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0042 KEEL WAY
�a k�r u�p y Town of Barnstable Building "`�''.""" :ps##This;Card So That�t is<Uis�ble From.the S,treet�=,A rouedPlans.Must beReta�ned on�J,ob;andthis Card Must be Ke t BABh'f3C`ABLB. a ,.Mn. �Y: 3-::`� *" Pp :• fie. €'y" -€ „s .. MASS sted Unt63Pf:<= r, -` �,,. s Where�a.Ce"rtificateeof Occu anc his Re aired,such�Build�n shall Not be Occu ied until a F�na1=:I•nspect�oo h been made Permit :..;a�w....+ '.' Permit No. B-18-1652 Applicant Name: VICTOR J. WIINIKAINEN Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: 42 KEEL WAY,HYANNIS Map/Lot 268 208� Zoning District: RB Sheathing: Owner on Record: PRIOR,JANET M&LORRAINE E Co"Ara 6t6eIName , VICTOR J.WIINIKAINEN Framing: 1 Address: 24 FLORENCE STREET Contractor'L c s �1®0053 ANDOVER, MA 01810 k � Est Project Cost: $2,250.00 Chimney: Description: reside Permit $35.00 Insulation: Project Review Req: FeePaid $35.00 Date 5/23/2018 Final: Plumbing/Gas C ARough Plumbing: .Building Official Final Plumbing: x This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after�issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicat on and the;approved construction documents for,Whiffilfhis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open forpublamspeetion for the entire duration of the � � d work until the completion of the same. ' rg Electrical �z �t f: € Service: The Certificate of Occupancy will not be issued until all applicable ignatures by the BUildmgand Fire®fficials are provided on,this permit. Minimum of Five Call Inspections Required for All Construction Work:_> ' 1.Foundation or FootingI� Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy 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 f M1 Town of Barnstable *Permit# Building Department EVerae 6 monthsfrom issue date BARNSTABLE, ® = Florence CBQ35 . 0 v� MASS. g Commissioner \� 'OTFp � 20 00 Main Street,Hyannis,MA 02601 MAY 2 3 www.town.barnstable.ma.us Office: 508-86249WN O� 8ARNS TABLE �\ Fax: 508-790-6230 EXPRESS PMUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address /i 2 � � � [Residential Value of Work$ 2_11 :_4-0 y Minimum fee of$35.00 for work under$6000.00 Ir- Owner's Name&Address 3-AIV 4J ,PR!,cA Contractor's Name]� �1a rY��iS/`��7�/� /� —Telephone Numberl:4"k,342-7s/d Home Improvement Contractor License#(if applicable)/0f5 9� Email: 1/;Jf_,a t�y1/� Z1tl�/tf Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ,E-Tam 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 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) P''Re-side R`GcYY�"/��,�y1� S W 4. ❑ Replacement Windows"/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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: QAWPFILESTORMST)CPRESS2017 t e Comrrtomveakh of Massadiusetls Dep=txerzt o,f1ndrtria1 Acdd-e7ds Office oflmwstigations 600 Was fitg#on Stmet Boston,M4 02M -- mmumassgoovIdia Workers' ConVensafionInsurance Affidavit BuRders/Cnntr-actursM - Lane lumbers �APPHamt Infarmafcabz ,/�� {�]/�' �}p Pt_lense F�rnzt 1`I� usine" mcaS�I7dQ3.� t`�� a t 1 i y /s`<�i A /'y l a Address` CO O 2- 7 7/0 Are you an employer?Check the appropriate bow ' Type of (required): project r . am a general contmctaz and I F aqua ed}: 1.El I am a employes" 4 ❑I g 6- [:]New employees(full andfor part-bme)_* have hired the sub-coutmctars 2.P�I am s sale proprietor ar parbn r- listed as the attached sheet ?- 0 Remodeling snip and have no.employees These sob-contractars have 8- ❑Demolitiflu who for me in any capacity. employees and have woalrers' 9. ❑Building addition [NO W.pdmrs'comp-imsmance cCMp.snag =Ml r -] 5. © We are a cozporatifln and its 10-❑Electrical repairs or additions 3111 am a homemnneer doing all wmic officers have esescised du;r 1 L❑Plumbing repairs or additions. of oa er MGL Tdf[Trio workers'camFr- a dine have n� 11 El Roof r airs ;isutance reed-]i c.15Z,§ (4 13.L�I other t �. employees-[No wodoe s' cosap-;•,sunmc required_] I I V/./.0 'AnyappBczeZ&atdmftboaff1nmstalsof�rnatthes tioabeTanshdtflug�eaaaa3cexs'oanpeasatiaapolicyinlvrmsaavL I Hameownes who submit dais dfidaei[i b9c=.q dtey axe d=g abb w43*sued&ea hue*abide rx =-m submit a new affidae¢t mdirom sorb_ fCoat<srin6 that cbecic this boat must atta3rhed av additumab slra�t sbouuig there of die s -cscto-xs and stste�rhethes*r not fhuse emitiesha�e