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Application number................ .�. ....................
QAFee .......................&�.:0.0..............I...............
&ARN ��
NAM - Building Inspectors Initials...
A' P .AJA..�� ff�18 Date Issued..............
........... ...:..........
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3. j (A bAHNS(AB Map/Parcel............................................. ...............
TOWN OF BARNSTABLE J15.
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: <18ce A-? �Aswlk
NUMBER VREET VILLAGE
Owner's Name: M4 . 4 A A. /4dy+ Phone Number �OO 9;7yJ_
Email Address: Cell Phone Number
Project cost$ � 7�, Check one Residential L/ 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
Siding Q Windows (no header'change)# F-1 Insulation/Weatherization
Doors (no header change)# Commercial Doors require an inspector's review
ED Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to ,✓ y�,� L
CONTRACTOR'S INFORMATION
Contractor's name r�,q y �r►g� �,.e�,o✓ir/��l/bed y / ,�. -
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# /, (attach copy)
Email of Contractor ~r 6;"t ��
>� e �hone number jj'�r
ALL PROPERTIES THAT HAVE STRUCTURE OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT,YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.'
a
APPLICATION NUMBER
y
*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.
Purpose of Event
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.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name: .
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANTS SIGNATURE
Signature Date .,?v'AO>e?
All permit applications are subject to a building official's approval prior to issuance.
Conunonweatth of Massachusetts
Division of Professional Licensure
'A Board of Building Regulations and Standards
M.ppr Specialty
Construc#io :S
.,
> �ires Q413/2020
CSSL-099913
TROY A THOMAS
499 NOTTING0►Nr DR I
CENTERVILLE MA Cj
I:
Gornmissioner
(921e W-Aff p"On wal!!nf'^l aumrlu3elia
office of Consumer Affairs&Business Regulation Registration valid for Individual use only
HOME IMPROVEMENT CONTRACTOR 9
NP�,�pp�on before the expiration date If found return to:
Realstr goiration Office of Consumer Affairs and Business Regulation
185 22 06/08/2020- One Ashburton Place-Suite 1301
TROY THOMAS K0Me IMp.80VEMENTS,INC. Boston,MA 02108 ^
TROYTHOMAS
499 NOTTINGHAM DR ----- Not tI WfthOU#S1g118tUr8
CENTERVILLE,MA 02632 Undersecretary
DATE(MMIDDIYYYY)
ACO CERTIFICATE OF LIABILITY INSURANCE
16. 0542312018
THIS CERTIFICATE 18 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)mist have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsemen S.
PRODUCER NAM CT
Donna Os;rowBki
Mark Sylvia Insurance Agency,LLC PHONE PAx
404 Main Street E No"£xt1:(508)957-2125 n o1.(508)957.2781
Centerville,MA 02632 ,mark marks ivlainsurance.com
_ INGURSRRI AFFORDING COVERAGE NAIGa3
INSURER A,Form Family Casualty Insurance
INSURED INSURER B
Thomas Home Improvements LLC INSURER G
PO Box 177
Centerville,MA 02632 INSURER D
INSURER E
INSURER.
COVERAGES CERTIFICATE NUMBER- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IL4SRTR ' TYPE OF INSURANCE A L B P LJCY NUMBER a MPt-ICY EFYv POWLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY 1 20OIX1416 ii 50112018 5101/2019 EACH OCCURRENCE
CLAIMS•MADF rx—�OCCUR i 1 I PREMISS(ELgm N ,C
t MEO ExP one efson I S $000
PERSONAL 8 ADV INJURY 1 S 1,000,000
l GEN't.AGGREGATE LIMIT APPLIES PER. } GENERAL AGGREGATE s 2•�,000
t
POLICY JGT L 1 LOC l PRODUCTS-COMPIDPAGG S 2.000;000
OTHER: i $
AUTOMOSILELIASILITY COMBlea
I GLELIMiT y'
i ANY AUTO r BODILY INJURY(Per p®rsan) S
OWNED i SCHEDULED 800ILY INJURY(Per accident) 5
AUTOS ONLY AUTOS = (((
HIRED NON-OWNED P OPC RTY DAiAAGE S
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAB OCCUR i EACH OCCURRENCE s
EXCESS LIAR CLAIMS PAADE f AGGREGATE S
t S
OED I IRETFUTIONS
A wORKERSCOMPEN AVON 1 2001W8053 5/07/2018 5/09/2019 PEA T oT
;AND EMPLOYERS'LIABILITY YIN '
+ANYPROPRIETORJPARTNEPJERECUTIVE � E.L,EACHACC7DENT S 1,000,000
iOFFICEWMEMSEREXCLUOED? I , 1 I INIAI
(MandatWInNH) E.L.DISEASE-iAEMPLOYEE S _ 1,000,000
ffesdesafe under EL;DISEASE POLICY LIMIT S 1,000.000
1 DCRIPTION OF OPERAT#0NS tretnn
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sefiedule,may be attached it more space IS required)
Carpentry
insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be
deemed to have altered,waived or extended the coverage provided by the policy provisions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Troy Thomas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
499 Nottingham Drive
Centerville,MA 02632
AUTHORIZED REPRESENTATIVE
C 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
In the event that while stripping the siding we find rot that needs to be replaced,the homeowner then
has to agree and authorize any replacement or restoration. Then in addition to the above contract
price,the homeowner agre
es to compensate the contractor for any repairs or restoration at the hourly
rate of$75.00 for a carpenter and$55.00 for a carpenter's laborer, plus the cost of materials.
