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A'k Town of Barnstable *Permit# / 7 — Expires 6 mo hs jrom Issue date Building Department Services v RAMST,mt,E, : Brian Florence,CBO MASS _s Building Commissioner 200 Main Street Hyannis,MA 02601 y SEP 282017 www.town.barnstable.ma.us Office: 508-862-4038 (OWN 0r 6NMN bf-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /3—i� c3 —A A . 7 Property Address t, L G V -I (j t� Jr r\.:�5 l'f (ter (-( '� 4ti14, esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address k A-t\.i V L✓a Sti-_ ��t( �Cy�+� cs Contractor's Name L LC Telephone Number 5_?�rgc'( Home Improvement Contractor License#(if applicable) /5 �L'3 Email: tA' A.,tom, Cn Gt4S 1- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I gjarthe Homeowner &-11have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# �v N V f Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ,.]�1����ou�(—LLAIId Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) E[Ie-side D—Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows HAN #of doors: "6cf *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the provement ors License&Construction Supervisors License is re d. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 77ie Commonwealth of-Vassachusetts Department of iiindustrial Accidents Office of lmwstigadans ' 600 Washington Street _= Boston,M4 02111 }vrvmillass_govldia Workers' Campensatian Insurance Affidavit Builders/CuntractorsMecfricianslPlumbers Applicant Infnrmatian Please Print LeQibIY i - 7 , N3ffi0($ncin¢cc,'0.rzgnlZatit}nFTnri - a _ �► t� \��—\ ��� %-��E=1. S ���- Address: City/state( : 11 I' Phcnei�: Are 3'o employer?Check the appropriate box Type of project(required): I. am a employes with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full andlor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors hzve g_ ❑Demolition working for me in any capacity employees and have wodcers' q. ❑Building addition [No warms' comp.insurance: comp.insurance required-] 5- ❑ We are a corporation and its 14.❑Electrical repairs or additions 3.❑ I am a homeo-imer doing all work of have exercised their 11.❑Plumbing repairs or additions myself [No zyorke:rs'gyp- right of exemption per MGL 12.❑Roofrepairs inmzance required.] t c.152,§1(4),and we have no employees-[No woders' 13.❑Other comp.insurance required.] 6 ;Any appticantthatchecks box toemit also fill out the sectionbeLowshmfingtheirwoaets'campensEti npolicyinfntnffition_ EameoWMM who submit this affid2ut indkztSn g they are damn all weir}and then hire outside cantcnctors must submit anew affidavit iadk=11g sari rContmctms If at check this bait m=attached as additional sheet shotcmg the nee of the sub-contsaDts and state whether or not those entities ham employees. If the zuh-contrj c rs have employee%they amst provide their wurkeas'comp.policy number. I ann art employer tkat,is pronzdit workers"cot gxwsahan imnirarnce for my employees. Below is the policy and job site rnformat om Insurance Company Name: ✓�`'QKCr' Policy#or Self-ins.Iic. (., M V 6 I(, ExpirationDate: /02 Job Site Address: Z'rJ 4�( t}- /�1 � 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. 157 can lead to the imposition of criminal penalti s of a fine up to$1,500-00 aniVor one-year imprisonment as well as civil penalties.in the farm of a STOP WORK ORDERand a fine of up to$250-00 a day against the-violator. Be ad-%vsed that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verbcation. I do k ere by cetfifyr utrdtsr t pains tiaWes ofpej�uq that the info rm adoit pron-i&d abore is hue and correct $ienature: Date: 2 Phone# Official use only. Do not trrite in this area,to be cotnp£eta by city ortatn-n official City or Town: PermitlLuense# Issuing Authority(circle one): 1.Board of Ilealth 3.Budding Department 3.Ci1y/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- Information and Instructions Massasihusetts Ge,nn al Laws c 152 reqaices all employers to provide workers' compensation for their employees. p tD this ,an enFIoyee is defined as.�-.emery pesson in the seavicc of another Vider any contract of hire, express or implied,oral or wut b u An employer is defined as"an individual,pmtn=14,association, Ysa r legal entity, or any two or more of the foregoi\ engaged in a joint mit rr ise,andinclndmg the leg & of a deceased employer,or the receiver or trustee of an individual,partnsr�,association or othe , loying employees. However tale owner of a dweIli;�house having not more tLmt three apartments atherein,or the occapant of the - dwelIinghouse of another who employs persons to do mai�ance, or repay work on such dweIting houseor on the grounds or'bm-Iding appUrtenanf thereto shall not because loyment be deemed to be an employer."M- GL chapter I52, §25C(,f)also sf�es that"every state or local Ticcy shall withhold the issuance or renewal of a license or permit to operate a business or to construct�uildings m the commonwealth for any applicant who has not produced acceptable evidence of complian4with the insurance.coverage required.-" Additionally,MGL chapter ISZ, §25C(7)states"Neither the commem wealth nor Ly ofits political subdivisions shall enter into any contract for the p? an ce of public work u atd acceptable evidence of complia;ace with the ins" AT,ce.. regtm ements of this chapter hav�been presented to the cunt -ting auto ozity ' Applicants Please El out the workers' comp n affidavit completely,by checking i-he boxes feat apply to your situation and.,if necessary,simply sub contractar(s)nam ), address(es)and phone numbers) along with their cerdEcate(s) of incTTT�ance. Limited Liabr7' Companies C)or Limited ility Partnerships(LLP)with no employees other than the members or partner are not required to workers' =o p nation insurance. If an LLC or LLP does have employes, a policy is required. Be advised a$rdayit maybe subm"ttnd to the Department of Industrial Accidents for confirmation of insurance cov(--Img-t- Also be sure to sign and date the afudavif The affidavit should be rets=d to the city or town that the application fiie permit or license is being regaesi�not the Department of TnrirTstrial Accidents. Shouldyou have any gnEsfions the law or ifyou�e requu-t- to obtain a workers' ompensation policy,please call the Dep artment at er listed below. Self-insured ecanies should ester their c self-m ce license number on the appropriate line.f City or Town Officials f Please be sure that the affidavit is complete and pried legibly. e Department Las provided a space at the bottom of the affidavit for you to fM out in the event the Office of Inv ons has to contact you rega cding the applicant Please be sure to fill in the peuuit/licrose numbeq which Will be us as a reference number. In addition, an applicant that must submit multiple P=hllicense applications in any given y need only submit one affidavit indicating cuu-cat policy intern ation Cif necessary)and under"Toni Site Address"the apP shoT 1d write"all locations in (may or town):'A copy of the-affidavit that has been officially stamped or made by the city or tovm may be provided to the ' applicant as proof that a valid affidavit is on fle for future permits or Iicens s A new affidavit must be fiJ1ed out earTre year.Where a home owner or citizen is obtaining a license or permit not re Eo any business or commercial-venture, (it. a dog license or permit to bum leaves etc.)said person is NOT req®�to bpmplete this affidavit The Offie c of Tnvest�ions would like to thank you in advance for your coopmati and should you have any questions, please do nothesifa to give us a caIL The Department's address,telephone and fax m=ber_ Tht Commmw(-,Jtb�of Mamach�t�s ' Degar iatnt of lsdustial AccUents O]t(�e Qf fvest�ntioRs (500 W n S#rl-,d Bostan�MA Q11I ` (,-L 4 617-727-49QO.Qxt 4-06 or I-9 MA,�, � Fax 9 f 17-727 7749 Revised 4-24-07 ma..