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0773 OLD STAGE ROAD
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M1.. - - �p y v d R: j .�'•. !.�J -� n it -�u ' ,� ' .. 5 11)g PL' - ,- yG� �. i y �.. t I 1 Y o P e 4. - 'P - _.i iu ?'' p.. , .,•^I y .,{ _+r e' " ..r+.+ 'u ), - '. . ..j. r .�' ,)r 9 .Y y ..1'i .. , s: P . . r e e �r > s > n u _ 1 r r - n" t r + , n Y , , y " � .; 'A �� p, k _ ;� ,� aa;• .s, _ 'ter `�.a m s.,' '�::` •r � - y K _ x r.. r •. �y k K SL r , 4: S a . - s �44'1 z 4 a 1 l v a • • u F r_ f+ - r L • a b � O s o ' { . A e > n : 5 Town of Barnstable 'ME Regulatory Services OF _ Richard V. Scali,Director snxrtsrnai.E. Building Division 9� Mnss $ Tom Perry,Building Commissioner 1639• ♦0 10rEn ° 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79Q 6230 Approved.• _ Feb: Permit#: HOME OCCUPATION REGISTRATION Date: al Name: cr Phone Address: J Village: Ce V t y-T V I I l J V a Name of Business: `Ciii 1 4e( i G es 1 Type of Business: C��� a Y t vl Map/Lot:-. I 1 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the . following conditions: • The activity is carried on by.the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter; odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities: • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display_of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires;parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be. included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the d lling unit. I,the unders' ed,have read and agree with the above restrictions for my home occupation I am registering., Applicant Date Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 [Town Hall) DATE: 02 lf' Fill.in please: APPLICANT'S YOUR NAME/S: v. t?f �1. +1D ,I F' 1 BUSINESS YOUR HOME ADDRESS: 0 -- y- IR V �eii.i r�iPSr.�''q41I;ff.F'r: r' iEA _ ' TELEPHONE # Home TeleP hone Number 1> t7P .. NAME OF CORPORATION: C) y fl0 3 NAME OF NEW BUSINESS S i CeC TYPE OF BUSINESS ealv\l Yla IS THIS A HOME OCCUPATION? YES _>c } ADDRESS OF BUSINESS. O c� S-Fa -'C Y� wIVI�AP/PARCEL NUMBER I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of_Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this.town. 1. BUILDING COM�1:ha SIO ER'S OFFICE This individu *- L:IinfoFf�� ermit re uirements that ertain to this e of business.: y P tYPi Si at e** �1COMMENT / 1 2. BOARD O HEALTH This individual h b n!'pformec o h it recvdiFem2n that pertain to this type of business: - - Authorized Sin e** MUST COMPLY WITH ALL 9 HAYgitpOUS MATERIALS REGULATIONS a COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) . This individual has been informed of the licensing requirements that pertain to this type of business: Authorized Signature** COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Maps/ Parcel /6 Application # �.�' Health Division Date Issued Conservation Division Application Fee Planning Dept. `.` Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation / Hyannis - Project Street Address 77 cS f Village �i%,�i�'�, Owner zE%1�Gr» Cy . S'�' Address 6 '3;>e� r), .S r Telephone l..)t- �� �`7 7 - 7 f -,,2 � Permit Requesty �r/.� Square feet: 1 st floor: existing yproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater..Overlay Project Valuation _ BD OD Construction Type Lot Size 30 Grandfathered: ❑Yes Ao If yes, attach supporting documentation. Dwelling Type: Single Family. Two Family ❑ Multi-Family (# units) Age of Existing Structure 7 5 Historic House: ❑Yes 494 No On Old King's Highway: ❑Yes,1fNo Basement Type: , 9.Full ❑ Crawl ❑Walkout ❑ Other , Basement Finished Area (sq.ft.). Basement Unfinished Area (sq.ft)� � Number of Baths: Full: existing new U Half: existing new Number of Bedrooms: 3 existing e new Total Room Count (not including baths): existing 11� new First Floor Room Count Heat Type and Fuel: idGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes �No Fireplaces: Existing_ New Existing wood7coal stogy : ❑*s ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ]existing £mt� new size_ Attached garage:aexisting ❑ new size Shed: ❑ existing ❑ new size _ Other:--'t Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 00 Commercial ❑Yes ❑ No If