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Permit Fee o96 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village 667 re4✓r//-R— Owner �T/✓� w�lrE�f Address/7ff/IDe4 S l� f Telephone 7p I Permit Request/rw�a/s'3i�✓G-{ry�7�a/oR 2�� 'of i4 /WW 3 o'��,tNi7.` ��P/1JGf 9Gt�/i✓�DNCf W?7 Square feet: 1st floor: existing/Mv proposed/lb tie 2nd floor: existing NONE proposedA/4* Total newYA�1 r Zoning District Flood Plain Groundwater Overlay moo Project Valuation `f�� Construction Type Lot Size °,� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure t Historic House: ❑Yes )(No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 1 Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) /10^,4 E Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 2-- new Uiv Half: existing i✓oHE new //G�E- Number of Bedrooms: 2. existing O new C7 o Total Room Count (not including baths): existing new First FloorApom CouT Heat Type and Fuel: ;V Gas ❑ Oil ❑ Electric ❑ Other $W: Central Air: ❑Yes %No Fireplaces: Existing / New 4 Existing wood/coal stove: X'es No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: U existing-9❑ n v_ size_ Attached garage: ❑ existing ❑ new size / Shed:?(existing ❑ new size72 Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current UseL Proposed Use - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name J;rfk,1!rA1 IWXIeTAAI Telephone Number Address �� Co/1�C2f�SS �S%�£�l— License# A��CS 02163 y Z Home Improvement Contractor# 12T3�`� Worker's Compensation #so/,c 412V 7� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 944i41 L.*,C SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ' ,rt ._fie ADDRESS VILLAGE OWNER '= DATE OF INSPECTION: G ,f __FOUNDATION. z FRAME S Il. INSULATION S 1.113 FIREPLACE k ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL , x GAS: ROUGH FINAL FINAL BUILDING ll = DATE CLOSED OUT ASSOCIATION PLAN NO. 'The Commonwealth of Massachusetts 4 Department of Industrial Accidents _ Office of Investigations - 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Abplicant Information Please Print Legibly Name(Business/Organization/Individual): 5������ � 12T/✓ Address: City/State/Zip:.. S�I�J��tt2 �� Phone#: �r7b�f16S-53 L� Are you an employer?Check the 20propriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2XI am a sole proprietor or partner- listed m the attached sheet. 7. f k Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition. employees and have workers' working for in an capacity. wo• g Y P ty � 9. ❑ Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 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.#: 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$1,50.0.00 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 uS4gake pains an a alties of perjury that the information provided above is true and correct Si afore: �^7 I�Y� Date: Phone#: 97G' �6s' 3V 12 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: w. 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 maintenance,construction or repair work on.such dwelling house• or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer.' MGL chapter.152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political'subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance s f requirements of this chapter have been presented to the contracting authority." ,w Applicants Please fill.out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no-employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial , Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured.companies should enterthei.r. 