--I,-gpVIcia i i ' Town of Barnstable Building Department Services . g P MINIMUM UM r ,� Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1. �J ��`� I¢ as Owner of the subject property n J P PAY hereby authorize ✓ ) S to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applican t Pools are not to be filled or utilized before fence is installed and all final inspections are erformed and accepted. --� Signature of Owner Signature f Applicant o 16L Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 639. h Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LI SE EXEMPTION Please nt DATE: r JOB LOCATION: number street village "HOMEOWNEkr: name home phone work phone# CURRENT MAH INO ADDRESS: cityhown state zip code The current exemption for"homeowners"was extended to in ude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not p sess a license,provided that the owner acts as supervisor. DE N OF HOMEOWNER Person(s)who owns a parcel of land on which he/she reside or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory t such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeo er. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be re onsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes resp'd ility fo compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. \ The undersigned"homeowner"certifies that he/she ds the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will co m with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or ger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXE ON The Code states that: "Any homeowner performing work for whi 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)Ifhis 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 woul with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully ayvare of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify Oiat he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several to s. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building permit forms EXPRESS.doc 08/16/17 d i i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 -r Boston, Massachusetts 02116 - Home Improvemen ontractor Registration mm Type: LLC z Registration: 155863 PROJECT MANAGERS LLC M ``' u Expiration: 55863 19 15 LEXINGTON LN. YARMOUTHPORT,MA 02675 a SCA 1 co 20M-05/11 Update Address and return card. Mark reason for change. j �e oarinwntueal�a�Pi�aaonc�iccoeCt� u =72= — y Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: __Registration Expiration Office of Consumer Affairs and Business Regulation =_ 05/14/2019 10 Park Plaza-Suite 5170 11� � PROJECT MANXG, =,LL — Boston,MA 02116 _ •—,. Q W ILLIAM PLANINSHEQ-: - 15 LEXINGTON LN. YARMOUTHPORT,MA 02675 Undersecretary Ot valid Without signature Construction Supervisor Massachusetts Department of Public Safety s of any use group which contain �®t Restricted to: eters)Of Board of Building Unrestricted-Building 991 cubic m g Regulations and Standards 35,000 cubic feet( License: CS-095981 less than space. Construction Supervisor enclosed p WILLIAM F PLANINSHEK 15 LEXINGTON LANE YARMOUTH PORT MA 02675 assachusetts Failure to assess a current edition of the NI GOV IDPS /�9 Code is cause for revocaMASS this license. State Building information visit:YVWW i L �Ki' �lyy�y` OPS Licensing inform Commissioner Expiration: 10/25/2018 r{ 0-1 COL i Town of Barnstable *Permit# Regulatory Services EFeieres6monthsfrom issue date RAJOWABLE, Richard V.Scali,Director �/ F%639. Building Division X-PRESS PFRMV Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 S EP 0 2 2016 www.town.bamstable.ma.us Office: 508-8624038 TOWN OF BAMS -0230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number- ���(/'� �� Property Address �Oq& 6 4 0af\,-5j4L Vi(i(#+CE esidential Value of Work$ JC 000 • V-DMinimum fee of$35.00 for work under$6000.00 Owner's Name&Address kA i\w V -4- q II Contractor's Name (2,12T c 4 M 4's'E'ZS Telephone Number -1 Home Improvement Contractor License#(if applicable) / 3 Email: l'Z�, ��, �� �O�'1w' t /5� �S 6 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner EZLJ�ha've Worker's Compensation Insurance Insurance Company Name �/j�l ,fie-4.ti_5 Workman's Comp.Policy# l-/y 12) 5-6 sm 7 7 - L f Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to wlat' • ❑ of(hurricane nailed)(not stripping. Going over existing layers of roof) ` PeRside placement Windows/doors/sliders.U-Value vr;1d-c4 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 of Permission. A copy o the Ho pr vement Contr ctors Lie se&Construction Supervisors License is require SIGNATURE: Q:\WPFILES\FORMS\building permit rms\EXPRESS.doc 06/20/16 27w Commomveakh of Masse dmsetts R�partment afradustrtal Accidents OJTWC of Finaestigations IF 600 Washington,street Bast n,CIA 0111 ivrvmmas&gvv/dia N�Tarkers' CumpensatianIusuranceAffidavit: BiiilderslContra:ciursJEIecfricians/Plunbers A�pp&,ml Infarmafian Please Prim Le�r�bIv Na= (BasmesslOrz=mtiz}nfFndt dnal}> ,qc C�fst tc1 l- l�t� � mane� � Are yoII employer?,Gheckthe appropriate box: T of project r 1. am a employer with 4. ❑I am a geu-eral contractor and I � e 1 ( �ic.n P � _ * have hired tie sub-contractors 6_ ❑New oons4n�ctian employees(felt a>rdforpnnt-time). 2.❑ I am a sole propuetcnr or partner- listed on the attached sheet. I- ❑` Remodeling soup and have no employees These sub-contractors have g. ❑Demolition wal-ing for mein any capacity- employees and hm a workers' 9. ❑Building addition [No worlmrs, camp.insurance comp-menrancf l required-] 5. ❑ We are a corporation and its 1 Q Electrical repairs or a ddions 3.❑ I am a homeowmer doing all work officers have exr=.-sed their 1 L❑Phnnbing repairs or additions f o myselfmyself [No worScers'camp- rig of Per MGL 13.❑Roofrepairs insurance required.]! c.152, §1(4�andwe have no employees.[Na workers' 13.❑Other 5 C4,ke—w A' �— comp-insurance required.] ?