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HomeMy WebLinkAbout0284 GOSNOLD STREET sr� , e " JOSEP�14 ._D .l:UZ _ TELEPHONE: 773-1120 Bnr/d,ng Commissioner EXT. 107 TOWN OF. BARNSTABLE ' BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 , 'tip... TO: Board Qf Selectmen FROM: Josep a -ell, Zoning Enforcement Officer REi A=306-110 DATE: August 7, 1987 The Sea Witch does have a license for its lodging house located at 363 Sea Street, Hyannis. . They also own the building across the street which contains two apartments. The apartments were rented to about six girls who brought their friends in and created a mess, damaging the apartments. I • o ' THE fps )••• #4 • a i BAH119PA SS. i �Athss. 7q. rF0 MAY M' 36 7 Kin steel, Jd Annie, M". 02601 TO: Joseph DaLuz, Building Commissioner FROM: Board of Selectmen SUBJECT: 363 Sea Street, Hyannis DATE: July 28, 1987 There appears to be multiple dwellings at the above mentioned location. They do not have a license. Would you please look into this matter and forward your results to the Board: Thank you for your cooperation in this matter. 0%! S Za'o-e GA u S 1 Clo o Gtuyt r d� �o�Di ITN E Taw • • • BAB119TAHL6, MA00. �/J mo Ohl. 36 7 M.1'. Stmel, .Jd y...ij, //.m. 02601 TO: Joseph DaLuz , Building , ommissioner FROM: Lawrence A. Hochschwender Deputy Licensing Agent SUBJECT: 363 Sea Street, Hyannis DATE: July 22 , 1987 This department followed up a request for inspection at 363 Sea Street, Hyannis , (map 306 parcel 44) regarding possible licensing violations . During this inspection no infractions of the licensing regulations were found. However, your department may wish to inspect various out buildings used as dwellings which may not have been recorded/inspected by any town agency. ['j ,RE7Y 1-605-331-0353 J(f + j Fax 1-605-335-0357 www.cnasurety.com PO Box 5077 Sioux Falls SD 57117-5077 Email: uwservices lwasurety.com " July 25, 2016 Agent Code: 20 16148 Town of Barnstable Building Inspector Town Hall 367 Main Street, 4th Floor Hyannis,MA 02601 Re: Bond#62460519 - Armando Pacheco 284 Gosnold Street Hyannis, MA 02601 $720.00 - Street Opening Township of Barnstable Company Code: 601 - Western Surety Company We have received a request to cancel or nonrenew this bond. We wish to comply with the principal's request by taking advantage of the cancellation provision pertaining to this bond. You are hereby notified that this bond is cancelled and voided as of September 1, 2016, or the earliest time permitted by applicable law, whichever is later. Thank you for your attention to this matter. cc: Frank L. Horgan Insurance Agency, Inc. Armando Pacheco Underwriting Services b� �y Town of Barnstable *Permit#�� I `- Expires 6 months from issue date Regulatory Services Fee 00 �- ® ESS PERMIT Thomas F.Geiler,Director Building Division MAR 1 3 2007 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 Property Address R�! �� r9 N S� �/Gt/L/�o S /�ifGt� O 2 ❑Residential Value of Work /�®-M,4-cZ0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address tl S G �i�,2lrS' N� t� Le D Contractor's Name_ �Y� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am 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 be on file. Permit Request(check box) r rat Re-roof(stripping old shingles) All construction debris will be taken to WZ44�i� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hist6nc,Conservation,etc. ***Note: Pro erty Owner must sign Property Owner Letter of Permission. e Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth ofMassachusetts ' D9arttnent'of IndicstriaZAecr'dents e Dfffce aflrivestigati'ons• . 