HomeMy WebLinkAbout0188 LONGVIEW DRIVE - - /deb' lj vic.U) D/ rIviL � _—
Town of Barnstable *Permit#
Regulatory Services Expires
ee 6 from issue
ERMff
167� s� Thomas F.Geiler,Director
- SEP 2 7 2012 Building Division ok 113/3112-
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
� N OF BARNSTAB� www.town.bamstable.ma.us
O ice: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number J� ` D9 q
v.
Property Address 4qn S
-Residential Value of Work—'
Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
CLu k-a--
Contractor's Name Telephone Number2� o �
Home Improvement Contractor License#(if applicable) f
? �
Construction Supervisor's.License#(if applicable)
dworkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I m the Homeowner
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_r`oof(hurricane nailed)(stripping old shingles) All construction debris will be taken t4aM 6L
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
#of doors
Ej Replacement Windows/doors/sliders.U-Value (maximum.35)#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 of the Home Improvement Contractors License&Construction Supervisors License is
` r quired.
I SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc
Revised 072110
1 -
* BnxxsTna�, •
039. Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize ,,�/ (A�'- ,d91 LJ to act on my behalf,
in all matters relative to work authorized by this building permit application for:
b 1
Address of Job)
SiXOer Date
4
Pant Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doe
Revised 072110
i
The Commonweakh of Massachuseth
Depart»t it of IndustFial Accidents
09we of Inwsdgadons
IF600 Washington Street
Boston,MA 02111
_ ry my mass.gov1dia
Workers' Compensafion Insurance Affidavit: BuddersfContaaetorslEhctncianslPBumbers
Applicant Information Muse Print Leeibly
Name(Btr�e�/daggu�atianllndivithusl): r/� ___( - �' Z'n�J
Address: /n-�j�c�
City/StateJZip: s Phone 4-
Jre you an employer?Check thee appropriate boa: Type of project(ied)-
Qls4am a etrtployer with 3 4- ❑I am a general contractor and I
! full andtbr s have hired the sub-contactors 6. ❑New tion
employees( pant-time).
2..❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling
ship and have no employees These st*-contradors have 8. ❑Demolition
woddng fix the employees and have wodazs'
��c¢3'- 9- ❑Budding addition
[No workers'comp.insurance comp-insurance-1
required-] 5. ❑ We are$corporation and its 10.❑Electrical reports or adtl>itans
3.❑ I am a homeowner doing all woah officers have exercised their 11.❑Plumbing repairs or additions
myseX o workers' right of exemption per MGL 12_❑Roof
repairs
insurance required.]1 c.152,§1(4X and we have.no
employees-[No wmkers' 13_❑Other
comp-insurance required-]
•Any apg"twat Est checks boa f 1 u also fill ant the section section below showing their woike camp policy infm a matio
1 l'iomemvaees wbo smbmit this affidavit iu bcsting they are doing all work sad then hire outside coattactms must submit anew affidwit indicating such.
tConwictors that check this bat must attached am addition sbeet showing the name of the sub-ca muxtaas gnd state wbetbu or not those efiths have
employees. If the snb-connacaots have employees,they imtst provide their works'gyp•ply number.
I am an employer that is providt;g workers'cotttpeasalion insurance for my eurplrryeea Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#:.Ca( — �� � I Expiration Date: I
Job Site Address: ��f FJ1. � Cityrstatel�ip�1�rt-1 he)
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 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage vetiftcaticm-
I do hereby Cub .& tke ' s d penalties of pe jury that the information ptwvided above is Grate and cornea
S Date:
Phone#: VV
Official sse only. Do not write in this area,to be completed by city or totm official
City or Town: Perm itUcense#
Issuing.Authority(circle one):
1.Board of Health 2.Building Department 3.City/Pown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.tither
Contact Person: Phone M
pp�. 1lassach Ilse Hs - I)Clrtruncnt of Public Sufco
atT h1 t3nartf nl'BuiltliIt 1 Itc.1ulatiuns antl titantl;u'tls
Construction Supervisor License
License: CS 102260
Restricted to: 00
R
MICHAEL MEAGHER JR
97 EMERALD LANE :
MARSTONS,MILLS, MA 02648
a--
J'"�" Expiration: 11/5/2012
tl mmi•si mor Tr#: 102260
i
�: ✓lte.'Jontmzaltu�ea�irt D�✓vGad�uJe�Q
1' 114 Office of ConnmmAffairs&BUsioess Regulation
HOME IMPROVEMENT CONTRACTOR
Registration 162938 Type:
Expiration: 4/27/2013 DBA
MRBROTHERS CONS7RU,CTION
MICHAEL MEAGHER JR ,�
97 EMERALD LN s
MARSTONSMILL,MA..Q264$:'.,;:u' +
-i:. Undersecretary t
Restricted to: 00 v;
00- Unrestricted
1G- 1 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
Refer to: WWW.Mass.Gov/DPS
. License or registration vPkid foes„individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
{`. 10 bark Plaza-Suite 70 .
