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HomeMy WebLinkAbout0044 ORR'S AVENUE S � �� �� .; \� C`� . . ..� �� I � � �� � t � I �'� � � � c�. -� ��� '�� .. E ° '' i �, f i i , . CAPE C® INSULATION [q7b- FINIR GLASS SIAMLISS SPRATTOAM SLISPINO.0 /ATTE OUTTIRS INSULATION CEILINGS �Y,t 1-800-696-66114 Town of Barnstable Regulatory Services Building Division .� 200 Main St • Hyannis, MA 02601 r �. 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 Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) �iv e r (vv r !l lame r)('o r.41 tal �Ac ;"e y Sincerely 2rHE ssi r, President Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .2 I Parcel I Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee J' ,�5 = OD Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address D Village�A&d.e lj Owner Z v 6f0.2fiAl Address W d Telephone G l 7 7 Z,`��G y` I Permit Request ,Lj y��P�9 GA2rhG rlb a IAO 44L-sO Aff 40- A-2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i Qd,, G Construction Type lilt Odd Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ANo On Old King's Highway: ❑Yes I<No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# t Current Use Proposed Use ti APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ���l��}��,JI�v /ion Telephone Number (P e 77S/ Z/ Address License # 40 O `l' :Ferl Home Improvement Contractor# (- Email Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6� �ldi SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. :y ,f C t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION Y FIREPLACE r il~ ELECTRICAL: ROUGH FINAL w y PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 4 FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. �uaoir �V mass. save. � A difigio."UYctt+aenuy. �r PERMIT AUTHORIZATION FORM 6, ROBERT PATTEN ,owner of the property located at: (Owner's Name,printed) 44 Orrs Ave HYANNIS (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a bui r it to erfo ins la ' n and/or weatherization work on my property. X Owner's Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating ` Contractor to the above referenced project: Participating Contractor O Date C7I'0 For office use Only Rev. 12132011 Mass•gar.husett:, ,•"Oeparfrient.ofPublic.Safety, -Board of Building Rt!yulations and Sta ndards C(1nSt1IN0011 511per1-is01, ,, License: CS-100988 HENRY E CASSEDV 8 SHED ROW �t1 WEST YARMo PTH " i ✓- � '� �'� Expiration Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ontractor Registration Home Improvement C. Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY , 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 45 20M-05/11 Address R Renewal Employment 0 Lost Card ................... ................._..........._....... -- _. ......_ ._ V/L6 (Q6'17fA72UJ2[UBCFG�fL o1bA,4dccX,&jef 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: `153567 Type: Office of Consumer Affairs and Business Regulation xp!ration:-<;1;?h15/20:16 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION;INC= HENRY CASSIDY 18 REARDON CIRCLE SO.YARMOUTH, MA 02664 Undersecretary N valid wi ut sign e a f _ -�— The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations 600 Washington Street A r Boston, MA 02111 V www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �, .// Address: City/State/Zip: ,� ( Phone - J?i1� Are you an employer? Check th appropriate box: Type of project (required): 1, 'employees am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6, 0-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.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12,0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13. Other ` employees, [No workers' comp, insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this aff davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: k+ � �, Policy# or Self-ins. U6.#: - ,50JJ' ;I I Expiration Date: b p� Job Site Address: ig S Ara f'�yl� /S City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurarv,%coverage verification, I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct, Signature: a Date: Phone#: /' R Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other n__. . n t.If CAPECOD-27 BDELAWRENCE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 6/30/2015 fIIS 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, r. