Loading...
HomeMy WebLinkAbout2477 MAIN STREET ter/ ' ° ., , ,,:. . '.r • roc V a • • • • • • • • a • • • . Town of Barnstable Building �Y)�;:� a °+}s' ba r r w'�^we <, ,.>::..v a:.� -nr, x ,ar ,\ r ^wm. n�i �, _ ".,�",°' " • Post This Card So;That itis;Visible_From the Street Appebved Plans Must,*be'Retamed on Job and this Card Must be Kept� r=.r% : BARN3['ABLE. �' x ,�' r } ',g„ ��� i .d': i ., "`�' r�' � •3` M" i Posted Untfl;Final•Inspection Hates Been Made it i � 7/ ' � '- r ! - irniiit ie" .Where a Certificate o�fiOccupancy,s Required,such Building shall Not be Occupied until a Final Inspection has been made er Permit No. B-20-723 Applicant Name: GERVAIS,VICTORIA L&STROUT,JONATHAN C Approvals Date Issued: 03/09/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/09/2020 Foundation: Residential Map/Lot: 257-013 Zoning District: RF-2 Sheathing: Location: 2477 MAIN ST./RTE 6A(BARN.), BARNSTABLE !_ iContractor'Name HOMEOWNER IS APPLICANT Framing: 1®37/Zd.f Owner on Record: GERVAIS,VICTORIA L&STROUT,JONATHAN Contractor License EXEMPT Address: 2477 MAIN STREET -•- ` .,;,Est Project' Cost: $ 10,000.00 Y _. . is � Chimney: BARNSTABLE, MA 02630 ' Permit Fee: $ 101.00 occi-�i ro , ` insulation. Description: Remodel Kitchen & Bath 7 x,Fee�Paid: $ 101.00 in 2 door openings. Strai Straighten ceiling.''install new�rT15 r 726,elte -- closeg g 4 � � ,4� x Final: insulation . updat plumbing,elecltrical. install newt cabinets ands Date 3/9/2020 new drywall. , t� �, , k m.; �/ '� Plumbing/Gas1 Project Review Req: � � Rough Plumbing: ;:� , _. , Building- Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application a'nd the approved construction documents forr4which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall fe in compliance with the local zoninggby l nd aws a 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. , is Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are,provided on th'is,permit. P Y =�. , Minimum of Five Call Inspections Required for All Construction Work: ' " : Service: 1.Foundation or Footing `l ' • Rough: 2.Sheathing Inspection ` I ,, . ; .M_„ ..,,,, • 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final : 4.Wming&Plumbing Inspections to be completed prior to Frame Inspection ection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: Insulation 6. nsu n o 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: "Perso -oa racting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). .� Fire Department - Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: pFT 'pw BUILDING DEPT. tip^ Application Number 3 BARNSTABLE, : MAR 0 6 2020 R` VIDA647:1 Permit Fee Zoning District TOWN OF BARNSTABLE ©e' Total Fee PaidNiti) /O l J. TOWN OF BARNSTABLE Permit Approval by /e/G46- On 3 0g Z0 BUILDING PERMIT Map Parcel D l 3 APPLICATION Section 1 — Owner's Information and Project Location Project Address 1 �i PncA\N c5 Village bctrni.-1\--00/5\& Owners Name -�t1N1/4\1w1 5 c r c SCANNED Owners Legal Address a,y 19 r4)c (") 5 k -, q 0 s)--e,b>... MAR 0 9 2020 City tbot f n S State M A Zip 0 b Owners Cell # 6 O ' a E-mail J vR.i\ on S k rto - 3(`f) ►l C-C) Section 2 —Use of Structure i'. Use Group g- 2j ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar `t" Renovation ❑ Pool ❑ Foundation Only Other— Specify 4 0*# Section 4 - Work Description ./a.