Boston,MA 02.11.
Not v I d without signature,
y
UED AS A MATTER op INFO O D EXTEND OR ALTER THE COVERA URER(S�1 GE AFFORDAUTHOR17FD REPRESENTATIVE
NOT AFfIR/aAnvF-LY OR NEGATT VELY VELY AIAk�►
CA OF MSURANCEDOESNOTCONMUTEA
CONTRACT SETWEEN'IHE 15S(IpJG INS .
ODUCER, THE CERTIiTCATE HOLDER_
UBpOCATION IS WAIVED,ae4o holder i9.R+ADDITIONAL WSURED,III
PoGnY(m-7 must be nncbrsed. h o noete doss nc ��s0`t0'ho -
' RT•ANT:N t eertlfi r n end Pn�omera, A st:+tomont an drls
me and
eondlN a1 the Poiey,cnrwn Poieles►eet'
eertlte ds hold v n Den of sU�h enderesme:+t(SF
CONTACT .
PRODUCER I NAME: FAX
PHONE PAX
OLD!:CAPE€COD INS.A(ZICY
E-UAIL
296 STREET ADDRESS:
CUSTOMER ID m NAIC ax
HWeCS. INSURERS)AFFORDING COVERAGE
236ELC INSURER At WVE.=5 MEhRUY C(1TSE'A1vX
INSURED `. INSURER It:
QE R coNsrRUcrEON ri�uRER C:
MEAGEEK ZWI10EIASLDSAMS INSURER DI
INSURER I- -
97 D STREET. INSURER F:
7AELSTCIN�MiLI-S.MA 02CrIf3 REVISION NUMBER:
COVERAGES CEFMFICATF NUMBER: 0 TO THE INctUW
ICY PERIOD IND10ATO'
TM41eT0 CERTI TWAT, P°UClE9 OF INS 9YTHE POLICIES D LffFb LESCRIBED HEREINN IBUBu JECiTO ALLTHE TUERIdS Et:CLUsIONB AND OONDTTIONS OF UC1i POLICIES,
TKR 13TH>;TANDI ANY REOUIRPMENT,TER!!OR CONDITION OF ANY CONTRACT OR OTHER COCUMt IT WITH REsPECTTC VJhI1CH THL CONDITIONS MAY HE ISSUED
OR MAY PERTA�THE INSURANCE AFFORDED
UMTT0 SHO>AT7 Y HAVE BEEN REDUGFD BY PAID CLAIMS. POLICY EFF°ATE POLICY EXP DATE
INBR LIMITS
ADOLrUSR
TYPEOF.INSURANCE POUCYNUMBER IM�°°�'mh IMNnCCtYYYY) '. s.
INOR WVD EACH OCCURRENCE
LTR•
GENERAL 1 IABIUTY. LIABILITY DAMAGE TO RENTED " S
COM IERCIAL GENERAL
PREMISES(Ea 00curtP4rA)
CI U4SMADE DCOUR.. MED FXP(Any one psMWI) 8
PERSONAL RA ADV NJURY $
GENERALAGOREMATE
GEML AGG GATE LIMIT APPLIES PER PRODUCTS:COMPIDP AGO S
POLIt Y PROJECT LOC COMBINED SNGLE
AUTOAMOM LIABILITY LIMIT(Ea eoddent) .