employees.Ifthe sdb-c=tsct=slmce employees,tficy nnstp=ide thek warh-exs'mmmp.policy m=bm Ian[ara eeepiaysr fl[ati�r prouPdu;g workers'coa�rrsrrfiar[i[esz[rar[ce for rrts*empfny�eex $ei"o[v is t7ieptrficy oral jab sits informadvra. Insurance Company Nam: Pdaficy A,*'or Self-ins-Lie. DTinctionDafe: Job Site Address Cityf5tatetap: Aftach a copy of the workers'compensation.policy-decbwation page(shaving the poficy number and empiration date). Failam to secure coverage as requiredundes Section 25A of MC L c`157—can lead to the imposition of criminal penalt%es of a fine up to$1,50D OG andlor one yearimprisonmanf,as well as civil peualfies.im the fonn.of a STOP WORK ORDERand a tine of up to V50-DO a day a4ainst the violator. Be advised that a copy of this statemerd maybe forwarded to the Office of Investigations of the DIA for insarance coverage yeri tioaL I d'a hereby cafffly r[atder thapains andparwh es gf17zejjuly tfi&fl[a iraformiE6vrjptmi&d ahmv is bus and correct Date 49 Phone ik j 422 O&W we ar[F}. Do not mite in this area,€[r be evinptsted by city orto n Officiat. City or Town: PerngitfLicense# Issuing Autharity(circle one): L Board of Health I Building Department 3.4t3YFown Clerk 4.£lechrical Impertor S.Plumbing Inspector 6.Other Confact Person: phone#: — -- — - 6 laformation and Instructions MaccarlrQae�fS Ga'neral Laws chapter I52 reqrares all euployerS tO provide wmi='compensation for their eagIoyees. p this fie,an errploy�is defined as'`._.every person in$ie service of another under any contact ofhII e, express or implied.oral or w1fth=f An ez P&T,er is defined as"an incliQidual,parta=b3p,association,corporation or other legaI en ,or any t4vn or more of the foregoing engaged in a Joint eoterpnse,and including the legal FeFueseoiafives of a deceased employer,or the recei-Yea•or trustee of an mdiyidnal,parihmmhip,association or otherlegal entity,employing employees. However the owner of a dwelling house having not more than three apartmeaits and who resides therein,or the occr�ofthe - dweIling house of anofer who employs persons to do mace,cans act on or repair wo&on such dwelling house or on the grounds or buildmg appurtenantthereto shaHnotbecanse of such employmentbe daemedto be an employer." MGL charpt er 152,§25C(6)also sfatEs that"every state or local licensing agency shan withhold$e issuance or renewal of a license or perrult to operate a business or to construct buildiags is the commonwealth for any. applicant who has not produced acceptable evidence of compfance with t7ie incur Ce.coverage required." Additionally,MGL chapter 152, §25C(7)states¢Neither the camnionweala nor any ofits political subcTivisions shall ester into any contract for theperfom=ceofpnbho work-until acceptableevidenceofcompliancewith the;n m-an". regzmca3.ients of this chaptea.bave been preseufed in the canraciing antho -" Applicants Please fM out the workers'compensation affidavit complettly,by checking the boxes 1h2t apply to your sifiaation aid,if necessary,supply sub-coafractor(s)name(s), ad&mss(es)andphoncrx— er(s)alongwiatheacertlficafe(s)of Insurance. Limiic�d Liability CP=eS(L-C)or Limited Liability Paitaecships(LLP)with no eanployees other.than.the members or partners,are not rbqui and to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy isrequaed. 13e advised that this affidavit may besalmrifttdtothe Department of Industrial Accidents for confnmation of m surza=coverage Also be sure to sign and date the afIIdavit The affidavit should be-retuned to 1-e city or town that the application for the permit or license is being requested,not the Deparmmed of . Ldustriai A cci ents- STlouldyon have any questions regardmg the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below Self-insured coinpanies should enfrx their self-h cares,ce license umber on the appropriate Ime. City or Town OMdals t Please be sure that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of the,affidavit for you to till out in the event the Office of Investigations has to corfiact yc ml'73rdin9 tlLe applicant Please be sure to EU is the perm'Miccmc number which wEl be used as a refereace m=Lber. In.addition,an applicant that must Sabmlt nzukiple peoaitUceose applications in any given year,need only sabmit one affidavit indir.ataig comet policy iu�rmation(if necessary)and under` ob Site A_d ess"the