HomeMy WebLinkAbout0086 WHITMAR ROAD --------------
Town ®f Barnstable *Permit# 7-78
Expires 6 months from issue datL,
Regulatory Services Fee
MAM Thomas F.Geiler,Director
16
Building Division
Tom Perry,C-110, 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
Property Address
0-11 LIT 00 t zt th '9 o a
residential Value of Work -
/'3' `7 &_0 Minimum fee of$25.00 for work under$6000.00
Ole
Owner's Name&Address
UJ )!��IAAA_JL4 pe
Contractor's Name- A -r-
------Telephone Number q o
Home improvement Contractor License#(if applicable.) -3
Construction Supervisor's License#(if applicable)
zworkman's Compensation insurance
Check one: X-PRESS PERMIT
0 1 am a sole proprietor
El I am the Homeowner AUG - 2 2007
I have Worker's Compensation Insurance
Insurance Company Name TOWN OF BARNSTABLE
Workman's Comp.policy z C91
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
Ej Re-roof(not stripping. Going over existing layers of roof)
EJ Re-side
El Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,,Conservatidh i !.--0jL
Note: ro
Owne. ust sign weer Letter of Permission.
Home
se is required.
SIGNAARE:
Q:Forms:exprmrg
Revise071405
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
UF www-mass.gov/dia
Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers
Applicant Inffornaation Tease Prin, I.egib�
Name(Business/Organization/Individual):
Address: P CD Roy gyp
City/State/Zip:__ ' O o,635 phone #:
[Are you an employer?Check the appropriate box:
Type of project(required):
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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling
ship and have no employees These sub-contractors have '8. ❑Demolition
working for me in any capacity. workers' comp.insurance.
[No workers' comp. insurance 5. El We are a corporation and its 9 ❑Building addition
required.] officers have exercised their 10.El Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. C. 152, §1(4),and we have no 12 KRoof repairs
insurance required.]t employees. [No workers'
COMP. insurance required.] 13.El other
*Any applicant that checks box#i 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 their workers'comp.policy information.
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.#: 7,77 x 6 t, Expiration Date:_ % — L)
Job Site Address:_gC� (,v f &0_ City/State/Zip: (ff/)
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 k 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 hereb" er t • and eyralt s o per ry that the information provided above is true and correct.
Signature: _
Date:
Phone#: So
rConta
only. Do not write in this area,to be completed by city or town official.
n: Permit/License#
hority(circle one):
(Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other g P
son: ,,,
r �Q
Fraser Construction
Roofing '& Siding Specialists
P.O. Box 1845, Cotuit MA. 02635
Email: fraser_constructiongverizon.net
. www.fraserroofing.com
I aS Phone 1-508-428-2292 & FAX ,1-508-428-0123 .
RE-ROOFING PROPOSAL
DATE: July 14, 2007 PHONE: 508-428-7217 ,
NAME: Janet Lewis
MAIL ADDRESS: same
e -
JOB ADDRESS: 86 Whitmer Rd. Cotuit, MA 02635
FRASER CONSTRUCTION hereby proposes to perform the following services in
a neat and professional like manner and in accordance with the manufacturer's
specifications and local building code.
-Remove and Haul away all of the old roofing material
-Re-nail all plywood sheathing as needed.
Supply and Install - GAF TIMBERLINE 30: 30 year transferable Warranty,
5 year Smart Choice protection, CLASS A FIRE & WIND RATED, ALGAE
Resistant, Standard Weight design, Self Sealing, Multi-Layered, Laminated
Architectural Style, Fiberglass Based Asphalt Shingle with New England's
Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against
ALGAE Containment.
Color: Price (30yr) $13,975 Initial
Price includes remove & replace rotted trim front main
A
Supply and Install - GAF TIMBERLINE 40: 40 year transferable Warranty,
5 year Smart Choice protection, Shingles are 17% heavier, Winds up to 80 mph,
CLASS A FIRE & WIND RATED, ALGAE Resistant, Heavy Weight design, extra
strong Micro Weave Core, Self Sealing, Multi-Layered, Laminated Architectural
Style, Fiberglass Based Asphalt Shingle with New England's Exclusive
COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE
Containment. `
Color: Price (40yr) $15,050 Initial
Price includes remove & replace rotted trim front main
Supply and Install - GAF TIMBERLINE ULTRA: Lifetime Warranty, 10 year
Smart Choice protection, Shingles are 25% heavier & thicker, Winds up to 110
mph, CLASS A FIRE & WIND RATED, ALGAE Resistant, Super Heavy Weight
extra strong Micro Weave, Self Sealing, Multi-Layered, Laminated Architectural
Style, Fiberglass Based Asphalt Shingle with New England's Exclusive'
COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE
Containment.