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 permitllicense number which will be used as a reference.number. In addition,an applicant . _ that must submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or ' town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to,burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents , Office of Investigations 600 Washington Street Boston,MA 02111 Tel, #61.7-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia 'ME Town of Bar"astable Regulatory Services MASS, Thomas F.Geiler,Director i639. � n Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �'^`�° Y�/l� , as Owner of the subject property herebyauthorize V` l 4�`'?"''�- to act on m behalf, y , in all matters relative to work authorized by this building permit Y-84 (Address of Job) *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S* ture of Owner Signature of Apphc t Print Name Print Name 3- a 1- 13 Date Q:FORM&OWNERPEPMISSIONPOOLS 62012 To' wn Sof Barnstable Regulatory Services . • MMSMAMZ. • Thomas F.Geiler,Director 1619. A`e� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 , HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. t DEFINITION I OF HOMEOWNER `"k" ! 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 or two-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.-L-l) r" ; The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable code,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner , Approval of Building Official { Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the ; State Building Code Section 127.0 Construction Control. ' HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)•for hire to do such}. work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . �i, . ' , - To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt - Massachusetts - Department of Public Safety Board of Building Regulations and Standards } Construction Super%isur License: CS-029634 STEVEN R MARTIN: - ' 16 CONGRESS ST SALISBURl 01902A r• Expiration Commissioner 01/09/2014 - � "�, ✓fie �omirrro�,iurea�i `"` �I T -\ Office of Consumer Affairs&Business Regulation; VSTVEN HOMEIMPROVEMENTCONTRACTOR Registration 124347 Type•.Expiration 6/11/2013 Individual 13 .MARTIN /1 STEVEN MARTIN 16 CONGRESS ST x; r SALISBURY, MA 01962 Undersecretary , 27) r s ?Fik�l filet Y max : S< a 8 e .• � 11Fa ' Y � €9TROI=; sr ( i f {` 8 .k i Zvi ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l/' V(p Parcel V� Application# 00(05 ` S x Health Division Conservation Division Permit# Tax Collector Date Issued' a F 6 7 Treasurer Application Fee _ Planning Dept. Permit Fee s Jo Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 1 586,A r.dl t c a Village ^ alip MA Owner ' J i 4 < Address Telephone J 1 C77e Permit Request c. ---SoI � j t � �;eLl'L ekj SW �c� , �- it?aAn r, ep,�,0c-,-,% Ci�vac� 11C�c l I X-LA kDr-e 3-S&AMIAL, t-e 173,1 Square feet: 1st floor:existing proposed Ul k 2nd floor:existing . At,,& proposed Total new Zoning District 'RD—__J Flood Plain 2t^M Groundwater Overlay Project Valuation 1 A.(_pG% M Construction Type Lot Size Grandfathered: VYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure/ Historic House: ❑Yes XNo On✓Old King's Highway: ❑Yes ;X`No Basement Type: ❑Full J-Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) W I A Basement Unfinished Area(sq.ft) 1 Number of Baths: Full:existing rh _ new iJ 1,A Half:existing 14 I ek new tV Number of Bedrooms: existing %0, new �J Total Room Count(not including baths):existing new First Floor Room Count , Heat Type and Fuel: �as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes *o Fireplaces: Existing New Ali l l - Existing wood/coal stove: ❑Yes .)m"No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed.,VCexisting ❑new size Yf,Pn I Other: era Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Cr -tl =7 Commercial ❑Yes )I No If yes, site plan review# CN CD Current Use St MAAkV W'W+IP Proposed Use BUILDER INFORMATION c7Fi ---- C l Name V 'Z i �° Telephone Number ®� �. Address G �^ License# 1 1444- Home Improvement Contractor# Worker's Compensation# ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 4 DATE I� FOR OFFICIAL USE ONLY R r . Y - ' PERMIT NO. DATE ISSUED MAP/PARCEL NO. I - ADDRESS VILLAGE ; OWNER . r a DATE OF INSPECTION: FOUNDATION 0,cwo5 Q `3 0 FRAME oP .3 26 bq ,dam INSULATION FIREPLACE ; 1 ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL ; GAS: ROUGH FINAL s FINAL BUILDING Z Z.f Q r- _ + � t DATE CLOSED OUT _ ASSOCIATION PLAN NO. s - _ *Z"` �.