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0428 SHOOTFLYING HILL RD
a to +' . o r r f � C ( � v i r � a G t t § .I Y • ��p � r�,YR '•A § v, ' yy RR A Pb 8 a " t a _ r, 2. Wb r r n o, e p 9' „ Town of Barnstable Building RARINWST: A � Post This Card So That it is Visible-From the.Street-Approved Plans'-Must be Retained on-lob and-#his Card Must be Kept � Posted Until Final Inspection Has Been Made �. � ` . � Permit 16sv Where.a Certificate of Occu anc is Re aired,such Buildm shall Not'be Occu red until a Final Ins ect�on has been made 1 e Permit No. B-19-2524 Applicant Name: RICHARD J PECKHAM,JR Approvals Date Issued: 08/21/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/21/2020 Foundation: Location: 428 SHOOTFLYING HILL RD,CENTERVILLE Map/Lot: 213-007 Zoning District: RD-1 Sheathing: Owner on Record: KLUN,VIRGINIA GALE TR �` Contractor Name .IHS Building and Remodeling Inc. Framing: 1 G Address: PO BOX 575 Contractor License: 190612 2 " CENTERVILLE, MA 02632 n-- Est. Project Cost: $3,000.00 Chimney: Y Description: Bathroom remodel: Enlarge existing shower enclosure. Relocate Permit Fee: $85.00 Insulation: shower window to be centered on new shower enclosure. �y Fee Paid:.' $85.00 Project Review Req: TEMPERED GLAZING AS REQUIRED. ONE BATH REMODEL IN Date: 8/21/2019 Final: �0 EXISTING SPACE NO CHANGES TO ROOM`DIMENSIONS. Rlumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspecti for the entire duration of the Final Gas: work until the completion of the same. (-- •- -- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work. , /j Service: 1.Foundation or Footing . :f Rough: { 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) tow Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application Number...... 1....!..(................ ...................... i • BUILDING DEPT. MASS. Permit Fee.......................................other Fee,....................... ►`` AUG O.5' 20 9 425.,Total Fee Paid.................. ......... . ....... .... TOWN OF BARNSTABLE ZI� 9 TOWN OF BARNSTABLE Permit Approval by.... on... �......1............. BUILDING PERMIT . ..............Parcel........�©... ............... _ Map. .......�I .......... APPLICATION �. -- Section 1 — Owner's Information and Project Location Project Address qc?& S'1 L oot t - kill pl(,� Village CQ-k+e,, �1 g— Owners Name Galt e— �W Owners Legal Address q 2$ f fill/ City C�a/1 I( State Zip 02 b 3 Owners Cell # 7 6-6 2 " Dom'?Z E-mail V lO C.o -c�a -fi Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use r ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment a Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar E Renovation ❑ Pool ❑,* Insulation Other—Specify. Section 4 - Work Description re► K► ode( 1. en 1cw g e e x s-ti n q s h owv- ZKCJ0 S V e--: q Last undated: 11/15/2018 Application Number..........................:......................... Section 5—Detail Cost of Proposed`Cofi trudtion 3�QCQ Square Footage of Project 50 Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design a � - Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage s ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private. Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: $ k c-o I beK.vU'S I am using a crane ❑ Yes U No I' Section 7—Flood Zone I' Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information' Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed -t• 13 ,Re Xard, c r. Required -E Proposed Side Yard-, Required Proposed },�J �.I�... ♦+�.` ,! 'vv�' 1J1.t+ ..t �. '� i � �R :�J+'� �. ...-�4 .a......."` ._.� ,'} Ya l j - ...�1 Has this property had relief from the Zoning Board in`&past? ❑ Yes ❑ No Last updated: 11/15/2018 IHS Building and Remodeling,Inc Email: Richard@ihsbuilding.com 32 Blackwood Drive Website: www.ihsbuilding.com Hyannis MA 02601 IIAS Phone: (774) 836-6654 —Building&Remodeling— Construction Contract This agreement is made by IHS Building and Remodeling, Inc (Contractor)and Gale Klun(Owner) on the date written beside our signatures. Contractor IHS Building and Remodeling, Inc BUILDING DEPT 32 Buckwood Drive Hyannis,Massachusetts 02601 AUG Q 5 2019 EDaytime Phone Number: 774-836-6654 T OwN�F Evening g Phone Number: 774-836-6654 BARIVSTABL E Email Address: richard@ihsbuilding.com Massachusetts Home Improvement Contractor Registration Number: 