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0311 BEARSE'S WAY
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Town of Barnstable Building EPostThis Card,.So That rt isV�sible3From:the Street=A; rovedPlans.Must be Retained onJ_ob andth�s Card Must-be:Ke" t pP p � AEl18, a��,'�,°'.a�&�� �3� r t ,„�" � -_'�,� ash��';-`�`i�e;�i.�'� � �.. � -�:� 'x•'n '' '�h�'§� \ `� 7.' �.� �� ��g '�F". & .2 � �.� , Posted Until Final Inspection HasxBeen Made \ Permit ,. ^R WhereaCert�ficate,,.of.O.ccu anc, is..Re u�redsuch;B.uldm shallNot'be OcCu�ied until a,F�nal;ans ecilon ;been made Permit No. B-18-2412 Applicant Name: Rebecca Collins Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/01/2019 Foundation: Location: 311 BEARSE'S WAY,HYANNIS Map/Lot 292 122 Zoning District: RB Sheathing: Owner on Record: BARNSTABLE HOUSING AUTHORITY ContactorName REBECCA L COLLINS Framing: 1 Address: 146 SOUTH STREET ' y `' C6ntractorX11cense_ ,, 072020 2 HYANNIS MA 02601 Est Project Cost: $24,518.00 Chimney: Description: SIDING,TRIM &SIDING REPLACEMENT �� . Permit Fee: $160.00 Insulation: Project Review Req: '\ Fee Paid, $160.00 � F Dt�e Final: 8/1/2018 - _;^ Plumbing/Gas y Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author zed by this permit is commenced within six months after;ssuance. ,; Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documentsfor which this permit has been granted. All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoni g by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access sireetor roadland shall be maintained open forrpubhc inspect on for the entire duration of the work until the completion of the same. Electrical ". The Certificate of Occupancy will not be issued until all applicable sign tures by�the Building andFire OfEleials are provided on thispermit• Service: Minimum of Five Call Inspections Required for All Construction Work: ~ 1.Foundation or Footing U11 _ Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: . "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable R�EcEr�T .KAM 200 Main Street, Hyannis MA 02601 508-862-4038 1630. Application for Building Permit Application No: TB-18-2412 Date Recieved: 7/25/2018 Job Location: 311 BEARSE'S WAY,HYANNIS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: REBECCA L COLLINS State Lic. No: CS-072020 Address: FALL RIVER, MA 02722 Applicant Phone: (508)678-5201 (Home)Owner's Name: BARNSTABLE HOUSING AUTHORITY Phone: (508)771-7222 (Home)Owner's Address: 146 SOUTH STREET, HYANNIS,MA 02601 Work Description: SIDING,TRIM& SIDING REPLACEMENT xJ _ O Cn Total Value Of Work To Be Performed: $24,518.00 0 M Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Rebecca Collins 7/25/2018 (508)678-5201 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees T otalost : 24 518.0 Date Paid # Amount Paid Check#or CC# Pay Type $ , 0 ! ee: $160.00 7/25/2018 ! $160.00 J XXXX XXXX XXXX-! credit card 1239 ............... ...... ....ee Paid: $160.00 li Q �,v' i �tHE„� TOWN OF BARNSTABLE Bufl-cang 201102846 iBARNSTABLE, Issue Date: 06/21/11 Permt 9 MASS. �pr16 3319. A Applicant: TONELLO,JEFFREY R Permit Number: B 20111247 Proposed Use: HOUSING AUTHORITY Expiration Date: 12/19/11 Location 311 BEARSE'S WAY Zoning District RB Permit Type: RESIDENTIAL INSULATION Map Parcel 292122 Permit Fee$ 35.00 Contractor TONELLO,JEFFREY R Village HYANNIS App Fee$ 50.00 License Num 53202 f_ Est Construction Cost$ 3,000 (� Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND WEATHERIZATION.AID SEALING,ATTIC INSULATION THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: BARNSTABLE HOUSING AUTHORITY BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 146 SOUTH ST INSPECTION HAS BE MADE. HYANNIS,MA 02601 Application Entered by: TP Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY.OR PERMANENTLY ENCROACHMENTS.ON PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS'DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION - RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. } WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIR MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). 