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HomeMy WebLinkAbout0070 OAK HILL ROAD Town of Barnstable *Permit Expires 6 mq s from' e d e Jl' Regulatory Services Fee ° sARxaTnatA M"M 6I9. Al Richard V.Scali,Director . Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3®- 3 Property Address n (residential Value of Work$ Soo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address n'1 �(PL � 0. O VjY k gat LJ S Q Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance "PRESS Check one: ❑ I am a sole proprietor JU'r 2 2 2015 I am the Homeowner O v U ❑ I have Worker's Compensation Insurance 'u OF BA RJ V S I.A g LE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ e-side Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows 610 #of doors: ri ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 .F The Coulnllonnwvealth of Massachusetts Department of Inrdustrial Accifdennts i Office of Investigations r,. GOD Washington Street Boston, M4 02111 ' ttythr.mass.govfadia Workers' Compensation Insurance Affida-vit: Builders/Contrac..tors/ElectizciansMumbers Applicant Information Please Print Legibh Name(Business OrganizatiawMvidual): Address: 9 D J6,9 City/State/Zip: a n Phone#: Are)on an employerY Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full andlorpert-time.). * have hired the sub-contractors 6. ❑New consttiutiou 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 an c aci employees and have workers y aP t 9. ❑Building,addition [No workers'comp.insurance . comp.insurance,.,. required.] 5. ❑ Wee are.a corporation and its 10.❑Electrical repairs or additions 3.( I am a homeoumer doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per a�1GI. 12.❑Roof repairs. insurance required.]1 c. 152,§1(4),and we.have no M AA employees.[No workers' 13.0©therA LX comp.insurance required.] 'Aay applicant that checks box 41 mast also fill out the section below showing their wwkers'compensation policy infottstioa f Homeowners who submit this affidsvir indicating they are doing all work and then hire outside contractors nrust submit a new affidavit indicating such- :Contractors that check this box trust attached an additional sheet showing;the name of the sub•comttuctors and state whether or not those etttitias have eatployees. If the sttb-€antractots have employees,they trust provide their wroakers'comp.policy clamber. I alit an elltplOver that is proigditig ttrorkers'cottipensaiioll ills/lraitce for atv ettiploy ees. Below is the polky antd jaib.site information. Insurance Company Name: Policy:«or Self-ins.Lie.4: Expiration Date. Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date). Failure;to secure coverage as required under Section 2 5A of MGI,c. 152 can lead to the imposition of criminal penalties of a foe up to$1,500.00 and{or one-year imprisonment,as well a,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 IlereBy .erri,5'nn er the pains and pen hies of perjury that the irifornialion plm ded above is true aiid correct Si tore: /� Date: toWq W30 a�c lv/a0� Phone M (O" Offtcial use on1k. Do not write in this area,to be completed bt'city or town officiaL City or Town: PerrnitfGicense 9 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City ffo-au Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Town of Barnstable Regulatory Services ppVIE Richard V.Scali,Director 4 Building Division " � . ~ Tom Perry,Building Commissioner mass. i639.� a 200 Main Street, Hyannis,MA 02601 Fp�y www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE: �/"fi JOB LOCATION: t l Qv14 ytf number �} l stye t �e village "HOMEOWNER": U/Q- �C p "7 LI&,7 naMe home phone# work phone# CURRENT MAILING ADDRESS: 022 Pl O /town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection p cedures d requirements�t he/she will comply with said procedures and requirements. gnature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot ` proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHRTXPRESS.doc Revised 040215 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (� Y /1 Map 0 Parcel /`� 7 v Application # Health Division Date Issued (2 Conservation Division Application Fe` Planning Dept. Permit Fee '� Zo Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address -70 OVMAk j' 9-J Village 1 HvAt-w t S Owner Fr A tjl� G�J'r V Address 76 QAV 4A i Telephone SOT' 771- /c/ 7() Permit Request-W1e*,V rAzP,tidN— PA& R Wu 64USe 4o C S4e_s - hM tZ 30 ND Aic ced I04Wk IL-Nek to 64SCMeWA CeL 5461 C6� l wcr S*,!