600 Washington Street . • ,� •• Boston,MA 02.Z,i�. - . • ' Mr .massgov/dia Workers' Compensation Insurance Affidavit:Builder9/Coritractor0,IeCt�'icians/PXt ers' A licant Woxmation Please PrintLe 1 Name(Business/Organizatiowludividual)' Address: Sly— City/State/Zip: Phone.#: 7 Axe you an employer?Check the appropriate box, 1;❑ I am a employer with 4. ❑ I am a general contractor and T F7qRemodeling oject(required):,. • employees (fall�d/ozpart time),*. .have hiredthe rub-contractors construction . 2.[] I am a'sole.proprzetor or partner= listed ctn the'attached sheet; ship,andhave no employees These sub-contractors have olitioA. i�yorlang for zne in any capacity, ernployeeo and hate workers' [No workers'comp,inswrahce comp,innsurance,t'• 9, ❑Building addition `3:�(required.] 5. ❑ We are a,porpozation and its 10,❑Electrical repairs or adcli zoos I-aarakomeowner-doing-a'll:yvork'- ----officers have exercised their 11:❑Plumbing re ` myself,[No workers'coal, right bf exemption per IvlGL Pairs or additions - insurance,required]t c. 152, §1(4),and we have no I2,❑Roof repaizs . , employees, [No workers' 13,❑ Other ' gonip,insurance required,] *Any applicant that checks box#1 must also felt out the section below sbowing their workers'compensation pokey infamsatieo, t Homeo-mers,Wbo submit this a$idayit indicating they are doing all woik and then hire outside oontractors must submit a new affidayitindicatin 'Contractors that check this box must attached an additional-sheet showing thename of the gib connectors and state whether new entities havecl employees, Xthe sub-contractors a employees,theymustprovidb thcil hensWOrk s' f the pub-contractors actors -Tam an emplayer,that is providing workers'compensation insurance for my employees, Below is the policy and ob sit irifarmation. 3 e Insurance CorTanyNazne• Polity#or Self-ins.Lit,& _ ExpirationDate; . ,Job Site Address' City/State/Zip; . Attach a copy of the workers'-cgrmpensation policy declaration page'(showing the policy number and e ' Failure,to secure coverage as required under Section 25A of IvfGL c, 152 can lead to xPu anon date), fine. tb 1500,00 and/or - the imposition of criminal S r one e e at'P y in?prisonmeni;as well as civil a '�e P nalties of a p naltl s in the form of a S of'u to$250,00 a da a TOP WORK,pRDER and a fine P Y gasnst thti violator, Be advised that a copy of this statement maybe forwarded#o the•Office of .- I ations of the bIA fox ixistr<a pe coves a verification, ' • I do hereby cerii fy under the sins an naltles of perjury that the information prgvided above is true and coprect. Si tore: -- _ • • Date; • Phone 2 _ Offcial rise only. Do not write m this area,tp be camplefed by city or town official City or Town: ' T'ermit(I,icense# . ` Issuing Authority(circle one),* 1:Board of Health 2,Building Department I City/Town Clerk 4,Electrical Inspector 5, Plumbing Inspector .6,Other Contact Person: Phone# Massachusetts General'Laws chapter.152 requires all employers to provide workers' compensationfor lihei=emp?ogees. Pursuant to this statute, an employee is defined as".,,every personinthe service of another under any contract of hate, express or implied, oral or written." An employer is defined as "an indiyidual,partnership,association,corporation or other legal entity,or any two or more of the fore o' engaged' a joint ente rise and including the legal representatives of a•deceased employer, or the sn rp � g g � �g J Io e5 ilowege1 the e receiver or trostcc•of an individual,parbieiship,association or othcz legal catty,employing � 7c , 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 onthe.grounds orbuilding appuitenantthereto shall notbecause of such craploymentbe dcemedto be an mPIo Yer." IvMGL chapter 152, §25C 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 construgt buildings in the commonwealth for any ptabl evidence of compliance with