‘ JJJ/(/� r 4 , ;l4 0 40 IP Vito, q to y k R 4 / P irrij �,� 2,4 `p i c,rl. � �4e s t 0143 lest L �i ,(A/ AV ! A L l h `t l r ly vi tl& g �"i�^ 6"4�r`� �!r` l►r � ` A.12�8�� �t�. �I ( � l� -kill gy�,� �v v v- ' rt♦ s' ,�P� f AAr � � it 1, J 9 fit,) i i a a�D vtt.r `'�' ve r liter ►t,_f s NAV Ott ci6' co J �,p ) Tt i�f°�'v (hotel 1 / update ;,.1 3 /2020 Application Number Section 5—Detail .y. Cost of Proposed Construction '1O 00 1 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6 - Project Specifics g4iring fY ❑ Oil Tank Storage ❑ Smoke Detectors g lumbing ❑ Gas ❑ Fire Suppression A di Strl.'.; ❑ Heating System El Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private a; Sewage Disposal El Municipal _ El On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane C Yes El No Section 7— Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8— Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 I ' • Application Number Section 9- Construction Supervisor 1 Name Telephone Number I Address City State Zip 1 License Number . License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date i Section 10 -Home Improvement Contractor i Name . Telephone Number , t . r Address City State Zip t i Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 1 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and o. Idocumentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date SeEliiin-1-1==. ome-OQiinexs License-Ex-empt on L1-1-61me-Ow e s Dame: 0 iN. u✓\ SA-(' `1 �C T(elepho ie:Number - k°`i ' 116- Ce or Work Number N e' I understand my responsibilities under the rulesnd regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. gnature,. Date S (- j 315?-"D PPLICANT SIGNATURE F t Signature Date 31 6 (; Print Name ,J 0(\ci\‘c'irvw1 SV-(o,J'r Telephone Number q orl - I E-mail permit to: V„.btu,. ° c,e, v 0.-,5 \k...„ a me,\\ Co \ Last updated: 1/31/2020 Section 12 — Department Sign-Offs Health Department E Zoning Board(if required) ❑ Historic District El Site Plan Review(if required) ❑ Fire Department n Conservation For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization I, , 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: , F (Address of job) Signature of Owner date Print Name I a Last updated: 1/31/2020 r . , , i . ...... .,„..... .. „ • ............... , „....... - e., ,„..,,,,,,,.._. . . ie ,:„, _ ...,„:„4,,",,,,„„ ......_,4irt,r,,,,,,: -1,,•••,:, 1::,„:::. :,:,:: „.....„ ..,,,. : „:„ xF,„,.••••••. ,,,x„,:,..,:z........,,, tea, ,scli. ,,,,,„ .":,„ . .,,,,, .,, .,,•:.,, :,..,,..„ ,•.:..:. _,,,,,,., ,,, , .. ;. .. . ...„.... ••••• • .. ......... . • . .........„. • ,..„,..•••:•• • 4:0!?,,a,;;•,,,,,,zaii,4„,„„azuzi,,,,31,4,07.,,L.:";•.:72:it„,,,, „...,....,„:„,,,,„,:.,„:„„:„„,,, ,,7,17.;73 ,--:::::-.7.,,,, , !:-..- 7.,,... ,,,-•- •,..,:".:.7:•-,;;;;7,---•---"...44,71.1.,. , . .. ..:•:.:,e:::. ....., :.!,i!, ,. .. , ... :,. ��. is • ff`2 ,:.: 3'F,„ • • iI< , '''':,':::•‘1,:.::-, :r-''''' 4--':','•••'•:;8';',7:-,,,,,1,11:.;. ..,-,,,,, ,,,,E,:,.•,•!: ;?.1..,:;-i.T:.,.;*,.:,:•:•:,...,,,,„,„;11!,;;,::A ,,..•,.:,; • 4 • a 'Nair• F`; •'•'•':g1•4-,:::t ld; .-':,,,,,•!`"•`'.:?•.:::9't.. ,,,,•'':..,:',7P,' ".,,!,.'.,,,, .. :-it:i."/:•,""-,,,;44IF a, � i ,� d s. k £ '. •• r% x/ie ap ....:: 4,71,,rP:::. ,,,,,,,,,,,.., ,,,,,•,,,,,,•„•: • .•,:,,,A„,..-,„•,,,..„21?•.;,,........„,„,,,,,,.„.._____ ,._ :.„...,,,,,..,..,,,...,..! .....:„: ......... ,. H.M/ �/ w °'�" i ,£y ...... .'•r,,:„„„„,,„„,,,,o, ''''''':?'-i:::::•••'..by ',2:::111Pit.:71114*' .... ...„.„,••• ..•.,.......„,:.:,•..„...„:„,„:„.....„.........• ••••••••••„„ „,...,i,,,1„.