- 3 L,-,--.04. •AnyapglicmtH1atdmdsboxF1rxxast09affi1 out the sectionbelow showing their workeiecamp rztS poycyiafoc=suob Hameo amem who submit this af5d2x d irrTcH-g they axe doing zU wcA su,4 then hire au=&contrxtom Est suhmit a new affidxdt mdirzhaa sacb_ ICaxmact mm that t 1.xSr i3us boot mast aitRc sn additional sheet showing the name of tha sub-comtcsctoa and state Whether or nut tbase eatities hxve employees. If the sub-caatxac=have employtL--%theymnsrpmvide their,xvrkrss'gip.galiep a,imber- I am an eittpLayerfliatispr4nfdhT,-iiarke-rscornp"LsidiaiiizLi7iranceformycitrFlojem Helow is lie policy land job site information. _ Insurance Company Fame: -�Vt�C•-� Policy-or Self-ins.Lie- �9 ��t l�' 5-�) '�G( 4 1 "-b- N( Fxpiration Date. l o f Job Site Addre L y y �' +t� `7 1�s � 16 l e. Cify/State/Zw: 1117 Attach a-copy of the w&rlcers'compensation policy declaration ion page-(showing the policy,number and expiration date). Fail=to secure coverage as required under Section 25A of MGL c.152 can head to the imposition of criminal penalties of a fine up to$1,500.00 and'or one-year imprisonmeri�as well as civil peuaties.in the fo>m of a STOP STORK ORDER and a fine of up to$250-00 a dap against the violator. Be ad Ased that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vetificafion_ I do herRby cer iy undierrlpains aims'a thatt}is info nuationprm-cdedabm w is true acid correct Sisnature- Date- Phone me ©Bkird use only. Da rtat write in this area,to be completed by city artairn official City or Town: Permitff ikense 9 Issuing Antbarity(ca-cle one): L Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: - -- ---- - -- - - 6 L Information and Instructions �u �rra;Trse s Ge ueaal Lames cbapi�r I52 regt�cs aII cmploye�s to F vide woz s'ca�ensa�ion fQr t3 t e 1plr�'ees- p � statute,an=pkyez is definexi as"_everypersonin e service of anofhcx Bader airy cowact ofhire, express or implied, oral or w " An Eznp&�� is (Inaed as"an indrvidBal,partnership,amocrahon,corporation or other legal entiy, or any two or more of the foregoing-engaged is a1oiat Vie,aaci iar-hLc'ffi2g thl--Iegal r=p=mi a&cs of a dxrzsed employer,or the receiver or traste,--of as individual,pmto=sbrp,assoe!am or otheslegal entity,e :[Ploymg empinye:s- However the owner of a dweIlmg""c,having not more than three apa d m=t s and who resides th=M,or tie occaPant of the - dwelling ho-ase of a w2=who eanplays p=sans to do maintenance,canstac-;on or repair woik on such dweIIing house or on the grounds or buil�g appurtnnant,'h ereto shall not bemuse of such employmea±be deeaned to be an employer." r l�IGL chap�a ISZ, §25C(6)al;*States fiat"every siatE or Jcal liic agehcy Shan witbhoId$ze issuance or renewal of a licerrse or permit to operate a b4siness or to construct bu ridings m the cornmonwealth for any applicantwho has notprodnced acceptable evidence of •mpZian-m with the inEm-ance.mverage reg�" AdrihionaIly,MGL chapt-r 152, §25CM states¢Neither e nor airy of its political subdivisions shall eaitrr iai any contract for tiiepeerfmmaa=ofpublic wo until.acceptable evidence of compliance with the filsuranrp._ m eats of this cbaptra been ptse�ted to the i ardio " have �m A-pplicants Please El otit the woj3=' compensation afFa ' co J Ietely,by e boxes apply to your sitnatian and,if necessary,supply sub-contrac t]Dr(s)naE e*), an3 phone numbers) along whhL their cerfiffmatc(s) of „crnmnce. Liroitad Liability Companies (LLC)or Liability Parinerships(LIP)with no employers other than tb-e members or partners,ale not regcmrd to taffy wo, ensation fiia ' ce- If an LLC or LLP does have MPjOyees, a policy is regmued. Be advised that this da maybe snlmntb!;d to the Department of Industrial Accidents for co�mation offi snce coverage. o be a to sign and date�e afdavit The affidavit should be retied to jhe cify or town that the application d-p or license is being requester not the Department of Fnaast,ja Acmd=ats- should You hayr any gncs't! regal3mg th law or ifyon are required-to obtain a wor3cers' compensation policy,please call the Depa tncat at m=ber below. Self-fi smaed=npanies should enf r their self-insm ce license namber on the agpzogriafe e. City or Town Officials Please be sure that the affidavit is camplcta and legibly. The Dep eat has provided a space at the both= of the affidavit for you to fell out in the event t9�e ce oflnvestigation spas contact you rcg g the applicant please be sure to, fill i a the pez:�nllice use numb which will be used as are ce number. In addition, an applicant that must Submit mult�Ic pew ztllice:ose appli in arty given year,need o submit one affidavit indicating unarm policy fi o=ation of necessary)and under°°.TOb ' Adams"tie applicant shoal wtife -a1I lac ativns in (may Or town)-"A copy of the-affidavit taut has been offi 1Ily stamped or maimed by the city or town may be provided to the applicant as proof that a valid affidavit is on file futm permits or licenses_ A new affidavrtmust be filled out esa-ch year.Me=a home owner or citizen is obtaiaing a license or permit not related fo any bn cinrcc or commercial 4P-n3nT- (ie. adog license or permit fi b41ez, 7= n is NOT rrsod to complete this affidavit Lie Office o f Inve �s iyplease do not hesifaiz t o give us The Departmcnfs address,telep Tht 0,of Massachas:(--#s . Dega-rtrltent of 1adusidal Accident ice rjf jr[�tiW� 654 Washm 11 S Q YA F111 Tf,-L 4 617-727-49CO�406 Qz 1-977-MA&33 Fax 617-727-7M R-eviscd 4-24-47 p €rr,asarzg�dTd Town of Barnstable ` Regulatory Services Richard V. Scali,Director ►� Building Division Paul Roma,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� I 4' "V , as Owner of the ro subject ( l property hereby authorize G�•10 e ��✓{� 5��25 • �-�- to act on my behalf, in all matters relative to work authorized by this building permit application for: Q' a aAo' ;- (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspectio e performed and accepted. Signature-of Owner Signature of Applicant (\ Print Name Print N e --Lo t L Date Q:FORMS:OWNERPERMISSIONPOOIS Town of Barnstable Regulatory Services pFTH Richard V.Scali,Director 4 Building Division aAxxarAsr.E Paul Roma,Building Commissioner �6. �� 200 Main Street, Hyannis,MA 02601 • www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 \ HOMEOWNER LICENSE TION \\ 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"w extheo luis�a wner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who s license,provided that the owner acts as supervisor. OF HOMEOWNER Person(s)who owns a parcel of land on which he/sintends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures aceuch use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered r. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shaible for all such work performed under the buildingpermit. (Section 109.1.1) I The undersigned"homeowner"assumes respo ibility,f'or co m fiance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies tha a/she understands the wn of Barnstable Building Department minimum inspection procedures and requirements and that he/sh will comply with said pro educes and requirements. Signature of Homeowner l Approval of Building Official Note: Three-family dwelling con ining 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: "An ho eowner perfo wing work for which a building permit is required shall be exempt from the provisions of this section ( cti n 109.1.1 -Lic using of construction Supervisors); provided that if the homeowner engages a person(s) for hire to do s ch work,that such ''omeowner shall-act as supervisor." Many homeowners who use this exemption are 1 naware 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 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:\WPFILES\FORMS\building permit formS\EXPRESS.doc 06/20/16 e rpaa�aona�uuea/��olgaadachweCld