Color: Price $18,275 Initial _ 6�5
Price includes remove & replace rotted trim front main L.
GAF Warranties the shingles and labor 100% through the SMART CHOICE
Warranty duration.
GAF Warranties the shingles to be ALGAE resistant for the duration of the
SMARTS CHOICE Warranty depending on the shingle that was purchased.
FRASER CONSTRUCTION is the Only Approved Applicator/Member of The
CEDAR SHAKE and SHINGLE BUREAU on CAPE COD
THE CEDAR SHAKE AND SHINGLES BUREAU Warranties the shingles for 20
YEARS if installed by approved applicator.
Any deviation or alteration from above specification will be executed upon
written orders and will become an extra charge over and above the estimate. All
agreements contingent upon strikes, accidents or delays are beyond our
control. Owner should carry fire, tornado and other necessary insurance upon
the above work. We, if not accepted within thirty days may withdraw this
proposal.
FRASER CONSTRUCTION: Carries Workman's Compensation and Public
Liability Insurance on the above work.
DATE OF ACCEPTANCE:
EiWmeowner Fraser onstruction
J/ Gd�
i
Board
Of-Building.�e I�t2i �
One Ashburton
aid Standards
®n Place - R00n, 1301
�®tee
Boston' Alassasetts 02chu�1�r®ve�ent`�0�. 10� _
��'act®r Registqti®n
FRASER Registration: 112536 CONSTRUCTION co. TVPe: DBA
DEAN®RASER EcPiration: 3/23/2009 T
P.0' BO 1845 r# 127920
COT , MA 0263.5
DPS-CA' SOMA-OS/06PC8490 i
-_ — Update Address n return{aa"z� —— rn card.
__"--. ❑ Address 16�ar&reason for change.
Board off newal � EffiPlo�ent
uuding�gulations and standards host Ord
HOME IWIPRgkV�EMENT CONTRACTOR
Odense or registration
Registration: 112536 before the a valid for individul use�Piratiain: Board of �tion date. lffound return to:
®aly
3/2y009 Tr# 127920 One Ashburton �egulalions and Standards
e: •DE;
Ashburton Place 1301
ERASER CONSTRUCTICy ATIL 0210S
DEAN FRASER N CO,,
4556 RT 28 /
COTUIT,AAA 02635
•- Administrator
Not valid without signature
- . i gestate
: : ::: :: : : ::.
:::::..:::.:::::.. .............: ::.::......::.::::::::.::::::: .:: ::: . .:{� :. : .... .:::.::::::::::::.:::::.::::.::.:.:::::::::::::::::::;:::::::::.:.::::::::.: DATE annnoD
:.::::......:.::.::::::::::::::.::::::::.::::::::::..::::::::::::......:.:::.:.:::::.. ::::::::::•::::::::::::.:::::::::::.:::::::::::::::•::.::::::. :::.::::.:...
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WISE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE,
& QUINN INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR,
449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
BROCKTON MA 02301 COMPANIES AFFORDING COVERAGE
COMPANY
24 A
INSUREDED HARTFORD UNDERWRITERS INSURANCE COMPANY
COMPANY
FRASER CONSTRUCTION CO B.
PO BOX 1845
COTUIT MA 02635 COMPANY
C
COMPANY
D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE'POLICY •......-
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THOD
IIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR
DATE(MM\DD\YY) DATE(MM\DD\YV) LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG. $
CLAIMS MADE�OCCUR.
PERSONAL&ADV.INJURY $
OWNER'S&CONTRACTOR'S PROT,
EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
AUTOMOBILE LIABILITY
MED.EXPENSE(Any one person) $
ANY AUTO COMBINED SINGLE $
LIMIT
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Per Person) $
HIRED AUTOS j
NON-OWNED AUTOS BODILY INJURY
(Per Accident) $
GARAGE LU181LITY PROPERTY DAMAGE $
ANY AUTO
AUTO ONLY-EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
EXESS LIABILITY AGGREGATE $
EACH OCCURRENCE $
UMBRELLA FORM
OTHER THAN UMBRELLA FORM ' AGGREGATE $
A WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY (UB-794XG 19-1-06 STATUTORY LIMITS 09-26-06 09-26-07
THE PROPRIETOR/ EACH ACCIDENT $.
