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HomeMy WebLinkAbout0287 STONEY CLIFF ROAD p___ __ ,-.._ l .1. . -,. . I I I,/ -lae , I - , C&I / A �,. i i e. , , �� y I ; 1-11 .i` b r N '.; r• �� 4' c= a a° i If,�' d s Y .k, s - • . t 9; a E' 9s' M� 4 Ja y Y, YA .a 'a q 1. I i' .i' I G ;` 1. C4 1J4 � 11 1 l' P°� p GI �t i, ! h .d a I " I, iF ;y, ^9 ,l1. 4 V n ! t` � �, ® ��" q� 'i tl 'r5. i y0=...' u., b '} n n A,' ,`I Ik i, q b 7� t ` t , . U ! y k ti�` y'; a <_' �� $i a a „'. o III k. . < 1'. n w p I_ t ',I• 4 ,i } Y N 1 SE h �1,d� ''.y v: AA c. 0 R �y'i 'I i 4 y ,1t �, A #4, ! A �i dr c P s "u 9 r r,sr 3 M_. e ".' Ck f` 4 ,; 1 i1' ° �' k 'e 'i , a' �' o ,� a 0 qg r P.. t , 1 ., .�rc . i ) �dR! h ti` f�l ., J _ I.. z I •y i " i P .. 9 a r.,. r - n, .,9" a.',' n._-o. 5c�...... _ -ris _ .� _o t2 __ 0 oFT„�, Town of Barnstable *Permit# �1. Eje 6 nronihs from issue'date P Regulatolry Services pT *PERMIT• g Thomas F. Geiler,Director 163.9 Building Division TOWN OF SARNSTASLE Tom`Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 „ www.town.b arras table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION, - RESIDENTIAL ONLY'. I Not Valid without Red X-Press Lnprint Map/parcel Number . L-7 ,Property Address 2 0 n s an,3 2�/ e4-LC�' Q[� a?"Y r(LuM`? ❑Residential Value of Work tQ_0 . Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address (m x V, PM I(ts'Pe h t) Contractors Name P •` '�' t-� hone Number— Home Improvement Contractor License#(if applicable)_ t Cif Construction Supervisor's License#(if applicable) moon ❑Workman's Compensation Insurance Check one: [�4 am a sole proprietor ❑ I am the Homeowner [` I have Worker's Compensation Insurance , Insurance Company Name L>0alb Workman's Comp.Policy LaKab - Copy of Insurance Compliance,Certificate must accompany each permit.. , Permit Request(check box) \' r ❑ Re-roof(stripping old shingles) All construction debris will be taken toLCI � Re-roof(not stripping. Going-over existing layers of roof) (0—Re*side , 4. #of doors t ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows ` *Where"required: Issuance of this permit does not exempt compliance with oyher town department regulations,i.e.Historic,Conservation,etc. ***Note Property Owner must sign Property Owner Letter of Permission.. A copy of the Home Improvement Contractors License& Construction Supervisors License is requi ed. SIGNATURE: , r Q:\WPFILES\FORMS buildi permit forms\EXPRESS.doC `$ ... .1 a .{art __ � ry •. .. BOard Building.It r ; . i HOMEgulati IMROV ons and Standards, Registrafion�': EMENT CON TRACTO q 101-149 R . _ ? EXp�i�atron I if 6/25/201.0 T JOHN p� ....n,Eividual 267680 y { F DUNN i John Dunnr = p 80 MA' ifr RIE ANN.TERRlYf CENTERViLLE.: r ✓;, MA 026Admini32 —` stra '-` Massachusetts'- Depa►-tment of Public Sitfe.t Board of BuildinT g .r ' Rc'UIatwns' and Standards i Construction'Su pervisor License License: _ Cs 14 007 Restricted to: '00 JOHN P DUNN BOX 924/80 MARIE ANN.TER { CENTERVILLE, MA 02632 r Expiration:_5/25/2012 Tr#: 24061 r License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301'. Boston,Ma.02108 Not valid without signature � Nlassdchusctts - Uelm, rricnt of Public SafctN Board of Building Rc<..ulations and Standards Construction Supervisor License License : C S 140 07 07 Restricted to: 00 I JOHN P DUNN BOX 924/80 MARIE ANN TER i CENTERVILLE, MA 02632 q Expiration: 5/25/2012 l ('utnmissiuncr �--- ---- Tr#: 24061 .4 The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street y Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: fC��� ►-� 2 City/State/Zip: Coi—Itau t t1k,Cob Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and T employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New.construction. 2.Is+, am a sole proprietor or partner listed on the attached sheet.. T ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P Y• 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised 11,❑ Plumbing repairs or additions 3 I am a homeowner doingall work h id the P 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 Vt 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: �Loi PFgi '� (J�( LRb Policy# or Self-ins.Lic.