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HomeMy WebLinkAbout0014 OLD TOWN ROAD �y ���Tu�N R� f � L CAPE CODTOVYN OF INSULATION N" 1-L rll 2: NtiR O1A55 SiAMtf53 30R Tra"I SUSPSN010 tATTS GUTTERS INSUWION CENINGf 1-800-696-6611 p ° � Town of Barnstable Regulatory Services Building Division 200 Main St .Hyannis, 1AA 02601 Date: j 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 lUicv 16 Dlefir'l',Q) /Y01d 7dwf? ed no s Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls 't wa. Us (y .) ( ) ( IU ) ( ) 00 A(0 S(a (,( 1 Sincerely l.� He y E Crnsulation, , President Cape Cod Inc. :r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I Map le Parcel bj::,q- 6dZ�, plication Health Division Date Issued Conservation Division Application Fee LYP Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address T!/ �ir� Village Vl Z 5 Owner \, le, EyYIGo Address Telephone �D D - '57 '61 2J6 Permit Request lqwl l i S kAV alv z5a(m io�h� Zn f-,�K s0(1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C/ Two Family ❑ Multi-Family(# units) ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count ca pi Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other t fz> Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodfcoll stove:"0 YOU 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 ❑ "' l Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) s' Name Telephone Number �JV Address �� �� /2 License #� /,0 4'xZ!6 &e2 Home Improvement Contractor# ,«�✓ Worker's Compensations / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE '"� 7-7 f 2��� j FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t MAP/PARCEL NO. t S .4 t ADDRESS VILLAGE i i OWNER ,F DATE OF INSPECTION: FOUNDATION ,l FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . z 't PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r Z f FINAL BUILDING j DATE CLOSED OUT ` ASSOCIATION PLAN NO. a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration _= = Registration: 153567 Type: Private Corporation Expiration: 12/15/A14 Trlt 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE ' SO. YARMOUTH, MA 02664 .� Update Address and return card.Mark reason for change. E] Address Renewal ❑ Employment ❑ Lost Card SCA 1 it 20M-05/11 Vlie. U�ammaanurea�a�C��ao�uael�2 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: A63567 Type: Office of Consumer Affairs and Business Regulation xpi ration:`;12%1'S/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION,INCH HENRY CASSIDY 18 REARDON CIRCLE',- SO.YARMOUTH,MA 02664 Undersecretary of val witho t sifnatke t Ili 1 cel �mm12ir s 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration 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 `_I Renewal I I Employntcnt I Lost Gird AINI U-t:Od{{L01!10 Ultire o(�'o, uu,er Affa, s r t3usue}/s Regul ttion License or registration void fori:;tltYidt ! HOME I 'p bV �`tJT"�1`YfACtb0c".'ewded l,crure the expiration date. If found return to; T ; Registration: 153567 Type: Officc of Consumer Affairs and Business Regulation F �-4.I, Expiration: 12/15/2012 Private Corporation 111 Pail:Plaza-Suite 5170 -:'ri Boston,MA 02116 iP POD INSULAI ION, INC `i. HENRY CASSIDY 455 YARMOUTH RD. HYANNIS,N1A 02601 -/a�id ----- reeUntlersce.retary ith t si�' lu ' Ada>..::hu�ctts-�cp;trtnlc'llt 111 hulllic ti:11Ct) B+,ar+l of Buildiw, Rc"ulatiuos antl St:uttl:u tls Qont5truction Supervisor License a: l icen •; CS 100988 r i1 ` HENRY CASSIDY 8 SHED ROW WEST �ARMOUTH, MA 02673 Expiration: 11/11/2013 ( ..,wiii..i..a,•r Trrt: 7620 a ' The Comption l r,. ,d th of Massachusetts Department ,�J Industrial Accidents _ W Office 0i /1lVeStlgattonS °' - 600 Vlilrshington Street Bost.,,Bosvt,o il1A 02111 �.