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HomeMy WebLinkAbout0544 OLD STRAWBERRY HILL ROAD 61d (S*.be,5, A* Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 3-26-13 Town of Barnstable Thomas Perry CBO ® 12:111 --� S Building Commissioner Cn 200 Main St. Hyannis,MA 02601 � RE: Building Permits =' .1 V Dear Mr. Perry, rn This affidavit is to certify that all work completed for 544 Old Strawberry Hill Rd,Centerville has been inspected by a certified Building Performance Institute (BPI)Inspector. Ceiling: R-30 cellulose Knee walls: R-11 fiberglass & R-7.2 Thermax All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a. T 3 Parcel '1 O 6 Ap ti ?_�O 1 Health Division Date Issued Conservation Division Application Fee > V Planning Dept. Permit Fee 'fit Date Definitive Plan Approved by Planning Board SM)3 Historic - OKH _ Preservation/ Hyannis Project Street Address S H 1-1 01 ��c aw�Qfcy tt�ll R,a. Village GaAA'.(__Y,l}e Owner Qamela 1' ' r, N ,aA 4 Address Telephone9` 1 11 Permit Request Ad 1-19 ce 1w l(osL 'to --Fine A i c , Seal :Ae 641 c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 048 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 newer Number of Bedrooms: existing _new - o Total Room Count (not including baths): existing new First Floor Roo` Count ca Heat Type and Fuel: ❑ Gas JR Oil ❑ Electric ❑ Other A Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/cgal stove:"❑Ye;R❑ No rn 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 A No If yes, site plan review # Current Use Proposed Use I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name cae, lia r - Telephone Number _ Sol 3 q? 0,3 9 g Address a ng� �J'e License # --C 1 ��}6 �S0" �aCmtaV�-�. (�_��j a6 3� Home Improvement Contractor# Worker's Compensation # T W/C 33 1 S 6 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO `'1 e m oyli SIGNATURE DATE R FOR OFFICIAL USE ONLY APPLICATION# . ' DATE ISSUED ,t MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING X, DATE CLOSED OUT ASSOCIATION PLAN NO. - •". ` 0 t . r 4.611 West A'i2in S-tteEt Assistance, .. _ IIjs=s,MA Q2bo1-3698 toss i sta ce T �508)T 1-54001( 08)Tr7434j cm 71 hues o ` o3on wvw-h O� HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE PIXASE FELL OUT AND_q(2\T IOS.FO IF YOU?ARE THE APPLICANT HO..NE OWNF.R- I I:, °�'� a� hereby consent to and av ree that weatheuzatiou work snap be done by the-Weathenzatiou Progr of Hons�Assistance Corporation ( herein alter zefescd as Agency") on the property lo4ated at CenA rylk\ 1�A 0`c1.63'a j The weatherization work done wM be based on programmatic pi oxides amd availaba q of feuding and it may include 0 or some of the following measares: Weather sb#p4&caulking of windows and doors,insulation of attics,sidewa)ls&basements,attic and other-ventilation measuzes and.possibly replacement of badly cIzfcdorated windows_In coumderation of the wcatheriza-don work to be done at my home I agree to the fobowing: j i 1_ I give permission to the 'Agency"its agents and ezoployees to travel onto or across said Property with Bach egmpment and materials as may be necessary to perform weatherzzation work on said property_ 2_ The Housing Assistance Corporation reserves the light to inspect the feel or utrTzty ba71 for the weatherized unit ou an ongoing basis for no more than five (5)ye;�xs after the•wea&mizaiion work is completed_ I have read the provisions of this agreement as fisted and freely give my consent Au Nome O'wn<�r= (Sigzatore) e-- —' Date= Agent (signature) Daft= C HAC approved Weather zation C=parry: C CL r"V8 Cali-ber BuDd-bag Remodeling Cans Cod Ln dadon =C-2L Creswell Coustmdi � Frostier F�zex y Solr logs Lola&Sous Feter Smith. Resolulion E��y Rock Solid CoTtwaon-- :, ,All Cape Tmsmla iOn ' The Connionwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 03111 ivivw ntass.gov1 dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeaMY Name(Business/Organization/Individual): C lt_n C r,C. Address: NvtYDH,C City/State/Zip:5,,,4 Y,,rMouA,MR 02VW4 Phone 9: 50$— 3 g 8 - 0 3 9 8 Are you an employer?Check the appropriate box: general contractor and I Type of project(required): 1.t] I am a employer with_ 4. ❑ I am a'; 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 S. ❑Demolition working for me in:any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance required.] I 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.