ANY 0 BODILY INJURY
ALL. NED AUTOS (Par pnmon) S
SCHE ULE AUTOS BODILY INJURY
HIRE AUTOS (par arrkInAn
PROPERTY DAMAGE s
NONI NED AUTOS ` (Per aoclderd)
EACH OCCURRENCE
UNIT LLA LIAR OCCUR AGGREGATE
1cXCE LIAR CLAIMS-MADE
DED TIBLE
RE. I ION F WO STATJTORYLIMITS OTHER
ue 49 P8dA-t t I IlO o11 1 tlD92d12 - E,L.EACH ACCIDENT S 100,000
Y�pE COMPENSATION'AND YIN . EL DISEASE-FJ�EMPLOYEE 5 104,000
EMPLOYE 5.LIABIUTY N
ANY PR ITOR MARTNEwEXEC M E.L,OLsE sE PDUCY.LIMIT 0 500,000
OFPIcEIaNE .EREXcd.IMED7
IMnndmnryi NH).
11 yet,d99CO kno-V
DEROKIPT10 of OPERATIONS b*1m
AL ITEMS
DFSCRIpT10N OPERATIONSlLOC �WdEDT�TM ATP-AotEnlnrrrn�DWARIa:R5 c:C1�.COv1S�.0a
TICS FS'Pi�, ANY PRIOR CP�TJPI
1 E&-rHER MI
IS C.oVeRF-D BYTF>fi NORLO'RS'COMPF.NSA7TOIVP0L=-
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED PouGES BE CANCELLED
TOWN OF BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILLBE DELIVERED IN
16 C:T.FAT K RD ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHDRIXED REPRESENTATTVE
Charizs J.Clark
Mk9F-IpFE MA 02644 1988-ED09 ACORD CORPORATION. All Tights reserved
ACORD 25(20 9109)
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�IMEi � TOWN OF BARNSTABLE Buildin
Application Ref: 201006681
* BA>t:IvsTASI,E. � Issue Date: 12/13/10
Permit
y MASS.
�Ar16
339- a Applicant: FRONTIER ENERGY SOLUTIONS Permit Number: B 20102703
Proposed Use: SINGLE FAMILY HOME Expiration Date: 06/12/11
Location 188 LONGVIEW DRIVE Zoning District RC-1 Permit Type: RESIDENTIAL INSULATION
Map Parcel 251079 Permit Fee$ 35.00 Contractor FRONTIER ENERGY SOLUTIONS
Village HYANNIS App Fee$ 50.00 License Num 160854 'rp/ l��
Est Construction Cost$ 3,200 �C D
Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND
ADD R-19 INSULATION OVER EXISTING R-19 INSULATION IN ATTI THIS CARD MUST BE KEPT POSTED UNTIL FINAL
INSPECTION HAS BEEN MADE. WHERE A
CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH
Owner on Record: BURKE,JOHN 181 JOAN H BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL
Address: 188 LONGVIEW DR INSPECTION HAS BEEN M E.
HYANNIS, MA 02601 .
Application Entered by: PR Building Permit Issued By:
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THE. OR;EITHER TEMPORARILY.OR PERMANENTLY.
ENCROACHEMENTS ON:PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.
STREET OR ALLY GRADES AS.WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY B&OBTAINED FROM-THE DEPARTMENT OF PUBLIC WORKS.
THE.ISSUANCE OF THIS PERMIT DOES NOT:RELEASE THE APPLICANTFROM'THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTTTRUCTION 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 SIX 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).
® ROOM
4 u 6•
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
w
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map I Parce Application # I b0 �
Health Division Date Issued -C\—A
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board r
Historic - OKH _ Preservation / Hyannis
Project Street Address S5� L 6AJ 6-V 1 EW
Village 144ANNI,5
Owner ZM-N ZQ Address' L®lib V I Es�1A1
Telephone
Permit Request ik� lei
NS y 4nPfn DID w A'r"t"1 c
Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
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
Number 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
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 # tl
Current Use Proposed Use
K
y � e
APPLICANT INFORMATION
---- (BUILDER OR HOMEOWNER)
Name lqq M� Telephone Number 331
Address 13 S �� Q L4 License
>Lk AIA (-)-ZSb 2— Home Improvement Contractor#
Worker's Compensation # (®t) L/D/zoi o
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 11 � /�
ti
FOR OFFICIAL USE ONLY
` APPLICATION#
DATE ISSUED -
MAP-/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION: .,
FOUNDATION
I FRAME
Gti
i44
7
INSULATION:
FIREPLACE
j
ELECTRICAL: ROUGH FINAL
i5
PLUMBING: ROUGH FINAL
! GAS:'-; ROUGH FINAL
ti
t
w: FINAL_BUILDING-
DATE CLOSED OUT
ASSOCIATION PLAN NO.