�-\ fll}"C— e3k.A1J4w- wwV�s c�-� ctill�lo� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation op 0 — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family JQ Two Family ❑ Multi-Family (# units) Age of Existing Structure ICI to` 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 3 Number of Bedrooms: existing _new - a v ks Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other t a, Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No co . Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ Qxisting r® nevP size_ M 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) 14t y c�ssz�y Name CPrK CO& TN 3v\4t W Telephone Number SOT- 77 5-18- Address License # /C b 9 � YqAtiNrs N►A-. D&A0 1 Home Improvement Contractor# IS3 SG-7 Worker's Compensation # (,v-cR O o S 2.S 110 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i A' FOR OFFICIAL USE ONLY y APPLICATION# t DATE ISSUED ` i s MAP/PARCEL N0. r ADDRESS VILLAGE, 'r OWNER ., s DATE OF INSPECTION: FOUNDATION FRAME ` INSULATION J.I 4 FIREPLACE i ELECTRICAL: ROUGH FINAL 1- PLUMBING: ROUGH FINAL- .J t GAS: ROUGH FINAL `7 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r J c 1 19d V�n� 0 Park Plaza- Suite 5,170 Boston,Massachusetts 02116 on Home Improvement C�tractor Reglstrati Registration: 153567 Type: Private Corporation - -- Expiration: 12/1512012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 ;Update Address and return card.Mark reason for change. Address U Renewal Employment [] Lost Card i -CAI 0 50on-W04-G1012i6 License or registration valid for irdividu1 use only office o Omer Affairs us ne Regul lion before the expiration date. if-found return to: HOM Type: office of Consumer Affairs and Business Regulation Registration: 153567 10 park Plaza-Suite 5170 Expiration: 12/15/2012 Private Corporation Boston,MA 02116 OD INSU!ATIO L TNG, .:_ HENRY CASSID`F''°;.::;i 455 YARMOUTH t and ith t si tore - HYANNIS,MA 026d, F _ : Undersecretary . ru-tntrnt Ot'Public sat'ctN M1las,uchusctt. Url Board t.r#'Building- Re,_,ulations ,ind $tandards Construction Supervisor License Licen,.se-CS 100988 Restricted to: 00 irU HENRY CASSIDY 4 8:�StiED ROW F���x�� a WEST YARMOUTH, MA 02673 Expiration: 11/11/2011 r - (MIMIi..i'mer Tr#: 100988 The Conxtnonwealth of Massachtcsetts Department of Industrial Accidents Office of Investigations 600 Washington,Street 1 !� Boston, MA 02111 yy www,tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elects icians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: ✓" ! City/State/Zip: Phone #: r0 7 7 A re you an employer?•Check th appropriate box: Type of project(required): I am a employer withQ 4. ❑ 1 am a general contractor and I6 ❑New construction * have hired the sub-contractors.. -.employees(frill and/of`part-time). 7, Remodelin❑ I am a sole proprietor-or partner- -contractors on the attached sheet. ❑ g ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition o workers' comp. insurance ' comp. insurance.x � 5. [] We are a corporation and its 10•❑ Electrical repairs or additions required.] 3.El am a bomeowner,doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other&1 1;0 fW-_ comp. insurance required.] `Any applicant that checks box 41 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 contmetors must submit a new affidavit indicating such. tContractors•that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those cnti tics have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information I Insurance Company Name: + n n Policy#or Self-ins,Lic.