the Insurance coverage required." applicant who has not produced'aecc . Additionany,MCrL ohapteL152, §25C(7)states"Nejthet the comnionvrealth nor any of its political subdivisions shall enter into any contract for,thb performakce of publia.work until acceptable�vitiEnea of camp nee tigithtlie in a e requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checldrig the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)i ame(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited•LiabMV Companies'(LLC) or Limited Liability Partnerships(LLP)with no-employees other than the in bers•or partners, are not required to carry workers'compensation fiom=e. If an LLC or LLP does have employees, a policy is required. Bp advised that this affidavit may be submitted to the'Departtent of Industrial ' Accidents for confirmation ofinsurance coverage. Also be sure to stgn anal date the affidavit. The affidavit should be returned to the city or town that the app4cation 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,' comp ensation,policy,please call the Department at the n=ber Mod.below. Self-insured companies should enter their. self-insurance license number on'the appropriate'lind — City or Tows Officials Plea.s.e be sure that the affidavit is complete'and printed legibly, The Department has provided a spacq 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;14nse applications in any given year,need only submit ono affidavit indicating current policy information:(if necessary)and under"lob Sife Address"the applicant should write"all'loc4ons m_L_(eity or town)."A cbpy of the affidavit that.has been off eMy stamped or markddby the city or town maybe provided to tho 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 relate dto any business or commercial venture (i.e, a dog license or permit to bum.loaves•eto.)saidpersbn_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 ilonothesitateto givens a call The Depaztment's address,telephone and fax number:. Dent of Mutual Aeci' ita Qf co of lu:Yesid A41a H4,, Q=,MA 02111 TO.0 617-727-4 ext 406 or I -MAS B Fox*617- 7-7749 , Revised 11-22.06. -'s df Town of Barnstable Regulatory Services BAMSTABM Thomas F.Geiler,Director MAW �Q3p!1639• 0. Building Division ED AAA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: — O 7 JOB LOCATION: 'IQ dy /ZlS ,'�XO 6 .2 6" a number treet village epc��.e C0 irVi a t1r� O "HOMEOWNER': 91A,� 5—D — name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance-with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme Sign re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner.shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt je= �i sle�' pF Town of Barnstable *Permit# `7 3 p Expires 6 months from issue date Regulatory Services Fee .��� M"M Thomas F.Gefler,Director Building Division Tom Perry, Building Commissioner X-PR8SS PERAMT 200 Main Street, Hyannis,MA 02601 Office: 508-862-403.8 S E P 15 2004 Fax: 508-790-6230 TOWN OF BARN P� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY S1��4BLE l Not Valid without Red X-Press Imprint Map/parcel Number 3060 ! R . Property Address 2 A 1.9& 0 ❑Residential Value of Work /T P jgjjbR= Minimum fee of.$25.00 for work under$6000.00 Owner's Name&Address AL?�`7 a2_� oi - Contractor's Name Telephone Number F 7 7 O a2:61 -i Home Improvement Contractor License#(if applicable) Construction Supervisor's.License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor Iff I-am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of insurance Compliance Certificate'must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) JE�'Re-side ❑ Replacement Windows. U-Value (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must s' Property Owner Letter of Permission. Home Improv ent tractors License is required. Signature 14"7,1Z4 Q:Forms:expmtrg Revist063004 r ❑ Assessor's offioe (1st floor): Q t /� K. I�, Assessor's map and lot number `_ y�fTHETO`I ten' 1 Board of Health (3rd floor): �� • Sewage=Permit' number .