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HomeMy WebLinkAbout0059 LOUIS STREET �-_ r �� _ t PERM Town of Barnstable Permit# 13 Regulatory Services Fee �� 6 mo m ue BARN _ MASS. $ Thomas F.Geiler,Director 039.NIA't TOE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 \! / 1 www.town.batnstable.ma.us 45 l i S/12 Office: 508-862-4038 Fax:450 - 0-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY —�/�(� Not Valid without Red X--Press Imprint Map/parcel Number ��— Propei-ty,Address cj L &ills residential Value of Work 4 i �0 3$� Minimum Fe of$35.IS:Lu nder 16000.00Owner's Name&Address �✓�� Contractor's Name 5&tHf4no /j,, IIV,At ,ts Telephone Number 1161- Home Improvement Contractor License#(if applicable) 17 3�L S Construction Supervisor's License#(if applicable) &Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ J,,am the Homeowner I have Worker's Compensation Insurance Insurance Company Name6✓ ✓c �© Workman's Comp.Policy# 1 Q 3 s y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors [2Replacement Windows/doors/sliders.U-Value 0 c .3 ® (maximum.35)#of windows _ 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 requKed. `.SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 053012. The Commonwealth of Massachusetts Print Form ID Department of Industrial Accidents Office of Investigations ` 1 Congress Street,Suite 100 Boston,MA 02114-2017 y www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): rig&6tk ojl,/Aw,, I-Le% Address: (o 4M/0"y /LOB City/State/Zip: L/McloIN v,-L86S Phone#: ��r7� — �a — C? Rev Ars�e,,y//ou an employer?Check the appropriate box: Type of project(required): 1.E I am'a employer with 9 b 4. F-1 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. ❑.Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp.insurance comp.insurance.) required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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' 13. ther ,✓1— comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must 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 u the policy and job site . information.Insurance Company Name: o N " t—aw 60,n Policy#or Self-ins.Lic.#: Expiration Date: g 3 J ��45 => t' City/State/Zip:Job Site Address: NN/5 0960/ 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 cetWfv under the sins and enalties o e 'u that the in ormation provided above is true and correct afar : ]Date Si . Phone#: "l®l a91? Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# 'Issuing Authority(circle one): 1.Board of Health_ 2.Build;ng.Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#: Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 5/08/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME:C Anita Little Willis of New Jersey,Inc. aCNN E. :856 914-4660 ac No): 856 914-1881 1015 Briggs Road E-MAIL DRESS: AMta.Little@willis.com PO Box 5005 INSURER(S)AFFORDING COVERAGE NAIC is Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER 13:Argonaut Insurance Co. '19801 Southern New England Windows LLC INSURERC:Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02865 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY S202945900 8/10/2012 08/10/2013 EEpAACCMHHp OCCURRENCE $1 OOO OOO. X COMMERCIAL GENERAL LIABILITY PREMISES &ELATED $50 OOO CLAIMS MADE �OCCUR MED EXP(Any one person) $5 OOO PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO-JECT LOC $ - A AUTOMOBILE LIABILITY S202945900 8/10/2012 08/10/201 COMBINED SINGLE LIMIT Ea BINEDt 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED id P BODILY INJURY(Per accent $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS $ Per accdent A X UMBRELLA LIAB OCCUR S202945900 8/10/2012 08/1012013 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 00O 000 DED RETENTION$ $ B WORKERS COMPENSATION AIC927698352394 8/21/2012 08/21/201 w -Y IMI OTH• AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 68028 8/21/2012 08/21/201 E.L.EACH ACCIDENT $1 OOO 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OOO 