yes, site.plan review# -Current Use :_ -- ---- - - - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� AG�y liy,,,,e D aS- C, Telephone Number, .5,pf 7,7- 7f °2 Address License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G %' _ DATE / \ . FOR OFFICIAL USE ONLY . } APPLICATION# ƒ < } PATE ISSUEDa t ` MAP PARCEL NO : { f ADDRESS VILLAGE / OWNER } ` DATE OF INSPECTION: . \ ! ,.FOUNDATION FRAME } INSULATION,' & � . - { FIREPLACE . } . , ELECTRICAL: ROUGH FINAL . ( PLUMBING: ROUGH FINAL \ . } GAS: , . ROUGH -,,-,, FINAL f FINAL BU|LDINq© . ; ~ :r JR DATE CLOSED OUT . & . . , � \ ASSOCIATION PLAN NO. x The Commonwealth of Massachusetts r f Department of Industrial Accidents ..� Office of Investigations 600 Washington Street Io l; Boston,MA 02111 www.mass go v/dia Workers' Compensation insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name{Business/organization/Individual): �����.� � r"Q C_vV,r Address: �t City/State/Zip: Phone #: ;O�r F re you an employer? Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors6' ❑ New construction ❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity._ workers' comp, insurance. 9. EJ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised thew 10.❑ Electrical repairs or additions 3.6 am a homeowner doing.an work 'right of exemption per MGL 1 LEJ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t. employees.[No workers' comp. insurance required.] 13.0 Other tArry 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 than hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub contiactors;and their workers'comp,policy information. 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. #: 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 undler Section 25A of MGL'c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fuze 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 cerli un%thepaL&nus andpenafties ofperjury that the information provided above is true and correct Si attire: Phone#: 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#: � M Information and Instr. tions Massachusetts General Laws chapter 152 requires all employers to provide w hers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the se ry ce of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corpo tion or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal re esentatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other Ie 1 entity, employing employees. However the owner of a dwelling house having not more than three apartments and ho resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, nstruction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because such employment be deemed to be an employer." MGL chapter 152, §25C(6)also tes that"every state or local 1' ensing agency shall withhold the issuance or renewal of a license or permit t operate a business or to con ruct buildings in the commonwealth for any applicant who has not produced cceptable evidence of com Iiance with the insurance coverage required." Additionally, MGL chapter 152, §2 C(7)states"Neither the mmonwealth nor any of its political subdivisions shall enter into any contract for the perfo ance of p b1ic work tR acceptable evidence of compliance with the insurance requirements of this chapter have been resent d to the co cting authority." Applicants Please fill out the workers' compensation idavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name ,ad&ess(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies LG1°c )i invited Liability Partnerships(L LP)with no employees other than the members or partners, are not required t ca,,,�r ye $work compensation insurance. If an LLC or LLP does have employees,a policy is required. Be a visEd that this aff avit may be submitted to the Department of Industrial Accidents for confirmation of ins ee coverage. Also be�sure to sign and date the affidavit. The affidavit should be returned to the city or town th the application for the pe it or license is being requested, not the Department of Industrial Accidents. Should y have any questions regarding e law or if you are required to obtain a workers' compensation policy,please alI`the Department at the number Iis ed