0 ' 0 0WPM nR BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ir Map Z Z Parcel \Z L Application Health Division Date Issued a� Conservation Division Application Fee go - Planning Dept. Permit Fee -%,Z. Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address -k\� Village H.. .. .S Owner Address Telephone x -L .Permit Request w�.A��.��. � zaZo►.9 , A .Z S�p. `�� C. ,. ��� �� � 1J�v �.w��o� ay62. -3$ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 0 Project Valuation 63oo o. Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family B"' Two Family ❑ Multi-Family(# units) Age of Existing Structure \R-ic Historic House: ❑Yes ❑ No On Old King s,.H,ighway: 0 Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other sj! + Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)� -� 3 Number of Baths: Full: existing Z new Half: existing new- " p Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing co new First Floor Room Count Heat Type and Fuel: ❑ Gas W"b it ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 4 o Address ?b 'u License# S Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY 4 .t kPPLICATION# - t " r DATE ISSUED MAP_/_PARCEL N0. I _ .. r ADDRESS VILLAGE OWNER _ 1 f r DATE OF INSPECTION: _ 'FOUNDATIONa "'•" FRAME x INSULATION. FIREPLACE ELECTRICAL: ROUGH FINAL .j PLUMBING: ROUGH FINAL i r GAS - ROUGH u - <t, FINAL i_:3t�FINAL BUILDING.< i r _DATE CLOSED OUT ASSOCIATION PLAN NO. f ` The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations .r q a m 600 Washington Street a dt a Boston, MA 02111 �•"`�� www.mass.gov/dia '. Worker's compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): .Zbsegal%C-- Address: ti City/State%Zip: S� '6'� a.z�s `�Fa`' . Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. [J I am a employer with 3 4.❑ I am a general contractor and r have 6. ❑ New construction employees(full and/or part-time).* hired the sub-contractors listed on 7. ❑ Remodeling the attached sheet.$ 2. ❑ I am a sole proprietor or partnership These sub-contractors have $ Demolition and have no employees working for employees and have workers'comp. 9. Building addition me in any capacity.[No workers' insurance.$ 10. Electrical repairs or additions comp insurance required.] _5. We are a corporation and its 11. ❑ Plumbing repairs or additions officers have exercised their right of 3. ❑ I am a homeowner doing all work exemption per MGL c. 152§(4),and 12. ❑ Roof repairs myself.[No workers' comp. we have no employees. [No workers' 13. [2'Other insurance required.] t comp.insurance required.] w.4:1W16 :.a .� *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 attach 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: c- d Policy#or Self-ins.Lic.#: w CL-3 S -3-4 OS 2-1 b'AS Expiration Date: Job Site Address: '3`\ a to ZS 4-6S w w-i City/State/Zip: yk:*,%*•"'NA N"°A' 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 `hereby certify under the ains�at3dpen hies of pe ' ry that the information provided above is true and correct. Signature: a Date: { C/ Phone#: r 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#: ACORD-. CERTIFICATE OF LIABILITY INSURANCE o9ioli�o1 THIS CERTIFICATE IS ISSUED AS A MATTER .OF INFORMA'i'0' PRODUCER (781) 344-8578 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATI C.L. Hollis Insurance Agency Inc AOLDE . THISLLTERTHE COVERAGEICATE AFFORDEED BY THE POLICIES BELOW.DOES NOT AMEND, EXTEND 01 27 Glen Street MA 02072- INSURERS AFFORDING COVERAGE NAIC# Stoughton INSURER A:LIBERTY MUTUAL INSURED — RESOLUTION ENERGY INC. INSURER B:ALLI"MRICA INSURANCE 43 Fieldwood Drive INSURER C: INSURER D: PO Box 1490 — Sa MA 02562- INS more BeachURER E: COVERAGES THEREQU REMIE TOTERMUC R CONLISTEDDITION OF AONY CONTRACTOR OTHER DOCUM NHAVE BEEN ISSUED TO THERT WITH RES ECOT TO WHICH THIISICERTIFICOATE MAYBE IISSOU D OR MAY PIERTA SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF S THE IN UCH POLICII AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/Yl') DATE(MM/DDNY) LTR INSRD EACH OCCURRENCE $ — GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence COMMERCIAL GENERAL LIABILITY / / / MED EXP(Any one person) $ CLAIMS MADE DOCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ FGEN'L AGGREGATE LIMIT