PARTNERS/EXECUTIVE X INCL
OFFICERS ARE: EXCL DISEASE—POLICY UMIT $
OTHER DISEASE—EACH EMPLOYEE $ 500 000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFF
>Fd'FI.�I ::: � � :::�::>;::::>:::>::::;::»::>;;;•;:;•;:;-;::;•;;:•;;•;:::::•::::.�::::::::.................::::.�:.............:::.:�:.................. NG WORKE
._::•:::::::.:..:::::::: :::.:.:...D�&�:.::.::.�::::::.�:::..::.::�:::._::::..:.::::::::::::::.:::::.::::::::::::::::.::.:::::::::::::::::::..:... : ... ..•::::::..,..:.:.::::...................... RS COMP COVERA
GE.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE-CANCELLED BEFORE' THE
EXPIRA710N DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
ERASER CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATEFIOLDER NAMED TOTHE
PO BOX 1845 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
COTU I T MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENT'S OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
p ij�1�F
f eeese �
Assessor's office(18t Floor): /7
Assessor's map and lot um r/721 ij ✓ 1�7 poi THE>p�
Conservation —.L' EPTIC-SYSTEM MUST BE �v
INSTAL LED IN comp IANCE
Board of Health(3rd(bor): p = iisai3rAnt
Sewage Permit number I ' — �o' Qa •_ 1MVI TITLE 5 V"L
Engineering Department(3rd floor): RONMENTAL,CODER AND oo �6)0•
House numbs[ (p 3�w �aY1��\
Definitive Plan Approved by Planning Board — ' n Taro I�T�O
APPLICATIONS PROCESSED 8:30-9:30 A.M.`and 1.:00-2-00 P.M.only
r
TOWN OF ; BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO Ap�
TYPE OF CONSTRUCTION
' 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a rmit according to the following information:
Location CITY/ ` �f✓ / �� rY%l.
Proposed Use Y
Zoning District Fire Districto��� 1
Name of Owner gw,:� Address CX/�
Name of Builder Address
Name of Architect Address
Number of Rooms -7 Foundation
Exterior c= 2 Roofing
L�rr�� (1 GEC 1F"(�(�C�Q t
Floors Interior /41
Heating_' G Plumbing
gr
Fireplace d4&6 Approximate Cost
Area
Diagram of Lot and Building with Dim' nslons Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License 06-!r(P
i
t' �, •
BAYSIDE BUILDING, INC.
rr
No-3 5 4 41 Permit For 12 Story j
Single +Fdmily dwelling ,
}Location Lot #14 , 86 Whitmar Road Y'
I COtult w ,
Owner ` Bayside Building, Inc . - 1'
Type of Construction Frame
Plot Lot
Permit Grantedfiber 92
Date of lrispection:��l7�g
C Wato letesn 19
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i�*V'N OF BARNSTABLE, MASSACHUSETTS ND "PER 1IT
Aa057 '114 DATE Oc cobor 13 19 92 'I-To
PERMIT NO. ..�1
APPLICANT Over ADDRESS 005 45 `(
(NO.) (STREET) ICONTR'5 LICENSE' I -
PERMIT TO Build dwelling OF
(--Li) STORY Si(lglc family dwelling NUMBBERNG UNITS 1 I
(TYPE OF IMPROVEMENT) NO, (PROPOSED.USE) I
AT (LOCATION) lot #14 86 Whitman Road] COtuit ZONING
(NO.) (STREET) DISTRICT
}}I
BETWEEN AND j
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT
BLOCK SIZE
BUILDING IS TO BE FT, WIDE BY FT, LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Sewage #92-476 i
1
f!
BOND 1
AREA OR 3UO8 6 • ft.
VOLUMEESTIMATED COST 30U,000 . F EMIT 240. 75
(CUBICISQUARE FEET)
OWNER Baysi-de Building, Inc,
•. • OTC .anteCV1 e, ) / �; BUILDING DEPT.