-V•vv..-••-V•-••V..w�•- V, r.�.AYY.►VI-MYV-►`Y. • • Department of hidas&al Accidents Office juice of Investigations• ' . 600 Washington'Street Boston,MA 02I11 - www.mas&gov/din Workers'Compensation Insurance Aflidavit: Builders/ContractorsAEleetridaidaRI Mbers ` Please Print Lem Applicant Iiaforimation ' Name(BusmessI0rP3izatiM&divid �Air�C_C5 "6 t�Z-' �C— Address: Z ,'ZD City/State/Zip one^#: �3 Are you an employer?Check the approprlate boa:. :: ,• = .Type of project(required): 1.❑ 1 am,a tagbyer v_vith 4. ❑ I am a general contractor and I 6. ❑New construction i .�: loyees.(faand/orparttime).* havehired&esub-contractors- 2. I am a sole propnetoi or pmt=- ` .'listed'on the attached sheet# ?� ❑ Remodeling ; ,7 _ _� These sub-contractors have 8.•[]Demofitioa =ship,and have no employees o� LF r workers' comp.lUSBTd =i r :Worldng_for me in any cacpaciiy. '' 9.' ❑ Building addition [No workers',cop,insurance ''5 (] We are a corporation and.its • --+-w- •] `= officers Have exercised their. 10.❑Blectrical repairs or additions 3.❑ I Mn a homMwner tio%$g all work ' 1=' tit of exctaption per.MGL ;1Y.❑ repairs or additions �niysel�Wo workers'_comp. " a 152,§1(4j,and we have no 12.❑.Roof airs insurance regd red.]t' _ e4loyees.(No workers: - : ` 13. 08iea }1 _. comp.insurance required.] *AnY appfieaut that ehedts boa#1 Mul also fill out fat section below showing&ea wow'won policy bhonation: t Homeowners who su'bmittbia affidavit indicating-IhW an doing a.0 o*andfitea biro outside=traotozs must submit anew affi& t indicating such. tCazma mat ebeck9vs bob rural attached on additional Bunt showing the name office sub-contra ctors andfiteir worker'comp•policy infozmedion. Jnyormattoll. Insurance•CompanyName: .Liu#: Pspaation Date ZZ Z Z-M 7— Job site�,ad�ress:' 18 . hod j : r•. City/staL to ft: l/r o Attach a copy of the workere compensation policy declaration page'(showing`the polio nutn�iration date). Faffure to,secure coverage as required under Section 25A of MGL e. 152 can lead to The imposition of dimmal penalties of a fine up to$1,500,00 and/or one-year as well as civil penalties in&form of a-STOP'WORK ORDER and a fine of up to MOM a day against the viol.Zr. $e advised that a copy of$ris statement may fie forwarded to the Office of Investigations of the MA far insurance t37eiage verification. . _",;. , •_,_•Tom,,,;. I do hereby cerdftAmderthefiam 161dpenalties of Perjury that the information provided above Is true and correct: Date:• Phone# Q kial-use only.'Do not write in this area,to be completed by city or town offictaL' ' '` '• r =~a �" "City or Town•'• Peruii lcense# �` F Issuing Authority(circle one): in artme 3. /To er actor 5.Plumbing In - 1.Board of Health 2.Build De C wn Ci k 4.Eleetri�al Inspector .g P h•Y �P 8 $P L -6.Other I r T • .. F ContactPerson:s •Phone#: a Information and Instructions MassachusettsGeneral.ems' • _ .Laws chapter 152 i'equiies all employers to provide work.