�J Other �'ri S U�l a�t on comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. r 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 shoeing 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: -Tp_o�n o l o o S v.-an aC C M n Policy 9 or Self-ins.Lie.r: T W C 3 3 1 $ _ Expiration Date: y / ! / 13 Job Site Address: 51A4 0`d 34com 6f\, City/State/Zip: CerA-ecy%l�p 1�\� 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certify under the pairs and penalties of petjuny that the information provided bone is true and correct Sisnature: Date: PhoneE: 39 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License Issuing Authoritly(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone AC®® DATE(MMMD/YYYY) ;`,� CERTIFICATE OF LIABILITY INSURANCE 11/9/2012 THIS CFRTI ICATE 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 NAmNEAcT Shannon Sperrazza Risk Strategies Company PHONEA _N (781)986-4400 FAC No:(781)963-4420 15 Pacella Park Drive ADDRLEss:ssperrazza@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE F3618 IC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURER B:Safet Insurance Company Cape Save, Inc INSURER c.Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1211954576 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. INSR TYPE OF INSURANCE A D S POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMMD MM/DD GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTEDF X COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence S 100,000 A CLAIMS-MADE Q OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) S 10,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY JFCT PRO- LOC $ AUTOMOBILE LIABILITY CEOa SINGLE LIMIT deTt S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) S AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Peraccident X Underinsured motorist BI split S 100,000 X UMBRELLA LUAB OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE S 1,000,000 DIED I I RETENTIONS S199448001 0/16/2012 0/16/2013 $ C WORKERS COMPENSATION Officers excluded X I WC STATU OTH AND EMPLOYERS'LIABILITYRY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN❑ NIA from coverage E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? - - (Mandatory in NH) C3318007 /9/2012 /9/2013 E.L.DISEASE-EA EMPLOYE S 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02630 Michael Christian/SMS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS(125 on1nn-ri ni The Arnon nema end inn^era►anieforad marl,.of arng;h A�-- Massachusetts- Department of Public Safety A Board of Buildin!t, Regulations and Standards Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 ('ummissiunc, Tr#: 102776 &Iwvw�w4ea,&119V Office of Consumer Affairs and Business Regulation 'aim_=`` 10 Park Plaza- Suite 5170 al�I Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. _ WILLIAM MCCLUSKEY _ - 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mirk reason for change. , Address -1 Renewal ; Employment _ Lost Card PS-CA1 0 50M-04/04-G101216 Jle&awwUW1c4vea1l/c/�-,11, :::ag4ae Office of Consumer Affairs&Bdsiness Regulation t� License or registration valid for individul use only , •"HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: .:171380 Type: �' a 3 10 Park Plaza-Suite 5170 � Expiration: -3114/2014 Corporation Boston,MA 02116 CAPE SAVE INC. :.-.._ WILLIAM McCLUSKEY�-;.' 7-1)HUNTINGTON AVENUE=:__ o a SOUTH YARMOUTH,MA1)2664 undersecretary Not valid wit o signs �_ ,I . �� � .� C�� C� � -. Q �-> �- � � � ' --� -_ .r _. _.,_.�.,..�._ R/12/2013/TUE 09:53 AM COMM Water Dept FAX No. 5084283508 P. 001 f Centerville••Osten We-Marstoms Nis P-O,BOX 369-1138dEET-, OSTI;RVTLLE,Iv.SSACHUSETTS 02655 vtvs.�.C��IIl'VvateZ_cORI_:, !'