#: wc4A 00_7_S9 © Expiration Date: 3G Job Site Address: -20 -(` hkk,\\ City/State/Zip f - M0-S M` , p'd- _,_, Attach a copy of the workers' compensation policy declaration page(showing the policy number andexpiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of.criminal penalties a a 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 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. X.do hereby certify u e pa and penalties of perjury that the information provided above is true and correct. Si nature: Date: �" / Phone#: Official cise only. 'Do not write in this area, to be completed by city or totUn official City or Town Permit/License# Issuing (circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector S..Plumbing Inspector 6. Other Phone#: Contact Person:' i '1 pp - (/S per Main '.I -.•;'; al'.Ll V..li 4"0 �i est ! ain Street u Hvan:�.s, MA 02601-3695 NE.RG .& HOME REPAIR CORPORATION TTY on all lines www.batconcapecod.org .ncapecod.org HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I r e`` 19, C: ;41/22- hereby consent to and agree that weatherization work may be _,.- --done-by-the—Weathenz-ation-P-r-oW--a-m-of-H-ou-siing-Assistance-Corporation--(-he-rein-after-referred-'a�---____-__ "Agency") on the property located at: 7240 014k&a l l rZoj4VAz1AZL fy 43 4 The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping& caulking of windows and doors,insulation of attics, sidewalls &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed. I have read the provisions of this agreement as fisted and freely give my consent. Home Owner: (Signature) - i; i Date: _1 A 26 1� Agent: (signature) Date: HAC approved Weatherization Company: rJ Caliber Building&Remodeling (:OtL nsulation Cape Save Creswell Construction Frontier Energy Solutions Peter Smith . Resolution Energy Rock Solid Construction All Cape Insulation ine tg 9,1508-778-5735 Rogers & Gray Ins. Page: 062 • Client#:4597 CCINSUL CORD,M CERTIFICATE OF LIABILITY INSURANCE °"5 11/2°°"'"Y' / 1/2011 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 WANED,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 Rogers&Gray Ins.-So.Dennis NAME: Margaret Young PHONE 434 Route 134 - "o E>n 508 398-7980 A/c No: 508-258-2102 P.0.BOX 1601 ADDRESS: South Dennis,MA 02660-1601 CUSTOMER IDq: INSURED INSURERS)AFFORDING COVERAGE NAIC# Cape Cod Insulation Inc INSURERA:Peerless Insurance 18333 455 Yarmouth Road INSURERB:Ohio Casualty In Hyannis,MA 02601 INSURERC:Atlantic Charter Isurance Companynsurance INSURERD:Commerce Insurance Company 34754 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. LA TYPE OF INSURANCE NSR POLICY NUMBER MUUR M/DDT MM/D0� LIMITS A GENERAL LIABILITY CBP8263063 04/01/2011 04101/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO NTED PREMISES Ea occurrence) $100 000 CLAIMS-MADE F x1bCCUR MED FRCP(Any one person) $5 QOD PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- LOG - PRODUCTS-COMPIOPAGG $2,000,000 D AUTOMOBILELIABLLIrY 11MMBCKVMK 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT ANY AUTO ' (Ea accident) $1 000 000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS - BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE $ . X NON-OWNED AUTOS (Per accident) $ B UMBRELLA LIAB $ X OCCUR 0001154514645 04/01/2011 04/01/201 EACH OCCURRENCE $1000000 EXCESS L1A6 CLAIMS-MADE DEDUCTIBLE AGGREGATE $1 000,000 X RETENTION 1 10000 $ - C WORKERS COMPENSATION WCA00525901 WC STATU- OTH- $ AND EMPLOYERS'LIABILITY YIN 06/30/2010 16/3012011 X O Y I ANY PROPRIETOR/PARTNER/EXECUTIVE TIER .. OFFICER/MEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT $500MO (Mandatory in NH) f yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $5OO,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors. Certificate Holder is an Additional Insured under General Liability for written contracts or agreements. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment _ ! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD ACORD CORPORATION.All rights reserved. AS668671M65331 MEE CAPE CO IN1� IF MASS f4 ' E ! INSULATION , R 2 9 Fq;-]-, ®®� FIBER GLASS SEAMLESS SPRATEOAM SUSPENDED BATTS OUTTfiRS INSUEATION ..ILU/05 i, 1=800-696-6611 MY f . i Town of Barnstable Regulatory Services Building Division i 200 Main St Hyannis, MA 02601 h, Date: { Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village i Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted I ' Ceilings Slopes ( )• OO (a1C7 ) (jt ) ( ) Floors I 1 Walls ( ) ( ) ( ) ( ) ( ) Sincerely my Ca dy r,President • Cape od sulation, Inc. .11 Of Engineering Dept. (3rd floor) Map .Z.�f Parcel O R-6 Permit# House# Z® Date Issued 3 to G} Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Sd o7s Conservation Office(4th floor)(8:30_ _9:30/1:00 2:00) �4(q T Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC 8Y 8� INSTA .�.! Doinitivtrcllan Approved by Planning Board 19E ENVIRONM. AND TOWN OF BARNSTABLE ``R`'e = Building Permit Application Pet Address Village V \ ®� Owner Address Telephone Permit Request © D First Floor square feet Second Floor square feet Construction Type 0 ®0� �FM� Estimated Project Cost $ L{L\0 I Zoning District Flood Plain �\ Water Protection Lot Size, 'A i_ Co 26 Grandfathered ❑Yes ❑No Dwelling Type: Single Family �, Two Family ❑ Multi-Family(#units) Age of Existing Structure 02Ak Historic House ❑Yes No On Old King's Highway ❑Yes 0,No Basement Type: *Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1�1 & Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing S 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 `4,0i1 ❑Electric ❑Other Central Air ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) W Attached(size) ❑Barn(size) ❑None PLShed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes PjNo Jf yes, site plan review# Current Use I z 5, e Qg Proposed Use Builder Information Name t- ��,aAe"` Telephone Number ', - 4-�(o Address Scl nr T. �-, q License# CQ e-V U Home Improvement Contractor# Worker's Compensation#-4 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 BETAKEN TO ` z, SIGNATURE DATE BUILDING PERMIT DENIED FOR THE 064LLOWING REASON(S) I FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED ' MAP/PARCEL NO. -+ ADDRESS. VILLAGE - {' OWNER t DATE OF INSPECTION: J E FOUNDATION ' ' FRAME _ INSULATION FIREPLACE - ELECTRICAL: ROUGH. FINAL ~*' PLUMBING R6IGH FINAL GAS: RCGH FINAL -*iFINAL BUILD ' i r� rn DATE CLOSE ! _ ASSOCIATIOI'�P N I r _,i^°`_ � ✓/ee �oo�nmo�uuea�i o�./�,craeaa/uaelld I . =" _> Restricted To: 00 34 8 53 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None Aumher {' Expires: 1G - 1 & 2 Family Homes . Restricted To 00 Failure to possess a current edition of the Massachusetts State Buiilding Code ` �{ ,,,.a► (� ,DEAN F STANLEY is cause for revocation of this license. - - 359 CAPTAIN LIJAH RD ` �' CENTERVILLE, MA 02632 °PYRE t The Town of Barnstable u►xtvsTnsc.E, 9eb "� �0�' Department of Health Safety and Environmental Services ArEOnn►'t° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner I 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: O DA �6= \� - `\ _�J MASS Owner's Name 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 agent of th r: 9)G k 0 D�o� D to Contractor Name Registration No. I OR ro / / ah-kk Date Owner's Name 0 n A. 7 e e O [yt • V �-+ A .C Oy Ol A at n O • .�y •IIA u A ~• O u'S� A , 0 9 0 u ~ �� O1 1riA 61 ^ y n c1 $ y A ,,1 A o g A 11 n1� n A jr ^ ^ h: it ^ �� � ' _/ `+ � n •�• ww � O .\ . ^~ e .� ►y o it o C" L71 O t • Ln IN to N o •p �-r --, arr 69 w e n IA 46-5 \b R b `+, a �' ^ �• �' `• � ' A (jam F�b H n LE • i u / bit J (-A 0 I FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ( ) Building Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF Barnstable TOWN HALL _ Barnstable, MA RE: Insured: CLARK, Frank A. & Bernice M. Property Address f70-QakHiIlTRoad Hyannis;MAC Policy Number: H0320368 Type of Loss: Lightning Date of Loss: 7/19/2010 File#: 111516 Claim has been made involving loss, damage or destruction of the above captioned property; which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail D. A. BENTLEY Adjuster 7/26/2010 'M