190612 Registration expires on 2/9/2020. IHS Building and Remodeling, Inc is incorporated in the state of Massachusetts. IHS Building and Remodeling, Inc will be referred to as Contractor throughout this agreement. Owner Gale Klun 428 Shootflying Hill Rd Centerville, MA 02632 Cell Phone Number: 508-662-0392 Email Address: vgklun@comcast.net Gale Klun will be referred to as Owner throughout this agreement. The Construction Site 428 Shootflying Hill Rd Centerville, MA 02632 1. Project Description A. For a price identified below, Contractor agrees to complete for Owner the Work identified in this agreement as the Project. The Project is described as follows: -Obtain necessary permits; -Demo existing bathroom and dispose of bathroom fixtures. Store toilet on site for reuse; -Remove linen closet next to the shower, and relocate toilet plumbing to accommodate larger shower enclosure; -Remove existing shower window,relocate the opening, and replace with awning style window; -Install new shower pan with center drain,install backerboard on shower walls and ceiling; -Tile shower floor using 2x2 mosaic tile; tile shower walls and ceiling, install 2 shower shelves and 2-3 shower bars. Contract price is based on installing 4x 12 subway tile; -Install shower seat. Style to be determined; -Install clear glass shower doors. Estimate is based on using MAAX Semi-frameless Brushed Nickel Bypass/Sliding Shower Door,or similar; -Prep bathroom floor for the installation, and install new ceramic floor tile. Contract price is based on installing 12x 12 tile; Signatures The signatures that follow constitute confinnation by those signing that they have examined and understand the Contract Documents and agree to be bound by the terms of these documents. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM This agreement is entered into as of the date written below. Gale Klun,Ow Signature) (Date) �- r-- K _ (Printed Name) 1HS T�ling, lnc, Contractor _ 7/8/2019 (Signature) (Date) Richard Peckham, President_ (Printed Name and Title) Page 13 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I' Please Print Legibly Name(Business/Orgenization/Individual)' Address: 32 Fc:, Qc)d fir. City/State/Zip: 144 aft*1-t S 026'0� Phone#: 77�f Are you an employer?Check the appropriate box: Type of project(required): 1.[91f am a employer with- 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity.acttY• employees and have workers' 3 9. ❑Building addition insurance workers'comp.ins+ nce 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 11.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance reguh.a]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. Y I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: A A /W. ��t ��-1.1'�-C� Policy#or Self-ins.Lie.#: f �L° �f00-'7�3 C�38 /Q� Expiration Date: Job Site Address: �l02 c4 c i �f� City/State/Zip:C Div lle. UA �263y 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 certify under the pains d aloes of perjury that the information provided above is true and correct. Signature: Date: Iq Phone#' -7 74/—9 36 —6 6 S�l ' 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 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 maiateriance,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 constrict 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-contractors)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 sire 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 Deparimeat of Industrial Accidents Office of Investigations 600 Washington Street Bastin,,MA 02111 - Tel.#617 727-4900 ext 406 or 1-8'T°1-mASSAFB Revised 4-24-07 Fax#617-727-7749 WwwMaw.gav/dia : Application Number............................................ Section 9- Construction Supervisor Name Ri Ck-wcl _-Pf� Telephone Number -77413 6-645.9'f Address 3 Z �3 c 'Lwao-4 Pk'City tf�ta'p"u S State Ater Zip . OUO/ License Number CS b t '?