1^ rl
ADDRESS BY (/
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY:PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY.PERMITTED UNDER THE BUILDING CODE, MUST BE AP-PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS, THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND fE
I, FOUNDATIONS OR FOOTINGS. MADE, WHERE A CERTIFICATE OF OCCUPANCY IS RE• MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE-OCCUPIED UNTIL r
MINAL INSPECTION
TI TO BEFORE
FINAL INSPECTION HAS BEEN MADE,
3. FINAL INSPECTION BEFpRE
OCCUPANCY. I
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS -LLIM6i'JG iIJSPECTiviJ APPROVALS ELECTRICAL 44SPECTiON AFFROVALS
*Z,1 N - Z 9 3
3 I HEATING INSPECTION APPROVALS ENGINEERING EPARTM NT
�'A S G ! 7_ -9
S A n- a`l--°!3 RD OF H LTH
r � L
OTHER ' SITE PLAN REVIEW APPROVAL
i
WORK SHALL NOT PROCEED UNTIL THE INSPF.C- PERMIT 'M!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BL
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK .15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. t PERMIT IS ISSUED AS NOTED ABOVE, NOTIFICATION
1111
1
o`����•. TOWN OF BARNSTABLE
_ BUILDING DEPARTMENT
TOWN OFFICE BUILDING
MUL
HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE: 01 j9/
An Occupancy Permit has beee/n/issued for 'the building authorized by
BuildingPermit $ .......... 3 .......... ..............................................._......._._.._ .... .._......_......»...................
. ....
issuedto ............ / �i..................... .... .........._.... ......_._.__. .
7.. _..._.� ....
Please release the performance bond.
o,TNf>, TOWN OF BARNS"1'ABL.E 35441
PermitNo. ................
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
7 ■YL
6�9� V'�rovr► HYANNIS,MASS.02601 Bond L1
CERTIFICATE OF USE AND OCCUPANCY
Issued to Bayside Building, Inc.
Address Lot #14, 86 Whitmar Road
Cptuit, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
January 27, 19 93
�G
Building Inspector
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map D Parcel "' Permit# I
Health Division t Date Issu ���
Conservation Division -�� ota b Fee
Tax Collector � �� 2YD0 r
Treasurer. ;e -
Planning Dept:
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
a
Project Street Address
Village C o TUIT ,
Owner C`1IY?-sn-J -DANi6L 1<0SSr' Address 8(0 WfftTYY�R(Z- TZV
'Telephone
, moo" FE�UC� �UtJ (pal'--0,• i� LL-"Iy6it� O+y PJ"k Sibi; OF
Permit-Request
y- 6�bxutr iUy a`-0'` tS Lpr; (c
Square feet: 1 st floor:existing proposed 2nd floor_: existing proposed Total new
Estimated Project Cos a Zoning District Flood Plain Groundwater Overlay
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 Cl Other
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 ❑Oii ❑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
BUILDER INFORMATION
Name --Cpoo -Fo'Al; (0 -Telephone Number
AddressqSS-1 • Tt• 131 License#
h'lPfas tt=tox rv`►� • o�� Home Improvement Contractor#
Worker's Compensation# '
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE s�;�
s
p FOR OFFICIAL USE ONLY 46 ' a
PERMIT..NO. 3 _
DATE ISSUED
�.
MAP/PARCEL NO.
ADDRESS VILLAGE
• OWNER +•`s � ,.. -• �` .. 1 �M•
DATE OF INSPECTION:
FOUNDATION
FRAME '
-INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL '
FINAL BUILDING r,
! 1 f
DATE CLOSED OUT
ASSOCIATION PLAN NO. #
The Town. of Barnstable
Department of Health Safety and Environmental Services
Building Division,
RAMMASS.STABLF� ' 367 Main Street,Hyannis MA 02601
9� 1639.
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
q Please Print
��
DATE: I aa000
JOB LOCATION:_ V� W 4 lTi'� Cc 1 U IT
number street 2 village (
"HOMEOWNER":
name II home phone# work phone#
W CURRENT MAILING ADDRESS: 1' ayyIpc to '
Co l v�T MA 0, 36'
city/town state zip code
5 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.
Signatq a 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.
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 to amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPTN
The Commonwealth of Massachusetts
m j- -... Department of Industrial Accidents
=:= Office offoyesmadoos
600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name ��lS KOSSWI'�tJ�
location f3o
city C o V -ohone# 05-
❑ I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in anv ca acity
I am an employer Providing workers' compensation for my employees working on this job.:: .::: <.;;::.:;:.:::.;:.:.;:.;:::;:<:> »>:<:>><
11:
comaanv name: :;.: ;;:<.;>;;:;:. .::::;; >.;:::
:.:::.;.....:. :::::::::::::: ::.::..::.::.::.
address.