••••,,, ••:,04,, •:„:40,1,:,,,,,,!!!::::••:,•„:,„,.,.....: •• „:„....... „.,......, •••••:::„,• ..„,,.,•„ .. ...„.,...0., .,.......,,,.„, •,...,,, „,, ,,..„::::„ ,.•••„ i•...„..., • ::: :„.:::::•„,..,.„,•,•,• . .„,.,,,,, i ....,,,..1, p '.......„...._. ms,,,,,,,,,•• . ...,,,,:y. . . . .:•.„„, , ,:, ..:, • .,...,...,. . ,,:::. „.,,,,..:„.N . „40,!1„,,r,„...,......„ ,,,. ..: .,,,.. ,,,„..4...,.. • . „,...,,, ,„•,,„,„:.......,.....„... „,„•• •••:,:1,,,1::„:J.. „.. ,,,,,, ,,,!,:il r .• ,„•,, • .. •,,.,,,, ••:::,„:„„:„„.::::•••••, • ..:„...,.,:„. . . ..,„:,: ,..„...„,„.......:„„ .., .„.::„,„,::,,.„.. ..,.,:„..,:u.1 N..,... . a. . .„, ,••::::::::::„.•„:„. ••••„:„K.,,,... '''' ' ''' .'"".'""''''''="771; "‘1".t.;4411614011trat..... , . " m• r r .. • x.. i , & lott - 6-61Y-- r,A.•ytat- / ....,.. . . . (14) b iril,v1,94k-4-7-/' -4 • SCANNED MAR 0 9 2010 - .0 iI * %% Jo; , `a1„ Ca, ,<_ '-� a. 44 fi l,31 ' ;.-,_ :R� ' fP., -titow,,,,,',,,,,:: 't ..A.,- pi.' .ftf,,‘1,4--- ''''-::'" r-:.'.:7‘5:rg,' ",,.:4,,11:'1i;i„4,=,x 1•',›1-,'• ,,,w' • y. .- ,7:„--.,i-'i.,',*,,4i!:%,,",.„,,,;,-;.•4,i,:,'',,-l,--,4,,i,'- :'—,-,,.-.•.!i-,-''•,',-.7,;. r 's 'n,' -„ ' ,, -«0" y-*' 'w gam; _ • F`'�.,,: - -7'' ' '" ., m ° "."-,•'•'.;-7,, ° _M fir,, ..; % "9"St;,5'' �'r- :;,a ,n' •: .s,''g e, ,:yr. '. Y--,%,•:t ' ''�',.' ,. th„ " r,_;-sab s:= -. ``i tqiy 'J,�'. '.;i4; „ 10 !.. ._.... u :-.° ?q.> ,a= r' > , . ,,,, -, ; :4, , ,.'',4 - ,....,,ti,i-cm„.0,,,,fee,u,.:4)„,: ,, _,.. „„„;,: s7,:::: .e.,„=:.,,-.,.:;...••: ir •,s1: , ,,,, :',,, N ,i)!, ,„ -;,;t4,-,: _..,,,i'" LA.W4W(1440414,1014***Sty,'-'.!file, s - [..!,.,,,,,z,iii, „. A, /�// ''E^.,- ,; ", ax � y s - ,-- tea'""" y,3 { i,rt, 4 € {g>„ 9 ,�e H rb e '4- titairls • of k✓/,y,4k� YeR,� - ,fi. ."6< �,x&,s � s,'�F'•` �'�� ��,�,��'�"�:;>�'. - .,�' J:: R :,. 4',,,; `'< ti-' "• Y:l� NSF d;' ' 'qk xa *.- E;' ;.fir-„ r'"^, ✓ ;,-, ..:� /,� /,� �- - .., . > :;P4A- ?Oh '-'q fir;' ¢'.^<,<'. _ - *",,, ';:10. ',.:'f ;', ,,, i,,,:-: '',•4''A•A'!,, ,'`-,--•' •„.=4*,,441,4,• ',- ,T4''',4'", '', •e:•:•-:::=" •„X.„•=4‘.4>/-11--,,,p•--4,4-"'-':.'4., ,-,-1.'• „':1; '-',„•''''''1„1:" lik ✓'a s.�_- ? e'.. d'2'...z,,;<"M., >�„ >' Sz='�° -" ._ ,"9/,",:'s< �:�'.o s t ','z .,.....:ad',u,::"u`�',p°.' 'tc'��` 8 �#s' . E is °too ivil i..tal, ;4r wiiiltiortvej,. kallvs)---t---04/1141/)----- -- •i •-- e • 11 ilitilin..4).4,3st4- -(441-11-----Ov4---. 44. --jita.--41/1"1414-(111114446 7) 1a '' ! -* Amay: ; ;z;;1 . - ° x :` �,:m,A �?" '.��' '""-._»>. _. • '4'�< „„,,,,";:r>i '{�„M- ^�'> .yl .,j%;;'ti:• ,v2. �'r:'•_�:v,`�'s .N>es�;, ,:iis; ,X, 0,w°, •4 -, r- "- szsA-. >.,,t 'a,may011,1 \.Al y 'a c), 'rr,% u . tea.x ; •'„Vi,T, -; - � .. 4<`' ;,, ,I:r-.. 1 ;;w/ r, ,..,.:.''',' iip /r?1 " „'A,st;•;i' 4H,' "., ' 4'x< �:� ,trA;;.(• ` '' ,;;'k > jj :s �pa'd //'`f 1 >;f G',,, ,`,.,rs '"e<`%; L s' "—' ,;,,AA ("'h { 1�,. :s 1 4:4,-(4, z =`1'a%S 0 ,, a .--a- _ - 14 ,0c > nff _ W t .s,>; -0" - , f. ''w „%.r;i'a✓ .r..,,./ r' :3,,.,.Lfk'a' ,a' " "k.. o.. ............. `•' % Vs,d, 'sE: , fSo"�tc,'v'�";;'„'n,,;;r8 .,,.�.'„�'„3>'; >::a:\`r•;:�,SXr^;v<m,,,.-, ,,�c� ;t, •tf,tT-"t t„-,,,,, ' �•,°" / tyu, : ...'afv4a ' •g<r'. a f k-q r, ,„, 34 • 1, .-, ! £'. �;%:. „ ;,.•�:, : +}��- : s,' c n _' (• • b"' Mom. • • "'•"8,,; ". 3 a;!t;r,„4 .F `-8(' ,f: 1! v; -';s'=a f; °/�. uy., e�. At, b E „ gi • • x ,.i , . (. ,m ;, ,a try s > ,, '. - , •"'•,<'� „s x l,4 �' „, :"s f ae..F.,) -t,...,.-.-". 4 % nj=s'3,. R_.aa „i.o.e,.`.,a ' • IV i%: _,.guy /qx <x'-,,,°.41F"4i R„-: -r '- i>^-.