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC'r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1. of 1 The ACORD name and logo are registered marks of ACORD #S214638/M214631 AXL I .f 1 ,f3 Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-095707 BRIAN D DENNISON t 7 LAMBS POND CIRG "E s Charlton MA 01507 dli�. " "' Expiration Commissioner 09/08/2014 �T �� /�( �Office of Consumer A airs n Busmess egulahon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119n014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 — Update Address and return card.Mark reason for chunge. �nf O mNayn Address Renewal Employment Lost Card C0a afCmsumer ARaIn&Baslaeu Rrguledoa License or registration valid for ludivldul use only ME IMPROVEMENTCONTRACTOR - before the expiration date.If found return to: 'AtiOffice of Consumer Affairs and Badness Regulation � �0 t73245 Type: 10 Park Plan-Suite 5170 ExplratioM gry92014 Supplement::eM Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK EAST DRIVE ` .. WOONSOCKET,R102B95 Undersecretary Not valid witbout signature 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 I_ l/(. ( 4/ �dy ,as Owner of the subject property hereby authorize R�rviw� ��►,�e-�'�ew �'""� "''rNE kl4 to act on my behalf, in all matters relative to work authorized by this building permit application for: 5 Lo4is Cr1+tiarvis, MN a3_-b� (Addresr�of Job) 13 Signature of Owner Date ow�.�114- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Usersldemnik\AppD=U.ocal\Microsoft\Windows\Temporary Int met Files\Content.Outlook\QRE6ZUBMEXPRFSS.doc Revised 053012 Town of Barnstable Regulatory Services Thomas F.Geiler,Director ,_ • r, E BARNSrAASS. ' Building Division 4 iOtFp r��a Tom Perry Building Commissioner q 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax:05'08 7�90 623b-----a COMPLAINVIN UIRY REPORT Y Date. by: : d� Rec Complaint Name: Map/Parcel ` Location �- Address: al� vi'/ do �ig / Originator Name: 7 AX k / Street: I/V)� Village: ��State: Zip: U� Telephoner Complaint Descri �6L 7;r 4 P J LO ;) OZ--F �Vo � 74 z ��S FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached Q:forms:complaint ji IIJI 1, 1,,111 4? ­Nm �F Le I ij' ............. '24 won TIMM 'a4 USE ""I Two R'� .............. 'All Usk 0 14,4*51 4 VIM oi W'W, 1c, T 6 V �A, �P�i64 PON ZA4 v""'am 00 1-110�,"OE "'g;gg, - -,RTIFt( SP ....... -MM y ...................................................................... po� q�i Pow .............. TWO fi-f V'i'*............iiii "T, N",�r �t OW, .now aw mwmm _00 Pon otm V 'g","42 .. .......... IN M0,115 Jr,, Qy—W, T n 1—y Z "'Tvf ..........- -V % W&L 47� psi 'Am- "I.......... E_I Ay 't 7_72, 3, �JY Vat',510 .......... ""02% lid T,tos'�I` 'M' egg "'U IN g ig Avj" .......... ..... .......... Humn ON SW gig rlrlrlrlrlrlrlrlrlrlrrrlrrr""",""Ill""I'l"-"-"-"-l-l-"-"-"-"-,'-,'-I............................'Ill""Il"",,""ll'I"""""""",, 62"A&I at:' ................. :L too I ­ Mr_."�' tog OWN M [F "Oh FM V r, 7K _'AM; 'W'+(_',�t. �R 'E, M ..Ipy WIVE ..... Pf" .......... UNPIN, HWI I.- W 2F d TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel f Permit# Health Division `%�`V� %tr krS�a�`� Date IssuedUN L� Conservation Division � (o �-� ' �j�a� Application Fee i 6F� 9. 12 Tax Collector A Permit Fee Treasurer Planning Dept. CONNE ACCOUNT Date Definitive Plan Approved by Planning Board #� Historic-OKH Preservation/Hyannis Project Street Address Village Owner 12 jG�2 -^c.�� Telephone Permit Request & Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation tr 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:0 existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address f�_ � �z ���-t.� -�L. License# _ O O Home Improvement Contractor# /D Worker's Compensation# /iG�'J�'_3V9 317 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5— FOR OFFICIAL USE ONLY s , I PERMIT NO. DATE-ISSUED f; MAP/PARCEL NO. Al ADDRESS VIL'L''AGE ) ± OWNER , f I, DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE f ELECTRICAL: ROUGH FINAL;, PLUMBING: ROUGH r FINALS GAS: ROUGH t'9�/ k FINALtj .