#:�� �;boqf-o Expiration Date: .lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine.up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.0.0 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 it rider thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Dater - (� Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ('nnt�rt Pnrenn• Phon P. #: _ Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an emplo},ee 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 conunonwealth 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-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 pen-nit 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 fiture 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 bum 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-MASS.AFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia I �YHFr Town of Barnstable Regulatory Services ' ASTABLE, Thomas F. Geiler,Director hsass. 16;Ay� � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Prop e rty Owne r Mus t Complete and Sign This Section If Using A Builder I, P h CIS S U�Z I I�5/CI , as Owner of the subject property hereby authorize ttsav to act on my behalf, in all matters relative to work authorized by this building permit application fora a-8r) Stays CLLe— (Ikddress of Job) Signafure of Owner. Dat PrintVame If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. tl Town of Barnstable Q Regulatory Services Thomas F. Geiler, Director + STABLE, + K" . Building Division Alfo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vnyw.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 'v"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. r 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 A -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." are that they are assuming the responsibilities of a supervisor(see Appendix Q, Many homeowners who use this exemption are unaw 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 a currently used by several towns. You may care t amend and adopt such fomi/certification for use in your community. Q:\WPFILES\FORMS\homeex empt.DOC Town ®f Barnstable ::2d6666 66 Expires 6 months from issue date X-PRESS PERW regulatory .Services Fee ��— Thomas F.Geiler,Director MAY 18 2006 Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1:7 0 y l Property Address zn-k—�D 0,j Co . []Residential Value of Work lQcrx Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �22t��`� �f 04,ki Lc-IS 5LIS-I t k--,s c�9 vLa Contractor's Name < 1 WA Telephone Number Home Improvement Contractor License#(if applicable) to L 1 4G -- Construction Supervisor's License#(if applicable) oL�-(ooC ) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#�1.�(�° SRO L(LnSq Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) EJ,Ke side ❑ Replacement Windows. 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. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 BOARD.O�UILDIN REGULAfiCONS a Licenser CONSTRUCTION,SUP ERVISOR I a • I' I NwmbeF�E�c ©1 007, : . . a ` " Tr.no:. 238,84 Expires'96;�5/v ©O6 IRes t d ©� I JOHN P DUNN =ate a I . . BOX 924/80•MARIE AKINRao CENTERUILLE, MA 4632° Commissioner _ 74 0 r« Beard of Building Regulations and Standards License.or registration val►cf for mdividul use only HOME IkAROVEMENT CONTRACTOR before the expiration date. if found return to: RegIstraion 101142. Board of Building Regulations and Staijards. . YExpira'tion 6�2r;/1006 I One Ashburton Place Rm 1301 Boston,Ma.02168 Type 4nc Ividu al T —' JOHN P. DUNNt 71 John Dunn �7 80 MARIE ANRTEf2R" ; t CENTERVILLE,'MA 62632 Administrator Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _ADDlicant Information Please Print Legibly Name(Business/organizationandividual): �O(-Fr-� C� •�y 1.1N — / l,Urte u p Address: t4 P, k-g_ ti InLet-- City/State/Zip: Lq.��e�2v�<<� 1-�l� G��3a- Phone t 92)(6- `T)- (-'uSGUr Are you an employer? Check the-appropriate box: Type of project(required):. 