f
CERTIFICATE OF LIABILITY INSURANCE. o7nanui�A7E( 2rndYYY)n-
Ms cihrtrXCM Is now AS'A 9A"m OF zwOI0aTI= aHW Am COMIn" w BIGHTS,UPON m CZE=ICM%Uht OUI ow..I' CR1T P2=
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curmcan livz R.
nOOMM, IE the eertifiostp bolder is an AMST ML luau=, the poliayU60 Must be and0114d'. IE Sv> AYDN.12 VMXVZD, subject
is the teas and acaditious of the Policy, grtain Policies eay s�Qnize an.ecdorasesot..A stateeaet as this aartlf gists.does pat
aaafer ri ts:to the vartiticate holder in lieuof suoe aedozaeaent(a),
Rogers i Gray ots;
�e Y Inaurance: �nLY:
etie:t.
PO BOX 1601 •�
South DwMim; MA 02660 atvrgeA rs.
. atrs�uttt arra�szto:t7ovnuia>< .:-. usa•'.
n�.A.A.L.It. Mutual Ineuaance Cc
Frontier Eaergy Solutions 'Ll;C lm. a,
39, Siasconaet Drive ..wo.,•a
9agavare Beach, HA. 02562 auttu�'o.
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COVEPAWS CSBTI iCATE HUHM: PJMBICH BUIMM,
THIS is.TO Czmrr PL1!,ffi PDI3=Or.PWWHM -_ WLW WWII uM-139OR' .TH9 _ raft 7HB goLlelr'YOAtW=ICARID.
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ALL Mmm.A=.UCMZD M M:TBB WOF&HStcompiluATIOH POKY. -
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WESTBdRdu(iA,: !(A 01581
�Tr Town of Barnstable
Regulatory Services
MAE& $ Thomas F. Geiler,Director
06 Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-0038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, , as Owner of the subject.property
hereby authorize -F2oi myZ eVu" SD-WnDm S to act on my behaY,
in all matters relative to work authorized by this building permit application for-
(Address of Job)
S' ature of Owner Date
-To Uurr-�
Pant Naine -
If Property Owner is applying for permit please complete.the
Homeowners License Exemption Form on the reverse side.
Q:F0RMS:0 WNERFERMISS]0N
Y
ay
Town of Barnstable
ofrru:r
o �, Regulatory Services :.
BARNsr,BLY_ 4 Thomas F. Geiler,Director
MASS.
Building Division
ArED Ma,�a
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA.02601 _.
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Pleast Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
T1he 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
s 1p eryis o r.
DEFINMON OF HOMEOWNER
Person(s) who owns a parcel of land on which he/sbe,resides or intends to reside, on which there is, or is intended to-
b!�, a one or two-family dwelling, attached or detached sinictures 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)
T_7e undersigned"homeowner"assumes responsibility for compliance with the State Building Code and_other
applicable codes, bylaws,rules and regulations.
The undersigned "homeowner"certifies that,be/she understands the Town of Barnstable Building Department
m_nimum 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
.7-hr Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
Of this section(Section I D9.1.1 -Licensing of construction Supervisors);provided that if the homeov;mcr argages a persons)for hint to do such
wor}:,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,
Rulcs&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness oft=results in serious problems,particularly
whcro the homeowner hires unlicensed persons. In this case,our Board cannot procccd against the unlicensed person as it A•ould with a licensed
Supervisor. Tbc homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her respons Hitics,many communities require,as part of the permit application,
that the homeowner certify that hdshe understands the msponnbilitics of a Supervisor, On the last page of this issue is a form curtly used by
several towns. You may can t amend and adopt such a forrn/certification for use in your community.