•ers' comp nsoMm ogees: Y• , t to , an employee is defined as `..every person in the service of anoth - any contract o€hire INS S=W ¢%press or implied,oral or wsz<ten.» defnied as u m vi¢1;al,Ta tCrAV so�0n,9wPor*S or other legal entity,or any two or more An emPlayer is >, _ ed iri a joint enterprise;and inchuling the legal representatives of a deceased employer,or flee of tbie foregoing engag arts association or ofliet legal entity,employing employees. Hovster: e receiver or trustee of an individual,P � of a dwelling house,having not more;than three-ap�eM abd who resides mere ,ox the occaP of the ownerpersons to do,mamteriaace,constriction or rep=woixtjn such dwelling house dweftbouseof:auot erwho employsp _ ` urtenant$ierem"shall not because of such emiploYet be deemed to-be in employer. or on the grounds or.bui DPP ' k en stall withhold the issuance or-. MG,chapter 152,§25C(6)also states that"every"state or local licensing agency renewal of a license or,Pez�to operate a business or to construct buildings in theeommonwealthfor any applicant who has not produced acceptable evidence•of compliance witli ttie insurance,coverage required.", _. Additionally,MGL�pte?152,§25C(7)states"Neither ¢commonwealth nor any of its political subdivisions s11a11 - cont W:t.for the p6apce of public work�acceptable evidence of� with the insurance Cuter mto`Hof &bVte have been pressented to lhe contracring au&o*-" Applicants .i n _ Please,fiIl out the workers' eom�pensation affidavit completely;by�checkmg tiie boxes mat apply to you sitaati4n az�d,i£ ease sub- s)naaie(s),`addims(es)and phone number(s)along with theft cerficate(s)of necessary,supply ' s with no employees oflier than the nswante. Lb3ilrA Liability,Companies(LLQ.orLimited.Liability�Parhiership ALP) members orpartaers;are notre pired-to carry workers' compensa' insurance: If an LLC or LLP does have "ployees,a policy is,required. Be advised that Phis affidavit maybe submitted to the Department of indulstriAl Ad confirmation of insmce coverage. Also be seer`¢to sign and date the affidavit. 'Ihe affidavit should` ed to the of town that ire applicagon for the permit or license is being requested,not the Deparfineot of -be retmrn Y y..., 16,dbtam a;work�' ,.. Accidents Should xon have any'gnestions'r ' the law or if you e Industrial. a, egardmg are requied, _ lease caIl the Depa0me t at the zuxuber:listed below Self-insured cximp 'compensat�on_pohcy,.P. amen should eater their. self-iusinrance lieensemember onme — me. — __ _._ _ a _ — — — — or Town Officials Please be,sure that the affidavit is complete and printed legibly.-,The Department" ed a space at the bottnm + of the affidavit for you to.ffi"out in the event the Office'of Investigations has.to contact You iegarding lh .applicant. m Please be smre to fill the perririt/licme numbea winch will be used as a reference inter.-in additiam,an appfieant •. . that must submit multiple Permit/l c se applications in any given'yea4 need only submit one affidavit Indicating current n if necessary)and under"Job Site the applicant should write"all locations m (city or policy iafomSatio (•, or maybe provided to The )•"A copy oi'the•.affidavit that has been officially st maped'or marked by the aty -applicant as proof thax-a valid affidavit is tm Me for;fat are pemnits or•liceases..A new affidavit must be.fi]led out each Where a hone¢owner or"cifizen is abming a license or permit not related to any business or eammnercial viaitare yea dog license or permit to linen leaves etc.)said person is NOT reared to complete this adavrt ' ,(i.e. oration and slwnld you have any questions, The Office'o fjuy�t Lions wouldlike.to thank you in advance co for your op please do not hesitate to give us a caL armo0fs address,telephone Bud,fax `' ' ' t " t The Dep - -,` The:C-0=0nWeM--of Massachusetts Department,of ludcWtrial Accidents 9f Iuv es igations r s: .i s -r,_ •� 60 Washington BOston,MA.U2111� ` ;* •• "• '.9 - �S. V. 9M t 1 •'! 4 1 ham+ }...y. ,. , �.. , fxi' .4. "LA : ?• a--.�r•4�1 ' f 'Tel.