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c o E t A/c No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERB:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURERC: 18 Reardon Circle INSURER 0: South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE POLICY EFFr04101/2016 LTR POLICY NUMBER MMIDD LIMITS. A. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR CBP8263063 04/01/2015 PREMISES Eaoccurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- '" X POLICY JECT CDC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431901 06/30/2016 06/3012016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD oFT Tod, Town of Barnstable *Permit# 7 3 6 Expires 6 months from issue date Regulatory Services Fee v� 1639. 6.1�$ Thomas F.Geiler,Director A'�D N10` Building Division Tom Perry, Building Commissioner -PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 OCT2003 Fax: 508-790=6230 EXPRESS PERMIT APPLICATION - RESIDENTT F�BARNSTABLE Q Not Valid without Red X-Press Imprint Map/parcel Number Property Address )q r)11 t <, ❑Residential Value of Work Owner's Name &Address e C� �0 ► l�� Contractor's Name C'1L- ��e���7� Telephone Number y b a l(o Dome Improvement Contractor License#(if applicable) ( ,3 to Lt,7b Construction Supervisor's License#(if applicable) © 10 1 ow--orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Comp1ensatio`n(Insurance Insurance Company Name . C n 0\`6 �.1 Workman's Comp.Policy# 6 r (I q \3 6-1 b x l `7 48 Permit Request(check box) E—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: Pro rty Owner ust gn rty Owner Letter of Permission. H e Improv en ctors License is required. Signature Q:Forms:expmtrg P,evise053003 M " t HERBST 35 Peep Toad Rd. Centerville MA 02632 (508)420-6216 PROPOSAL SUBMITTED TO: WORK PERFORMED AT: Bob Patten 44 Oats Way 36Iona ST Hyannis MA Boston M4 02131 ; r Cell Phone#61 -719-5641 ierby propose to furnish the materials and perform the labor necessary for the op etion of the following; ti Id at e i dfeltt tOWN %gg Thank You r t M1f b1w nd,above work to performed In , w o dµreoma s la st}b tan# his it tsasfoI 4 o ,a ou ire � �`n.�pletion Any alleraton s�� am�above involving extra costs well` a add ` nd r wrltte>i" Y _ . . ,g�?eement,and bec ext cha over and above signed istimate/agreement PLCTFUL " } OF PROPOSAL The above prices s ci�ca nv cobd "o Satisfactory,we herby accept you are autho ' d t 'e4 vl # a ON w'il-t a:as specified above. Signatures) a �s Date: Y 4 ,Y } * This proposal may be withd � ^'p p y Rrb said company If not acceptedq��luts30 days Board of Building Regulations and Standards ' 1 HOMIE IAI QRQ1/EIYIOENT C'ONTRACTO'R Re` st inns12 _6fklQ004 n'dividual MARK HERBST J MARK HER BST 1� 35 PEEP TOAD RD: C.ENTERVUE,MA 02632 Adn inistr l- for i �k r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3011 3 Map C4 Parcel Application # Health Division Date Issued Conservation Division Application Fee C=-'et'k Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 614 0,��� Village Owner6h Ee__ Address Telephone �'Q 72Y !� �4 ( Permit Request / i n Square feet: st floor: existing '7 v proposed 2nd floor: existing ' 00 proposed STotal new Zoning District Flood Plain Groundwater Overlay Project Valuation 0Z�) Construction Type Lot Size 0ac9onLS 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 Kind's Highway:�❑Yes; ❑ No Basement Type: Wru'll ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 750 (/ Number of Baths: Full: existing new Half: existing new, Number of Bedrooms: existing _new Total Room Count (not including baths): existing new So—­e_ First Floor Room Count!::' Heat Type and Fuel: U-8�s ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes LING Fireplaces: Existing New 1� Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name !'