(1193 License Type C-5 Expiration Date - 07A�T/0 , Contractors Email rl cl1 a )'"bui i . Cow- Cell 9 7 7 9 -E3 6 I understand my responsibilities under the rules and regulationseT icensed 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 C and Town of Barnstable:Attach a copy of your license. Signature Date 07P-7/1 Section 10-Home Improvement Contractor Name THS Wr/Chkt QW"')' Telephone Number 77(/_8-36 ~' 66 ' Address 32 Bu C1W 9r•City "*t!S State MA Zip O7-6-0- Registration Number /40 6 l 2 Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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 e T of Barnstable.Attach a copy of your H.I.C... / Signature Date 7`14/19 Section 11 —Home Owners License Exemption Home Owners 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 APPLICANT SIGNATURE Signature Date r/J Print Name �: 7' /Q-y� Telephone Number 7711--ff 3 686V E-mail permit to: �! �'O' 5 fjui �di C'oYn_ Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ 'Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ a e „s - :• J E-- 1 Conservation ❑ For commercial work,please take your plans directly to the fire department,for approval. Section 13— Owner's Authorization as Owner of the'subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner. date . Print Name ' f, '4 Last updated: 11/15/2018 t Commonwealth of Massachusetts ®t Division of Professional Licensure �,..� Board of Building Regulations and Standards Con strg.aMrPtbp�rvisor t CS-094193 -` fires: 07/2912019 f RICHARD J PECKHAW d 32 BUCKWOOti DRIVE HYANNIS MA 02 01,r, r1'�?r.5�•1�t��� Commissioner `Fw�_• ��ze �parnirreo�.zulea,�C�o� ` C/f/f(zaaccc�ivaelt Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registratlon4 Exialration 19061_22-,,;��-@ 02/09/2020 IHS BUILDING AND REMOCDEEING,INC. RICHARDJ.PECKHAM � ,Q 32 BUCKWOOD I HYANNIS,MA 02601 Undersecreta t f4 C E' IIAC41111 VI 111Oii Ol.11YiGlli Division of Professional Licensure BoardI.r ofVI BuIYINilding Regulations and Standards Constrr��it"rvisor CS-094193 0�ires: 07/29/2021 P�RICHARD J CKS r 32 BUCKWOdD DR. HYANNIS MA`D2601 Commissioner 1 L r 318b1SN8V8 30 NMO I 6W .9 0 Ond 1d30 DATE(MMIDDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE `� 1 05/31/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Toni Davies GH DUNN INSURANCE PHONE (508)759-3132 Fnc No: .E-MAIL allusers@ghdunn.com ADDRESS: @g P O BOX 99 INSURERS AFFORDING COVERAGE NAIC# W.WAREHAM MA 02576 wsURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: IHS BUILDING & REMODELING INC INSURERC: INSURER D: 32 BUCKWOOD DR INSURER E: HYANNIS MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 409279 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDIYCY YYY MMIDDIYCY YYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F1 OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ - MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR - EACH OCCURRENCE - $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED F RETENTION$. - $ WORKERS COMPENSATION PER KSTATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A NIA NIA AWC40070364382019A, 05/06/2019 05/06/2020 - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN' Town Of Falmouth ACCORDANCE WITH THE POLICY PROVISIONS. 59 Town Hall Sq AUTHORIZED REPRESENTATIVE Falmouth MA 02540 C Daniel M.Croyey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD A' 113 -00-"4 Engineering Dept. (3rd floor-) Map Parcel iF 2 3 0 0 Permit# House# 47_5� 51kor J kX k(U ill Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) �+ r ee ( 0? 4, Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) (0 I�..�1 Planning Dept. (1st floor/School Admin. Bldg.) INN SEPTIC SY "IS DefinitiveApproved by Planning Board 19 STALLED IN , ICE WTH A�§ TOWN OF BARNST NFAENTA .� a T,01Cec IERII Building Permit Application `� `dress S 'Ptf, (A Village r°'o, A L 4 Owner Address 116; e to I JOS Ulf R-Jc�21, sue, Telephone �� ��v SEA ra� S0�1y/� Permit Request EN c F)se_ t 4 i A f V-i t) First Floor squar � ® oor square feet Construction Type `Z k �- Estimated Project Cost $ qTa Zoning District Flood Plain Water Protection Lot Size o lste A-G Grandfathered ❑Yes ❑No Dwelling Type: Single Family O' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes UWo� On Old King's Highway ❑Yes la,10 Basement Type: pull ❑Crawl ❑Walkout ❑Other -b Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing �9 New G►2qyy.,e 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) fj Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes p10 If yes,site plan review# Current Use Proposed Use Pk,!r," - Builder Information Name t�u s�9 UA, {-Qum' Telephone Number + Address l;1 (2jQAeA �s/1ti11 . License# ® cc) 3 � tl� l�.