applicant should write"all locxtivns in ( S'or town).'A copy of ffie-affidavit that has been.officially stamped or madced by the city or town maybe provided to the applicant as proof that a valid affidavit is on fle for fat= 'permits or licenses_ A new affidavit must be izIled otrt each year.'Where a home owner or citizen is obtaiaiug a license or permit not related tQ any business or commm vial vim= a dog license or permit to burn leaves etc-)said person is NOT required to complet u this affidavit The Of of Investigations would hke to fhank you in advance fur your cooperation and should you have any quzsliom please do not hmif to give us a call The Depsrizuent's address,telephone and fax=nber Thu cb�79?eatth Degarbnmt afl-E6mftid AMUenta Do� 11�E11� Tt,-L 4 617- -49W eat 406 or 1-97-MA&AM Fax#617 727'749 Rzvismd.4-24-07 . °FINE lqf, Town of.Barnstable Building Department BAMSTABLE. ' Brian Florence,CBO BMsa i639. a��� Building Commissioner jED MA'S 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 as Owner of the subject property hereby authorize Y L' 74 /1 71 /h C� �n P to act on my behalf, in all matters relative to work authorized by this building permit application for: Opn 'Iola (Addres o fob) **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 erformed and accepted. Signature of Owner S tore of Applicant a Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPODI S Rev: 10/17 'Town of Barnstable �oFTHe,�� Building Department o� Brian Florence CBO STIM Building Commissioner Mom• $ 200 Main Street, Hyannis,MA 02601 j°rFD MA't p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION, 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"was extended to include owner-occupied dwellings of six units or less and .. to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection.procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act ' as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ' I� C�lie�pomvrrcarcureall�z a�C%vLa�ac6ic l Co sumer ,Affairs&B usiness ReQuiati on • � b - HOME IMPROVEMENT CONTRACTOR Registration:;<�'I`00053 Type: Expi ratio r_�=6!&t2M Individual I VICTOR J.WIINIKAf(�E=i� Cal =_ Victor Wiinikainen 58 CAPE COD LN BARNSTABLE,MA 02630! Undersecretary I '� t ' Commonwealth of Massachusetts �� Division of Professional Licensure Board of Building Regulations and Standards Constrkll tt6h SdPp rvisor E;s ires: 09/2912019 CS-o00998 VICTOR.)WIINIKAINE PO BOX 69 �U2668�` s WEST Bt\RNSTABLE MA Commissioner N License or registration valid for individual use only jV before the expiration date. If found return to: Office of Consumer �r and Business Regulation 10 Park Plaza St Boston,MA 02116 r_a No valid without signature Construction Supervisor Unrestricted,-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic.meters)of enclosed space. - Failure to possess a current edition of the Massachusetts /�— State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Town of Barnstable *Permit##-�(J� �o� Expires mmon hs from u ue date �T Regulatory Services Fee IA MABLF, 9� ass059.. $ Richard V.Scali,Interim Director QED MA't A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY l_Vbg Not Valid without Red X-Press Imprint Map/parcel Number 10 a. d Property Address Y e Residential Value of,Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresses fq &PI � r3 Contractor's Name !'r OA J, Telephone Number - / Home Improvement Contractor License#(if applicable),—/�,:� Email:;ftG��s Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance .378VL5 �� � Check one: r F�am a sole proprietor �M01 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance 8dV Insurance Company Name Rai 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) ❑ Re-side gl'leplacement'Windows/doors/sliders.U-Value �E (maximum.35)#of windows #,of doors: a ❑ 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: 10 QAWPFILESTORMSUilding permit forms\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts rA Department of IndustrialAccidena Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/fndividual): V G t� cy �1 v 1C � � /l►: ����� Address: , :�_g City/State/Zip: iVS1i 64 1L. Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a y emp to er with 4• ❑ I am a general contractor and I 6. New construction employees(M and/or part-time).* have hired the sub-contractors tam 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 11.