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HomeMy WebLinkAbout0124 MEGAN ROAD 7,1 Application number �o V .0 Fee � .......................................... Building Inspectors Initials-(;. .............................. OCT 12 2018 DateIssued..... ......................................... T( &IN 0� BARNS FABLE 5- Map/Parcel........ .............;?.il......................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1-,I q e-q 14 YAA(P4 S NUMBER STREET VILLAGE Owner's Name: 0—a m 41 n 4-(rt e o n, Phone Number 14 Email Address: Cell Phone Number 7 3 G `�` Project cost$ 5� b Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application fora building permit in accordance with 780 CMR 6 tom''/Owner Signature: Date: TYPE OF WORK ED Siding Q Windows (no header change)# F-1 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review 10 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Ya l- CONTRACTOR'S INFORMATION Contractor's name --J Cl e� Home Improvement Contractors Registration (if applicable) # /�d £f y' (attach copy) Construction Supervisor's License# C 6 /%lG (attach copy) Email of Contractor Phone number Pp F- 717"� � ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER .....................................................:...... F�r *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature LDate All permit applic ons are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information doe ng Please Print Legibly Name (Business/OrganizatiorAndividual): 36 CheckerbegyLane Address: West Yarmouth,-MA 02673_ City/State/Zip: 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.09�am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• t 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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. of repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other 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 is the policy and job site information. Insurance Company Name:_ Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 thepai nd penalties ofperjury that the information provided above is true and correct Si afore: Date: 2-0 1 6 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 thf6e'apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do'mai'tenance,`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 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 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 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 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 burn 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 Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-877-MASSAFE Fax#617-727-7749 i Revised 4-24-07 www.mass.govCdia N A Commonwealth of Massachusetts Division of ProfessionalrLicensure Board of Building Regulations and Standards Construcfiw S hft*r Specialty CSSL-099166 E*plres 01/24/2020 "'CV wy MW JOSEPH E KING > g �� 36 CHECKERSERRY LANE,' 1MEST YARMQUTH MA�`02673CL '. Commissioner Office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to. TYPE:Individual Office of Consumer Affairs and Business Regulation Registration, Expiration One Ashburton Place-Suite 1301 1508899 a 05/04)2020 Boston,MA 02108 JOSEPH E.KING - s ' JOSEPH E.KING 36 CHECKERBERRY Wo—vaild Without re WEST YARMOUTH,MA 02673 Undersecretary J retary CAPE COD INSULATION FISIR GLASS HAM LISS SPRAY FOAM 3USPINOI0 YATTS OUTTIRS INSULATION I:III INOS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 r Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation,,-hle. perforiried 8?= completed the insulation and weatherization work at the property listed h;elow. CapewCod Insulation did this in accordance to the specifications listed on the buildi% permit application. All work has been inspected by a certified Building PerfornQ 6e Institute 1:0 '(BPI) inspector. All work preformed meets or exceeds Federal &•State Req .rements k Property Owner Property Address Village CAxot yx) AeAr) /l Y Alef44.1 AD fy1.4*fI S X= Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (>C) (z6 ) ( ) (�) Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ( ) �N�►^ (VOr !l /fier lCOr,41ed y Sincerely rry ssi r, President Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � �j TOWN 4F BARNSTABLE I� Parcel �`-' � Application # Health Division M 8• 54 Date Issued _rrll Conservation Division Application Fee �y Planning Dept. Permit Fee DIVISION Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ✓*I dYl e- Village �/�,�. /,S Owner 4Qj2_Vx/ '4Agn" Address Telephone 220 4?_, 5,1- 7- Permit Request_A6Z off' ale��141 Z_-7/oIJ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,2Sw,Q , o Construction Type-�1���� 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 0 No On Old King's Highway: ❑Yes J(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 # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name GlalGi' /� ,?7e�t4l Telephone Number Address d 4 License # Z�)7A Home Improvement Contractor# Email Worker's Compensation # , C��0 / fev/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r - G FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER Ii �. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i DocuSign Envelope ID:D01990B5-8FB7-42E8-BBC3-F8F60BB81CB3 CIPAIIIING mass save COI 0--y PERMIT AUTHORIZATION FORM I, Carolyn Ahern ,owner of the property located at: (Owner's Name,printed) 124 Megan Rd Hyannis (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my,behalf and obtain a building permit to perform insulation and/or weatherization . work on my property. DocuSigned by: 0 w Qu�.vu, KOE21 45131... 7/31/2015 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date ■❑f�ff] 01 For Office Use Only Rev. 12132011 Massachusetts - Depariment.of P.iiblic.Safety. -.:Board of BuildingR6 gulations and Standards .;. Construction Supervisor License: CS-100988 .' HENRY E CASSID ' 8 SHED ROW If WEST YARMOU" �. �J " "' ' Expiration Commissioner 11/11/2015 Y , Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116, Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation ' 1 Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE ` SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 ❑ Address Renewal Employment Lost Card V/ae cpo1"M0WeoeaCC1 11aK1jaacicote Office of Consumer Affairs&Business Regulation License or registration valid for individul use only UVOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ;153567 Type: Office of Consumer Affairs and Business Regulation xpiration 12-/5/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION, HENRY CASSIDY 18 REARDON CIRCLE: SO.YARMOUTH,MA 02664- Undersecretary, Y qNvalid 4 The Commonwealth of Massachusetts Department of Industrial Accidents --- '! Office of Investigations 600 Washington Streit Boston, MA 02111 t k= www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informations Please Print Legibly Name (Business/Organization/Individtial): t..,✓`a � � U AddressA IS li 9, City/State/Zip: l! ` �Vft Phone #: -1114 114 Are you an employer? Check th�appropriate bog: Type of project(required): 1. I am a employer with 115 - 4. ❑ I am a general contractor and 1 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 workingfor me in an capacity. employees and have workers' y p 9. '❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their I I. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P • 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. Other (� comp. insurance required.] *Any applicant that checks box 91 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 is the policy and job site information. C, `� . Insurance Company Name: V � e �✓ , Policy#or Self-ins:Lic.#: j'� Expiration Date: • � / � G2�a 1 Job Site Address:l,2,re —r �9�.t� /2a City/State/Zip: 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 insurand coverage verification. I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct. Signature: C Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: CAPECOD-27 BDELAWRENCE ACORO" DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/30/2015 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 poiicy(les)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 CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 IAIC,No Ext: AIc No):(877)816-2166 South Dennis,MA 02660 EMAIL ADDRESS: INSURER(M)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERB:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURERC: 18 Reardon Circle INSURER D: South Yarmouth,MA 02664 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�TR TYPE OF INSURANCE DD R POLICY NUMBER MMIDDY� MMLDD//YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR CBPI3263063 04/01/2015 04101I2016 PREMISES Ea occurrence $AMAGE TO RENTEU__ 100,000 MED EXP(Any one person) $ 5,000 4 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESP,ER GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCE00431901 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (CORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 18 Reardon Circle South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Engineering Dept. (3rd floor) Map Parcel �5 A Permit# 2557- 1 House# Date Issued / Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Iq S Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) SF. TIC SYSTEM MUST BE . Planning Dept. (1st floor/School Admin. Bldg.) INSTALLED I LANCE Definitive Plan Approved by Planning Board 19 WIT ENVIROWIT AND TOWN R EO S TO WN OF BARNSTABLE Building Permit Application Project Street Address 2-4 ME"I's Village ,(Q n n j-s Owner (' }(ZO Lyti( N&*,( Addr s �2 Cvh- Telephone `n 1� 90_ 7�`,0-- ° Permit Request ( p j Lf A ) q UU First Floor square feet Second Floor square feet Construction Type W eon Estimated Project Cost $ l ub p Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 12 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes [ANo On Old King's Highway ❑Yes C No Basement Type: raj 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 3 New Total Room Count(not including baths): Existing J New First Floor Room Count 5 Heat Type and Fuel: UGras ❑Oil ❑Electric ❑Other Central Air ❑Yes To Fireplaces: Existing 1 New Existing wood/coal stove ❑Yes g Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None 9 Shed(size) ( d " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name 1,r2,�� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE C21V-4 -- DATE BUILDING PER IT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - t; PERMIT NO. DATE ISSUED: ; MAP/PARCEL NO. fA ADDRESS VILLAGE ' OWNER - DATE.OF INSPECTION: _ FOUNDATION FRAME - INSULATION - _ FIREPLACE ELECTRICAL: ROY�(,H FINAL PLUMBING: RO[7 iTl- FINAL GAS: Rii3` FINAL `} FINAL BUILDINH "" DATE CLOSEDio .M r - - ASSOCIATION PRN I . oFTMe rqy� . . The Town of Barnstable • .