below. Self insured companies should enter their self-insurance license a ai"on the appropriate line. City or Town Offici Please be sure that. e�affidavit is complete and printed legibly. The D.ep ent has provided a space at the bottom of the affidavit for y .0 to fill out in the event the Office of Investigations has t contact you regarding the applicant. Please be sure to filliin the permit/Iicense number which will be used as a referen e number. In addition, an applicant that must submit and tiple permit/licease applications in any given year, need only bmit one affidavit indicating current policy information% f necessary) and under"Job Site Address"the applicant should ite"all locations in (city or town)."A copy o.' e affidavit that has been officially stamped or marked by the city o town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new vit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any bus' ess or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this f davit The Office of Investigations would like to thank you in advance for your cooperation and should y have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The-Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.m,ass..gov/dia I oFTHE 'Town of Barnstable O Regulatory Services 4f� uxxsswste = Thomas F. Geller,Director Building Division ��ED µrat s` • Tom Perry, Bt fldfng Commissioner _ - 200 Mairi.Streef,_Hyannic�MA_02601- . ._.. i 1'1 wfv.town-b arasta.b l e-ma-us Office: 509-962-403 8 Fax: 509-790-6230 HOMMOWNER LICEI`'sE EXEMMON Please Print DATE: ��3/GQ�/�• , f Jos LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: l� E G J 79 s city/tower. state Zip code Tbc current exemption for"homeowners"was extended to include_owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as SlIpeIVISOI. - DEFA'ITION OF HOMMOVeNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family,dwelling, attached or detached stmctures accessory to such use and/or farm structures. A person who constructs more than brie home in a two-year period shall not be considered a homeowner, Such "homeowner"shall subimt to the Building Ofcial on a form acceptable to the Bolding Official, that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) Tlae undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that-helshc understands the Town of Barnstable Building Department rrri,,;rrn,,,,insvcction procedures and requirements and that he/she will comply with said procedures and c_--- - -�---__ r6qu r 8 — Signatirt-c of Homemvncr Approval of Budding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to canply with the State Building Code Section 127.0 Construction Control. ; HOMEO.WNER'S EXEMPTION The Code states that: "Any hcmwvincr performing work for which a building permit is required shall be excerpt from the provisions of this section,(Sectirin 1D9.1.1-Licensing of construction Supcnrisors);provided that if the homco`vner engages a person(s)for birz.m do such work,that such Homeowner shall act as supervisor h arry homeowners who use this exemption arc unaware that they are assurrang the responsibilities of a supervisor(see Appendix Q. R.ulrs&Rzgvlations fDr Liman ing Construction Superrisors,Section 2.15) This lack of awareness bftcn results in serious problems,particularly when the homeowner hirrs unlicensed persons. In.this case,our Board cannot proceed against the unlicensed persan as it wrould with i licensed Supervisor. 'Ibe horireowner acting as Supervisor is ultimately responsible. To ensure that the bDm=wmcr is My aware of Iris/her3rspDnsibrlltles,many communities require,as part of the permit application, . that the homeowner certify that hdshe understands the=,spmmibilities of a Supervisor. On the last page of this issue is a form currently used by several trams. You may taro t amend and adopt such a fm ✓certificaEon for user in your community, Q:forms:homeo:cmpt ' , THWE Town of.Barnstable a� ? Regulatory Services _MARL * Thomas F.Geller,Director 'Building Division '\ Tom Perry,Building Commissioner \� 200 Main Street,Hyannis,MA 02601�l www.town.barnstable ma.us Office: 508-962-403 8 Fax: 509-790-6230 Property Owne Must Co lete and Sign his Section f Us