��......................................... .... ��� Z BAB.39T4DLE, i Engineering Department (3rd floor): ,.» rsea �J..,_ i639 House number �0 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only. §* TOWN OF BARNSTABLE ': BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ........ 19/—/-/OZoeYES....-....��';! 5,,,,,,,,,,,,,,,,, . ....... ... ...... . ..... TYPE OF CONSTRUCTION l S l-r� �- v o......... 2!'IJ�u1 .....7.. ' ........:......................... ....................................................... *TO THE INSPECTOR OF BUILDINGS: The undersigned hereby plies for 5j Ifermit according to the following information: Location (�' b�.................................. s✓............................ ././'?........s..................................................................... ProposedUse ....f"..CS/...0... ................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner............ '77.A.:....,DA r�/f/I:.. IvNEk.....Address .......:............................................................................ Nameof Builder ........ .... ...............rS...t-so►. �..............Address .............................................. .................................... * T Name of Architect .........�./ ...........................................Address ..................1 Number of Rooms '.; '..� � ........................Foundation .A4w _:................................................... t Exterior .. .C- <f!" ...Roofing d Floors . .... "t ..--h.............................. .... .... ........../..1c ,o /0 Heatingh Plumbing'• /Z 4SA- - "!..Y...,1? .................................... .. ........ . ................................................ r Fireplace ..:... 15 Z ......Approximate Cost �D...I U 4 Definitive Plan Approved by Planning Board _________________________ 9 Area /V� � ................... as Diagram of Lot and Building with Dimensions Fee ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding-the above construction. Namee� .��7......................... .... ......... 7 _ Construction Supervisor's License 0� ® s DANNER, ETTA A=306-110 . 34327 Permit for ..Interior Alterations No ............... .................. Single Family Dwelling .... .. cc... ...... `7v �....V�, Location ..?M... :t.......................... .....................Hyann .s....................................... Owner ......Etta..Danner............................... _ J Type of Construction ......F.1~AR.e..........:............ .............................. ............................................ Plot ............................ Lot ................................ Permit Granted .....MaY A......................19 91 Date of Inspection ....................................19 Date Completed ......................................19 PER1V11T COMPL ETE[) .ti. Assessor's office(1st Floor): Assessor's map and lot n Conservation �v ' WP�o To`. ward*-H&altlH3rd flo ): a0 • Sewage Permit number 174,�.3 t DASI7TULL i Engineering Department(3rd floor): ��/ rayq. \�d° House number ! 11, �o Val Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2W. P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District Fire District � I Name of Owner / /v! 06N/v E� Address 2- // Name of Builder � Q�1% // CN v Address Name of Architect /v�N Address Number of Rooms �- Foundation Exterior�J�/ti ll ��� �,�&014/kSRoofing Floors / �� Interior Heating Plumbing ; Fireplace Approximate Cost Area `O!