1 FRAME! INSULATION _ FIREPLACES - ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH ' FINAL GAS: ROUGH FINAL _ r 'FINAL BUIWING DATE CLOSED OUT ASSOCIATION PLAN NO. k 5 , ll $ .4.. YL."^'SAC....--. :.. !`� �, y.r,. !�°��y.. .at 3 '�,r,' �C '^'Y' •#� �.rk"�," _ .f'c..,-. v`Y., ��w.�. .,..^r -.. ,.mrr „ ,, ._ .,.. .. .�". s_ ,..: y..w<.r .•i::. '}'-.._„ ,� _j,.. 4. ii ..y+,..' -r iT.r �,q�%"5.1F-ra. :7'. 3 �• '- � h..:�' "� .Y.<:. ,. �y n.... t. b 'If vn, r�: 14 5, h _.v� I. - - "A- -.�.�3 -0 �., ,'+�'�'. :x. . a ... .. �.:.ry ..... «� ... {+ Y '$ ✓e-. _- .. -.:r, ....,:r... --'.s � .r.V;�. a ..._. . ,.. ..- �A x x, s ->l'^w `7 ,�� -w..r � -Q7 ' ... ,< -. a cse.,`,Z.'�' ,_�.. ( :1' ( ,_.. $, ;ew. `i4 'rF'''' .� '.i"�j" •. � -+Y;�. t y `� .l I C � �1 t � 4...\ .,..�..� i, ,, ��—��__ a �� ', t. r ,, �� t �. . -., �� C x �. Assessor's 'map and lot number ....... .. .. ................ ,. SEPTIC SYSTEM MUST BE K. INSTALLED IN COMPLIANCE Sew_aa Permit number g ..,.: �........./. °�,.',....:..:. ! WITH ARTICLE II STATE M , " 'SANITARY CODE AND TOWN ofT�ETo� BAR1 '7*T!XBLE } Z BA"i ABLE, AG` y; RUIL"DING INSPECTOR. 00 i679• '. ' C' C1 CLU a O /�.v1 AP?PLICATION FOR PERMIT TO. .. /L :....:..............r.. �� ..... . ....::...(............................... TYPE OF ,CONSTRUCTION. .. 4.:b.1.7..... ..:. :..................................................................................... ................t4 .........19...1� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...............-.' .....SU!�1 �(1 .....�A 4..... ............ `M.v�1.4�,........................................................... Proposed Use ,........ e'� Zoning District .:... .i........ .�`1 ,....................................................Fire District .....4�............................................................... J Name of Owner�l r �1�� ..�Q 4� 4`?..� .........Address �..0 .... ..... Nameof Builder ..... .. . �.l-..........................Address .......:............................................................................ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .............CN\"R-.......................................Foundation N........................................................... Exierior ........ ............................................Roofing ............ ................................................. Floors ...........Q�,- . c...................:................................Interior .................................................................................... Heating ....................... ?c7..................................................Plumbing .................................................................................. Fireplace ......................... ?. ....................,...........................Approximate Cost 3?Uv_ ®O Definitive Plan Approved by Planning Board --------------------------------19--------. Area y� Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF,HEALTH Qj I hereby agree to conform to all the Rules and Regulations of the own of Barnstable regarding the above construction. nn Name ..........W ..... . i.C. ......... Beaton, Daniel E. Jr. 1 W-5 3- add 2nd floor No ............... Permit for .................................... XXXXXIf over portion of dwelling Location ............3.3...Johnny...Clake...Road............ . .... . ...... . ...... ................ Centerville ............................................................................... rt Daniel E. Beaton, Jr. t. Owner .................................................................. Type of Construction ..............frame...................... . ................................................................. .............. Plot .. ......................... Lot ................. ............ March 24 1 76 Permit Granted .......... .. .............J'•........19 '7 Date of Inspection ..... ........0*1/6)64 Date Completed ........ ...... ......... 19 PERMIT REFUSED ............................................................ 19 ............. .............................................................. .................................. ............. ......... ........... ............................................................................... ............................................................................... Appirovecl ................................................ 19 ................................................................................ ............................................................................... Assessor's map and lot number ..........2J. .......... 92 e age Permit number ....... .......................... It IN E TOWN OF' BARNSTABLE I BARES LE. NUB. 1639. BUILDING INSPECTOR A69 1k,1 APPLICATION FOR PERMIT TO .............F�-........................H......q....a...................................................... ,q/V7 14� TYPEOF CONSTRUCTION ............4n?..... .. ..................................................................................................... Ar. .............. .........19....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............................:�.................. ........................................................ o ...................0........................................................... Proposed Use ..... ............... ........................................................................................................................................... Zoning District ... District . .........)............................................................ .. .....................................................Fire .... Name of z-Owner . ......Addr`e'sss. ................................ _Q1, ......co N....... ............................................ K*"*** Q .1 4 -1 --)1RiA- Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............cyl\-R, Foundation .............�.p........................................................ ............................................. Exterior ....... ............................................Roofing .............(-.,.S ...................................................... Floors ......... ........Interior . .......................................... Heating .................... ...............................................Plumbing'Plumbing .............................. ...................................... ........... ..................................................... Fireplace ......................... .................................................Approximate Cost ......4.3.(�j 0.0...os�.................................. .... . . ... ..... .. ... ... Definitive Plan Approved by Planning Board --------------------------------19--------- Area .................................. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of theNTown of Barnstable regarding the above construction. Name ............. .......................................................... ............ Beaton, Daniel ,E. Jr. A=210-48' dd xx 2nd floor No ................. Permit for ..... .............................. over portion of- d llin g ermit for -'. . .. -�d....�m d llin g ........... e - W . ............................... .......... ..................................... Y C Location .......- 33 J nn. Cake Road �V� 9 ............ ........Y................................ nte v jl ... ..... .............. .......... ... ..?it�EYAN.......................... A Owner ................Daniel E. Beaton, Jr. .................................................. Type of Construction ............ K�MRI�................... ............................................................ Plot ................... at ............................... Permit Granted ...............March...........24..............19 76 Date.of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................. ..... .................. 19 . ................. ...................... ................. ...... ............... ............. ..................... ........................................ .................................................................................... Approved ................................................ 19 ............. ................................................................. ..............................................................................