-Siding to be stripped and cleaned of all old siding&debris
-Home to be papered with Typar house wrap
-SBC Grade A white cedar shingles to be used in the installation
-All shingle installation to be in accordance to validate manufactures warranty as discussed
-10 Yard dump trailer will be needed on site; and will be removed at completion of the job
-Contractor will be responsible for,all building permits needed at the property
NOTICE REQUIRED BY LAW
With the agreement of the contract$500.00 of estimate is due.
Further payments under this contract are as follows:
1/2 of the estimate clue-at the start;and remainder due at completion of the job.
Balance of all materials and labor shall be payable in full upon completion of work described in
this contract. Payment as agreed upon shall be made when due. Any payments which are
delayed shall be subject to a finance charge of 1.5% per month.
The contractor warranties the work completed under this contract for a period of one
year from the date of completion.
During the stated warranty period the contractor shall be responsible for the service of
the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair
due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner.
All warranties for the materials supplied by the contractor shall be passed directly to the
homeowner. The homeowner may be required to register or mail in such warranty card or evidence of
ownership in order to activate such warranties. Homeowner failure shall not create any responsibility
for the contractor under the warranty provisions;the choice of repair of replacement shall be at the
discretion of the contractor.
The homeowner acknowledges that the form, content, and notices contained in this
contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A,
and regulations promulgated there under. In the event of any instance of non-compliance,only such
portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any
such portion not in compliance shall be read and interpreted so as to have its intended meaning to the
maximum extent allowed under such law and regulation.
. Signed as a sealed instrument on this date:
Date: Homeowner
Contractor
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): e3 /4:wx �? dI✓tole�/ .f
Address: !,d'
City/State/Zip: az4�,-VI Phone#: 7�
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 6 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 partner- listed on the attached sheet. 7.1-"Remodeling
These sub-contractors have
ship and have no employees 8. . Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp, insurance.:
9. Building addition
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 11% Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. Roof repairs
insurance required.]t c. 152, §1(4),and we have no
- employees. [No workers' 13. Other .
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. -
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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._#: 1o0/ ZAJ;96571 Expiration Date:
Job Site Address: City/State/Zip•f
Attach a copy of theworkers'compensation policy declaration page(showingthe policynumber and expiration date)
--
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct.
Signature: ao Date: - d ` d6/6
Phone#: d
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): s
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Assessor's office(1 st Floor): B!i3 MU
Assessor's map and lot number i i 7 3 b a�.:`.�1iLi[ { �tl�STTLL.ED IN Co
'l Conservation(4th Floor): ' �-•- ' WITH TIT
ENVIRONMENT
Z Board of Health(3rd floor): ] AR-
Sewage Permit number L/ TOWN REGIJ
�r a
3 Engineering Department(3rd floor)`. �• �s���
House number
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED,8:30 9:30 A.M.and 1;00-2:00 P.M.only
�e ;TOWN : OF BARNSTABLE
'BUILDING ' INSPECTOR
APPLICATIOWFOR PERMIT TO
TYPE OF`CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location J1 Z J d LV 5 i 244E )Za/. COVZZ z 0*16-_ AV I D ZG:3pZ
Proposed Use ✓DCI RPl
Zoning District Fire District
/h 04
Name of Owner&N 0 Cl I*Wg— Address `/Z� DLU S b— 12d eE7ll mll11fe,
Name of Builder All CIL /AA0S Address /.3 97Ag -h) Z,±j L- e,47VI7,
Name of Architect Address
Number of Rooms Foundation �a0.99�7 CUI�CRf3T�
Exterior Gl"M�' f IM89 C S th G LL-3 Roofing Z 3S# hlSeo *L 1^ 3 T14-t� 5�/']A-&L6S
K051309— tiN
ooct owl �OR.tM —
Floors 3 I 6 Interior w 81 1 p
Heating F 14 W v ��S Plumbing d WL 0+2 0 V C
Fireplace Approximate Cost `14 . bOU - llU
is �
Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of n abl4regaii above construction.