� �� Ju WYl' I J,;ic1N.S.govIdla Worker's compensation Insurance Aftitj;,-:11: Builders/Contractors/Electricians/.Pititi.ibet,s applicant Inl'ortuation Please Print Legibly t Vanli (lit.tsinc s/Organizacior�/Individual): t \tltlft;ss: __ t'u)i.�lat %lil): ,Xceo Phone#: .a6 -775 Arc you an eutployerY Check tl►e appropriate box; Type of project(requit•e(I): I. Lq I ant a employer wide_.. 4• ❑ I and a„rnc i:d contractor and I have 6. n New canstruction r.lupluyres (full and/or part-time).* hired tllc ,ni)-,:ontractors listed on 7. F] Remodeling ��---ll the attache:,.1 �hcct.[ L� I atn a sole proprietor or partnership These sul.t ,.miractors have 8. Dernolitiort aril have;no etrtployees working for employee:,;m,l have workers' comp. 9. Building addition me m any capacity. [No worlcers' insurance.[ 10, ❑ Electrical repairs or xdditiuus ruulp insurance retluire(l.) 5. We are a t otltoration and its r 11. k'lurnUing repairs ur a,.lilitious officers it,n;-cxercised[heir right of I hilt a hotneowtier doing all work exempiiuii p;r MGL c. 152§(4),and 12. Roof repairs myself. [No workeas' comp. we have nt,;,nployees. [No workers' nsurauce requirid.J r comp. msur:'uce required.] l3. Ocher / ��'�I�Pl `Any appltcau(that checks box #1 must also fill out the section below show)ll.their workers'compensation policy information. i Ituwatwuets who submit this affidavit indicating they are doing all Hotl,;w i tl :n hire outside conu'actors must submit a naw affidavit indicating such. !t.onttnc0.ns that check this box must attach an additional sheet showing d" taut z.of the sub-contractors and state whether or not those entities have employee,_It he wh-a utraclvrs have employees,they must provide their workets'cotitp poh,.y number. t ant an employer that is providing workers'compensation iii�u;rice for my employees.Below is the,policy and job site htsurance Company Name: AtI(,� C_,� �"` f la to ( ::.` yl S 0 !'alley itur.Self-iris. l,ie. #: tW A 00 `1� 5_cl f Expiration Date: ! /� .lob Sitc Address: . 1 w� � W�Y��� Y��N —�---�,tt t/` � �� City/State/Lip: T Attach a copy or the workers' compensation policy declaration page(;!,awing the policy number and expu•nhnn date). l ullmc to secure coverage as required under Section 25A of MGL c. 15.'.eau cad to the itllpOsttlOn Of Grinlmal pt:nalties Of a fiuC up to$1,500.00 d0dJut t.ntr-year hilprisuutncnt,as well as civil penalties in the form of a STOP Gv(WK ORDER and a fine of up to$250.00 a day against the violator. Be.advised hat a coEy of this statement tna e forwarded to the Office of Investir,ati;-ns of the DIA for insurance coverage verification. I do here c if under the ins and penalties of'pei.iruy that the infortnatiott r•ovide above is t ut�d correct. Sl"IldtUIC" ---- Date: �i_r k'lt�me'Ik: official use„rtly. Do it write in this area,to be completed 1) ly or town official City or Town: I'ermit/License# tssuiab AtIthority (circle one): j I.hoard of Health 2. Building Department 3.City/foti n Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: _.._--- Phone#: I I r I lrl No, 1605 N. Client#:4597 CCINSUL ACORDL, CERTIFICATE OF LIABILITY INSURANCE D07 ATE(MMlplllYYYY) THIS CERTIFICATE IS ISSUED A201 S A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEIR?THIIS2 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS 111 UTE A CONTRACT BETWEEN THE I$$UIN6 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If tho ca�tjrlcata holder is an AbDIT1ONAL INSURI_I].the policy(ies)must be endorsed.IF SUBRQGATiQN IS WAIVED,suti)uri m the terms and condlllons of the policy,certaln pollcl66 may re4udlo an endoreamenL A 6taternent on this certificate doer not corlter riUIItJ to(he Cert(flcate holder in lieu of Such endorsemenl(s). PRODUCER IALf Rogers&Gray Ins.-50. Dennis NAME: Mal' aret Youn Pvc°itE No Exl:508 760 4602 rtik 215�, .6 434 Route 134 E-MAIL Arc Nu- BJJ-3-16• _ South Donnis, MA 02660-1601 -_— — 508 398-7980 _ INBURgR(o)AFFORDING COVERAGE � NAIC 8 - �— ---- INSURER A!Peerless Insurance 18333 INEURED .