� <,;:i=" " sa-".....- -, • M • 7'�p"'� "�, lb;;- '/� .. ;',5ti ;N, CF1 $c„r�c,�..was:'.,> '` ,.... , .y '1- <*� > "%`-x�,: ` ,s..,,N_,..,�„_,z->',":,:"ate.,',;may ,'`x € {, , % �`',1`, ,, ,.. «� w: • cV+, :fir,- ° V,f ,�g� � a ,y S P Z •i q,„1 - '*i;'¢'c'r k;,. ' D'',.,s ,' _ >,-"`' r � ••�,a" :ram ,� ` ;''' - 41 '• :t .': • �''-,�, I. ��%di n /3,.;.;A3,%"-! „4.0„ `04 `.y Alt y L3''.:,; _ �o' fix°', ,. • ��� �;�,s�6`„r, P.r� .,.. .�.. k. . i;k „'" ;',. �,4.,a� $. '';' _ .'a•-;`' f '1 ,fie' xP"' ,"1"0,�. ,': .,k _ �viY= s,,.4,,r;.! :4 r 'f�- E . ' «;€i•^, 4ta'a4x:< _ • ,may. .ems!, �"g,"•..�z ,„,„k',- _ y sd „„,�• ,-.,, -eB>•% — v ;%u';lA"'.F,#'F•�-•��h ,,'...„,,,{f3n,,,,,,mk;,,,,,,,T` ttp,^>Te."na+; ',v 4% yc5±�%"g„- .g.w' -'� '"-�sia.r��.Yr�s�,{ ;o:ax.^�>s- .' '�'�• dr� :. ����,�✓ 4'".z �;r�t� sr.�aa% � -� -.....tea. ,: );', f.s �w %`' ^'a ✓ x. rr� .. ;F r'�Y ,.r/^: !.=•." .. �4/,'rf .[fir. <^ a'.si w yy, Y �{ i,TA's,a.., a" , x, �', h N of ;•�'yn'v .?.,,,,,:F -s c' , ;'?y;+x, - ,"i•. M"^nli;,r, .Mq,?d4a ' ':: i;� : .� s ;if • -' a''/ l.' ••,,1• rha .".._ .„ g,.. wExi<' ,£1' 'iu� 'spy ,. 3, " eelx,r,.' • ••"a,:a„- a. ,:aO,9v/%' 3 �.«moo. � , µ , s .4'. _ ' „., . - ,t"' , .om -v�. .;.-- , p•ro,r ' . . .' .., :,• .m. 41 , a.. , w, i ; 3f/. [ • _ z;s Y-y' t :, ": a" *„ #x.' ''•,`�z;_�'-'-a% ,,.xxr�"' Y/ IS• y+,^`� „s�s 9,r ,{� . ,F r," , 'fi=.; ' , myf,,c - F'j.' .N .,7'.p se I;i ' r � '3 42Cwcc M F �s.•-,�'AA .....' , •f,�,,'.<t Se t3•`=,oz. ,.tr: �' „ •,` yF,i ;,, ' e:mS FG'"csYs Kw d , , , . a$q .,. *� "' k. •,r4fi.1 ,s', :f ii,-',•`l i1i • i9 "J?3'S .' 4t. �,p a•,, ,r'd" W . "-.`Fe4• C` ,�a', Spit $Pfs $ I I I , w owe.Cji:14101.M.S.L-1'6,-'4.11,... ...fiV,-,...- .1[ .•:,,..11:1,1, * ...,...a.a......C.i..4L a te-7, A.:I .""ktla kt2) 'Aekir.."' 4 • _________-_JI..T - ,_._ -..aI a __.=_r . -,,__ _._1 ..3�...1f.16 - lam • fq ' "f . > *te" �� ; . ,a . . _•-_ ,4 r .a .Y j. Y. ..w yy • .� .^*e.Q^• :.,1c, .•<,, m,3>adaa','�Zu9+teM'.uia,.,., 4p*-:0g ti '?. " 4 ;>A .,, 3 vi �s yi s• t,z r ; ;r. 4` ; ' �S''"° •, ,,z: spat. a, c P. ',.• 1.,:ik,;-.44.,:---if--...:,..,-J,-;. ;.*-rt-;"4:gt. 4.; EY ? : \Y 3• N efe'. `. `9$s s F.• F '""N.,<•.ly,•ii..:. :::gay.`.' .(a P. r r mow..; " d s: ?:. ' :•: "„c igai aN .".:.L,.. tt:" ee : .. t y.•y b.X: 3i'. .. .. ':.,: igggiriv, .. .u :.3 �„,� 5�' k7 . r m ' RekY w I1 0 lit 10/7;occLthek, t6 _1,11,,,,,,,_,Etly_vdn. ,141_4.e/A.N4:1_etA lb 9g--2119--1- / • • ' , 4,, jrit.M “ttill.*.j ' 10 pi,F3 i , i tit V 1 E t,P • 30'' 3 19-41( to t cria rJLW 3O erg ' ; awgit t rd_er Nla wallya , i 9.1, eh,* 1.,ril : f OS3� s3v'` ^� Y Der D1rvt �"." LI Vi�1 to - Oct Yy = 1 f • The Commonwealth of Massachusetts _—_ Department of Industrial Accidents !,_1==4 —=" - Office of Investigations =sat'- 600 Washington Street •. _- Z. . Boston,MA 02111 :-__ -�' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): h f/(9(//' ((-10114) . Address: 3.11'77 Ik/I, City/State/Zip: 1,,J 04 4,i' C Phone#:. .iatZH4=ZV--atta;j_________ Are you an employer?Check the appropriate box: • Type of project(required): 1.❑ I am a employer with. 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anyaci employees and have workers' capacity. 9. 0 Building addition [No workers' comp.insurance comp.insurance.: _required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.L`7 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions mysel£[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 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. 