&'Z Telephone Number / L Address License# 5 Home Improvement Contractor# 16 -7 74t 15 I Worker's Compensation # ALL CONSTRUCTION DEBRIS RESU TING FROM THIS PROJECT WILL BE TAKEN T v 2� SIGNATURE - DATE _ /� r r i .d FOR OFFICIAL USE ONLY a r ` APPLICATION# 7 DATE ISSUED t - MAP/PARCEL NO. f ADDRESS VILLAGE x OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION r t FIREPLACE { ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,i E DATE CLOSED OUT t' ASSOCIATION PLAN NO. m r f. e =i. The Commonwealth of Massachusetts Department of Industrial Accidents Q Office of Investigations 600 Washington Street Boston, MA 02111 a y� www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -A licant Information Please Print Le ibl Name (Business/Organization/Indivi dual): 7� . Address: `1�ZC� � e City/State/Zip: . ?c, Phone #: �(_,2 Are you an employer? Check the appropriate box: Type of project(required): i.ElI am a employer with 4. ❑ I am a general contractor and I empl (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2, am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. ins rance.1 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.. o workers' com right of exemption per MGL Y � P• 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required] *Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensatiea policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the v'olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for in ance coveragt<y tion. 1 do hereby certify er e pa' nd s perju at-t e information provided`above is true and correct: Si ire.--- Phone#: Official use only. Do not write in this area, to be completed by'city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspect&r S. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide•workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on-such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certificates) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the'pemvt or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(ifiiecessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a.home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'not hesitate to give us a call. The Department's_address, telephone and fax number: �•� N ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Teo; 9.617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07; www.mass.gov/dia of tM r �P� tis a t f MASS, Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize /%/6�C� 1 """"`"'---to-aetAon;my behalf, in all matters relative to work authorized by this building permit application for: ddress of Job) �S' tu.re-ocf Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRE55.doc Revised 072110 Town of BarnstabrIe Of TF1E v Regulatory Services a�tzrssTtar E, Thomas F. Geiler,Director Building Division 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 Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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\co sidered a homeowner..1Such "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 witlr,said procedures and requirements. Signature of Homeowner # �l Approval of Building Officiaf _+ d „t•- .�'' 1 ^gem y� 4 - ' Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section I27.0 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'h meowner 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. Q:forms:homeezempt u N fu?.Gc - r Is ct I / ov� 0 f " f- 6• mAA1 MEANE SCALE I HEREBY CERTIFY THAT THE ABOVE DWELLING AS SHOYVNpT�iAT IT CONFORMED x0 THE T IS IACATFD ON THE GROUND AT THE TIME IT WAS CONSTRUCTED AID THAT THISD O�YN 3 ZONING MORTGAGE dC SPECTIONOWA PERFORMED IN ACCORDANCE WITH THE TECHNICAL STANDARDS INSPECTION. WAS LOAN INSPECTIONS AS ADOPTED BY THE M S DARDS FOR MORTGAGE SUR AS AND IL ENGINEERS gNCORP� SACHUSETTS ASSOCIATION OF LAND % o SATED. for 1,5 HRI ST OP ER COSTA R. L.S . DATE 17�E.957 .c,4L^,IDUT,y, �/.31G 7.-4iV T INlassarhusctts- Bclr i-tmcnt of Public Safctc Board of Building Regulations and Stand;u•ds Construction Supervisor License License: CS 95110 Restricted to: 00 rk� , MICHAEL PATTEN 31 IONA STREET ROSLINDALE, MA 02131 Expiration, 1/20/2012 (' nunisi�ner Tr#: 16512 7 All OfficeoCco�n u a s shi �t?