-_.....__ Crape Cod Insulation Inc INSURERS:Evanston Insuranca Company 455 Yarmouth Road "SURERc:Atlantic Charter Insurance -- _ Hyannis, MA 0260,1 x INJURERD:.Commerce Insurance Company INJURER E: T _ IN60RER F; COVERAGES CERTIFICATE NUMBER: _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICI,E$ OF INSURANCE LISTED IJEI_C V HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE I ED. N MAY BE ISSUE NG ANY PERTAIN. T'H TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH'THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN '. Li NSURANCE AFFOrDED BY,_THE POLICIES DESCRIBED, HEREIN IS SUBJECT TO ALL, THE.TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVI BEEN REDUCEQ BY PAID CLAIMS. RdSR� ADDLSUBP( 'I,;LtR TYPE OF INSURANCE tl_ i, POLICY,DFF- POLICY EX rnLlcvNun+L�Ii MMIDDIYYYY hIJOD1YYYY LIM1T5 q GENkRALLIA8ILITY11145 C130.W3063 4101121012 04/01/201 EACH OCCURRENCE $1 UU0 U0U X COMMERCIAL GENERAL LIABILITY. p �q 7 !00 — (�CLAIMS-MADE IDX OCCUR. MEDEXP(Anyorwpereon)PERSONAi,&AOV1NIURY 0GENERAL AGGREGATE 0GEN'L AGGREGAI E LIMIT APPLIE8 PER; ' PRODUCTS-COMPIOP AGG 0POLICY PRO-IPrj LOCAUTOMONILE uABIuTY12MMBCKVMK 4101I2012 p4/011201 COMBINED SINGLELIMIT[?a accident 0 AIVY AUIti -�' -BODILY INJURI'(Pcr Pcrswl) ALL OWNED SCHEDULED _ __. AUTOS X AUTOS !' ' BODILY INJURY(Per aceiuwll) S X HIRED AUTOS )( NON-OWNEU ... PROPERTY AUT03 S 3 H _X UMLIK"LALIA8 OCCUR XONJ453512 4101/201204/01/2O1 EACH OCCURRENCE $1000000 EKCEtiy LIAR _ CLAIMS.MADE AGGREGATE �1 0U0 000 DID X RETENTIOPI 10000 C WONKEN$DOhIFENBATION AND EMPLOVEM''�LLII�AgBTINLITY YIN VNCA005259t12 6130/2012 06/30/201 X VVG STATU. Dili. -� - OFFICENM�M�OER kXCI-Up &�DGUTIVE E.L•EACH ACCIOFNT 1 000 000 FNI NIA Ihlendnk(Iry in NH)Ir ynn,gebcnon unUnr E.L.DISEASE_EA ChIPLOYEE -$1 Q00 09U DESCRIPTION OF OPERATIONS Unlow ___ _ E•L.DISEASE,POLICY LIMIT a1,000,000 UEBCNIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Al(anh ACORb 10,Addi la—I kumnrLs LjOadu19,11 me 8PRC610 regUlr9p) "Workers Comp Information.r Included Officers or Proprietors C.erllflcate Holder is Included as an additional insured unaor General Liability When required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®188 -201D ACORD CORPORATION.All r(ght3 r4salved. ACOHu 25(2010105) 1 of 1 The ACORD name and logo aro roglstered marks of ACORD #S83849/M83848 MEY OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at Te wh �� (Property Address) 1,2Z6491 (Pr perty Address) Ca C d hereb authorize . M v t Y , (Subcon ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. ' Owne s Signature /i Date R2'o7 0 6 7 . 0 0 2 A P P R A I S A L D A T A KEY 428834 SARNACKI VINCENT & DO RENE LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 21, 700 900 46, 500 1 A-COST 69, 100 B-MKT BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 853 JUST-VAL 69, 100 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 55BC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 55BC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 217001 LAND-MEAN +Oo 691001 73020 IMPROVED-MEAN -360 2501 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] [ •'r ] [R267 067 . 002 ] LOCI 14 OLD TOWN ROAD CTY] 09 TDS] 400 HY KEY] 428834 ----MAILING ADDRESS------- PCA] 1011 PCS100 YR193 PARENT] 168785 SARNACKI, VINCENT & DORENE MAP] AREA] 55BC JV] MTG] 0000 P 0 BOX 127 SP1] SP21 SP31 UT11 UT21 . 24 SQ FT] 853 CENTERVILLE MA 02632 AYB] 1930 EYB] 1975 OBS] CONST] 0000 LAND 21700 IMP 46500 OTHER 900 ----LEGAL DESCRIPTION---- TRUE MKT 69100 REA CLASSIFIED #LAND 1 21, 700 ASD LND 21700 ASD IMP 46500 ASD OTH 900 #BLDG (S) -CARD-1 1 46, 500 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 900 TAX EXEMPT #DL LOT 3 RESIDENT'L 69100 69100 69100 #PL 14 OLD TOWN RD OPEN SPACE COMMERCIAL INDUSTRIAL SPLIT 72893 EXEMPTIONS SALE] 11/93 PRICE] 55000 ORB] 8907/266 AFD] I TE LAST ACTIVITY] 03/23/95 PCR] N Al R,267 067 . 