APPLIES PER: / / POLICY JE O LOC 02/27/2010 02/27/2011 COMBINED SINGLE LIMIT $ 1,000" $ AUTOMOBILE LIABILITY AWN5092655 (Ea accident;, ANY AUTO / / BODILY INJURY $ ALL OWNED AUTOS (Per person) — X SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Per acciden') NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) — AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY OTHER THAN EA ACC $ — ANYAUTO AUTO ONLY: AGG _— EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- 09�02�2010 09/02/2011 TORYI_IM III TS ER A WORKERS COMPENSATION AND WC2-31S-370523-039 500,' EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE 500,' OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE$ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500, SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS NATIONAL GRID CORPORATE SERVICES LLC DBA NATIONAL GRID, ACTION INC. , COLONIAL GAS CONpANY AND N-STAR ELECTRIC ARE LISTED AS ADDITIONAL. INSUREDS. CERTIFICATE HOLDER CANCELLATION ( ) (508) 790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE l ATTN: MIKE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO M. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,E HOUSING ASSISTANCE CORP FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON 1 460 WEST MAIN STREET INSURER,ITS AGENTS OR REPRESENTATIVES. _ ® AUTHORIZED REPRESENTATIVE P" - �,� F� ralmIm HYANNIS MA 02601-3698 ©ACORD CORPORATION ' ACORD 25(2001/08) Page INS025(0108).05 ELECTRONIC LASER FORMS.INC.-(500)327-0545 ,. NI-Issachusctts- Department of Public SafctN �� ✓�ze a�nonan o- czc tu4elff.6 y Buard of Building R.e!�tilations and Starttlar(Is Office of Consumer Affairs&Business Regulation I Construction Supervisor License ( .HOME IMPROVEMENT CONTRACTOR License: CS 53202 , = r` Registration:,, 162158 Type: Restricted to: 00 Expiration 1125/2013 Individual tiq 1 JEFFREY R.TONELt.O;_ Y JEFFREY R TONELLO { PO BOX 151.6 I SAGAMORE BEACH, MA 02562 :;.. I JEFFREY TONEL-L 60 STATE RD. = g e SAGAMORE BEACH`MA-02562 Undersecretary Expiration: 7/14/2011 Tr#: 19157 C:,nnmi: iuncr /� . Restricted to: 00 I - Untwiricted r 1 2 Family Homes / I tilure to possess a current edition of the [assachusetts State Building Code cause for revocation of this license. efer to: WWW.Mass.Gov/DPS s 460 West Main Street HOUSING Hyannis, MA 02601-3698 ENERGY & HOME REPAIR ASSISTANCE r (508) 771-5400 F (508) 790-2425 CORPORATION TTY on all lines www.haconcapecod.crg a&6zvedid LANDLO Rz�w t � TENANTS }•�.L a�_ ti it 1 PHONE PHONE S &—7-7 I- q 0-i Dear Landlord, Your tenant is eligible for services through the Weatherization Program. Program regulations permit us to spend an average of$5,000.00 in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established private contractors_ We will conduct a final inspection to make sure that all work is completed to specifications. Prior to making the inspection and doing the work we must have your permission. If you want your tenant to participate in the program, please sign the agreement and return the form to me. This agreement states that: 1. You will not raise the rent because of the Weatherization work or for one year from the time the work is completed. 2. You.will not evict your tenant for one year following work completion date except for good cause related to the tenants failure to pay rent or serious or repeated violation of the terms of tenancy_ 3. If you sell the property during the specified period, either the new owner must assume.the obligations under the agreement prior to sale, or you must refund to us the entire amount of materials and labor we spent in weatherizing the unit. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a CURRENT TAX BILL OR DEED listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible_ Failure to fill out the entire form will result in a delay in processing the application. If you have any questions please call Michael Sartori at 508-771-5400, ext. 105. . Sincerely, At Ruth Bechtold Assistant Director n Energy and Home Repair Department 02 ..i."I^ 1?.)-- �itl•,L�Lr`� rmmlilrt_Ij j.�:j; L3t��tr?•fl Ii ��� C 7 d c; t i t` u C . _La,id.lc,r__T�t a;i._c�.r.