1,❑-I am a employer with b 4• ❑ I am a general contractor and I s ❑N construction employees(fall and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet $ 7• emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. . 9. ❑ Building addition [No workers'imp.insurance S. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required,] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[^j Plumbing repairs or additions myself.[No workers' comp, c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t . employees. [No workers' l3.❑ Other insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinforrnatios: t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit and icstiMg such =Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp,policy infbrmativa. ram an employer that Is providing workers'compensation Insurance for my employees. Below is the policy and job site information. pp_ Insurance Company Name: k1so cc � Policy#or Self-ins..Lie.#: ce, s)�)G 4(a., Expiration Date: `C� v Job Site Address: City/State/Zip: LQ _4.,P_LU (C tlp_-02�3� Attach a copy of the workers' compensation p.olicy 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$1,300.90 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Q Date: Phone#: [1Bc0F_,rd ial use only. Do not write in this area,to be completed by city or town ofjicW. or Town: Permit/License# Issuing Authority (Circle Owe): of Flealth 3. Building Departme�at 3.City�owu Clerk d.Electrical Inspector 5.Pluabing Iasg�e or ther tact Person: Phone#: xi .i®rrnata®n anu 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, t 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 it license or permit to operate a business or to construct buildings in the cornmonwealtb 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)namae(s),address(es) and phone mumber(s) along with their certificate(s) of insurance. Limited Liability Companies(LLQ 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 Depar went 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 con3paii-m ftuld der$heir 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 fll out in the event the Office of Investigations has to contact you regarding the applicant. - Please be sure to fill in the permitlicense 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=ent 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. 617-727-4900 ent 406 or 1-o77-MASSAFE Revised 5-26-05 Fax ILI,` 617-727-7749 VWv V.mass.gov/dia r °Ft�E�ati Town of Barnstable Regulatory Services i ` MASS ` Thomas F.Geiler,Director 'ATEDMA'�a, , Building]Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 S, www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508=790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Mr-9. h LCu, �� I ,as Owner of the subject property �� `�-1� J P P nY . hereby authorize �O�k� p ��� to act on my behalf, in all matters relative to work authorized by this building permit application for. a � (Address of Job) - p Signature of Owner Date , S LS�?. rint Flame Q:F0RMS:0V NERPERMIMION r f pF?► Town of Barnstable *Permit# ' respires 6 months from Issue date ? ,,,JIM , : Regulatory Services Fee MASS s639. Thomas F.Geiler Director � QED MP't� _ Building Division �yA1" U:::i �' .= Q y PRE f 1. ..ebb!: 9 Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 A i,j G i U0 F) Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTA-_ E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address (A&;- �--- i C� i ❑Residential Value ofWork' t 0 t)5 Minimum fee of.$25.00 for work under$6000.00 Owner's Name&Address -� � Q52 I-IIJ 64e-1 C— Contractor_s_Name�C ��j N I� ' Telephone Number9 �)-) Home Improvement Contractor License#(if applicable) t O 11 �-A Ci Construction Supervisor's License#(if.applicable) C)1 L1 [bj ❑Workmen's Compensation Insurance Check one: El I am a sole proprietor &1;the Homeownere Worker'sCoAmpensation Insurance Insurance Company Name NI ���.b1`� ���j1"-�S 0 `-�`' ���•/ � . Workmen's Ccimp.Policy# Cs (& 06 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. 