1 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 1 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: • Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy..of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. -`. I do hereby certi under the pains and penalties of perjury that the information provided above istrue and correct Signature: �' Date: 3 4 Phone#: q01 - 9` - )"1 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." • An employer is defin-,; as"an individual,partnership,association,corporati or other legal entity,or any two or more of the foregoing • -_ . in a joint enterprise,and including the legal -• ves of a deceased employer,or the receiver or trustee of an i••dividual,partnership,association or other legal .,c.a employing employees. However the owner of a dwelling ho having not more than three apartments and • '• resides therein,or the occupant of the dwelling house of another ho employs persons to do maintenance, .• ;on or repair work on such dwelling house or on the grounds or bull." : appurtenant thereto shall not because of ,h ch employment be deemed to be an employer." MGL chapter 152,§25C(6)als'�,states that"every state or local lice ing agency shall withhold the issuance or renewal of a license or,permit operate a business or to contra, buildings in the commonwealth for any applicant who has not prodn •\cceptable evidence of complia;ice with the insurance coverage required." Additionally,MGL chapter 152, §2\;C(7)states"Neither the co..,. anwealth nor any of its political subdivisions shall enter into any contract for the perfo '�.`ance of public.work until 'table evidence of compliance with the insurance requirements of this chapter have •-- presented to the con• : '%'g authority." Applicants Please fill out the workers' compensatio"affidavit completel 4,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name( address(es)and 1.hone number(s)along with their certificate(s)of insurance. Limited Liability Companies(L►,C)or Limited j ability Partnerships(LLP)with no employees other than the members or partners,are not required to workers'co.' ensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised this affida r• may be submitted to the Department of Industrial Accidents for confirmation of insurance coy-, :_e. Also b. sure to sign and date the affidavit. The affidavit should be returned to the city or town that the applicatios, for the . ..• or license is being requested,not the Department of Industrial Accidents. Should you have any questi`,,. ing the law or if you are required to obtain a workers' compensation policy,please call the Department at..e ai ber listed below. Self-insured companies should enter their self-insurance license number on the appropriate lin City or Town Officials Please be sure that the affidavit is complete and printed 71,,_bly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office .vestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whic y `,, be used as a reference number. In addition,an applicant that must submit multiple permit/license applications any :Aran year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site ddres}'the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officiall;stamp-.1,or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for • ' - perm', or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a • . e or p g.it not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said +erson is NO equired to complete this affidavit. The Office of Investigations would like to thank yo in :• • ce for '.ur cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax num• : The Co n wealth of M •,�usetts Departm f Industrial Arai. : ,ts ... i r e Investigations 600 W,: •gton Street Bo .n. MA 02111 Tel.