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HomeMy WebLinkAbout0445 MAIN STREET (CENT.) n �a e �v a 1 F is j. • t o 0 a Town of Barnstable Building PostThis Gard,S,o That�t is,\lis�ble From"the Street, A r",oved";Plans MustbeReta�netl on.J,ob a`ndthis,:Gard Must�be Ke t �, MA.S ,.✓a,�.s'4 b', e iPosted Until'Final Irspection Has Been Made y as yam eaa+s Where aCeriificate,of°Occu anc is`Re, cared Fsuch'Buldm shallNot"be Occu ied"un#il-a=Finallns ct�onhasbeen ma`de:, ° Permit Permit No. B-18-2093 Applicant Name: THOMAS C.WHITE WOODWORKER LLC. Approvals Date Issued: 07/06/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/06/2019 foundation: Location: 445 MAIN STREET(CENT.),CENTERVILLE Map/Lot 208-089 003 Zoning District: SPLIT Sheathing: �� er a Owner on Record: HERBERGER,CHARLES TR Contractor fume - THOMAS C.WHITE Framing: 1 n WOODWORKER LLC. Address: 445 MAIN STREET _ £ Gontractor; icense 1772.83 2 CENTERVILLE, MA 02632 u� Chimney: Description: Window replacement(2), Roof F Est Protect Cost: $5,000.00 Permit Fe'e: $35.00 Insulation: Project Review Req: Fee Paid: $35.00 Final: . Ju� Date 7/6/2018 t Plumbing/Gas Rough Plumbing: <. A Final Plumbing: Y Building Official fr Rough Gas: This permit shall be deemed abandoned and invalid unless the work auth�onzed by this permit is commenced within six months afEeri"ssuance. Ir" 7 Final Gas: All work authorized by this permit shall conform to the approved application and thapproved construction documentsifforwhich this permit has been granted. All construction,alterations and changes of use of any building and structures shall be incompliance with the local zonmgby laws.and codes. •.�" This permit shall be displayed in a location clearly visible from access street or roa(I and shall�be-maantamed open for public inspection for the entire duration of the Electrical work until the completion of the same. a r r Service: The Certificate of Occupancy will not be issued until all applicable signaturesjby"the 6"I'l r g�and Fire Off cials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: 31 ., _ ` Rough: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department: ".Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �y - rj' V Application numbe ••••• Date Issued................ its a ' � � Bu'Iding Inspectors Initials..... .......... rq JUN 2 81018 map/Parcel....... .. ......... .................................... .................... M ' TOWN OF BARN9�ABLE EXPEDITED•PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /yT NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Numbers .�lGC3 G� ld Project cost$ �G7�C�, eats • Check one Residential t/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK change)#�� nslaonWeaheization� Siding Windows(no header" 0 Doors (no header change)# Commercial Doors require an inspector's review E Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name����li1 "S C ` Home Improvement Contractors Registration(if applicable)#— 72d (attach copy) Construction Supervisor's License# <j' (attach copy) AJ t- Contractor_ tx?o tC�= 'o� Phone number ®®�. v 3 ^0 Email�f C�i _Yo ALL PROPERTIES THAT HAVE STRUCTURES OVER.75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. �nrA#AI ,nern0111 Aoncnve► aFJ:n►tF d PERMIT CAN BE ISSUED. c APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If 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. s. Fuel Type Testing Lab Offsets from combustibles front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number I 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 i APPL ANT'S SIGNATURE Signature Date R , All permit applications are subject to a building official's approval prior to issuance. t lr The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov%dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElecctriciansPlee �umb bs Applicant Information Name(Business/Organizati on/Indmdual)' Address: City/State/Zip. a. Phone#: - v Are.you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.111 am.a employer with 6. []New construction have hired the sub-contractors 7 E]Remodeling employees(fall and/or part-time).* listed on the attached sheet. 2. I am a sole proprietor or partner- Tliese sub-contractors have g, []Demolition ship and have no employees employees and have workers' 9. Building addition working for me in any capacity. m�rce o workers'comp-insurance comp. 10:[]Electrical repairs or additions [N 5. ❑ We are a corporation and its required.] officers have exercised their 11.0 Phrmbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL MR]Roof repairs myself.[No workers'.comp•- a 152,§1(4),andwehaverio insurance required.]t 13.❑Other employees.[No workers' comp.insurance required-] spay applicant that checks box#1 must also fill out the section below sbowmg their workers'compensation policy information f Homeowners who submit this afdavit indicating they are doing all work and then hire outside side contactors must submit a new aff davit indicating such !Contractors that cbeck this box must attarbed an additional sheet showing the name of the sub-contractors and state wbether or not those entities have they mast provide their workers'comp.policy number. employees. If the sub-contractors have employees, �job site I am an employer that is providing workers'compensation insurance for my employees. Below is thep olicy information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: the policy number and expiration date). Attach a copy of the workers' compensation policy.declaration page(showing P P penalties of a Failure to copy o coverage as required under Section 25A of MCTL 0. 