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. Home Improvement Contractors License is required. Signature Q:Farcas:expmtrg Revise063004` .4 • 1 7 v pF�►+E y0y. Town of Barnstable Lp" Regulatory Services ♦. a RARNSTAB IX Thomas F.Geiler,Director 9. 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, gtt:�'`Z-AIlz -,as Owner of the subject property oy l� to act on m behalf, hereby authorize .��.L y in all matters relative to work authorized by this building permit application for: (Ad ress of Job) Signature of Owne ate Print Name Q:FORM&OWNERPERMISSION q� f. EAgineering Dept. (3rd floor) Map 17 Parcel ` Permit House# 0�8 PUS, Date IssueQ Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) qa-Sq Y. N Fee •��/�� �y� Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) kqjCt ��qL ' N Planning Dept.(1st floor/School Admin. Bldg.) CO �IMF Definitive Plan Approved by Planning Board 19 BARN STABLE, MA 8& p QED MA'S a`i± TOWN OF BARNSTABLE Building Permit Application Project Street Address. 02 9 7 Village Owner /0 0,&70n/ArLm SvS�„Lg i Address Telephone 7 7/ d Z 7 L/ Permit Request p �X 2 h" 7V t-dr� 4,orS �l2 c,9•J C 2 �lO First Floor square feet Second Floor square feet Construction Type 4�?RTrA s�NG Pt Estimated Project Cost $ 3 O, "0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Vd' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes tf No On Old King's Highway ❑Yes 0"N0 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric p Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) (Attached(size) ❑Barn(size) None ❑ ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes WrKo If yes, site plan review# Current Use Proposed Use -�- Builder Information Name�J�j�/ �A1Jj2a> i//L n Telephone Number Y2_r— qS-/ F Address /!r ��' ��r.�"wlt) /`D 677ii; License# 45-7U 3 2- AW 122i 42?l� Home Improvement Contractor# /00 7 4-10 -G T4- 7— Worker's Compensation#Oeg&d 513 Z 2..9 2, C NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUIkT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. Z ALL CONSTRUCTION DEBRI RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9--.17-92 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY o PERMIT NO. ` DATE ISSUED MAP?/PARCEL NO. — t ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ FOUNDATION t FRAME *` INSULATION t FIREPLACE 4 ` ELECTRICAL: ROUGH i FINAL PLUMBING: ROUGH FINAL . GAS:'; ROUGH FINAL ' FINA''�;BUILD•ING 7.. DATE CLOSED OUT ASSOCIATION-PLAN NO. ' I • � � e ��. it I'" �.► Z lip � � C ♦ �;.�, •~=10 `- � ! Oar:'` �r►� I � � ,�.��► �l � .' 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Z i BAB39TLBLL, J Engineering Department (3rd floor): oo % 9, m' Housenumber ........................................................................ o�OYPyAV APPLICATIONS PROCESSED 8:30=9:30 A.M. and 1:00-2:00 P,M.}only TOWN OF BARNSTABLE BVILDIHG INSPECTOR APPLICATION FOR PERMIT TO ........K0.0.-4....... ............................................................ TYPEOF CONSTRUCTION ........... . ./.00A... !��.. ........................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 237 � -- � o►�e.y.....�..L►. . ...�.:.. .,.at,,, e.�V.Location .......................................... w......... . . ... ........................................... • ProposedUse .... ............................................................................................................................. Zoning District ...............................................Fire District -......Q Name of Owner .rN � ... .7 ).NSK.�..........Address Z.8�.. oUe ...� k4t...,K.A f Name of Builder ... ..Nr-2ZA....HQ1.-C,...�. ere�.Address .�.�4�... l�C�n.?1�...�.....'........ f�?�`..��070 Nameof Architect ..................................................................Address ..........................,............................................................ -Number of Rooms ............O.Q.�......................................Foundation ...Z. ?.red cok-).....�t�,',,(M(Z►.