�r• c,_ �t � TENANTIPROPERTY OWNERIAGENCY WEATHERIZATION AGREEMENT 1. T(tg Parties to this Agreement are thefioiiowing: 11al ,; (hereafter known as Tenant), (print your tenants�n/a�m�e) �a &o s?A�i�f' 11�t«ram AWke�nc(4 (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation(hereafter known as Agbncy). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) 4')a" unit# ,and currently leased or rented to the Ter) nt: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises.to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agencys inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts,Department of Housing&Community Development(DHCD)may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and — inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: C� INI"* ONLY ONE OF THE FOLLOWING TIAL `"* I consent to performance by the Agency and its contractors of any eo,, Weatheriza work determined necessary and appropriate by the Agency as a Xresult of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any and all work,including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2010. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the performance of repairs by the Property Owner. 'fs. E, i .. 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuelfutilities used at the above address in each of the past three years and the future three gears. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8. In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through .. 20AP/ f-approximately one year from the time the work is completed., a) The present rent$ per month will not be raised for any reason. (The rent amount must be filled in). However,this Paragraph(8a)will be waived by the Agency in writing if, and only if,the premises are leased under a state or federal rent subsidy .programx in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program Please state which Housing Subsid pr ram your tenant is on and through which Agency: c1s,� 1��`U I b) The Property Owner will not institute any summary process action for possession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor Tenant). c) In the event the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below: -The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency)in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement-, or —The Property Owner shall pay the Agency an amount equal to the cost,as certified by the Agency, of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said amount shall be paid to the Agency immediately upon sale. 9. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above,the rent shall not be raised more than %.per. for an additional period of one,year,and the provisions of 8b and 8c above shall continue in effect for such period. However, the rent provisions of this Paragraph 9 may be waived by the Agency in writing if, and only if,the premises are leased under a state or federal rent subsidy.program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor Tenant and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement,the provisions of this Agreement shall govern. However, if such other lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program, contains stronger protections for the Tenant such stronger.protections shall apply. i 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the . Weatherization materials installed and labor performed on the.premises, as well as attorney's fee and court costs. The Property'Owner may also be liable for damages to the Tenant in accordance with applicable law, in such instance,the Property Owner shall reimburse the Tenant for attorney's fees and court costs. Without limiting the foregoing,the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal.government, as well as the eligibility of the Tenant under WAP.program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: Date__ �__ Phone: �`l�? 1 12 a- x \ e " ,� � ,, Address: • G AUTHQg'>q� SOUTH STREET 02601---..