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HomeMy WebLinkAbout0022 SKUNKNET ROAD SXIL �y �- r, A ,a o o � - I v c. Town of Barnstable Building (Post This Card So-That it is Visible From the Street Approved:Plans Must be Retained on Job and:this Card Must be Kept '"' iPosted Until,Final Inspection Has Been Made. erWhere a Gertificate`of Occupancy is-Required. uch Building shalP� I Not be Occupied until a Final Inspection has been madme , it Permit NO. B-20-1439 Applicant Name: ENRIQUE SANTIAGO Approvals Date Issued: 06/17/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/17/2020 Foundation: a Location: 22 SKUNKNET ROAD,CENTERVILLE �- Map/Lot: 192-047 Zoning District: RC Sheathing: Owner on Record: SHAPIRO,JOSHUA A& DEBORA C . Contractor Name-,ENRIQUE SANTIAGO Framing: 1 Address: 124 CULVER-ROAD i Contractor License: CS 106463 2 ORLANDO, FL 32825 Est. Project Cost: $3,000.00 `* J Chimney: Description: replacement of windows, rotten trim,and siding 1, Permit Fee: $35.00 I 1 Fee Paid:`) $35.00 Insulation: Project Review Req: Final: Date: 6/17/2020 Plumbing/Gas ! Rough Plumbing: � g ',-,.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 inspection for the entire duration of the Final Gas: work until the completion of the same. �,- r•' 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: Service: 1.Foundation or Footing - 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) Low 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 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT /" ` Uitizen Web Request Page 1 of 2 ems;-zAa� r � «�. - Citizen Request Management - Internal Use Request ID: 55003 Created: 1/12/2016 11:37:25 AM Status: Closed Assigned To: Lavelle,Timothy Health Office ' Anonymous: Yes Category: Chapter 108 Hazardous Materials E.C. Date: 1/26/2016 Created By: Sousa,Vanessa Citations: Health Office x �;F, Time Worked: 1.50 Response Time: 0.50 G :, Requestor Details: Email: Request Location: 22 SKUNKNET ROAD Centerville Parcel Number: Map: 192 Block: 047 Lot: 000 Request: Silver car was delivered this morning to 22 Skunknet for repairs.This is apparently a repair shop at a residential property.This is the fourth time a car was delivered,worked on and taken away within the past 6 months.There are chemicals stored on the ground at the end of the driveway as well as junk and debris scattered throughout the back yard. Request Work History: Entered on 1/13/2016 8:56:17 AM by Lavelle,Timothy f Last modified on 1/13/2016 8:56:53 AM TL checked site on 1/12/16 and spoke with Eric Santiago,tenant. He claims that he he has only worked on personal vehicles at that property. He had some empty antifreeze containers and a half gal of motor oil at the end of the driveway- nothing approaching repair garage amounts of hazmat. He has a construction business and had some construction-related materials in his yard. One of his shed roofs had blown off in the last windstorm and he is in the process of fixing the shed -.some gardening chemicals were observed outside of this shed. He also claimed that it was his day off and he planned on bringing a lot of the debris in the yard to the dump.TL advised Mr. Santiago how to properly store hazardous materials and left. Will follow-up in one week. Entered on 1/19/2016 1:36:34 PM by Lavelle,Timothy TL follow-up on 1/19/16 - spoke with Mr. Santiago's wife.There was one registered vehicle in the driveway. Shed had not yet been repaired, but trash had been removed from the yard. http://issgl2/InternalWRS/WRequestPrint.aspx?I0=55003 1/20/2016 .. �Uitizen Web Request Page 2 of 2 Remaining items in yard include construction supplies, kids toys, and outdoor equipment. No automotive service or repair materials were observed. Case closed. I Internal Note History: Entered on 1/12/2016 11:37:25 AM by Sousa, Vanessa Email sent by TM. Recall Robin that on January 