�,11 i Exierior ... � �r�... �> ...............................Roofing .......... A..... . ...................:................................ Floors ..... J.Ov.A...........................................................Interior ......... �K?C ................... g Plumbing ..... .<J.�..... 4_\�.f(�� . _Heating ... . ...... ... .................... �. oc� Fireplace ....... ....................................................Approximate Cost ......1.. oQ�. Definitive Plan Approved by Planning Board ________________________________19________ . Area .....`. 1 Z_ S�r_• Diagram of Lot and Building with Dimensions Fee . — SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. ................................ Nam ..... ........V .. .............. Construction Supervisor's License .00.a ..75_7...... SUSZINSKI , BERNARD `0p No 31323.. . . . .. Permit for ...Addition.................... .... .. .... Single Family Dwelling ......................................................................... Loca-tion .....287 Stoney Cliff Road ........................................................... ......................Centerville............................ Owner .........Bernard....Sus.z.i.n.s.k.i................. .. .... .... ....... . .. .. . .. .. Type of,ConstrLiction ....Frame......................... .. .. .... .. ......................................................................... Plot ............................ Lot ................................ ml October 2-0 , .-..19 87 rr Permit .Gran ............I....................... Date of Inspection ....................................19 Date Completed .......................................19 _ : - - � •`-�1.�r ^.:�~_%':.ice-,�'rii�:-v-:C-•�.•.s Z/I"1.rt'-�►' ^-7��. a �.z��•. -�<•:- �� is ti AirCv xi v?��.�•.•���`�vr .•� +.• -+�,=^Kv - - - P.AC'tOgS PZCTSTFATZO{`[ t ' -'t��a:cF c� Bu:Z�ir-�c FeSulaticrs and Stan�r�s t - . F,sz;au►' tar Flace — ace I30i '• _ [ - etts $Qs to r., I�=?0 V�'tr {► ccN i gAC e CF t - _� -�_i 100740 Ex�=catia;, t cr _Vn T c CQPqcFATl.C3N � ' j t ,mvA ffI! 7 T"-e= - FiriA C T=4� C- -_77 �:C�;� it..,pcnV�t , ;NC F✓ t- i R_rras Cap=Li , S 7_ - s 5'S Ne":`a:. Pd . 0263Z [ i•=c;= C r : `i• • [�G.r'YI Y, r V%y ti yam:`i Z�. DEPARTMENT Of PURL ONE AtHBURTON PLA ' l BOSTON, MA 0:1 - CONSTRUCTION SUPERVISOR LICENSE Numbet -* Expires: .+ . :. • v•; -•.-•'ram '"..•..•ti-- _ --++Y-• 7- -j••Z -- •- TNOMAS X CAPILZI JR :CO PERCIVAL OR - W BARNSTAOLL, MA 02660 - The Commonwealth of Massachusetts Department of industrial Accidents 1 a 0/IICd 0/JaYCSt/�ftl/1S 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit loc a ion f G S�S�- W i�rifl I am a homeowner performing all work myself. I am a sole proprietor_rd have no one working in any capacity I am an employer pro%idins workers' compensation for my employees working on this job. coml2any name: address:' r09- insurance co �� � � oolicv I am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed beloA %%ho have the following worker_' compensation polices: m any name: address: n #: i olic # insurnnceco. company name- insurance co, �mn nevi a .00 and/or Failure to secure coverage as required under Section 25A of MGL 1S2 ens lad to the imposition of enm100. 0 2 day of a hoe e. to s[�00 one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of SI00.00 a day against me. I aaderstsad that a copy of this statement may be forwarded to the Ounce of Investigadow of the DIA for coverage verification. do.hereby certify underyh&pains and pen es of perjury that the information provided above is true and correct gate Signarurc:L_�&- 4--- — - Print name i�s�f/6/l� /.i �� i Phone# Cchck do not write in thisarea to be completed by city or town oflieiai permit/license# rnBuilding Department— E3Licensing Board261 ❑Selectmen's Otreediate response is required Health Department---------------- phone p; (508) 398-2231 ext. rl0ther v 1 { y IME The Town of Barnstable le 9q, WAS& Department of Health Safety and Environmental Services Building Division - 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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:g��,dF