002 P E R M I T [PMT] ACTION [R] CARD [000] KEY 428834 000000001 PERMIT—NO MO YR TYPE VALUE CK—BY MO YR °sCMP NEW/DEMO COMMENT LN PROPERTY ADDRESS ZONING IUISTRICT CODE SP DISTS.I DATE PRINTED CSTATE LASS I PCs I NBHD ON NUMFILEI 1 4 OLD TOWN ROAD 09 R8 400 09HY KEY NO. 01/04/96 1011 00 SSBC R267 067.002 LAND/OTHER FEATURES DESCRIPTION 1 ADJUSTMENT FACTORS T 428834 d Br%Dale s:e Dmenson v UNIT ADJ'U.UNIT LOC./Y R.SPEC.CLASS ADJ. COND. PE PRICE PRICE ACRES/UNITS VALUE Description SARNACKI, VINCENT g DORENE MAP- / cD F DepinrA,-� ILAN O 1 21,700 700 CARDS IN ACCOUNT - L '10 1BLDG.SIT 1 x .24 =10 258 34999.9 90299.9 .24 21T00 ff9LDGiS)-CARD-1 1 46,500 01 OF 01 A #OTHER FEATURE 1 900 iBATHS 1 .0 U 1 x C= 100I I 3500.0 3500.0 1.00 3500 B ?tDL LOT 3 MARKET !FIREPLACE U X i C= 100 3100.0 3100.0 1.00 3100 3 4PL 14 OLD TOWN RD INCOME I- NO SS MT S x C= 100 7.2 72 853 6100-3 USE G !SHED S 12 x 24 195 D= 43 9.6 3:2 288 900 f APPRAISED VALUE D J A 69,100 r U PARCEL SUMMARY S . (LAND 21700 T : I BLDGS 4650C M ' I 0-IMPS 900 _ E i I TOTAL 69100 N N CNST T I DEED REFERENCE Type DATE Recweea PRIOR YEAR VALUE s Book Page Inst. MO. Yr.D Sales Price LAND 21700 I 3907/266,TEI111/93 55000 BLDGS 47400 1481/352: �00/00 TOTAL 6910C BUILDING PERMIT REMODELED FY96 J I Amount ' LAND LAND-ADJ INC ME SE SP-BLDS FEATURESI BLD-ADJS UNITS Num bar D­ Type 21700 90t7 500 Class Con51. Total Vear Buill Norm. Obsv. Units Unils Base Rale Adl.Rale A 11 Age Depr. Contl. CND. loc. 4b R.G. Repl.Cosr New Atll.Repl Value Stories Meighl Rooms Rms BaIM19 I Fix. Partywell Fat. 01C 000 100 100 61.00 61.00 30 75 19 80 100 80 58084 46500 1.0 5 3 1.0 4.0 Desc riplwn Rate Square Feel Repl.Cost MKT.INDEX: 1 0Q IMP.BY/DATE / SCALE: 1/OO.90 ELEMENTS CODE CONSTRUCTION DETAIL SAS 100 61.00 853 52033 R E SINGLE FAMILY DWELLING CNST GP:00 FEP 65 39.65 140 5551 *---10---*----12----* STYLE 03 ANCH 0.0 --------------------(1-0 ! FEP ! ! DESIGN ADJMT 00 0.0 -- ------------ - ------ --------------- 1 ! ! EXTER.WALLS T�WOOD SHINGLES 0. 14 14 ! EAT/AC TYPE 02GAs----------------0.0 iNT-E-R:-F7►IISH 01WAlL80A96 CJ.O 1 I ---- --- - -------------------! ! ! INTER.LA-YOUfi QO 6- .0 ------- ------- - -- 1 INTER.3UALTY 02 AM_E A5 EXTER. 6.0 *------------29--*---10---* � FlO�R STROCfi 02WD JaIST78EAM 6.0 D W ! 30 EF L-009 -COVER 06CARPET 9 VINYL 6.0 E Total Areas Aa. 140 Boso 853 ! BASE ! � bUFq?TYPE ___ 012 ABLE-ASPH SH 6.0 T BUILDING DIMENSIONS ! L E *R C 1 1 C kL 01 VE ft A G Q E .Q A SAS 412 S01 W29 N17 E29 N14 FEP 17 ! FOUN6ATION 000NCRETE 9LOCK 94. W10 S14 E10 N14 .. SAS E12 S30 ! I ------- ------ ---------__-----__---- I L ! NE2Gffa0_R 600 SSBZ- HYANNIS ! LAND TOTAL MARKET ! ! PARCEL 12----X AREA 1106 VARIANCE +0 +6146 STANDARD �S 10/ A-3 Town, of Barnstable, O,^ Expires 6 monthsfionvissue date. .'. ry Services . Fee.. 5- 9� 16 9. 100� Thomas F.Geiler,Director '°rEDMA'tA Building Division Tom Perry, Building Commissioner Office: 508-862-4038 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Fax: 508-790-6230 Sl�� 2 9 2003 EXPRESS PERMIT APPLICATION - RESIDENTIAL O Not Valid without Red X-Press Imprint TOWN OF BARNST n Map/parcel Number a ' %i6(j;� Property Address C)`& ��W n \43 . \kA CACN \.kS Qc�ti [Residential Value of Work Owner's.Name&Address r\c& e(N-- Contractor's.Name Telephone.Number—" -- -p Home Improvement Contractor License#(if applicable) Construction Supervisor's.License.