152 can lead to the imposition of criminal p fine up to$1,500.00 and/or one-year imprisonmen,as well as civil penalties in the form of a STOP WORK ORDER and a fine the violator. Be advised that a copy of this statement may be forwarded to the Office of of up to$250.00 a day against verification. Investigations of the DIA for insurance coveragerovtded abov is true correct: enalties of Perjury chat the information provided I do hereby certify u ih P p �� Date: Si ature: 7 ©�q9 Phone#: pfh eial use only. Do not write in this area,to be completed by city or town official Fermit/License City or-Town: ' # issuing Authority.(circle one): ]ISP1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbin 6.other Phone#: Contact Person: i ' Z 'Information and Instructions 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 id the service of another under any contract of hire, express or implied, oral or written." j An employer is defined as"an inliividual,partnership,association,corporation other legal entity,or any two or more of the foregoing engaged in a joint\enterprise,and including the legal repres ' es of a deceased employes,or the receiver or trustee of an individual,`partnersbip,association or other legal enty,employing employees. However the owner of a dwelling house having not more than three apartments and who ,esides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constrgcton or repair work on such dwelling house or on the grounds or building appu tenant thereto shall not because of mchfemployment 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 bmldings in the commonwealth for any applicant who has not produced acceptable evidence of compliancedwith the insurance coverage'required." Additionally,MGL chapter I52,§25C(7)sibtes"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until accepkable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting�thority," � t` Applicants Please fill out the workers'comp ensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addre'ss(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 cant'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 re to sign and date the affidavit The affidavit should be returned to the city or town that:the application for the t, or license is being requested,not the Department of Industrial Accidents. Should you have any questions re gar ' the law or if you are required to obtain a workers' compensation policy,please call the Department at the er 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 prime legibly. The Department has provided a space at the bottom _ of the affidavit for you to fill out in the event the Offi.e of Investig�tions has to contact you regarding the applicant, Please be sure to fill in the permit/license number w ch will be usedas a reference number. In addition,an applicant that must submit multiple permit/license applicatio in any given ye •,need only submit one affidavit indicating current policy information(if necessary)and under"Job S' Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officiy stamped or marked by the city or town may be provided,to the applicant as proof that a valid affidavit is on file f i future permits or lice-N es. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining[ja license or permit not related to any business or commercial venture i.e.a do license or permit to( B bum leaves etc, sand P ) person rs NOT required , complete this affidavit The Office of Investigations would like to thank you in advance for your coop 'on and should you have any questions, please do not hesitate to give us a call. 0 The Department's address,telephone and fax m nber: The COm1 manwealthi of Massachusem Department Of Industrial Accidents'' *-Ce oflayssiagatiam , 600 Washington greet; ; Bodup,MA 02111 Td.#617-72 4M ext 406 or 1-V7-MASSAM � Revised 4-24-07 \ax#617-727-7749 Www,mass. o�/d1a Town of Barnstable ' Building Department ,.s�arsresra Brian Florence,CB{? ass Building Commissioner 200 Main St- et,-Hyannis,MA'02601 www.town:barnstable:maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete-and Siam.Tbis.Section If Using A Builder ra C-Y- ;as Owner of the subject property hereby authorize to act on my behalf .in all mattets relative to work authorized by,this building pettait application for. (Address of Job) **Pool fences and alarms are the_ responsibility of the applicant Pools are not to:be.filled or utilized before,fence:is.installed and all inspections are performed and accepted. w 4 Signature of Owner Signature of Applicant . - Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS ` Rev:10/17 m. 1 a+ N C C M u ;° = (q __ t t d c } .„, y;;.. i�C� w m i /e vnuyruuer////�o ��fi/cWaac CC t �6flce�f�G'onsumer.Qflir�Rusmess�egu�ation c HOME IMPRGVEM�NT CONtRACTOR Registration valid for individual use only c O YPE:LLG i befgre the expiration date. If found return to: N i% f' � m - r Aegistration Expiration ' , Office of Consumer Affairs and,Business Regulation 10 Part,Plaza-Suite 5170 p� p` 11l21l2019 Boston,MA 02116 tb } M T HOMASC `A'H T{E�/�700D1NORKER LLC. CD CL 9 W Q O i { OMAS: WHITES i 1 - t CO .0 Q I.