� I' Ic I HOME IMPROVEMENT CONTRACTOR u Registration },,167948 . Type: . Expiration: , 4�1J39/2012 Partnership CONSTRUQT�ON ' iITT i MICHAEL PATTEN - 24 ATLANTIS STREET�i WEST ROXBURY MA o-2132s `: Undersecretary P i J n G v\ V_ l� � y1 i t� ©c k:. . o• ° TOWN OF BARNSTABLE Permit No. __2888gZMST ---------------- { _ Building Inspector Cash nY OCCUPANCY PERMIT Bond -------------------- ,•�a -------- r Issued to John Keane Address Lot #15, 44 ©rrs Avenue, Hyannis Wiring inspector— Inspection date Plumbing Inspector _ Inspection date Gas Inspector �.,,, Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 19,1 .................................................. Building Inspector '4 ,,� T '�•� TOWN OF BARNSTABLE BUILDING DEPARTMENT D683lT : TOWN OFFICE BUILDING . rAa HYANNIS, MASS. 02601 v uY 3 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been fiissued- for tl`e building authorized ,by BuildingPermit #.,a ... .. ....... .................................................................... _..................................... issued to ..................._.... ......_...�... .. ....................... .....................„_.... .._...................... _..._.. _ ..... Please release t e performance bond. low ' . TOVGNTQF`B� BL 3SACHUSETM, T PE M I � �w- r �R' �.`l ` ' ►' JOB: WEATHER CARD NU } M. DATE_ .- Jan"" 20* 19 86 PERMIT John Xwane Bive�7ak Road, So3.em 1%, tU22bb5 APPLICANT ADbRESS- 1 INo.I taTIIEET) `ICONTY•i-ilcalls� PERMIT TO Sui1d.�; "' (I STORY Family � DWELLRNNUMBE G UNITS "( _TYPE O► IMPROVEMENT) - NO. - - - - �SPROPOSED USE) - - ZONING AT(LOCATION) Lot 15i 44 0rrc rAv*r=sv �A� DISTRICT (NO.I (STREET) t 'BETWEEN AND 7 ICROSS'�STREET) ,. - - _ ICROSS.STREET) LOT SUBDIVISIOH. - LOT BOCK SIZE BUILDING IS'TO BE FT- WIDE BY, F7.LONG BY FT. IN HEIGHT AND'SNALL CONFORM IN CONSTRUCTJON.� f s-r rO17ypE• -- - 1JSE°GROUP BASEMENT.WALLS'OR FOUNDATION (TYPE) REMARKS: Swage #85-1136 ` _ _ _ " ' Bond AREA OR 7" sq. ft. 45,000.00 PERMIT 46.00 VOLUME, ESTIMATED COST $ FEE .$ -" - (CUBIC/.SQUARE FEET) -John;Keane OWNER'- ' ' • BUILDING DE BY FT. -,�, o� 1• ADDRESS r t ( TH16 PERMIT -CQNV YS:NO�tIGHT_TO_OC'CUPY ANY STREET, ALLEY OR SIDEWALK OR ANY -PART'TM Rr'OF�EITHER T P RIL-Y OR Cop PERM ANENT'LV'.�N.CI;OACHMENTS ON PUBLIC PROPERTY, NOT SPECIFACALLY PERMITTED UNDERIT BUILDING CODE;-MUST--BE AP- i • 'PROVED, BY TtiE•JURISDIC.TI.ON.STREET-MR ALLEY GRADES ASARWELL AS DEPTH-AND 1'OCATION OF PUBLIC SEWERS MAY BE OBTAINED ��� FROMTHE DEPA'RT:MENT.b F'PUBLIC.WORKS. THE ISSUANCE OF THIS;PERMIT-DOES,NOS RE•LEASE.TME APPLAC.ANTJLFROMLTAi5�14D1,7 N¢ OF htiA/ +AR iFSk�L.46 Ydili!)tOfIZH.ES7.7i 1.0 TdON9�r.•._.='�"'�t�•• --.�, •_'��: -�:•��.__ �� '_ MINIMUM'_OF,,.rTHREE'.CAL-L -•- PpROV.ED PLANS'MUS ERETA *T-INED-ON-,JOB ANDH1S-".WHERE APPLICABLE:SEPAR-ATE INSPECTIONS REQUIRED:F.OR PERMITS ARE :REQUIRED FOR - AL,L R CONSTUP`T]Ofd_WOR-Ka, CARD-KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, `PLUMBING -AND 1. A FODNDATJON�rOF;FOOTINGS• -- MDE. WHERE--A .CERTIFICATE OF.OCCUPANCY IS-RE MECHANICAL_INSTALLATIONS. 2. PRIOR'TD' VIE N<i-STkUCTURAL QUIRED;SUCH'BUIL'DING SHALL NOT BE OCCUPIED UNTIL 1 'MEMBER Ta LATH). FINAL_INSPECTJON'HAS BEEN-MADE. S.F NAL'1 SS�N- BEFORE 'POST THIS-XARM SO ITAS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS .PLUMBING INdie'CTION APPROVALS - .ELECTRICAL INSPECTION APPROVALS-I _ A4 2 ),P6Vr!