#617 727-49+it ext 406 or 1-877 MASS• '+. Revised 4-24-07 Fax#617-727-7749 www:tnass.gov/dia fl . 1 • X: nn AurnIESF pF A , Ap) Application number 1 - .... � ,. �. AUG 0 2019 Fee ..�.> .. ) - 1.1 Teo J�. :::1:: : 0rs Init �, ....) a RNSTABLEd Map/Parcel aS 7 TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION �-II Address of Project: 4 " I 1 N\Ul\f 5 k ctt.)c 6 acne A V\&. NUMBER STREET VILLAGE Owner's Name: J o(lck -no l 0 \('OO 'C Phone Number C Ll o riJ 91 b- 9 ga 1 \ Number �Email Address: J CA`���leAsCO�c �1a`‘•C°"d ell Phone 001-0 116 Z 1 g � 9 Project cost$ S"�y 0 p v° Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building accordance with 780 CMR Owner Signature: ( Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# El Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review 1J Roof(not applying more than 1 layer of shingles)' . Construction Debris will be going to p,Oa 5iv,IVI Ili CONTRACTOR'S INFORMATION Contractor's name Sd c. ' Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) • Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 1 �.. , APPLICATION NUMBER... ' *For Tents Only* Date Tent(s)will be erected Removed on . number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES * - - 4 Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION ix Homeowner's Name: - Telephone Number 161 - (7I to " Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnsta . Signature Date .g'/ 0//1 APPLICANT'S SIGNATURE 01) _ Signature Date F561(9 All permit 'pp cations a • subject to a building official's approval prior to issuance. - . The Commonwealth of Massachusetts t� 4 Department of Industrial Accidents = `,. E Office of Investigations p — `_ 600 Washington Street .»i�•!� n - w Boston,MA 02111 y,.:'-=Li,.5�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): V(.)(16Z.-4:JL a r-N �S-1-< 4-)ri 1-. Address: P q-21 tiNA a,I,n S City/State/Zip:6a,rr\A h .6l ( t¢,;`�'((>> hone#: /a 1 -7 ' 4 — 11." 1 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 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 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P tY $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.N I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.®Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and pe • o perjury that the in ormation provided above is true and correct. ,)( Signature: 60M\V\ (p Date: 3 O If 9 Phone#: L� / t1" i lb `0 Official use only. Do not write in this area,to be completed by-city'or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f"• Information and Instructions Massachusetts General Laws chapter 152 requires all em o oyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...ev, person in the service of another under any contract of hire, express or o lied,oral or written." An employer is s fined as"an individual,partnershi association,corporation or other legal entity,or any two or more of the foregoing e •aged in a joint enterprise,and' ,luding the legal representatives of a deceased employer,or the receiver or trustee o • individual,partnership,ass o ciation or other legal