-J `' A1;5A MAIN ST. p c I ERViLI-E,MP. O?6323 S UnderSecretaly No# U U z CENra16L1 Without Signature Q : � o U H a U lip �t r Town of Barnstable *Permit#g-� ? _Lj6qq Expires 6 months from issue date �T '^ Regulatory Services Fee 16 a BAJRtNWAB 9� MASS. 1639. Richard V.Scali,Interim Director �� AlED MA't� � Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Va[id without Red X-Press Imprint Map/parcel NumberQ OG 08 1003. Property Address i lt� (1\�+�a—B IZ V ILL.r (A ' a ®Residential Value of Work$ (�C�0C7� Minimum fee of$35.00 fofwork under$6000.00 Owner's Name&Address Contractor's Name W3 \1���� Telephone Number�50 v�c� —Q 3 (I Home Improvement Contractor License#(if applicable) 1,7 7 y 3 Email_-_lW W co-O WO(M R ED Q FSl�) k)E Construction Supervisor's License#(if applicable) CS PP1 ❑Workman's Compensation Insurance , ` , " Check one: NOV 2 2 2017- Rj I am a sole proprietor ❑ I am the Homeowner TOW&I OF BARNSTABLE ❑ I have Worker's Compensation Insurance [7 G Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ® Re-roof(hurricane nailed)(strip shingles) All construction debris will be taken to`k, (� 1LWoC I ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors:J ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:. Property Owner must sign Property Owner Letter of Permission. A p of the Home provement Contractors License&Construction Supervisors License is e e , SIGNATURE: r , Q:\WPFILES\FORMS\buil mg permit forms\EXPRESS.doc Revised 061313 1 v 4 • Tti Town of Barnstable Regulatory Services . M,ABS $ Thomas F.Geiler,Director 16 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 Property Owher Must Complete and Sign This Section • If Us ing A Builder I, �Lt;w;:7 0C y� ,as Owner of the subject property hereby authorize y 7, to act on my behalf, in all matters relative to work authorized by=this building permit application for. 7 -(Address of Job) S' tore of Owner - ate Print Name - If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. « Q.F0RMS-0WNERPHRMW10N t i From: 11/22/2017 08:06 #081 P.002/020 CHARLES HERBERGER FAMILY REVOCABLE TRUST as amended'and restated THIS DECLARATION OF TRUST is entered into on the Aay of November, 2016, between CHARLES HERBERGER, of Barnstable County, Massachusetts, as Settlor (the "Settlor"), .and.CHARLES HERBERGER, of Barnstable County, Massachusetts, MELVINA F. BROCK, also known as BEBE BROCK, of Barnstable County, Massachusetts, and JENNIFER FADIMAN, of York County, Maine, as initial co-trustees (hereinafter referred to collectively as the "Trustee"). The Settlor originally created a revocable trust.by an instrument dated November 21, 2013, entitled the "Charles-Herberger, Family Revocable Trust." This new Declaration of Trust is intended by the Settlor to amend, restate, and supersede such prior instrument. Accordingly, the following is an amendment and restatement in its entirety of the "Charles Herberger Family Revocable Trust. All assets currently owned by the "Charles Herberger Family Revocable Trust" (or any similar designation)shall be controlled by this new Declaration . of Trust. WITNESSET14: The Settlor desires to create a trust to be held, administered and distributed in accordance with the provisions of this Declaration of Trust. Accordingly, the Settlor has transferred to the Trustee, and the Trustee acknowledges receipt from the Settlor of properties listed on the attached Schedule "A." -These .properties, together with any other property which_ may be conveyed to the Trustee subject to the trust hereby created, shall be held, administered and distributed by the Trustee, upon the trust and for the purposes and uses herein set forth. The trust initially created by this Declaration of Trust shall be known as the "CHARLES HERBERGER ' FAMILY REVOCABLE TRUST." ARTICLE I-IDENTIFICATION A. Children. The Settlor has no biological or adopted children;however, Melvina F. Brock, also known as, Bebe Brock, is'the daughter of the Settlor's late wife and the Settlor considers her to be his daughter. All references to the"Settlor's daughter" shall be to Melvina F. Brock, also known as Bebe Brock. B. Grandchildren. Melvina F. Brock, also known as Bebe Brock, has three (3) children, Jennifer Fadiman, Adam Brock and James Brock. The Settlor considers these three (3) individuals, Jennifer Fadiman, Adam Brock and James Brock, to be his grandchildren. All CH 1 1--rom: 11/22/2017 08:13 #081 P.017/020 ARTICLE IX- NO CONTEST CLAUSE , If any beneficiary of a trust created hereunder in any manner, directly or indirectly, contests the validity of this Declaration.of Trust or any of its provisions, or institutes or joins in, except as a party defendant, any proceeding to contest the validity of this Declaration of Trust or to prevent any provision hereof from being carried out in.accordance with the terms hereof, then all benefits provided for such beneficiary are revoked'and shall pass as if that contesting beneficiary had failed to survive the Settlor. Each benefit conferred herein is made on the condition precedent that the beneficiary receiving such benefit shall accept and agree to all of the provisions of this Declaration of Trust or any trust created hereunder, and the provisions of this Article are an essential part of each and every benefit: The Trustee shall be reimbursed for the reasonable costs and expenses, including attorneys' fees, incurred in connection v«th the defense of any such contest. IN WITNESS WHEREOF, the Settlor and the Co-Trustees have hereunto set their hands as of the date first above written. 