#617-727=490oiii 4m oi'•1477 MASSAFE -` - -;',Fax'#617=7274749 Revised5_26725 °j' �ovw;mass,govfc3ia � ;C7 LOT 24 ,yq,� ,t 11 5 N76 0 9,30 LOT' 25 o Q y g.2. Wo W g. •:::::::::;': p I9t O 'n0 lonv r ayt p eye O ,30„ g Q J LOT 26 30 NOTE'- PRE EXISTING, NON-CONFORMING ��21 RES ZONE- "RD-1" This MORTGAGE INSPECTION Plan is F°r FLOOD ZONE. "B" Bank Use On1 TOWN: _8A1�N�TAR YE---------- REGISTRY OWNER: ED_WARD A. TE7L ME&sI©SEPfi_C._TELIIIs_'R _ DEED REF -CE)U�S�M49_ -BUYER• �AYW_ ._u_ ----------------- DATE: __O,LQ2,1�_5---------- PLAN REF: 9,2BB L _-- ----SCAI,E:1"- 30_—FT. I HEREBY CERTIFY TO �l KIS�.d K MOR rar. r — THAT THE BUILDING OF YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS "TZ PAULA. CONSULTANTS OWN AND THAT ITS POSITION DOES CONFORM - MEq�TNEW „ THE ZONING LAW SETBACK REQUIREMENTS OF THE No.RITHE8 40B INDUSTRY ROAD �l`6WN OF _ BAh'NS4 LE — __AND THAT MARSTONS MILLS, MA. 02648 IT DOES—AOT_ LIE WITHIN THE SPECIAL FLOOD TIAZARD A��Fsso�p AREA AS SHOWN ON THE H.U.D. MAP DATED_?f02 9 !� TEL: 428-0055 Ca it —Panel 250001 0008 D ��"". �� FAX 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT PO I — SURVEY, NOT TO BE USED FOR FENCES, ETC. 1:7672 JDR t o , /tOld wk ! I _ i I ri I—1 I I 1 IZ �p I t { ! I �L I I I I It r _U E Q 1 114 — j i I 1 Ir0 t� , �__•-I � � � � 7 ir Rc9. i so N! MA 6 0- I 1-7 , 7- I 1 lIT Aiw f I l 4 �s - �c. Ea't'.46.Viz. CCL -.xa C,I 2IJ — ' _ I I I IT i __ tI�- . 1acL _i a $.1�z.e �xc _ � I y 001 �' �$�iii®� 114M S. 26 m. i Town of Barnstable Regulatory Services 9 snRN'Tasi,e,g Thomas F. Geiler,Director Fo; ,p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �Gi he `Wat`('S , as Owner of the subject property hereby authorize VA--,cO ���C�- 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 �3CkVl� �Clc-fir S Print Name QTORMS:OWNERPERMISSION 1 V Yr 11 V A ""A J LO L"LYAW, Regulatory Services �xxsTan . ' Thomas F.Geiler,Director p "ss. 1639. ,•� Building Division plED►,M�6 Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us ace: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement;removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: E­'11-161coy- 7KJe0C?_- ='o "CJL� Estimated Cost 0 Address of Work: Owner's Name: C` S C.\ayl�p_ Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law MJob Under$1,000 OBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the age of the owner: V��p 1,3" JEZ � GVyc.<.oe i D to Contractor Signatur Registration No. OR Date Owner's Signature Q vwpnes.farms:homeaffi day Rev: 060606 Board of Building Regulations and Standards i i t HOME IMPROVEMENT CONTRACTOR Registration: 124793 Expiratiow :8725/2007 Type: Inciividuai Vasco E. Nunez,Ili Vasco Nunez,LII 79 Mayfair Rd. LG..r« i,rsL'✓` S.Dennis,MA 02660 Administrator ` 477-2 License: CONSTRUCTION SUPERVISOR Number.;;-CS 069680 Blrthdat6:A:b/03/1948 d Expires 10/03/2008 Tr.no: 2714.0 RestFicteda 1" VASCO E Nl1NEZ ICI 79 MAYFAIR RD S DENNIS, Commissioner I i °CINE rq� Town ®f Barnstable *Permit#�Voff 'L Expires 6 months from issue date Regulatory Services Fee $ASTABLE, : Thomas F. Geiler,Director .9 MASS. i63 E S PER RRI Building Division tFp WI Terry, CBO, Building Commissioner JUL 2 2 2008 200 Main Street,Hyannis,MA 02601 www.town.banistable.ma.us Office: 508fb 30F BARNSTABLE Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number !t7 6 Z 9 Property Address ®Residential Value of Work 0," c Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address )Jin/ f1 Li I ctd i-i O i z-L Contractor's Name Lj A-1Ar6 k[ 4LA,6,9:e+,,/ Telephone Number IIome Improvement Contractor License,#(if applicable) j�fo ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to yt_,—tP -t' ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: ^� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revise020108 Board grguildd � .. NAME °g Re�'ulatioUs uQe =3 G1TPRpVEME and Standards Reg�st atro� NT Col"RA n �3 48 CrpR EXp�ratron 06 License or.r 9 4/S120.10 before th egistratIon y ^JAYNE t type Indfvid Try 2g Board a exP�ration