%�y z 2 _ 9 - - " - •HEATING-! SPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS 1 �I OTHER 2 2 t �S 1 WCRK S.A" NCT PROCEED UNTIL THE L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS -INDICATED ON THIS CARD :NSPECTCR -IAS a"PPROVED'T4E VARICUS D WITHIN 519(MONTHf'Of'.DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. ' - OR WRITTEN NOTIFICATION. -NOTEDI A601r r ad 41-_ 9, , f, x� we 487 n:liuz' ` We, LUTHER ORR and ADDIB ORR, husband and wife, 8m tenants b ��s� entirety, both y the od Barnstable (Hyannis), Barnstable co,,,,y,M— t deratioa pstd,grant to HOMER COOPER, PHILIP COOPER ^DA COOP COOPER, as joint tenants, and fiR all of 4 Teramar Nay, White Plains, New York. �th ' • j etaadin Barnstable (Hyannis), Barnstable Count Lh vi d� bounded and described as follows: y• Massachusetts, Lot 15 as shown on plan entitled "Plan of Land Hyannis-Barnstable, bSass., as surveyed for Luther & Addi Orr, Scale 1 inch - 80 feet, September 1956..." recorded with s Barnstable County Deeds in Plan Book 130, page- 43. a i Together with a rinht to use Orr's Avenue f $ shown on the above described plan in cor-mon $with others entitled thereto fo r all purposes for which ways are now or may hereafter be used. 1 Being a portion of the premises conveyed to us r in deeds from Caroline G.Harris recorded with . Barnstable County Deeds in Book 949, page 397 Rf " and in o Book 1051, page 230.. _ The financial consideration for this conveyance r r Is Twenty Five Hundred Dollars, Y t -- � - i - —. - „"'�fr"�1 ill�/ini'r--�_r-w- -�.r •'w_�- .'t13d=A our hg�ds sad ftop tb,E'i . 23rd day of September19 70 y Barnstable ., September 23, to 70 P-wft tly appea+md the&haw nan*d Luther Orr i asd resioovledg�t}+e twegdea 4a,trvaseot ea hee his act and deed. ° Rosamond Milne t hh_SSBir 1i 4Sao�t -OCT 21 197C °J n ii My oomm(:ibn rzplms November 10, !fl 72 ? od 91 Via! 2 Al SEPTIC SYSTEM MUST BE - r, sessor's ma and lot n _i p umber ............................................ s INSTALLED IN COMPLIANCE �Py�FTHE't0�o S I I Cn Sewage Permit number WITH TITLE 5 ......... . \' } fO F ENVIRONMENTAL CODE AND : BJEaSTanLE, i House number ... .;!L�..L'....................... ........... TOWN RE IONS 9 MAGa �p 1639. \00 0 MPY a' y TOWN OF BARNSTABLL BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... kV..!. d...... �Q ...f�.�.`.�............. ................................................ 'TYPE OF CONSTRUCTION ............W a°.d. ....l:.t xat~....Ci4.hs f rvc fr o .............................................. :....���. ................19. 5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �� ....�.r-�........z:2 ......... 'Ke .................. .................................. ProposedUse ..............�' S!. .e h C: ..................................................................................................................................... Zoning District .............i ...............................................Fire District .... � S $ 1...../1?4SS a Go+t Name of Owner ......�l..P ......Addres� e ? � (f ....�?........ ..��'�n.h.C...................... ................................ Name of Builder ......".�.A.r!.......'.`:.�c?h ...........................Address ................ . ..................................... . . yy�� L / �� h�� Name of Architect ...fif...... .5`� I)��................................Address / l sl ....................................... ...... .. . ....... .................... Number of Rooms ........... .. Foundation k Z.................... ........................................I—................................... Exlerior .............. ' .................................................. . 5 �....... l...s........V1 .`. (r- Cede,r..............Roofing .......q.s�� . 11 /��✓��G�.1/hdCY1mrn7�lnterior ................................. 1 Floors ......... �.f'?. ................. ............. Heating Plumbing ......G� pht'?'....... n..��.... �.....15 ........ .(�... �l Fireplace ........M)..................................................................Approximate. Cost ...... y UC�O.................... ......... ............i.... ..... Definitive Plan Approved by Planning Board ---------------_----------------19________ . Area 0.......... ...... r �� ........,.. Diagram of Lot and Building with Dimensions Fee �.{.V ............... ... SUBJECT TO PPROVAL OF BOARD OF HEALTH l 9 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......1. .. ............................. Construction Supervisor's License .....0,.2-4............... 