04 CHARLES HERBERGER, 9e or an o-Trustee MELVINA F. BROCK, also known as BEBE BROCK, Co-Trustee JENNIFER FADWAN, Co-Trustee COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss. On the �--day of 2016, before me, the undersigned notary public, personally appeared CHART ES HERBERGER, proved me through..satisfactory evidence of identification, which was personal knowledge, to the person whose name is signed on the preceding or attached document as Settlor as - / tee, and acknowledged to me that he signed it voluntarily for its stated purpose. NOTARY UBLI My commission expires: C QaoLw i k, 2013 16 t-rom: 11/22/2017 08:14 #081 P.018/020 COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss. On the day of November, 2016, before me, the undersigned notary public,. personally appeared MELVINA F. BROCK, who proved to through satisfactory evidence of identification, which was to be the person whose name is signed on the preceding or attached document as Co-Trustee, and acknowledged to me that she signed it voluntarily for its stated purpose: JAMES TRASK Ng ARY PUBLIC Notary Public y commission expires: 6 _Z S'=A i Massachusetts ,�rryw fi` Commission Expires Jun 25,2021 Mk STATE OF= 1 'I CLSS RUM4j���-e (County) On the �)-�:*iday of November, 2016, before me, the undersigned notary public, personally appeared JENNIFER FADIMAN, who proved to me through satisfactory evidence of identification, which was cn� !T--) , to be the person whose name is signed on the preceding or attached document as Co-Trustee, and acknowledged to me that she signed it voluntarily for its stated purpose. KO3ARY PUBLIC ` JAMES TRASK commission expires: Notary Public _ Massachusetts Commission Expires Jun 25,2021 ,H 17 The Commonywalth of Massackusetts Department of Industrial Accidents O,,(j`rce of Insystigations 600 Washington Street y. Boston,MA 02111 wiviv.mass_gov/dirr Workers' Compensation Insurance Affidavit Builders/ContractarsiElectr n' s/Plumbers Applicant Information Please Print r 'bl Name(Busme)Drgauization,%dividaal): ®� A-s � rJLi�1 LT'� �.1 Q U_XQ1VC!A 1 —C Ad&ess: C;tyrstatrr L vcc� d 32 Pho #_ b S Are you an employer?Check the appropriate bGx- Type of project(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I 6_ ❑New construction employees(foil andlor part-time)*. have!tired the sub-contractors 2.W1 I am a sole proprietor or partner- listed on the attached sheet. y- Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp-insurariml 9_ ❑Building addition required.] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12..❑Rod repairs pairs insurance required.]T c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any appliciw that checks box#1 mast also fill out the section below showing ihea woisenO compensation policy infornntrien. Romeownels who submit ibis affidavit i dkxftg they are doing allwotk and then hire outside coutnwtors unost submit a new affidavit indicating such, f Contractors that check this bout must attached as additional sheet showing the name of the sab-camtwiDn aad state whether or not those entities have ' employees. If the sub-contractors have employees,they oust provide their workers'comp.policy number. lam an employer thatisproiMin .workers'congwisation insurance for itty employees. Below is the policy and job.site informadon. Iustuance Company Name: Policy#or Self--ins_Lic.#: Bxpiration Date: Job Site Address: City/State/zip: Attach a copy of the workers'compensation polio*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 rite up to$1,500.00 andror one-year imprisonment,as well as cMI 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 y cart; Wd h pants pettab7es ofPRejrtry that the ittformafion prmR a is � and correct Si Date: Phone#: c V [-O Official use only. Do not unite in this area,to be completed by citv r town official' City or Town: Permitllicense# Issuing Authority(circle one): 1..Board of Health 3.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector, 6.Other Contact.Person: Phone 0: 6 Dff'"ef�""zoracue � lP a �/j�aaeac�i�cJe ice onsumer air &Business egu ation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration 177 Office of Consumer Affairs and Business Regulation 11/21/2019 1283_„ _-:.. -......._., 0 Park Plaza-Suite 5170 THOMAS C. Boston M WHITE 1IVOODINORKER LLC. A 02116 THOMAS C.WHITE`. ti 415A MAIN ST CENTERVILLE MA o2632 Undersecreta Not Valid Without Signature ry: I ! Massachusetts Department of Public Safety Board of Building Regulations and Standards I License:: - CS 06 6 58 2 Construction Sup ervisor ISOr THOMAS C WHITE ,fir 415A MAIN ST CENTERVILLE MA 02632, //J��-- Expiration: Commissioher 03/14/2019 v6fficef�G'nsume�AfairsY&�usin '�tegu�ation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 177283- `__._ 11/21/2019 10 Park Plaza-Suite 5170 THOMAS C.WHITE.WOODWQRKER LLC. Boston,MA 02116 THOMAS C.WHITE 415A MAIN ST A CENTERVILLE,MA '02632._ Undersecreta Not valid without signature ry; Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 27 Parcel Application #. S6' Health Division Date Issued Conservation Division �vILDING DSOT:Application Fee Planning Dept. FES 1 Permit Fee Date Definitive Plan Approved by Planning Board s 20�r Historic - OKH _ Preservation/Hyannis 0F8AF?NS7-ggLE V1� lw �� 1 Project Street Address A Village����i1V lea W\v� cpa G1°2 Owner.Ct2c.�� Pri13r�16�� cA�leL`( Address Telephone Permit Request kwQ aCW-S 1k ' C AcAKjG�z w Re --'RCuqo y C �.145 T A ��l a Z�ttil S �� Tl�rz `3� C�17 So 1�v1`���D N. st r �IoLiS AAVR Roa' "' o' l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 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 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 U.new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ _. Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �( o,-Ak/vs CAJOo—t Telephone Number c`�D 9 9 3 Address L�l S lq ��'� ��� ` License# d a Home Improvement Contractor# �o�,c� Email Aww o©DWd VQd0&-J V'z'C`Norker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE F DATE c2 /S//'�L FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED r MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME t INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 600 Wasb&gtM i4eet Boston,MA 02HI tDFPi4LTI O=gVP/W7a Wcwlm& Cmmp2IIS3 ianInsur2nce Affidavit lkff{leFS/Cumft=w= kctr��.ersApplicantII Please Print E�ey Are you oat employer?fFteckthe apprapriate bay Type L❑ I ant a employer wig 4 ❑I am a general conf mctar and Type of project{req>za et _ ' employees(fall anlfor Paoi-fime).