in A wilder I'• ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work a oriwd by this bud permit application for. (Address of job) Signature of er Date • P r , ame If Property Owner is applying for permit please complete the Homeowners License Exemption Form.on the reverse side. Q:FORMS:OWNERPERMISSIO?1 O ----------------------- e , �' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application 4cab Health Division Date Issued ,a 1 t Conservation Division Application Fee Planning Dept. .Permit Fee Date Definitive Plan Approved by Planning Board (29 12 / / Historic - OKH _ Preservation / Hyannis Project Street Address -7?3 Village CP KAP,r W Owner Cg er p, U C1A_r"ZIP, Address 7-73 S Telephone S S 7 7 i 74 Permit Request Ns�\u� o,� u.re ,� �r.� R 3� ce.ltvkase 0w1& A')&kkkc l R�'kC_ S�Alf COS '► BOA -l)Lr &0Of-s W 1r C No Q�e� �w rAQ l gib A-mscr�l� ��i L��5►�-�en� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District . Flood Plain Groundwater Overlay Project Valuation 4 b Construction Typea*4-rv-- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �, Two Family ❑ Multi-Family (# units) Age of Existing Structure L9-75 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 ` newer k co a Number of Bedrooms: existing _new 1 Total Room Count (not including baths): existing new First Floor Room Count k:J Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ... Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION I (BUILDER OR HOMEOWNER) r c(9n�51 Name C!! Pff C-O zJSL.,14+t00 Telephone Number S01- 27 5 - lc-N Address `f SS yA-rm 00-0, c4 License# 1 y �N,a is rrb�l. .29=(9�� Home Improvement Contractor# !53 S G 7 Worker's Compensation # uuc f�Da S 25q©2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /- FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE J ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING F w DATE CLOSED OUT ASSOCIATION PLAN NO. P � Tlr.e Gotnrnonwealth of Massaclzitsetls Y Department of hidustridl Accidents 1 l offsce'of Investigations_ 600 Washington Street w'Boston, 717A 02I.11 y www.mass.g'ovIdia Workers' Compensation Insurance Affidavit:*Builders/Contracto'rs/Electl-icians/Plumbers Applicant Znformat-iozz Please Print Leaibly Kamp- (Business/Organization/Individual): `TA�_C'f t Address: City/Slate/Zip: Phone #: Are you an employer?-Check th appropriate box, Type of project(required): am a employer with 4 �.I am a general contractor andl ei>7:ployees(full and/ofpart-tire):*• have.hired the sub-contractors 6 ❑New construction 2.❑ 1 ain a sole proprietor-or partner-. listed on the attached sheet. T. Remodeling shipand Have no employees These sub-contractors have - 8. [� Demolition working for me in auy capacity.• employees and have workers' coin insurance.$ 9. [ 'Building addition [No workers' comp. insurance � P• _ required.] S: [] We are a corporation aAd its 10.E Electrical repairs or additions 3.❑ I am a bomeowner.doing all work w officers have exercised their 1'1'.Q 1'ltizrtbing'repairs or additions myself. [No workers' comp. �u #right of exemption per MGL 12.[f Roof repairs- insurance required.] t c. 152, §1(4), and we have no ` ;emplo_yees:•[Noaworkers 13.[] Other(y,ea�ALIatI «` comp,insurance required.] ''Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Norncowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submif a new affidavit indicating such. 1Contraetors that check this box must attached an additional sheet showing the name of.the sub-eontracto'rs and state whcthmor not those entities have employees. If the sub-contractors have employees,they must provide their wokcrs'comp;policy number. . I ain an employer that is providing workers'compensation insurance formy employees: Below is the police and job site information , Insurance Company Name: /,t�-r� � __ �j�f,$Vll�li/! , Policy.# or Self-ins, Lic. #:. JIA�n Zs°1 .