e--,c-r Est. Cost_ Vic?o � Address of Work: ag>"6�noaiy r-1c Owner's Name Date of Permit Application: 9/7-4 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Building 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 agent of the owner: oD 7 S� Date Co ctor ame Registration No. OR Date Owner's Name Engineering Dept. (3rd floor) Map /7if Parcel Permit# House# 2— S-;"7 �c� Date Issued Board of Health(3rd floor)(8:15= 9:30/1:00-4:30) - syV -S- t3fee 6v cL — Conservation Office(4th floor)(8:30- 9:30/1:00`,2:00) 01 , I Planning Dept. (1st floor/School Admin. Bldg.) (SEP=, �'i�(s T BE De initive Plan Approved by Planning Board 19 OE TOWN OF BARNSTAB a, E AND Tow r n N REGUL TIONS Building Permit Application P ject Street Address Village ,.� l '�C� . Owner >f ��c�c �n/'s.t�y Address a gr1Z Telephone 771—eiz;%Z Permit Request s r First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ z 6w Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 21fo If yes, site plan review# Current Use Proposed Use Builder Information Name '10,41 Telephone Number 61— 9.f/9 Address V I" License# 43"7 D .3 '- , iZ� r �', i-�!d>/.o^�/ f�►'�-' Home Improvement Contractor# 1,!1,o 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 PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. ` DATE ISSUED + MAP/PARCEL NO. r - ADDRESS E VILLAGE ' OWNER , DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: - ROUGH FINAL + PLUMBING: tt RO H FINAL GAS: O FINAL FINAL BUILD w r t oil rtm Cl DATE CLOSET Marco ~ S + ' ASSOCIATIONS Nit ; -77 ' 1,0ME . IMPROVEMENT CONTRACTORS REGISTRATION j �. Board of Building Regulations and standards t one Ashburton Place - Room 1301 t .eosto n, Massachusetts 02108 [ -�"_"-"""""""""""""""""""-"-"- IMPROVEMENT CONTRACTOR .ecstration 100740 Expiration 06/23-/98 PRIVATE CORPORATION _ HOME BPROYDE{i CONTRACTOR - F � rj Ra,istratiaa IaC74O CAPIZZI FfOME IMPROVEMENT., INC. / T,aa - FRNATE CORPORATION Thomas Capizzi , Sr . � ��.�` E:piratiart 4b/_3/98 1645 Newton P.d . � Cotuit MA 02635 t CAP:ZZI HOME L'!PROVUE:T, INC —o Thasa5 CapiZZI, Sr. - I .4T.1.ItNLSir•.1.�.ri �,�.Ilr fiA QL�•:" X"'e DEPARTMENT � �j.�' Ii7�• ONE SNOUR - DOSTUNJ �kUC,i iON-.SUPENVISOR LICENSE - ,n lzp'^`'7```'#Expires 1.clecl:zl.0 U - - - A �S�yXt .GAP.IZ�I.-JR: 1,,:.5 A I.E;.? tiA` 0266a 14,E`�'1v`4�;; - l��• � _ � The CUlnnlott►t'ealth of Afttssachusetts ' ti: Department of Intltrstrial Accidents Office nlloDestig2defls 600 il'avNit ton Street -4� BoVolt,Afars. 02111 Workers' Compensation Insurance Affidavit lican _ini.rm am • / Z !2rlYll07�' G locati pL hone 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capaci- I�IML..,....=._-_.::-....�•...�. �.._.i.a....Ma1.:Z��wc:c..� ''.:._: - . ' i:�y?ss�'..._:.....�.r_..:.._ _: n7- FJ I am an employer providin;workers' compensation for my employees working an this job. company name: address: insurance co. 0%?2% noiicv # /ems L.tl&—gal I am a sole proprietor,general contractor,or homeowner(circle one) and hav:hired the contractors listed below who have the following workers' compensation polices: company name: address cih•• hone R: insurance co. olicv 9 �.-ai-._..:..:.�.--.�Jlt-�-..._':J.r�� J:�:a�:.+:::..-_.:.�:.' - �- L:a a �-!��a.•:aS��ra.LY2i.. Sa.P` '_ -1:;,1?.L.: - .'..^r. - company name: address - city: u phoneR• insurance co. r�ttach add polio 9 atonal sheet tf nc '—"""'''°—"" _ •.-*-r---.._*--r---••- CCSsa i::sC:: tc: �-.::c;,��:i'-:1r Niut'ri� "'T_�.''_... 4 r:��w•.et�r-:n•�� '-s%-•_•�.,,�r-r-a < <<,.=�:...�-_'•-.' Failure to secure coverage as required under Section 2iA of\ICL 152 can lead to the imposition o:criminal penalties of a fine up to S1.500.00 and/or one •cars'imprisonment as\\•ell as civil penalties in the form ora STOP WORK ORDER and a fire orS100.0o a day against me. I understand that a copy of this statement ma% be rorn•arded to the Office of Investigations or the DIA for corcragc reification. I t10 hereby cerrifr turd t ains and nalti s of perjun•that the information proritled 6ot•e is true and correct. Sianaturc - Print name i ! Fhone# _;' official usw c u Ic do not\\•rite in this area to be completed b�•eit,•or torn o[reial "• • cih or town: permitlicense N r1Building Department C]Liccnsing hoard l]check if immediate response is required 05c1ectmen's office �llcalth Department contact person: phone nothcr : . The Town of Barnstable MASS • .