-... Tenant Signature /1 Date Agency Signature_ f_ Date �l z �, f aa � oQ 39 Town of Barnstable *Permit# OFtME,. S. Expires 6 months from issue date Regulatory Services Fee $ Thomas F.Geiler,Director y v Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Q -1 Not Vai#d without Red X-Press Imprint Map/parcel Number a -l a I dU ,` /� Property Address c� f���r� t�y t Gi�►r1�S MA Residential Value of Work L4 J aS Minimum fee of 1�for work under$6000.00 Owner's Name&Address f() "1 0o ri 146 � an YY1 �(v0 Contractor's Name S O r- r IC I flume_ _XnN p M erJ Telephone Number 5M7 7 7.5-'t l 17 8 .HomeImprovement Contractor License#(if applicable) 1O3 75 7 > PRES �� IT Construction Supervisor's License##(if applicable) 0,5 Co Co y A U C 4 7 n 1 n 0&kman's Compensation Insurance TOWN OF BARNSTABLE Check one: ❑ I am a sole proprietor ❑ I am the Homeowner EKhave Worker's Compensation --Insurance Insurance Company Namei0 Gt c� -� Z✓1Cl l�Si-� C (Yl Pt Workman's Comp.Policy# 1 LK_ 7 W 4 9 4 ,O oZ.OOP Copy of Insurance Compliance Certificate must accompany each permit. f. Permit Request+(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows '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 o me Improvement Contractors License&Construction Supervisors License is re SIGNATURE: Q:\WPFILES\FORMS\buildingpennitforins\EXPRESS. oc Revised 090809 • - 1 The Commonwealth of Massachusetts Department of Industrial Accidents . Off lee of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiort/Individual):S(1 r� K-12 tt Yl� T_M n rbVf-- Address• L99 t�rr►S We- PO City/State/Zip: OL i5 MA od(001 Phone#: 5 0�'f• 7 7,5 - !-7 7 3 Are you an employer?Check the appropriate box: Type of project(required): 1.1� l am a employer with Ct - 4.. ❑ 1-am a general contractor and I employees(full and/or part-time). T• have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance.= required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.[I Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.�'ffl Other comp.insurance required.] 'A»y applicant that checks box#1 must also II out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and Job site information. Insurance Company Name: Qssoc_.%-a it c ':r ku4 f ke S MA Policy#or Self-ins. Lic.#:AAA_ZOb%4 9 gl ,3d1 kb l6 Expiration Date:_ Cal / Cal . Job Site Address: �l Ur Yy City/State/Zip: Attach a copy.--of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to se a coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,300.00 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 insuraiwe coverage verification. 1 do hereby ce r s and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone#: 7 Official use only. Do not write In this area,to be completed by city or town offlclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: rti Town of Barnstable Regulatory Services Thomas F.Geller,Director �Eo Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder subject j subproperty I, Sgwl-m4 per."Pev ,as Owner of the hereby authorize ( ' dg- r to act on my behalf, in all matters relative to work authorized by this building permit application for. \3/1 &446s- G�%y ,1Y.4-A AS .(Address of Job) , _2 � e 5igna of r I?ate BARNSTABLE HOUSING AUTHORITY 146 SOUTH STREET WAHNIS,MA OW Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n-RC)R MR-n WNF.R PF.R Mi.CC7nN •�C�RD►® CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE(MMID01YYYY) SPRIN-1 01/05 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden S Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax:508-790-1414 �INSURERSAFFORDING COVERAGE NAIC# INSURED - ('INSURER A: Associated Industries.of MA - INSURER B-- __- ---�--- Sprinkle Home Improvement Inc. INsuRER C 199 Barnstable Rd INSURER D Hyannis MA 02601 --- INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YYYY DATE MM/DD/YYVY LIMITS GENERAL LIABILITY. - - I EACH-0CCURRENCE $ r j COMMERCIAL GENERAL LIABILITY ) I. PREMIUAMAI SES(Ea occurence $ CLAIMS MADE a OCCUR- MEO EXP(Any one person) $ PERSONAL&ADV INJURY l' FGENERALGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER:POLICY PRO• LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO � (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIRED AUTOS I • _ I BODILY INJURY I.