* have hired.the sub-coatactos G_ New 2. I am a sale pmptietw orpartnee- fisted car e arched s heet 7_ [ Reffiode g ship and have as emplosyees These sob-caafad=have � E]Dili Ewn w d-ng forme in any capacitg employees andhave worms' �,���,7�&qg,� [NO i4 od:ew ccIIIp-Trim ce COMP.iMSM 30 1 • . g. El'""• adelftica 1 5. ❑ We are a coaporafi=and ifs 10-❑Elecbical repaim er ad&ions 3_❑ I am.a h=wumer doing all work officers have esemised fheEr ME]Plnmbiagrepaiss or trdcftfiaus mysiel f[No waxk=1 omp- right of you per Me- a[:1 Roofrepaim kmranceregruimd-]i a 152,g1(4�and we lave no ti employam[Na WQdM& 13-E],o her cow insara=required] ;Amyspg&o�B�atr?zeds'�as�l�stalsafiIlon£tlre�aabeIox ffiesnmdces'm¢apenmfi++�pGHC3ri � # ner�s�u say-&9& tb y w dam Oval a A d nlim aaui&C t cam=.t MIIFMk a nezvafRft&mdirmin 5MdL TCaatmdocsffist azec3rtL¢s bore nsast armed sa sdditiana2 seer shaming thenameofthe SUIF-Cantctmmand St2tewhegm arnor tbase eo shams employees.Iftbe scb-cnnftxdumkxvz eniployea%due3' lrmttdde•figv aa�s•tom.P OILY nmulS- I oat arr eriipz*W;6Mtis pro VhUrfg Ivvrkers caaTetzsatirrrrt gasr_iratres fbr ury eaW&t' wea: $elow it thep rcp aad ph site- i�t,�ortaatioa . . Iastrta�eCotnpartyl�amP- `� . C Paficy or&f-im tic-a • uDafe_ Job Site Adds CifylStafp: Arch a copy of the warmers'compensatkapolicy'declaration page(shy the poficy number and expur"4 Sate}. Failnm fro serum~cDverage as required under Se Corn 25A.o€MJM-m lP—iaa lord fro the impossilion of criminal petialtaes of a fine up to$L 5OQOQ andlar one-geasimpdsonmeuk as well as civa penalties in fe form of a STOP WOR1K€RDERaud a i m Of I O$250M a day aggainst ffie violator- Be advised fiNd a copy of this statement maybe forwarded to tive of of Imredigatiams of the DIA for± =„w coverage o - I&kff,16Y cgr7 tic thir u far=a€nva pr"i&d �s hw oz d=rrect tR 1 S [Cont, at to only. 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Building Division , r '"� Paul Roma,Building Commissioner �`.� ; 200 Main Street, Hyannis,MA 02601 i� www.town.barnstable.ma.us 1 , Office: 508-862-403 Fax: 508-790-6230 i • HOMEOWNER LICENSE EXEMPnON . Please Print DATE: ` r;, JOB WCATION: number street t village "HOMEOWNER": .. name home phone# work phone#^ CURRENT MAILING ADDRESS: / ity/town state yip code The current exemption for"homeo ers"was extended to'include o er-occu ied dwellings of six units or less and to allow homeowners to engage an in 'vidual for hire who.does no possess a license,provided that the owner acts as supervisor. DEFIIdIT ION OF HO WNER Person(s)who owns a parcel of land on 'ch he/she reside or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attach r detached es accessory to such use and/or farm structures. A person who constructs more than one home ' a two-y - period shall not be,considered a homeowner. Such "homeowner"shall submit to the Building O cial o a form acceptable to the Building Official,that he/she shall be re onsible for all such work performed un the uildin ermit (Section 109.1.1) The undersigned"homeowner"assumes re ns ility for compliance with the State Building Code and other applicable codes,bylaws,rules and regul ions. ' The undersigned"homeowner"c s that he/she derstands the Town of Barnstable Building Department minimum inspection procedures an requirements an that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building OfficiLy Note: Three1 dwellings containing 35,000 is feet or larger will be required to comply with the State Building Code Section 1.27.0 Construction Control. / HOMEOWNER'S ON The Codeitates that: "Any homeowner perform' work for which a building permit is required .f shallbe exempt from the-provisions of this section(Section 09.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire o do such work,that such Homeowner shall act . as supervisor." Many homeowners who use this exemption are unaw re 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 e/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used several towns. You may care to amend and adopt such a form/certification for use in your community. Town of Barnstable Regulatory ServicesMAM ' Richard V.Scali,Director. & Building Division Paul Roma,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 Using A Builder C\ )c�r�-� �I -� ,s§ e-t �of the subject property hereby authorize ©` i')K � to act on my behalf; in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed an all final . inspections are performed and accepted. lignatur e of ignature of Applicant ; v, ,e—i via, B way- Print Name Print Name Dat Q:FORMS:OWNERPERMISSIONPOOLS i Office of Consumer Affairs&Business Regulatiod ''.EMP ROVFMENT.CONTRACTOR_ - $w.__0;',0stratidn: 83 Type;.. piration �IF� — ..LLC_- - THOMAS C.WHITE'tlCfQOMW_K€R LCC. ; �,THOMAS WHITE I4j'5A-MAIN-ST. I CENTERVILLE,MA 02632 Undersecretary j t Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066582 Construction Supervisor THOMAS C WHITE 415A MAIN ST CENTERVILLE MA 02632 e5' Expiration: Commissioner 03/14/2019 Construction Supervisor Restricted to: s of ay use group which contain Building n991 cubic meters)of Unrestricted- less than 35,000 cubic feet enclosed space. assachusetts possess a current edition oft on of this license: / iFailure to p. Code is cause for revoc MASS.GOVIDPS �r State Building inform at' visit:WWw DPS Licensing Shea, Sally From: Shea, Sally Sent: Monday, March 06, 2017 9:05 AM To: 'twwoodworker@verizon.net' Subject: ViewPermit, Permit No:TB-17-415 Hi Tom, We can move forward with your application once we have a full house floor plan with rooms labeled and areas being worked on shown: Much appreciated. Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. ` 508-862-4031 1 < M- AV\ � - w `. �111L®IN(�OET . TOWN 0f€3ARNSTQL DOMN Al R is t ut Y � - . : V AI r FINE r Town of Barnstable *Permit# -7 y NAP O� Tres 6 maalhs from issue-date Regulatory Services e . HA 9. �$ +^ Thomas E Geiler,Director d1le- Building Division OC� Tom Perry,CBO, Building Commissioner 200 Main Street,.Hyannis, MA 02601 ®`( www.town.barnstable.ma.us Oi'l ice,�. O62-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X=Press Imprint Map/parcel Number Property Address q s— (ws `-tRIFOET ['Residential. Value of Work o Ot�, Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address Cm Contractor's Name c ,L.G/ VV ("�'F Telephone Numbers TC S �L2 -to I lome Improvement Contractor License# (if applicable) Construction Supervisor's License# (if applicable) ��� ❑Workman's Compensation Insurance Check one: . gI am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) [A- Re-roof(stripping old shingles) All construction debris will be to_��4_1s_mz� �_4AUS ❑ Re-roof(not stripping. Going over - existing.layers.of roof) ® Re-side 7. tv �: ❑. Replacement Windows/doors/sliders. U-Value (maxiMum`.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:. Property Owner must sign Property Owner Letter of Permission. A of th ome Impro ent Contractors License is required. S 'NATURE: i 1.'"I'I-II.I-.S\FOIZMS\building permit forms\EXPRESS.doc Revised 100608 . r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + 600 Washington Street Boston, MA 02111 s• '�� www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print LeLTibly Name(Business/Organization/Individual): Address: City/State/Zip 1C; .jltZ t& Phone.#: S�0 C.-> Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . ` 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or parttier listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp. insurance comp. insurance.$ 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 I LE]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12 Roof repairs �5 i Mt,.J c 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. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: 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 tip 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 certi n r th am ndd alties of perjury that the information provided above is true and correct.ate. la / Signature: � © © D J? _ Phone#: m)^ c7 O U `�M a 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#: k . Information and Instructions 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 hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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, if necessary,supply sub-contiactor(s)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 permit(license 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 Qf ee of Investigatims, 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ..ofera'i-� Town, of Barnstable Reglxlatory Ser-t ices, -'� - f-' Thomas F.Geller,Director sscss _ ��, =b�¢ •�$ - BviIdin Division TFn g'O �rY Tom perry, Building Commissioner 200 Main Str=4.14yannis,MA 02601 wmlw-town.b a rnsta ble-m e.us Office: 508-862-403 8 Fax: 508-790-6230 'rape�rty 0 ' Cr Must CompXete-and Sign This section { If Usiiig A B uild.er 7 c H A R L :Is Owner or"the subject property' heteby authorize O to act on my behalf, in all matters relative to work authorized by this bnil4g permit application for jAds , (Address of Jo a / J /24- �� r Signature of Owner. bate C Print Narne -ifPr'operty Owndris applying for permit please complete the,Homeo'wnets License,. Exemption Porff on the reverse side. 4 fie � ,Zonusea �� ),trttrit nt Of 71777. Public 1#�4- V Office of Consumer Atia�rs&B mess iiegutattoa il. Massachuxstts yp{etlE IMARpEMEN .,CONTRAGz(tR Board of Suildin« Ie��ulations.tntl Stant4arcls a )strat)on;. #237U2 y Type . Construe#icon Supervisor Licence Reg E�cpiraUon 3/28I2013 DBA License: CS -6M2 �►pR LG lz Tt IpMAS C WHITE .. Thomas While r . r 41:5A MAIN ST h 4t5A Main ! r CENTERVILLE MA U2632 C�ntt'rv►Ite AAA 022 `, i3udersecreary s�. Expiration: 311412013 _. l-unun+sinner M License or;regestratron valiii for)narv)dui use only .�����a hefQre the exptrat<on date. if found return-to r ' r'x Q�of Consumer Affairs and�usmecs I`et . � ��ParkPlaza Sutte5170: � ` j ��toa,MA 02116: • o Totrd3i�;wtthout�egnature � x .r } pFTHE Tph'y Town of Barnstable *Permit p� Expires 6 months rom issue date ST,,B Regulatory Services: Fee S , 00 9 - Thomas F.Geiler,Director sbgp. a�0 e 'f 619. Building Division Tom Perry, Building Commissioner X: 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 MAY 1 2 2004 Fax: 508-790-6230 EXPRESS PEPMT APPLICATION - RESEAWYMOOMM NSTABLE Not Valid with otit Red X-Press Imprint Map/parcel Number, �y� -��3 Property Address UA , (DA� 2, Residential Value of Work 3000- O 0 Owner's Name&Address Contractor's Name - `�`'`'L`�� Telephone Number Home Improvement Contractor License#(if applicable) q � a Construction Supervisor's License.