entity,employing employees. However the owner of a dwelling h o use having not more than 'I ee apartments and who resides therein,or the occupant of the dwelling house of anoth; who employs persons o do maintenance,construction or repair work on such dwelling house or on the grounds or buil. g appurtenant thereto;shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)a •,:states that"ev state or local licensing agency shall withhold the issuance or renewal of a license or permit operate a • siness or to construct buildings in the commonwealth for any applicant who has not produced cceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§2 ,\ 7)sta,s"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perform\t e o public work until acceptable evidence of compliance with the insurance requirements of this chapter have been pit- .:; ted to the contracting authority." Applicants Please fill out the workers' compensation ffida ' ompletely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(•;,addre• -s)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies is LC)or L -d Liability Partnerships(LLP)with no employees other than the members or partners,are not required to c•:rry workers , I pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affix•. • may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also b s e to sign and date the affidavit. The affidavit should be returned to the city or town that the ap s lication for the pe 0 it s) license is being requested,not the Department of Industrial Accidents. Should you have an questions regardin_the w or if you are required to obtain a workers' compensation policy,please call the Dep• on ent at the number 1`.ted low. 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 complet- and printed legibly. The De o artmen` 'as provided a space at the bottom of the affidavit for you to fill out in the ev,,nt the Office of Investigations ',.s to co ct you regarding the applicant. Please be sure to fill in the permit/license umber which will be used as are erence n,. ber. In addition,an applicant that must submit multiple permit/license a •lications in any given year,need o, y sub a't one affidavit indicating current policy information(if necessary)and unde "Job Site Address"the applicant should writ-""all locations in (city or town)."A copy of the affidavit that has bee officially stamped or marked by the ity or to b, may be provided to the applicant as proof that a valid affidavit is o file for future permits or licenses. A new affida,'t must be filled out each year.Where a home owner or citizen is obta a ing a license or permit not related to an. busines or commercial venture (i.e.a dog license or permit to burn leaves et►)said person is NOT required to comple` this a' o•vit. The Office of Investigations would like to tha you in advance for your cooperation and s'ould yo!.have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax num''er: The Comm•nwealth of Massachusetts Departmen,of Industrial Accidents Office o .estigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-477-MASSAFB Revised 4-24-07 Fax#617-727-7749 www.mass.govfdia Bk 32244 Pg113 #40321 08-23-2019 @ 02 : 38p OUITCLAIM DEgA I, DONNA M. KAHEL1N,TRUSTEE of the NEMEC FAMILY TRUST, under a written Declaration of Trust dated March 27,2014,evidenced by a trustee certificate being recorded herewith,with a mailing address of Post Office Box 125,Osterville,Massachusetts 02655, for consideration paid