� Diagram of Lot and Building with Dimensions Fee � D / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab regarding the bov n truction. Name I Construction Supervis is License DANNER, BE-RNICE No -3-5-9 3�Permit For REMODEL-- KITCHEN Single Family Dwelling - Location ` 284 Gosnold Street j Hyannis e. r a.• . e Owner 3 -Bernice-Danner o Type of Construction Frame I { 1 7 1 r Plot i t Lot N w Permit Granted June -8, 19` 93 Date of Inspection ` 19 z Date Completed 19 + { , t, YJ Assessor's Office(1st floor) Map Lot / p�Pe�mit# J� Conservation Office(4th floor) q �U x. Date Issued Board of Health 3rd floor 8:30-9:30/1:00-2:00) tLle&ee Engineering Dept.(3rd floor) House#1 Planning Dept.(1s1floor/School Admin. Bldg.) ? _ • BARNBTABLE. Definif a Plan A oved by Planning Board 19 e� TOWN OF BARNSTABLE Building Permit Application 11 Proje Stre dress 0���fJaC� Village 1 rA t Owner Address a 4E2EZ(� Telephone (2/0 /o f ?t S 7 I S Permit Request t tZ 2- Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ teoo ` Zoning District Flood Plain Water Protection Lot Size d,dG } Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use eb5(eo C e✓• Proposed Use Construction Type 6pt) xA r Commercial Residential Dwelling Type: Single Family Two Family lJ Multi-Family Age of Existing Structure CC Basement Type: Finished Historic House N Unfinished l/ Old King's Highway Number of Baths 2 oU 4L'?--No.of Bedrooms 5 Total Room Count(not including(baths) t First Floor Heat Type and Fuel Central Air C7 Fireplaces. J Garage: Detached Other Detached Structures: Pool Attached Barn None ✓ Sheds Other Builder Information C, Name tZ2- -5 I r-A c Telephone Number 77S 0¢57 Address 3 R�5- 1rA �' License# � 1 Sf3 v� l �/b►—j1�1 RX- Home Improvement Contractor# Worker's Compensation# ( G NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED — MAP/PARCEL NO. — -- ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 3 t INSULATION FIREPLACE ELECTRICAL: . f ROUGH FINAL - PLUMBING: ROUGH FINAL + GAS: r ': ROUGH FINAL e y FINAL BUILDING + — DATE CLOSED OUT ' ASSOCIATION PLAN NO. y ` I�y� 4.�y.'•M 4 �Q:'�y�►J •/i'17k�p:�,;!'t�4•^'1. 1..{=.�1r The Town of Barnstable Department of Health Safety and Envirodmental Services Building Division 367 NtAin Stred.Hyaank MA 02601 •r, y))`m (Moe: 509-790.6227 Rslph Cmssea Date _ AFFIDAVIT HOME 1MPPROVEI4MNTCONIRAMORLAW , SUPPLEMENT TO PERNIITAPPUCATION MGL c 142A requires that the"rmottstruc ion,afteradons,ratoyWan,i!tp*mMemb2dew tonverm°a► irnprovemertt, remmmi, demolition. or construction of an addition to a w p owner oor=pied building containing at I+:ast one but not mart than tour c4a+dUng units fit tO which 2m sdjaccm 4 to such residence or building be done by re&c cd contractors,with eettala exiotpdons,along with other 16— _D ©a Tape of Wort , �. t rst Cast C _ Address of Work: Owner Name_ Date Of Permit Application- 419, I herelm cxrtifv that: Registration is not required for the follaaing remn(s): Wcric Gtdudcd try•law lob tmda S1.000 r, Building not ow=-ac=pied Omer Pullin€own permit No;:cc is herebygi,xn tt•W:: Ott' TRS PULLING THEM OWN PERMIT OR DEALING ivrm tMEGISi= CONTRACTORS 17 FOR RPPLICAELE POINTE VROV0,1EN WORK DO NOT HAVE ACCESS TO TEE :71ON r---OC= ' C?=: Gi?r.RA?M'Ri 7) L' ER?•4Gi.c. 147A s SIGNED UNDER PENALTIES OF PERJURY 1 hcreby apple for a permit as the a*gtnt of the owner: �f-D 1GZO C uactor name Registration No. F" OR i I :�.-\ ✓1tQ -IJO�IYU/72d/Z/.!/(,ClAA./2 O�✓U(.Q.65�ZCLlP.�6 Restrcted T0: 00 DEPARTRAT of PUBLIC SAFETY IouS n'ICTIGn SUPE'VISOR C VS? 00 - Hone } e ` 'res: °irthcate: IA - Masonry only '`..� �o�?.' Y..d�I 91I997 °9/28,1953 1G - 1 & 2 Fa&iiy Hoes ti.1 ,. possess r 7 i -f Failure to possess a current eH'tic� tCe {�ESaC?Ucetts Mate Biuii'_d4n9 Code CRhIG H AS'CRTA is'canse for revocation of ,his license. 