#(if applicable) ❑Workman's.Compensation Insurance Check one: ❑ I am a sole proprietor [Y I am the Homeowner r1. I have Worker's.Compensation Insurance. Insurance Company Name Workman's.Comp.Policy# Permit Request(check box) Ef Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. SignaturS 1_4�ryo—�Cu t er L; �Totms:expmtrg Revised 121901 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map czq(—O 7 Parcel Permit# Health Division Date Issued 711,3 Conservation Division G Fee.. �,5'. Tax CollectoYL r Treasurer ' Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village �� �v Clos , Owner y n���� �� �n� C ��.coo.c,k Address kL- O Telephone x-1 Permit Request 0.Ge M CA a a L&)- �Ja_� � Square'feet: 1st floor: existing - proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain - Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes,attach'supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure LO Historic House: ❑Yes &Mo On Old King's Highway: ❑Yes SrNo Basement Type: ❑Full U16rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new Half:existing new Number of Bedrooms: existing a new Total Room Count(not including baths):existing 5 new First Floor Room Count Heat Type and Fuel: was ❑Oil E(E'lectric ❑Other Central Air: ❑Yes @ No Fireplaces: Existing O New Existing wood/coal stove: ❑Yes Who Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:10existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes . ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name- b/3�C20.1� Telephone Number Address License.# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Lfy\ SIGNATURE ¢, S rl) � ) DATE t f FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED - = MAP/PARCEL NO. • ADDRESS ' d... VILLAGE OWNER.. DATE OF INSPECTION FOUNDATION FRAME t INSULATION z FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL : a GAS: ROUGH FINAL a. "3 FINAL BUILDING DATE CLOSED.OUT . ' • ASSOCIATION PLAN NO. C The Town of Barnstable Department of Health Safety and Environmental Services Building Division - 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 BuiIding'Commissioner 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: C e_ e rn,ec�v Estimated Cost /b 6 .0 O Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ®Job Under$1,000 Building not owner-occupied gOwner 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 l000 Owner's Name q:forms:Affidav Thee Commonwealul of Massac lusens == Department of Industrial Accidents 600 Washington Street ;0 Boston,Mass. 02111 Workers' Com ensation Insurance davit �,,,,,, ,,,,;,�• •,",,,,,,,,��„'�,;'��• / .��/,���///%/////.�%%�% " e `'Y�/%////%////%///%///%���%%%%%%///�%M////%///%%%/////////W7 , name location: 1A y n \ city �k phone I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity %/////%%/''//////O////%%%//////%%%%%%%////////%////%//%%/%%/////%///%%%/%/////%/////%%%////////%//%%/%%%/O//////%%%////%%///�%%%////%/%/%�/%%%�% ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: .. addre3s- city, phone#� insurance cn. nniicv# • //////.�//.(//////////.u'�////////////l//Ll%/.�///////�'�////////////////////////////////.i/ii/a� /.��%>„�- ❑ lam a sole proprietor, general contractor, o omeownt:r circle one)and have hired the contractors listed below who have the following workers' compensation polices: .. ....... comoanv nsme• address: phone#� ... ...... dtv - ::.:.. pnitcv# insarnnce ca. iii rr; /,U:,,;isi//////////////i/;/u//////%/%//////i%/////.�//.i//////�///iii%////G///////i////////////////////�/.%//�;�/////////////////////////////////// ///////.%//// /.�i//.