• �;F;, �� � c� OFFICZ OF Z x4m r BOARD.OF WATER CO)AMSSIONERS u WATER ro WA.TFA SuFEFluT NDEN'T DEPT. TEL.No.508-429-6691 r FAX No.506-428-3508 FAX COMMUNICATIONS YfFSSAGE DATE: TO: ,A.TTN; .FRO. M. - — FAX# WE ARE SENDNGTPAGES 1NCLUJTNG TEIS COVER LETTER. PLEASE CALL 508-429-6691 IF YOU DO NOT RECEIVE THE TOTAL NUNMER OF DOCUN[ENTS MAR/12/2013/TUE 09:53 AM COMM Water Dept FAX No, 5084283508 P. 002 Ce pterville-OstervMe-Marstons Mi Rs Water Department TOY..,, - P.O,SOX 369-U38 MAIN STREET OSTERVILLE,MAfiSACHUSETTS 02655 WR'W.cornMWater.coI11 oFFicE 07 of IAIATER aoAY,�)OF WATER co1vMSSIONEERS WATER stneMrmENT EPT,, TEL No.508-42"691 FAY.No.509 428-3508 March 12, 2013 Ms.Mary McNabb 10 WA-Way Centerville,MA 02632 Re:Account#5932 10 Sail-A-Way Centerville,M.A. Dear Ms.McNabb: y On Tuesday, March 5, 2013 at your request to re read the water meter at your property mentioned above, our technician discovered that the back-flow device on the hot water heater is capped and sealed with a nipple and should be open to the atmosphere. This is a cross-connection violation according to the Rules and Regulations of this Water Department and the Drinking Water Regulations of the Commonwealth of Massachusetts, 310 C.M.R. 22.22. It is recommended to have this resolved by a licensed plumber. Enclosed please find a copy of the "Cross-Comection Survey Report Form& Violation Notice" we are sending you for your review and records. Could you please call the Water Department office at 508-428-6691 when this repair has been completed or if you have any questions. We greatly appreciate your cooperation in this matter. Sincerely, Herbert L.Mc Sorley Assistant Superintendent enc. j HLMCS/jw Cc: Town of Barnstable Plumbing Inspector MAR/12/2013/TUE 09: 53 AM COMM dater Dept PAX No. 5084283508 P. 003 Crass-connection Survey PeportForm & Violation No.-icc 4vn7ER �. (Prini Clearly) Date of CC Survey l 2� I .1.D 13 PVVS ID# 4 / 0 / 2 / 0 I 0 / 0 ; 2 P W S Name C =V.)IZE-lb'=V=-KkMM MM WAM DEFT. MY TM: 0STO=, FA 02655 1. Facility Name (Business, Co., Corp.): 2. Facility Address: /O Sp�, 1 —!a . I,0 A en fier i r! _, VIA Q a 6 a 3. Mailing Address: I -` 4. Contact Person; No-C Me-Nabt> Phone - 5. Type of facility; El Industrial Ercommercial ❑ Institutional ❑ Municipal N,'Other re,s i4e,-y 47;a. 6. Describe the facility use(i.e. motel, school): IFr,, s,-ct cj ek tin na Q 7. Size of service connection: t inch. is service connection metered? YES ❑ NO 8. Is there a supplemental protection at meter required (containment device)? ❑ YES XNO If YES, what type of backflow device is in use? ❑ Reduce Pressure Backflow Preventer(RPBP) ❑ Double Check valve Assembly (DCVA) 9. Does this facility require non-interrupted water service? ❑ YES NO 10, Does boiler feed utilize chemical additives? ❑ YES N NO If YES, is the boiler protected with a backflow device? ❑-YES ❑ NO 11. Does this facility have an air conditioning cooling tower? ❑ YES X NO If YES, is the cooling tower protected with a backflow device? ❑ YES ❑.NO 12. Is a water saver in use on condensing lines or cooling tower? ❑ YES (� NO If YES, is the make-up supply line protected with a backflow device? ❑ YES ❑ NO 13. Is process water in use in this facility? ❑YES R[NO If YES, is the process water"potable"water or"raw" water? ❑,Potable •❑ Paw is the process water lines protected with•a backflow device? ❑ YES '❑ NO 14. Does this facility have a fire protection system? ❑ YES . •R NO If YES, is the fire protection system supplied by a dedicated water line? ❑ YES ❑ NO What type of backflow device is being used on the fire protection system? ❑ Single swing check valve (SSCV) • ❑ Reduce Pressure Backflow Preventer (RP3P) ❑ Double Check Valve Assembly (DCVA) ❑ Other 15. Contamination: ❑Biological (type) ❑ Chemical Compound Other(describe) j I 2o ) 1 L -17/ -f ❑ NO violation(s) was/were found at the time of this cross-connection survey was conducted. Exact Location of Cross-aorinection Degre9 of Hazard Comments able ck .