$ NON-OWNED AUTOS 'I(Per accident) I � PROPERTY DAMAGE i (Per accident) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO ! i OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY L, EACH OCCURRENCE $ OCCUR CLAIMS MADE I I AGGREGATE $ DEDUCTIBLE } ( I — $ RETENTION $ •. - 1$ ---- WORKERS COMPENSATION TORY LIMITS ER _ AND EMPLOYERS'LIABILITY -- A ANY PROPRIETORIPARTNERIEXECUTIVED AWC7004943012010 I 01/01/10 I 01/01/11 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I E.L.DISEASE•EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below ] E.L.DISEASE•POLICY LIMIT $500000 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS' CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SPRNKHO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1-0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax #508-775-1350 REPRESENTATIVES. Margo Mack AUTHORIZED REPRESENTATIVE 199 Barnstable Rd. Kelley A.Sullivan annis MA 02601 ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office t`Co, m°' ' arcs' ifsiuess egu a one License or registration valid.for individul use only HOME 1MPROi/EIVFIrNT CONTRACTOR before the expiration date. If found return to: Registration: U3757 Type: Office of Consumer Affairs and Business Regulation Exptratiortt 12 Private Corporate! i0 Park Plaza Suite.5170 WEE Bostofi,l MA 02116 HOIVI ��iNC. Brad. SpriAle 199 Ilarhstabte 12d =YMEN j . Hyannis,"Wl7�U26F 9 _ UnderiecFetasy Not valid without sin 'ture \, g Massaehusetts- Department of Public:$ufet� Restricted to: 00 Board Of Building Re;ulatioris.and Standards 00- Unrestricted Construction Supervisor License 1G-1 2 Family Homes License: CS 6643, Restricted to: 00 BRAD.K SPRINKLE iI m Failure to possess a current edition of the ' 190 LOTHROPS LAN `' Massachusetts State Building Code . W BARNSTIMLE, MA 02668 r is cause for revocation of this license. i axw ! Refer to: WWW.Mass.Gov/DPS Expiration: 10/8/2011 ('unimissiunrr Tr#: 5478 .t ' ry , Engiwering Dept.(3rd floor) Map Parcel �it# 19 ., House# '�� Date Issued Ii�/�'� Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee 5 .C-Zt Conservation Office(4th floor)(8:30-9:30/1:00=2:00) Pla ept. (1st floor/School Admin. Bldg.) THe►p D fi i. v .,P n Approved by Planning Board 19 TOWN OF BARNSTABLE 'E°" Building Permit Application roI ct eet Address 3 j/ � � wa, Village Owner - Address /,'/g /�� . Telephone -7/ 7 Permit Request ® First Floor square feet Second Floor square feet ,Construction Type RaQ r �e�G Estimated Project Cost $ 4 12,94 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes p No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name �� T� [;�9�? fix,���,�r�r �A� fA4 , Telephone Number 7 76--3 Address�, Q, , ��( �yh License# Home Improvement Contractor# /6 9?/ Worker's Compensation# 9O'74q11 9D 9& NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE WDATE /a� /f BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) " FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO.- F ADDRESS VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION r r v i FRAME INSULATION - v 1 FIREPLACE ELECTRICAL: ROUGH FINAL + r F PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED.OUT T ASSOCIATION PLAN NO. . t i of Barnstable • The Town _ : 'r ' ntal Services KM g Department of Sealth Safety and Environme e � Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no._ Date AFFIDAVIT HOME NT TO PERNIIT APPLICATION SUPPLE requires that the " 0°s�ction, alterations, renovation, repair, modernization, MGL c. 142A re-existing conversion, imQrovement, removal, demolition, or construction of an addition to any welling units or to owner occupied building containing at least one but not more than four ended contractors, with own Q structures which are adjacent cTequirements.r building be done by registered certain exceptions,along with other Est.Cost I " Type of Work• Address of Work• Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner puillug own Permit Notice is hereby given that: PERwr OR DEALING WrM UNREGISTERED OWNERS PULLING THEIR OWN FUND UNDER WORK DO NOT HAVE FOR APPLICABLE HOME IIVIPROVEMENT ER MGL a 142A ACCESS TO THE ARBITRATION ITRATION PROGRAM OR GUARANTY SIG D UNDER PENALTIES OF PERJURY permit as the gent of the owner: . I hereby apply for a p h a Registration No. Contractor Name Date OR. Owner's Name n�tP The Conunonwealth of.Massachusetts I - On: #� . _.