❑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' comp.insurance required.] *Any.applicant that checks box#1 must also Ell out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue 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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Cify/State/Zip: - o Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andppalties of perjury that the information provided above is true and correct c. Signature: .a� Date: C5 Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector S.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 employer,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 Iocal 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 with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"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 have been presented to the contracting authority." Applicants PIease fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)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 permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the 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 AcUdents office,of favestigations 600 Washington Stet. Boston,MA 02111 TeL#617-727-4900 ext 406 or 1-V7-MAS9AFE Revised 4-24-07 Fax#617-727-7749. wRVw.mass.govfdia �TMET � Town of Barnstable Regulatory Services muss I'E'$ Richard V.Scali,Interim Director i639 �� Building Division Tom Perry,Duilding 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 as Owner of the subject property hereby authorize /('"I'e t to act on my behalf, in all matters relative to work authorized by this building permit (Address of J b tI- **P.00l 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. S' tore of Owner Signatur 'of Applicant W/ r/V e /clulv Z/V Print Name Print Name Date Town of Barnstable - Regulatory Services J oFtrr To�� Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner - MASS. X 163 . ��� 200 Main Street, Hyannis,MA 02601 QED�11°� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 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"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 rise this exemption are unaware that they are assuming the responsibilities of a superasor (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. Massachusetts -Department of Public Safety i Board of Building Regulations and Standards j Construction Supervisor` License: CS-000998 s # 1 IS. v VICTOR J W IINItAMN;,,, PO BOX 69 �#.i i W BARNSTABLE MA�0266 J.•�+-� �rn� Expiration Commissioner 09/29/2015 j lP�1 e�oa/z�rearecuea��o�C%liG�oaT�c/ae%ld , Office of Consumer Affairs&Business Regulation �. OME IMPROVEMENT CONTRACTOR _ egistration 00053 Type: - =Expiration -6/8/201_� Individual j VICTOR J.WIINIKA &WIF j Victor Wiinikainen y ' u. 58 CAPE COD LN BARNSTABLE,MA 02630 �' Undersecretary n tJ ,. U Massachusetts -Department of Public Safety ' Board of Building Regulations and Standards { Construction Supervisor i License: CS-000998 VICTOR J WIIN1t AINEN PO BOX 69 � W BARNSTABL MA02668 I 9, 1 �l �r n, Expiration Commissioner 09/29/2015 j r License or registration valid for mdmdul use only before,the'expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 j Not valid without signature 9 4141 Town of Barnstable , Permit W o3 Expires 6 months from issue date Regulatory Services Fee • aAaxsrAKS., • NAM �' Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ' Map/parcel Number Property Address Zesidential Value of Work$ 0 rig ; Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3f4/rr G /R 1' iR Contractor's Name 11 c o � , /6�'►'� ��/Y �✓ Telephone'Number 62, Home Improvement Contractor License#(if applicable)/C>C�<%S � Email: /GT®f Bt1/1/s�� 411L/�✓il Cd�C� ? Construction Supervisor's License#(if applicable) G ❑Workman's Compensation Insurance X-P!.RESS PERMIT Check one: I Tam a sole proprietor OCT — 7 2013 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance i Insurance Company Name TOV!VN OF BARNSTABLE 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) ❑ Re-side oReplacement Windows/doors/sliders.U-Value ® (maximtim .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. i ***Note: Property Owner must sign Property Owner Letter of Permission. . A copy of the Home Improvement Contractors License&Construction Supervisors License is require &o G.. SIGNATURE: G QAWPFIIM\FORMS\building permit forms\EXPRFSS.doc Revised 060513 .