2, a green Honda Accord was delivered on a flatbed truck by Davis Towing and was worked on for a few days on the gravel driveway-then was taken away. System entry on 1/12/2016 11:37:26 AM: Assigned to Lavelle,Timothy l System entry on 1/19/2016 1:36:34 PM: Request Closed by lavellet s http://issgl2/InternaIWRS/WRequestPrint.aspx?ID=55003 1/20/2016 Anderson, Robin From: McKean, Thomas Sent: Tuesday, January 12, 2016 10:49 AM To: Anderson, Robin; Lavelle, Timothy Subject: 22 Skunknet Road r just received another call about this repair shop: A silver car was delivered this morning to 22 Skunknet for repairs. This is apparently a repair shop at a residential property. This is the fourth time a car has been delivered, worked on and taken away within the past 6 months. Recall Robin that on January 2, a green Honda Accord was delivered on a flatbed truck by Davis_ Towing and was worked on for a few days on the gravel driveway-then was.taken away. Tim -There are chemicals stored on the ground at the end of the driveway as well as junk and debris,scattered throughout the back yard. 1 tell DEC 28 N! : 50 CAPE SAV-E.--111�'�--�'�- . i'arl Weatherization 508-398,0398 December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis, MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application #201100878, Status A, Parcel 192047 at 22 Skunknet Road, Centerville, Permit type: RADD, and issued on 2/25/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-30 Cellulose insulation was added to the attic. Walls were dense packed with R-13 cellulose insulation. Basement sill was insulated with R-19 fiberglass batts.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey ok �.ll3flZ ; t ito , r �"J`•' �Ird`*fit ..rL .mF'� '� i Y4.i` r3,,,.�t,� �': ► I'ffir i 4 s i�l°i � qA TL c a r3 if rip Al 4,iAtk, I��� 11 ��, r - t_ . t + �," d "`fit Y ' lot c i Town of Barnstable �.�114 l°'yti Regulatory Services Thomas F.Geiler,Director BARNSTABLE. . . Building Division 1639. ptEa �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT#Ll 9 FEE: $ J SHED REGISTRATION 120 square feet or less �KuAJ i4� i 69E-V (/L-&F- Location of shed(address) Village. j�1 R(' o�� �r �G'6� 0Y- ??J= Property owner's name Telephone number Size of Shed Map/Parcel# �a 3 ate —a Signature , Cn Hyannis Main Street Waterfront Historic District? s_ Old King's Highway Historic District Commission jurisdiction? x� Conservation Commission(signature required) co PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE rn COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION EE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 OC 10 OF PROPERTY LINES MAY NOT BE ACCURATE STANDARDLEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY: EDGE OF DECIDUOUS TREES ^^^ EDGE OF BRUSH t ' ORCHARD OR NURSERY, V-v 7-4 EDGE OF CONIFEROUS TREES MARSH AREA Z - — EDGE OF WATER __= DIRT ROAD DRIVEWAY PARKING LOT PAVED ROAD ------ DRAINAGE DITCH ----- PATH/TRAIL ap PARCEL LINE 192 ** mrtto� MAP# 21 a PARCEL NUMBER #1860 =HOUSE NUMBER 2 FOOT CONTOUR LINE 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION 22 C=K=X= STONE WALL -X—X- FENCE RETAINING WALL RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK \ Q 13 BUILDING/STRUCTURE DOCK/PIER rs� N HYDRANT e VALVE ® ' MANHOLE ~ O POST p� FLAG POLE T O W N O F B A R N S T A B L E O E 0 6 R A P N 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is on enlargement of a **NOTE:The parcel lines are only graphic representation DATA SOURCES:Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James 1 100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE 13 TOWER " E 0 10 20 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation.`Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=20 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2003 Town of Barnstable Assessor's tax maps. O LIGHT POLE O ELECTRIC BOX - - - F:\dgn\conservation.dgn 06/17/03 11:39:25 AM Z" Town of Barnstable Approved © �� �° Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: o111-7 0 Name: e Phone#: J W— 7 7 S 7 3 :2-3 Address: �� UN`Ciy67r— Village: 1ti1��Zlil L L C— Name of Business: ®--t-�/'!�' e��.�f✓LKL� l�G�/�Nr�l/�° Type of Business: ,%7''UM CC C 4 V iy6 Map/Lot: / �z INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersi ed, ave r ad and agree with the above restrictions for my home occupation I am registering. Applican Date: Homeoc.doc TO ALL E BUSINESS OWNERS DATE: / /7 o Z Fill in please. " am�„ f. _ APPLICANT'S YOUR NAME:- oHAj (Ag!0.4,v.y ,� ec.111,J�� BUSINESS , R YOUR HOME Rod, . of E ADDRESS:2-2- ,�uN;c r_,97n1215z✓1 LLB lPf4 S 7;?- TELEPHONE 9- ���`�"` ��' Telephone Number Home 5 U F- 7 7S7-7 S-2-�3 NAME OF NEW BUSINESS c /A2 Li_,-t ✓11 1 a TYPE OF BUSINESS_ / p�tc= CD��•4NryG IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES= NO ADDRESS OF BUSINESS 22 2D, MAP/PARCEL NUMBER 1U ,04-7 When starting-a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. -This form is intended to assist you in obtaining the information you may need'. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office(Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual has be formed of an permit requirements that pertain to this type of business. A t iz�dSature** COMMENTS:_,��,,_, �.4= � v 2. -BOARD OF HEA H This individual ha n informed of a it requirements that ertain to this type of business. Authori gnatur COMMENTS: '44 '::670. 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Puthorized Signature** COMMENTS: Business certificates (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. i Town of Barnstable Permit: -7'C,( 04,q ZU A Regulatory Services Date:q L�.1, °FaE rod Thomas F. Geiler, Director Fee:�.?G. Building Division � BARNSIraBLE, Tom Perry, Building Commission Q �ss. �a i639. 200 Main Street, Hyannis, MA 026 �°rEn Mai a www.town.barnstable.ma.0 SEP� 0 RFC, Office: 508-862-4038 BY a 508-790-6230 TOWN OF BARNSTABL SOLID FUEL STOVE PERMIT Owner: 56ShUC- cSl'YoZpIYD SYr Phone: 50S-SC,00-4g94 Install at: o;G V f)Kn C#- Village: Celn4e 'Ul 1 I e Map/Parcel: Date: q I8� 2p1� Stov A. ew/ Used B. Type: adiant Circulating C. Manufacturer: Lab. No. D. Model No.: Chimney A. New/Existing (If existing, please note date of last cleaning) B. Flue Size \-)_I 12— v C. Are other appliances attached to Flue? 00 D.. Pre-fab Type and Manufacturer E. Masonry: Line nlined Hearth tt A. Materials: �,c� l� °6 B. Sub Floor Construction: 1,`oo Installer Name: Address: Phone: Location of Installation: H.I.0 Registration # Construction S rvisor# OR check VHomeowner Installi o lie rise required APPLICANTS SIG.NATURE APPROVED BY: t,ll a) q17 Please make checks a able to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y Please Print Legibly Name(Business/Organization/Individual): o l IJ Address: L� City/State/Zip: C uvLa- \,i <<�- 0P-X_,3P-_ Phone.#: 509 a0 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2.❑ I am a sole proprietor or partner-' listed on the attached sheet. 7.. 0 Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of W DIA for insurance coverage verification. I do hereby c un r the s"and penalties of perjury that the information provide abov is true and correct. Si ature• Date: Phon fficial use.only. Do not write in this area,tb 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 ti AW Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public woric 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)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to brim 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. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable of 1HE rail. Regulatory Services * Thomas F. Geiler,Director * IAMSTABL.E, 9� ,�� Building Division Arfp ,ts 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: o t JOB LOCATION: s y o-,,J -C, C �— number street village "HOMEOWNER" �o�� .