� .Expiration Date: �Obo R . Job Site Address: 73 (�1(>C 5 �' City/State/zlpnle dle MIA• 003�. Attach a cop), of the workers' compensation policy declaradoii'page(stiowing'the policy number and expiration date). Failure to secure coverage as required under Section,25A of MGL c. 152 can lead to the'irriposition of•criminal penalties of a fine up to $1„500.00 and/or one-year unprisonznent,ras 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-c y of this statement may be forwiarded to the,.Office of Investigations of the DIA for insuance'coverage verification. I do hereby certify u e pa' and penalfies ofperjury that the�inforrnation provided above-is true and correct. ". a a :) Signature: �' . ,. ' - - ' Date: Phone#: ` Official use only. Do not write in this area, to'be•rompleted by,city or town ofjciaL y City or Town; , Perrriit/Licerise# Issuing Authority (circ)e'one7) , 1: Board of Health 2.'Building Department 3, City/Town Clerk '4:Electrical Inspector 5. Plumbing Inspector 6.'Other.' yF a, Contact'Person: Phone # tLO(jur's,'6' "ray-1ttS /� Client#: 4597 '�^ CCIINyS�U,Lgp� AC,Q.RC�IM CERTNFICA 1 E {�F LII'i'61LITY INSUI�f�►NCF— " °Are(M""U'"r„ 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),AUT Fla RL?E❑ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTpN :If thn certificate holdei is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to Itic terms and conditions of the policy, certain Policies may require an endorsement.A statement on this certificate does not confer rights to the (:"tlliczjte 1101der ill lieu at Such eudorsament(s). rl�uuuCck CONfAC Ru9urs a Gray Ins. -Su. Dennis NAME._ Margaret Young PHONE 5Q8-76Q-46Q2 w I•AX - ... .�RuutG 13 t ac No Exl1: _ rvc N� 5U8 258 2102 _.-..._ P 0 box 1601 A oRtas. Youngma(arragersgray,conl ' A06DC SIJUI(i Dennis. NIA 02660.160-1 INSURER(S)AFFORDING COVk KAGL7' C.Jp,:: Cod Insulation Inc .. INs RERA:Peerless (flsurarlca ____.T - -.,..._• 18333 — 455 Yarmouth Road INSURtRe:Ohio Casualty Insurance Company HY uulis, MA 02601 INsuRERc:Atlamic Charter Insurance — - INSURERO.CommOrC@ Insurance Company __•.w_, 3�1.7594�_ CERTIFICATE NUMBER: I'd I 1 J cr11'I.Y' ri L41 1'I 1L- r ULIGIE�Ur INSURE NCE LISTED BELOW HAVN NUMBER: E BEEN ISSUED TDTHE INSURED NAMED AOOV(O OR THE f QLICY PERIOD ^ur..,•,1u+ NU I A'I I Hu!)UVDIIVG qNY rtEQUIREPAENT.TERM OR CCINDITjON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS t:CK Ilri(;,�TE h,1AY BE I;;SLIED OFt NIAY PERTAjN;THE INSURANCE AFFORDED$Y THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO ALL:THE TERIvis, i:.+,l.ltiSi(rN5 ANU(:ONUI-PIONS QF 5VGH POLIGIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rFISR . nH I fY'Pk QF INSUt4�NGk �,R p POLICY NUMBER ULIcI EFF POLICY EXF MMrOl7 NUrllt)OIYYI'Y L11YIIrS A iitnkRAl-LWtlIUrY - ' CBP8263063 04I0112011 041011201 000 00'0 X�\_uh.�alcn\.ntvr;NLw>,LI_Irv31Llt1' -' _ [TAIvITGETORFNTE�-`^` _ r I Ir,,+.rtaghu\qt -"—I `' r .•. PRCMISFS 11a nrautencial ���QQ�OQQ',_,_---- ... ro,kLl k:Y.l'(riny W1V Pul50N) _ y�Qt)Q ,,LA.. �. - .._ _—._.�. - _ • . - PERSONAL It,AQY INJUftY 0,000,000 GENERAL AGGREGATk2,000tQQQ- ,., r:c�a<..zrec.rlr \I°r•^ueaNeFc. _ PaoouCrs cbNurpPAcu �2,000,QQ4 - - TAU10ivioulL.L LIABILITY 11MMBCKVMK 04101)2011 M1211,120112 COMBINED SINGLE LIMIT .I AN, At I10 (Ea dCGdJPI) I - Y BODILY INJURY(rarp•rwn) S -- f tl JvVlr'kUAVIOj t_A AU 1 Cog BODILY INJURY(Pal ac:.•Wanl) ` X. (ISPROP6RTYDAMAGE - --- j � fVl'rVI.IYVIVI.I I F\ll 11,);i - ti ur+IultcLLA L1A15 X occuR UU01254514645 410112011 041011201 EAc I occuraFu Ncr: m'I 000 000 _ -- CL.Ajnas,MA0r: AGGREGATE y'1 OQO 000 _ _._�.__.__. __. ......... n ,I,a Nu(nvp 10000 -_-.- YORhLItS t UNIPLNSATION WCA00525N2 06/30,12011 06/30/201 X WC STATU• orH- i AND Enlr(orERs'uAalLn-Y n Y�I�S v,tROPI\t I L,h1PARI NL-i _CUI'1vC YYI N - r ` EL.17ACIIACCIt]CN1 � Q,DDQ e.4 li CI.fy i Alt4t^h tX(,LUDL;O N N(A +' ', :7 -• j 50 . 16.urutnr - - .y' „ ' E.L.DISLASE,EA EMPCme �SQQ,000 rn,at,PnOIV(:r l)PFHAIHINS nelnev F.L.DISEASE•POLICY L 0,000 I UC�I:nIYIlUt1 lF Uvt:KA I'IUNJ I LOCAIIUN$I VCtiICLES(AIt8CL1 ACORO 1101,Adddlodal Romar%s$aUad4lc,4 more SPacC IS requwco) - Workers Comp Information Included Officers or.Proprietors (Sac Attached Descriptions) CERTIFICATE HOLDER CANCELLATION 10'Days for Non-Pa rnent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • t - • AUTHOR"' U REPRESENTATIVE .. , 01988-2009 ACORD CORPORATION,All rights Ivszrved. 1COrtD.15 1 of 2 ' The ACORD'ilaine and logo are registered marks of ACORD" • lid6H575/NI6$179 M<wY ° � . �t 671-1 ,. 