� . .... .... Y The Coma omifeahh of Massachuseffs Deparftnenf of lnelmsfizal Accidents Office o,f lei sfigadons s 600 Washington Street Boston,MA 02LU wn m Tnasmgov1di a Workers' Compensation lusm-ance,Affidavit:Builders/Contractors/E ectricians{Plumbers Applicant Information q/ } Please Print Lexibly Name(Business/organization/Individual): K Address: rg C o,P CityfSta&ZipigA,RtVS�/Fa 4£/�d e 2 to 3 a Phone 47 2 `---7 3l d Are you an employer?Check the appropriate bom T •_ sin a contractor �of project(required): 1_❑ I am a employer with . 4 ❑ I and I 6- ❑New con s5nrct_ employees(full and/or part-time)* have hired the sub-contractors 2_�am a sole proprietor orpartner listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition. w forme in an capacity. employees and have workers' working y spa. ty_ 1 9_ ❑Building addition [No workers' comp_insurance comp-msurance- 5. ❑ We area corporatimand its 10_.❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself [No workers'comp. right.of exemgtioa per MGL I2_[_1 Roof repairs iinmance rid-]1 c.152,§1(4} and.we Imm no employees-[No workers' 13.❑Other comp-insurance required-] *Any eppbc=t flat checks boa#1 umst also U out the section below sh3wing their wodseW compensation policy iafrrmtim *i,H.�o�meowners who submit this affidavit indicating they ere doing,all vcA sand flea hire outride contractors muse submit a new a�dwk indicating such- `Cont mctors that check this ban must attached an additional sheet showing the name of flee sub-caaructocs sari state whetlter or not those eadjes have employees. If the mVcoat mctars hale employees,they must pmvide their warkers'comp.policy number. lam an employer that.isprmriding workers'compensation insurance for my employees. Below is See poiicp and job site information. Insurance Company Name: Policy,{#or Self-ins_Uc.#: Expiration Date: Job Site Address: City/Statel : 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 in3prisaament as well as civil peaalties 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 Investigations of t#te DIA far insurance coverage verification_ I do hereby ce fy under the nains and penalties ofpedjuy that the information praviz erd above is Mrs and correct Si `v Date: Phone Q,Utctal use only. Do not write in this area,to be completed by city or town officiat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.C1tF>'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 employer;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 Iocal licensing agency shaII 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 with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"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 have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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"the 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 Massachuse,t ' Department of 1i dustrial Accidents office of Westigations 600 Washington Street: Boston,IAA 02111 Tel.#617-727-4900 ext 406 or 1-377 MASWE Revised 4-24-07 Fax#617-727-7749 - www.mass-govfdia - oFE r Town of Barnstable °t Regulatory Services 9=nxiv tsg Thomas F.Geiler,Director p�16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 ww.w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 F Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize Y/C'/6/— 1"Olyn 4al nLO-0 to act on my behalf, in all matters relative to work authorized by this building permit &0,d 1,L)OLJ IL). (Address of b) **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 �er Signature of pplicant . ����Q�i��" l."�'/dam 1 G' �� � � l/. ►J��ot � r�T � � f�l Ar 15/V Print Name Print Name Da e Q:FORM&OWNERPERMISSIONPOOLS 6/2012 �IKE� Town of Barnstable Regulatory Services swxxsrwst s Thomas F.Geiler,Director aiwes. 9�i°rEp3.t6. 