Name
Construction Siipervisor's License ® `2 Co5
's
HOWE, ARNOLD
No Permit For BUILD ADDITION
Single Family Dwelling R
Location 1124 Old Stage Road
Centerville
Owner -Arnold Hnwg-
e
Type of Construction " Frame
Plot Lot
Permit Granted Nnuemher g� 19�c
Date of Inspection: /
Frame /�� i�/ 19
Insulation 4Lz
19
Fireplace 19
Date Completed 19
M.
f r
Joseph D. DaLuz Telephone: 790-6227
Building Commissioner
r
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
TOWN OFFICE BUILDING
HYANNIS, . MASS. 02601
DATE 4A N
TO: .�/I dw0 S AJs 7
C'oiut i 1414 o�2 63s
The lc�Am inspection at 9UOW&.
�12y 5 /19-5 r- does not comply with MA Building
Code No. %9�1� 3yD 3-`� f/d� outer 17,4rafe- dov,
Please contact this office for reinspection.
Thank you ,
Building InfSDeCtor
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Arnold and Mary Howe .
1124 Old Stage Rd.
Lot # 20
Book 1481 Page 118
107'1•-/+
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Proposed Structures for the Howe Property
25-0" +/-
84'8" P.w....a«... .hamu
32,0"
n
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+ —202-7" .
Project:. Howe Addition La ad nos Construction
Date.: Nov. 6 , 1993. Custom Homes, Additions, Remodeling
i 13 Thankful La¢e' CoWit,MA 02635,(508)428-4097 .
/73..... .. "Assessgr's map and lot number .. ...... 1 :x:......... �oFTHEro�
SEPT
Sewage Permit number ....Ui '1 . .. lr . . l� `lE INSTAIC SYSTEM MU
V, INSTALLED IC
COMP
„T� T TABLE,
H i
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use number ........................................................................ r
MAB
q ENVIRONMENTAL CODE�� �b ar a�e�
�A` �E �TIONS
TOWN OF BARNST
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO CO ...... f}. 'J!/.. ........!71..:
TYPE OF CONSTRUCTION ................�1...........�7 ................................�11.///..........................................................
r
. .........................19. �..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby
/applies for, a permit
according to the following information:
Location ...�.�0� ....�1 l.L°..` S .. ,.�J.�..../.��!.:.... ' X .r.�rr r �1. .i��.�..................................................
1 / / V/�Nn
ProposedUse ....................( ...................................................................................................................................................
f L" �; ,/
Zoning District ........................................Fire District .4:A) /�/�`��4e
Name of Ownerm/�r/U..:� .%:........... �W.0................ .Address .l. ...�� .. ......c .�1�: �C" �:./r-......
Name of Builder .... .... - Mess ,. . . , .. V .
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ........0.........................................:.............Foundation ��� .�1�...................... .. .................................
Exterior .&..........................................Roofing .... ....... ..... ... ...........
Floors ....(.. 1.{' ..:........... Interior J
.. ............................................... ....................................................................................
Heating /�.� .................Plumbing ... `''`��...............................................................
.....
Fireplace ..:,lv .........................................Approximate Cost d
Definitive Plan Approved by Planning Board -----------_--------------------19________, Area ..C2.90F .............
Diagram of Lot and Building with Dimensions Fee .�/....'�""'...................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
A-)�
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .....�.... .:.......... .....................
� 6
HOWE, ARNOLD B.
N; 22.2��2.... Permit for ...:�P�PITION
.........................
Sin ..............
Location 1124 Old Stacre Road
...............................................................
Centerville
.............................................................................
Owner ....Arnold. . ...B......H.owe.............................. ....... .. . .......
Type of Construction .Frame.........................................
..................................................................................
Plot ............................. Lot ................................
March 27, 81
Permit.'Granted ........................................19
Date of Inspection *Jf........................19
Date Completed ........................ 19
PERMIT REFUSED
.. . ...................... ..... 19
..................................................
..............................I............ ..
..,................................................
Ba..M1 . B.
A..................................................
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. ................ ................................................................
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