�xrrsrnsi.E, • `0�' Department of Health Safety and Environmental Services �Eo�►'�' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date le-22 "7 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 requiremYents. Type of Work: � „�f,j�/� Est.Cost Qo® Address of Work: � �✓zp �,�,cj Owner's Name A/7/0 Date of Permit Application: %l e—V 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply,for a permit as the agent of the owner: fo-9 Date C ntra or Name Registration No. OR Date Owner's Name Assessor's offioe (1st floor): � ,/ - i THE Assessor's map and lot number ....;......... ... ..... ...��.•... ..... Q� ` Board of Health (3rd floor): Sewage Permit number 1�Ps�2Q�1+�5 a�x� k "�1 2 Z g ...c».�.......................... ....................`..., 11 BASd9TSDLL. � AM Engineering Department (3rd floor): °o M6 9• e$' House number ........................................................................ a MAI a\ APPLICATIONS PROCESSED 8:30=9:30 A.M. and 1:00-2:00 PM. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....A.....f ..0C !: ...... t .!.� 1. ...h............................................................ TYPEOF CONSTRUCTION ..........`t..�.na�.� ..... . ........................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ZV� VTC> .... ��-.). -...� ,,........ ..Q�t.�IT ,.r�.0 ProposedUse ............... �..J1`............................................................................................................................. Zoning District .............................................Fire District --.....0 M M ........................... .................................. Name of Owner � K ..........Address Z8-7....570.Q.CY ...�a :................ Name of /Builder Address Ak.-, ... ..... Nameof Architect .....................................................t.............Address .................................................................................... Number of Rooms ............�.1�1: .a......................................Foundation ... �f�j C�,�, ���'.�I�b ►�1��C Exterior ......... ....a...............................Roofing ...........1��..�'MeT.................................................... r via,� ,, � L Floors ...... _............. .Interior `.. Heating :: ...................................Plumbing ..... .07... .WlC.:1 !: !................................. $ Od Fireplace ....... �.0 ......................................................Approximate Cost ......`.. .�.0. . Definitive Plan Approved by Planning Board ______________________________19________ . Area .....V. Z..SY............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO.APPROVAL OF BOARD OF HEALTH 4 0 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 j.....�_.. ,. ........!�!j?!�.... .............. Construction Supervisor's License .0Q:T47S.-.T . SUSZINSKI, BERNARD A=17 —`J41 31323 ADDITION No ................. Permit for ................ .......... ........ Single Family Dwel in Location .....28.7...S ton ey Cliff Road Centerville .....................................................................I......... Owner ......Bernard Suszinski ........................................................... Type of Construction ... Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .........October',., 2.0.,..:lq 87 _. � a Date of Inspection ....................................19 Date Completed ......................................19 r , i - . -4�,.��i� -" �` - - " , I �­',, ,, , ."� . , - ,�7��,,v, -,-�I,;,, ,�".,11�;,�,�. -� - ,� -�;�' ,,�,­-t- - ,� � -1,` - .�w� 4� T���X�,o ,,:,,i i - ��­ � ; , � --, ,.�t' .�� - � ,ajo . 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