< FINAL BUILDING 3 l DATE CLOSED OUT ASSOCIATION PLAN NO. .t ' r The G`otrimanwealth of Massachusetts Department of Industrial Accidents Office oflnyesfi98tfans . 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance AffiXXXV:davi INNIN// --location hone# •::Z. // 7 2. •I am a homeowner gelformingall work myself ca am a sole Io rietor a ad [] I nd have no one worla�a in //%%/ //// � om ensation for my eI5 C .�.,. •n:; Y?,n; Y:S.t�t�:::�;:•r,<:>:G�•".+,';`t:. +";?`:'r ,.<?`;`Jcs.`•Y},�{;";�:r'+•'`' 1���3i�t'^?;•'•i•r,••3•;�;: •di p work g...... ?:<: ::<:i.>T''w ,..Y.v. ? •.:-.}•}{}?+!::r:x+•^.{•:.%•., .}fi.: ?8 ..}d.,.i�.•r- 1 er. 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I mmdersfsmd tlisit a' copy of statemeatmxy be forwarded to the Offi ormatian pr-ovided abnue_isscr 'u_id coirect I da hereby-eekomndertkepains-and-penalties-of-perjury thath¢-in f Date PFione ' Priat name ��'•�'' • ' 6fH.clal us a only do not write in this area to b e completed or town oifidal by dty _ pertnit/iicense# (3Bui1dingDep,r ment city or town: ❑Licen.9ine B oard❑selectmezes omc: cantactperson: • Information and Instructions Massachusetts General Laws chapter�152 section 25 requires all eemployers va oy ersonm.the serviceers' compensation for of another under nay contract nlovees. As quoted from `Law , an employee is d fin ryp .. nfhire,'express or mope or or , association, corporation or other legal entity, or any two or more of An employer is defined as an individual,�artners hip _ in a ioint enterprise, and including the Legal representatives of a deceased employer, or the receiver or the foregoing engaged trustee of an individual,partnership, association or other legal entity, employing employees. However the owneous a . dweniDg house having not more thanthree apartrnents and who zesides therein;•or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or onthe grI .. or 'shall not because of such employment be deemed to be an employer. •' building appurtenant thereto NIGL chapter'152 section 25 also states that every state or local licensing agency shall withhold the issuance Sr 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 co�verage required. Aanaitionceo public h t� 6r the' comm.onwealth•nor any of its political subdivisions shall enter into any P 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 th ox that of iasuranPe as lies all affidavits your company names, address and phone numbers along with a certificate _ _ _. submittedto the Departmeat.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The•affidavit du d*be returned to the city or town that the application for the permit or license is not the D artment of Industrial Accidents. Should you have any questions regarding the"last"o �ifyQu being requested, eP ber•listedbelow:.' - are r egaired,t6 obtaia.a workers' cA' eensatioiz polioy,please call file Department afthe num . . . ,,. City or.Towns . ••1.1.::7�LV be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom oft e . Please Investigations l�to contact you regarding the applicant. Plea�ser affidavit for you to fill out in the event the Office of Investig th e'rmit"fh�cense nupabei which willbe used as a reference number. Tfie affidavits mayie re ��_to•a. e to fill be sur ,. - -��' "eats have been made the DepartaientbY,mati or FAX unless other arrangem ^,,,,.• • -� investigations would like to thank you in advance for you cooperation and should you have any�,uestions. . The Office of ,.s. .. _, .,. ..,, - please do not hesitate to give*us•a calf. NP The Department's address,telephone and fax numb er. r.. ., .. : . ....... .