Q:for-ns:h omccxcmpt
f
t Th.e Commonwealth of Massachusetts
Deparfrtz ent of Industrial Accide/zls
�. Office of Investigations
600 Washington Street
t '`• Boston,MA 02111
'y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
.Applicant.Information Please Print Legibly
N3IIle..(Business/Organization/Individual): �v t ` '� �•I C �U�
Address:
City%State/Zip:. t0 k MK Phone #: 33"1 ' 3"47 ��Z3
Ar, ey ou an employer?-Check the appropriate box: Type of project(required):
l Iam.a employer with Z 4. 0 I am a general contractor and I
- * have hued the sub-contractors... 6. 0 New construction
employ_ei•- t11 and/ofpart-time). -- - -- -
2 �:I`am a'sole propnetor.or partneT listed on the attached sheet. 7. Q Remodeling
These s.ub-contractors:have
ship and have no employees 8. 0 Demolition
k einn ca ttY wormg- forma employees and have workers'
9. .D Building.a..dition
[No workers' comp. insurance comp. insurance•.$
required] 5. We are a corporation and its 10.❑ Electrical repairs or additions
3.0 I am abomeowner doing.all work_ officers have exercised their 11.0 Plumbing repairs or additions
myself..[No workers' comp right of exemption per MGL 120 Roof repairs
insurance required] t c. 152, §1(4); and we,have no
employees. [No workers' 13:0 Other
comp.insurance required:)
*My applicant that chccks.b.ox#1 must also'fill out the section below showing their workers'compensation policy information.
t Homeowners who submiCttiis affidavit indicating they are doing all work and then hire outside contractors must,submil a new affidavit indicating such.
icontractors that check this box Tm st attach an additional sheet showing the name of the sub-contractors and stale whether or not those entities.have
employees: If tho.sub-contractors have crnployces;they must provide their.workers'comp,policy number.
I am.:an::einployer that;is providing workers'compensation insurance for my employees. Below is the policy and job'sr.
informadar. , c
Insurance Company.Name. 1�l M M �v� I`� KSV NA)(
Policy#::or Self tns tic: # Gj0.I .! di Expiration Date: ZO
Job Stte Address: 1-coleoz, LO UL-T-V" 16IV City/State/Zip: it
Attach.a copy.of the workers' compensation policy declaration page (showing the policy number and expiration`date).
Failure:to secure coverage as requued under Section 25A of MGL c.. 152 can lead to the imposition of criminal penalties of a
fine up`to..$J,500.00 and/or one-yeai:'impri onment,:as welhas.civil penalties in the forth 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 forwarded to the Office of
Investigations of the DIA for1nsurance:coYerage verification.
11do hereby certi. sunder t e pacns;,andpenalties ofperjury that the information provided abovejs trite and correct.
Si atnre:
Phone#-, � ) '
Official Use only. Do not write in this area,to,be completed by:city or town official
City be Town: Permit/License#
Issuing Authority (circle one):
l: Board of Health 2.Building•Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
f
Massachusetts Department trf Puhlic Satefv Board of Building;Re;iulatibns ant] S
Construction Su tantJ.irds pervisor Specialty License
License: CS SL 102778'
Restricted.to: ,IC I
CONOR .'
MCINERNEY
39 SIASCONSET DRi1/E .
SAGAMORE.BEACH, MA'02562
Expiration: 8/19/2012
. - --Cunimissinncr _
Tr#: 102778
'i
Off.
e of Consumer License or re Affairs&Business Re .ulation istration valid for individul use only g g Y
HOME IMPROVEMENT_CONTRACTOR before the expiration date. If found return to.
Registration: µ1.60854 Type: Office of Consumer Affairs and Business Regulation
f Expiration_ 91812012 LLC ; 10 Park Plaza-Suite 5170
j Boston,MA 02116
FR TIER ENERG`LSOLJJTICNS i
MCINERNEY CON,Ol2 -
135 STATE RD Su at
�� i VWW��►''IVVVtl�'i` �
SAGAMORE BEACH MS02562`+ Undersecretaryi
alid without signatu
- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 3 0` Parcel ;Application #
Health Division Date Issued
Conservation Division Application Fee Ito 0
Planning.Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _Preservation / Hyannis
cPr re_oject--St� e____ et Address
Vill g 4 c—� V Z(0 0 t
<Owner—W-1-U r:k1t uv- _-e,t 44 U Address S (f o4t rl Ted' N/4to f�te-
e-Teleph�o'ne'- 3c�f Y /S7� l �+f G�S6� �775'- S 5
e_Permit_Reques �►�t4�CU y- WzrT s.4 C)OLA L'kkk arTSCe_5% (A + WkW_ep� CI L&j `W 4g q
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Pr_o� t Valuafion 1 69 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
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
tea t C)
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count= 9
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
�i
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove 0 Yes ❑ No
Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑mew 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)
c� V0�6
Nam, IvomeZ Telephone-Numbe= 9 78 °QC&
cAd Tess= �w 1�J v'tS `License-#�
Home Improvement Contractor# l Z- q3
Worker's Compensation # "49-117 J
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO qUVWLOU-A-�j
SIGNATURE �-=--__ D TE —fig- 6 — 2-v 0
FOR OFFICIAL USE ONLY
!APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
is-F FOUNDATION'
1
r FRAME
` INSULATION
FIREPLACE
L�
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
:j
`GAS: ROUGH-..1 FINAL
- FINAL BUILDING4: • +`- = --�U
DATE CLOSED OUT
ASSOCIATION PLAN NO.