-�;_r Department of Industrial Accidents - �_•; ;_�, --���' O>�ceol/ovesligat/ons \ �''1':._--r; 6011 Washing-ton Street �- Boston.Mass. (1 111 - Workers' Compensation Insurance Affidavit A51ie nformation• Please PRINT"lei N _ a ;rnam ' location // A,14 a4 D ncitv 4k v>r -- ' .# _ X 1 am a hom owner performing all work myself. IZ I am a sole proprietor and have no one working in any capacity am an employer providing workers compensation for my employees working on this job. Somnanv name r`7y1-A,1 ,4 / /La: Trr a%Il 4 Ewe. may• phone#: 7-7-4Zp776-�• go insurance co I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city•• phone#- insurance co policy# �__ ..4.� .. .. - ,,,e,,,:. •:,�•eT:-s.-,-�•::—r�,�-�'•f-+�T":—=�"-,erg•-....T�- ;Ts':rr.+w-eac•..,,.::'ii-+.,.•.Zeta.:r•-�a.�•_�!;.�,-:-•.=.--.r cnmPanv name• address- city. phone#• insurance co nolicy# .Attach additiiinal sheaf if necessar w, `:-;; r.r`�,. a'T-c•{•.�1 7,2 r. `e.•.•;r ?�;w+�+�� ==4X: Failure to secure coverage as required under Scetion 25A of 11fGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur oneyears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. ' I do hereby certif under the pains and penalties ojpedun•that the information provided above is true and correct. ,� i �n to s Si=nature: Date Print name 1,e- /i-r-A 6P-S` __Phone it '77,1- 776 A a official use univ do not write in this area to be completed by city or town official r city or town: permit/license# riBuilding Department C3Ucensing Board (7 check if immediate response is required 0Sclectmen's Office C311eallh Department contact person: phone#• r9Other In„ud;;`)s PtAi Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers coni-pansation for the employees. As quoted from the "law", an etnpinree is defined as every person in the service of another under anv contract of hire, express or implied, oral or written. An e►npinrcr is defined as an individual. partnership, association. corporation or other legal entity. or an two or nor the foregoing, engaged in a,joint enterprise, and including the le-al representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However ili owner of a dwelling, house having not more than three apartments and who resides therein, or the occupant of the dwcllin'g house of another who employs persons to do maintenance , construction or repair work on such dwelling he or on the `_rounds or building appurtenant thereto shall,not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that every state or local licensing agency sliall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. t ..s. Taw..__ .y.... _v .•.r...',(d.'a'..::{ n.j .•q.,'.,�.. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 vdtt have any questions regarding the "law"or if you are require,- to obtain a workers' compensation policy, please call the Department at the number listed below. City or Toivns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o-. the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie.- be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any question_ please do not hesitate to give us a call. r-ara.,_w�.._...........-�.�.._......... ..-..-..aw.•...w+.r--..�+-r t�..•.r....,....-e- �.ewrs+ea". The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 n�nnr #• (617) 777-4900 nyt- 406. 409 or 175 he lk _ # .. 4� �fy R '3 u .. ,�'� t S s ofPBOy�FI� NT CC RR G I.a Boats u'i > a_ng Regulat `OF25 antll TRATION � i Y �$a x ,Ore Ashby Place ons cf Standards urton Room =1301� } Boston, Massachusetts; 02108.. HOMEiIMPROVEMENT CONTRACTOR Registration 108918 i f e Ex.plr`at3- 08/27/9g -f- -- TYP DBA x Bra 1. .,��,.v;" § x :' � r � I -'� • ��iEe'Po�iv�nanure¢ll�o�,�aaeae�uueQ`a:G 7 I HOME IMPROVEMENT CONTRACTOR THEODORE L . HhTCHCOC,K., h' ion, `108918� i Registrat T►iEODORE 'L .211/55. 1 Type HITCHCOCK.. - aDBA P tn aPir LISA LN'X 08%27/98 ,. W BARNSTASL MA 02668 I` THEODORE L= HITCHCOCK THEODORE L 'HITCHCOCK s G� ,80X 211/55 LISA LN ADMINISTRATOR BARNSTABIE MA,02668 1 .. ... _ ._. _.... .....}a'. III. 7 .• ` Assessor's Office(1st floor) Map ✓ Parcel Permit#. 3 ll 3� Date Issued " Board Fee Engineering Dept. (3rd floor) House# . 