�D'I_L9CVIJ�D 1�'15 Home Improvement Contractor m 2h3b Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PE IT DENIE R THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY 4 ` PERMIT NO. JAI ! ` DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE > '` OWNER 6 DATE OF INSPECTION: t �- FOUNDATION ' + FRAME, INSULATION }. FIREPLACE ELECTRICAL: ROUGH FINAL ^ PLUMBING: s"„ROUGH FINAL ; GAS: ROiJGH FINAL FINAUBUILDING DATE CLOSED OUT ASSOCIATION PLAN,NO. f The Town of Barnstable • mma Department of Health Safety and Environmental Services • ,�- Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date 5W Z5 tc c,�' 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. Est.Cost Type of Work: Address of Work: Owner's Name W A-ttLOVe� Date of Permit Application: L'�l le I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under S1,000- Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING 'THEII.ICOABI E HOME_UMROVEME T WORK D OR DEALING WITH ORNOT HAVE CONTRACTORS FOR AP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Registration No. Date " • Contractor Name OR r - "' The CO11111tonwealth of Massachusetts Departinent of Industrial Accidents office 811=909211011S 600 {f'ashington Street Boston, Afass. 02111 Workers' Compensation Insurance Affidavit �pplic��t reformation• Please PR11VT l'trbmil �•"'"" "'""�'"""�'-"���'"'���'^' _ n. . .. __ . . '-sew r name: 1✓��—!2_ I�C�S locationZ� �n City phone# 1a❑ 1 m a homeowner performing all work myself. m a sole proprietor and have no one working in any capacity 1..::....eta: MZZIMM z ,z -mrw.-+ s,� n _: .-"•"^ " "'�.mow,^.- f., ,n•» :. ::,, I am an employer providing workers' compensation for my employees working on this job. company name: address city: phone#: insurance co. policy# ,_,'.. r .:..+a,jv JAY-V. .4, •i +�J!.! !,�tpwVS'10+'.+.'1"7K'a �!iwWl.;M!(.'xri•�w.nua`.�.r. 1 am a scCe2ro rietor, ene ----.,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: - address: city: phone#• insurance co policy# .a ......,' ,•e«- arrt*.' T•R' '�au; ^�i- a�t.,r.►.,* xa�>;'+z_ _.,:,"'ram"`y`,'.•`�r1 —...�•a,......,.�s.=.,...waiv.."'" ::s.+n�� =.....: — .u..tbr .;' company name: address: city Rhone#• insurance co policy.# :Attach addi_tio_nal shier if necessarx f,; ""ly: c^�F lily_�4 cc•' • *3i �;, ; _ �emaiai- 1 Fslilurc to secure coverage as required under Section 25A of D1GL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herebl,cc, under the pai is n►rd p tafies o perjure'that the information provided above is true and correct. Si nature DateM'T �3qS C� Print name Phone# .4 YYiip/fY .# of 621 use only do not write in this area to be completed by city or town official city or town: permit/license# 7rjBuilding Department sing Board C]check if immediate response is required 13tmen's Office 011ealth Department contact person: phone#; nUthcr ��_.,A,.'^.n--'--�,.-y.^.ra�r�»ee•.' ,,„ _ - - 3f i i1i (remised 3195 P1A) information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for'their employees. As quoted from the "law", an employee is defined as every person in the service of another und`cr any contract of hire, express or implied, oral or written. An emph ver is def ined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoim, engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recei�!er or trustee of an individual , partnership, association or other legal entity;.employing employees. However the owner of a dwellim, 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,tite grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even,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, 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. ;K Cite or Towns 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. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. �.;,au.c-,,....:-�,.......,.:,_.._.......-,.,.�<•...._..�,....s�.q..,•....•a;n.r.•.�.'.o..s-,,cv.,_w_..,..-� m••-.;X•—�--•",ava�..�,_ -r.�,r,.w.,1a.....r+.-.,,�.....• The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 «Jashington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 ,�y��a.-:;�`.,' ./, . � . I o3lL»2ovu�reamg 01.1&7!a.c ueje& 1 . DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuaber: Expires: Restricted'To, 00 4,`PATRICK E LANCASTER 10 COACH LN } issb R BARNSTABLE, ..MA -02630 IF o ,w. :?HOMEIMPRQVEffNT` CONTRACTOR 3 iltt .. Registrati '9n 103438 f,AlYpE A- ,IND VIDUAI _ FEzP-1ratigA, 07/08/98 fir• g' ' PATRICKLANCASTER Patrick E L-ancaster r _ �`�`_ "°""'"Yis�nTOR' Bar,nstable�MA'02630 , Assessor's office(1st Floor): Assessor's map and lot num 3 Q o 7 i tec t SEPTIC SYSTEM DUST BE P•.