-4, me ❑ High Low aa�l ❑ High ❑ Low La cx /lr' l ❑ High ❑ Low _ EG r mo ❑ High ❑ Low 1 certified that the above cross-connectlon survey findings are•true,,(aianatures required) Cross-connection Survey-Conducted by a MassDEP Certified Cross-connection Surveyor -7—"rnor C V­ (a2 /01 / iS' CC Surveyor Name (Print) MassDEP Cert.ID# Exp. Date Signature Phone# Cross-connection Survey Witnessed by: (Facility Owner/Representative) =acility Owner/Representative Name (Print) Title Signature Jote: Use the.attached table for protection options. • Provide to the facility owner/representative a copy of this.form. J :/OPS/XCONN/CC Survey Report Form#7 (Revised 08101/2011) MAR/12/2013/TUE 09: 53 AM COMM Water Dept FAX No, 5084283508 P, 004 TA13LE 22-1 Types of Back-flow Prevention Devices Required: Subject to the provisions of 310 CMR 2222(10), Table.310 CMR 22-1 shall serve as the guide for the type of protection required. AG -Air Gap AVB -Atmospheric Vacuum Breaker RPBP Reduced Pressure$ackflow Preventer PVB -Pressure Vacuum Breaker DCV.A, -Double Check Valve Assembly BPLA,V -Backflow Preventer with Intermediate Atmospheric Vent Acceptable Types of Backflaw ,�reventers Types of Hazard on Premises AtRP)3 P DCVA AVB PVB BPIAV Comments* 1.Sewage Treatment Platt X2. Sewage Pumping Station X3.Food Processing X X *Tf no health hazard exists4.Laboratories X X* *If no health hazard exists 5,Fixt=s with hose threads on inlets X X X X In addition to an air gap separation, all fixtures that have a threaded hose type connection shall at a minimum, be equipped with a AVB in accordance with 248 CMR 2.14 6,Hospitals,Mortuaries, Clinics X X 7.Plating Facilities X X 8.Irrigation Systems X X X* X,�* Each case should be evaluated individually. * An AVB can be used if no back pressure is possible and no health hazard exists. ** Pressure Vacuum Breakers can be installed if back pressure is not possible 9. Systems or Equipment Using Radioactive X X Material 10. Submerged Inlets X X X. * If no health hazard exists and no back pressure is possible 11,Dockside Facilities X X 12.Valved outlets or fixtures with hose X X X* Each case should be evaluated individually attachments * If no health hazard exists and no back pressure is possible 13.Commercial Laundries and Dry Cleaners X X 14. Commercial Dishwashing Machines —X7 X I X. *If no health hazard exists 15.High and Low Pressure Boilers X X* *If chemicals arc added 6. Low Pressure Heating Boilers X F esidential and small commercial, having no chemicals added 17.Photo Processing Equipment X X . 18.Reservoirs—Cooling Tower Re-circulating X X Systems 19.Fire Protection Systems: For cross connection control,fire protection systems may be classified on the basis of water source and arrangement of supplies as follows; y;r Town of Barnstable *Permit# 6�5�� Expires 6 months from issue date .Regulatory Services Fee :t�:�S -oD Thomas F.Geiler,Director Building Division Vr Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 n www.town.barnstable.ma.us ,L Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint � Map/parcel Number —j 1 04 =- u-C Property Address y ��- LA ) 519 NUZE RR\1 R ILL_ �J, C6- Residential Value of Work ,000 ^��pd� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address M( I`F%R G L M c— N C A L`1 6- 4 `1 0Lb SYRNWR�r6ZM 1 \LL 0-A C15n13'66RQkkL : � Zae.3,2- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman'.s Compensation Insurance � �� PERMIT '� Check one: Xm I am as ole proprietor I am the Homeowner JUN 1 1 2007 I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) D(Re-roof(stripping old shingles) All construction debris will be taken to_h L) U _ ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town departn"WRa`ti'Wi s,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors Liczen e;i required. ��QZ SIGNATURE: L tjj Q:Forms:expmtrg Revise061306 pFfME r Town of Barnstable Regulatory Services BMWSTABLE, : Thomas F.Geiler,Director MASS. 1 1639• A Building Division rF0 MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ------------- HOMEOWNER LICENSE EXEMPTION 9 Please Print DATE: & " f `7`C�— (0—7 JOB LOCATION: 7 9 0 L 6 STkAW 6 CIRQ.,'( H1` L `l'�y�A L' .i'"TE �`LA— number street village "HOMEOWNER"Am"AC L M C-K1 G ALy name uu home phone# work phone#- CURRENT MAILING ADDRESS: J "l A y L b S`t'P AW 9 0 R M HILL 0l � E ICI T�IR V I LLE PIA Pa(,31 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. NC Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work