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 HOMEOWNER LICENSE EXEMPTION 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"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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. C:\Users\decolltic\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 Massachusetts - Department of Public Safety ' Board of I Building Regulations ulations and Standards�e�oav���oaacoetrlC1 o`'C%7/�aaocrc�rraclt� �.," Office of Consumer Affairs&'Business Regulation Construction Supervisor _ OME IMPROVEMENT CONTRACTOR License: CS-000998 _ egistration: 100053 Type ..r�r Expirationa_6/8/2014 Individual VICTOR WHNI](AINK PO BOX 69 �l. y VICTOR J.WIINIKA N' "L- , w ; I W BARNSTABLE) 0 Victor Wiinikainen 58 CAPE COD LN �r r`J � �� �"�� Expiration BARNSTABLE,MA 02630 `-~ Commissioner 09/29/2015 Undersecretary I a .. License or registration valid for individul use only before the-expiration date. If found return to: F Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 I. Not valid without signature ' I J r J(Z $*t USTea'l G �dC 1110 -,. yXG PT post • •nKiev't� � ` , _x A'? 2 X o:9�gp4lev w-31��)iA ifU �sts r 8a�3' JL V Zrr 6tti-X?$f a orfi-AP °F"E tq� . 'L The Town of Barnstable • .�axsres�. • 9MASS. Department of Health Safety and Environmental Services ` TEDMD'�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Iz lXiS) Type of Work: Z04&4de4z�ll4teiAr/�" Z&K�/e- Estimated Cost fipoe " Address of Work: Owner's Name: V��✓�T �/�i �Z Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: &aZZ2 Date Contractor Name Registration No. OR Date Owner's Name g1brins:Af day • n.•,.. � r,ri7 Boslot(, Mass. 02111 Workers' Compensation Insurance Arrtdayit d�ljsant information• .. ._ . � - �•Pleasc�'R= 1F2��� -� _7 �-- s •tm�: p _' t=.is\ hone - 1 am a homcowner performing all work myself. I am a sole proprietor and ha'v! no one v.orking in am• capacity am an employer prop iding workers* comp-nsation for my employees work-ing on this job. company name: ' .�Z G� /�. L' 16t� a a a r c« 1 G' G�� /yE-�.C%i yu7.c� /� •�� city: r,� 7V 7— /yW �2-� 3� a• _L police- a/ T r / / �z Vt�ti r 1 n f t r t) _ ___ __ ._-. ...',c •-•,..rr---c^.,-�-•.�•'�^,�;.c I am a sole proprietor. general contractor. or homeo\v"ner(circle orie) and have hired the contractors listed belo\k ssho has.: the folio«ink, workers* compensation polices: coinnant• n, -riddrcw a• m an phone 0: nnrry a t3Clti3dtlfo5liTsSffIC�Xt r r rn ct crxl 00 and/or Failure to secure coycrage as required uadcr Section 25A o[�tGL t5Z can tend to the tmposftioa of crttataat PCdAldo O.• r one years'imprisonment as well as civil penalties io the farm o[a STOP WORK ORDER mad a rime o[S100.00 a diy agaiast me. I aaderstaad that a copy of this statement may be for"arded to the Otricc o[Investigations of the DU for coverage veriCcatioa. do hereby eerti f runir ins ar: enaleies of perjury that(he injortnation provided above is(rue and correct. �— Daze eA— Signature Print name �'— �Swi� Phone A A-laic,', use only -do not%rite in this arcs to be completed by city or town official city or town:_ permi(Aiccnsc x rlBuildiag D71Uard oLicensiag cisclectmen's Office I 0check if immediate response is required Qtlealth Department phone a: r'IOthcr_�— contact person: _ _- t HOME IMPROVEMENT CONTRACTOP,S REGISTRATION i Board of E3uildinc Raculations and Standards i ~ One Ashburton Piace — Room 1301 Boston , MESsacih Setts 02108 i OME IMPROV`M`N i CONTRACTOR ----- -- -- ------------------------- - .ecistration 100740 Ex 0 /23/00 YPe — PRIVAT` COP,PORA-ION �_ra on CAP:Z77 HOME V iMPR ` I homaS CaP1Z= i SC - MGNi v. 1645 Newton Rd . ��� E^• !c" Oo':i/ :1 Cotu_- MA 02635 ! -- MA • - - V%� li 6)�1)ILG7[tlY.QIU, 6�`���LIlCw3�: • - _ 0:?ARia�RT OF PUS!IC SAFzif CC4STRUC7iox SU?ERViSuR IICEHSE Nu�Ez-: Expires: dirudaCe: CS W 8 i2 14(2E(1954 19(lE/196J A - . ' .. •• Resa�,:t«d To: It THCII�S z t-PIZZI JP. �.::..—.r y: ;� . 285 PERCIVAL OR 1 y r ?mil;.,.'. �" ` i .! '�; �• tr (Lot...................•tt. deep) , -tell- ellAr . •�" min. p• n 14 • "1 T aQ N \ • • u . A A a 1, • ^ •�: • : 1-. 1 •. • , • ,, 94 ' s }94 .1 (Lot•...................ft.- deep) Z n A :a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o�� Parcel Permit# L3S 75 Health Division a U//�1 ✓�� Date Issued r. ,.: � Conservation Division Av Feed- �J Tax Collect i a I ft. AMICAY.17MLTST OBTAIlV A SEWER COL'OiI0P1 PERMIT FROM TILE Treasur — - Et'I0 'ER=�?O DIVISION PRIOR To CONdTIwU'C'1 Planning Dept. Date Definitive Plan Approved by Planning Board ' ,Historic-OKH Preservation/Hyannis Project Street Address ��Z &�, Village Owner �oL� �.P/ate Address Telephone ll g� .3��,7 ,Z 77,5-9_3z/ Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing _ proposed Total new Estimated Project Cost - e' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes to On Old King's Highway: ❑Yes 0-�o Basement Type: ' ❑Full ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new _ Total Room Count(not including baths):existing new _ First Floor Room Count Heat Type and Fuel: ❑Gas 0 Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage:0 existing ❑new size Pool:❑existing ❑new size— Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:0 existing ❑new size_ Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded O Commercial ❑Yes U/No If yes,site plan review# �S Current Use Proposed Use BUILDER INFORMATION Name 741W �,�r✓/Z�� Telephone Number 9_967 Jor Address fG�lrN�-u/�u�v✓/?Q C!7y,,i M,4 License# duTO3 Home Improvement Contractor# 1®D 7�l Zl Worker's Compensation#Of9 G✓a V'Z z,>'7- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - SIGNATURE DATE FOR OFFICIAL USE ONLY IT PERMIT NO. DATE ISSUED - MAP/PARCEL NO.:. ADDRESS ' • = "� .. ' F - VILLAGE OWNER ii•. t r f ••: S G 1. � s , DATE OF INSPECTION. ' 5 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL •+ - �i GAS: ROUGH FINAL f �, FINAL BUILDING DATE CLOSED•OUT ASSOCIATION PLAN NO. ' r) Map Parcel 0 6Y Permit# t House# �� Date Issued 7� Board of He4th(3,rd floor)(8:15 -9:30/1:00- ) Fee Conservation i Office(4th floor)(8:30- 9:30/1:00-2:00) _ Planning Dept.(1st floor/School Admin. Bldg.) THE 1p; 1� Defi • ' e n Approved by Planning Board 19 •_ -- • BARNSTABLE. , MASS �039. EO MAC a`� TOWN OF BARNSTABLE. Building Permit Application Project Street AddressL/— Village ' Owner Address J11 P0D 1a UL h)JQ /(n o L Telephone �� Permit Request / i�l -- + j First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ c, 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 ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) of ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# _ Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# 4fk'urrent Use Proposed Use y� Builder Information 1Na -!1 r gVS Telephone NumberX&�_// �? Address 3 License# � Home Improvement Contractor# Worker's Compensation#� ���06 Lc-) 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 T SIGNATU DATE A BUILDING PERMIT DE,NIA FQR THE F OWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE s i m� OWNER DATE OF-INSPECTION: FOUNDATION _ r s t - e FRAME d INSULATION FIREPLACE - .? ELECTRICAL: , ROUGH FINAL PLUMBING: ROUGH {FINAL GAS: ' ROUGH FINAL FINAL BUILDING DATE CLOSED OUT F t ASSOCIATION PLAN NO. ' i . : The Town of Barnstable MASUL• L►susrnet� • 9�A �0�' Department of Health Safety and Environmental Services 1679.rE ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMI"TAPPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: -Est. Cost � ® tttt�� Address of Work: /a Owner's Name i 1 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 pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HONE IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL C. 142A SIGNED UNDER PENALTIES OF PERJURY I her by apply for a perm' s t agent of the owner- Date ntractor Name Registration No. OR Date Owner's Name i The Commonwealth of Massachusetts �.i _. Department of Industrial Accidents eflice affnyestigatiafts 600 Washington Street Boston,Mass. 02111 Workers' Cogg nsation Insurance Affidavit name: location: t city 4h(ohe#. ❑ I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one working in any capacity ❑ I am an employer oviding workers' compensation for my employees working on this job. A Id a company name: address: city: hone# insurance co. olicv# ❑ 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#: insurnnce co: Volicv# company name- ........... address: city-. phone#: inunrance co. olicv# i %//////i. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify t e pains and penalties of er'ury that the information provided above is t;rruuo Z619 rrect Sigma - Date / _ Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# fOBuildi,ng Department Licensing Board ❑check if immediate response is required Selectmen's Office Health Departmentcontact person: phone#; ' Other (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 employer, or the receiver c 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renew: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who hx 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 have been presented to the contracting authority. 