10 Park Plaza -'Suite.5:170 Boston;Massachusetts'02116 Home Improvement Ca ltfactor Registration k E ' Registration: 153567 s Type: Private Corporation t_ Expiration: ,4 2/15/2012 Tr# 206433' CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. ^r- HYANNIS, MA 02601 ,Update Address and return card.Mark reason for change.. Address Renewal Employment Lost Card 4 DPS-CAL is 5OM-04/04-G101216 Office o merAffairs§kBnus ne ReguI tion License or.registration valid ford d.vidu!use' !y before the`expiration date. If found return.to Registration: 153567 Type: Office of Consumer Affairs and Business Regulation # `r.1 ;a Expiration: 12/15/2012 Private Corporation' 10 Park Plaza-Suite 5170'� f Boston,MA 02116 OD INSULAT.I:ON IhIC.: r e HENRY CASSIDY 455 YARMOUTH RD HYANNIS,MA 02601 Undersecretary t a d ith t si tore•" _ "- @,Mass#tchusetts Dcpur°tinent i►f Public S.tfct �, Board'of Buildin- Re 1 .gulations and Standards ^ Construction>Supervisor License; R X }, yl r License: CS 100988 HENRY,CASSIDY" a 8 SHED ROW r _ ` WEST YARMOUTR, MA 02673` r Explratlor. 11/11/2013 r. v Tr#: - - , 7620 : ` s. 411 r 6 ,* 1 ' �r fy f i' 4j f. .c. . - .. H, .A , roe X 1 „ p' y' `.: '_ .i(.. 7 1 ' ..4'�S^ •.c�._.}: '4 i HOME OWNER WrATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. AP r-,q A hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation( herein aftei referred as "Agency") on the property located at: E,,:� a*_ tieLLe o 7 .3.L.. The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping&caulking of windows'and doors,insulation of attics,•sidewalls &basements,attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the.right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed. I have read the provisions of this agreem=-as listed and freely give my consent. Home Owner: (Signature Date: Agent (signature) Date: :✓� .:t HAC approved Weatherization Company : .6 r J 4_ All Cape Energy Building Performance, Caliber Building&Remodeling F, Cape Cod Ins_uiatzon Cape Save Frontier Energy Solutions' Lohr.&Sons Michael T.McMahon . Niall Hopkins Builders Resolution Energy OK (0�13�13 . TO 4N:OF BARNSTABLE CAPE C® NSULATION1013 JUN 10 AM 9: S7 . . �Cl FIRER GLASS SEAMLESS- SPAAYPOAM SUSPSNDCD _ SAM OUAl1! INSULATION CEILIMO! 1-800-696-6611 DVT 0V Town of Barnstable _ Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: / 2 fA L/// Dear Building Inspector' Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ,7-7,01V vd so Insulation Installed: Fiberglass Cellulose. R-Value Restricted Unrestricted Ceilings Slopes Floors ( ) ( ) ( ) ) ( ) Walls ( ) ( ( ) ( ) ( ) ivt'r (vor ll Sincerely VHy ssi r, President Ins ation, Inc. L . QE) G OF e I oFtr Town of Barnstable *Permit# O Expires 6 moatlis from issue date Regulatory Services Fee + + LIRNSTABLE, r� $ Thomas F. Geiler,Director a lfD AAAy a Building Division Tom Perry,.CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 r www.town.barnstab le.ma.us Office: 508-862-4038 Fax:-508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY. (� Not Valid witlrout Red X-Press Imprint, Map/parcel Number Property Address �3 Q�G� �� 0/�")?Ca Residential Value of Work 1_p o Minimum fee of$35.00 for work under$6006.00 Owner's Name&Address tbL/9 /1/ z-4 Contractor's Nam e� �� � G—t° /��t��C f' Telephone Number] Home Improvement Contractor License# if a licable ( PP ) Construction Supervisor's License#(if applicable) � �Y(� „ SS PERA IT ❑Workman's Compensation Insurance Chec ne: MAY I am a sole proprietor TOWN OF 8AR(�S ' ❑ I am the Homeowner T A5.LE ❑ I have Worker's Compensation Insurance - Insurance Company Name Workman's Comp. Policy# z Copy of Insurance Compliance Certificate must accompany each permit' Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping.'Going over existing layers of roof) 2'Re-side 4&1 #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44):#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter.of Permission. A copy of the Home Improvement Contractors License&:Construction Supervisors License is qui d _ SIGNATURE: Q:I W PFILESIFORMSIbui ld ing permit formsTXPRESS.doc° - Revised 070110. .. i The Commonwealth of Massachusetts Department of Industrial Accidents , i Office of Investigations �` IN 600 Washington Street k�\ Boston, .AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): / �V Address: % 9K)Cy1f, 2 City/State/Zip: /li/S OG ne #: 17 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 6. ❑ New construction epipl'oyees(full and/or part-time).