0 ......... ... Permit for .... Story ...................... Single ...................... ................... r. - ot...15:p,, 44 Orrs Avenue Location .... ...... ............................................... i s .................................................. Owner .....John Keane....................................... ► Type of Construction ..........Frame................................. .....................0........0.................................................. Plot :........................... Lot ................................ January 29, 86 Permit Granted, .................... .....................19 UU1U of lnspecticjf!-: .� ........19ep Date Complete ..Z�.........19& R wy - ' w ' V 9Z s &0 F N Of 03 Z5 ' �CAFR r 'a A IV SCAB E«; f:3CJ 0.4 Tom' z 0/; I HEREBY CERTIFY THAT THE ABOVE DWELLING IS LOCATFD ON THE GROUND AS SHONNjTHAT IT CONFORMED TO THE TOWN'S ZONING SETBACK REGULATIONS AT THE TIME IT WAS CONSTRUCTED AND THAT THIS MORTGAGE INSPECTION WAS f PERFORMED IN ACCORDANCE WITH THE TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS ADOPTED BY THE M SSACHUSETTS ASSOCIATION OF LAND SUR AS AND I L ENGINEERSo INCORPORATED. r T!f!S LOT /STX/E- i HRISTOP COSTA R.-L.S . ` vAFy coA4sv1-rAAl r 172 FA57-lFAL MourN.1qyGV �:F•9L 1�OvTH, �� . Assessor's map and lot number. ................... ........................ CF THE t0 3 Sewage Permit number. .............,................. ....... /. Z BARNSTADLE, i 5' House number ./. .. PAS& 9 0 40 i 63 q. `00 i°?1pM p. TOWN OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO v 1 n` C � `^ ' ( ........................ TYPE OF CONSTRUCTION ............W. 15. ........fir'G.&,.C....., ........: �.c.....!� 19.... . TO THE .INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r".........:....:�.......Location (���..`:.....�..rJ..........!..! i-S �' !l�P......................1.�...�9..`1..�!:'.�.................................................,................:. ProposedUse ..............` P !•r'CP.Y t.. :............................................................................................................,.......... ........... Zoning District ........... . .... .................................i .....................Fire District .�i.`/.. !. .!..'..5...............,................ Name of Owner 1./.C.>.�?.�:......?C .�.(.c: !:.' ........................Address.,,.. ..........".T ,�:....�.'�.�.vPr� , �: � /�j,' Name of Builder ......- UAr�.......'��'.G.f:.�'...........................Address ...... ......'��: ....ri:..�........... ........................ . i �l r.!2.1.t. /.::..............................Address ......... Name of Architect ... ............. ......:. .......:.................................... Number of Rooms ...........6.......�......................... .....Foundation Exierior .......5 arc r W.A.,...C....C-C .............Roofing ....... ....`. ................... ............................. f � Floors .. i'� �� r, .�r ..(!h r s /�r,ra�.,7 Interior .................................................................................... L / ! .....r ?„ht`r. � n.r ........Heating .. .. ....... .... ......... Plumbing1... �� G• i v.Gh,�'' Fireplace .......11n...................................................................Approximate. Cost ... �.5.U00.:. ..G .. ............................:.... ' Definitive Plan Approved by Planning Board --------------------------------19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH `y: ;�• if 1 �V �Vv i OCCUPANCY PERMITS REQUIRED FOR NEW DWtLLINGS I hereby agree to conform to adl the�"Rules and Regulations of'the Town of Barnstable regarding the above construction. Name''.......... .................................. Construction Supervisor's License .,....0 . ... ..�.. ........ � —_'__' ----� — -'- --- ~ z�V�� �i ut __. Location —..I��..l�.x—.44. __.. . � -------------------------'' Owner —..Jobn� .:____.__._____ ' Type of Construction _—..]Y����------_. � ----------------'---------.. Plot ---------. Lot ---------'— ` ' January29 86 Permit G,on�yJ -----.� --.�---'lV Date of |nopoc�on ------------lA Do/a Completed —. -----------l9 ' ` ' ' ^ ' ' _ - ` " - ' ~ ' . ��/^^�'/^ ~ . U -' / ^ ^ -_ -