alid for ind�vi z VVAYNs HALLGREN � ' r> ual 5070, OtiegsofBuildingRe"date--Iffound. dul use on! 1igLLGREs .;i Boston hburton pI ..gulatiops$� return to y' ¢6}n/ALKSR Sr ` ton,1lla.021 ;fee Rm 130 t8 tl r 08 1 ds tra(or _ �. without sig'.tare 6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02II1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El ectricia.ns/P.lumbers Applicant Information Please Print Legibly Name (Business/Orgmizationllndividual): PA—lAt O' JA L L&,Z I A� • Address: � d.j�a.i� '-as- S I . City/State/Zip: /-1,9• 0-o 6 d Phone 6/9-SY Z 7 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 employees(full and/or part-time).* have hired the stab-contractors partner- listed on the attached sheet. 7. ❑Remodeling 2.W1 am a'sole proprietor or ship and have no employees `These sub-contractors have g, ❑Demolition employees and have workers' working for me in any capacity. t 9. ❑Building addition comp.insurance. [No workers' cQn7p.InnrranCC regtnred] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El 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.&Roofrepairs inSrrranCe required-]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required] *Any applicant that ehecla box#1 must also fill out the section below showing their workers'comps .on policy infarrnation. t Eiomeowners who submit this affidavit indicating they arm doing all work and then hire outside cantraetors must submit a new affidavit indicating such. Tcontractors that check this box must athzhcd an additional sheet showing the name of the sub-contractors and stale whether or not those cnti$cs have. employees. If the sub-conbactors have employees,they must pravidt their workers'comp.policy nianbcr. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/Statdzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to scare coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a E=tip to$1,500A0 and/or one-year imprisown ut, 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 statEmerit may be forwarded to the Office of InVCSti ations of the MA for inerrrancc covers c verification. I do hereby certify 7ndar the pains d penalizes of perjury that the information provided above is true and correct, Si shoe: Date: 2 /A Phone# ' %— S-5 Z-7 Official use only. Do not write in this area, lb be completed by city or lown officlaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Information and -instructio 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, association or other Iegal entity, employing employees. Howeve r the e house ha not mar e than three a artnuents and who resides therein, or the occupant of the owner of a dwelling having P dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or n renewal of a license or permit to operate a business or to construct buildings to the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract form the performance of public work until acceptable evidence of compliance aZth _n the in-surace re ' emenls 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-eonf actors)name(s), addresses) and phone numbers) along with their certificates)of insurance, Limited Liability Companies(LLC) or Limited Liability Partnerships(LIP)with no employees other than the members or partners, are not required to carry workers' compensation ina rance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the pert 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 Dumber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp 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 thep - ermitJlicensc number which will be used as a reference number. In addition, an applicant licant that must submit multiple permitllicense applications in any given year,need only submit onp affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicaat should write"all locations in (city or town)."A copy of the aff davit 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 fo any business or commercial venture (Le. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would Moe to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call Me Department's address, tr1cphone•and fax number. The GommonwWth of Massachusetts Deparkment of Industrial Accidents Office of Investigat ans 60f)Wasl igGn Street Boston, MA 02111 Tel. # 617-727-490.0 ext 4-06 ar 1-V7-MASSAFB iced 11-22-06 Fax# 617-727-7749 www.mass.gov/dia {�..•+�'may Town of Barnstable r r * &UMSfABLE, 16_39. 1e$ Regulatory Services 'OTfn►��A Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230' Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize 0 4Yj ti c- NaAq KC-A to act on my behalf, in all matters relative to work authorized by this building permit application,for. (Address of Job) Sign( Da e of Owner e Print Name , Q:\WHILESTORMS\building permit forms EXPRESS.doc Revise020108 �t ire Town of Barnstable i Kam. Regulatory Services saxrtsTnst E Thomas F.Geiler,Director '�: A � Building Division lfD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER":_ name home phone# work phone# CURRENT MAILING ADDRESS: 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 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 or two-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,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department " minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official I Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC Town of Bari tstabk *Permit# v Kqpbw 6 months frost sane date swan Teets, Regulatory Services Fee Dc� co KASSM +tee Thomas F.Geiler,Director Building Division Peter F.DiMatteo, Building Cotmmissioner 200 Main sty, gyms,lA OkO1 -PRESS PEA �T Office: 508-862-4038 Fax: 508-790-6230 DEC 1 6 2005 ••EXPRESS PERNIIT APPLICATION RESIDENTIAL ONLY Not Valid without Red%Presslmpriat TOWN OFBARNSTABLE [aplparcel Number & �- rol-M Address i �mr+�ec drl �C) �� iQV t l� ,l/�/l (��(�� (p Residential Value of Work 7 28C o cx'-.) wner's Name&Address t u C. 1 `-7- . �ScAcrept $. 7 4, L::f=( ontractor's NameVA;C-6- Telephone Number J 22a 3v SaS (,5 11 ome Improvement Contractor License#(if applicable) Z 4-'°l ' Dnstcuction Supervisor's License#(if applicable) ( (o 1 be 9 0 ]Workmaes Compensation Insurance Check one: , AirI am a sole proprietor ❑ I am the Homeowner ❑ I have workices compensation Insurance c surance Company Name I 641 ' Policy# �® � O Z®2 :rmit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value -r 3 (maximum.44) ❑ Other(specify) ''Where required: Issuance of this perant does not exempt compliance with other towgdepartm xt regulafions,i e.Historic,Conservation,etc. pature i 2 �e rr ms:evuft vised121901 II p�opo� � 141 vASCO:NUNEZ:CARPENTRY 79 Mayfair Rd SOUTH DENNIS, MA 02660 MA Ltc..#069680 ' #124793 d. (866) 398 1511 • Toll Free. , (50$) 398 1511 • Dennts, MA . PHONE: DATE TO:. . Ms. Jane Wickers. _ 978 .;462-2207 9`/11/20.05 J 17 School :St JOB NAME/LOCATION d. By field MA 019:22 Andersen Windows 118.:Short .Beach Rd.: Craigville MA 0263.E 6174838-2941 JUMBE7.R JOB PHONE:.; OB N 77:8 2207; 5i08 449.4 We hereby submit'specificattons and estimates for:' 1 Remove four wood en Andersen "icre/awnin windows from b g ._ porch area, and replace%install with'four. new Andersen casement';,windows. ;New Andersen casement: win daws will have white vinyl" clad exterior, with.;natural; wood interior, :saone .colored screens, st:one `col:ored hardware;: and no grilles: New:windows will be: aobroximately; ix..inches smaller in length and four inches smalaer in height, per con.vers'ation.:on 2. Sup' interior/exterior trim and;framing materials, where..neede.d .;Exterior.