* have hired the sub-contractors 2.Wf am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'-comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions i myself. [No workers' comp. c. 152, §](4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: 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 up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in.the form of a.STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder t e Spains Znafties,9fperjury that the information provide7//-� a 71, e`and correct. Date: Signre: Phone 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#: Information and Instructions Massachusetts General Laws chapter 152 requires,all employers to provide workers' compensation for their employees. Pursuant to tfi`is 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 enghanitidual, a joint enterprise,and including the legal represenkives of a deceased employer, or the receiver or trustee of partnership,association or other legal end ,employing employees. However the owner of a dwelling house h ving"not more than three apartments and who esides therein, or the occupant of the dwelling house of another who mploys persons to do maintenance, cons ction or repair work on such dwelling house or on the grounds or building apouftenant thereto shall not because of su employment be deemed to be an employer." MGL chapter 152, §25C(6)also scat that"every state or local licen ng agency shall withhold the issuance or renewal of a license or permit to ope ate a business or,to construe buildings in the commonwealth for any applicant who has not produced accep ble evidence of complian a with the insurance coverage required." Additionally,MGL chapter 152; §25C(7) ates"Neither the comm wealth nor any of its political subdivisions shall enter into any contract for the performance o public work until ace 'ptable evidence of.compliance with the insurance requirements of this chapter have been present d to the contractin authority." Applicants Please fill out the workers' compensation affidavit co et'ely, y checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es) ne number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Lia 'lity Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers' comp s 'on insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit s b submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be re to si and date the affidavit. The affidavit should be returned to the city or town that the application for the pe it or licens is being requested,not the Department of Industrial Accidents. Should you have any questions regar in the law or i ou are required to obtain a workers' compensation policy,please call the Department at the nu ber listed below. elf-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the"affidavit is corirplete and printe legibly. The Department has rovided a space at the bottom of the affidavit for you to fill out in the event the Off e of Investigations has to contact ou regarding the applicant. Please be sure to fill in the permit/license number w ich will be used as a reference numb n In addition, an applicant that must submit multiple permit/license applicatio s in any given year, need only submit o e affidavit indicating current policy information(if necessary) and under"Job ite Address"the applicant should write"al ocations in (city or town)."A copy of the affidavit that has been off ially stamped or marked by the city or town be provided"to the applicant as proof that a valid affidavit is on fil for future permits or licenses. A new affidavit m t be filled out each year. Where a home owner or citizen is obtain' g a license or permit not related to any business or co mercial 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 thalik 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 C minonwealth of Massachusetts Dep ment of Industrial Accidents w ffice of Investigations 6 'Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 - www.mass.gov/dia a4 Town of Barnstable Regulatory Services nsnss �` Thomas F.Geiler,Director T�►,�+' Bullffing Division: Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Z�D r ,as Owner of the subject property hereb' authorize Y to act on my behalf, in all matters relative to work authorized by this building permit application for. 2 �;-71W c'-�k (Address of J na o - - . f r ;,YYate Print ame �-- r C� c r ;llassachusetts Department of lluhlic Safct� Boars!of Building;'Regulatiom and St�nct.tt cls ;Construction Supervisor License License: CS` f8096 RICHARD E LEBOEUF• 20 BACON RD" , ~ ' .HYANNIS,MA 02601 cam— .yip c� ExpuaUon:, 6/23/2052 ( rnm�.eciuncr .' Tr#: 27920 t Office o onsumer arcs mess e u a ion " •..HOME IMP-ROVEMENT.CONTRACTORx r t Registration �,142516 ,Y' Type t 7 Expiratlon {4/3712012 . Fndwidual i Y Ri' ar E.LeE aeuf € 01,110 # Richard.LeBoeuf� L = W 20 Bacon-Road Hyannis,MA 02ti0.1-' ,t _ Undersecretary ' ! i Complaii t quiry Report Date; Rec'd by: Assessor's No: /f` Taint Name: Comp Location Originator Name;-i— A Street• State: zip' vllage: � Telephone:D/E Complaint Description: G�21i�� Qi Inquiry Destai tion: p • 9 For OMCC Use OJdr ' Ins ectors P / '� Action/Comments Date• O Inspector. ���� 4 - -------- Follow-up - Action 7d Additional Info. Attached Cop),Distabucon: Mli&.-Department File Yellow•Inspector pink Inspector(Return to Office Manager) INSTALLED IN COMPLIANCE WITH TITLE 5 ENVIRONMENTAL CODE AN 33ARISTABLE, T OWN 0 F BA.RN,ST-ABLE . . NN N �� INSPECTOR �� �� �� 0NNN�N0N ��N� N ������ �"0� 0NN�� � _ APPLICATION FOR PERM0[ .TO ..P^.4181.----..--..--.-.~,--,.-.....-..-..- TYPE OF CONSTRUCTION .�� -..---.-------.--.-.---.-.--.__-.-.-.-'.---.--- . . .. -��_~ ��---.-...---.]*�.��.. ~ ' TO THE INSPECTOR DF BUILDINGS:' ' The undersigned hereby applies for o pannh according to the following informodwn, L�' �� V ~ �nco�on ����=«..»*e��..a����m�.x����.��' '� '+«:�-�---'.��/'.--^-'---,------.-----'' ' Proposed Use-�������----. `---~`~- -.J�r��.[....�.------------. ------.------------.. Zoning District -,--. -------..Fire District ---.���.��-----------,-------. | 7 � /�� /��� Nome of Owner ---..A66,ex ?`-�-==�.. ..�7�.. .."-- , Nome of Builder ./� .. ' ----Ad6nesx ..................- .......................................................... - / ' Nome of Architect ----.-----------------'A66reu .........................................................v of Rooms -. --------------------Foundotion --����y�l����~,"-.-....~.--,-.---,� ' � Exterior ----- / .�" .....................................................Roofing --- -_-----------' � ' Floors --� ..�~,'`_-------------]nx��r ---. .-.----_--,---._ ' ---------- � Heating --����.�-- .........................................................Plumbing ----.------.--.---.--..-----.... � Finep|o. oe ------_--------------------.Approximote Coo� ........ ......................................... � . , Definitive Plan Approved by Planning' Board lQ----, Area ....... --~~� � Diagram of Lot and Building with Dimensions Fee ' �/�---`r- -------- ` SUBJECT TO APPROVAL OF BOARD OF HEALTH / �� ~ . � �� 6°X' l0y- � ' > ( ' � � � � . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS | hereby agree to conform to all the Rules and Regulations uf the Town of 8omnsto6|e regarding the above construction. ~ Nom^��^ � ~^—^~--'^''^'-~~`''~--'�v°.......................... � Construction Supervisor's License 1 �� ............... U � - s ,? PHIL"LIPS, E. FRANKLIN i 28732 Enclose Porch No Permit for e ' Single Family Dwelling �• ................................................................................ , 773 Old Stage Road Location ................................................................ ` Centerville ......... .......................................i.... ................. t "r Franklin E. Phillips Owner .S ' Type of Construction ,.Frame............................. ?, Plot ............................ Lot ................................ ;+ , ..P '• Permit Granted .......lleceniber 4, 19 85 Date of Inspection ....................................19 Date Completed rbs ...... ........ gA.19 ;fit � o� � _ _• 1 r.