License or registration valid for individul use only Officc of Consumer Affairs&Business Regulation I g OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egii:tration: ,.,155863 Type: Office of Consumer Affairs and Business Regulation Expiration:;__5%�k--61:7; LLC 10 Park Plaza-Suite 5170 T. Boston,MA 02116 PROJECT MANAGERS_i WILLIAM PLANINSHE 15 LEXINGTON LN. `'''• YARMOUTHPORT, MA 02675 Undersecretary Not valid w' t nature Massachusetts -Department of Public Safety Unrestricted-Buildings of any use group which Board of Building Regulations and Standards 3 contain less than 35,000 cubic feet(991m )of :Construction Supervisor enclosed space. License: CS-095981 WH IAAM F PLA$IN 15 LEXI NGTON YARMOUTH PORT i 'r_ so j Failure to possess a current edition of the Massachusetts �— Z'% ,, 1,' ` State Building Code is cause for revocation of this license. Expiration Commissioner 10/25/2016 For DPS Licensing information visit: www.Mass.Gov/DPS i l TR AVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GHUB-5B50797-G-15) r CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 1751 NAICS : 238350 ------------------------------------------------------------------------------------ STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 50 PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 159 TERRORISM NONE TOTAL ESTIMATED PREMIUM 550 DEPOSIT AMOUNT DUE 550MP A/R (WCIP) # Minimum Premium: $ 500 EMPLOYERS LIABILITY MINIMUM: $ 50 ST ASSIGN: MA DATE OF ISSUE: 09-21 -15 WC OFFICE: ORLANDO INDUS AFF 161 PRODUCER: EDWARD J MCGRATH INS 2399K i AW TRAVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6HUB-5B50797-6-1 5) r INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 13439-MA INSURED'S NAME : PROJECT MANAGERS LLC RATE BUREAU ID: 000719051 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 264791739 ENTITY CD 001 PROJECT MANAGERS LLC 15 LEXINGTON LN YARMOUTH PORT, MA 02675 SIC CODE : 1751 NAICS : 238350 CARPENTRY NOC 5403 IF ANY 9.86 CARPENTRY - DETACHED ONE OR TWO FAMILY DWELLINGS 5645 IF ANY 8.06 m- m= O� D O� O� O� O� m- II DATE OF ISSUE: 09-21 -15 WC ST ASSIGN: MA SCHEDULE NO: 1 OF MORE 003535 FF Town of Barnstable *Permit Expires 6 nths frym issue date Regulatory Services Fee r a a s a BARNSrABLE, $ Thomas F.Geiler,Director ERMIT Building Division AUG 29 20t3 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us officWmw Fax: 508-790-6230 ]CX %%UERMIT APPLICATION - RESIDENTIAL ONLY 4e'� Not Valid without Red X-Press Imprint Map/parcel Number Property Address �0 �h �'�a,h SystZ� nrW#Nt1z1j11A /"�.i residential Value of Work$ UMinimum fee of$35.00 for work under$6000.00 Owner's Name&Address Kei r l rl 911un qoil 6, A) Contractor's Name ��l C�Ck GI cif C1 Telephone Number �T`t 7 Z Z p 5 Z Home Improvement Contractor License#(if applicable) 173 '1_I Z- Email: . Construction Supervisor's License#(if applicable) ❑WorkFlsaZm ensation Insurance e: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re st(check box) f Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 'Jt,�ii it C L7�r ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FO S\building permit formsT-XPRESS.doc Revised 060513 Email: 1 The Commonmealth of Massachusetts D"ep=ftnent of Indastrial Accidents - O,fce of fmvestigations 600 W-ashington Street Boston,M,4 02.UI "," nnass gorldia Workers' Compensation Insurance Affidavit: Bu lders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name( t tiondndh idual): cafe 1 eCy h �(c. 'oyl Address: 1 � vi-�o f A City/StatriZip: i l`, 3r/ Phone#_ 1 2 o -� Are you an employer?Check the apprapriate b T of project r 4. I am a contractor and i Type ( ��� 1_❑ I am a employer with 1�� 6. ❑New mnstruction employees(full and/or part-#ime)* have hired the sub-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me in any capacity. employees and have wormers' 9. Building addition [No workers' comp.insurance comp-insurance-'I required] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_❑Pg repairs or additions myself [No workers'comp. right of es�emptian per MGL 12. Roof mod) epans insurance f c_ 152, §1(4),and we hitve rra employees_[No workers' 13.❑Other comp.insurance required-] *Amy appliaat that checks box#1 mmst also fill out the section blow shawmg they votkeis'compensation policy imfurmatim *Homeowners crho submit das affidavit indicstmg they are doing aII uorTt amd then hire outside contractors mmst submit anew affidavit ind"icsting sash. tCoatcactors thst ched k this bout must attached m additinoal sheet showing the name of ffte sods-comtrxtors and state whether or not those emitks bsve emsplayees. If the sib-amtndars hsve employees,they mntst provide their tvarkess'comp.policy number. -Taman einplayw that isprm�ieUHg n orkers'compensation insurimce for itty employees Below is Ste policy and job site information. Insurance Compaq Name: Policy 9 or Self-ins-Lic.9: Expiration Date: Job Site Address: City/Statel : Attach a copy of the workers'compensation policy declaration page(showing the polic),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 ciizl 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 maybe forwarded to the Office of Iurestigations of the DIA for insurance,coverage yerification- I do hereby certify,emenddeer�t ns a14 on ' of ty that the infonrtativn provided above is fnw and correct Signature- l`�`sy Date: Phone#- l-z' Oftcial use only. Do not tsrite in this area,to be completed by city or town offrciaL City or Town: PermitlLicense# Lssuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityiTowa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 - vn uuww� 'do. of Oil B Information and Instructions No. of Gas Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. No. of Air C Pursuantto this sta't\ute,an employee is defined as"...every person in the service of another under any contract of hire, Pump express or implied, oral or written." itals: 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 ha t g 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 s�es 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 ' h the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonw th nor any of its political subdivisions shall enter into any contract for the performan of public work until accep le evidence of compliance with the insurance requirements of this chapter have been pre s ted to the contracting thoiity." Applicants Please fill out the workers'compensation affida it completely by checking the boxes that apply to your situation and; if necessary,supply sub-contractors)name(s), addr s(es)and hone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or L' ed lability Partnerships(LLP)with no employees other than the members or partners,are not required to carry work e pensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this a vit may be submitted to the Department of Industrial Accidents for confrmation of insurance coverage. Al e sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for e p it or license is being requested,not the Department of Industrial Accidents. Should you have any questions egardin the law or if you are required to obtain a workers' compensation