(//////////%/�/,lG�"'///,�/ %%//•. comnnnv name: address- tits phone#� Failure tofrLsurant a ceure co;fv�4 /�/�/�/���,��///�/�����/�/��������/�� ernge as requited under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one nears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Omce of Investigations of the DIA for coverage verification 1 do herebv certify under the pains and penalties of perjrsry that the information provided above is true and correct Sizmture'E�(' �o Y�^ n Date J _ _ Print naine�©�e c� Q C\Cu--�r Phone# S -ba 5 ') _ ` ofncial use only do not write in this area to be completed by city or town otncial dtv or town: perrnit/ficense# ❑Building Department ❑Licensing Board check if immediate response is required ❑Selectmen's OMce ❑Health Department contact person: phone if: ❑Other_. mvum r,95 P1Ai Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for rh-, employees. As quoted from the "law",an employee is defined as every person in the service of another under any cam- 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 c: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recce ve: trustee of as individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnc=and who resides therein, or the occupant of the dwelling house of another who employs persons to do ma;^te ce, construction.or repair work on such dwelling house or on the grounds c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local Iicensing agency shall withhold the issuance or renew I: of a Icense or permit to operate a business or to construct buildings in the commonwealth for any applicant who h u not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither-the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contras ;ng 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 along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Depa=cnt at the number listed below. City or Towns 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 permitllicease number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrang= have bees made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Investloatlons 600 Washington street Boston; Ma. 02111 fax#: (617) 727-7749 ' phone #: (617) 77.74900 ext 406, 409 or 375 f Department of Health Safety and Environmental Services Building Division a ►IM � 367 Main Street,Hyannis MA M601 r� Office: 508-862-4038 Ralph Crosson Fax: 508 790-6230 Building Commission: HOMEOwNmLIGEISE EXEMFTION nn Plem Print JOB LOCATION: VA - 1tmmba stetxt N1age frame home phone# work phone# CURRENTMAUMGADDRESS:_' C, \\"Z-l A a • Itown sofa tip code The exemption for"home was extended to include ed dwelfina of sic units or less and to allow homeowners to engage an individual for him who does not possess a license,=mdded that the ovt�et acts a!�e�M DEMMON OFHOIV>EOWNEB Petson(s)who owns a parcel of land an which he/she resides or imtmds to reside,an which theca is,or is intended to be,a one or two-family dwelling,attached or detached arnw, aceessM to such use and/or farm stractsum A person who consttucts more thaw one home in a two-year period shall not be considered a homeowner. Such - ."homeowner"small submit to the Budding Official an a form acceptable to the Building Official,that he/she shall be Mr..:ns,Ule fbr all such wwk_*,"d_+**_+ed underthe building,wit (Sewn 109.1.1) The undersigned, meowna"awes responsibility far compliance with the State Building Code and other applicable codes,bylaw%roles and regulations. Tye unde signed"homeovvnet"ogt irm that he/she understands the Town of Barnstable Budding Department minimum inspection procedures and requirements and that he/she will comply with said procedures and C�)CN&V-�-f f Sigtma m of H=wwna Appwvd of Building OMdaii Not= Tyreafamtly dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 C [Iswwtion ConavL HOMEOwNER's SON The Code sores d= "Any I-fi X na pRSorentag wort faratdch a bnddhtg pamk is ttgoued shall bC ammpt ftosei the pmviskm of dds sad=(Sarum 109.1.1-Umismg of coffin Sgwvb m);peovided that if tste homeowner eagaga a pasoa(s)for bhe to do scab work,thou stub Homwwaershd I ace as sgmvisw:' Mmy homm"M who toe this estmption nee naawaeo dhatthay are as=mWg the reqwnWW=of a sapavemr(see ApPeodix Q, Rnia&PAPI titters