�.,... The Commonwealth Of Massachusetts Department of of Industrial Accidents ptffce of lnyestigatlons 600 Washington Street Boston,Ma. 02111 , fax#: (617) 727-7749 ii• f6171 727-4900 ext. 406 409 or 375 Town of Barnstable Regulatory Services sMaxsznsLE, Thomas F.Geiler,Director 1639• Building Division lED Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 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 which are adjacent to building containing at least one but not more than four dwelling t or to structuressuch residence or building be done by registered contractors,with certain exceptions, along with other requirements. _Estimated Cost Type of Work:, ��� %� " e z Address of Work: C Owner's Name: 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 ROVEMENT WNOT CONTRACTORS FOR APPLICAB PROGRAM OR G ARANTY HOME IMPFUND UNDERM 142A. ACCESS TO THE ARBITTION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: �/� 7� � �•" n Registration No. ate tractor Name OR Date OYrner's r;ame RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x .0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost 11J Nw NSTR,U�.aN,ry�RF y.:. S®R AR,T�jU Res 1g.�p�,y„�O r 'ry �Y/�B ��(�j�,q+8��x0 \ Board A u. r.9 egu atidns an Standards HOME IM,PPROVEMENT CONTRACTOR Regis tr�ip: 104499 �. \ 14/2006 j. to Corporation ART DOLGOFF I i ��n it A Tk ur Bo" y1j 19 McCormick Dr. #! W.Barnstable,MA 0 Administrator a i n //,, r: Engineering Dept. (3rd floor) Map Sv Parcel u v Permit# 2-0 2 O 7 House# Date Issued Board of Health(3rd floor)(8:15 9:30/1:00-4:30) Fee 0�2.e':aG Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) IHE Definitive Plan Approved by Planning Board 19 ; RNSTABLE. 1639. TOWN OF BARIVSTABLE Building Pit Application o Project Street Address Village A54 Owner . C�iG{/1` o C�C� �6>'!6 tJGyt� Address Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ D O 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 b Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other v Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) SONumber 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 CJ Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name ��-2r _) F Telephone Number Address �, ) -T& Lct,!�,6-y\ (f License# Home Improvement Contractor# Y)c�Q;S � Worker's Compensation#&2f/I,6Z (0 y 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 TOlc�/Y� SIGNATURE JDATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) J F• :F ti FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. f 1 t ADDRESS VILLAGE OWNER j DATE OF INSPECTION: FOUNDATION . r FRAME '1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL / 4 FINAL BUILDING DATE CLOSED OUT F. ASSOCIATION PLAN NO. , t °F SHE Tp� The Town of Barnstable • snFuvsrnsLE. • 9� ,0� Department of Health Safety and Environmental Services .eIEDN►o,�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. Type of Work: Est.Cost Address of Work: 5 GGGp J�` Cwbc.�0 Owner's Name 'ii 1 Cc/l ��m/�3 C>C.y►�1 Date of Permit 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: ! A Aq(!5 _ .. .I /cat ct �S Date/ Contractor Name Registration No. OR Date Owner's Name ` The Commonwealth of Alassacrhuscas � i� ;� -;--_= _.- Department of 1►nlustria/Accidents r Office Of10=1fgaUonS l:w 600 «avNitrtwi Street •� tic-. � Bt►ston. A1u.vs. 02111 Workers' Compensation Insurance Affidavit Applicant information: 7 _. Please PRINT 1eb,Gfi:: name• /Y}!il> �✓(��c �—e� location: '7I ��2�1 Can Old city 1! d?6 M-6 4 Phone# 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity . -.,..;+w}-r.,---..n. .. �� .avr.�s+raS.�x:arr.ae�mr.+•l�g•n,✓..;+ -r�r....�.,.a+...era'tP'.m,++m. •...w.rn ..... ..�t ;..mr*<ti^--�:r.,a�• •--.- .,_. I am an emplover providing workers' compensation for my employees working on this job. company name: �`✓«a'��� address: city: Phone#: insurance co. C I �� 7ZJ oC� 601icy# we 1 am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#: insurance co. 120licv# f... .•. �. ..:ri..:•-�:.. y�L^. _......_ : -�"Y'^.:^ _:^:.�......._f-�•-2ti�-r� ,r. �,.^S•y ,5��,}•. ^'T'f�.i.�; .,..p..y..;.t_.L - . - _•�G..+l.:�:u_:....w.rah_.r:i�JY�..w.w.l�n.iir.rrb.iSti!S:_ .. ... .. _�. s company name: address: city: Phone#: insurance co polio'# _..._._.__r. �..._.. . �. ..7_.. :Attach additional sheet if necessary;« ,r- _ � � . � �•� _ �,. .,,,.,.. '*� at=":�.:�� ` Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to tic Office of Investigations of the DIA for coverage verification. I rlo herehr certify lilt rp !' s and n ties of perjun•that the information provided above is true and correct. Sicnature Date Print name �� Phone# .