fop--, >s1� ild N Wilis—required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided tha�61i�eowaor-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 2.151 ehis l ck�� aw reness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot pr�lee8 gaidst1thtl0 fictrrtd 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 respon 'v;�m,n ,come u`nit1es require, issue is a form he currentit ly used by that the homeowner certify that he/she understands the responsibilities of a u�perns_ p�g i several towns. You may caret amend and adopt such a form/certification for use in your community. : Q:forms:homeexempt The Commonwealth ofMassachusetts .Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111' 4 wi�w.mass.gov/dia ' �,'orkersr Compensation 14surance A- idavit: Builders/Contractors/Electricians/Plumbers A_PWirnnt Information .Please Print I,e®ibly Name(Business/Organizationflndi-y•zdual):14I C (AC L C; 1^t l T Address: 5Li TRAW86-11.FY t(U- � City/State/Zip:CCkTEd�,%► CLL.0 NtA,(1eo3j Phonet-S-0 8 1 Are you_an.employer?.Check the appropriate box: :Type of pioject(required):• _ 4. I am a general contractor and I 1.❑ I am a employer with 6, []New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or Partner- ship and have no employees These sub-contractors have g• Demolition �vorkin for me in an capacity. employees and have workers' g y P ty 9. ❑Building addition [No workers' comp.insurance comp, insurance.$' required.] 5. [� We are a corporation and its 10.❑Electrical repaizs or additions officers have exercised their 11. Plumbing repairs or additions '3.�I am a homeowner doing ill-work . . g p myself.[No workers' comp. right of exemption per MGL 12%Roof repairs z insurance.required.]t c. 152, §1(4), and we have no employees. [No workers' 13. Other_ S1 ®l comp,insurance required.] Any applicant that checks boz#1 must also fill out the section below showing their workers'compensation policy information, t Homeowners,who submit this afidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have. employees, Ifthe 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 jab site information. Insurance Company Frame: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip• 'Attach a copy of the workers' compensation policy declaration page'(sho-yemg the policy number and expiration date). Failure.to secure coverage as,required under Section 25 A 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 Es statement maybe forwarded to the Office of Investi?atiors of the DIA for insurance coverage verification. I do hereby certtfy under the pains and penalises of perjury that the informaton provided above is true an'd ccYrect. . Si atuie: Date: Phone O,Trcial use only. Do not write in iyis area, tb.be completed by.city,or town official City or Town: ' Termit/License ii Issuing Authority(circle one): -1.Board Ofgealth d.BuildiingDepartment 3. City/Tomn Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other IContact Person: Phone t: �1V (�AtZxn�t✓ C�Ri iJD�! �V� rJ&IU r PLCXti [to 4 3 = 3sn G•P�. l !J Ste- t OOGO GAL_ „�>ISPpSA� SIT - ust= IC>Qo Galt_. . c5UP-WALL AZE.A = tSc> S- . +1� IG� 5P, /_ 2.�� V ?IS 6.Rr). NI 4 .ExP. TOTdL t7ES[G►.1 = d25 -T oT4 tr 7,,A t L`( V-L_0V_/ = 3 6 FID. s PRO P. a awttciMc ( � 9 0 E.,reGc>.L&Ttc)tJ (�l�-rE I"tQ l I u� 02 LASS s� I� TAMy 1 nyD� MIN PST lt� u sox 8,P KTER �t Y1 N I a 73! �.iiin• /� / ,, IIJ V` 57,o 0 /Pe nesU INV. A Z, see 50�� 4 VD5T IW. 6AL. le-7 f -box 9c.4 seprlc T'A W W4 1000 yb'8 �tNV• IUV•9G,Z , G A I.. tiG.0 `• LAN A P�T "EA"' wlru •� MEDIUM S A m o WASHED j SroN� C I Z T t F=I G t_U3 %t-J P�ZG?1=L L C>C,41TI y�� 1 %u-?QPk' �.-rC [Z/z1/77 NO W^TF-P- tz/19 /77 p>PCrsvosEfl t �C 1�•r 1 h `( 'r I-1�T' 'C 1-t G �U:Jry Q A't't D I.t 5[-lC:r�•c/►J 1=�t__l>.t..1 �2.t=_t=�=F�i_►1I t: i-i -[:l_t�t.a Gc;.lrtt't_�(, u/ ►'1[-i Tt-A;: 1 VE L U -. 