policy,please call the Department at e number below. Self-insured companies should enter their self-insurance license number on the appropriate e. City or Town Officials Please be sure that the affidavit is complete and rioted legibly. The \hasntac tilt has provided a space at the bottom of the affidavit for you to fill out in the event Office of Investigatiocontact you regarding the applicant Please be sure to fill in the permitllicense nun er which will be used e number. In addition,anapplicant that must submit multiple pernnitllicense appii ations in any given yealy nit one affidavit indicating current policy information(if necessary)and under" bSiteAddress"the appuld 'te"all locations in (city or town)."A copy of the affidavit that has been fficially stamped or mar city or wnmaybe provided to the applicant as proof that a valid affidavit is on e for future permits or l new affi vit must be filled out each year.Where a home owner or citizen is ob g a license or permit not related to any business.or commercial venture (i.e. a dog license or permit to bum Ieaves e .)said person is NOT required to complete this affi vit. The Office of Investigations would like to ank you in advance for your cooperation and should you ve any questions, please do not hesitate to give us a call. The Department's address,telephone and Ax number. Th4 Commonwealth of Massachusetts Department of industrial Accidents Office of kyestigatlQns \ 600 Washington Street Boston,MEN 02111 TeI.#617-727-4900 ext406 or 1-877 MMASSAFE Revised 4-24-07 Fax#617-727-7749 - Www.mass�,gov/ilia a ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYY'f) 01/24/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE LY•AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME:CT Joanne Bretton Southeastern Insurance Agency, Inc. °�Ne.NoErt 508-775-5154 N 508-790-0557 641 Main Street E4AAIL Hyannis, MA 02601 PROCUCER INSURERS)AFFOROINo COVERAGE NAIL 1e43URED INSURER A Arbel 1 a Mutual Ins Co 117000 All Cape Exterior Remodeling LLC INSURER AEIC Insurance MtSURER C 67 SEA STREET APT A4 INSURER D Hyannis, MA 02601 NSURER a INSURER F COVERAGES CERTIFICATE NUMBER: 2013 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NM ADOl_ I POLICY LTR TYPE OF INSURANCE I IN � SR VNO )CY NUMBER EFF POL1C1'EXP LRAM GENERAL�rTY 850004193 01/14l2013101fl4l2014 EAC.OCCURRENCE S 1,000,00( X COMMERCIAL GENERAL UAINUTY I S 100,O ��PREMISEs IEa�i __._ — CWMS-MADE l I OCCUR MEC EXP, rry.A one xson) $_ -_ S OO A PERSONAL 6 ADV INJURY $ 1,000,00( _ GENERAL AGGREGATE S 2,000,00C j GEWL AGGREGATE LJMIT APPLIES PER I i I '. PRODUCTS-COMPAOP AGC $ 2,000,00 POUCr JECI LOC I AUTONOeU LIABI COMBINED SINGLE LIMP $ !Es acoOCnl) ANY AUTO i I I BODILY INJURr rPer De wr. S H ALL OWNED AUTOS I BODILY NJ'JR`'Pa eCOOV'l S SCHEDULED AUTOS i PROPER"DAMAGE $ HIRED AUTOS I Per aCoow+q II NON-O-WNED AUTOS I I 5 I j S UMBRELLA UAB �y OCCUR I EACH OCCURRENCE S EXCESS^^. LIAB���IMSMAOE� i AGGREGATE S F^DEDUCTIBLE I I I I S RETENTION S I I S ArrDErIRSCOM NUAsTY WCC500789601201 01/1412013'01/1 41201 4 X RS IAiU- 7, _ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N i E EAC.ACCDEN- - s--- 1,000,00( B OFFICE"EMMR EXCLUDE[r NIA (Mandmory i1 NH) j E._DISEASE EA EMPLOYEE $NH) DISEASE EA 1,000,0,00 o"scRl OF�OPFRATIoNs below OMVER INCLUDED E L DISEASE-POLICY JMIY S 1 000 00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEWLEa (Attach ACORD 101.Addlu,.l Remarks Schedule,If mom$cats Is wrik'w) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE digplay purposes only lJoanne Bretton ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page _of AGENCY NAMED INSURED Southeastern Insurance Agency, Inc. All Cape Exterior Remodeling LLC POLICY NUMBER 67 SEA STREET APT A4 Hyannis, MA 02601 CARRIER NAK CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2$ FORMTITLE: ACORD Certificate of Liability Insurance Garage Liability [NSA AD01 POLICY EFFECTIVE POLCY EXPIRATION LTR INSRD POLICY NUMBER DATE(MM100/YY) DATE(MWDD/YY) LRMTa AUTO ONLY-EA ACCIDENT S ANY A,-Z; OTHER THAN EA ACC S AUTO ONLY ADG S Automobile Liability INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLCY NUMBER DATE(MMIDDIYY) DATE(MMIDO/YY) Excess/Umbrella Liability INSR AC 01 POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMMO/YY) DATE(MWDDNYY) LMfTS 5 s Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MWDOfYY) DATE(MMMONY) LMITS • ACORD 101 (2008I01) v 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COREY & COREY CONSTRUCTION 1672 FALMOUTH RD #117, CENTERVILLE, MA 02632 PHONE 1-508 -775-8240 CE_ RTAINT_ EED LANDMA _ K LIFETIME - ALGAE RESI ANT ARCHITECTURAL S: LE RE - ROOFING PRO _= OSAL August 10,2013 KARIN RAFFA Tel: 508-8 4942 Cell 4046 MAIN STREET EM: kgc 680@aol.com CUMMAQUID,MA Tel: 5 -865-2045 Home r COREY & COREY he eby proposes to perform a following services in a neat and professional manner and in accordance wi the manufacturer's sp ifications and local building codes. Remove and Haul Away All o he Old Asphalt oofing Shingles. Supply and Install CERTAIN ED LAN AR: LIFETIME WARRANTY, 10 YEAR SURE START PRO ECTI ,CLASS A FIRE RATED,COPPER/CERAMIC STONES for a UL 15YEAR WARRANTY AGAINST ALGAE CONTAMINE 40 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,C EGORY III HURRICANE STORM/HURICANE NAILED 6 NAILS PER LE MULTI-LAYERED,LAMINATED ARCHITECT RAL YLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: CHAR AL BLACK Supply and Install 8" WHIT ALUMINUM RIP EDGE on All of the Eaves. Supply and Install CERT EED WINTER UARD(Ice&Water Shield)WATERPROOF UNDE AYMENT SYSTE on Roof Eaves,Valleys& Under a Step Flashing on the kylights and Gable Walls. Supply and Install #15 B ACK SATURATED FEL ROOFING PAPER Supply and Install AL &NEOPRENE SO PIPE FLASHINGS Supply and Install R BER ROOFING EDGE TAP PRIMER/SEALERS/LAP& SEAM S ANTS to All the Seams and Ot er Edges. Clean and Remove D, bris from work area after job is comp ted. TOTAL INVESTMENT ------ ------ $ 5950.00 COREY & CONSTRUCTION POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing, Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$80.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a CATEGORY IH HURRICANE-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Comp sation d Public Liability Insurance on the above work DATE OF ACCEPTANCE: 1 ACCEPTED BY: SUBMITTED BY: r KARIN RAF A CHARLES COREY, C NSULTANT HOMEOWNER COREY & C STRUCTION r _ License or registratioq valid for individul use on ly /� rt r nr rrrr.rrora/ before the expiration date. If found return to: '� Office or Consumer Affairs&Busi6essfegulation Office of Consumer Affairs and Business RegulOME IMPROVEMENT CONTRACTO*. 10 Park Plaza-Suite 5170 egistratlon: ,;;192 E Type: Boston,MA 02116 t xpiratipn: 9/T1f2014 DBA r� i r REY AND COREY CONSTRUCTION i TRICK CLIFFORD _ 3 LDWIN RD ofvalidith, signatureNNIS. MA 02638 Uadersecreary. r Massachusetts - Ckpartment of Public Safety Board of Building Regulations and Standards 1 Cnn%frwt>,iR Sulx n iu r Spccialh + License C"1-10595� j PAMCK CL FFORD - 12 BAI DWIN RURD lip - - r i J. n ��► Expiration Con"issroner 06/02/2016 Town of Barnstable *Permit#- C) X6 issue Regulatory Services EFee rres6mont/�c �,� • s�txsrws�. . P� ibA ,$ Thomas F.Geiler,Director / prFp MA't&' Building Division *Fax-: I Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601www.town.bamstable.ma.usOffice: 508-862-4038 -790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY D Not Valid without Red X-Press Imprint Map/parcel Number rty Address �C� ��� �� C� l ��• � ����►M✓►1�C/ �i u N �7�/� 11 .