�..r. .�..�.. r. c icial use onh• do not write in this area to be completed by city or town officialy or t,wn: permit/license# I"(Building Department F ❑Licensing Board F ❑check if immediate response is required ❑Selectmen's office F: �`: ❑Ilcalth Ucpartmcnt contact person: phone#; I1Utttcr !: r . Ire\ISed PJAI Information and Instructions Massachusetts General Laws cliapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted loom the "law". an etnphrnee is defined as every person in the service of another under anv contract of hire, express or implied. oral or written. An emplt trer is defined as an individual, partnership, association, corporation or other legal entity, or anv two or more of the foregoing enuaged 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 wli6 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 oil the urounds 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 -.vithhold 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. neither the commonwealth nor any of its political subdivisions shall enter into any contrast 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 cliecking the box that applies to your situation and supplying company names. address and plione numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile affidavit should be returned to tite city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you leave any questions regarding the "law"or if you are required to obtain a workers' compensation police, please call the Department at the number listed below. .--- ,-........,•.,,,.__:.,.... .-•---- -.,. .--....-:.....:r,.....r..�.:_-._a-._...tea.-_=.---,.r....,�:. ....- _..__ . _ City or Towns Please be sure that the affidavit is complete and printed legibly. The Department ltas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations leas to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. Tile 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 Live us a call. '_..-;y,v_r.•.._.,.:. . ._-.,.._..v...r... _�.�„�.cr.-.•.r..:-.r..-. ..-n-,aw...e�......+max.+�.-•a�:s..,.-rewrr+,^{.ts....++..-e... .++w ..*awt..+.�..r-r��•srn•r ter- *r+.aww ww� Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents _« Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 IT �' w v v ✓'1 Y ti.�6Wv.g rr5¢�g �roll fg w y ri fr i r 4K�� s A 1 yr_ _ l y l C J` b r E7yk�`5hf cep, r i7 i.. +w s IT— L, 4 i dJ ` O WEn Engineering Dept. (3rd floor) Map Gl Parcel Permit# House# Date Issued P� ��- Nd t Board ofL3e 3rd floor (8:15 -9:30/1:00-4:36) - y�� �c�• Fee t ✓ll Conservation Office(4th floor)(8:30-9:30/1:00:2:00) Planning Dept.(1st floor/School Admin. Bldg.) THE geetAddress Approved by Planning Board 19 ��; BARNSTABLE. rFO NIP'B`� TOWN OF BARNSTABLE Building Permit Application Village y-t,,(.MA('S Owner 06Y10o6k) Address Telephone Permit Request &C2:Z First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ tit?S-0 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) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Q-9-Gwx C F"Cl � Telephone Number Address `) C,/o-) License# 06 Home Improvement Contractor# Worker's Compensation# Gtt" �/a NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / CaA,YtCAA SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ~ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED , MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. °*THE r, The Town of Barnstable �►aivsras�, Department of Health Safety and Environmental Services ATEc�►�" Building Division 367 Main Street,Hyannis MA 02601 I Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. f� Type of Work: Est.Cost 7' Address of Work: 1 4...,rl t S Owner's Name U/4 J4 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name The Commonwealth of Massachusetts Department of Industrial Accidents ` t Office of/niveS6921/0" 11W 600 Washington Street Boston, Afuv& 02111 Workers' Compensation Insurance Affidavit �pplicant,tnformatton• - Please PRINT lebt�l�s� name: �P v9-tom) =✓lC.