3 // F,.J f BARNSTABLE. MASS. 19 + lfD Wlp'�a TOWN OF BARNSTABLE Building Permit Application R Project St ess 311 i3 A er S +r tuA�/ Village y A ra d s i -owner QArt,as-Tec,ble H evrtt: 7 Al Address. jq4 soj rN4 S' .,rc C N>"AAI.A r Telephone ')/ �. t Permit Request x Ro m,F plenr,. .Y q g-L rk jobl, I i-�- First Floor J,y 2S 3 6 square feet Second Floor I Li X 3 6. V G D square feet �`- Estimated Project Cost $ ,SG 0 , el C) Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use 1(LZ-J% J O A, C_ r, 1 Proposed Use Construction Type 1v o a Commercial Residential (� Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished / Historic House .N o Unfinished Old King's Highway Number of Baths j No.of Bedrooms L/ Total Room Count(not including baths) ( First Floor Heat Type and Fuel o e I rho wwfa�, Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name G n,�„-�c� b) ���,,,�,; yrj, o�.A f—/ Telephone Number '7� 1 7-Address )�,1 b S'o L�h t ��e e '�1 License# 0 1 1 o 3 't1�/iUA1lS f " Home Improvement Contractor# A11,4 Worker's Compensation# (w 10 3 d a."3 S_J NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO %a wA< �-«� >C►�I SIGNATURELZ DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERM NQ. DATE I SU D j MAP/ R EL NO. ADDR SS VILLAGE + s { s # c OWN 4 + M DATE. F SPECTION: FOU ATION s + ' t FRAME, INSULATION FIREPLACE. ' ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: (t ROUGH FINAL FINAL BUILDING s DATE CLOSED OUT s ASSOCIATION PLAN NO. The Connnonivealth of Afassachusctts •+:il -__-=j;_ Department of Industrial Accidents' .. N ashini;ton Street Boston.Alas. 02111 Workers' Compensation Insurance Alydavit Please PR bliIYT l'e� QRI'Itcar,. :iuv�n�as:v�' . ._. .. . d name: locition• city phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one•working in any capacity i... .:...:.+.L— 1 am an employer providing workers' come sation for my empl ees working on this job. om Idr t insurince co. I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: � cill• phone#: - incur�ncc co policy# : .. -.-r.�- — 4cm:t.-•.5:.::)a•4s-��r,s"".�'1Rnfr"n9Fc'r�a'�. � _ _ _-__ 'T.n:FI!s.�t�''�rTR;:!der.�R'�i���i*.+�•�+�4r;�g�•:'L:"."'�' c6mranv name: cddress- cin•• phone#• insurance co policy# .Attach additional sheet if Dec __ Fuilurc to secure coverage as required under Section ZSA of D1GL 15?+c lead to the imposition of criminal penalties of a fine up to 51.50U.U0 and/or one years'imprisonment as well as civil penalties in the form of a STOP NvORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herebt•certify router the pains and eiralties of perjury that the information provided above is true and correct. 4-anaturc— �/Print name ,2)rVI n-..r H lib 7Ltr.l J'v ✓Phone# official use onh• do not write in this area to be completed by city or town official city or town: permit/license# r iBuilding DepaId Licensing Boar p check if immediate response is required oselectmen's Of Dliealth Depart cont�person: phone#; pother IM'Ised 3,95 PJA) The Town of Barnstable tg Department of Health Safety and Environmental Services t� 1659. BuiIding Division 367 Main Street,Hyannis MA 02601 Ralph Cmssea Office: 508 790�Z27 Building Commission( Fax: 508 775-3344 For office use only Permit no. Date AFFIDAVIT HOME E"ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,.rrmoval, demolition, or construction of an addition to any p:e-adsting owner occupied building containing at least one but not more than four dwelling units or to sftuc=cs which are adjacent or buildin be done registered contractors,with certain exceptions+ along g with other.. to such residence g by requirements Type of Work: l� yFiv. Est Cost— Address of Work: S)1 8 09&3 ILE t`'A Owner.Name: Date of Permit Application: t o I hereby certify that: Registration is not required for the following reason(s): Work excluded by law =Job under S1,000 Building not owneroccupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNIiEGIS'f1UtID FOR APPLICABLE HOME IMPROVEMENT W���OT 42A HAVE ACCESS TO THE ITR ARBATION PROGRAM OR GUARANTY FUND SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 10 h r famka , 3AA Date Contractor name Registration rice OR ' gate Owner's name .