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(S �.IOT BASET7 0 os-rezv%u G- o �IrCASS� u4,grQtlMEk,lT �,UczVc�f TttE= of S��S Stacwt.r� AP CAt,.1"T' _,,- -r/--- 1 hbT IBS U5C-D `O ac:Tctz.MtNt_ Lo'r LtN(ES' Loa WIDS �)C--,U, Co. t ".e TOWN OF BARNSTABLE Permit No. 1 Building Inspector Cash $352.00 (Capew .de revel pmenf OCCUPANCY : 'PERMIT Bond No building nor structure shall'be erected, and no land, building or structure shall be used for a. new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate.of occupancy has been issued by the Building Inspector." Issued to Llewellyn Realty ` rust Address 544 Old Strawberry Hm Rn;;d. gvnn, G Wiring Inspector ra=� Inspection date Plumbing hnspecto ( * Inspection date xs 4 ��. r-' Gas Inspector r Inspection date Engineering Department _, fiat. ,_ it/ �r f L Inspection date-. ( r' THIS PERMIT WILL NOT BE VALID, AND THE BUILDING i SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 197 ...................-.. �.. _ .. ......, _... ..... �Building Inspector �_ Assessor's-map and lot 'number . ..J.4..I..3....L'.10 SEPTIC SYSTEM MUST DE 17 7l INSTALLED IN COMPLIANCE 4 ' Sewcgge AF rmlt:number - ............................... WiThl ARTICLE !I STATE ;.s ? SANITARY CODE AND u TOWS y�F7NET0�' TOWN OF `BAR' -S' LYVBLE C hrQ is . BARNWABLE;ii ! 9. BUILDING-1- IN-SPECTOR' 'FO,.MAY b, �a o c x:3 APPLICATION40R PERMIT TO ; 0`9�? ,";'.. .. �... �—�� �". ........5?.......................................... TY.Pf OF COhISTRUCTION �.. . :...... ... .^I ... ....... �Y.............. .... ....................... ............................ ......... a ,. .:.. ...................19� .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follow' g informat' . a f Location 1. p 11 ... QALZd f`f..........:�u ....... .. Q..... .............................................. ' .......................... ProposedUse ...... ........................ . ......................................................................................................................................... ZoningDistrict ............. ... ............. . . ............. . ........ ... ....�i[e Dis rict .;.:�;................................ .......... ' Name of Owner . : Address .'... Q Nameof Builder ...........................................Address .................................................................................... Nameof Architect .........: ........................................Address ......... ......................................................................... Number of Rooms .....(9........................................................Foundation Z ....................................... rt'.... .................................:..........Roofing A ...................Exlerior �.�.l+!�L....... .... ............ .................................. Floors ......... ..... ....P.Grr.......................................................Interior ............................................... . Heating `.L........ �... .' �?'.! ? ........................Plumbing .... .®.��. ................................................... Fireplace .........................!U..0..............................................Approximate Cost .�.J�.0.00..............................,................... Definitive Plan Approved by Planning Board -----------____---------------19________. Area ....... '.. .... . .................... Diagram of Lot and Building with Dimensions Fee cam„ ...°.. ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Ile ,�v r , 4 I hereby agree to conform to all the Rules and Regulations of the Tow of Barnst a re in construction. f : No . .. ....... ................................. ' : :. ,level lyn Realty.Trust I No 2.0.012...... Permit"for ........CRms.truct.3.Ag.. singlg family...dwelling........................ Location ...O.U.sS..rt w.b.pricy.. il l..Rd,... E .................HY.annis.............................................. Owner Type of Construction .....wa d..fxame............... I E .......................................................... .................. Plot ............................ Lot ......#11................... . - 1 Permit Granted XalCtrb,..],3.........19 78 —bate of Inspection .....19 �. ............................... Date Completed ..yIJXZg t .............19 r -, Y/,W/?f PERMIT REFUSED ` .........................y..................................... 19 ' .............................................. ............................. - r ................................................................... ........ ..................... ..................................................... ` ............................................................................... ' Approved ................................................ 19 ............................................................................... 1 t 77 Assessor's`map and lot number .. ...��.A. .. ....!... .. . iy� Sewage Permit number ............... ............................... *THE T0� TOWN OF BARNSTABLE Z ]IMSTADLE, i "6 BUILDING INSPECTOR 1 °^ APPLICATION,FOR PERMIT TO � (• � ,Wt ' TYPE OF CONSTRUCTION ....... .:.'*;t� ,?�..... 1 . ................................................................................... ..`......... .i�..........................19....... . J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: j Location ..'........ ........ f ( t Cz'.... .. h.k `. ..........j.L'.- .yF °�....?.............................................. Proposed Use r�:f c _ t �,C. T !t± .- ... ...... ... ....... ... ..... . .. ZoningDistrict ...................................................................`....Fire District .............................................................................. Name of Own t'+.t .t' �•. 1 1`1 111.............................................Address c''a.. .. F..!... C�c .�.c.� ........I � ........... Nameof Builder ... :5....................................................Address .................................................................................... l4�. Name of Architect 1 M �..........................................Address Numberof Rooms G' Foundation ....: +�'�` �`........:......................................................... .................................................................. Exterior t rt F -: P c4+�1 t r-- ................................j'................................................Roofing . ................................................................................. t r ' t? i tS f�(Z� �c_x-t- Floors .................................................................................:....Interior .................................................................................... Heating .........................T..........1............ :............................Plumbing ...`..............r .`. .. ....................................................... ' `Car",. Fireplace .......................'.�...r:...............................................Approximate Cost .�...:...:...::.......... .................................... r Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .: f '............ ............................ Diagram of Lot and Building with Dimensions Fee �`' SUBJECT TO APPROVAL OF BOARD OF HEALTH 60 tiv A it I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....................:................. ......................................... Capewide Developement Corp. M-273 L-106 T r � 't• Y t No 2 012..... Permit for ..c5?n*.tKIMr,3AU&....... A C single..fn .�y...€Wet,�.lt�g......................... Location ....:544„Old S.tr.awbggry...Hi 1l..Rd. F ......... H annis Y.............................................................. . Owner D... .....lo ement..�4r R.,...... Type of Construct' n s f ..................... ...................................................... Plot ....... ................ Lot ....,161.1..................... ' Permit ranted Ma rch 13 19 78 Date of Inspection ....................................19 t Date Completed .................:....................19 t � � PERMI REFUS D G n . ............. ..... �?I9 ..................................... .. .... ......1 . .... . ..� .. .. /... �............ ........... ......................................................... Approved ................................................. 19 ............................................................................... ...............................................................................