f .
i
The Commonwealth of Massachusetts
.Department oflndustria[f(ccidents
Office of Investigations
+ 600 Washington Street
Boston, MA 02111
:.•` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluznbers
Applicant Information .Please Print Legibly
Name (Business/Organization/Individual): u4CO I�JC.UU2__ r_n r A- A
Address' -7!1 VVGUl ccs
City/State/Zip: S o • efl Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. I am•a general contractor and I construction•
mployees(full and/or part-tiine).
* have hired.the stib-contractors 6. ❑ New
2. I am a sole proprietor or�parttier listed on the attached sheet T. Q Remodeling
2.eI
ship and have no employees These sub-contractors have g. ' Demolition
workingfor me in an ca aci employees and have workers'
Y P city. 9. .0 Building addition
[No workers' comp.•insurance comp. insurance.t
required.] 5. We are a corporation and its '10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I I"❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 goof repairs
insurance required.] t G. 152, §1(4), and we have no
employees. [No workers' 13 themCa P.Qifi�e1�-
comp. insurance required.] �6
1S
*Any applicant.that checks box#1 must also 51l 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.
XContractors that check this box must attached an additional sheet showing the name of the subcontractors.and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins. Lio_ M ig �� D Pi' Expiration Date: 9 /i2
Job Site Address: City/State/Zip: I Gfovi4s a-2(ea
Attach a copy of the workers' compensation policy declaration page (showing the policy num er 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 WA for insurance coverage verification.
Ido hereby certify under t pains andpenalties ofperjury that the information provided above is true and correct.
Si ature: Q Date: /2— /0. ` -01 d _
Phone #:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Perrrit/License#
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6. Other
Cnnfart Pa.rcnn: Phone#:
Inf®rmat' and gnsttucti®ns , : •
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."
Aa 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
o'r on the grounds or building appurtenant thereto,shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the 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 cczth the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
' compensation affidavit completely,b checking the boxes that apply to your situation and, if
workers' oY
u the wo
Please fill out mp
necessary, supply sub-contiactor(s)name(s), addicss(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
.Plea.sc 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" fhe.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 e,filled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(i.e. a dog license or permit to biirn 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 Mnssachusetts
` }department of Industrial Accidents
Office of Tn�estigat�.azxs
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 ar 1-877-MASSAFE
Fax # 617-72777749
Revised 11-22-06
www.mas,-,.gov/dia
f
1 ri : =
273:.
79 Mayfair Rd
South D:enms, MA 02660 .
Al
69680
capecodwirf4.
dows.com LC #124793 `
{865) 398 1511 T691 Free
(5Q8) 398 I...*.bennfs, MA
PHONE DATE
TO M/M Arthur:Beatty 508 A28-"1518 9%30/2010
699.
Co to it Rd. JOB.NAME/LOGATtON
st llsar _ MA 0 :
WindowsMons Mi
Sunrysid:e Restaurant
282 Main St-,
yariniS, MA. 02601
JOB NUMBER J06 PHONE".