and in consideration of TWO HUNDRED NINETY-FIVE THOUSAND and 00/100($295,000.00)DOLLARS, co co co grant to VICTORIA L.GERVAIS,a single woman and JONATHAN C.STROUT,a single o< man,as joint tenants with rights of survivorship,both with an address of 2477 Main Street, Barnstable,Massachusetts 02630, om 6 with QUITCLAIM COVENANTS, Cm c 0 that certain parcel of land, together with any buildings thereon, located in Barnstable, ns Barnstable County, Massachusetts, now known and numbered as 2477 Main Street, - Barnstable,being more particularly bounded and described as follows: .c'c-c On the North by the County Road; cOn the West and South by land now or formerly of Barney Hinckley; and N CV ir;. On the East by the lane. -0 Q The above-described premises are conveyed subject to and with the benefit of reservations, restrictions,rights,rights of way,covenants,appurtenances and easements of record insofar as the same are now in force and applicable. 0 For title see deed dated March 27,2014 and recorded with the Barnstable County Registry of Deeds in Book 28079, Page 277. MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 08-23-2019 @ 02:38pm Date: 08-23-2019 @ 02:38pm Ctl#: 1073 Doc#: 40321 Ct1#: 1073 Doc#: 40321 Fee: $1,008.90 Cons: $295,000.00 Fee: $902.70 Cons: $295,000.00 Bk 32 244 Pg114 #40321 I hereby certify that(a)I am the sole Trustee of the said Nemec Family Trust,under a written Declaration of Trust dated March 27,2014;(b)said Trust is in full force and effect and has not been altered,amended,or revoked;(c)all of the beneficiaries of the Trust are of full age, and none of such beneficiaries are under any disability, a corporation selling all or substantially all of its Massachusetts assets;or a personal representative of an estate subject to estate tax liens;and(d)I have been duly authorized by all of the beneficiaries of said Trust to execute, acknowledge, and deliver a Quitclaim Deed to Victoria Gervais and Jonathan Strout for consideration paid in the amount of S295,000.00,conveying the property located at 2477 Main Street, Barnstable,Massachusetts,and to execute and deliver all documents and take any action necessary to consummate said transfer. Grantor hereby releases any and all homestead rights to the within premises,whether created by declaration or operation of law,and further states under the pains and penalties of perjury that there are no other individuals entitled homestead rights to the property being conveyed herein. THE REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK. Bk 32244 Pg115 #40321 Executed as a sealed instrument under the pains and penalties of perjury on Apo I �(,r ,20I9. Nemec Family Trust b ihr-freit7I4Z‘: y: M.Kahelin,Trustee COMMONWEALTH OF MASSACHUSETTS COUNTY OF BARNSTABLE On this 2tPday of A)011 L ,2019,before me,the undersigned notary public, personally appeared Donna M.Kahelin,Trustee aforesaid,(a) ✓personally known to me, or (b) proved to me through satisfactory evidence of identification which was ,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that she signed it voluntarily as her free act and deed for its stated purpose and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of her knowledge and belief and signed as the free act and deed of the Nemec Family Trust. Notary public My commission expires: CHRISTINE A. JENNESS. PublicNotary _14_1147272°114"Na_ JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS RECEIVED & RECORDED ELECTRONICALLY