� �w ��- �60-�1�1°�� Sod name c t, 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,k, 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 minimu inspection proce es and requirements and that he/she will comply with said procedures and requi en . S' nature Alomeowner 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. 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\FORM S\homeenmpt.DOC �1HE r Town of Barnstable * k Regulatory Services MAS& Thomas F. Geiler,Director 1639. 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 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 If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 201 I 00 81 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village 'E: Owner r,S aA a I(Zn Address D Telephone `s --N Permit Request r_r—_L -ul LDS6 �j-dyfl U I,l�bf L` Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay � oe Project Valuation 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other L Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name SAO!�Ibji A4c Cto 4 v)y Telephone Number Address - rA.4 614 License # 2, 7 TG IC Z Coro Home Improvement Contractor# (y 1/3 Z Worker's Compensation # 1AIC, 166q 6� ?�' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE '+ J 1"2 Z FOR OFFICIAL USE ONLY 5 APPLICATION# K DATE ISSUED { x MAP PARCEL NO. ADDRESS VILLAGE ' k OWNER' _ I ;F DATE OF INSPECTION: ? FOUNDATION I'. FRAME E INSULATION ' FIREPLACE If ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL .t GAS: ROUGH FINAL t` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 t F L r f Office of Consumer Affa/sa. d Business Regulation 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card Expiration: 10/6/2011 CAPE SAVE WILLIAM MUCCLUSLEY ^_.............. .._._.____..._.. 8201 S. HOURD CT CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. Address l Renewal Employment Lost Card Ir r ��c err t f�•1�.�xEzi�!Ji r f'.,!fir,:sc:r�r,rae1.�3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only. i before the expiration date. If found return to-. :.? �HOME IMPROVEMENT CONTRACTOR �w Office of Consumer Affairs and Business Regulation ... Registration: 164432 Type: 10 Park.Plaza-Suite 5170 =' Expiration :1p/612011 Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM MUCCLUSLEY "7C HUNTING AVE. --- S.YARMOUTH,MA 02664 Undersecretary Not valid wit out signature W 11:1�'+ailttl`crtr I)cll.trtlncnc of 11111blit 134:tt d of 13111lddn-, Rt''Is1.1tifoils 111d ;4 id tr'tis Ucert:se; CS SL 102776 Restricted to. IC is ; WILLIAM MC CLUSKY 37 NAUSET ROAD . ` WEST YARMOUTH, MA 02673 �--G--�-� Expiration: 6/28/2013 1"e=. 102776 v!pee ojInvesfigadons 600 Washington Street �* `r . Boston,MA 02111 *".mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoolicant Information ease Print LlWbly Name(Business/orgenizationqndividual): i L°,kf i�l✓I__ ) �1 j'�(� t ► c}!���s A 1}(��a C'( Mkt Address: ISM 1 Ci /StateJZi dylt�� Phone#: Off- 3 9 - osck Are you an employer?Check the appropriate box: 1.1I am a employer with_' 4. ❑ I am a general contractor and I T of project(required): 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. ❑Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employes 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 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 3a.❑ i am a homeowner acting as a employees. [No workers' 13.( Other� S j�p . that general contractor(refer to#4) comp.insurance requited.) *Any applicant t checks box#1 must also fill out the section below showing their workers'comMs8 iodiolicy intbrmadon. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConttactons that check this box must attached an additional sheet showing the nun of the subcontnactm and state whether or not thou entities have employees. If the sub-contractors have employeaa,they most provide their workers'comp.policy number. Ian an employer that is providing workers'coin pensation insurance for my employees, Below is the polky and job sfte imformmd" Insurance Company Name: CA4A 0-1 u )C Policy#or Self-ins. Lic.#: ", Q' -r) S Expiration Date:�2� Job site Address: 2Z S��'� t•��i-t city/Statelzip: C;& 1ILLF: ��3 � Attach a copy,of the workers'compensation porky 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil in of criminal DERpenaltiesof i of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to true Office of na fine Investigations of the DIA for insurance coverage verification. I do hereby cerdfy under dire Roku:d," of perjury that the informadon Provide.d above it true and eorreett Signature: Date: -z Z-3 Phone t,_ ©fflelaf use only. Do not write in this area,to be completed by city+or town offlciai City or Town: Permit/License# Issuing Authority(circle one): I-Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,;AC40RCERTIFICATE OF LIABILITY INSURANCE °1/1-�°/°° � NCE 1 �1r2010 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 Shannon Sperrazza Risk Strategies Company PHONE , (781)986-4400 i A/C No:(781)963-4420 15 Pacella Park Drive ADDRESS:SS errazza@risk-strategies.com Suite 240 PRODUCER 00018476 Randolph MA 02368 INSURERS AFFORDING COVERAGE j NAIC># INSURED INSURERA:Seneca Specialty Insurance Co I INSURER a,KeatingGroup Ins Services Michael McCluskey, DBA: Cape Save INsuRERc:Chartis Insurance 7 C Huntington Ave INSURER D; j INSURER E: _ South Yarmouth MA 02644 INSURERF: I COVERAGES CERTIFICATE NUMBER:CL1011132675 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, t EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE N R 1 w I POLICY NUMBER rM/DDY YYY j OLIC EXP LIMITS 1 GENERAL LIABILITY (1 j EACH OCCURRENCE $ 1,000,000 1 X. COMMERCIAL GENERAL LIABILITY DAMAGE D PREMISES Ea occurrence $ 50,000 A _ 110/16/2010110/16/2011 — MED EcP(Any one parse, i$ 10,000 {. j PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE i$ 1,000,000 �GEN L AGGREGATE LIMIT APPLIES PER: i I i I ; PRODUCTS-COMP/OP AGG i$ 1,000,000 I X POLICY PRO- LOC ! j $ -- j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 6208200 1/6/2011 (Ea accident) j$ 1,000,000 +11/6/2010 t ANY AUTO � _ ALL OWNED AUTOS ALL INJURY(Per person) ?$ I I, X i SCHEDULED AUTOS j BODILY INJURY(par accident) $ j ? PROPERTY DAMAGE X HIRED AUTOS I (Per accident) $ I X NON-OWNED AUTOS j I $ X'.UMBRELLA LIAR i i $ _ OCCUR ; EACH OCCURRENCE _ $ 1,000,000 ' EXCESS LIAR CLAIMS-MAD y) I fi i AGGREGATE $ 1,000,000 ,000,000 !DEDUCTIBLE 023578601 � 0/16/2010 10/16/2011' $B ; ;RETENTION $ , !$ C I WORKERS COMPENSATION i I -chael McCluskey X 1 WC STATU- OTH-( AND EMPLOYERS'LIABILITY YIN I I TORY LIMITS! 1 ER I j ANY PROPRIETORIPARTNERIEXECUTIVE I s excluded from coverage! E.L.EACH ACCIDENT ;$ OFFICER/MEMBER EXCLUDED? NIA; 10/21/201010/21/20111 500 000 (Mandato in NH) 1 9930951 If es describe under ; E.L.DISEASE-EA EMPLOYE $ 500 L000 DESCRIPTION OF OPERATIONS below i j I E.L.DISEASE-POLICY LIMIT $ 500,000 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS '°- ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD Town of Barnstable ti (� 10� Regulatory Services . Thomas F. Geiler,Director 9 l�Ea,,,,�a Building Division Tom Perry Building Commissioner 200 Main Street,Hyannis,MA 02601 viimtown.barnstable..ma.us - Office: 508-862-4038 Fax: 508-790-6230 Property 0,,vner Must ` Complete and Sign This Section If Using A 'Builder I, �,)o S I+V tq S�W Ro , as Ovme'r of the subject property . hereb5author17-e / �' to act on my behalf, m all natters relative to work authori7Ad by this buidding permit application for: Z Z YK(W cFleF AD C6 x J1(cc rb � (Address of Job) ignature of Owner Date Print Name �' \ If PropejU Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FOR:Ai S:0VYN,,7-RPHR?,4IS S i0:"3