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 along with a certificate of insurance 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 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 emce of Ipvestlgatloas 600 Washington Street Boston,Ma 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 I — ;r . .:: DATE(MMIDDIYY)8W 4R 05/04/9c-ov ERTIFIAE Of Ll RULJ A G wcER ? THIS CERTIFICATE IS[;SUED AS A MATTER OF INFORMATION ONLY AND CONFERS h 3 RIGHTS UPON THE CERTIFICATE Di ike Swan 6 'Crocker HOLDER:THIS CEPTIFI SATE GOES NOT AMEND,EXTEND OR le Lot's Hollow Rd. ,PO Box 429 ALTER'THECOVE1 1AGI:AFFORDED BY THE POLICIES BELOW. D: Leans MA 02653-0429 "» COMPANIES AFFORDING COVERAGE D. rid D Rust COMPANY A Assuz an( a Co. of America Ili to No. 508-255-3212 Fax No. — -- — — r): RED COMPANY. B Credit ( _neral Insurance Co. Paul J. Cazeault etal' DBA Paul coMPANY` -..J. -Cazeault Sons _Roofing C COMPANY D �t VERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURt oWED ABCVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION'OF ANY CONTRACTOR OTHER.�C ;UMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDEDBY THE POLICIES DESCRIBED E 22-N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE,BEEN REDUCED:BY PAID CLA. `•` TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIfi,13N LIMITS DATE(MM/DD1YY) ;`DATE(MWD!.v!} GENERAL LIABILITY C ENERAL AGGREGATE $ 1000000 Z X COMMERCIAL GENERAL LIABIU-ty CFP25552812 05/01/98 05/01. c, FRODUCTS•COMPIOPAGG $ 1000000 CLAIMS MADE OCCUR FERSON.AL&ADVINJURY $500000 OWNER'S&CONTRACTOR'SPROT EACH OCCURRENCE $ 500000 FIRE DAMAGE(Anyone fire) $300000 MED EXP(Any one person) $ 10 0 0 0 AUTOMOBILE LIABILITY ::OMBINIED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS — HIRED AUTOS O-ODILY INJURY - I (Per accident) $ NON-OWNED AUTOS — I 'ROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY i EACH ACCIDENT $ f AGGREGATE $ I EXCESS LIABILITY =__ L-ACH OCCURRENCE $ } UMBRELLA FORM AGGREGATE $ $ I OTHER THAN UMBRELLA FORM WORKERS'COMPENSATIONAND " I X TORYLAMITS' OER EMPLOYERS'LIABILITYEL EACH ACCIDENT $ 100000 T !THE PROPRIETOR/ - ( INCL SWC17005901 08/09%97 08/09,/98 EL DISEASE-POUCYLIMR $500000 IPARTNERSIEXECUTIVE ai. OFFICERS ARE: x EXCL EL DISEASE-EA EMPLOYEE $100000 OTHER t, i DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS Roofing C..RTIFICA'TE:HOIDER; CANCEEUiT[ON........... . SHOULD ANYOF THE AB01 DESCRIBED POLICIES BE CANCELLED BEFORE THE ..,»s-• EXPIRATION DATE THERECF,THE ISSUING COMPANY.WILL ENDEAVOR TO MAIL DAYS WRITTEN NC TICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUC d NOTICE SHALL IMPOSE NO OBLIGATION ON,LIABI1 ITY 3. � OF ANY KIND) ON T E COMPANY,ITS AGENTS OR PRESENTATIVES. fr_• . --� AUTHOR ATIVE �L,CORD 25-S(1Z95)>. ©ACORD CORPORATION 1988-:. r= + •i, t:G?�a���`Q'��foe'�tc�,"�y�� sn i, .��:^_ x � S �y.,�rr° ,,�'`iy� r+�f�4y�j(�{ �"• � { T•,¢`E M IN -s.� ,.$a r A - LJ tu1G�' 1^�L� 1 J ,�y ,:�*sh' x..� i r' F'RQ VZME, . RA maphOl � 7ypez t�ARTM q{��'• � � �.:�2 ��£' i �• yy^ i1 xJ(* t i �h ^" 8�• � x '$W''^fJhR*t„4���1V3�1� .L) 5�. ('�AA T� f�U���x ,� P u �yazezv. ,ff r + +nor arri ?a a r s , 1tt3 7#k r nit' S s sA�� y�"i ¢ T +"• ,"*Y' i¢ �p4{� ��„ AU 'CAZEAti'QT,%6N5 !jR00,f J67-1 F1 r) �E i :j l DEPARTMENT'OF PUBLIC SAFETY ONE ASHBURTON PLACE, RM 1301. BOSTO A 02108--16i8 CONSTRUCTION SUPERVISOR LICENSE Number: Expires: CS 026325 10/20/1.999 ids--- Restricted' To 00 Y IV, PAUL ._i CAZEAULT 1585 MAIN ST OSTEk.-VILLE, MA 02655 - - �'� spa Keep top for receipt and change Wr, bf-address; notification. R� i 1 M—AnA IIPP fS t f8$€a i , fill b�.'rN 4a $ 4 t•He} �enm42,...-r; '-'^:,:-.•.rA*-e-"'y�f3Clta c!2^e`.-^'�'x:.""*d:+"r':�°.. .b. ,.:�'§'r' RE-ROOFING If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application Map/parcel number Sign-offs from vTax Collector #of squares of shingles or square footage of roof to be shingled specify stripping old shingles or going over old roof. If going over how many roof layers existing now what size are rafters? What is span? Complete dwelling information for the Assessor's Dept.-if known Workerman's Comp. form Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) / Home Improvement Contractor's License OR Homeowner's License Exemption(RESIDENTIAL ONLY) Check expiration date on license 7/9l9 JF- COMMERCIAL WORK-No License is required. Fee g4orms-PERMITS 1 Rev 6/2/98