for droning Coam=don Sgwvimm Sad=2-15) This lade cf awaentns oSen romps is salons pmbIcm paacnimiy wbm*o homwwaa hhes uWWcnsed pamm Ln this core.aw Board carrot panned against the nnH=sed pawn as it would with a Geensed SuPavisac The homwwuw acmtg as Supavbw b therm ody eespoatdML To crime that the homeowoa is f aiy aware of bbAw nspomibliltIm tmny commmwn- I P as part of the pamit application, Chant the homaowaa cm*that he/she tmdasmndt the mpomMft of a Supavimr. On the impage of bb isms is a form ameeatly used by sevaai towns. You may case to amend and adopt such a foemleati5iemn form in y m t ttmmtmity. Assessor's map and lot number I.............................................. Bpi THE TO .Sewage Permit i, j number ....... ............. ................... 33AWST11DLE, House number MAO .............. .......................................................I 03 0'R-f TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT-TO .... ...... . ......... .............. TYPE OF CONSTRUCTION .......... .............................................................. .............. .......... 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliesfor a permit according to the-following information'. e .............. ........ ........................Location ......... ... .. . ....../ ..........f.........(�2e!�w.... .... .. ProposedUse ........... ..,................................................................................. ................................... 5 ZoningDistrict ...................... ... .......;..............................Fire..............................Fire District ....... ........... .............................. e of Ownei,6;1�?e�;_In4'7 �:'�Jl 4 ...... � �'� !! /... ?a�� Nam ................. 'Ad%eg A...... Nameof Builder ......... ............Address .................................................................................... Name of Architect ................Address .................................................................................... Number of Rooms ►.................. ....................Foundation . ......... .. .. ........ ........... 60 .....3. ... ........................ ) ..... . U.... ............ ExieriorI . . . . . e414..1...Roofing .....0 ....... ..................Floors .......... ...........Interior ...................................... ................................ Heating .......... ..................................Plumbing .......... Fireplace ............ ..........................................Approximate Cost .................. ..............:........................ Definitive Plan Approved by Planning Board -------------------------------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 Barnstable regardipg the above construction. .................IN a m e-,,-.'..... .... .....2'. ........ Greenbrier Dev. Corp.. , A-z6$=g$ . No .21.504.... Permit for ...1.L.s jDxy..d-wejj:ing t�. ......................... Location ... .......... ..............................U....Hyd 11;14 n ....:::............ Owner ............ Type of Construction .......y .. ram ` ..................... .............. ......... `................. Plot ............ ........... I t ..........t .................. Permit Granted .......... tub. 1 79 Date of Ins.pection ......4................a...........19 Date Completed .......:............... ............19 PERMIT REFUSED ............ ............................................... 19 .. .. �r.. i. .l... v........................ ........... .. .............. . .... .........................�. ............... . . ............................ Approved .......:.........: ...........................................................0................... ...............................................................................