385 SEP, STREET I i HYANNIS, Itz 02601 i i. I w Sr1 Y� ` ;4 �✓/L¢L/dIM//)//✓nU/B!/��t O�✓�LOdd6C�UJ¢�1 HONE INPROVBUT:CONTRACTOR , 4 1 = Registrafion,' 102014 ' Type PRIVATE.,CORPORATION MExpiration 06/30/96 Ernest B� NOrriS & Son Inc "'I- Craig N. Ashworth f r s G� Sea St j r ADMINISTRATOR ydnnl3 MA 02601 e: �, z Y A i iI `�•=`C F ,)rJ'/L�; T O r '1`?J�' 7?NTDUSTRJI�ACCTDENT'S G00 ��'/.SHI?�'GTON SZT�L1`�]' _ ;10STON, MASSACI-USL= 02111 James Ga�aaet stone, -wOTt]Q:RS-COMPENSATION INSURANCE- AFFID/NVIT 1. (licensee/permiacc) ' wick a princip2l p12cc ofbusinus/raidcnccsc 385 Sea Street, Hyannis, MA 02601 �,, (Ciry/StacclZip) do hereby eerti fi. undcr the pains end pcn2ltics of perjury,,zh2t: ' Ism an employer providing the following workers'compensation coverage for mycmployccs working on this job wrn1 nnnRn7A l'6sur2ncc Company Policy Numbcr �) l am x sole proprietor and h2ve no onc working for me- j) I 2m 2 sole proprietor,gcncrd contraor or homeowner (cirdc onc) snd have hired nc�concraaors listed below -who h2ve the following worker:compcnmtion inn=mcc policies: ✓' �' IJ0��1S L, e� � i,3ar A ' K-irire of Contractor Iasu=cc Company/Policv Number 1\zmcofContractor Ins=nccComp2nyfPolicyNumber r I�2mc of Contractor Inn=ncc Company1Policy Number Q 1 2m s homcownu performing211 the work myscIE , rF {: 1\OTF-- r1cr5c be z :tc 6-.%%-tic bcr_cowacrt v bo employ p<rcooit*10 rut Iatcntocc,coo rtnsa'•oo or rcpsirwo(14 on 1 '. . 1•-c11;nr.of not more tbn.a tbrc<uciu is tv<boraco--'acr 0&0 ruldu or oa the t n rvunds ippucesnt tS<rcto:rr aot Ecocr=lly I cenr,dcrc2 to be croploycrr un&r tic vok<ri Carapcantioo Act(CL C.152.tc<t.1(5)).1pplicstioo by t boacowocr for a 1i<cns< or perr+rt r-..:y cv;&Ccc the 1cE.J It:"cI:_cr_aoycr coder tbc Goticcrr't;,orapcont*,on/act i eaetrst:nt eo�er�e tnre copy of tiers st:tcrmrr+-;U6;ic:�•uecd to t�,c Dcp-'^ent o!]ndustriJ f.codcnu'Orieco!lnrce:nu for. t<rifiation:nd th-t f ilt re to s<ew<envecy<::rcSuir<d undcr Section_'151,of JV GL 152 e:n)cad to the irrpoutan of-iti�in�penJe;a w'* contirtins or a fine of up to Sl 500.00::Zfcf i nrrisonrncnt of vp w onc yex and civil pen-lciu in the form or:Stop T✓ork Order,nd= I k' rw of s100.00 d:y af.:inrt me- February dx of February . 19 94 ;:. Signed this Y �i Lice :ce/Pcrmiacc LiccnsorlPcrrniaor . 3 tom-•— � '- - . / j ---------------- ,07, / r • r+ -" tyA,.. ..-:�+ ,. �, :�,•. k .. l .r ����..: ^awl � .�,.f,,,S2-"�. 'e ,�,a•. >ar .�.�. � �.a4..� ,.H'.> ,.may S. {Rt x�s;.�. � i. - 4+. .€. d e...._.c S'- y i 5r..y'c• d,. 2 i� L....,.,p,.:. r'»`rj„ v'�t :`T'x s r' -err • if I VA fig N®R,p II Lf �s, 3c�3 Z D --D---.e_I j is--�i—gn�(eI�-d-__For: o;•_-IIrj . --I-- ---J--'-_--�,_-i�I-j-i�-1�-I-I-.—'-..._O_--.-lJ•-lI���/.-_'J.I-._.�-.�_--_'3_-.--,-_Ot�`./-/-;,'/b�`II9-S (/�i--i/- G..--_�-���.1..i w-_-/-.�C...✓--l..i_._-.../.ib-_j.'-�:.'_�.-_�-�-%---.le---/_.i/-_.yO��f-�.._..rs_-vt-��-._j.-.c.F-f'_--;--._-.r.--..rf.._s i._[✓i�.O�.--��v-�`-'-._*-P---_L-IhA--o�i_ n�j�,Iy-./-e --,�-i-�ii i�3r II-i--------��iI�I--�vI-i i\---`---.<;.7tt,t--_�-.oit`i'f-��-Ii-.2-_-+-v_.-f-.��--•-"i.�ybS.F�Iii-!-''i--- �—I.�--�_-j" ,i_�`gn�n—e,w'7d —Iy B--��y,: I,.I-.--►--.L-�-s I;Ij I.I,II—�--�i-�II i'I���1•-'-t ram-��Ii—'i—iiI� I— I— This isO � .W a. r'n ~o O. rC Ci g' fi ✓Jn fa�l Y-- �d'1 eOs.iO g Gny/7 a n must not be released or copie ha applicable fee or de R ate: Scale: has been paid or job ordeA;dress � ptaced• SCANDIA KITCHENS,INC. City State, Zip <toprov.By: RANGE OOKTOP iVEN MICROWAVE 1 yrd i MICRO T.K.# HOOD //e COMPACTOR DISHWASHER lop REFRIG. A. INK W . SINK It 17NN CEILING HT BHT SOFFIT CASINGS KICKCOV�N/ FLOORING COUNTERTOP COUNTERTOP EDGE--.. SACKS?LASH CAB.GLASS MISC. ST j SS' E I. G. : � t i I .10 SK-10 `� I '