�uuvsrns[.e. • 9eb MASS. ' Department of Health Safety and Environmental Services 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: `-N--C,L P—P, n51rue-7l I> 1J Est.Cost Address of Work: i ZLy rY1� P—D Owner's Name CYft"&L-4 4 ` X, Date of Permit Application: ��' T 92 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 Cunrnrunwctrllli of:11ursuchusctts Department of Iudustrial.9ccidcnts OfffceOf1109=692118ns 600 f f'ashhig tun Street Burton. Mass. 02111 Workers' Compensation Insurance Affidavit. Llppiic•tnt information• Please PRINT fe-ihly name: ��I✓y�yl� s�'�'� Incition• M ?—&irN OD 9, 9 .r n city Ai'j'\1 1 S nhonc# 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity _..—re._.---_....._....r...—.-.�.rv.+...f'w�4r1 T'.'��./,7r!+'•:.i/T���...� �•.�nT'•�•^. ..�.ww+.._...__ [J 1 am an employer providing workers' compensation for my employees working on this job. cmmvanv name: address- city: rhnne#: insurance cn. Itnlicv# [� I am a sole proprietor. general contractor, or homeowner(circle atte) and have hired the contractors listed below who have the following workers' compensation polices: cnmPanv name, address: cin•: nhonc#• insurance co Poliev# �- •t.`..- .... Yw1' _ � `•��.....:••ram -_ -- _lr�Y�::�-.\�iT••l^.��w•y. ..�T�...-- .....�.....i�-i_... . comnnn%• name• adtlress: rite: Phone#• insurance co, # Attach additi onnal sheet if nrecssary, ,•;•._ F �!' '� **-- - _ _"M ''�""'•` '=•^- �T' _' -- _t i f _. --- •(� •J.r'`t..Y•�� .- a�.0'iY w. _rFW_� -_'r��ai.111!'�.i.I�i!.Wtwr/L Failure to secure coverage as required under Section 25A of h1GL 152 can lead to the imposition of criminal penalties ol'alline up to S1.500.00 andiur unc scars' imprisonment as well:ts civil penalties in the form of a STOP 1VORK ORDER and a fine of SI00.00 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 hercbr cerrif-under the pains and penalties of perjuq that the information provided above is true and correct. Si_nature Date g/9/ -7 Print name 6/1Z,AV AH6eW Phone official use unh do not write in this area to be completed by city or town official city or town: permit/license# rjBuilding Department OLiccnsing board L o check if immediate response is required c3Selec[men's Office 1-_ C311calth Department contact person: P hone#: r-1Uthcr i. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers* ccmi:ren slit ion for th employees. As quoted from the "lay '% an enrplt{ree is defined as every person in the service 01 ancrifier under an%• contract of hire, express or implied. oral or written. An emplorcr is defined as an individual. partnership• association, corporation or other legal entity, or any twee or me the foreaoin�a, enuaged in a joint enterprise, and including the le-al representatives of a deceased employer. or the recciver or trustee of an individual , partnership. association or other legal entity, employing* employees. However t! owner of a dwelling, house having not more than three apartments and who resides therein, or the occupant of the d\\!cllin`,, house of another\vho employs persons to do maintenance , construction or repair work on such dwelling he or o» the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ: _ � P MGL chapter 152 section 25 also states that even, 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 -%f•ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. 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 require to obtain a workers compensation police, please call the Department at the number listed below. - City or"I owns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pl, be sure to fill in tite permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. Tite Office of inyesti=ations would like to thank you in advance for you cooperation and should you have any questic 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 Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Land In ...AARN51A.B.LE...................... Belonging to ...Charles R ..Metcalf,,,,,,,,, Deed in Book ............... Page........... .. .. .... .................... . Land Court Certificate No. A?P7.... in Book ..667....... Page ...... InB.a.r..n..st..abl..e..... Registry ..District ....... B Recorded Plan ...Land...Cou.r.t..Plan...No...27099... f.i.i.ed..w.i.t.h..C.e.r.t......No...�§l�7 Date Plan jAY..IqZZ......................... ...... . . .. .... .... .......... in ..Barnstable.. Registry ....PJ.s.t.r.i.q.................. Book ....450....... No. ..V..... Filed Plan No. ....................................... MORTGAGE INSPECTION PLAN WILLIAM E. CROWELL, JR., ESQ. Carolyn Ahern Loan No. 124 Megan Road, Barnstable (Hyannis) A�k Lc.