#(if applicable) a ._ ❑Worlanan's Compensation Insurance $ Check one: Ln Ln {� I am a sole proprietor ❑ I am the Homeowner - p °D ❑ I have Worker's Compensation Insurance rn Insurance Company Name Workman's Comp.Policy# 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 1;7y k 4 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exe pt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: roperty Owner mus gn Property Owner Letter of Permission. Home Im eme ontractors License is required. Signature Q:Forms:expmtrg Revise053003 I o�,HE Tom, Town of Barnstable Regulatory Services 1 ST7 M� Thomas F.Geiler,Director e 639- Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using A Builder I, v e-r'b e.r CJ tom' ,as Owner of the subject property hereby authorize 707 ?4 to act on my behalf, in all matters relative to work authorized by this building permit application for: -"reed Ce v-vi 11 e (Address of Job) "b Sig ature 0f Owne Date Me, i� 0 . �� et-bercea- Print Name Q:FORMS:OWNMUERMISSION • 711LC "rppy/y1)7,O4t1//Clll[IL Oy✓I�IQ�6d� \\ Board of Building Regulatidns and Standards _ HOME IMPROVEMENT CONTRACTOR Registro on; 123702 Exprra ron --3,/28/2005 ype lrrdvidual �,j { Thomas C Whitg",,N \1�If2 .R LLC j Thomas White - 415A Main St. (� Centrville,NIA 02632 -- Administrator i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map oc 09 Par el OF,?D©3 Permit# Z4 Health Division 1 D y Date Issued 2"02 ,v 2_ Conservation Division ZGzZMZ Application Fee Tax Collector ;7/e_ -0 Permit Fee GV 62 �/_>CP_0 SEPTIC SYSTEM MUST SE-Do.LG' e e Treasurer_ INSTALLED IN CONIPLIANC?—,; ,�-�e� Planning Dept. WITH TITLE 5 w 1{'���� Date Definitive Plan Approved by Planning Board ENVIRONFAENTAL CODE ANt. TC1V16tol REGULA,.IONS Historic-OKH Preservation/Hyannis Project Street Address . ¢5J M Ar l k) S k - Village L i�_7 PQ 1 Ll_�F_ Owner I+F— C (2 (�_,E(Z Address Telephone Permit Request l' l_ 0 /U i R C 0 C Square feet: 1st floor: existing Coo 11 proposed 2nd floor: existing l�C-o proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 71 SaO, a 0 Construction Type Et?A14E two d Lot Size /• �5 ✓SCR L Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �l Two Family ❑ Multi-Family(#un its) ) Age of Existing Structure ! 6,10 Historic House: 1 Ves ❑No On Old King's Highway: ❑Yes )No Basement Type: ❑Full drawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /_5"D 4 Z =A 1% Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 0 Half: existing ! r: news C3 Number of Bedrooms: existing 4- new O 1 Total Room Count(not including baths): existing new Q First Floor Room'Ciount _S' =5 Heat Type and Fuel: 0 Gas 2&Oil ❑Electric ❑Other � R- nj Central Air: ❑Yes A No Fireplaces: Existing �2 New 0 Existing wood/coal stove: Cl Yes ,fit No Detached garage:Kexisting ❑new size Z c,4(� Pool: ❑existing ❑new size N o Barn:O existing ❑new size 21J d Attached garage:O existing ❑new size /N 0 Shed:;A existing ❑new size 10 Xifi Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes a-No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �t� #i/5 W b--f/ TF Telephone Number Address S/4 /-1 4-1 N S e License# c S 0 Sg y/ L LZ—/7i A 02-6 3 y Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GCJ N d l�s /U S �� /L 1� ✓�L L SIGNATURE DATE /I/z-�Z� FOR OFFICIAL USE ONLY PERMIT NO. it <� DATE ISSUED - MAP/PARCEL NO. ADDRESS - VILLAGE , OWNER DATE OF INSPECTION: • t FOUNDATION FRAME f r J INSULATION FIREPLACE C 1 { ELECTRICAL: ROUGH= �_�xT FINAL -�•- - - ; � _ _ PLUMBING: ROUGH_ FINAL,, f 1 { S � • .• y.r .. GAS: ROUGH. I f FINAL FINAL BUILDING DATE CLOSED OUT- ASSOCIATION PLAN NO. X `� 1 J(�;-X &w���X Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 123702 Type: Individual Expiration: 3/28/03 Thomas C. White - Thomas White _ 415A Main St. Centiville, MA 02632 Update Address and return card.Mark reason for change. iii Address 1 i Renewal 7� Employment '7 Lost Card Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 123702 One Ashburton Place Rm 1301 Expiration: 3/28/03 Boston,Ma.02108 Type: Individual Thomas C.White Thomas White 415A Main St. _ , — Centrville,MA 02632 Administrator Not valid without signature ' g ��e �amwrcaivaea a�✓�Craaac6uraella 4 t BOARD OF BUILDING REGULATIONS - License: CONSTRUCTION SUPERVISOR M Number GS 066582 a +, Bvthdate 0 1/4/1954 l x; � Expires0'3/14%2003 Tr.no: 11690 Restricted 00 THOMAS C WHITE` _ 41'SA MAIN ST 33y CENTERVILLE, MA'02632 Administrator' "a�R`4-+s+^*�^ T pm*,+•�,-�,rr '-^,r ta . y^,.r,�,.., w-=?.,.r,,.�,.-� - . The commonwealth of Massachusetts --t Department of Industrial Accidents -_ - - Office 0117Yes11981fans - 600 Washington Street _- Boston, Mass, 02111 Workers' Com ensation Insurance A 5davi� / nn ocaticn• ' . 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' FaBure to secure eovera;e as requiredvnder SeetionZSA of MGL 1S2 can7ead to the imposition or erbrdnalpenalties ota ffittenp to 51,50Q.1)0 md/ar -, one years'implitontnent�srrll.asclvffpenalttesin�ofInvestigatipnsportheDlAiarcOerageveziticatioono. d0adapagattutmaltBtdersfsm>i4isita' . copy or this statementmay be forwarded to the Off `• - tr u •th - e-information-providednbnue_islcu�uucarre� -- .. I da hereby�erfifYu h ' cdtss-andpgn 'es-O p j Datev - :. Plion # r ' print name b�"� e . do not mite in this area to b e campletad by city or town. oflicialwe only - ' permithicense# [jBtndinglleoatrnent dtp or town - ❑Licensing Bawd ❑ elect;te`t s OSSce cantsctpers ow. ' Information and Instructions ens saceir husetts General Laws chapter 152 section 25 requires all employers to provi de wo serf another underanyati for tcoatract " an to ee is.defined as everypersoa ,nTi1 ees.._As quoted from comp te—`law ' _ ern P Y F&ie,'express or imp lie oral or ►n employer is defined as an individual,liartnership, association, corporation or other legal entity, or any two or more of foregoing engaged is a joint enterpation or other legal entity, emprise,-and including the Legal representatives of a deceased employer, or the receiver or se for 3.e fortee o£an individual=partnership,of employees. However the owner.of a .. Y,• swelling house haying not more thanthree apartramts and who zesides therein;•or the occupant of the dwelling house of ' soother who employs persons to do maintenance,construction orr d�aed to bean empl rk on suph dweMng house or onthe grounds or r. 3��g aFpuxtmant thereto shall not because of such employment GL chapter 152 section 25 also states that every state or local licensing he commonwealth for ency shall withhold an he ia plicaat who has M y P of a license or permiE.to operate a business or to construct buildings in t br not rodu'ced acthe ceptable evidence'of compliance with the insurance co�aactgfo=thueirerfoArsua�a e°nf ublic workuut�Z P of its political subdivisions shall enter into any P commonwealth'nor any p acceptable evidence Of comphance with the insurance requirements of this chapter have been presented to the contracting a4 Wrrl may. ,• .' .1 , • -'. • •• .. . ... • . 