Frt Apt 508 77S 3539.
iNe hereby submrt-specificattons and estimates for
3�
> l Remove .four pair of wooden double hung window sash/balances and replace/instaii with four
Harvey, Industry''allinyl `double hung windows in same locations, ( ,one :in bath room, and three;;
in bead rooms ) .1
* New Harvey windows will have a white unpi exterior with awhite vinyl interior; white
{ hardtaare, "tiltwash ability, 1/2' scre;ens and grilles, between the glass with a ;6/6 pattern A11`
new windows will have; LowE glass argon filled`:insulated glass
2 Insulate the cavities of new:` wind,:ows
3 Tarke old windows fo th'e dump:
a
Supply interior/exterior trim and' fram.rng materials where needed. Make repairs to ori;e . _
exterior. sill in bath .r.00m.
5 Make arrangement for delivery of.'.new windows
This proposal :does not include any:painting, 'staining, ;or other repairs. not described above
All `Harvey windows.:described above.:will<be prepas.d by< the home owner..
** If this proposal is sat sfactory, `please sign the YELLOW copy and return with ..payment
schedule,:
** Please make a' heck payable to Vasco Nunez Car entr p y. in the amount o $ for :your
new Harvey iaindows described above and please include this check with you
i ned
Allow :3 4 weeks for delivery. Upon completion of this job I will g proposal.
J give you he invoice for the
windows. A tax credit::may apply to this order
t1 ; � llQ
.®S�hereby to fumish'material and tabor complete in accordance with the above specifications,for the sum of:
One Thousand Six Hundred Twenty One a'nd 69,%100 .Dollars:
1,621. 69
dollars($ ).
Payment to be made as follows:
" Labor & mat'erials less new Wind o4s ..Payable upon completion at time of completion. .$ 675.00
All material is guaranteed to be as specified.All work to be completed in, professional
masher according to:standard practices Any alteration or deviation from above specificatior;s Authorized
involving eictra costs will be executed only upon written orders,,and wi become an extra .Signature
charge over and above the estimate All agreements confingent upon strikes,accidents or
delays beyond our control.Owner to carry fire,tomado,and other necessary insurance.Our Note:This proposal may be
workers are fully covered by Worker's Compensation insurance. Withdrawn by us if not accepted Withi" 15 days.
y
Acceptance of Proposal—The above prices,specifications and con
-
JOB are satisfactory and are hereby accepted.You are authorized to do the work as ��
specified.Payment will be made as outlined above. i ture _ //
Date of AcceptaJ � __ _'�_ Si ature __
_�
Py�%THErO�y TOWN OF BARNSTABLE
i BARNSTABLE, i
16 9 BUILDING INSPECTOR
O�N NPY p''e
APPLICATIONFOR PERMIT TO .....................................:.......................................................................................
TYPEOF CONSTRUCTION .....................................................................................................................................
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
8 Location ........L .............. .AN.?a.( . . ......Or..........0Z AJT--r.r..�.�.�.�.1� �..�.. .... �l.b s.*.......................................
ProposedUse ...........� e...............................................................................................................................................
V
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner .VA-I -AA40W)....L,4416).e.,r...................Address A ,��rv��l�t�s.l 1�P....... d �JTd'lol?�
Name of Builder In.(�...5..........t..A.....1.... A.............Address
............... ........... ... .. .... . ..........
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..................................................................Foundation .-C-wvotlotc. ..................................:.......
Exterior41.4... .... .. ...............:......Roofing ..........W.A.4!d..........................................................
Floors .......carque7N; ...................................................Interior ....................................................................................
Heating ..............................................................:...................Plumbing .............. .......a.........................................................
Fireplace ...................................Approximate Cost ... ...f+ P�
............................................... .........................................................
Definitive Plan Approved by Planning Board ---------------_-----.---------19
Diagram of Lot and Building with Dimensions ry
SUBJECT TO APPROVAL OF BOARD OF HEALTH
rz T'a�'S
o V m W l -Z
00 (D
o2
0
w a, o
cc
•^
J
�„r Q
� '�G Z(
>- A �
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the.above
construction.
r
Name . ... ti..... ............ . . ....... ..........................
Lafleur, Raymond
No AM?.... Permit for .......add garage to
single family dwelling
Location .....,188 Longview llrive.................
Centerville
Owner Raymond Lafleur
Type of Construction ..................frame r
................................................................................
Plot ......................... .. Lot ................................
August 14 72
Permit Granted ........................................19
Date of Inspection ................19
Date Completed ... ......19
PERMIT REFUSED
................................................................ 19
...............................................................................
................................................................................
...............................................................................
............................................................................... i
Approved
...............................................................................
...............................................................................