-)-r3 6 1", Q-) 37 9 MEGAN ROAD July 3, 1996 JN 64477 Scale 1"=30, TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION' Please print. - DATE JOB. LOCATION I-Wq m e6 ,9W 4D Number Street address Section of town HOMEOWNER" ? 8 Name Home phone Work phone - PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupier dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, 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 Offic: on a form acgeptable to the Building Official, that he/she shall be responsif for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE _ 00-6� -aAeltl APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. - 1 HOME OWNER' S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to" do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of iwarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/bier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the ' lazt page of this issue is a form currently used by several towns. You may --are to amend and adopt such a form/certification for use in your community. ■■e ■■■■�ee�e■ee ■■ei!■■MEN ■■■■■■e■■■■■■■e Ie■■■■■e■■■■■ ■ ■■U■■■■_■■■■■■■■S■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NNE WWWWW" 1ii1■■■■■■■■■■■■ ■■■■■■■■■■!■!■s■■■!■■■ems■ ■ ■■ m■■■■■■■■■■■■!■ 1[■■■■■■■■■■■■■■■■■!1!1!■�■■■■■�■■■ ■■■■■■■■■■■■!:7■mil■■■■■■■■�■■■■�1�m■elam mmmorma �+�■ ■mo■■mo MENEM �0�■■■■■■■■■■� ■i��■i�i■■■ ■■■e■■■■ ■ommEmm■ . ■.' ■■■■■■■■■ ■■ Jam■■■■■■ee■■■ ■l r.,_.._...._ . . _. ....r..�!!■■■■■■■■■■■■■ MEN, �■■■■■ee■s■ ■ ONE ■ MEMO - -m■m ■NNE m,� ■ �2 Assessor's map and lot number ............... ........................ SEPTIC SYSTEM" MUST BE INSTALLED IN COMPLIANCE VUH ARTICLE II STATE y� r. Sewage Permit number ...........................�... ' SANITARY CODE AND TOWN RECULATIONSg ; OFT11ET0 TOWN OF BAR.NSTABLE- i SAUSTADL p6 9 � BUILDING INSPECTOR �n aar°'• ��APPLICATION FOR PERMIT TO ..... ......��r'./ .v. �?...:............................... ....................................................... TYPEOF CONSTRUCTION ........................ ..... .. .......... ....................................... ................................... ....+.... .. ........19. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap lies for a permit according to the following inform ion: Location ....... . 1�.......... ............................. .. .. ....................................... ... .................... ................. ^ ProposedUse ......................... .........................:.................... .......... Zoning District ........ .... .........................................Fire District ...... ....... ................ ....... .............................. .... . � ��. �Name of Owner /Address Nameof Builder ��.......1�........................................................Address .................................................................................... Nameof Architect l� s'.......................Address ..........1�..............?....................t....................�............ Number of Rooms .......1..1.......................................................Foundation / ... . ................... .................... Exterior ....... ...:..................... ................. ....Roofing ..... .....�; �...... .............................. Floors .....................Interior ........... .................................... ................ ....... ........................................................................... ... ..................................Plumbin ......H eating if ........... g celo Fireplace ........................................Approximate Cost 3 �v v Definitive Plan Approved by Planning Board ___ __ _ ____ I__19 Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to-all the Rules and Regulations of the Town of Pq table re rding the above construction. Name ....................... r Dacey, William E., Jr. 16428 one story No .................. Permit for .................................... single family dwelling ..................................................................... ........ ... Locat,o Megan Road Hyannis ............................................................................... Owner William E'..Dacey, Jr. .... .......................... i frame Type of Construction .......................................... Plot ............................ Lot ................ 6......... I t Permit Granted J .. .. 5 19 73 .. .2............... Date of Inspection ......................... ..........19 Date Completed ......�.? L.9 .....19 a PERMIT REFUSED ............................................ ................ 19 ............................................................................... ................................................................................ ............................................................................... { ............................................................................:.. Approved ................................................. 19 ............................................................................... .