X.
city
:::;::::»>.:<::;:::::::;.::;:;.. lice#
•insurance co. „
am a sole proprietor, general contracto homeowner( ' cle one)and have hired the contractors listed below who
win workers' co ensation olices:
the fo mP ............ . . . . ..................:.: ::.:::.::<.:::::;:.:.;:: >.::.;:.:;:.;:.>;:;:.;»:>..;:;:.;:;:.;.;;:.::;:.:::;:>:<:;::<;:;:<::.;::.:;.:;::>:.;:.;>;:.;:..;>::.;:;:<>
:.>
comoanv name
address.
53...... ....n.......l.. ....
ci tv
... :. .. 1 fir•.. :: :::.......::::.:::.::..vhon � � �,.:::..::........
smy
::.::.::.::..:..:..........
..........
insurance co:..:....:;;;;:: :•.:. ::..:.:..
oLcv#
conrmanv name: :.;;;:;;;;;;-;::.;:<•::<- ;:.;-.
address:
...
:................................, .;. hone#r•�~'�;:::'::»>�:>:: ..:..
...........
citv-
. .........::• ::•::::.:::......................::.........
insurance co..
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crirniaal p
x tu enalties of a fine up to$1,500.00 and/or
one years'imprisonent as weR as dvfi penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ma I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is trw.and correct
Signature Z4
Print name I�11ZST�`0 P2 • 1\OSSr W P) Phone#
oiHdal use only do not write in this area to be completed by city or town official
city or town: permwacense# ❑Brdlding Department
❑Licensing Board
0sdectmeres Office
❑check if immediate response is required QHealth Department
contact person: phone#; ❑Other
(revues 9%95 PIA)
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MnY-20-00 SOT 12 :01 PM ROBERTn M ROWE 509 510 1902 P. 02
JAIN 0 5 2 -
4 G
mminnivyi
ACORD; CERTIFICATE OF LIABILITY INSURANCE 7230/19"; ()/19
------ 99
PROnUCER Lume'uL 11--?werifice &7MI Gj THI$ CERTIFICATE 19 19 ()�t5 AS��/�WYLA 6P III ORMATIOk
luiuu w ONLY AND CONFERS NO RIGHTS UPON THE ':ERTIFICATE
LLwILu�r 24aabUR'LLR{UU Cum
Y nuwrrc. /nla L.cICIIru_hIc wM!5 IdGT AMENbJ1_,lTEN5 Olt
1 SFeen Street ALTER THE COVERAGE AFFORDED BY TH12 POLlinES BELOW. _
Framingham, HA 01701
INSURERS AFFORDING COVERAGE`
508-620--9575
IB1NBf11 [TID17D uw1ull LIWfluld nlll!1'>tpn.I- J.1.I411olnu. MInn(IAT TMETT911hT1"Tt' 1-11
INSURER B:
qR5 PLDTTT STREET IN4NRfRf; _
M14KtilYM'1M.Ilf), MA 02050 INRURER_D:
iIr9URCRC:...—.�.,�_....�..._�,.._�_...._�.- _:.�... .. - ---'• .- -- -.
COVERAGES
, .9L•IIILURAIISE LIATEE 6CL8'N 11.I:'D llCel!Il,dUes!A 911�III8Ui1lD II.I.I.ICD!.DO:'C fOn TI IC POLIOIJ t•GI}IQO 1{IDIQI,TCD.IIOT MITI LOT�.IIDIIIO
ANY rRCQUIRCMCNT. TEnM Oil CONDITION Or ANY CONTRACT On OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY I k,ISSUED OR
MAY PERTAIN, I Ht INSUKANL:b AI-I•UKUCU DT I tit VVLII-Its ut�IUKlotu ntr!tIN IS SUDJE,:1 'fu ALL THE TERMS.ESC4L!I,7,IC+N.}ANn r,CINnIT I)N\nr Al Ir.H
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
111011 — POL,ICYiPiiCTIVE POLICY SAPIRATioN __ LIMIT9
LTR. TYPE OF INSURANCE POLICY NUMBER DAT9(MMIDO/YYI DATE IMMIDD/YYl
"t"MAL UAtl1U1/ rACI I OCCUHRCNOC 1,000,000 �
X COMMERCIAL GENERAL UA811.N`.' NnC DAMAOC(Any en_fire) .150,000
CLAIMS MADE I IL I OCCUR MED EAP(Any one person) !5,00 0
A ibu 9100755 12/29/99 12/29/00 PERSONAI,a_ADVINJURY 11,000,000
0ENERALAGGRWATB__— 12,990,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMROP AGG 12,000,000
POLICY PRO.