° ''`� �ponservation �� �� INSTALLED IN COMPdolANC /Board a Health um f r): WITH TITLE:5 : Desisr�nta � Sewage Permit number �8`� Engineering Department(3rd floor): ENWRONMENTAL CV))r^AIV %6 o• House number Definitive Plan Approved by Planning Board r 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN . OF BARNSTABLE BUILDING INSPECTOR APPLICATION JFOR PERMIT TO TYPE OF CONSTRUCTION o O A -�ra..rn e fib. 0,4 19 Ga TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location LA a o n r Frti �N \til; 2c1 , (' e 1•eru 11 A O 2l�3 2 Proposed Use Zr g-sy \\C-'K LR V er Vi V&-+WY\ Zoning District Fire District CrnA�- Name of Owner ],1z S �O0.Y-\ Address 14 a-? SN-e-ar FV` 4 , m Qj, Conieiu,I`° Name of Builder d '� `` - - "^ Address ph, Qa of 0 I YYI o-S h ra eQ Q 2 cjq Name of Architect Address 4 1 Number of Rooms Foundation PsQnr Exterior Roofing COO-ef- "<< `fOo Floors e''F�S Y Interior- '5 o T-o ,V— Heating Plumbing C'N iSA t&R Fireplace s hO Approximate Cost Lj, o n Area L 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 Barnstable regarding the above construction. Name Construction Supervisor's License l . " SLOAN, VIRGINIA GALE m ADD DORMER No 3 4 8 5 3 Permit For - Single Family Dwelling + 428 Shobtfl in Hill Road -Location' V g r - + Centerville t Owner. = Vixgiriia. Gale Sloan -- -Type of.Construction `Frame • I � ,� is ,_ y Plot _ Lot Permit Granted Febrdary 25, 19 l-. 92 • F Date of Inspection 19 ~ Date Completed 19 M k . ral r , r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. l DATEe� JOB LOCATION S�c� Number St eet Address Section Of Town "HOMEOWNER" / �Q_S[O S O a.- 3 003 G. -Name c Home Phone Work Phone PRESENT MAILING ADDRESS S� J Cv,�ev,ll4 V 2 b 3 Z City/Town State Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: ' Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a. form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes,' by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic - feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. MISC5 HOME OWNER'S EXEMPTION The code states that. Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) . This lack of awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of' a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Assessors hmap and lot number .... ... ...... .. f FTHE Sewage Permit number ....... . .... ` SEC SY EM WsTq�Lt MUST J AHF9TOEILE, House number .."7��................................................................ EA/ p Vl/fT� i'lY�� i�lA' . .. „6 9 IVVjRONM6 C MPY a. TOWN ®F BARNS r f� � SO PPPR��1$V BUILDING I N S P E C T 0 p solso 10 C01ASO APPLICATION FOR PERMIT TO ............. N���.C!®M� ,`,c,1............. TYPE OF CONSTRUCTION ....d�-r�i�l .......... .:3.......................19 Q TO 'TH.E. INSPECTOR,OF ;BUILDINGS: .....1• � '�'1 4j - ..: �9��� �:, � r_ The undersigned h re y applies fo a 'permit acco ding to the. o ing i rmati n: ����� Location ............ ............... ...... ... .. .. .. . . ..... ... ...... ............. ...................,... Proposed Use ......... . ........... .... ..... ZoningDistrict ........................................................................Fire District ...................................................................... ... . Name of Owner ... 044i'? .Address .0 >�. ........ ..:.��0.., ., .. / e , Name of Builder : ... ........ ........ ............ ....................Address 3�...............:........... <... :�Vls Name of Architect //��.���rr Address ........... .../..:.26y� .......... .... ... Number of Rooms ...: ...0 .. .............................Foundation . . ..... .................... .... .................... ..:... Exterior .. ............................`.... :...................Roofing r.................. Floors ...........0�. ........................................................Interior ..Z .. Plumbing ( ......................... Fireplace App�ozimdte'Cost ...:' .f.,9i.,�� .1J ....... Definitive Plan Approved by Planning Board _____________________________19________. Area ....to.....o....................... 4 Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH 's'c^3 " G t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........................................... ............. WALKER, GEORGE f No,' .21.5.1.... Permit for ...Addition............ G, .� ,,...Sin 1.e...Eamil .Dwellin.'.�,. g fir.. g.......... a Location A-42.8...Shoot...E.1. in .H11.1...Rd e.t'Y g•' r t .-', Centerville ....... ...................................................................... d Owner .....:Ge.Qrge.. ......................................... Type of Construction ....Zridle......................... 4 ................................................................................ Plot ............................ Lot ................................ i 4 _ 4 ` Permit Granted ......A .r]..1...2.4.,.... �, i - � i < � • Wea 'Date of I nspe on ..19 } , Date Completed ...................... 19 PERMIT REFUSED " - ; 4:i ...... .W. ... .........................:.......... 19 ........... ............................................... r - i" 1 P.f.. r+'7 ...... .................................................. ...............� ..................................................... ` iy L!y,. • 'mil ".Isq ..........................................l.................................... 1 i If Approved ................................................ 19 , .............................................................................. ....................."......................................................... , Assessor's map 'and lot number 1, .. Al_3 �� 4. \ ......... is,,THE T� n + . i Sewage Permit number .........fi� .!>..14 ......................... Z 33ARX TABLE, i House number .... ro roes p '039. \00 a Uri a' TOWN OF BARNSTABLE BUILDING INSPECTOR n �--- � APPLICATIONFOR PERMIT TO ..................................... .........................................................:................... TYPE OF CONSTRUCTION ... ....: Yf !' -..... � •1....L6.................................7!�. ';,,'�.!....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............... ..........................,t 1.1 a ..................................................................................................... Z Pro osed Use ....!h: � ��.�l�t *lt�t ►it-f �� �� -'p . .... ZoningDistrict .................... ................................. .........Fire District /�............... .................................... .. ,Name of Owner .. .. G .Address k"! . /,;,".:'•!/Y ,....:. :! Name of Builder :Q:././�''1 /`.U..Y....... /Y �=r-.....Address 3�... .. ....(„�,A �- . 1' �aC.i .Name of Architect ....!..`...K��:�•::.......................................Address .................................................................................... Number of Rooms ........ ........... Foundation .. .................................................�r Exterior ... •/C..............:..................../..1..� Roofing ......�.........................�......�(.'.�.........�..................... j jf " -�' Floors � ...�" ......................Interior ...........:�....���:rt:7%......:........................................... Heating r�Xl� /J.�' ri�-'+ � Plumbing rlf2i/,i —cis, �- .....................2:............................. ,.............................................. Fireplace .....E.L.i•! i'e '..................................................Approximate Cost ........... .. ...�� �- ••�l/�........................... Definitive Plan Approved by Planning Board ________________________________19--------. Area �6 l� ................... ....................... U Diagram of Lot and Building with Dimensions Fee ..----- SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. CY 1(67'-'�� Name ..................................................U.............................. WALKER, GRORGE A=213-7 , No ,2215!.. Permit for ..AaUt; Qn, ......... ...... ngle,,,Fam�ily,,,Dwelking,,,,,,,,.,,, Location ....#428„Shoot Flying Hill Rd. ..............Cente rvi l l e Owner ..George..Walker.............................. Type of Construction .......F.rra.Irie...................... ........................................... .................................... Plot ............................ Lot ................................ Permit Granted/....Apr ... il 24 , 19 80 ..... ..... 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