`will.:have white cedars dewallshing. es weaved to edges of. new.windows ._Interior trim w l match existing trim with no stool °cap, (:'picture framed ) 3. Make arrangement for delivery of new windows, and take o. windows to`.t6wh landfill. ':: 4. S.upply:`towm building: permit .on .a .cost basis, payable upon :.completion _.of.,job This proposal does not include any painting or staining * All Andersen products .described..above:will be.prepaid' by owner. ** If this proposal .is satisfactory,. please..sign the YELLOW copy and return with payment schedule. i ** Please make payment of new Andersen windows with Fairview Millwork .Inc. directly via Curly Carey, . ( 508-394-2219. .) . **** WE ACCEPT VISA/MASTERCARD FOR LABOR PAYMENT BY SWLPE ONLY **** We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Three Thousand Two Hundred Eighty and 00/100 Dollars dollars($ 3,280.00 ). Payment to be made as follows: Labor: 50% Down payment to start. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1640 00 Labor: 50% Upon completion at time of completion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1640.00 A11 material is guaranteed to be as specified.All work to be completed in a professional p manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature - Q 1i charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Workers Compensation insurance. withdrawn by us if not accepted within 4)0 days. Acceptance of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as t0ce'_� specified.Payment will be made as outlined above. Xature a r1 /�s/0�-- Signature Date of (eptanc, : oRODUCT 13f28M uSE NTH 771 ENVELOPE NEBS To Reorder.1-800-225-6380 or www.nebs.com PRINTED IN USA AB _ le Ur1�}a7�ru�LC�seaGUt• l�/F'crJfILrJLU:W6 _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration; 124793 Expiration, ;8/2512007 Type- Individual Vasco E.Nunez„lil: Vasco Nunez,III 79 Mayfair Rd. S.Dennis,MA 02660 Administrator d _ r _ ✓lie IJa9;vgzOriu��L o�✓�' vttc�i�r6e�d BOARD OF BUILDI G REGUIu4Y#OlVS License: CONSTRUCTION:SUPERVISOR F � •Number CS 06968U - Birthdate 10/03/_7948 Expires 10lQ3/2006 Tr.no: 2545.0 Restncted. 1G, VASCO:E NUNEZAII 79 MAYFAIR RD S DENNIS, MA 02660 Commissioner OFTHE Ta Town of Barnstable ♦ Regulatory Services BARNSTABv MASS. Thomas F.Geiler,Director �A .i63q �0 TED 39 Building Division Elbert Ulshoeffer,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATION 120 square feet or less 18 SA or eeatc. Rd. Ceo-Irnr✓i Location of shed(address) Village Tavie- (J;cke�sa - as o Property owner's name Telephone number gx ► � aD � l 0�9 Size of Shed 30 Map/Parcel# o RO-1 - �. CD t --a Signature Date rn r � Hyannis Main Street Waterfront Historic District? rA, Old King's Highway Historic District Commission jurisdiction? kP LaCW—WA) Conservation Commission(signature required) �7 (� aAu mlAc 1 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE f COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedteg 9288 SUBDIVISION PLAN OF LAIID IN BARNSTABLE Bearse & Kellogg, Civil Engineers Ltay 11, 1950 V E A/ ` 22 21 _ < 20 t ET ° RE ' F66.4`� h �ji4io� copc 18 Ce L Ja �lJ o �o , -35 m 3 87 f e�T 26 ' S•.;udi•rision of Lotr. 2 24, & 1 j 7 ' Saorn on Plan 9,vsL Filed vrit: Cert. o: Title lio. 9696 Registry District nF Barna+ nle County s Separate certificates of title may be Issued for land shown hereon as.ln.ts...Z.7... ...ZB............................. d'�+4 plan By the Court. "..'. —A h-- LAND REGISTRAT10N 0ff10E JAht. 14 1952 �A Suk a rthis Pw eo ffft to ee Midi ..........................+�J... .. ............!''� �. W.T.F1#rk*.bvimor*rcot ecotde . L O (O Cv 1 I I I I 1 I r I I I ' 1t i 1 , �._ a I L. I: I I I 1 st . 1. 1 ,...... .,,.. ,... ........1. i, ..� ..' .. - .. .: -...:III I .:...:lot : ' '...'..:. t 1 '.: 1 ! ' `:•1. 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