1 ...1. .' '�. ' +. , T:,.. . • • .• •y Applicants . Please fill in the wbrkers' compensation affidavit completely,by checldn.g the boxthat applies to your situatioa'and' ; ly�g company names, address and phone numbers along with a certificate of insurance as all affidavits maybe pP artmeut.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Dep '^ date the affidavit. The'affidavit should'be returned to the city or town that the application for the permit of licensIt e is not the D artment of Industrial Accidents. Should you have any questions regarding the"law"or ifyQu being requested, �P lease cZl aie Depai:tmeat atthe number listed below:: •aze requited,to obtain a viorkeis' campensatioit policy,p . . . f - City or Towns ^ -m'othe artmeat has rovided a space at the bottom . ete and ri ated legibly. The D ep p c 1 e that the affidavit is omp P Please e sus 'cant, Please b event Office of Investigations has to contact you regarding the apply - davit for you to fill out in the ev r _ v re' n" offs Y ...._,�.. � - um'��er,�Tfie y . .�. T 'cease iiwnber whichwilLbe'used as a tefeieace n . . uitlie. ermitlli .ae sure.to fill unless othei arrangements havebeenniade:' •r.,. -, the Departrnentby or would like to thank you in advance for you cooperation and should you have an 9uestions. . The Office of Investigations _, ,� >•.Y. please do not hesitate to give'us a caL PINE The T}epartment's address,telephone and fax numb er. �_,,... .. The'Commonwealth pOfMassachusetts , :..4. Department of Industrial Accidents • Otflce®t 1nYestlgagot►s • 600 Washington Street T__l_— AAf M111 .. �ZME T°� Town of Barnstable Regulatory Services saxxsrnstE. ' Thomas F.Geiler,Director v MAC`. � �pleD MA't0.- Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: Estimated Cost Address of Work: � �� GIN U L L E Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): nWork excluded by law ❑Job Under$1,000 []Building not owner-occupied El 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 R PENALTIES OF JURY I here y app y for a permit as the a o e owner: l C2- D to Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffi d ay. Assessor's map and lot number ,............................::........:..... Q�o%7NE Toy Sewage Permit number l.�.�!tP ,,.. ........ .... ..:....... INSTALLED IN DC)6���L �O�a< WITH TITLE ♦� � BAHBASeTADLE, i a Hoy�se number ................... ... ....................... NVIRONMENTAL DOD �� H g39• TOWN REGULATIGNS�O"pY°'. TOWN ,OF BARNSTABLE BUILDING INSPECTOR APPLICATION'FOR PERMIT TO UA;A:..: .. V........ ?'. C•A..V�............................................... I TYPE OF CONSTRUCTION :S nA ACD;.... '�Fo�M �1�wv !»�..I•(A „ a..l.. ...........19.R. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to- the following information: c .�• Location .. . 7...... � ....tw�.l.r..�-Crl.jt'.CAV1.{+A&W...t..'mA.r...d.;t.63.L.......................................... . ProposedUse; !4.�Q1 ... ...5 .e....................................................................................... Zoning District`s.. .�!.C, ....... ...Fire District ` T�,Q..t1.1A�.1C..". 'T .V.�. ........... 1 � . . Name of Owner !M eV..n.A.. C,� '.�.�P'C, ........Address ..��.al:•,` ..�11!)i?I.l. .r�?.�........L!�.nT�, ,. Akt Name of Builder- .4*Xk+W1;%rc..... �t.......Address .. �... 3......h'ea 5!�Z.. Wa`:1.................... Name of Architect ....fSpn. .......................... ........Address � f............................... Number of Rooms ....PA?....................:............................Foundation QU.4�.e+.e.Q...y.�v............ .3o.. Exterior W.*AT 4......0 ...OAA7..1.............. . .................. Floors ..0A(A.1 CC.... .........................................Interior . F.�' �S1�t.:. V. 0101hi Qf) Heating ....non..c..............................................................Plumbing ............................................................. Fireplace .... .,............................................................Approximate Cost �5��............ ............-•....................................... Definitive Plan Approved by Planning Board -----Y-----_--____-----------19------ . Area ................. �. ............... Diagram of Lot and Building with Dimensions Fee j l...y....:. SUBJECT TO AP ROYAL .OF BOARD OF HEALTH s a 330 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the T n of Barnsta 1e re ar ing the above construction. Name .... :. ............................. HERBERGER, MELVINA - 24284 Build Garage No .... emit for .................................... ... Q...Aw.�a,�, ng................ _ �+ Location 4.45 Main Street ......................... ... Centerville . ......... ^•M '. ................. elvina Herberger Owner ................................................................... - J 'r Type of Construction Frame �- _� 4 # + ........................................................... Plot Lot .................. .. ......... ' fir VI 4 :August 13,Y 82 Permit Granted .......1.............. ....... .......19 . a �eeG+ /� ' Date ofalnspectioj� ��� Date CompletedQZ.-. a9 ilk IQ W+ ' - .T .