��: .7 Residential Value of Work$ o "`� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4? 11 o- " Contractor's Name �NSSC I�`ro V\h S0►'\ Telephone Number k/ Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) L !� 1. P. ,...... _ __ w + ❑Workman's Compensation Insurance ckone: AUG 2 2 2��3 I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN-OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [R❑ e-side eplacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit fo \EVRESS.doc Revised 060513 ijCckvicA r 0 � � 00a The Commom of Massachuselys Deparhnent of Industrial Accidents 0%Wce o,f Imaestigatians 600 Washington Street Boston,MA U2111 wn," inuss.gmldia Workers' Campensatiun Insurance Affidavit:Builders/Contraefiors/ElectriciansMambers Applicant Infarmation Please Print Leeibly Name Musiws�Qafiao&&v dnaq: �, � S S To \V"1 u,-, Address: '�&"v\ :S(",��t al 0 Are you an employer?Check the appropriate bG= Type of project(required): fl_❑ I am a employer with 4. ❑ I am a general contractor and I 6- ❑New construction employees(full and/or part-time)-* have hired the sub-comtractois I am a sole proprietor or listed an the attached sheet 7- ❑Remodeling 2_ These ors have ship and have no employees es a d have g. ❑Demolition worming for mein any capacity_ employees and have workers' 9 ❑Building addition [No workers' Camp_insurance comp_m�nrarrtr I 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions required-] ner doing all work officers have ❑e exercised their 11. Plumbing repairs or additions 3_❑ I a myself[No workers'comp- right.of1( ),exemption dper have n 12_❑Roof repairs insurance regnirEd_]f c_ 152, §1(4},and we have no- employees-[No workers' 13_❑Other comp_insurance required_] *Any spphcanr that dhedcs box fl rmist also fM out the section b elow shooing then wo�cers�doatpensatioa polidp infarmatiaa f Hnmeawners who submit this af6dav9 iniFrstiug they axe doing all wm t and then bile oatside caotzactnrs iffis I submit a new affidsort me icetio such ZCbntmctocs that check this boat mast attached an additinnal sheet shuwing the name of die svtrcaatrscton Intl sate whether ornot those entities love easpluyees. If the sib-cant-ct—hsre empl(7gees,they tmtst pmvide their—ken'romp-policy number. I am an employer that is pm iWHg"wrkers'conrperuvttian irmarartce for my ongrloyeas. Belau is Ste palicy an,d,job site in_formadam Insurance Company Name: Policy#er self-ins_Lit#: Expiration Date: Job Site Address: , City/Statt0p: Attach a copy of the workers'compensation policy declaration page(showing the policy number and elation date). Failure to secure ca-verage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500,00 and/or one-year imprisonment,as well as civil penalties in the foam 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 maybe forwarded to the Office of Investigations of tfie DIA for insurance,coverage verification_ I do hmvby certt;fy under the pains and penalties ofpedw y that the information provided above is hue and correct Simatum: ''�_) 'k. Date- Phone#: S- OJEd,al ttse only. Do not trrite in this area,to be campiete+d by city or town officiaL City or Town: PLTmitUCCnSC# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions f Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuanttos statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in:a joint enterprise,and including the legal represen ves of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal enti ,employing employees. However the owner of a dwelling house having not more than three apartments and who r ides therein,or the occupant of the - dwelling house of another who e oys persons to do maintenance,co lion or repair work on such dwelling house or on the grounds or building app thereto shall not because of suc employment be deemed to be an employer." MGL chapter 152, §25C(t7 also states that very state or local lice g agency shall withhold the issuance or renewal of a license or permit to operate a b mess or to constru buildings in the commonwealth for any applicant who has not produced acceptable evi nce of complia e with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Ne er the co nwealth nor any of its political subdivisions shall enter into any contract for the performance of public ' k until a eptable evidence of compliance with the insurance requirements of this chapter have been presented to the c trac' g authority." Applicants Please fill out the workers'compensation affidavit complete ,by ecking the boxes that apply to your situation and; if necessary,supply sub-contractor(s)name(s),address(es)an phone n ber(s)along with their certificate(s)of in cnrarnce. Limited Liability Companies(LLC) or Limite iability P ersh. s(LLP)with no employees other than the members or partners,are not required to carry workers' mpeasation' cc. If as LLC or LLP does have employees,a policy is required. Be advised that this davit maybe submi to the Department of Industrial Accidents for confirmation of insurance coverage. A] o be sure to sign and da the affidavit. The affidavit should be returned to the city or town that the application for e permit or license is being ested,not the Department of Industrial Accidents. Should you have any questi0 regarding the law or if you are r ed to obtain a workers' compensation policy,please call the Department at e number listed below. Self-insure mpanies should enter their self-insurance license number on the appropriate ' e. City or Town Officials Please be sure that the affidavit is complete printed legibly. The Department has provided a spa t the bottom of the affidavit for you to fill out in the event e Office of Investigations has to contact you regarding th plicant Please be sure to fill in the permit/license n ber which will be used as a reference number. In addition,au plicant that must submit multiple permit/Iicense ap lications in any given year,need only submit one affidavit indic current policy information(if necessary)and and "Job Site Address"the applicant should write"all locations in ty or town)."A copy of the affidavit that has b n officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit i on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is btaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn lea s etc.)said person is NOT required to complete this affidavit The Office of Investigations would a to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calla r The Department's address,telephone end fax number: The Commoavvealth of Massachusetts Depatiment of Inclustdal Accidents L- office of kvestigations 600 Washington Street Boston,MA 02111 TeL#617-727-4900 w 406 or 1-877 MA-SSAFE Revised 4-24-07 Fax# 617-727-7749 - www.mass_gov/dia � E Town of Barnstable \ Regulatory Services .. ` ALASS.I'E Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ✓%i/ lG��`�— , as Owner of the subject property hereby authorize d s3 �6�;rl_S�i to act on my behalf, in all matters relative to work authorized by this building permit Lt (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature o Applicant Print Name J 10. of Oil B Punt Name No. of Gas E No. of Air C Pump Date �tals: Q:FORMS:OWNERPERMISSIONPOOLS 62012 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner �. 