AUTOMOSILe LIABILITY
f'.nMflINFf)91N(:1 F 1 IMIT
][ n1„rrtuTi, (rnnnMdnnl! 11,000,000
q!I,QwNQfT 01,ITQA
9004YINJUR'r 1
SCHEDULED AUTOS (Por poryon)
A X NIRFr.A11TAS MAN 9302CAO 12/29/99 12/29/00 10010114JUR'r
X NON-OWNEDAUTOS (P.,—*dent) 1 _
PROPERTY DAMAGE !
(Pat 00010onp
GARAOH LIABILITY AUTO ONLY-EA ACCIDENT I
ANY AUTO OTHER THAN EA ACC I
At IT(T^NI Y A00 I
— _—.._....._._._—_._.._,..__-_—_---_—.._., —.-__.._,—__— —_._.._.._._._..__...__.__.._ ..___..__._......_._......__.._
EXCESS LIABILITY EACH OCCURRENCE 12,000 000
X OCCUR CLAIMS MADE AGGREGATE "12 000 000
UMB 9204599 12/29/99 12/29/00 1 _
A DEDUCTIBLE !
RETENTION S .I
WORKERS COMPENSATION AND WC STA7U-
TORV LIMIT9 ER
EMPLOYERS'LIABILITY WCS 9501545 12/29/99 12/29/00 E.L.EACH ACCIDENT !1,000,000
A t:.L-UIStASt•CA tMFLUYCt I1 000,000
E.L.DISEASE-POLICY LIMIT 15,000 f 000
OTHER .. ._ .. ... .. . . .,
DESCRIPTION 6F OPERAT1ONftOeA1ION9NEHICLe919XCLU9IONS ADC[D BY ENDORSEM[NT19P[CIAL PROVI91ONS
l
CERTIFICATE NOLb�R ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
.._ -- ............. _. ....__.._.._..._.._......_........ ..
BROULI3 ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED SEI:,Re THE EXPIRATION
PERFECTION FENCE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 4,0 DAYS WRITTEN
905 PLAIN STREET NONCE TO TH9"K1VIi:AIk H%l—trl NAM—IV II+t LVI,VVI kAILl.It IUVU'JV'*HALL
I�LRSHFIEL.D, MA 02050 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUR IR,ITS AGENTS OR
REPRESENTATIVES.
AUTHORI;F�REPREBENTgIIVE �—
I
I .
ACORD 28-5(7197) _.._..,.._.,,,,.._..: .. .......... -..................._. .. . - -- -- ----- - ...o ACORD CO ('ORATION 1968
QUOTATION
Ea?'
-- Po s r
Flo
W post
XL
W
This quotalicn is subjsx to a-Nept,anq
by?eKadior Fence Ccrp,maragernent
and may be withdrawn by us if not -
Qaccepted wit iin fourleer (14)days. '
m Custom Designed For Date:
N / Street Drawn By.
i
E j Fence. Cdy Drawing No.
965 Plain Street•Marshfield,MA 02050 Telephone No. _ 7 Approved By:
1'8®®-537-2900 Approval by Customer File No.
MAY-20-00 SAT 12 :05 PM ROBERTA M ROWE 508 540 4902 P. 03
� t
Icl 800-537-2900
781-837-3500
FenC,?
�OAe Fax: 781 639 1105
"Gu640m Oo c�dnOrc and Planners" -
rt/ CT' c / /Q j J ! l r�O 40'75
i
i
I
a
995 Plain Street,Roues 139.MarArseld.MA 03050 `
li
� t
�Na 300
CIF
- ate..
f L0Gt1T/O/C/.GE,2T/,may T,U,,gT THE
OATS 7-N�S"/AE.0/tic=A�/O ur'ETBA C,�
.�EQUi.2E�lE�VrS o.� 7.41
� 2�lSTAZ3L� :4ot/o 45- A/,07-
�.�GATE.G�
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. . . ..._.-may.