�•2�✓1 location: ( J 19-n a son O//1 0 cite 4,r_ 1- /12 -Phone# I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working to any capacity , f` ... mM'!��+}4,sw '•.!N' dTM� "tr.V21y R•. ��+•^--� -r z z .h+�•-•.xra e..•.,r,,�ya�r�.a�.:-•*sue . !�* �rr^ �• k"�y '�."...�.+M..ntpw*^„�"`^,!�'3T•'.' e•+�+�,;�?+-•? :.....+...,....:..::,.7...,., � ._:::,....•:..vs��.re,.««..a:...,u.- '; ,.xy,...., ,rmiur- tiis:.:w: .:..:;...,^. ::L'r:n:rmos.�-�:_.. __,.:.:,r,.. .i....:.�..:......._....__...�...:... I am an employer providing workers' compensation for my employees working on this job. company n rme• address: city: Phone#: insurance co ��&,t Policy#&IC7131.) 017 ...... ....._� .,mot, - - —•....-� �. �,:�,„ ..:..,_.....:�,...... I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company n•tme• address: city: phone#• incur-ince co Policy# .... .. ..._.. n'[ _•:!...,ri`r.•L-=•-�••— :':^Te�", rrT .. �...•c •^.rr, L's'^o^,,�-Faa ra"'v?*^v$�:}' �.'..`�wt 'rG'?. ai i �:.�P •-. .�,z_ _...._......._.,.__... ......__ -.....a..a:.�.c._......::....:s�.3+`s::.:a„�:r�...�m:.x�a•tea..::;'uti�td ��.�.-��_ iva -�.s �, �.'' ;i�.a»+ioaat !c..a.u:c:.�c company name: address: city: phone#: insurance co Policy# Attach additional sheet if necessary r, r,,,a;•xc;,u: Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP N1.ORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereAy certi utder he Ws and nal es of perjun•that the information provided above is true and correct./ Sianature Date Print name J�pt,%J F/I.u.B.� Phone# r.`'ofrciai use only do not is-rite in this area to be completed by city or town official city or town: permit/license# r�Building Department OLicensing Board 0 check if immediate response is required oselectmen's Office r [)Ilealth Department contact person: phone#; nOther (m,sed 195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted front the "law", an etnpl(me is defined as every person in the service of Another under anv contract of hire, express or implied, oral or written. An einpli,per 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 lei-al 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 dwellin- 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 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, 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. ;,. - ; _ - t Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should 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. Citv or Towns Please be sure that the affidavit is complete and printed legibly. Tile 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. Y..y,�e'v.»r�.-»,......._�...._..—^v:.,r..• -.--. eur--r,s...:-.rt•.�...w,s.. +e..• ^,-^c..•rT??*T.•q-o_:.s..w..wsev.•4.us?ev*+�+''. .r+.�+ ...'_. .. .. .,. ". .... ._. ,- .... 77a!!►+a.as+�a.ca^s'.+r+x3.1!^l.. !t'w`�+•\'nAa�.r.f>�.,-wnq The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 a ' tt. S ((��{{,,``,, V•Y�1 ry..4y.,•-a 7, S •-'My itjh, r �S+ ,: h� �' 1 j � �� � x � �} y.` "a5+ f•= r *Q. .:�, - L :r^tv ri -t +s� a i x c v:. - t .�" ! Y I_L/.a/�r/ t. �•�1 /���?Y2*�:. He.: l�j C .3�Zej k 4. �.t ttcs YtiW c Y-.• r + t`T2 f." - yEyi..,� �m ��^r q•1 t, ,' �. S+y A F=) rY - t �,�° is .t" �� :i T.•t i '-.i t : .t ", IUr1E. REGVS'T Dv�iVlENT ,evNfiFtA 1 Qh��"y i RAT �s�x=• 3o'ard >oft 'Bua Ming R'sgulat'ions sand Stan ar+d + k13O , r s O n e As h k�urton,-.p l a`. e r x t 3x< s ^ � � ix t n �,Sa r tsa s # rX 5ij Sx .ru i Bostc Massachusettsk 02108 lx -`"5e M�.'� li5, i s tlj s fi :i Y t i ,t hiO'M MPR--WEME-NT :.GO 'r�RACTOR `- c � r t Rego. trat�.op 7, 125Gb � Expiration 04/06/-9� tii3� � � �J� 5 •+ '� { x� � r 4 i x° M" k. x Y rHOME IMPROVEMENT CONTRACTOR Y Registration 4125A 'E S _ s. aY 'h Type DBA i fir fi 40,- EANr.�C.14�FRASER �' ! . s~r + �.5 �dr4 0dt 97 ,=:DEANS"C. :FRASER Expiration. 5'r1 TARRAGON s:CTF GUTUIT . MA: .O635t. >r r xt DEAN C-ERASER : F ' DEAN C. FRASER #1'x 't. yY ? �,. ` ceMco.�i *�tm71 TARRAGON Cl ADMINISTRATOR UI1 .t'1A 02635 l .7• t ,� :. s 4 ,... .. r ., CUT