200 Main Street, Hyannis,MA 0260 www.town.bari3stablema.us Office: 508-862-4 38 Fax: 508-790-6230 HOMEOWNER LICENSE EXE TION Please Print DATE: JOB LOCATION: number street village "HOMBOVJA'ER": name home phone# work phone# CURRENT MAILING ADDRESS: city/to state zip code The current exemption for"homeowners" extended to include wrier-occu ied dwellingsof six units or less and to allow homeowners to engage an individual for hire ho does not possesi a license,provided that the owner acts as supervisor. DEF MON F HOMEOWNER Person(s)who owns a parcel of land on which h she resides or' tends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures a essory to su h use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a omepwn Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall bkre6o ible for all such work Derformed.under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for c pliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she unders ds th Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply th said p cedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,0 cubic feet or larger will be req ' ed to comply with the State Building Code Section 127.0 Construction Control. H OWNER'S EXEMPTION The Code states that: "Any homeowner pe orming work for which a building pe it is required shall be exempt from the provisions of this section(Section 109.1.1- icensing of construction Supervisors); ovided that if the homeowner engages a person(s)for hire to do such work,that s ch Homeowner shall act as supervisor." Many homeowners who use this exempti are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licens g Construction Supervisors,Section 2.15) This lack�f awareness often results in serious problems,particularly when th homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it woul with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for i' e in your community. 0. C:\Users\de.coUUc\AppData\Local\Ivlicrosoft\windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\TX'RESS.doc Revised 053012 W AS rT 0.K � t fi l � a o�--o � 14-CICOS&�"Wt c � Ord .© t - - Item: 0001 Laadon: n — Qua nli tp:_ , RO Size=51 1/4"W x 81 DOC� Fir 48"x80" Double Door 1842.59 5/8" H Unit Size=50 9/16"W x i (� �-f— x Lf i/l (.✓ 81" H Product Category Exterior Doors ` Product Type Exterior East Product ( ! n r Product Material:Wood �IyT/' �J �t L li✓"1�/ S Material Type:Fir l✓" ' Configuration(Units viewed from Exterior).Double Door Factory Finish Option No Frame Material ReetiSaver Astragal Type Wood Astragal Astragal Material Fir Slab Width 48" Slab Height 80" Product Style Sash Glass Type Clear Panel Type Raised Panel Thickness 1-7/16"Innerbond Insulation Insulated Glass Performance Option Performance Senes(TM) Model F7508 Handing Left Hand Outswnng Casing/Brickmould Pattern None Rough Opening Width 51 1/4" Rough Opening Height 81 5/8" Total Unit Width(Includes Exterior Casing) 50 9/16" Total Unit Height(Includes Exterior Casing) 81" Hinge Type Ball Bearing Hinge Brand Reeb Hinge Finish US3 Bright Brass Jamb Depth 4 9/16" Sill Composite Outswnng Sill Finish Mill Multi-Point Lock None Bore:Single Lock Bore 2-318"Backset Strike Jamb Prep.No Weatherstrip Type.Compression Weatherstnp Color Bronze Custom Height Option No Flush Bolt Finish Bright Brass-US3 Finish Exterior Door Color Type.Unfinished Finish Interior Door Color Type:Unfinished Finish Frame Exterior Color Type Unfinished Finish Frame Interior Color Type Unfinished Item Total:$ 1842.59 Comments: Item Quantity Total:$ 1842.59 SUBMITTED BY: SUBTOTAL: $ 1842.59 ACCEPTED BY: TAXES( 6.250 %): $ 115.16 DATE: GRAND TOTAL: $ 1957.75 PRICE/PAYMENT TERMS: 00 -Net 30 days.1-1/YY.15 days;subject to credit approval and standard terms and conditions. -FOB factory. Price based on Furnishing Materials only. Quote ID 550 Or 3 0I011111PDI9 Version 28 1 11 131 r Shepley Wood Products 216 Thornton Drive (art\ 2g Hyannis,MA \ 508 862-6200 Cwtonw. Projoct: Russ Johnson Salesperson: Rick Ainslie Terms: PO: IS rep: Delivery/Pickup: Delivery Delivery Method: Req'd Ship Date: 4/19/2013 Quote Date: 04/19/2013 Prior Call Req'd: Print Date: 0411 9/2 01 3 -- Shl ppinQ Information Contact: Contact: Address. Address Phow Phone: Fwc: Fax: EmO: Email: Shipping Method: Quote ID 550 1 Of 3 :J411 900`.: Varsron 2 B 1 11 13 1 ✓fie Consumer Affairs& a� aaaaclatio.n License or registration valid for individul use only ., Office of Consumer Affairs&Business Regulation e y I HOME IMPROVEMENT CONTRACTOR 'before the expiration date. If found return to: VRJOHNSON Registration: 148637 Type: Office of Consumer Affairs and Business Regulation Expiration: A0112/2013 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 BU LD NG-AND REMODELING BUSS JOHNSOM 136 CEDAR ST WEST BARNSTABLE,'MA t}2668 Underseccoary Not alid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-088967 RUSSELL D JOEff 136 CEDAR ST ; West Barnstable MA 0� // n1 tij yfy Expiration Commissioner 07/20/2014 �tKE r Town of Barnstable *Permit# Expires 6.months from issue date Regulatory Services Fee anxrtsrAat.E, � MAWz . `m� Thomas F. Geiler, Director V ATFD Mtp`l� Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA,02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/ rcel Numbe -2 �� Pr perty Addre 4 �1a (\ 1 S� VG4.� ��ill� Residential Value of Work - inimum fee of$25.00 for work under$6000.00 Owner's Name&Address KtL V) Contractor's Name (/� �1 r�bJ �/� C G Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)❑Workman's Compensation Insurance X.►pRESS PERMI Chec ne: I am a sole proprietor DEC, ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance 170VVN OF BARNSTABLE Insurance Company Name 44,1,J cI l-�J' Workman's Comp. Policy# [kciu --To)- l ra 1 �D o Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ hk box) -roofec(stripping old shingles) All construction debris will be taken t ❑ Re-roof(not stripping. Going over existing layers of roo t ��� vJi�loa s'u Re- ide I d l t 1 +l Replacemen Window doors/sliders. U- (maximum .44) 1, ( 1; rn *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,ConseriOul,etc. ***Note: Property Owner must sign Property Owner Letter of Permissfgn..- l,Fy A copy of the Home Improvement Contractors License is required.` ' s` . SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 100608 � s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia If Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L ibl Name(Business/Organization/Individual): Address:--P, v City/State/Zip: C,40A I C APhone.#: Are you an employer?Check the appropriate box: Type of projoet(required): 1.❑ I a employer with . 4. I am a general contractor and 1 6. 0 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 g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.[] Electrical repain ar additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 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 infomration. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.M Autr,�h 0 20 t5'T Expiraii �V+t V 3 0 0 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 realties of perjury that the information provided above is true and c recL Signature: Date: 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 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 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 einployer,-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 corriinonwaith 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 subgivisrem shall enter into any contract for,the performance of public work until acceptable evidence of eompliance vsZth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'-empensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),_address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should 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" I.he 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 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 j Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia • .o_ �---_.._.----�_ ems' ? �las.�:tchusctts - Depat tntcnt of Public Sat`ct� Boartl'(d Building'. Rcgulatii Constru ms :tncl St,tncJards t ction Supervisor Specialty License License: CS SL 99382 _ Restricted to: RF,WS HECTOR SANCHEZ 286 STRAWBERRY HILL ROAD CENTERVILLE, MA 02632 t."tttttti"iun`t Expiration:.9/14/201, Tr#: 99382 Home Improvement En�anuel m P O Box 311 02632 Centervi1136 -1671 Tel. (509) ent license# 145356 Home Improvem Owner Hector Sanchez chezl @msn.com Hejob# 160 12-11-2009 Work place: Karen Rafa 4096 Main ST Barnstable Nl 508-847-2093 ice includes: skylights (leaking right n°�') price velox skyll shingles may break.) Put new e lights and p architectural. (Some 1.Take out old sky g ewter gray rubbish) d the owner 2.Match existing roof p Clean all for nails. ( �,11 warranties an 2 Magnetic clean up warranty °n installation. n1.9.1. c 142A; ear craftsmanship cmr 11•R 10-y rovisions of 780 rights under the p material: $3,g00.00• Total for labor and I day of work weather permitting. If agree sign below. Client/-�r9�G ��_.?_ _ date----- -------------------- Constructer ---------- ------------ date---l�! ` � � LJoensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Home Improvement Contractor License# 145356 Restriction Company Emmanuel Construction Name Hector Sanchez Address P.0. Box 311 City,State,Zip Centerville,MA,02632 Expiration Date 1/12/2009 Status Current No complaints found for this Licensee. Bac.k.TQSearch http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=HIC 145356 12/11/2008 z3v Q Town of Barnstable er" Historic Preservation Division MAM 6 9. 230 South Street, Hyannis, Massachusetts 02601 (508) 790-6270 Fax(508) 790-6454 October 4, 2001 Mr. Richard G. Tasker 25 Pine Grove Kings Way . Yarmouth Port, MA 02675 Dear Mr. Tasker; Enclosed please find a copy of the inventory on the former Cummaquid Post Office.The mail boxes in the current Post Office are not the mail boxes used in the original post office. The original boxes are currently located at Trayser Museum. I am not sure of the dates of closure of the original post office or why it was closed. Perhaps the Postmaster can give you information regarding who has jurisdiction over the current post office. Hope this info helps. Sincerely, Patricia Anderson, Director 3✓ I i � aa; S Photo Courtesy of Warren G. Ryder D. Davis Store and Post Office c1905 FORM B - BUILDING In Area no. Form no. MASSACHUSETTS HISTORICAL COMMISSION h 32 Office of the Secretary, State House, Boston Town Barnstable (Civpmaqu id ) _ 44046 Address Main St (Rte 6A) , Barnstable ' David Davis Store ✓ Name Original Cummaquid Post Office Present use Williams Company - Designers and Builders Present owner Roger P. Williams 1 1R w�a�� w Description: a" Date c.1870 - _ Source Deyo, S. Style Victorian jCanP Cod Vernacul; 4. Map. Draw sketch of building location Architect in relation to nearest cross streets and other buildings. 'Indicate north. Exterior wall fabric shingle Outbuildings (describe) � Other features post and beam frame, 4- �p mortise and tenon construction r � L � ¢� Altered restored Date 1977 �1pp Moved Date 93 5. Lot size: cOne acre or less XX Over one acre W v Approximate frontage 67 ft. Approximate distance of building from street 6 ft. 6. Recorded by Marilyn E. Strauss Organization Barnstable Historical Commission Date 1980 (over) Researcher Patricia J. Anderson Photo # 10-12,�;-t,32 i I FORM B - BUILDING In Area no. Form no. MASSACHUSETTS HISTORICAL COMMISSION A 32 Office of the Secretary, State House, Boston 1. Town Barnstable (Cummaquid ) �4046 Address Main St (Rte 6A) , Barnstable David Davis Store Name Original Cummaquid Post Office Present use Williams Company - Designers 2. Photo (3x3" or 3x511) ' Staple to left side of form and Builders Photo number ' Present owner Roger P. Williams ' 3. Description: Date c.1870 Source Deyo, S. - - - - - - Style Victorian /Cane Cod Vernacular 4. Map. Draw sketch of building location Architect in relation to nearest cross streets and other buildings. 'Indicate north. Exterior wall fabric shingle Outbuildings (describe) Other features post and beam frame, C p mortise and tenon construction C 42 a �p Altered restored Date 1977 � a (ip Moved Date 5. Lot size: rOne acre or less XX Over one acre ,v v Approximate frontage 67 ft. Approximate distance of building from street 6 ft. 6. Recorded by Marilyn E. Strauss Organization Barnstable Historical Commission Date 1980 (over) Researcher Patricia J. Anderson Photo # 10-12A-r,32 30M-5-77 7. Original owner (if known) David M. Davis Original use general store Subsequent uses (if any) and dates U. S. Post Office, Cummaquid 1897-19�8, prnfPGcinnal office 1964 to present 8. Themes (check as many as applicable) Aboriginal Conservation Recreation Agricultural Education Religion Architectural XX Exploration/ Science/ The Arts settlement invention Commerce Industry Social/ Communication Military humanitarian Community development XX Political Transportation 9. Historical significance (include explanation of themes checked above) This small building,located in front of the former David Davis home in the 1870's and 1880's was used as a general store. Later, in 1897, used as the Cummaquid Post Office, incorporated into the store. Mr. Davis' daughter, Edith, was postmistress for many years. In 19_48, the Post office moved across the street and the heirs of David Davis sold (1953) the store. In the field, directly behind this building, lies the grave of Iyanough, Sachem of Cummaquid, who befriended the Pilgrims, and from whom Hyannis and Wianno derive their names. 10. Bibliography and/or references (such as local histories, deeds, assessor's records, early maps, etc.) Registry of Deeds - Barnstable Barnstable County Atlas, 1858, 1880, 1907. Deyo., Simeon (ed.) , History of Barnstable County, 1890.